Industry Driving Surface Compatibility Research and Education

Medical device housings are subject to cracking, crazing and discoloration from some disinfectants that are used to reduce rates of healthcare-associated infections (HAIs), and this can lead to equipment breakdowns. Surface compatibility with chemical disinfectants in the healthcare environment is a growing area of research and requires education of healthcare professionals and key stakeholders around the associated challenges and opportunities. ICT spoke with Ellen Turner, global market development manager of specialty plastics in medical devices for Eastman Chemical Company, and Laurie Rabens, senior product manager in marketing for Clorox Healthcare, regarding what healthcare personnel need to know.

Q: If surface compatibility with disinfectants is not on a healthcare professional’s radar currently, how would you summarize the multifactorial challenges currently?
A: Minimizing surface damage is important in the healthcare setting because damaged equipment can hide pathogens, be very costly to replace and affect the overall image of a hospital. The pathogen threat is continuing to evolve, and disinfectants must stand up to the toughest pathogens. The challenge is that more powerful disinfectants are also typically associated with poor surface compatibility, because the very ingredients that break down pathogens can break down other things as well. This can put the healthcare professional in a difficult spot of making tradeoffs between efficacy or compatibility. Replacing damaged equipment adds unnecessary costs to facilities when most are already financially constrained. Surface damage like discoloration, cracks, residue, and stickiness, can negatively affect patient perception of the facility. Anecdotally, facility staff often have makeshift “solutions” for handling equipment that has cracked or became discolored due to disinfectant use. This highlights the fact that healthcare professionals are aware of these problems but sometimes feel resigned or powerless about finding solutions.

Q: How is surface compatibility science being developed now and how will it benefit healthcare professionals and other stakeholders in the healthcare setting?
A: Currently no industry standard exists for evaluating surface compatibility with disinfectants, leaving healthcare professionals without the necessary tools or education to make optimal decisions about which disinfectants to use, or even what surface materials to incorporate when designing their facility. The same is true for medical equipment manufacturers. For biomedical engineers and designers, material compatibility with disinfectants is often an afterthought, but it should arguably be a key part of the design process if the equipment requires cleaning and disinfecting. Eastman has developed a four-step test method that can differentiate the performance of different plastic materials under conditions commonly found in a healthcare setting. This test can help predict the reliability of a material after exposure to disinfectants, lipids, drugs or drug carrier solvents. The test is simple and quick, taking only 24 hours, compared to other test methods that can take weeks or even months. From Clorox Healthcare’s perspective, it would benefit the industry to establish this test as the industry standard for equipment/device manufacturers, disinfectant makers and hospitals. Disinfectant manufactures like Clorox Healthcare recognize the importance of improving disinfectant chemistries to maintain efficacy against pathogens while limiting damage to surfaces.  Healthcare professionals are already seeing new products being introduced to address this issue as well as educational resources to enable product selection.

Q: How can infection preventionists, environmental services professionals and other healthcare stakeholders become more conversant about this issue and implement awareness and real change in their institutions?
A: It is important for healthcare professionals to speak up and work with biomedical engineers regarding medical device materials and design. One way to do this is to specify in equipment RFIs and RFQs that materials should be able to withstand frequent exposure to a wide spectrum of disinfectant agents. There must be greater awareness across the board that high-performance material options exist that can stand up to these challenges. Healthcare professionals can have a powerful voice in demanding a higher standard of material and better design in order to minimize the risk of infection.

Q: What is the future of surface compatibility science and how will it impact the manufacture of medical devices and materials for the built environment in healthcare?
A: As the industry looks to the future, it is clear we need materials that can withstand disinfectant challenges. The last thing healthcare professionals should worry about is whether their equipment will break down because of the choice of disinfectant. Design is another important consideration, not only for equipment but also for healthcare facility countertops, floors and furniture. Better design choices include making surfaces easier to clean and avoiding gaps and crevices where fluids can pool, etc. No matter how much you focus on design, however, materials must be chosen that can withstand the disinfectants necessary to keep patients safe.

Q: What should healthcare professionals do to better evaluate how disinfectants are currently used in their facilities and how this may impact equipment and surfaces?
A: It’s also important to learn about what disinfectants work best on the relevant surfaces in your facility. Ask the disinfectant manufacturers to provide data and recommendations on various surfaces to have the assurance that it is safe to use. By choosing disinfectants that have strong efficacy and excellent compatibility, healthcare professionals should expect their equipment and surfaces to last longer and maintain a “clean” look in their facilities. Healthcare professionals should also track when equipment is failing and communicate directly with manufacturers. A failure could also include if a device becomes discolored, tattered, or if the surface gets sticky after cleaning. It’s important to be clear about your performance requirements so that manufacturers use the right materials.

Q: As the science grows and advances, what can members of the healthcare community do now to become more involved in the dialogue around surface compatibility?
A: Talk to your device manufacturers and get to know your clinical/biomedical engineering department. Alert them if you notice consistent damage caused by certain disinfectants. Proactively ask equipment manufacturers for instructions about how to clean and disinfect their products. Cleaning and care guides vary widely and can sometimes be difficult to navigate. It’s important for healthcare professionals to raise their voice to ensure their needs are met, as this is critical for patient health and safety.