Preventing infection transmission is one of the many challenges facing healthcare facilities today. Among the strategies for preventing healthcare-acquired infections is proper surface cleaning and disinfection. The environment plays an essential role in transmission of infection since anything that moves from patient to patient (hands, equipment) can act as a vehicle for transmission. With attention to improving practices for cleaning and disinfection of environmental surfaces and non-critical patient-care equipment, there is an increase demand for using pre-moistened germicidal wipes. Germicides are biocidal agents that inactivate microorganisms.1 Terms with the suffix “cidal” or “cide” refers to the killing action. Germicides with label claims as virucide, bactericide, fungicide, tuberculocide can kill the type of microorganism identified by the prefix.2 A growing number of pre-moistened germicidal wipes are being manufactured with different chemical formulations that are classified as low or intermediate level disinfectants and are Environmental Protection Agency (EPA)-registered for hospital use. Some pre-moistened wipes chemical formulations are quaternary-ammonium compounds, alcohol-quaternary ammonium compounds, chlorine based, and hydrogen peroxide based. A commonly preferred pre-moistened wipe is the alcohol-quaternary ammonium germicidal wipe.
The active ingredient of alcohol-quaternary ammonium wipes is quaternary ammonium chloride (quat). Each wipe is saturated with a specified number of parts per million (ppm) of active quaternary ammonium chloride e.g., 5,000 ppm or 2,500 ppm. The percentage of alcohol (usually isopropyl alcohol) in the ingredients may vary by manufacturer. Users will find the percentage of alcohol in the product’s material safety data sheets and in some products alcohol may be listed as an ingredient on the label. Because alcohol has rapid action against microorganisms, the higher percentage of alcohol in the chemical formulation can contribute to the faster kill times.
Alcohol-quaternary formulations are safe to use on non-porous hard surfaces. With repeated use, one does not experience build-up on the surface or streaking. Alcohol-quaternary formulations are not corrosive to metals.
Quaternary ammonium compounds are good cleaning agents and are widely used as disinfectants for noncritical environmental surfaces in healthcare settings. The bactericidal action of the quaternaries has been attributed to the inactivation of energy-producing enzymes, denaturation of essential cell proteins, and disruption of the cell membrane.3 Quats are fungicidal, bactericidal, and virucidal against lipophilic (enveloped) viruses and are generally not tuberculocidal or virucidal against hydrophilic (nonenveloped) viruses.4 Their action against microorganisms is generally slower. The overall contact time for quats is usually 10 minutes. Because they are not tuberculocidal, they are classified as low level disinfectants.
Alcohols have rapid action against vegetative forms of bacteria and they are also tuberculocidal, fungicidal and virucidal.5 With the addition of alcohol to the quaternary ammonium chlorides, kill times for microorganisms is faster thus contributing to an overall faster contact time. The alcohol-quat formulations are tuberculocidal thus classified as intermediate level disinfectants. There is also demonstrated increased activity against some hydrophilic (nonenveloped) viruses. Alcohol-quaternary ammonium products that have high percentage of alcohol in their formulations will have a broader range of efficacy against pathogenic microorganisms plus faster kill times. For example, a 55 percent isopropyl alcohol (w/w) and quaternary ammonium chloride formulation 0.5 percent (w/w) is fungicidal, bactericidal, virucidal and tuberculocidal killing 26 microorganisms in 2 minutes or less.
The Material Safety Data Sheet with any disinfectant product should always be available for review. Although the risk is low for potential health hazards associated with disinfectant products, caution should always be observed to avoid splashing to the face and eyes and personal protective equipment, such as gloves, should be worn as appropriate. The EPA requires manufacturers of disinfectants to list hazards and precautionary statements. Alcohol-quaternary ammonium chloride germicidal wipes are combustible. Warning labels on the product container and the MSDS should indicate “Combustible. Do not store near heat or open flame.”
In today’s busy healthcare environments, selecting a disinfectant product that has efficacy against a broad range of pathogenic bacteria with faster kill times is desirable. Establishing good practices for cleaning and disinfecting non-critical environmental surfaces and patient care equipment that are frequently touched is essential for preventing cross-contamination of problem pathogens seen in healthcare environments. Clinicians need products that are easy to use and accessible. Pre-moistened germicidal wipes with alcohol-quaternary ammonium formulations are examples of such products.
Jean Fleming, RN, MPM, CIC, is clinical director of infection prevention and education for Professional Disposable International, Inc.
1. Rutala W. Disinfection, Sterilization and Antisepsis Principles, Practices, Current Issues and New Research. APIC Conference Proceedings, 2006, APIC. Page 13.
3. Mayhall GC. Hospital Epidemiology and Infection Control, 3rd Ed. Chapter 85: “Selection and Use of Disinfectants in Healthcare”. Lippincott Williams & Wilkins. Philadelphia. 2004. Page 1505.
4. Mayhall GC. Hospital Epidemiology and Infection Control, 3rd Ed. Chapter 85: “Selection and Use of Disinfectants in Healthcare”. Lippincott Williams & Wilkins. Philadelphia. 2004. Page 1508.
5. Ibid. Page 1494.