Transcript The Mechanisms of Cleaning - Home

Infection Control Facts:
How to Select an Ideal
Disinfectant
Lee Nesbitt, BMSc
Manager, Professional & Technical Services
Virox Technologies Inc
Phone: 1-800-387-7578 x115
Email: [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 Issue
October 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

Most
Susceptible
Viruses (enveloped)
 Bacteria (Gram +ve & Gram -ve)
 Fungi
 Viruses (non-enveloped)
 Mycobacteria
 Protozoa
 Bacterial Spores

Least
Susceptible
Consider the Device Classification
(According to Spaulding)
Once the device has been defined
determine the Disinfection Process
Choose the CORRECT
Product
Critical Devices*
Semi-Critical
Devices
Sterilization
High Level
Disinfection
Intermediate
Level Disinfection
Low Level
Disinfection
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
3 Log /
99.9%
3 Log /
99.9%
6 Log /
99.9999%
6 Log /
99.9999%
Fungi
5 Log /
99.999%
5 Log /
99.999%
Non-Enveloped
Viruses
3 Log /
99.9%
3 Log /
99.9%
Enveloped Viruses
Vegetative
Bacteria
Mycobacteria
Spores
4 Log / 99.99%
HLD
Chemical
Sterilants
5 Log /
99.999%
5 Log /
99.999%
6 Log /
99.9999%
6 Log /
99.9999%
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
Must have
good cleaning
ability to
remove
organic soil
load on
surface.
Alcohols are
not
effective
cleaners
as they do not
contain
detergency
Properties
Is effective in a
soil load.
Will not lead to
development
of resistant
organisms
AHP
Chlorine can
be
inactivated by
a soil
load and do
not
contain
detergency
Properties
Phenolics are
ineffective
cleaners
Quaternary
Ammonia
Compounds
are not
effective
cleaners
AHP contains a
combination of
superior
surfactants
that are
proven
effective
cleaners in
synergy with
H2O2
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.
Active
ingredient
evaporates
Active
ingredient
evaporates
Leaves active
ingredient
residual on
surface
Leaves active
ingredient
residual on
surface
Active
ingredient
hydrogen
peroxide
evaporates
from surface
Alcohols
Chlorine
Phenolics
QUATs
AHP
Vegetative
Bacteria
YES
3 min to 10 min
YES
10 min
YES
5 min to 10 min
YES
3min to 10 min
YES
30 sec to 20
min
Enveloped
Viruses
YES
3 min to 10 min
YES
10 min
YES
3 min to 10 min
YES
3 min to 10 min
YES
1 min to 5 min
Fungi
YES
3 min to 10 min
YES
10 min
YES
3 min to 10 min
YES
3 min to 10 min
YES
3 min to 5 min
NonEnveloped
Viruses
NO
YES
10 min
YES / NO
Product
Specific
Review label
3 min to 10 min
NO
YES
1 min to 5 min
Mycobacteria
YES
3 min to 10 min
YES
10 min
YES
3 min to 10 min
ONLY WITH
SOLVENT OR
ALCOHOL
3 min – 10 min
YES
1 min to 5 min
Bacterial
Spores
NO
YES
10 min
NO
NO
YES
10 min
OPA
Gluteraldehyde
AHP
Fungi
YES
10 min
YES
20 min – 45 min
YES
5 min – 20 min
Mycobacteria
YES
10 min
YES
20 min – 45 min
YES
5 min – 20 min
Bacterial Spores
YES
32 hours
YES
8 – 12 hours
YES
20 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
Nonflammable 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
OPA
Gluteraldehyde
AHP
Does not have storage
limitations
Non-flammable or
combustible
Do not store at elevated
temperatures and keep
away from ignition sources.
Non-flammable or
combustible
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
Alcohols
Chlorine
Phenolics
QUATs
AHP
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
Will not lead to
development of
resistant
organisms
Active
ingredient
evaporates
Active
ingredient
evaporates
Leaves active
ingredient
residual on
surface
Leaves active
ingredient
residual on
surface
Active
ingredient
hydrogen
peroxide
evaporates
from surface
OPA
Gluteraldehyde
AHP
Indoor Air Quality
(VOCs)
Contains high levels of
VOCs which contribute
to poor indoor air
quality
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
Will not lead to
development of resistant
organisms
Leaves active
ingredient residual on
surface
Leaves active
ingredient residual on
surface
Active ingredient
hydrogen peroxide
evaporates from
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
Alcohols
Chlorine
Phenolics
QUATs
AHP
Positive
environmental
profile including
indoor air
quality.
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;
often contain
hormone
disruptors
Contains no
VOCs and no
hormone
disruptors
Will not lead to
development of
resistant
organisms
Active
ingredient
evaporates
Active
ingredient
evaporates
Leaves active
ingredient
residual on
surface
Leaves active
ingredient
residual on
surface
Active
ingredient
hydrogen
peroxide
evaporates
from surface
Carries EcoLogo
or Green Seal
Certification
Does not meet
certification
criteria
Does not
meet
certification
criteria
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.
Contains high levels
of VOCs which
contribute to poor
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/0b1fe
at2.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.phacaspc.gc.ca/publicat/ccdrrmtc/97vol23/23s8/fcindexe.html
