Selection of an Ideal Disinfectant William A. Rutala, Ph.D., M.P.H. Director, Hospital Epidemiology,...

Selection of an Ideal Disinfectant

William A. Rutala, Ph.D., M.P.H.Director, Hospital Epidemiology, Occupational Health

and Safety, UNC Health Care; Research Professor of Medicine and Director, Statewide Program for Infection Control and Epidemiology, University of

North Carolina at Chapel Hill, NC, USA

Disclosure: Clorox

LECTURE OBJECTIVES

Review the role of the environment in transmission of nosocomial pathogens

Review the properties of an ideal disinfectant Review the key considerations for selecting the

ideal disinfectant Kill Claims Kill and wet-contact time Safety Ease of use Other factors

DISINFECTION AND STERLIZATION

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 but high numbers of bacterial spores.

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

Processing “Noncritical” Patient Care Objects

Classification: Noncritical objects will not come in contact with mucous membranes or skin that is not intact.

Object: Can be expected to be contaminated with some microorganisms.

Level germicidal action: Kill vegetative bacteria, fungi and lipid viruses.

Examples: Bedpans; crutches; bed rails; EKG leads; bedside tables; walls, floors and furniture.

Method: Low-level disinfection

Low-Level Disinfection for “Noncritical” Objects

Exposure time > 1 minGermicide Use ConcentrationEthyl 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

LECTURE OBJECTIVES




ENVIRONMENTAL CONTAMINATION LEADS TO HAIs

There is increasing evidence to support the contribution of the environment to disease transmission

This supports comprehensive disinfecting regimens (goal is not sterilization) to reduce the risk of acquiring a pathogen from the healthcare environment/equipment

KEY PATHOGENS WHERE ENVIRONMENTIAL SURFACES PLAY A ROLE IN TRANSMISSION

MRSA VRE Acinetobacter spp. Clostridium difficile Norovirus Rotavirus SARS

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

Thoroughness of Environmental Cleaning

Carling et al. Am J Infect Control. 2013;41:S20-S25

0

20

40

60

80

100

HEHSG HOSP

IOWA HOSP

OTHER HOSP

OPERATING ROOMS

NICUEMS VEHICLES

ICU DAILY

AMB CHEMO

MD CLINIC

LONG TERM

DIALYSIS

%

DAILY CLEANING

TERMINAL CLEANING

Cle

aned

Mean = 32%

>110,000 Objects

Mean proportion of surfaces disinfected at terminal cleaning is ~30%

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

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 MRSA ON HANDS AFTER CONTACT WITH ENVIRONMENTAL SITES

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

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

Increased Risk of Acquisition of HA Pathogen from Prior Room Occupant~120%

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

ALL “TOUCHABLE” (HAND CONTACT) SURFACES SHOULD BE WIPED WITH

DISINFECTANT

“High touch” objects only recently defined (no significant differences in microbial contamination of different surfaces)

and “high risk” objects not epidemiologically defined.

FREQUENCY (mean) OF HCP CONTACT FOR SURFACES IN AN ICU (N=28) AND WARD (N=24)

ICU WARD

Huslage K, Rutala WA, Sickbert-Bennett E, Weber DJ. ICHE 2010;31:850-853

MICROBIAL BURDEN ON ROOM SURFACES AS A FUNCTION OF FREQUENCY OF TOUCHING

Surface Prior to CleaningMean CFU/RODAC (95% CI)

Post Cleaning (mean)Mean CFU/RODAC (95% CI)

High 71.9 (46.5-97.3) 9.6Medium 44.2 (28.1-60.2) 9.3Low 56.7 (34.2-79.2) 5.7

The level of microbial contamination of room surfaces is similar regardless of how often they are touched both before and after cleaning

Therefore, all surfaces that are touched must be cleaned and disinfected

Huslage K, Rutala WA, Weber DJ. ICHE. 2013;34:211-212

Thoroughness of Environmental CleaningCarling et al. Am J Infect Control. 2013;41:S20-S25

0

20

40

60

80

100

HEHSG HOSP

IOWA HOSP

OTHER HOSP

OPERATING ROOMS

NICUEMS VEHICLES

ICU DAILY

AMB CHEMO

MD CLINIC

LONG TERM

DIALYSIS

%

DAILY CLEANING

TERMINAL CLEANING

Cle

aned

Mean = 32%

>110,000 Objects

ENVIRONMENTAL CONTAMINATION LEADS TO HAIsSuboptimal Cleaning

There is increasing evidence to support the contribution of the environment to disease transmission

This supports comprehensive disinfecting regimens (goal is not sterilization) to reduce the risk of acquiring a pathogen from the healthcare environment

Quality Improvement

MONITORING THE EFFECTIVENESS OF CLEANINGCooper et al. AJIC 2007;35:338

Visual assessment-not a reliable indicator of surface cleanliness

ATP bioluminescence-measures organic debris (each unit has own reading scale, <250-500 RLU)

Microbiological methods-<2.5CFUs/cm2-pass; can be costly and pathogen specific

Fluorescent marker

SURFACE EVALUATION USING ATP BIOLUMINESCENCE

Swab surface luciferace tagging of ATP Hand held luminometer

Used in the commercial food preparation industry to evaluate surface cleaning before reuse and as an educational tool for more than 30 years.

MONITORING THE EFFECTIVENESS OF CLEANINGCooper et al. AJIC 2007;35:338

• Visual assessment-not a reliable indicator of surface cleanliness

• ATP bioluminescence-measures organic debris (each unit has own reading scale, <250-500 RLU)

• Microbiological methods-<2.5CFUs/cm2-pass; can be costly and pathogen specific

• Fluorescent marker-transparent, easily cleaned, environmentally stable marking solution that fluoresces when exposed to an ultraviolet light (applied by IP unbeknown to EVS, after EVS cleaning, markings are reassessed)

Fluorescent Marking Solution

Target After Marking

Target Enhanced

TERMINAL ROOM CLEANING: DEMONSTRATION OF IMPROVED CLEANING

Evaluated cleaning before and after an intervention to improve cleaning

36 US acute care hospitals Assessed cleaning using a

fluorescent dye Interventions

Increased education of environmental service workers

Feedback to environmental service workers

†Regularly change “dotted” items to prevent targeting objects

Carling PC, et al. ICHE 2008;29:1035-41

LECTURE OBJECTIVES




PROPERTIES OF AN IDEALSURFACE DISINFECTANT

Broad spectrum Fast acting Remains wet Not affected by environmental

factors Nontoxic Surface compatibility Persistence

Easy to use Acceptable odor Economical Solubility Stability Cleaner Nonflammable

Rutala WA, Weber DJ. Infect Control Hosp Epidemiol 2014;35:855-865


Broad spectrum Should have a wide antimicrobial spectrum, including kill claims for

all pathogens that are common causes of HAIs and outbreaks Fast acting

Should have a rapid kill and short kill/contact time listed on the label Remains wet

Should keep surfaces wet long enough to meet listed kill/contact times with a single application or meet wet times recommended by evidence-based guidelines (60 seconds)



Not affected by environmental factors Should be active in the presence of organic matter (e.g., blood, sputum,

feces) and compatible with soaps, detergents, and other chemicals encountered in use

Nontoxic Should not irritating to the user, visitors, and patients. Should not induce

allergic symptoms (especially asthma and dermatitis). The toxicity ratings for disinfectants are danger, warning, caution, and none. Ideally choose products with the lowest toxicity rating.

Surface compatibility Should be proven compatible with common healthcare surfaces and devices



Persistence Should have sustained antimicrobial activity or residual antimicrobial effect

on the treated surface Easy to use

Should be available in multiple forms, such as wipes (large and small), sprays, pull tops, and refills; directions for use should be simple and contain information about personal protective equipment as required

Acceptable odor Should have an odor deemed acceptable by users and patients

Solubility Should be soluble in water



Economical Costs should not be prohibitively high but when considering the costs of a

disinfectant one should also consider product capabilities, cost per compliant use, etc.

Stability Should be stable in concentrate and use dilution

Cleaner Should have good cleaning properties

Nonflammable Should have a flash point above 150oF


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




dilution)Phenolic UDIodophor UDQuaternary ammonium UDImproved hydrogen peroxide (HP) 0.5%, 1.4%____________________________________________________UD=Manufacturer’s recommended use dilution

BACTERICIDAL ACTIVITY OF DISINFECTANTS (log10 reduction) WITH A CONTACT TIME OF 1m WITH/WITHOUT FCS.

Rutala et al. ICHE. 2012; 33:1159-61

Organism 0.5% IHP 0.5% HP HP Cleaner-Dis 1.4% IHP

1.4% HP 3.0% HP QUAT

MRSA >6.6 <4.0 >6.5 <4.0 <4.0 5.5

VRE >6.3 <3.6 >6.1 <3.6 <3.6 4.6

MDR-Ab >6.8 <4.3 >6.7 <4.3 <4.3 >6.8

MRSA, FCS

>6.7 NT >6.7 NT <4.2 <4.2

VRE, FCS >6.3 NT >6.3 NT <3.8 <3.8

MDR-Ab, FCS

>6.6 NT >6.6 NT <4.1 >6.6

Improved hydrogen peroxide is significantly superior to standard HP at same concentration and superior or similar to the QUAT tested

Hospital Privacy Curtains(pre- and post-intervention study; sampled curtain, sprayed “grab area” 3x

from 6-8” with 1.4% IHP and allowed 2 minute contact; sampled curtain)

Decontamination of Curtains with Activated HP (1.4%)Rutala, Gergen, Weber. Am J Infect Control. 2014;42:426-428

CP for: Before DisinfectionCFU/5 Rodacs (#Path)

After DisinfectionCFU/5 Rodacs (#Path)

% Reduction

MRSA 330 (10 MRSA) 21*(0 MRSA) 93.6%

MRSA 186 (24 VRE) 4* (0 VRE) 97.9%

MRSA 108 (10 VRE) 2* (0 VRE) 98.2%

VRE 75 (4 VRE) 0 (0 VRE) 100%

VRE 68 (2 MRSA) 2* (0 MRSA) 97.1%

VRE 98 (40 VRE) 1* (0 VRE) 99.0%

MRSA 618 (341 MRSA) 1* (0 MRSA) 99.8%

MRSA 55 (1 VRE) 0 (0 MRSA) 100%

MRSA, VRE 320 (0 MRSA, 0 VRE) 1* (0 MRSA, 0 VRE) 99.7%

MRSA 288 (0 MRSA) 1* (0 MRSA) 99.7%

Mean 2146/10=215 (432/10=44) 33*/10=3 (0) 98.5%

* All isolates after disinfection were Bacillus sp; now treat CP patient curtains at discharge with IHP

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

Transfer of C. difficile Spores by Nonsporicidal Wipes

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

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




dilution)Phenolic UDIodophor UDQuaternary ammonium UDImproved hydrogen peroxide 0.5%, 1.4%____________________________________________________UD=Manufacturer’s recommended use dilution

Quaternary ammonium compounds (e.g., didecyl dimethyl ammonium bromide, dioctyl dimethyl ammonium

bromide)Rutala, Weber. Am J Infect Control 2013;41:S36-S41

Advantages Bactericidal, fungicidal, virucidal

against enveloped viruses (e.g., HIV)

Good cleaning agents EPA registered Surface compatible Persistent antimicrobial activity

when undisturbed Inexpensive (in dilutable form) Not flammable

Disadvantages Not sporicidal In general, not tuberculocidal and

virucidal against non-enveloped viruses

High water hardness and cotton/gauze can make less microbicidal

A few reports documented asthma as result of exposure to benzalkonium chloride

Affected by organic matter Multiple outbreaks ascribed to

contaminated benzalkonium chloride

Sodium HypochloriteRutala, Weber. Am J Infect Control 2013;41:S36-S41

Advantages Bactericidal, tuberculocidal, fungicidal,

virucidal Sporicidal Fast acting Inexpensive (in dilutable form) Not flammable Unaffected by water hardness Reduces biofilms on surfaces Relatively stable (e.g., 50% reduction in

chlorine concentration in 30 days) Used as the disinfectant in water

treatment EPA registered

Disadvantages Reaction hazard with acids and ammonias Leaves salt residue Corrosive to metals (some ready-to-use

products may be formulated with corrosion inhibitors)

Unstable active (some ready-to-use products may be formulated with stabilizers to achieve longer shelf life)

Affected by organic matter Discolors/stains fabrics Potential hazard is production of

trihalomethane Odor (some ready-to-use products may be

formulated with odor inhibitors). Irritating at high concentrations.

AlcoholRutala, Weber. Am J Infect Control 2013;41:S36-S41

Advantages

Bactericidal, tuberculocidal, fungicidal, virucidal

Fast acting Non-corrosive Non-staining Used to disinfect small surfaces

such as rubber stoppers on medication vials

No toxic residue

Disadvantages Not sporicidal Affected by organic matter Slow acting against non-enveloped viruses

(e.g., norovirus) No detergent or cleaning properties Not EPA registered Damage some instruments (e.g., harden

rubber, deteriorate glue) Flammable (large amounts require special

storage) Evaporates rapidly making contact time

compliance difficult Not recommended for use on large surfaces Outbreaks ascribed to contaminated alcohol

PhenolicsRutala, Weber. Am J Infect Control 2013;41:S36-S41

Advantages Bactericidal, tuberculocidal,

fungicidal, virucidal Inexpensive (in dilutable

form) Non-staining Not flammable EPA registered

Disadvantages Not sporicidal Absorbed by porous

materials and irritate tissue Depigmentation of skin

caused by certain phenolics Hyperbilirubinemia in infants

when phenolic not prepared as recommended

Improved Hydrogen PeroxideRutala, Weber. Am J Infect Control 2013;41:S36-S41

Advantages Bactericidal, tuberculocidal,

fungicidal, virucidal Fast efficacy Easy compliance with wet-contact

times Safe for workers (lowest EPA

toxicity category, IV) Benign for the environment Surface compatible Non-staining EPA registered Not flammable

Disadvantages More expensive than most

other disinfecting actives Not sporicidal at low

concentrations

LECTURE OBJECTIVES




Key Considerations for Selecting the Ideal Disinfectant for Your Facility

Rutala, Weber. Infect Control Hosp Epidemiol. 2014;35:855-865

Consideration Question to Ask Score (1-10)

Kill Claims Does the product kill the most prevalent healthcare pathogens

Kill Times and Wet-Contact Times

How quickly does the product kill the prevalent healthcare pathogens. Ideally, contact time greater than or equal to the kill claim.

Safety Does the product have an acceptable toxicity rating, flammability rating

Ease-of-Use Odor acceptable, shelf-life, in convenient forms (wipes, spray), water soluble, works in organic matter, one-step (cleans/disinfects)

Other factors Supplier offer comprehensive training/education, 24-7 customer support, overall cost acceptable (product capabilities, cost per compliant use, help standardize disinfectants in facility)

Note: Consider the 5 components shown, give each product a score (1 is worst and 10 is best) in each of the 5 categories, and select the product with the highest score as the optimal choice (maximum score is 50).

SELECTION OF THE IDEAL SURFACE DISINFECTANTKill Claims

Disinfectants used in hospitals should be EPA registered Hospital disinfectant must show activity against Salmonella,

Pseudomonas and S. aureus Label are very specific about their kill claims (1-10 min

contact time) Does the product kill the most prevalent healthcare

pathogens including those that Cause most HAIs Cause most outbreaks Are of concern in your facility

MOST PREVALENT PATHOGENS CAUSING HAI

Most prevent pathogens causing HAI (easy to kill) S. aureus (15.6%) E. coli (11.5%) Coag neg Staph (11.4%) Klebsiella (8.0%) P. aeruginosa (8.0%) E. faecalis (6.8%) C. albicans (5.3%) Enterobacter sp. (4.7%) Other Candida sp (4.2%)

Common causes of outbreaks and ward closures (relatively hard to kill) C. difficile spores Norovirus Rotavirus Adenovirus

Middle East Respiratory Syndrome-CoronavirusMERS-CoV

New and Emerging PathogensMERS-CoV, Ebola, Enterovirus D68

Will likely not have an EPA-registered disinfectant on the market to kill it

Manufacturers may not make claims about emerging pathogens without EPA approval, which may take 18-24 months for new pathogens

Until an EPA-approved claim is available, users may refer to the hierarchy of microbial susceptibility to select the appropriate disinfectant

For example, an EPA claim against poliovirus could be used for MERS-CoV as well as inactivation data of coronavirus

Decreasing Order of Resistance of Microorganisms to Disinfectants/Sterilants

PrionsBacterial spores (C. difficile)

MycobacteriaSmall, non-enveloped viruses (noro, polio, EV-D68)

Fungal sporesGram-negative bacilli (Acinetobacter)

Vegetative fungi and algaeLarge, non-enveloped viruses

Gram-positive bacteria (MRSA, VRE)Enveloped viruses (Ebola, MERS-CoV)

Most Resistant

Most Susceptible

Inactivation of Coronavirus by Disinfectants/Antiseptics and Survival on Surfaces

Sattar, Springthorpe, Karim, Loro. Epidemiol Infect 1989;102:493 3 log10 reduction in 1m by 2% glut, 70% alcohol, 1% PI, phenolic, and

5,000 ppm chlorine Hulkower, Casanova, Rutala, Weber, Sobsey. Am J Infect Control

2011;39:401 2 log10 reduction in 1m by phenolic (use-dilution), OPA, 70% ethanol,

62% ethanol, 71% ethanol

Disinfectants and antiseptics effective in 1min







Most Resistant

Most Susceptible

GUIDELINE FOR THE PREVENTION OF NOROVIRUS OUTBREAKS IN HEALTHCARE, HICPAC, 2011

Avoid exposure to vomitus or diarrhea. Place patients with suspected norovirus on Contact Precautions in a single room (lB) Continue Precautions for at least 48 hours after symptom resolution (lB) Use longer isolation times for patients with comorbidities (ll) or <2 yrs (ll)

Consider minimizing patient movements within a ward (ll) Consider restricting movement outside the involved ward unless essential (ll) Consider closure of wards to new admissions (ll)

Exclude ill personnel (lB) During outbreaks, use soap and water for hand hygiene (lB) Clean and disinfect patient care areas and frequently touched surfaces

during outbreaks 3x daily using EPA approved healthcare product (lB) Clean surfaces and patient equipment prior to disinfection. Use product

with an EPA approved claim against norovirus (lC)

MacCannell T, et al. http://www.cdc.gov/hicpac/pdf/norovirus/Norovirus-Guideline-2011.pdf







Most Resistant

Most Susceptible

C. difficile EPA-Registered Products

• List K: EPA’s Registered Antimicrobials Products Effective Against C. difficile spores, April 2014

• http://www.epa.gov/oppad001/list_k_clostridium.pdf

• 34 registered products; most chlorine-based, some HP/PA-based




Kill Claims Does the product kill the most prevalent healthcare pathogens 10, 8Kill Times and Wet-Contact Times






SELECTION OF THE IDEAL SURFACE DISINFECTANTKill and Wet-Contact Time

How quickly does the product kill the prevalent healthcare pathogens?

Does the product keep surfaces visibly wet for the kill times listed on its label?

Kill Times for Most Prevalent Pathogens

Each disinfectant requires a specific time it must remain in contact with the microbe to achieve disinfection. This is known as the kill time or contact time

Some disinfectants may have a kill time for bacteria of 1m, which means bacteria in label disinfected in 1m

Other low-level disinfectants, often concentrated formulas require dilution, are registered by the EPA with contact time of 10m

Such a long contact time is not practical

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







10, 8





SELECTION OF THE IDEAL SURFACE DISINFECTANTSafety

Does the product have an acceptable toxicity rating (danger, warning, caution, none)?

Does the product have an acceptable flammability rating?

Is a minimum level of personal protective equipment required?

Is the product compatible with the common surfaces in your facility?








10, 9

Ease-of-Use Odor acceptable, shelf-life, in convenient forms (wipes, spray, surface area wet for 1-2m; wipe not torn easily or fall apart), water soluble, works in organic matter, one-step (cleans/disinfects)



SELECTION OF THE IDEAL SURFACE DISINFECTANTEase of Use

Is the product odor acceptable? Does the product have an acceptable shelf life? Does the product come in convenient forms to meet your

facility’s needs (refills, sprays, liquids; surface area wet for 1-2m; wipe not torn easily or fall apart)?

Does the product work in the presence of organic matter? Is the product water soluble? Does the product clean and disinfect in a single step? Are the directions for use simple and clear?

DISINFECTANTS ANDHEALTHCARE PERSONNEL SAFETY

Environmental (Low Level) disinfectants: Risks Skin irritation (dermatitis) Allergies (including asthma) Rarely reported in US

Environmental disinfectants: Protection for HCP Proper PPE by HCP (gloves, gowns) Training for proper use and disposal

Training and PPE minimize risk

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









10, 7



SELECTION OF THE IDEAL SURFACE DISINFECTANTOther Factors

Does the supplier offer comprehensive training and ongoing education, both in person and virtual?

Does the supplier offer 24-7 customer support? Is the overall cost of the product acceptable (considering

product capabilities, cost of infections that may be prevented, and cost per compliant use?

Can the product help standardize disinfectants in your facility?










10, 7





Kill Claims Does the product kill the most prevalent healthcare pathogens 10, 8Kill Times and Wet-Contact Times


10, 8


10, 9


10, 7


10, 7

50, 39


LECTURE OBJECTIVES




Selection of the Ideal DisinfectantConclusions

Disinfection of noncritical environmental surfaces/equipment is an essential component of Infection prevention

Disinfection should render surfaces and equipment free of pathogens in sufficient numbers to cause human disease

While the perfect disinfecting agent may not exist, a careful process of selection and use are necessary to reduce harm to patients and staff

When determining the optimal disinfecting product, consider the 5 components (kill claims/time, safety, ease of use, others)

Select the product with the highest score as the best choice for your healthcare facility

THANK YOU!www.disinfectionandsterilization.org

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