Infection Control Today - 11/2001: Brushing the Surface of Disinfectants

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Brushing the Surface of Disinfectants
Surface Disinfectants Crucial in Battle Against Nosocomial Infections

By Kelli M. Donley

One of the easiest methods of protecting yourself from getting the flu each winter is to avoid touching handles and buttons. Bathroom doorknobs, water faucets, and elevator buttons are touched every day by each person with whom you work. Imagine the number of germs transferred from person to person via these common sources. Germs thrive in new environments and a causal handshake can transport them to a new land of opportunity. Hospital surfaces, in this aspect, are no different than hands. Bed rails, gurneys, carts, counters, sinks, IV poles, lead wires, diagnostic equipment, and more are all touched by a variety of people daily. Are you cleaning these items efficiently, keeping both OSHA and specific hospital guidelines in mind?

The Lex Luther of healthcare is nosocomial infections, with Staphylococcus aureus serving as his trusty kryptonite. Nothing frustrates healthcare workers (HCWs) more than seeing a patient become infected with a new pathogen during hospitalization. This situation leaves hospital officials saying mea culpa and the door wide open to malpractice suits. Proper cleaning of surfaces can greatly reduce the risk of nosocomial infections by eliminating pathogens on commonly touched areas.

Characteristics of efficacious surface cleaners

Surface cleaners should have a broad antimicrobial spectrum, work quickly and effectively when blood or other protein is present, have a low toxicity, and be safe for HCWs to use.

While there is some controversy surrounding whether it is necessary to have a surface cleaner that serves as a tuberculodicial, there is no doubt that each cleaner should be bactericidal, fungicidal, and virucidal. The selected cleaner should be able to kill a variety of potentially deadly germs following Earle Spaudling's, MD, hierarchy of microorganism resistance to disinfection and sterilization.3 This hierarchy describes the susceptibility of microorganisms to disinfection in a descending order. He also classified medical devices on how the device is used and how it should be disinfected. These classifications are low-level, high-level, and sterilization. The ranking in descending order of microorganisms is: high-level disinfection or sterilization: bacterial spores (i.e., Bacillis subtilis, Clostridium difficile); intermediate-level disinfection: Mycobacterium tuberculosis and nonlipid and small viruses: (i.e.,coxsackievirus, hepatitis A, polio, rhino)3; low-level disinfection: fungi (i.e., Aspergillus niger, Candida albicans, Trichophyton mentagrophytes), gram positive and gram negative vegetative bacteria (i.e., Pseudomonas aeruginosa, Salmonella cholerasesuis, Staphylococcus aureus), and lipid or medium-sized viruses (i.e., cytomegalovirus, Hantavirus, herpes simplex virus, hepatitis B virus, HIV, respiratory syncytial virus).

Another important aspect of the antimicrobial spectrum is whether the Environmental Protection Agency (EPA) has approved the chemicals in use. Also, how quickly does the cleaner work? Each of these factors much be taken into consideration when selecting the appropriate surface cleaner to match a healthcare facility.1

The EPA requires each hard-surface disinfectant to have a label listing an ingredient statement and the concentration of each active ingredient. Each disinfectant must also have a EPA registration number on the label and clearly list the kill times for microorganisms that the product aims to eliminate. To receive one of these numbers from the EPA, a disinfectant is tested and must adhere to regulatory requirements pertaining to safety and efficacy.4

The Occupational Safety and Health Administration (OSHA) has specific guidelines for hospitals concerning surface cleaners and how to properly disinfect areas that have been potentially exposed to either HIV or HBV. This guideline states: OSHA's current stance is that EPA-registered disinfectants for HIV and HBV meet the requirement in the standard and are "appropriate" disinfectants to clean contaminated surfaces, provided such surfaces have not become contaminated with agent(s) or volumes of or concentrations of agent(s) for which higher level disinfection is recommended.2

Forms of disinfectants

There are a plethora of disinfectant products on the market, and while their scents, colors, and packaging vary, the true differences in these products are their form and active ingredients. Safetec, an infection control company based in Buffalo, NY, manufactures a variety of products, including SaniZide Plus--a quaternary ammonium compound. The liquid disinfectant has a broad spectrum of antimicrobial action and is alcohol free. Kelly Ticco, marketing manager, said that while their product is strong enough to kill dangerous pathogens, it is still user friendly.

"SaniZide Plus is an intermediate level Quaternary ammonium compound. Our alcohol free formula is non-toxic, non-corrosive, non-flammable, and will not stain surfaces. When the customer selects SaniZide Plus they get intermediate level (tuberculocidal) strength in a non-toxic formula," she said.

Officials from Palmero Health Care, report their DisCide Ultra line kills a myriad of germs including TB within 5 minutes. The quaternary ammonium high-level alcohol solution is sold in a variety of forms including towelettes, spray bottles, foil packs, and wall mount canisters containing the disinfectant. Other companies also manufacture disinfectants in aerosol cans, foams, and gels.

Education surrounding disinfectants necessary

While each disinfectant has its faults, the benefits are far more important. The proper use of these chemicals is essential in operating an efficacious healthcare center. However, knowledge on how to use these chemicals is just as crucial.

Each disinfectant has the potential of breaking down gloves. While some chemicals make the gloves more porous, others make the latex brittle and hard. Point being, following Universal Precautions for handwashing and frequently changing gloves extremely important when cleaning with these disinfectants.

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