Q&A: Approaches to Disinfection in COVID Era

Caitlin Stowe MPH, CPH, CIC: “There’s still a lot we don’t know about SARS-CoV-2 and the direct mechanisms of transmission…. It can be aerosolized. However, there is evidence of indirect transmission from surfaces to people.”

Coronavirus disease 2019 (COVID-19) spreads mostly through the air, in droplets or aerosolized particles. But, as Caitlin Stowe MPH, CPH, CIC, tells Infection Control Today®, “there is evidence of indirect transmission from surfaces to people. So, while it’s probably not the primary way that it’s transmitted, it’s still an important mechanism to consider. That’s why it’s still really important to do hand hygiene to get the virus off your hands. And to also make sure that you’re disinfecting those surfaces appropriately.” Stowe is the clinical affairs research manager at PDI, a company that makes disinfectants for health care systems, and other businesses and industries. Like many industries associated with health care, the COVID-19 pandemic has a unique test. “In the industry side,” says Stowe, “as a disinfectant manufacturer, we face challenges in sourcing raw materials. So, making sure we can get the chemicals needed to make the disinfectants. The plastic containers or any of the packaging that we have to use to ship the disinfectants.” With the COVID-19 vaccines, she’s optimistic that the end is in site but cautions non-health care professionals. “Wash your hands. Social distance. Wear a mask. Get your vaccine, if you can, and be a good, informed health consumer.”

Infection Control Today®: What do you see as the major challenges facing hospitals and other industries as we try to deal with COVID-19 at this point in the pandemic?

Caitlin Stowe MPH, CPH, CIC: Honestly, we’re facing a lot of the same challenges that we did at the beginning of the pandemic: making sure that we have adequate personal protective equipment [PPE], supplies for our health care providers and our frontline staff, making sure we can get an adequate amount of disinfection products so that we can clean and disinfect surfaces adequately. Testing is also a concern, making sure we have enough testing supplies to complete the number of necessary tests needed in certain areas. ICU bed availability, staffing for those beds. There are just so many things that we continue to face as challenges in the health care setting. But also, we now face the additional challenge of burnout. Our staff are a year into this pandemic. They’re tired. They’re frustrated. I get it. And so that’s just adding an additional layer of complexity. In the industry side, as a disinfectant manufacturer, we face challenges in sourcing raw materials. So, making sure we can get the chemicals needed to make the disinfectants. The plastic containers or any of the packaging that we have to use to ship the disinfectants. We have to make sure that we are maintaining adequate supply so that our customers can get what they need. It’s really just ensuring that we’re meeting the needs of our customers. We are manufacturing 24/7 and making sure that we are still getting the raw materials we can get to meet our customer needs.

ICT®: On the manufacturing side, are you at all concerned about the COVID-19 variants that have been cropping up?

Stowe: A virus will naturally mutate on its own over time. That’s called antigenic drift. And that’s very common in any kind of virus, especially in the single-stranded RNA coronaviruses, like we see with SARS-CoV-2. What the variants do is they’re actually making—theoretically—some of them are making the virus maybe more severe in infection. So, the virus is actually trying to target itself to be more transmittable in a human body. However, in the past, and what we’re currently seeing is that does not equate to any kind of resistance in disinfectants. So, much like how microbes become resistant to certain antibiotic classes, we still don’t see any resistance to disinfectants with those antimicrobial, multi-drug resistant organisms. We’re seeing the same thing with the viruses. At this point, we have no concerns that disinfectants will be less effective on these variants of SARS-CoV-2.

ICT®: Do you worry that we're reopening too quickly? I mean, everybody wants to reopen, because it’s killing the economy. Millions are out of work. What do you see are the challenges in reopening?

Stowe: Vaccination is going to be the hallmark strategy in overcoming this pandemic. And so even if these variants…. And what we’re seeing is that there is some thought that some of these variants may actually cause the vaccines to be less effective, which is a concern. However, the vaccines that we currently have available have efficacy of up to 95%, which is amazing. So even if these variants were to cause a drop in efficacy, we’re still looking at maybe 75% to 85% efficacy, which is still phenomenal. So, vaccination will still be the hallmark prevention into getting us back opening. We’re still going to have to continue to socially distance. We’re still going to have to continue to wear masks for the foreseeable future, until we can establish good

herd immunity within our community in the nation to ensure that we’re protecting those vulnerable people that can’t get the vaccine. We’re all going to have to do our part be diligent about mask wearing hand hygiene, social distancing, even if we’ve gotten the vaccine, until we’ve achieved that herd immunity, which I’m hoping will be by the end of the year, looking at projection of vaccination, manufacturing, and how they’re getting vaccinations and how rapidly they are. We are seeing positive trends already, that in most states, I think it’s over 40 [states], we’re seeing downward trends in infections, in the number of hospitalizations per day. And that hasn’t happened in over seven weeks. We are seeing a little glimmer of hope. Death rates are still continuing to climb, but those tend to lag about two to four weeks out. So that’s expected. But I think we might be seeing the start of a downturn, but I think it’s honestly still too early to say if we peaked or not. And so social distancing and hand hygiene, that’s still really important. And your vaccination is also going to be the most important thing you can do for yourself and your family.

ICT®: Your company specializes in manufacturing disinfectants for surfaces. Now I read that that’s not really a problem as far as COVID is concerned? True or not?

Stowe: It’s hard to say because there’s still a lot we don’t know about SARS-CoV-2 and the direct mechanisms of transmission. We do you know that it’s mainly spread by those droplets. It can be aerosolized. It’s inhaled that way. However, there is evidence of indirect transmission from surfaces to people. So, while it’s probably not the primary way that it’s transmitted, it’s still an important mechanism to consider. That’s why it’s still really important to do hand hygiene to get the virus off your hands. And to also make sure that you’re disinfecting those surfaces appropriately.

ICT®: Airflow has become a big topic in hospitals, and in office buildings, and anywhere people congregate. How do disinfectants and airflow work together? Are they just two separate things?

Stowe: That’s a good question. We know that this virus can become aerosolized, right? We saw that with the original SARS virus back in South Korea and China. We have seen it in cases of it here where it became aerosolized. The surface and air work together obviously, things that float in the air can land on surfaces, and they can potentially be transmitted. There are no disinfectants that are cleared that I know of to decontaminate the air. And so, that’s where UV [ultra violet] light comes into play. You can use that layered approach. Doing great surface decontamination disinfection with a disinfectant wipe. And then you can bring in your UV light to get that secondary, in addition, terminal cleaning. We have a lot of facilities that have actually implemented UV light as an extra step in their terminal disinfection process to just kind of make sure that all the surfaces and the air in their room are being adequately disinfected.

ICT®: I’ve heard about self-disinfecting services. No doubt you’ve heard about that, too. But are we still a long way from that point where most services will be self-disinfecting?

Stowe: I believe, yes, we’re probably still a little bit off in that. We know that there are various chemicals and metals like copper and silver that are naturally antimicrobial that can be impregnated into surfaces, curtains, fabrics, all that stuff. There’s actually a new technology out there that was just launched last year. That is a polymer that is combined with a quaternary ammonium compound that can be sprayed on a surface. And it has a kill claim through the EPA for up to 96 inches or 24 hours. It continues to kill the things on the surface that it’s been applied to even after you’ve walked away. You spray, walk way, and it continues to protect. And that’s used as either a daily disinfectant or you can use it as a once-a-day disinfectant. We continue to have that antimicrobial or self-cleaning properties, even after you’ve done your initial disinfection. There are technologies like that out there. They’re fairly new. We know a lot about them, but there’s still a lot we don’t know. And so, it’s going to take I think probably a few more years of research and playing around with kind of what the perfect disinfectant looks like for different surfaces before we have completely self-disinfecting surfaces.

ICT®: Now when a company, such as your company, makes a disinfectant, whom do you aim that product at? Are you trying to sell to the hospital administrator? The environmental services team? Who do you envision, first, using that product and, second, giving the go-ahead to buy that product?

Stowe: It depends on the hospital. Most hospitals have a very formalized value analysis committee. And there’s a process that we go through that’s very well-defined, where it’s a multi-disciplinary committee that is made up of hospital administration, EVS, nursing, biomedical engineering. Just various disciplines that come in and evaluate products. Most of the time, when someone is looking at implementing one of our products, it’s actually a whole hospital decision. There might be few key decision makers, such as the infection preventionist, environmental services, director of nursing. But at the end of the day, we want everybody in the hospital to feel comfortable using a product. It’s got to be a product that everybody feels comfortable using. Feels safe while using it. Understands how to use it. It’s kind of a whole hospital process.

ICT®: I don’t know if you want to name names but is there a hospital system or health care system that does disinfecting really well?

Stowe: Any consumer can go on to the CMS Hospital Compare and the Medicare Compare websites and they can look at hospitals’ cleanliness scores. You can tell hospital cleanliness through the patient satisfaction scores, which are publicly reported. But you can also look at a hospital’s infection scores. And so that might be a nice key indicator, look at their C. difficile rates. And maybe they’re just general, you know, hospital infection rates, or ratios, you would be able to tell a lot. And the CMS website’s really nice and it’ll tell the general consumer if the hospital performs better than average, worse than average, about the same as the average. It’s really a nice, very easy to understand system that consumers can use to make the best choice on where to receive care. A lot goes into play with that, but that’s what I would recommend,

ICT®: I would assume that they would take into account that some hospitals might tend to get more patients with infections. There are demographic challenges.

Stowe: Yes.

ICT®: Is there anything that I didn’t ask you that you think your fellow infection preventionists need to know about disinfecting as we go forward?

Stowe: Just to say, “Hang in there.” We see the light at the end of the tunnel finally, which is so reassuring. For anybody that’s not an infection preventionist who’s watching this, be a good citizen. Wash your hands. Social distance. Wear a mask. Get your vaccine, if you can, and be a good, informed health consumer.. Look at the CMS website. See where the best place in your area to get care is. Those are risk-adjusted. CMS does account for the patient demographics and maybe the socioeconomic status of the community. And so that is risk-adjusted, which is really helpful. Be an informed consumer. Take charge of your health and protect yourself through the rest of this.

This interview has been edited for clarity and length.

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