Infection Control Today - 08/2003: Success Story

Disinfectants in the Custody Setting: A ViableAlternative to Toxic Chemicals

By Larry Weiss, MD

The ongoing outbreak of methicillin-resistant Staphylococcusaureus (MRSA) in the California Correctional System beginning last yearbrought national attention to the difficulty of managing infectious disease in acustody setting. In 2002, the Los Angeles County Jail diagnosed 928 inmates withMRSA. Close quarters, poor personal hygiene, high-risk behaviors and the factthat in most cases, the prisoners themselves are responsible for cleaning anddisinfection, make custody a particularly challenging infection control problem.

While the extent to which a routine of cleaningand disinfection has in limiting the spread of illness in prisons has not beenstudied, there is strong support for the practice. Unfortunately, the mostcommonly used disinfectants are toxic, and in the hands of prisoners, have beenused as weapons when forcibly ingested and as a form of mace when sprayedin the eyes. Faced with this risk, many institutions have cut back or eliminatedthe use of disinfectants, leaving themselves open to the epidemic spread ofinfectious disease.

A new class of intermediate-level disinfectants,based upon breakthrough nanotechnology emulsion, is non-toxic to humans andprovides a safe and cost-effective infection control alternative for anyhigh-risk environment, and is particularly well suited to the custody setting.

This nanotechnology emulsion, which iscommercially available under the trade name EcoTru, is the only EPAregistered disinfectant that is not required to carry cautionary statements onthe label. The practical implications are that it is not possible to ingest atoxic dose and it is not necessary to use an eye-wash if it were to splash inthe eye. This eliminates compliance procedures dictated by the OccupationalSafety and Health Administration (OSHA) and the Environmental Protection Agency(EPA), as well as HAZMAT training and certification costs that can besubstantial in industries with high employee turnover.

The safety profile of this new disinfectant is ofparticular importance in custody environments where toxic disinfectants havebeen implicated in deliberate poisonings. All other disinfectants and mostcleaning products are poisonous. While quaternary ammonium-based disinfectants (quats)are the dominant disinfectants in use today, they represent a dangerouslyoutdated technology and are ill suited to the custody setting. Quats arepulmonary and ocular irritants and systemic poisons if ingested. They are theprincipal cause of occupational dermatitis and asthma in healthcare andjanitorial workers. Recent studies have documented that approximately 2 percentof healthcare workers are allergic to quats. Most are sold as concentrates thatare extremely toxic, irritating and corrosive. Errors in dilution can result inhighly toxic or, alternatively, ineffective use dilutions.

Norwalk-Like Virus (NLV) is a major concernbecause it is highly contagious and the most common cause of acutegastroenteritis in the United States and worldwide. NLV causes as many as 20million episodes in the U.S. annually, resulting in more than 300,000hospitalizations and at least 2,500 deaths. It is a major cause of absenteeism.Following recovery and return to work, patients remain contagious, shedding livevirus for as long as four weeks. NLV is especially well adapted to confinedpopulations such as military deployments, cruise ships, dormitories and prisons.Quats have no efficacy whatsoever against NLV and related viral species.Although as of this writing (June 2003), we are unaware of any EPA approvedtesting methodology for the noro virus. The new nanoemuls ion germicide has adocumented 99.99 percent inactivation of the surrogate virus, Feline Calicivirus(FCV).

While the role of the environment in thetransmission of tuberculosis (TB) remains uncertain, the explosive emergence ofresistant TB raises the stakes as well as the consequences associated with thisorganism. The cost of treating a patient with resistant TB can be as high as$150,000 and take as long as 18 months. The Mycobacterium species are consideredthe most difficult of bacteria to kill and remain the standard for antibacterialdisinfectant efficacy. Quats alone have had limited or no efficacy against TB.

Quats that make claims for TB efficacy containalcohol or extremes of pH, increasing both the toxicity and the materialsincompatibility. The new nanoemulsion germicide has a 5-minute TB claim, whichis comparable or better than all but the most toxic and corrosive alternatives.

Recent reports from the Centers for DiseaseControl and Prevention (CDC) and the California Department of Corrections havenoted the appearance of MRSA in the jail populations. This is of particularconcern because this new strain of MRSA was invasive and capable of initiatingan infection without a break in the skin. It is highly contagious and difficultto treat, requiring a mixture of antibiotics and occasionally several weeks ofintravenous antibiotics. MRSA is known to survive for days to weeks on surfaces.Once established in an institutional setting MRSA can be very difficult toeradicate. The new nanoemulsion disinfectant is designed to be the only safe andnoncorrosive disinfectant alternative for MRSA.

Quats are notorious environmental contaminants.More than 100,000 metric tons are produced in the U.S., and massive amounts ofpollutant byproducts are produced during their manufacture. Once manufactured,quats end up in the soil and aquifers where they degrade slowly, if at all.

Varying degrees of contamination with quats arefound in many rivers, streams and municipal water supplies. In contrast, the newnanoemulsion disinfectant is readily biodegradable under both aerobic andanaerobic conditions and doesnt accumulate in the environment.

This new nanoemulsion disinfectant is the onlycompletely noncorrosive disinfectant option. The most rigorous standards forcorrosion are those established for use aboard civilian and military aircraft.It is the first and only disinfectant that has passed all of the aircraftmaterials standards, including plastics, painted surfaces, vinyl, fabrics,leather and metals. It can safely be used throughout the work environment,including equipment, computer keyboards, automobiles, and emergency medicaltransport vehicles and equipment.

A system has been developed which pairs EcoTruwith patented microfiber mops and cloths to simplify procedure and assure aconsistently high level of disinfection at a reduced cost. Simplicity of use isthe best predictor of good compliance. The system efficiently captures withinthe microfiber matrix where effective kill times are assured. The mop heads andcloths can then be washed and reused hundreds of times.

Because it eliminates the bucket, there is nocross-contamination and disinfectant use is reduced by more than 90 percent. AnEPA study found that the this system can reduce annual cleaning and disinfectingcosts by as much as 60 percent as compared to conventional practices.

Larry Weiss, MD is senior scientist forEnviroSystems, Inc.