Infection Control Today - 08/2003: Success Story

Disinfectants in the Custody Setting: A Viable Alternative to Toxic Chemicals

By Larry Weiss, MD

The ongoing outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in the California Correctional System beginning last year brought national attention to the difficulty of managing infectious disease in a custody setting. In 2002, the Los Angeles County Jail diagnosed 928 inmates with MRSA. Close quarters, poor personal hygiene, high-risk behaviors and the fact that in most cases, the prisoners themselves are responsible for cleaning and disinfection, make custody a particularly challenging infection control problem.

While the extent to which a routine of cleaning and disinfection has in limiting the spread of illness in prisons has not been studied, there is strong support for the practice. Unfortunately, the most commonly used disinfectants are toxic, and in the hands of prisoners, have been used as weapons when forcibly ingested and as a form of mace when sprayed in the eyes. Faced with this risk, many institutions have cut back or eliminated the use of disinfectants, leaving themselves open to the epidemic spread of infectious disease.

A new class of intermediate-level disinfectants, based upon breakthrough nanotechnology emulsion, is non-toxic to humans and provides a safe and cost-effective infection control alternative for any high-risk environment, and is particularly well suited to the custody setting.

This nanotechnology emulsion, which is commercially available under the trade name EcoTru, is the only EPA registered disinfectant that is not required to carry cautionary statements on the label. The practical implications are that it is not possible to ingest a toxic dose and it is not necessary to use an eye-wash if it were to splash in the eye. This eliminates compliance procedures dictated by the Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA), as well as HAZMAT training and certification costs that can be substantial in industries with high employee turnover.

The safety profile of this new disinfectant is of particular importance in custody environments where toxic disinfectants have been implicated in deliberate poisonings. All other disinfectants and most cleaning products are poisonous. While quaternary ammonium-based disinfectants (quats) are the dominant disinfectants in use today, they represent a dangerously outdated technology and are ill suited to the custody setting. Quats are pulmonary and ocular irritants and systemic poisons if ingested. They are the principal cause of occupational dermatitis and asthma in healthcare and janitorial workers. Recent studies have documented that approximately 2 percent of healthcare workers are allergic to quats. Most are sold as concentrates that are extremely toxic, irritating and corrosive. Errors in dilution can result in highly toxic or, alternatively, ineffective use dilutions.

Norwalk-Like Virus (NLV) is a major concern because it is highly contagious and the most common cause of acute gastroenteritis in the United States and worldwide. NLV causes as many as 20 million episodes in the U.S. annually, resulting in more than 300,000 hospitalizations and at least 2,500 deaths. It is a major cause of absenteeism. Following recovery and return to work, patients remain contagious, shedding live virus for as long as four weeks. NLV is especially well adapted to confined populations such as military deployments, cruise ships, dormitories and prisons. Quats have no efficacy whatsoever against NLV and related viral species. Although as of this writing (June 2003), we are unaware of any EPA approved testing methodology for the noro virus. The new nanoemuls ion germicide has a documented 99.99 percent inactivation of the surrogate virus, Feline Calicivirus (FCV).

While the role of the environment in the transmission of tuberculosis (TB) remains uncertain, the explosive emergence of resistant TB raises the stakes as well as the consequences associated with this organism. The cost of treating a patient with resistant TB can be as high as $150,000 and take as long as 18 months. The Mycobacterium species are considered the most difficult of bacteria to kill and remain the standard for antibacterial disinfectant efficacy. Quats alone have had limited or no efficacy against TB.

Quats that make claims for TB efficacy contain alcohol or extremes of pH, increasing both the toxicity and the materials incompatibility. The new nanoemulsion germicide has a 5-minute TB claim, which is comparable or better than all but the most toxic and corrosive alternatives.

Recent reports from the Centers for Disease Control and Prevention (CDC) and the California Department of Corrections have noted the appearance of MRSA in the jail populations. This is of particular concern because this new strain of MRSA was invasive and capable of initiating an infection without a break in the skin. It is highly contagious and difficult to treat, requiring a mixture of antibiotics and occasionally several weeks of intravenous antibiotics. MRSA is known to survive for days to weeks on surfaces. Once established in an institutional setting MRSA can be very difficult to eradicate. The new nanoemulsion disinfectant is designed to be the only safe and noncorrosive disinfectant alternative for MRSA.

Quats are notorious environmental contaminants. More than 100,000 metric tons are produced in the U.S., and massive amounts of pollutant byproducts are produced during their manufacture. Once manufactured, quats end up in the soil and aquifers where they degrade slowly, if at all.

Varying degrees of contamination with quats are found in many rivers, streams and municipal water supplies. In contrast, the new nanoemulsion disinfectant is readily biodegradable under both aerobic and anaerobic conditions and doesnt accumulate in the environment.

This new nanoemulsion disinfectant is the only completely noncorrosive disinfectant option. The most rigorous standards for corrosion are those established for use aboard civilian and military aircraft. It is the first and only disinfectant that has passed all of the aircraft materials standards, including plastics, painted surfaces, vinyl, fabrics, leather and metals. It can safely be used throughout the work environment, including equipment, computer keyboards, automobiles, and emergency medical transport vehicles and equipment.

A system has been developed which pairs EcoTru with patented microfiber mops and cloths to simplify procedure and assure a consistently high level of disinfection at a reduced cost. Simplicity of use is the best predictor of good compliance. The system efficiently captures within the microfiber matrix where effective kill times are assured. The mop heads and cloths can then be washed and reused hundreds of times.

Because it eliminates the bucket, there is no cross-contamination and disinfectant use is reduced by more than 90 percent. An EPA study found that the this system can reduce annual cleaning and disinfecting costs by as much as 60 percent as compared to conventional practices.

Larry Weiss, MD is senior scientist for EnviroSystems, Inc.

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