Metrex - Protecting People

According to the CDC, transferral of health care associated pathogens from environmental surfaces to patients is largely via hand contact with the surface. In their 2003 Guidelines for Environmental Infection Control in Healthcare Facilities, they state, “Although hand hygiene is important to minimize the impact of this transfer, cleaning and disinfecting environmental services as appropriate is fundamental in reducing their potential contribution to the incidence of health-care associated infections (HAI).”

There is an alarming 1.7 million HAI reported:

• 33,269 HAIs among newborns in high-risk nurseries;
• 19,059 among newborns in well-baby nurseries;
• 417,946 among adults and children in intensive care units (ICUs);
• 1,266,851 among adults and children outside of ICUs.
• 99,000 associated deaths

Approximately 1 out of every 20 hospitalized patients will contract an HAI.

Ten most common pathogens that account for 84% of all HAIs:

• Coagulase-negative staphylococci (15%)
• Staphylococcus aureus (15%)
• Enterococcus species (12%)
• Candida species (11%)
• Escherichia coli (10%)
• Pseudomonas aeruginosa (8%)
• Klebsiella pneumoniae (6%)
• Enterobacter species (5%)
• Acinetobacter baumannii (3%)
• Klebsiella oxytoca (2%)

Because you stand between infection and the people you care about, it’s important to know and hold staff accountable for proper surface disinfection.

We will walk you through the proper essentials of surface disinfection so you can protect your patients, staff, yourself and loved ones.

First understanding the level of disinfection needed for instrument or surface application is critical.

As represented in the table, high level disinfectants are used for heat sensitive, semi critical medical devices. They inactivate all vegetative bacteria, mycobacteria, viruses, fungi, and some bacterial spores. Examples of these products are glutaraldeyhdes, peractetic acid and hydrogen peroxide. However, high level disinfectants are highly toxic. They are not recommended for noncritical instruments/devices or environmental surfaces; such use is contradicts maufacturer label instructions for these toxic chemicals.

Intermediate level disinfectants can be used on noncritical instruments and environmental surfaces. Majority of the intermediate level disinfectants do not kill spores but inactivate Mycobacterium tuberculosis var. bovis (TB), which is substantially more resistant to chemical germicides than ordinary vegetative bacteria, fungi, and medium to small viruses. Examples of these compounds include sodium hypochlorite, alcohols, phenolics, and some idophors. CDC recommends the use of these disinfectants when: 1) uncertainty exists as to the nature of the soil on these surfaces (blood or body fluid contamination versus routine dust or dirt) 2) uncertainty exists regarding the presence or absence of multidrug resistant organisms on surfaces.

Low level disinfectants can be used on noncritical instruments and environmental surfaces. They are typically labeled “hospital disinfectant” without the “tuberculocidal” claim because they lack the potency to inactivate mycobacteria (TB).

Because Mycobacteria have the highest level of intrinsic level of resistance among the vegetative bacteria, viruses and fungi, disinfectants (i.e. intermediate level) with a TB claim on the label is considered capable of inactivating a broad spectrum of pathogens, including much less resistance organisms such as bloodborne pathogens (HBV, HCV and HIV). It is this broad spectrum of capability, rather than the product’s specific potency against mycobacteria, that is the basis for protocols and OSHA regulations indicating the appropriateness of using tuberculocidal chemicals for surface disinfection.

Step 1: Cleaning

CDC states, “cleaning is the necessary first step of any disinfection process. The actual physical removal of microorganisms and soil by wiping or scrubbing is probably as important, if not more so, than any antimicrobial effect of the cleaning agent used.” If the surface is not cleaned before terminal reprocessing procedures are started, the success of the disinfection process is compromised.

Step 2: Disinfection

Once all organic matter, salts and visible soils are removed from the surface, a fresh pre-saturated wipe or towelette is applied to the surface for the recommended contact time listed on the label to disinfect the surface.

The method, thoroughness and frequency of cleaning and the products used are determined by health care facility policy. Infection control practitioners typically use a risk assessment approach to identify high-touch surfaces and then coordinate an appropriate cleaning and disinfecting strategy and schedule with the housekeeping staff.

However, the CDC recommends that high touch surfaces in patient care areas (door knobs, bedrails, light switches, wall areas around the toilet and the edges of privacy curtains) should be cleaned and or disinfected more frequently than surfaces with minimal hand contact.

Horizontal surfaces with infrequent hand contact such as window sills and hard surface flooring in routine patient care areas require cleaning on regular basis, when soiling or spills occur, and when a patient is discharged from the facility. Cleaning of walls, blinds and window curtains is recommended when they are visibly soiled.

Cleaning for Spills and Body Substances

Both CDC and OSHA recommends prompt removal and surface disinfection of an area contaminated by either blood or body substances. This can vary from a 2-3 step process. In patient care areas, workers can manage small spills with cleaning and then disinfecting using an intermediate level germicide or EPA-registered germicide from the EPA list D or E. For spills containing large amounts of blood or other body substances, workers should first remove visible organic matter with absorbent materials and then clean and decontaminate the area.

To meet your every day surface disinfectant needs, use the premium, trusted brands, CaviWipes and CaviCide to kill TB in 3 minutes and MRSA, VRE, HIV-1, and HBV in 2 minutes.

Concentrated or Ready-To-Use?

According to the CDC, concentrated intermediate level disinfectants have been occasional vehicles of health-care infections and pseudoepidemics. Members of the genus Pseudomonas such as P. aeruginosa are the most frequent isolates from contaminated disinfectants. Their ability to remain viable or grow in use-dilutions of disinfectants is unparalleled. This survival advantage for Pseudomonas results presumably from their nutritional versatility, their unique outer membrane that constitutes an effective barrier to the passage of germicides, and/or efflux systems.

The CDC recommends the following control measures to reduce the frequency of bacterial growth in disinfectants and the threat of serious healthcare–associated infections from the use of such contaminated products.

First, some disinfectants should not be diluted; those that are diluted must be prepared correctly to achieve the manufacturers' recommended use-dilution.

Second, infection-control professionals must learn from the literature what inappropriate activities result in extrinsic contamination (i.e., at the point of use) of germicides and train users to prevent recurrence. Common sources of extrinsic contamination of germicides in the reviewed literature are the water to make working dilutions, contaminated containers, and general contamination of the hospital areas where the germicides are prepared and/or used.

To alleviate some of these concerns, Metrex recommends using a ready-to-use disinfectant such as CaviCide to eradicate extrinsic factors in solution contamination.