Transcript Diapositiva 1 - Process Cleaning Solutions

Can disinfectant efficacy claims
be achieved in practice?
Disinfectant Claims
• Products with specific claims for
disinfection of environmental
surfaces offer greater efficacy than
generic disinfectants?
Can disinfection of environmental
surfaces be achieved in practice?
• Unfortunately laboratory testing of
disinfectants is not a reflection of
how disinfectants are used in the
health care environment.
• 2011 | September
• Cleaning and Maintenance
Management
• When Disinfectants Fail: How Newer
Technologies Can Help
• Discussing the downfall of
disinfectants.
• Author: Dr. Benjamin Tanner
• Traditional disinfectants have
undoubtedly prevented a great number
of infections over the years.
• Regrettably, though, many outbreaks
are still spread by contaminated
surfaces, and the technical drawbacks
of liquid disinfectants may be partially
to blame for high facility-acquired
infection rates in health care.
• Chemical disinfectants registered by
the U.S. Environmental Protection
Agency (EPA) kill microorganisms
reliably in laboratory tests; there is no
question about that.
• However, disinfectants routinely fail in
practice.
• French et. al.showed that conventional disinfection
failed to reduce the presence of methicillin-resistant
Staphylococcus aureus (MRSA) on 66 percent of
tested surfaces and Byers et al. found that
conventional disinfection failed to reduce
vancomycin-resistant enterococci (VRE)
contamination in 15.9 percent of sampled sites.
• Most recently, Stibich et al. reported 33 bacteria per
square centimeter "before cleaning" in rooms of a
cancer center and a reduction to 27.4 bacteria per
square centimeter after traditional terminal room
cleaning and disinfection.
• The main reasons disinfectants fail in
practice are described below:
• Product not applied liberally for the
right amount of time
• Wrong active ingredient in use for the
microorganism(s) of concern
• Contaminated surfaces are missed by
cleaning staff.
• Dwelling / Contact Times the number
one reason disinfectants fail in practice
is that too little volume is applied to
target surfaces, and liquid that is
applied is not left there long enough to
do its job.
• In laboratory testing, the ratioof liquid to
surface area is enormous; if one wanted to
use this same ratio to clean the high-touch
surfaces in a single hospital room — to get
true disinfection — about a gallon of product
would be needed.
• The volume of product required to get true
disinfection from liquid chemicals on a
surface is simply not realistic in many cases.
• The reality is that hospital staff may only spend 10
minutes cleaning a room, so adhering to label-stated
contact times is not practical in this context.
• Furthermore, disinfectant will run off vertical and other
irregular surfaces during the proposed contact time
and may simply evaporate before the proper dwell time
is reached.
• A study conducted by Antimicrobial Test Laboratories
LLC demonstrated what happens to the efficacy of a
disinfectant chemical when used in a manner close to
what is commonly observed in the field.
• The results of this controlled laboratory study showed
that for ultra-low contact times, traditional
disinfectants left many microorganisms behind on the
surface.
• Dr. Benjamin Tanner is the principal of
Antimicrobial Test Laboratories, an
independent testing facility specializing in
the research and development of
antimicrobials, including disinfectants. Dr.
Tanner holds a B.S. in Molecular Biology and
a Ph.D. in Microbiology and Immunology
from the University of Arizona, where he
studied environmentally mediated disease
transmission and assessed infection risks
for workers.
Spread and persistence of Clostridium difficile spores
during and after cleaning with sporicidal disinfectants
• Letters to the Editor / Journal of Hospital
Infection 79 (2011) 93–98
• S. Ali*
• G. Moore
• A.P.R. Wilson
• Department of Microbiology, University
College London Hospitals,
• London, UK
• Accepted by J.A. Child
• Available online 19 July 2011
• This study highlights the limitations of
two commercially available sporicidal
disinfectants against C. difficile spores.
Preliminary suspension tests
confirmed that both sporicides
exhibited sporicidal activity sufficient
to pass EN 13704 standards (>3 log
reduction in 60-min contact time) under
clean conditions (data not shown).
However, when tested under practical in-use
conditions, they failed to prevent the transfer
of spores during cleaning, and failed to
achieve a 3 log reduction in residual spore
numbers after 60 min.
Our findings support those of others, and
suggest that current validation standards
used for the development of commercially
available sporicides do not accurately reflect
in-use practices.
Healthcare practitioners should take
precautions to ensure that existing
disinfectants have in-use sporicidal
activity against C. difficile spores.
“ In use refers to how product is used in practice”
Consider converting to evidence based
cleaning practices.
• Cleaning processes based on evidence of outcomes
in your facilities.
• Consider ATP and microbial testing of cleaning
processes.
• Focus on cleaning which has always been the most
effective method of reducing environmental
contamination.
• Apply a disinfectant after cleaning as insurance.
We recommend generic sources of hypochlorite at
1000 ppm preferably with Health Canada registration
with a DIN for use on hard non porous surfaces in
health care facilities.
• French et. al.showed that conventional disinfection
failed to reduce the presence of methicillin-resistant
Staphylococcus aureus (MRSA) on 66 percent of
tested surfaces and Byers et al. found that
conventional disinfection failed to reduce
vancomycin-resistant enterococci (VRE)
contamination in 15.9 percent of sampled sites.
• Most recently, Stibich et al. reported 33 bacteria per
square centimeter "before cleaning" in rooms of a
cancer center and a reduction to 27.4 bacteria per
square centimeter after traditional terminal room
cleaning and disinfection.
• General purpose detergent and water
or detergent wipes should be used for
all routine cleaning. (If an item is
heavily soiled, detergent and water is
the preferred method).
• Converting to evidence based cleaning
practices is safer, more effective and
sustainable