Disinfectants, Detergents and Microfiber:Current and Future Issues

William A. Rutala, PhD, MPHDirector, Hospital Epidemiology, Occupational Health and Safety;

Professor of Medicine and Director, Statewide Program for Infection Control and Epidemiology

University of North Carolina at Chapel Hill and UNC Health Care, Chapel Hill, NC

DISCLOSURES

• Consultation and Honoraria ASP (Advanced Sterilization Products), Clorox

• Grants CDC, CMS

Disinfectants, Detergents and MicrofiberObjective

Describe emerging knowledge and controversies related to disinfectants, detergents and microfiber cleaning products

DISINFECTION AND STERILIZATIONRutala, Weber, HIPAC. www.cdc.gov, 2008

• EH Spaulding believed that how an object will be disinfected depended on the object’s intended use CRITICAL - objects which enter normally sterile tissue or the

vascular system or through which blood flows should be sterile SEMICRITICAL - objects that touch mucous membranes or skin

that is not intact require a disinfection process (high-level disinfection[HLD]) that kills all microorganisms except for high numbers of bacterial spores

NONCRITICAL - objects that touch only intact skin require low-level disinfection

DISINFECTION AND STERILIZATION

• EH Spaulding believed that how an object will be disinfected depended on the object’s intended use CRITICAL - objects which enter normally sterile tissue or the

vascular system or through which blood flows should be sterile SEMICRITICAL - objects that touch mucous membranes or skin

that is not intact require a disinfection process (high-level disinfection[HLD]) that kills all microorganisms except for high numbers of bacterial spores

NONCRITICAL - objects that touch only intact skin require low-level disinfection

Disinfectants

• Disinfectants are recommended for noncritical patient care objects (CDC, 2008)• Disinfectants are recommended for Precaution/Isolation

patients (CDC, 2007)• Disinfectants are recommended for blood/OPIM (OSHA,

1991)• Disinfectants (or detergents) are recommended for other

noncritical environmental surfaces (CDC, 2002 and 2008)

LECTURE OBJECTIVES

• Disinfectants Knowledge and controversies

• Detergents Knowledge and controversies

• Microfiber Knowledge and controversies

CLEANING AND DISINFECTING ENVIRONMENTAL SURFACES

Cleaning (removes soil) and disinfecting is one-step with disinfectant-detergent. No pre-cleaning

necessary unless spill or gross contamination.

LOW-LEVEL DISINFECTION FOR NONCRITICAL EQUIPMENT AND SURFACES

Exposure time > 1 minGermicide Use Concentration

Ethyl or isopropyl alcohol 70-90%Chlorine 100ppm (1:500 dilution)Phenolic UDIodophor UDQuaternary ammonium UDImproved hydrogen peroxide 0.5%, 1.4%____________________________________________________UD=Manufacturer’s recommended use dilution

DISINFECTION OF NONCRITICAL PATIENT-CARE DEVICESRutala, Weber, HICPAC. 2008 www.cdc.gov

• Disinfect noncritical medical devices (e.g., blood pressure cuff) with an EPA-registered hospital disinfectant using the label’s safety precautions and use directions. Most EPA-registered hospital disinfectants have a label contact time of 10 minutes but multiple scientific studies have demonstrated the efficacy of hospital disinfectants against pathogens with a contact time of at least 1 minute. By law, the user must follow all applicable label instructions on EPA-registered products. If the user selects exposure conditions that differ from those on the EPA-registered product label, the user assumes liability for any injuries resulting from the off-label use and is potentially subject to enforcement action under FIFRA. (II, IC)

EFFECTIVENESS OF DISINFECTANTS AGAINST MRSA AND VRE

Rutala WA, et al. Infect Control Hosp Epidemiol 2000;21:33-38.

CONTACT TIMES FOR SURFACE DISINFECTION

• Follow the EPA-registered contact times, ideally Some products have achievable contact times for

bacteria/viruses (30 seconds-2 minutes) Other products have non-achievable contact times

• If use a product with non-achievable contact time Use >1 minute based on CDC guideline and scientific literature Prepare a risk assessment

http://www.unc.edu/depts/spice/dis/SurfDisRiskAssess2011.pdf

Disinfectants

• Disinfectants are recommended for noncritical patient care objects (CDC, 2008)• Disinfectants are recommended for Precaution/Isolation

patients (CDC, 2007)• Disinfectants are recommended for blood/OPIM (OSHA,

1991)• Disinfectants (or detergents) are recommended for other

noncritical environmental surfaces (CDC, 2002 and 2008)

Surface Disinfection:Should We Do It?

The use of disinfectants for non-critical items in health care is controversial (especially in some

parts of the world)

Justification for Using a Disinfectant for Non-Critical Surfaces

• Surfaces may contribute to transmission of epidemiologically-important pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter

• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing

contamination on surfaces• Detergents become contaminated and result in seeding the patient’s

environment with bacteria• Disinfection of non-critical patient care items and equipment is

recommended for patients on isolation• Disinfectants may have persistent antimicrobial activity

Justification for Using a Disinfectant for Non-Critical Surfaces

• Surfaces may contribute to transmission of epidemiologically-important pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter

• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing

contamination on surfaces• Detergents become contaminated and result in seeding the patient’s

environment with bacteria• Disinfection of non-critical patient care items and equipment is

recommended for patients on isolation• Disinfectants may have persistent antimicrobial activity

ENVIRONMENTAL CONTAMINATION LEADS TO HAIs

• Microbial persistence in the environment In vitro studies and environmental samples MRSA, VRE, Ab, Cd

• Frequent environmental contamination MRSA, VRE, Ab, Cd

• HCW hand contamination MRSA, VRE, Ab, Cd

• Relationship between level of environmental contamination and hand contamination Cd

ENVIRONMENTAL CONTAMINATION LEADS TO HAIS

• Person-to-person transmission Molecular link MRSA, VRE, Ab, Cd

• Housing in a room previously occupied by a patient with the pathogen of interest is a risk factor for disease MRSA, VRE, Cd, Ab

• Improved surface cleaning/disinfection reduces disease incidence MRSA, VRE, Cd

RELATIVE RISK OF PATHOGEN ACQUISITIONIF PRIOR ROOM OCCUPANT INFECTED

0 0.5 1 1.5 2 2.5 3 3.5 4

MDR Acinetobacter (Nseir S, 2011)

C. diff (Shaughnessy M, 2011)

VRE (Drees M, 2008)

MDR Pseudomonas (Nseir S, 2011)

VRE (Huang S, 2006)

VRE* (Dress M, 2008)

MRSA (Huang S, 2006)

* Prior room occupant infected; ^Any room occupant in prior 2 weeks infected. Otter , Yezli, French. ICHE. 2012;32:687-699

EVALUATION OF HOSPITAL ROOM ASSIGNMENT AND ACQUISITION OF CDI

Study design: Retrospective cohort analysis, 2005-2006

Setting: Medical ICU at a tertiary care hospital

Methods: All patients evaluated for diagnosis of CDI 48 hours after ICU admission and within 30 days after ICU discharge

Results (acquisition of CDI) Admission to room previously occupied

by CDI = 11.0% Admission to room not previously

occupied by CDI = 4.6% (p=0.002)

Shaughnessy MK, et al. ICHE 2011;32:201-206

KEY PATHOGENS WHERE ENVIRONMENTIAL SURFACES PLAY A ROLE IN TRANSMISSION

• MRSA• VRE• Acinetobacter spp.• Clostridium difficile

• Norovirus• Rotavirus• SARS

TRANSMISSION MECHANISMS INVOLVING THE SURFACE ENVIRONMENT

Rutala WA, Weber DJ. In:”SHEA Practical Healthcare Epidemiology” (Lautenbach E, Woeltje KF, Malani PN, eds), 3rd ed, 2010.

ENVIRONMENTAL CONTAMINATION ENVIRONMENTAL CONTAMINATION ENDEMIC AND EPIDEMIC MRSAENDEMIC AND EPIDEMIC MRSA

Dancer SJ et al. Lancet ID 2008;8(2):101-13

ENVIRONMENTAL SURVIVAL OF KEY PATHOGENS ON HOSPITAL SURFACES

Pathogen Survival Time

S. aureus (including MRSA) 7 days to >12 months

Enterococcus spp. (including VRE) 5 days to >46 months

Acinetobacter spp. 3 days to 11 months

Clostridium difficile (spores) >5 months

Norovirus (and feline calicivirus) 8 hours to >2 weeks

Pseudomonas aeruginosa 6 hours to 16 months

Klebsiella spp. 2 hours to >30 months

Adapted from Hota B, et al. Clin Infect Dis 2004;39:1182-9 andKramer A, et al. BMC Infectious Diseases 2006;6:130

FREQUENCY OF ACQUISITION OF MRSA ON GLOVED HANDS AFTER CONTACT WITH SKIN AND ENVIRONMENTAL SITES

No significant difference on contamination rates of gloved hands after contact with skin or environmental surfaces (40% vs 45%; p=0.59)

Stiefel U, et al. ICHE 2011;32:185-187

ACQUISITION OF MRSA ON HANDS AFTER CONTACT WITH ENVIRONMENTAL SITES

ACQUISITION OF MRSA ON HANDS/GLOVES AFTER CONTACT WITH CONTAMINATED EQUIPMENT

TRANSFER OF MRSA FROM PATIENT OR ENVIRONMENT TO IV DEVICE AND TRANSMISSON OF

PATHOGEN

TRANSMISSION MECHANISMS INVOLVING THE SURFACE ENVIRONMENT

Rutala WA, Weber DJ. In:”SHEA Practical Healthcare Epidemiology” (Lautenbach E, Woeltje KF, Malani PN, eds), 3rd ed, 2010.

ACQUISITION OF C. difficile ON PATIENT HANDS AFTER CONTACT WITH ENVIRONMENTAL SITES AND THEN INOCULATION OF MOUTH

Justification for Using a Disinfectant for Non-Critical Surfaces

• Surfaces may contribute to transmission of epidemiologically-important pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others

• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing

contamination on surfaces• Detergents become contaminated and result in seeding the patient’s

environment with bacteria• Disinfection of non-critical patient care items and equipment is

recommended for patients on isolation• Disinfectants may have persistent antimicrobial activity

Disinfectant Product SubsitutionsDonskey CJ. AJIC. May 2013

Improve Effectiveness of Cleaning/DisinfectionDonskey AJIC. May 2013

Automated Disinfection Devices Donskey CJ. AJIC. May 2013

Does Improving Surface Cleaning and Disinfection Reduce Healthcare-Associated Infections?

Donskey CJ. AJIC. May 2013

“As reviewed here, during the past decade a growing body of evidence has accumulated suggesting that improvements in environmental disinfection may prevent transmission of pathogens and reduce HAIs. Although, the quality of much of the evidence remains suboptimal, a number of high-quality investigations now support environmental disinfection as a control strategy”

Justification for Using a Disinfectant for Non-Critical Surfaces

• Surfaces may contribute to transmission of epidemiologically-important pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others

• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing

contamination on surfaces• Detergents become contaminated and result in seeding the patient’s

environment with bacteria• Disinfection of non-critical patient care items and equipment is

recommended for patients on isolation• Disinfectants may have persistent antimicrobial activity

Surface DisinfectionEffectiveness of Different Methods

Rutala, Gergen, Weber. 2013, Unpublished Resutls

Technique (with cotton) MRSA Log10 Reduction (QUAT)

Saturated cloth 4.41

Spray (10s) and wipe 4.41

Spray, wipe, spray (1m), wipe 4.41

Spray 4.41

Spray, wipe, spray (until dry) 4.41

Disposable wipe with QUAT 4.55

Control: detergent 2.88

It appears that not only is disinfectant use important but how often is important

Daily disinfection vs clean when soiled

Daily Disinfection of High-Touch SurfacesKundrapu et al. ICHE 2012;33:1039

Daily disinfection of high-touch surfaces (vs cleaned when soiled) with sporicidal disinfectant (PA) in rooms of patients with CDI and MRSA reduced acquisition of pathogens on hands after contact with surfaces and of hands caring for the patient

Justification for Using a Disinfectant for Non-Critical Surfaces

• Surfaces may contribute to transmission of epidemiologically-important pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others

• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing

contamination on surfaces• Detergents become contaminated and result in seeding the patient’s

environment with bacteria• Disinfection of non-critical patient care items and equipment is

recommended for patients on isolation• Disinfectants may have persistent antimicrobial activity

Transfer of C. difficile Spores by Nonsporicidal Wipes

Cadnum et al. ICHE 2013;34:441-2

• Detergent/nonsporicidal wipes transfer or spread microbes/spores to adjacent surfaces; disinfectants inactivate microbes

EFFECTIVENESS OF DISINFECTANTS AGAINST MRSA AND VRE

Rutala WA, et al. Infect Control Hosp Epidemiol 2000;21:33-38.

Bacterial Contamination of Water With and Without a Disinfectant

• Detergent become contaminated and result in seeding the patient’s environment with HA pathogens. Ayliffe et al. Brit Med J. 1966;2:442-5

Justification for Using a Disinfectant for Non-Critical Surfaces

• Surfaces may contribute to transmission of epidemiologically-important pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others

• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing

contamination on surfaces• Detergents become contaminated and result in seeding the patient’s

environment with bacteria• Disinfection of non-critical patient care items and equipment is

recommended for patients on isolation-CDC 2007 and OSHA 1991• Disinfectants may have persistent antimicrobial activity

QUATS AS SURFACE DISINFECTANTSWITH PERSISTENT ACTIVITY

Study of computer keyboards: Challenge with VRE or P. aeruginosa

Keys wiped with alcohol or quats (CaviWipes, Clorox Disinfecting Wipes, or Sani-Cloth Plus)

Persistent activity when not removed

Rutala WA, White MS, Gergen MF,Weber DJ. ICHE 2006;27:372-77.

Justification for Using a Disinfectant for Non-Critical Surfaces

• Surfaces may contribute to transmission of epidemiologically-important pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others

• Disinfectants prevent HAIs• Disinfectants are more effective than detergents in reducing

contamination on surfaces• Detergents become contaminated and result in seeding the patient’s

environment with bacteria• Disinfection of non-critical patient care items and equipment is

recommended for patients on isolation• Disinfectants may have persistent antimicrobial activity

LECTURE OBJECTIVES

• Disinfectants Knowledge and controversies

• Detergents Knowledge and controversies

• Microfiber Knowledge and controversies

Justifications Used by Some for Using a Detergent for Non-Critical Surfaces

• Environmental surfaces and noncritical patient care items contribute minimally to healthcare-associated infections

• No difference in HAI rates when surfaces are cleaned with detergents versus disinfectants

• Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)• Costs• Occupational health exposure issues• Use of antiseptics and disinfectants may select for antibiotic resistant

bacteria• Less environmental impact

Justifications Used by Some for Using a Detergent for Non-Critical Surfaces

• Environmental surfaces and noncritical patient care items contribute minimally to healthcare-associated infections

• No difference in HAI rates when surfaces are cleaned with detergents versus disinfectants Contaminated surfaces provide an important potential source for transmission of

HA pathogens. Greater than 20 studies have demonstrated that environmental disinfection interventions can end outbreaks or decrease incidence of HAIs

• Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)• Costs, occupational health exposure issues, less environmental impact• Use of antiseptics and disinfectants may select for antibiotic resistant

bacteria

Justifications Used by Some for Using a Detergent for Non-Critical Surfaces

• Environmental surfaces and noncritical patient care items contribute minimally to healthcare-associated infections

• No difference in HAI rates when surfaces are cleaned with detergents versus disinfectants

• Use disinfectants for epidemiologically-important pathogens (MRSA, VRE) Given the high prevalence of epidemiologically-important pathogens in most

countries in the world and that routine screening is rarely conducted, we should employ disinfectants for all hospitalized patients as unsuspected colonization is a routine occurrence

• Costs, occupational health exposure issues, less environmental impact• Use of antiseptics and disinfectants may select for antibiotic resistant bacteria

Justifications Used by Some for Using a Detergent for Non-Critical Surfaces

• Environmental surfaces and noncritical patient care items contribute minimally to healthcare-associated infections

• No difference in HAI rates when surfaces are cleaned with detergents versus disinfectants

• Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)• Costs-approx same QUAT-$0.16-0.20/use gal ($20/1:128dil) vs detergent-

$0.23/use gal ($15/1:64dil)• Occupational health exposure issues• Use of antiseptics and disinfectants may select for antibiotic resistant bacteria• Less environmental impact

Justifications Used by Some for Using a Detergent for Non-Critical Surfaces

• Environmental surfaces and noncritical patient care items contribute minimally to healthcare-associated infections

• No difference in HAI rates when surfaces are cleaned with detergents versus disinfectants

• Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)• Costs• Occupational health exposure issues• Use of antiseptics and disinfectants may select for antibiotic resistant

bacteria• Less environmental impact

Occupational Exposures to Disinfectants at UNC Health Care

• In regard to skin or respiratory irritation and allergies in HCP, most studies refer to glutaraldehyde or formaldehyde, these products are not recommended for use on noncritical surfaces

• Surface disinfection in US generally accomplished by QUAT, phenolic, improved HP and chlorine

• We are evaluating all chemical exposures for ten years (2003-2012, 9500 employees) and have rarely seen an employee in OHS with chronic respiratory complaint related to a low-level disinfectant (~30M persons days of exposure [Weber, Rutala, Consoli. 2013. Unpublished data])

• Need well-designed immunologic evaluations of randomly selected HCP and controls, not case series without controls

Justifications Used by Some for Using a Detergent for Non-Critical Surfaces

• Environmental surfaces and noncritical patient care items contribute minimally to healthcare-associated infections

• No difference in HAI rates when surfaces are cleaned with detergents versus disinfectants

• Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)• Costs• Occupational health exposure issues• Use of antiseptics and disinfectants may select for antibiotic resistant

bacteria• Less environmental impact

Is There A Relationship Between Germicide Use and Antibiotic Resistance

Weber DJ, Rutala WA. ICHE 2006;27:1107-1119

• Possible to develop mutants in the laboratory with reduced susceptibility to disinfectants and antiseptics ( 1ppm to 4ppm, triclosan) that demonstrate decreased susceptibility or resistance to antibiotics.

• Concentration of triclosan used in practice greatly exceed the MICs observed (4 vs 2000-20,000ppm), the clinical relevance is questionable

• To date no evidence that using antiseptics or disinfectants selects for antibiotic-resistant organisms or that mutants survive in nature

• Antibiotic-resistant bacteria are as susceptible to germicides as antibiotic-susceptible strains

• Germicides should be used where there are scientific studies demonstrating benefit

Justifications Used by Some for Using a Detergent for Non-Critical Surfaces

• Environmental surfaces and noncritical patient care items contribute minimally to healthcare-associated infections

• No difference in HAI rates when surfaces are cleaned with detergents versus disinfectants

• Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)• Costs• Occupational health exposure issues• Use of antiseptics and disinfectants may select for antibiotic resistant

bacteria• Less environmental impact

Environmental Impact

• Bleach Reacts with soils, bacteria and stains; 95-98% rapidly breaks

down to salt and water; remaining 2-5% treated by sewer and septic systems

Does not contaminate ground water because it does not survive sewage treatment

• QUATs Almost completely degraded in sewage sludge

How About “Green” Products?

• Today, the definition of green is unregulated• It can mean:

Sustainable resources/plant-based ingredients Free of petrochemicals Biodegradable No animal testing Minimal carbon footprint Traded fairly

• It can, but does not always mean “safer”

Efficacy of “Green” Products to Inactivate MDR Pathogens

Rutala, Gergen, Weber. Unpublished results. 2013

• No measurable activity against A. baumannii, A. xyloxidans, Burkholderia cenocepacia, K. pneumoniae, MRSA and P. aeruginosa, VRE, Stenotrophomonas maltophilia

LECTURE OBJECTIVES

• Disinfectants Knowledge and controversies

• Detergents Knowledge and controversies

• Microfiber Knowledge and controversies

WipesCotton, Disposable, Microfiber, Cellulose-Based, Nonwoven Spunlace

Wipes Cotton, Disposable, Microfiber, Cellulose-Based, Nonwoven Spunlace

Wipe should have sufficient wetness to achieve the disinfectant contact time. Discontinue use of a disposable wipe if it no longer leaves the surface visibly wet for > 1m

Microfiber Cloth/Wipe/Pads

Microfiber Cleaning

• Pad contains fibers (polyester and polyamide) that provide a cleaning surface 40 times greater than conventional string mops

• Proposed advantages: reduce chemical use and disposal (disinfectant solution not changed after every third room, clean microfiber per room [washing lifetime 500-1000x]); light (~5 lb less than string mop) and ergonomic; reduce cleaning times.

• Does the microfiber provide the same or better removal of microorganisms on surfaces?

Efficacy of Different Microfiber Cloths at Removing Surface Microorganisms

Smith et al. J Hosp Infect 2011;78:182-186

• Mean log10 reduction ~2. Overall mean differences in the performance of individual, reusable cloths showed a log10 reduction of <1.

Mean Number of C. difficile Removed from Laminate on Repeat Washings of Cloths

Smith et al. J Hosp Infect 2011;78:182-186

• Mean log10 reduction was >2. The performance of the reusable cloths improved initially, but then slightly declined after 150 washes

Effectiveness of Microfiber Mop(Rutala, Gergen and Weber, Am J Infect Control, 2007;35:569)

Disinfectant-regular mop 95%

Disinfectant-microfiber system 95%

Disinfectant-microfiber mop and regular mop bucket

88%

Detergent-regular mop 68%

Detergent-microfiber system 95%

Detergent-microfiber mop and regular mop bucket

78%

Microfiber Efficacy and Use• > 2 log10 reduction for microbial removal. Smith et al. JHI. 2011;78:182

• Currently, we use the microfiber mops for the floors with a disinfectant. We use several cotton, wiping cloths per room for elevated surfaces but are transitioning to microfiber cloths

• We use a disinfectant because cleaning cloths such as microfiber or cotton can disperse microorganisms when a disinfectant is not incorporated or is depleted

• The ability of cotton/microfiber to retain QUATs ensures that microbes in contact with cloth/pad are also in contact with QUAT and will not redeposit on surface

• Instructions on preparation, use, and washing should be followed to maximize cloth performance

Microbial Contamination of Reusable Cleaning Cloths

Sifuentes et al. AJIC. Epub. 2013

Microfiber towels harbor greater numbers of bacteria compared with the cotton towels

Microbial Contamination of Reusable Cleaning Cloth

Rutala, Gergen, Weber. AJIC 2007;35:569

• Hospital laundering practices should be assessed to ensure they are sufficient to remove all viable microorganisms from microfiber• Microfiber may have special laundering processes (may

exclude bleach, fabric softeners, wash temperatures <200oC and drying less <140oC)• Our assessment of our routine laundering cycle showed

no microorganisms recoverable.

WipesCotton, Disposable, Microfiber, Cellulose-Based, Nonwoven Spunlace

Optimizing Disinfectant Application in Healthcare Facilities

KD MacDougall, C Morris. Infection Control Today. June 2006

Significant decline in the concentration of QUAT when cotton rags or cellulose-based wipers were compared to nonwoven spunlace wipers

Optimizing Disinfectant Application in Healthcare Facilities KD MacDougall, C Morris. Infection Control Today. June 2006

• Do different wipes provide a higher active QUAT concentration: yes Virgin cotton rags and cellulose-based wipers: 30-70% drop in QUAT

concentration in first 3 hours Nonwoven spunlace wipers with a fiber content intended to yield QUAT

compatibility: ~10-15% drop

• Summary-Nonwoven spunlace wipers maintain the QUAT concentration released to surface at near target concentration levels. A sharp reduction in QUAT with cotton, microfiber and cellulose-based wipers (electrostatic attraction between two oppositely charged ions [quats +, bacteria/cotton/microfiber -]). The QUAT retained in cotton/microfiber ensures that microbes in contact with cloth/pad are also in contact with QUAT and will not redeposit on surface

Effectiveness of Different Wipes and Solutions in Removing MRSA from Surface

Rutala, Gergen, Weber. Unpublished results. 2013

Solution Cotton KC 06411 Microfiber Cellulose

Sterile Water 3.07 3.22 3.88 2.39

Detergent 2.88 3.08 3.47 3.13

QUAT 1 4.41 4.60 4.51 4.40

QUAT 2 3.76 3.74 3.87 2.75

Even though cotton and microfiber retain QUAT, they provide equivalent removal/inactivation of MRSA from surface (log10 reduction) as nonwoven spunlace wiper

Objective

Describe emerging knowledge and controversies related to disinfectants, detergents and microfiber cleaning products

Disinfectants, Detergents and MicrofiberSummary

• Contaminated surface environment in hospital rooms is important in transmission of HA pathogens

• Appropriate use of disinfectants prevent transmission of pathogens and reduce HAIs

• Detergents alone do not kill pathogens and can cross-contaminate the environment

• Microfiber cloths are effective in removing microorganisms from surfaces. To prevent dispersion of microbes we use a disinfectant.

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