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Transcript
Efficacy, Selection and Use of Disinfectants and
Detergents in Environmental Cleaning/Disinfection
William A. Rutala, PhD, MPH
Director, Hospital Epidemiology, Occupational Health and Safety;
Professor of Medicine and Director, Statewide Program for
Infection Control and Epidemiology
University of North Carolina at Chapel Hill and UNC Health Care,
Chapel Hill, NC
DISCLOSURES
•
•
•
Consultation and Honoraria
 ASP (Advanced Sterilization Products), Clorox
Honoraria
 3M
Grants
 CDC, CMS
Efficacy, Selection and Use of Disinfectants and
Detergents in Environmental Cleaning/Disinfection
•
•
•
•
•
Role of the environment in disease transmission
Factors that affect disinfection
Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment
Efficacy of disinfectants
Selection and use of disinfectants
Efficacy, Selection and Use of Disinfectants and
Detergents in Environmental Cleaning/Disinfection
•
•
•
•
•
Role of the environment in disease transmission
Factors that affect disinfection
Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment
Efficacy of disinfectants
Selection and use of disinfectants
DISINFECTION AND STERILIZATION
Rutala, Weber, HIPAC. www.cdc.gov, 2008
•
EH Spaulding believed that how an object will be disinfected depended on
the object’s intended use
 CRITICAL - objects which enter normally sterile tissue or the
vascular system or through which blood flows should be sterile
 SEMICRITICAL - objects that touch mucous membranes or skin
that is not intact require a disinfection process (high-level
disinfection[HLD]) that kills all microorganisms except for high
numbers of bacterial spores
 NONCRITICAL - objects that touch only intact skin require lowlevel disinfection
DISINFECTION AND STERILIZATION
•
EH Spaulding believed that how an object will be disinfected depended on
the object’s intended use
 CRITICAL - objects which enter normally sterile tissue or the
vascular system or through which blood flows should be sterile
 SEMICRITICAL - objects that touch mucous membranes or skin
that is not intact require a disinfection process (high-level
disinfection[HLD]) that kills all microorganisms except for high
numbers of bacterial spores
 NONCRITICAL - objects that touch only intact skin require lowlevel disinfection
KEY PATHOGENS WHERE ENVIRONMENTIAL
SURFACES PLAY A ROLE IN TRANSMISSION
•
•
•
•
•
•
•
MRSA
VRE
Acinetobacter spp.
Clostridium difficile
Norovirus
Rotavirus
SARS
ENVIRONMENTAL CONTAMINATION LEADS TO HAIs
Weber, Rutala, Miller et al. AJIC 2010;38:S25
•
•
•
•
•
Frequent environmental contamination
Microbial persistence in the environment
HCW hand contamination with the environment
Prior room occupant with MRSA, VRE, CDI is a significant risk for
acquisition of these pathogens.
Improved surface disinfection removes pathogens and reduce
HAIs
ENVIRONMENTAL CONTAMINATION
ENDEMIC AND EPIDEMIC MRSA
Dancer SJ et al. Lancet ID 2008;8(2):101-13
ENVIRONMENTAL SURVIVAL OF KEY
PATHOGENS ON HOSPITAL SURFACES
Pathogen
Survival Time
S. aureus (including MRSA)
7 days to >12 months
Enterococcus spp. (including VRE)
5 days to >46 months
Acinetobacter spp.
3 days to 11 months
Clostridium difficile (spores)
>5 months
Norovirus (and feline calicivirus)
8 hours to >2 weeks
Pseudomonas aeruginosa
6 hours to 16 months
Klebsiella spp.
2 hours to >30 months
Adapted from Hota B, et al. Clin Infect Dis 2004;39:1182-9 and
Kramer A, et al. BMC Infectious Diseases 2006;6:130
FREQUENCY OF ACQUISITION OF MRSA ON GLOVED HANDS AFTER
CONTACT WITH SKIN AND ENVIRONMENTAL SITES
No significant difference on contamination rates of gloved hands
after contact with skin or environmental surfaces (40% vs 45%;
p=0.59)
Stiefel U, et al. ICHE 2011;32:185-187
RELATIVE RISK OF PATHOGEN ACQUISITION
IF PRIOR ROOM OCCUPANT INFECTED
MRSA (Huang S, 2006)
VRE* (Dress M, 2008)
VRE (Huang S, 2006)
MDR Pseudomonas (Nseir S, 2011)
VRE^ (Drees M, 2008)
C. diff (Shaughnessy M, 2011)
MDR Acinetobacter (Nseir S, 2011)
0
0.5
1
1.5
2
2.5
3
3.5
* Prior room occupant infected, 120% increased risk; ^Any room occupant in
prior 2 weeks infected. Otter , Yezli, French. ICHE. 2012;32:687-699
4
EVALUATION OF HOSPITAL ROOM ASSIGNMENT
AND ACQUISITION OF CDI




Study design: Retrospective cohort
analysis, 2005-2006
Setting: Medical ICU at a tertiary care
hospital
Methods: All patients evaluated for
diagnosis of CDI 48 hours after ICU
admission and within 30 days after ICU
discharge
Results (acquisition of CDI)
Admission to room previously
occupied by CDI = 11.0%
 Admission to room not previously
occupied by CDI = 4.6% (p=0.002)
Shaughnessy MK, et al. ICHE 2011;32:201-206

TRANSMISSION MECHANISMS INVOLVING THE
SURFACE ENVIRONMENT
Rutala WA, Weber DJ. In:”SHEA Practical Healthcare Epidemiology”
(Lautenbach E, Woeltje KF, Malani PN, eds), 3rd ed, 2010.
ACQUISITION OF MRSA ON HANDS AFTER CONTACT
WITH ENVIRONMENTAL SITES
ACQUISITION OF MRSA ON HANDS/GLOVES AFTER CONTACT
WITH CONTAMINATED EQUIPMENT
TRANSFER OF MRSA FROM PATIENT OR
ENVIRONMENT TO IV DEVICE AND TRANSMISSON OF
PATHOGEN
TRANSMISSION MECHANISMS INVOLVING THE
SURFACE ENVIRONMENT
Rutala WA, Weber DJ. In:”SHEA Practical Healthcare Epidemiology”
(Lautenbach E, Woeltje KF, Malani PN, eds), 3rd ed, 2010.
ACQUISITION OF C. difficile ON PATIENT HANDS AFTER CONTACT WITH
ENVIRONMENTAL SITES AND THEN INOCULATION OF MOUTH
Donskey CJ. Am J Infect Control 2013;41:S12
Disinfectant Product Substitutions
Donskey CJ. AJIC. May 2013
Improve Effectiveness of Cleaning/Disinfection
Donskey AJIC. May 2013
Automated Disinfection Devices
Donskey CJ. AJIC. May 2013
Does Improving Surface Cleaning and Disinfection
Reduce Healthcare-Associated Infections?
Donskey CJ. AJIC. 2013;41:S12-S19
“As reviewed here, during the past decade a growing body
of evidence has accumulated suggesting that
improvements in environmental disinfection may prevent
transmission of pathogens and reduce HAIs. Although,
the quality of much of the evidence remains suboptimal, a
number of high-quality investigations now support
environmental disinfection as a control strategy”
Efficacy, Selection and Use of Disinfectants and
Detergents in Environmental Cleaning/Disinfection
•
•
•
•
•
Role of the environment in disease transmission
Factors that affect disinfection
Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment
Efficacy of disinfectants
Selection and use of disinfectants
Efficacy of Disinfection
Influencing Factors
Rutala, Weber, HIPAC. www.cdc.gov. 2008
•
•
•
•
Organic load present-interfere by protect microbe from
exposure or alters the disinfectant making it less
antimicrobial
Type of microbial contamination-intrinsic resistance varies
Level of microbial contamination-larger the number of
microorganisms, the more time needed to inactivate them
Concentration of disinfectant-the more concentrated the
disinfectant, the greater its efficacy and the shorter the time
to achieve kill. Use manufacturer’s recommended usedilution.
Efficacy of Disinfection
Influencing Factors
•
•
•
•
Temperature-activity increases as temperature increases
pH-increase in pH improves the antimicrobial activity of
some disinfectants (e.g., Quat) but decreases the activity of
others (e.g., hypochlorites)
Duration of exposure-must be exposed to disinfectant for
kill time
Water hardness-high concentrations can reduce the rate of
kill because cations in water interact with disinfectant to
form insoluble precipitates
Efficacy, Selection and Use of Disinfectants and
Detergents in Environmental Cleaning/Disinfection
•
•
•
•
•
Role of the environment in disease transmission
Factors that affect disinfection
Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment
Efficacy of disinfectants
Selection and use of disinfectants
PROPERTIES OF AN IDEAL DISINFECTANT
Rutala and Weber. Infect Control Hosp Epidemiol. In press
•
•
•
•
•
•
•
•
•
•
•
•
Broad spectrum-wide antimicrobial spectrum
Fast acting-should produce a rapid kill
Remains Wet-meet listed kill/contact times with a single application
Not affected by environmental factors-active in the presence of organic matter
Nontoxic-not irritating to user
Surface compatibility-should not corrode instruments and metallic surfaces
Persistence-should have sustained antimicrobial activity
Easy to use
Acceptable odor
Economical-cost should not be prohibitively high
Soluble (in water) and stable (in concentrate and use dilution)
Cleaner (good cleaning properties) and nonflammable
LOW-LEVEL DISINFECTION FOR NONCRITICAL
EQUIPMENT AND SURFACES
Germicide
Exposure time > 1 min
Use Concentration
Ethyl or isopropyl alcohol
70-90%
Chlorine
100ppm (1:500 dilution)
Phenolic
UD
Iodophor
UD
Quaternary ammonium
UD
Improved hydrogen peroxide
0.5%, 1.4%
____________________________________________________
UD=Manufacturer’s recommended use dilution
Quaternary ammonium compounds
(e.g., didecyl dimethyl ammonium bromide, dioctyl dimethyl ammonium bromide)
Rutala, Weber. Am J Infect Control 2013;41:S36-S41
Advantages







Bactericidal, fungicidal, virucidal
against enveloped viruses (e.g., HIV)
Good cleaning agents
EPA registered
Surface compatible
Persistent antimicrobial activity when
undisturbed
Inexpensive (in dilutable form)
Not flammable
Disadvantages






Not sporicidal
In general, not tuberculocidal and
virucidal against non-enveloped
viruses
High water hardness and cotton/gauze
can make less microbicidal
A few reports documented asthma as
result of exposure to benzalkonium
chloride
Affected by organic matter
Multiple outbreaks ascribed to
contaminated benzalkonium chloride
Sodium Hypochlorite
Rutala, Weber. Am J Infect Control 2013;41:S36-S41
Advantages










Bactericidal, tuberculocidal, fungicidal,
virucidal
Sporicidal
Fast acting
Inexpensive (in dilutable form)
Not flammable
Unaffected by water hardness
Reduces biofilms on surfaces
Relatively stable (e.g., 50% reduction in
chlorine concentration in 30 days)
Used as the disinfectant in water treatment
EPA registered
Disadvantages








Reaction hazard with acids and ammonias
Leaves salt residue
Corrosive to metals (some ready-to-use products
may be formulated with corrosion inhibitors)
Unstable active (some ready-to-use products may
be formulated with stabilizers to achieve longer
shelf life)
Affected by organic matter
Discolors/stains fabrics
Potential hazard is production of trihalomethane
Odor (some ready-to-use products may be
formulated with odor inhibitors). Irritating at high
concentrations.
Improved Hydrogen Peroxide
Rutala, Weber. Am J Infect Control 2013;41:S36-S41
Advantages






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Bactericidal, tuberculocidal, fungicidal,
virucidal
Fast efficacy
Easy compliance with wet-contact
times
Safe for workers (lowest EPA toxicity
category, IV)
Benign for the environment
Surface compatible
Non-staining
EPA registered
Not flammable
Disadvantages
 More expensive than most other
disinfecting actives
 Not sporicidal at low
concentrations
Alcohol
Rutala, Weber. Am J Infect Control 2013;41:S36-S41
Advantages






Bactericidal, tuberculocidal, fungicidal,
virucidal
Fast acting
Non-corrosive
Non-staining
Used to disinfect small surfaces such
as rubber stoppers on medication vials
No toxic residue
Disadvantages










Not sporicidal
Affected by organic matter
Slow acting against non-enveloped viruses (e.g.,
norovirus)
No detergent or cleaning properties
Not EPA registered
Damage some instruments (e.g., harden rubber,
deteriorate glue)
Flammable (large amounts require special
storage)
Evaporates rapidly making contact time
compliance difficult
Not recommended for use on large surfaces
Outbreaks ascribed to contaminated alcohol
Phenolics
Rutala, Weber. Am J Infect Control 2013;41:S36-S41
Advantages
 Bactericidal, tuberculocidal,
fungicidal, virucidal
 Inexpensive (in dilutable form)
 Non-staining
 Not flammable
 EPA registered
Disadvantages
 Not sporicidal
 Absorbed by porous materials
and irritate tissue
 Depigmentation of skin caused
by certain phenolics
 Hyperbilirubinemia in infants
when phenolic not prepared as
recommended
Efficacy, Selection and Use of Disinfectants and
Detergents in Environmental Cleaning/Disinfection
•
•
•
•
•
Role of the environment in disease transmission
Factors that affect disinfection
Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment
Efficacy of disinfectants
Selection and use of disinfectants
Most Prevalent Pathogens Causing
Healthcare-Associated Infections
Rutala, Weber. Infect Control Hosp Epidemiol. In press
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
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






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


Staphylococcus aureus (15.6%)
E coli (11.5%)
Coagulase-negative Staphylococcus (CoNS)
(11.4%)
Klebsiella (8.0%)
Pseudomonas aeruginosa (7.5%)
Enterococcus faecalis (6.8%)
Candida albicans (5.3%)
Enterobacter spp. (4.7%)
Other Candida spp. (4.2%)
Enterococcus faecium (4.1%)
Enterococcus spp. (3.0%)
Proteus spp. (2.5%)
Serratia spp. (2.1%)
Acinetobacter baumanii (1.8%)


Modify Disinfectant Used
C. difficile spores-over the past
decade, incidence of C. difficile
increasing and now most common in
some hospitals
Norovirus
DECREASING ORDER OF RESISTANCE OF MICROORGANISMS
TO DISINFECTANTS/STERILANTS
Most Resistant
Prions
Spores (C. difficile)
Mycobacteria
Non-Enveloped Viruses (norovirus)
Fungi
Bacteria (MRSA, VRE, Acinetobacter)
Enveloped Viruses
Most Susceptible
EFFECTIVENESS OF DISINFECTANTS
AGAINST MRSA AND VRE
Rutala WA, et al. Infect Control Hosp Epidemiol 2000;21:33-38.
Tuberculocidal Activity of Disinfectants
Rutala et al. Am J Med 1991;91:267S



A modified AOAC
tuberculocidal activity test was
used to assess 14 hospital
disinfectants
Effective-2% glut, 0.8%HP plus
0.06% PA, 1000ppm chlorine
Not effective-QUATs, 100ppm
chlorine, and 0.13% glut not
effective
C. difficile spores
DISINFECTANTS AND ANTISEPSIS
C. difficile spores at 20 min, Rutala et al, 2006
•
No measurable activity (1 C. difficile strain, J9)
 CHG
 Phenolic
 70% isopropyl alcohol
 95% ethanol
 3% hydrogen peroxide
 Disinfecting spray (65% ethanol, 0.6% QUAT)
 Disinfecting spray (79% ethanol, 0.1% QUAT)
 0.06% QUAT; QUAT may increase sporulation capacity- Lancet
2000;356:1324
 10% povidone iodine
 0.5% hydrogen peroxide
DISINFECTANTS AND ANTISEPSIS
C. difficile spores at 10 and 20 min, Rutala et al, 2006
•
~4 log10 reduction (3 C. difficile strains including BI-9)
 Bleach, 1:10, ~6,000 ppm chlorine (but not 1:50)
 Chlorine, ~19,100 ppm chlorine
 Chlorine, ~25,000 ppm chlorine
 0.35% peracetic acid
 2.4% glutaraldehyde
 OPA, 0.55% OPA
 2.65% glutaraldehyde
 3.4% glutaraldehyde and 26% alcohol
Product + Practice
ALL “TOUCHABLE” (HAND CONTACT) SURFACES
SHOULD BE WIPED WITH DISINFECTANT
“High touch” objects only recently defined (no significant differences
in microbial contamination of different surfaces) and “high risk”
objects not epidemiologically defined.
MICROBIAL BURDEN ON ROOM SURFACES AS A
FUNCTION OF FREQUENCY OF TOUCHING
Surface
Prior to Cleaning
Mean CFU/RODAC (95% CI)
Post Cleaning (mean)
Mean CFU/RODAC (95% CI)
High
71.9 (46.5-97.3)
9.6
Medium
44.2 (28.1-60.2)
9.3
Low
56.7 (34.2-79.2)
5.7


The level of microbial contamination of room surfaces is similar regardless of how
often they are touched both before and after cleaning
Therefore, all surfaces that are touched must be cleaned and disinfected
Huslage K, Rutala WA, Weber DJ. ICHE. 2013;34:211-212
Surface Disinfection
• Wipe all “touchable” or “hand contact” surfaces with
•
sufficient wetness to achieve the disinfectant contact
time (> 1 minute).
Daily disinfection of surfaces (vs cleaned when soiled) in
rooms of patients with CDI and MRSA reduced
acquisition of pathogens on hands after contact with
surfaces and on hands caring for the patient
Efficacy, Selection and Use of Disinfectants and
Detergents in Environmental Cleaning/Disinfection
•
•
•
•
•
Role of the environment in disease transmission
Factors that affect disinfection
Advantages/disadvantages of disinfectants used on
environmental surfaces and non-critical patient equipment
Efficacy of disinfectants
Selection and use of disinfectants
Key Considerations for Selecting the
Optimal Disinfectant for Your Facility
Rutala, Weber. Infect Control Hosp Epidemiol. In press
Consideration
Question to Ask
Kill Claims
Does the product kill the most prevalent healthcare pathogens
Kill Times and WetContact Times
How quickly does the product kill the prevalent healthcare pathogens
Safety
Does the product have an acceptable toxicity rating, flammability rating
Ease-of-Use
Odor acceptable, shelf-life, in convenient forms (wipes, spray), water
soluble, works in organic matter, one-step (cleans/disinfects)
Other factors
Supplier offer comprehensive training/education, 24-7 customer
support, overall cost acceptable (product capabilities, cost per
compliant use, help standardize disinfectants in facility
Score
(1-10)
Disinfectants
•
•
•
•
Disinfectants are recommended for noncritical patient care
objects (CDC, 2008)
Disinfectants are recommended for Precaution/Isolation
patients (CDC, 2007)
Disinfectants are recommended for blood/OPIM (OSHA,
1991)
Disinfectants (or detergents) are recommended for other
noncritical environmental surfaces (CDC, 2002 and 2008)
DISINFECTION OF NONCRITICAL PATIENT-CARE DEVICES
Rutala, Weber, HICPAC. 2008 www.cdc.gov
•
Disinfect noncritical medical devices (e.g., blood pressure cuff) with
an EPA-registered hospital disinfectant using the label’s safety
precautions and use directions. Most EPA-registered hospital
disinfectants have a label contact time of 10 minutes but multiple
scientific studies have demonstrated the efficacy of hospital
disinfectants against pathogens with a contact time of at least 1
minute. By law, the user must follow all applicable label instructions
on EPA-registered products. If the user selects exposure conditions
that differ from those on the EPA-registered product label, the user
assumes liability for any injuries resulting from the off-label use and
is potentially subject to enforcement action under FIFRA. (II, IC)
CLEANING AND DISINFECTING
ENVIRONMENTAL SURFACES
Cleaning (removes soil) and disinfecting is one-step
with disinfectant-detergent. A one-step product
achieved EPA claim in presence of soil. No precleaning necessary unless spill or gross
contamination.
Justification for Using a Disinfectant for
Non-Critical Surfaces/Patient Equipment
•
•
•
•
•
•
Disinfectants have antimicrobial activity and detergents do not
Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Justification for Using a Disinfectant for
Non-Critical Surfaces/Patient Equipment
•
•
•
•
•
•
Disinfectants may have antimicrobial activity and detergents do not
Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Donskey CJ. Am J Infect Control 2013;41:S12
Surface Disinfection
Effectiveness of Different Methods
Rutala, Gergen, Weber. 2013, Unpublished Results
Technique (with cotton)
MRSA Log10 Reduction (QUAT)
Saturated cloth
4.41
Spray (10s) and wipe
4.41
Spray, wipe, spray (1m), wipe
4.41
Spray
4.41
Spray, wipe, spray (until dry)
4.41
Disposable wipe with QUAT
4.55
Control: detergent
2.88
Transfer of C. difficile Spores by
Nonsporicidal Wipes
Cadnum et al. ICHE 2013;34:441-2
•
Detergent/nonsporicidal wipes transfer or spread microbes/spores to
adjacent surfaces; disinfectants inactivate microbes
Justification for Using a Disinfectant for
Non-Critical Surfaces/Patient Equipment
•
•
•
•
•
•
Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Disinfectants may have persistent antimicrobial activity
Bacterial Contamination of Water With and
Without a Disinfectant
•
Detergent become contaminated and result in seeding the patient’s
environment with HA pathogens. Ayliffe et al. Brit Med J. 1966;2:442-5
Justification for Using a Disinfectant for
Non-Critical Surfaces/Patient Equipment
•
•
•
•
•
•
Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation-CDC 2007 and OSHA 1991
Disinfectants may have persistent antimicrobial activity
QUATS AS SURFACE DISINFECTANTS
WITH PERSISTENT ACTIVITY



Study of computer keyboards:
Challenge with VRE or P.
aeruginosa
Keys wiped with alcohol or
quats (CaviWipes, Clorox
Disinfecting Wipes, or SaniCloth Plus)
Persistent activity when not
removed
Rutala WA, White MS, Gergen MF,
Weber DJ. ICHE 2006;27:372-77.
Justification for Using a Disinfectant for
Non-Critical Surfaces/Patient Equipment
•
•
•
•
•
•
Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Disinfectants may have persistent antimicrobial activity
Efficacy, Selection and Use of Disinfectants and
Detergents in Environmental Cleaning/Disinfection
Detergents
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





No measurable antimicrobial activity
Contaminated surfaces provide an important source of HA pathogens
Similar cost (~$0.20/use gallon)
Disinfectants are cause of skin, respiratory irritation or allergy
No evidence that using disinfectants selects for antibiotic-resistant
bacteria
Disinfectants should be used where there are scientific studies
demonstrating benefit
Employ disinfectant on noncritical surfaces for all hospitalized
patients as unsuspected colonization is a routine occurrence
How About “Green” Products?
•
•
Today, the definition of green is unregulated
It can mean:





•

Sustainable resources/plant-based ingredients
Free of petrochemicals
Biodegradable
No animal testing
Minimal carbon footprint
Traded fairly
It can, but does not always mean “safer”
Efficacy of “Green” Products to
Inactivate MDR Pathogens
Rutala, Gergen, Weber. Unpublished results. 2013
•
No measurable activity against A. baumannii, A.
xyloxidans, Burkholderia cenocepacia, K. pneumoniae,
MRSA and P. aeruginosa, VRE, Stenotrophomonas
maltophilia
It appears that not only is disinfectant use
important but how often is important
Daily disinfection vs clean when soiled
Daily Disinfection of High-Touch Surfaces
Kundrapu et al. ICHE 2012;33:1039
Daily disinfection of high-touch surfaces (vs cleaned when soiled) with sporicidal
disinfectant (PA) in rooms of patients with CDI and MRSA reduced acquisition of
pathogens on hands after contact with surfaces and of hands caring for the patient
Kill Claims for Most Prevalent Pathogens
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•
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Each disinfectant requires a specific time it must remain in
contact with the microbe to achieve disinfection-kill time or
contact time
Some disinfectants may have a kill time for bacteria of 1m, which
means bacteria in label disinfected in 1m
Other products, often concentrated formulas require dilution, are
registered by the EPA with contact time of 10m
Such a long contact time is not practical
CONTACT TIMES FOR
SURFACE DISINFECTION
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Follow the EPA-registered contact times, ideally
 Some products have achievable contact times for
bacteria/viruses (30 seconds-2 minutes)
 Other products have non-achievable contact times
If use a product with non-achievable contact time
 Use >1 minute based on CDC guideline and scientific literature
 Prepare a risk assessment
http://www.unc.edu/depts/spice/dis/SurfDisRiskAssess2011.pdf
IMPROVED HYDROGEN PEROXIDE (HP)
SURFACE DISINFECTANT
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Advantages
 30 sec -1 min bactericidal and virucidal claim (fastest non-bleach contact
time)
 5 min mycobactericidal claim
 Safe for workers (lowest EPA toxicity category, IV)
 Benign for the environment; noncorrosive; surface compatible
 One step cleaner-disinfectant
 No harsh chemical odor
 EPA registered (0.5% RTU, 1.4% RTU, wet wipe)
Disadvantages
 More expensive than QUAT
BACTERICIDAL ACTIVITY OF DISINFECTANTS (log10 reduction) WITH A
CONTACT TIME OF 1m WITH/WITHOUT FCS.
Rutala et al. ICHE. 2012; 33:1159-61
Improved hydrogen peroxide is significantly superior to standard HP at same
concentration and superior or similar to the QUAT tested
Organism
Oxivir-0.5%
0.5% HP
Clorox HC HP
Cleaner-Dis
1.4%
1.4% HP
3.0% HP
QUAT
MRSA
>6.6
<4.0
>6.5
<4.0
<4.0
5.5
VRE
>6.3
<3.6
>6.1
<3.6
<3.6
4.6
MDR-Ab
>6.8
<4.3
>6.7
<4.3
<4.3
>6.8
MRSA, FCS
>6.7
NT
>6.7
NT
<4.2
<4.2
VRE, FCS
>6.3
NT
>6.3
NT
<3.8
<3.8
MDR-Ab,
FCS
>6.6
NT
>6.6
NT
<4.1
>6.6
Efficacy, Selection and Use of Disinfectants and Detergents in
Environmental Cleaning/Disinfection
Summary
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MRSA, VRE, C. difficile, MDR-Acinetobacter comprise a growing reservoir
of epidemiologically important pathogens that have an environmental mode
of transmission
Contaminated surface environment in hospital rooms is important in
transmission of HA pathogens
Appropriate use of disinfectants prevent transmission of pathogens and
reduce HAIs
All touchable surfaces should be wiped with disinfectant
Detergents alone do not kill pathogens and can cross-contaminate the
environment
THANK YOU!
www.disinfectionandsterilization.org