Infection Control Today - 11/2001: Brushing the Surface of Disinfectants

Brushing the Surface of Disinfectants
Surface Disinfectants Crucial in Battle Against NosocomialInfections

By Kelli M. Donley

One of the easiest methods of protecting yourself from getting the flu eachwinter is to avoid touching handles and buttons. Bathroom doorknobs, waterfaucets, and elevator buttons are touched every day by each person with whom youwork. Imagine the number of germs transferred from person to person via thesecommon sources. Germs thrive in new environments and a causal handshake cantransport them to a new land of opportunity. Hospital surfaces, in this aspect,are no different than hands. Bed rails, gurneys, carts, counters, sinks, IVpoles, lead wires, diagnostic equipment, and more are all touched by a varietyof people daily. Are you cleaning these items efficiently, keeping both OSHA andspecific hospital guidelines in mind?

The Lex Luther of healthcare is nosocomial infections, with Staphylococcusaureus serving as his trusty kryptonite. Nothing frustrates healthcareworkers (HCWs) more than seeing a patient become infected with a new pathogenduring hospitalization. This situation leaves hospital officials saying meaculpa and the door wide open to malpractice suits. Proper cleaning of surfacescan greatly reduce the risk of nosocomial infections by eliminating pathogens oncommonly touched areas.

Characteristics of efficacious surface cleaners

Surface cleaners should have a broad antimicrobial spectrum, work quickly andeffectively when blood or other protein is present, have a low toxicity, and besafe for HCWs to use.

While there is some controversy surrounding whether it is necessary to have asurface cleaner that serves as a tuberculodicial, there is no doubt that eachcleaner should be bactericidal, fungicidal, and virucidal. The selected cleanershould be able to kill a variety of potentially deadly germs following EarleSpaudling's, MD, hierarchy of microorganism resistance to disinfection andsterilization.³ This hierarchy describes the susceptibility ofmicroorganisms to disinfection in a descending order. He also classified medicaldevices on how the device is used and how it should be disinfected. Theseclassifications are low-level, high-level, and sterilization. The ranking indescending order of microorganisms is: high-level disinfection or sterilization:bacterial spores (i.e., Bacillis subtilis, Clostridium difficile);intermediate-level disinfection: Mycobacterium tuberculosis and nonlipidand small viruses: (i.e.,coxsackievirus, hepatitis A, polio, rhino)³;low-level disinfection: fungi (i.e., Aspergillus niger, Candida albicans,Trichophyton mentagrophytes), gram positive and gram negative vegetativebacteria (i.e., Pseudomonas aeruginosa, Salmonella cholerasesuis,Staphylococcus aureus), and lipid or medium-sized viruses (i.e.,cytomegalovirus, Hantavirus, herpes simplex virus, hepatitis B virus, HIV,respiratory syncytial virus).

Another important aspect of the antimicrobial spectrum is whether theEnvironmental Protection Agency (EPA) has approved the chemicals in use. Also,how quickly does the cleaner work? Each of these factors much be taken intoconsideration when selecting the appropriate surface cleaner to match ahealthcare facility.¹

The EPA requires each hard-surface disinfectant to have a label listing aningredient statement and the concentration of each active ingredient. Eachdisinfectant must also have a EPA registration number on the label and clearlylist the kill times for microorganisms that the product aims to eliminate. Toreceive one of these numbers from the EPA, a disinfectant is tested and mustadhere to regulatory requirements pertaining to safety and efficacy.⁴

The Occupational Safety and Health Administration (OSHA) has specificguidelines for hospitals concerning surface cleaners and how to properlydisinfect areas that have been potentially exposed to either HIV or HBV. Thisguideline states: OSHA's current stance is that EPA-registered disinfectants forHIV and HBV meet the requirement in the standard and are "appropriate"disinfectants to clean contaminated surfaces, provided such surfaces have notbecome contaminated with agent(s) or volumes of or concentrations of agent(s)for which higher level disinfection is recommended.²

Forms of disinfectants

There are a plethora of disinfectant products on the market, and while theirscents, colors, and packaging vary, the true differences in these products aretheir form and active ingredients. Safetec, an infection control company basedin Buffalo, NY, manufactures a variety of products, including SaniZide Plus--aquaternary ammonium compound. The liquid disinfectant has a broad spectrum ofantimicrobial action and is alcohol free. Kelly Ticco, marketing manager, saidthat while their product is strong enough to kill dangerous pathogens, it isstill user friendly.

"SaniZide Plus is an intermediate level Quaternary ammonium compound.Our alcohol free formula is non-toxic, non-corrosive, non-flammable, and willnot stain surfaces. When the customer selects SaniZide Plus they getintermediate level (tuberculocidal) strength in a non-toxic formula," shesaid.

Officials from Palmero Health Care, report their DisCide Ultra line kills amyriad of germs including TB within 5 minutes. The quaternary ammoniumhigh-level alcohol solution is sold in a variety of forms including towelettes,spray bottles, foil packs, and wall mount canisters containing the disinfectant.Other companies also manufacture disinfectants in aerosol cans, foams, and gels.

Education surrounding disinfectants necessary

While each disinfectant has its faults, the benefits are far more important.The proper use of these chemicals is essential in operating an efficacioushealthcare center. However, knowledge on how to use these chemicals is just ascrucial.

Each disinfectant has the potential of breaking down gloves. While somechemicals make the gloves more porous, others make the latex brittle and hard.Point being, following Universal Precautions for handwashing and frequentlychanging gloves extremely important when cleaning with these disinfectants.