Infection Control Facts: How to Select an Ideal Disinfectant Lee Nesbitt, BMSc Manager, Professional & Technical Services Virox Technologies Inc Phone:

Infection Control Facts: How to Select an Ideal

Disinfectant

Lee Nesbitt, BMScLee Nesbitt, BMScManager, Professional & Technical ServicesManager, Professional & Technical ServicesVirox Technologies IncVirox Technologies IncPhone: 1-800-387-7578 x115Phone: 1-800-387-7578 x115Email: [email protected]: [email protected]

2003: CDN Hospitals notified >900 patients that improper sterilization of equipment may have exposed them to HIV, Hepatitis and other diseases. $150M class action lawsuit filed alleging negligence in failing to meet adequate sterilization standards.

Government ordered a province-wide audit of hospital infection-control practices

Healthcare Quarterly Vol. 8, Special IssueOctober 2005

Canadian law clearly establishes a positive duty on care providers to inform patients of errors that occur during their care

When care providers realize that patients may have been exposed to infection from equipment, other patients or healthcare workers, a legal obligation may arise to contact patients to warn them of the risk and provide advice regarding appropriate follow-up testing and care.

The removal of adherent visible soil, blood, protein substances (tissue) and other debris from surfaces by mechanical or manual process

Generally accomplished with water and detergents

Removes or eliminates the reservoirs of potential pathogenic organisms

Viruses (enveloped) Bacteria (Gram +ve & Gram -ve) Fungi Viruses (non-enveloped) Mycobacteria Protozoa Bacterial Spores

Most Susceptible

Least Susceptible

Once the device has been defined determine the Disinfection Process

Choose the CORRECTProduct

Consider the Device Classification(According to Spaulding)

Sterilization

High LevelDisinfection

Intermediate Level Disinfection

Low LevelDisinfection

Critical Devices*

Semi-Critical Devices

Non-Critical Devices

*Foot Care Instruments defined as critical according to CCDR Vol. 23S8 (Dec 1997) Infection Control Guidelines: Foot Care by Health Care Providers

refers to the level of disinfection required when processing noncritical items or some environmental surfaces and kills most vegetative bacteria and some fungi as well as enveloped viruses but not mycobacteria or bacterial spores.

refers to disinfectant that kills vegetative bacteria, most viruses and most fungi but not resistant bacterial spores.

refers to a process which destroys vegetative bacteria, mycobacteria, fungi, enveloped and non-enveloped viruses, but not necessarily bacterial spores

refers to the chemical disinfection process that destroys all forms of microbial life including bacteria, viruses, spores and fungi.

LLD ILD HLD Chemical Sterilants

Enveloped Viruses

3 Log / 99.9%

3 Log / 99.9%

Vegetative Bacteria

6 Log / 99.9999%

6 Log / 99.9999%

Fungi 5 Log / 99.999%

5 Log / 99.999%

5 Log / 99.999%

5 Log / 99.999%

Non-Enveloped Viruses

3 Log / 99.9%

3 Log / 99.9%

Mycobacteria 4 Log / 99.99%

6 Log / 99.9999%

6 Log / 99.9999%

Spores 6 Log / 99.9999%

6 Log / 99.9999%

What’s in your bottle?

Disinfectants are the backbone of Environmental Infection Control

>8000 Products registered in the U.S. & Canada

50% of which are used for Healthcare Infection Control

There are 300 different active chemistries› 14 are in 95% of the disinfectant

products› 6 are the most common

Detergency properties for cleaning Not Readily Neutralized in Organic or

Inorganic Matter Microorganism Resistance will not develop Broad-Spectrum & Fast Acting Germicidal

Activity

Alcohols Chlorine Phenolics QUATs AHPMust have good cleaning ability to remove organic soil load on surface.

Alcohols are noteffective cleanersas they do notcontaindetergencyProperties

Chlorine can beinactivated by a soilload and do notcontain detergencyProperties

Phenolics are ineffective cleaners

Quaternary Ammonia Compounds are not effective cleaners

AHP contains acombination ofsuperior surfactantsthat are proven effective cleaners insynergy withH2O2

Is effective in a soil load.

Testing is done with no soil load.

Neutralized by soil.

Testing is done with a soil load

Testing is generally done without a soil load.

Testing is done with a soil load.

Will not lead to development of resistant organisms

Active ingredient evaporates


Leaves active ingredient residual on surface


Active ingredient hydrogen peroxide evaporates from surface

Alcohols Chlorine Phenolics QUATs AHPVegetative Bacteria

YES3 min to 10 min

YES10 min

YES 5 min to 10 min

YES3min to 10 min

YES30 sec to 20 min

Enveloped Viruses

YES3 min to 10 min

YES10 min

YES3 min to 10 min

YES3 min to 10 min

YES1 min to 5 min

Fungi YES3 min to 10 min

YES10 min

YES3 min to 10 min

YES3 min to 10 min

YES3 min to 5 min

Non-Enveloped Viruses

NO YES10 min

YES / NOProduct Specific Review label3 min to 10 min

NO YES1 min to 5 min

Mycobacteria

YES3 min to 10 min

YES10 min

YES3 min to 10 min

ONLY WITH SOLVENT OR ALCOHOL3 min – 10 min

YES1 min to 5 min

Bacterial Spores

NO YES10 min

NO NO YES10 min

OPA Gluteraldehyde AHP

Fungi YES10 min

YES20 min – 45 min

YES5 min – 20 min

Mycobacteria YES10 min

YES20 min – 45 min

YES5 min – 20 min

Bacterial Spores YES32 hours

YES8 – 12 hours

YES20 min – 6 hours

Safe to Transport & Easy to Store• Improper storage of disinfectants may lead to

explosions or fires Long Shelf Life• Improper or prolonged storage of disinfectants

may lead to growth of bacteria in them Non-Corrosive & Material Compatible• Using the wrong type or level of disinfectant may

cause corrosion or other damage to expensive items such as flexible endoscopes

Alcohols Chlorine Phenolics QUATs AHP

Does not have storage limitations

Flammable Highly reactive with other chemicals creating toxic by-products

Toxicity poses risk for water and food contamination. Cannot be used around children

Caution with products that contain solvents or alcohols

Non-flammable or combustible

Realistic Shelf life and stabilty

Readily evaporates decreasing concentration

Readily degrades once open, diluted product must be made fresh daily

Relatively stable in both concentration and Use Dilution

Relatively stable in both concentration and Use Dilution

Stable in concentrate and Use Dilution

Compatible with a wide variety of surfaces and materials

Concerns with plastics and glues

Concerns with stainless steel and fabric materials

Concerns with residue build up on vinyl

Concerns with residue build up or Quat burn on some flooring and vinyl

Concerns with prolonged exposure to copper and brass


Does not have storage limitations


Do not store at elevated temperatures and keep away from ignition sources.


Realistic Shelf life and stability

Shelf life decreases to 75 days once bottle is opened

Once activated shelf life rapidly decreases

Shelf life does not decrease once opened

Compatible with a wide variety of surfaces and materials

Concerns with plastics and glues

Concerns with residue build up on vinyl

Concerns with prolonged exposure to copper and brass

Non-Toxic to humans & animals Non-Allergenic & non-sensitizing Non-Hormone disruption

• Certain microbicidal chemicals or their breakdown products can disrupt hormone function in humans & animals

Safe for the User and Patient• Exposure to cleaner & disinfectant vapours

may cause respiratory sensitization• Improperly rinsed endoscopes or other devices

may release residues of disinfectants into body cavity


Indoor Air Quality (VOCs)

Contains high levels of VOCs which contribute to poor indoor air quality

Creates high levels of VOCs through reactions with surface and soil load

Contain VOCs; Toxicity poses risk for water and food contamination

Contain VOCs; Contains no VOCs

Does not contain hormone disrupting or carcinogenic chemicals

Does not contain APEs / NPEs

Highly reactive creating toxic / carcinogenic by-products

Phenolic Compounds have been found to be carcinogenic

Many formulations contain APEs / NPEs

Does not contain APEs/NPEs ; is not carcinogenic








Indoor Air Quality (VOCs)


Contain VOCs; Requires special ventilation

Contains no VOCs

Adverse Reactions to Residues left on surfaces after reprocessing

Residues have lead to anaphylactic reactions

Anaphylactic reactions to both vapours and residues

No Active Residue left on surface





Environmentally sound (Biodegradable) • Environmentally-stable sanitizers &

disinfectants can contaminate food or water (groundwater & surface water)

No Active Residual Chemistry Good Air Quality

• Free of any pungent smell • No Volatile Organic Compounds (VOCs)• Use of gaseous or volatile products may

negatively affect indoor air quality• Fragrance Free


Positive environmental profile including indoor air quality.


Creates high levels of VOCs through reactions with surface and soil load

Contain VOCs; Toxicity poses risk for water and food contamination

Contain VOCs; often contain hormone disruptors

Contains no VOCs and no hormone disruptors







Carries EcoLogo or Green Seal Certification

Does not meet certification criteria



Only1 product meets Canada’s EcoLogo criteria

Received certifications by EcoLogo and Green Seal

OPA Gluteraldehyde

AHP

Positive environmental profile including indoor air quality.


Contain VOCs; requires special ventilation

Contains no VOCs; does not require special ventilation

Restrictions to Disposal

Restrictions in disposal

Restrictions in disposal

Can be disposed into municipal waste water

Clearly outlines the requirements of what must be included on a label• Name of Product & Manufacturer• DIN must be on the main panel• Active Ingredients• Intended Use• Net contents• Lot Number & Expiry Date• Precautionary symbols and cautionary

statements

Label requirements continued:• Claims• Area or Site of Use• Directions for Use

• Specific directions for preparing in-use dilution including ratios or metric units

• Reference to level of hardness of product diluent at time of testing

• Pre-cleaning or cleaning requirements• Contact Times• Temperature• Stability of diluted or in-use product

Label requirements continued:• Rinse procedures• Directions for Use for intended use against

bloodborne pathogens• Reference to PPE• Directions for disposal of infectious waste

Remember: Match Product with

Protocol› Surfaces vs

Instruments Cleaning = 1st step Disinfection = 2nd step Contact Time is

MANDATORY!

Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Care, Health Canada. Dec 1998, Vol 24S8

Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care, Health Canada. July 1999, Vol 25S4

Guidelines for Environmental Infection Control in Healthcare Facilities, CDC. MMWR June 2003, Vol 52, No RR-10

Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings, PIDAC, May 2006

Block S. Disinfection. Sterilization, and Preservation, 5th Ed. 2001

Mayhall CG. Hospital Epidemiology and Infection Control, 3rd Ed. Philadelphia. Lippincott Williams & Wilkins, 2004:1473-1522

Cokendolpher JC & Haukos JF. The Practical Applications of Disinfection and Sterilization in Health Care Facilities, Chicago. American Hospital Association, 1996: 47-59

Rutala WA. APIC Guideline for Selection and Use of Disinfectants AJIC 1990:17(2) 99-117

Bessems E. The effect of practical conditions on the efficacy of disinfectants. Int Biodeter & Biodeg 1998:177-183

Crawford L et al. A Comparison of Commonly Used Surface Disinfectants: Alcohol-, Phenol-, Chlorine- and Quat Disinfectants. www.infectioncontroltoday.com/articles/0b1feat2.html

Russel AD. Glutaraldehyde: Current Status and Uses. Inf Con & Hosp Epi 1994;15 (11) 724-733

Rutala WA. Sporicidal Activity of Chemical Sterilants Used in Hospitals. Inf Con & Hosp Epi 1993; 14(12) 713-718

Rutala WA & Weber DJ. The benefits of surface disinfection. AJIC 2004;32(4) 226-229

Woldkoff P et al. Risk in cleaning: chemical and physical exposure. Sci of Total Env 1995:215:135-156

Sattar SA. Current issues in testing, selection and use of microbicides in infection control: a critical review. AICJ 2004;9(3):84-100

Health Canada. Therapeutic Products Programme Guidelines: Disinfectant Drugs. Fall 1999

Degussa, Hydrogen Peroxide: Properties, Handling and Application

Hugo, Inhibition and destruction of the microbial cell

Ascenzi, Handbook of disinfectants and antiseptics

CCDR Supplement, Vol 23S8 (Dec 1997), Infection Control Guidelines: Foot Care by Health Care Providers. http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.html

Documents

Infection Control Facts: How to Select an Ideal Disinfectant Lee Nesbitt, BMSc Manager, Professional & Technical Services Virox Technologies Inc Phone: