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

November 1, 2001

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

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
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

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

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.