Surface Disinfection
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Surface Disinfection. Narrowing the Gap between Science, Regulation & Practice. Steve Wollak – Account Executive – 3M Co. Mary Brachman RN MS. DisinfectHO-Aug’05. Are we cleaning/disinfecting the right way?. 10 Factors Influencing Effective Cleaning and Disinfecting.

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Surface Disinfection

Narrowing the Gap between

Science, Regulation & Practice

Steve Wollak – Account Executive – 3M Co.

Mary Brachman RN MS

DisinfectHO-Aug’05



10 Factors Influencing EffectiveCleaning and Disinfecting

  • Proper Procedure/Best Practices

  • Type of surface

  • Surface orientation/design

  • Concentration/Dilution

  • Organic Soil Present

  • Resistance of Microorganism

  • Contact Time of Disinfectant

  • Amount of solution used

  • Method of application

    – Spray Bottle vs. buckets

    - Mop/Bucket vs. Microfiber

  • Ventilation, temperature, humidity


Are we cleaning the right way?

Are we set up the right way?

How we can help SAVE the Environment?


Are we cleaning the right way?

Super Bugs

- MRSA

- VRE

- Norwalk

Procedures

- 10 Key Points

- Contact Time

Quat Binding


MRSA

Methicillin-resistant Staphylococcus aureus

  • Discovered in 1961 in the UK.

  • Widespread in hospital settings

  • Commonly termed a “Superbug”

  • Superbug:

    • Strains of bacteria

    • Resistant to antibiotics

    • Hard to treat

    • Causes

      • Fever

      • Lethargy

      • Headaches

      • Skin boils or abscesses

  • In rare cases can cause pneumonia, blood infections,

  • toxic shock and death.


VRE

Vancomycin-ResistantEnterococcus

  • Discovered in 1985

  • Found in the digestive and urinary tracts of some humans

  • Dangerous to immuno-compromised individuals

  • Pass resistant genes to other bacteria

  • Resistant to the antibiotic Vancomycin

    While infection of healthy individuals is uncommon, it is possible that they could be colonized with newly-resistant bacteria.


Norwalk
Norwalk

Norovirus

  • Causes around 50% of all gastroenteritis

    • Stomach pain

    • Diarrhea

    • Vomiting

  • Considered the most important group of viruses associated with this condition

    Today, Norovirus may refer either to the entire

    group of viruses or just Norwalk.


10 key points
10 Key Points

CDC Guideline Housekeeping Surfaces1

General Recommendation

  • Keep surfaces clean e.g. regular basis, spills, visibly soiled (EC II; D/S IB)

  • Wet dust horizontal surfaces regularly e.g. daily, 3x/wk using disinfectant (D/S IB)

  • Use:

    • Detergent or disinfectant, depends on nature of soil (EC II)

    • Use disinfectant (D/S IB)


10 key points1
10 Key Points

CDC Guideline Housekeeping Surfaces1

General Recommendation

  • Disinfect “high-touch” more often than “minimal touch” surfaces (EC II)

  • Follow mfg. recommendations for use, (EC/DS IB, IC), especially dilution (D/S IB)

  • Contact time > 30 seconds (D/S II)


10 key points2
10 Key Points

CDC Guideline Housekeeping Surfaces1

General Recommendation

  • Avoid cleaning methods that produce aerosols or disperse dust (EC IB)

  • Replace solution:

    • frequently per facility policy (EC II)

    • frequently per facility policy e.g. every 3 rooms or < 60 minutes (D/S IB)


10 key points3
10 Key Points

CDC Guideline Housekeeping Surfaces1

General Recommendation

  • Change & decontaminate mop heads:

    • at least daily, after spill clean up & per policy (EC II)

    • regularly (D/S IB)

  • Clean & disinfect BBF spills (EC, D/C IB, IC):

    • Tuberculocidal (Phenolic), Quat with HIV/HBV label claim or Bleach


Factors Influencing Cleaning and Disinfecting

Bacterial Spores

C. difficile

Mycobacterium

Tuberculosis

Non-lipid (small) viruses

Norwalk

Fungi

Atheletes foot

Vegetative Bacteria

Pseudomonas

Staphylococcus

Lipid viruses

Hepatitis B

HIV/AIDS

SARS

Resistance of Microbes to Disinfectants

ST

HLD

ILD

Hard to Kill

LLD

Easy to Kill

ST-sterilant HLD-high level disinfectant

ILD-Intermediate level disinfectant LLD-low level disinfectant

Favero, MS. In, Block SS. Disinfection, Sterilization & Preservation, 1991


Factors Influencing Cleaning and Disinfecting

Contact Time

Time to kill microorganisms on surfaces:

EPA testing methodology

Vs

Pre-cleaned surfaces


Testing Disinfectants against Bacteria

EPA Hard Surface Carrier Test

  • 60 Non-porous carriers

  • Test organisms - Salmonella, pseudomonas, staph aureus

  • Organic Soil (5% blood)

  • Hard Water

  • Requirements – 59/60 no growth


Time to Kill Organisms on Surfaces

Log10 Reduction

S. aureus

P. aeruginosa

Rutala, W. ICHE 2000;21:33-38


Contact time is rarely per label claim; exposure time 1- 1.5 minutes

10 min. contact time require 6 applications

6 log reduction in 30 seconds

Contact Time on Non-Critical Surfaces¹

Rutala, W. APIC 2003


Low-level disinfection (LLD) for at least 30-60 seconds is supported by at least 14 scientific studies

10 minute contact time is meant for EPA registration, NOTthe time it takes to kill microorganisms on pre-cleaned surfaces

Contact Time on Non-Critical Surfaces²

Rutala, W. APIC Annual Ed. Conference; 2005


Disinfectants for supported by at “Non-critical” Surfaces

Chlorine 5% 1:100 dilution (sm. spills)

1:10 dilution (lg. spills)

Germicide Use Concentration

Alcohol 70-90%

500 ppm

5000 ppm

Phenolic Mfg. use dilution

Quat Mfg. use dilution

Exposure time > 1 minute

Rutala, W. APIC Ed. Conference 2005


QUAT Binding supported by at

Some fabrics and materials have a strong attraction for the active ingredient in QUATS.- QUAT preferentially attaches or exhausts to fabric -- QUAT level in solution is reduced - - Efficacy of the disinfectant decreases - Disinfectants are registered with the EPA and efficacy claims are approved at a specific level of active ingredients. When the QUAT level is less than the level approved by the EPA, the efficacy claims are no longer valid.

Quaternary Ammonium Chloride


QUAT Binding supported by at

Disinfectants:

  • How are you using them?

  • How do you test them (test kits)?

  • How do we know that the surface is clean and disinfected (Environmental Monitors)?

    PPM

  • Testing done to meet EPA requirements for the disinfectant claim

  • If it falls below the PPM it is out of spec and no longer a disinfectant

    How to calculate ppm QUAT in a Disinfectant

    The EPA registered label specifies the percent active

    “ quaternary ammonium chloride” in the concentrate.

    Add the total active ingredients and use the following equation to determine

    PPM QUAT.

    (% Active)÷(100)÷(1+dilution) x 1,000,000 = _______ ppm QUAT

    Example – 13.238% + 13.238% = 26.476%

    26.476% ÷100÷(365+1) x 1,000,000 = 723 ppm


Cleaning Methods: supported by at

Spray bottle, squirt bottle, or hand pail?

Is one method better than the other?


Effectiveness of disinfection methods for vre

First supported by at 60/376(16%) 0/135

Second 8/82 (10%)

Third 3/28 (11%)

Fourth 0/10 (0)

Effectiveness of Disinfection Methods For VRE

No. positive surfaces

Spray Bottle

Bucket

Byers. ICHE 1998;19:261


Additional questions
Additional Questions supported by at

  • CJD killing agent – Bleach/CDC

  • Bactericidal Hand Soap in patient rooms vs. “green” nonbacterial soap – no CDC reference as a requirement.

  • “Dispatch” – not a 3M product


Any questions
Any Questions? supported by at

Steve Wollak – 3M Company


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