Transcript Disinfectants, Detergents and Microfiber: Current and Future Issues

Disinfectants, Detergents and Microfiber:
Current and Future Issues
William A. Rutala, PhD, MPH
Director, Hospital Epidemiology, Occupational Health and Safety;
Professor of Medicine and Director, Statewide Program for
Infection Control and Epidemiology
University of North Carolina at Chapel Hill and UNC Health Care,
Chapel Hill, NC
DISCLOSURES
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Consultation and Honoraria
 ASP (Advanced Sterilization Products), Clorox
Grants
 CDC, CMS
Disinfectants, Detergents and Microfiber
Objective
Describe emerging knowledge and controversies
related to disinfectants, detergents and microfiber
cleaning products
DISINFECTION AND STERILIZATION
Rutala, Weber, HIPAC. www.cdc.gov, 2008
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EH Spaulding believed that how an object will be disinfected depended on
the object’s intended use
 CRITICAL - objects which enter normally sterile tissue or the
vascular system or through which blood flows should be sterile
 SEMICRITICAL - objects that touch mucous membranes or skin
that is not intact require a disinfection process (high-level
disinfection[HLD]) that kills all microorganisms except for high
numbers of bacterial spores
 NONCRITICAL - objects that touch only intact skin require lowlevel disinfection
DISINFECTION AND STERILIZATION
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EH Spaulding believed that how an object will be disinfected depended on
the object’s intended use
 CRITICAL - objects which enter normally sterile tissue or the
vascular system or through which blood flows should be sterile
 SEMICRITICAL - objects that touch mucous membranes or skin
that is not intact require a disinfection process (high-level
disinfection[HLD]) that kills all microorganisms except for high
numbers of bacterial spores
 NONCRITICAL - objects that touch only intact skin require lowlevel disinfection
Disinfectants
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Disinfectants are recommended for noncritical patient care
objects (CDC, 2008)
Disinfectants are recommended for Precaution/Isolation
patients (CDC, 2007)
Disinfectants are recommended for blood/OPIM (OSHA,
1991)
Disinfectants (or detergents) are recommended for other
noncritical environmental surfaces (CDC, 2002 and 2008)
LECTURE OBJECTIVES
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Disinfectants
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Knowledge and controversies
Detergents
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Knowledge and controversies
• Microfiber

Knowledge and controversies
CLEANING AND DISINFECTING
ENVIRONMENTAL SURFACES
Cleaning (removes soil) and disinfecting is one-step
with disinfectant-detergent. No pre-cleaning
necessary unless spill or gross contamination.
LOW-LEVEL DISINFECTION FOR NONCRITICAL
EQUIPMENT AND SURFACES
Germicide
Exposure time > 1 min
Use Concentration
Ethyl or isopropyl alcohol
70-90%
Chlorine
100ppm (1:500 dilution)
Phenolic
UD
Iodophor
UD
Quaternary ammonium
UD
Improved hydrogen peroxide
0.5%, 1.4%
____________________________________________________
UD=Manufacturer’s recommended use dilution
DISINFECTION OF NONCRITICAL PATIENT-CARE DEVICES
Rutala, Weber, HICPAC. 2008 www.cdc.gov
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Disinfect noncritical medical devices (e.g., blood pressure cuff) with
an EPA-registered hospital disinfectant using the label’s safety
precautions and use directions. Most EPA-registered hospital
disinfectants have a label contact time of 10 minutes but multiple
scientific studies have demonstrated the efficacy of hospital
disinfectants against pathogens with a contact time of at least 1
minute. By law, the user must follow all applicable label instructions
on EPA-registered products. If the user selects exposure conditions
that differ from those on the EPA-registered product label, the user
assumes liability for any injuries resulting from the off-label use and
is potentially subject to enforcement action under FIFRA. (II, IC)
EFFECTIVENESS OF DISINFECTANTS
AGAINST MRSA AND VRE
Rutala WA, et al. Infect Control Hosp Epidemiol 2000;21:33-38.
CONTACT TIMES FOR
SURFACE DISINFECTION
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Follow the EPA-registered contact times, ideally
 Some products have achievable contact times for
bacteria/viruses (30 seconds-2 minutes)
 Other products have non-achievable contact times
If use a product with non-achievable contact time
 Use >1 minute based on CDC guideline and scientific literature
 Prepare a risk assessment
http://www.unc.edu/depts/spice/dis/SurfDisRiskAssess2011.pdf
Disinfectants
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Disinfectants are recommended for noncritical patient care
objects (CDC, 2008)
Disinfectants are recommended for Precaution/Isolation
patients (CDC, 2007)
Disinfectants are recommended for blood/OPIM (OSHA,
1991)
Disinfectants (or detergents) are recommended for other
noncritical environmental surfaces (CDC, 2002 and 2008)
Surface Disinfection:
Should We Do It?
The use of disinfectants for non-critical items in
health care is controversial (especially in some
parts of the world)
Justification for Using a Disinfectant for
Non-Critical Surfaces
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Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Disinfectants may have persistent antimicrobial activity
Justification for Using a Disinfectant for
Non-Critical Surfaces
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Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Disinfectants may have persistent antimicrobial activity
ENVIRONMENTAL CONTAMINATION
LEADS TO HAIs
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Microbial persistence in the environment
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Frequent environmental contamination
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MRSA, VRE, Ab, Cd
HCW hand contamination
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In vitro studies and environmental samples
MRSA, VRE, Ab, Cd
MRSA, VRE, Ab, Cd
Relationship between level of environmental contamination and
hand contamination
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Cd
ENVIRONMENTAL CONTAMINATION
LEADS TO HAIS
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Person-to-person transmission
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Housing in a room previously occupied by a patient with the
pathogen of interest is a risk factor for disease
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Molecular link
MRSA, VRE, Ab, Cd
MRSA, VRE, Cd, Ab
Improved surface cleaning/disinfection reduces disease
incidence
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MRSA, VRE, Cd
RELATIVE RISK OF PATHOGEN ACQUISITION
IF PRIOR ROOM OCCUPANT INFECTED
MRSA (Huang S, 2006)
VRE* (Dress M, 2008)
VRE (Huang S, 2006)
MDR Pseudomonas (Nseir S, 2011)
VRE^ (Drees M, 2008)
C. diff (Shaughnessy M, 2011)
MDR Acinetobacter (Nseir S, 2011)
0
0.5
1
1.5
2
2.5
3
* Prior room occupant infected; ^Any room occupant in prior 2 weeks
infected. Otter , Yezli, French. ICHE. 2012;32:687-699
3.5
4
EVALUATION OF HOSPITAL ROOM ASSIGNMENT
AND ACQUISITION OF CDI
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Study design: Retrospective cohort
analysis, 2005-2006
Setting: Medical ICU at a tertiary care
hospital
Methods: All patients evaluated for
diagnosis of CDI 48 hours after ICU
admission and within 30 days after ICU
discharge
Results (acquisition of CDI)
Admission to room previously
occupied by CDI = 11.0%
 Admission to room not previously
occupied by CDI = 4.6% (p=0.002)
Shaughnessy MK, et al. ICHE 2011;32:201-206
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KEY PATHOGENS WHERE ENVIRONMENTIAL
SURFACES PLAY A ROLE IN TRANSMISSION
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MRSA
VRE
Acinetobacter spp.
Clostridium difficile
Norovirus
Rotavirus
SARS
TRANSMISSION MECHANISMS INVOLVING THE
SURFACE ENVIRONMENT
Rutala WA, Weber DJ. In:”SHEA Practical Healthcare Epidemiology”
(Lautenbach E, Woeltje KF, Malani PN, eds), 3rd ed, 2010.
ENVIRONMENTAL CONTAMINATION
ENDEMIC AND EPIDEMIC MRSA
Dancer SJ et al. Lancet ID 2008;8(2):101-13
ENVIRONMENTAL SURVIVAL OF KEY
PATHOGENS ON HOSPITAL SURFACES
Pathogen
Survival Time
S. aureus (including MRSA)
7 days to >12 months
Enterococcus spp. (including VRE)
5 days to >46 months
Acinetobacter spp.
3 days to 11 months
Clostridium difficile (spores)
>5 months
Norovirus (and feline calicivirus)
8 hours to >2 weeks
Pseudomonas aeruginosa
6 hours to 16 months
Klebsiella spp.
2 hours to >30 months
Adapted from Hota B, et al. Clin Infect Dis 2004;39:1182-9 and
Kramer A, et al. BMC Infectious Diseases 2006;6:130
FREQUENCY OF ACQUISITION OF MRSA ON GLOVED HANDS AFTER
CONTACT WITH SKIN AND ENVIRONMENTAL SITES
No significant difference on contamination rates of gloved hands
after contact with skin or environmental surfaces (40% vs 45%;
p=0.59)
Stiefel U, et al. ICHE 2011;32:185-187
ACQUISITION OF MRSA ON HANDS AFTER CONTACT
WITH ENVIRONMENTAL SITES
ACQUISITION OF MRSA ON HANDS/GLOVES AFTER CONTACT
WITH CONTAMINATED EQUIPMENT
TRANSFER OF MRSA FROM PATIENT OR
ENVIRONMENT TO IV DEVICE AND TRANSMISSON OF
PATHOGEN
TRANSMISSION MECHANISMS INVOLVING THE
SURFACE ENVIRONMENT
Rutala WA, Weber DJ. In:”SHEA Practical Healthcare Epidemiology”
(Lautenbach E, Woeltje KF, Malani PN, eds), 3rd ed, 2010.
ACQUISITION OF C. difficile ON PATIENT HANDS AFTER CONTACT WITH
ENVIRONMENTAL SITES AND THEN INOCULATION OF MOUTH
Justification for Using a Disinfectant for
Non-Critical Surfaces
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Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Disinfectants may have persistent antimicrobial activity
Disinfectant Product Subsitutions
Donskey CJ. AJIC. May 2013
Improve Effectiveness of Cleaning/Disinfection
Donskey AJIC. May 2013
Automated Disinfection Devices
Donskey CJ. AJIC. May 2013
Does Improving Surface Cleaning and Disinfection
Reduce Healthcare-Associated Infections?
Donskey CJ. AJIC. May 2013
“As reviewed here, during the past decade a growing body
of evidence has accumulated suggesting that
improvements in environmental disinfection may prevent
transmission of pathogens and reduce HAIs. Although,
the quality of much of the evidence remains suboptimal, a
number of high-quality investigations now support
environmental disinfection as a control strategy”
Justification for Using a Disinfectant for
Non-Critical Surfaces
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Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Disinfectants may have persistent antimicrobial activity
Surface Disinfection
Effectiveness of Different Methods
Rutala, Gergen, Weber. 2013, Unpublished Resutls
Technique (with cotton)
MRSA Log10 Reduction (QUAT)
Saturated cloth
4.41
Spray (10s) and wipe
4.41
Spray, wipe, spray (1m), wipe
4.41
Spray
4.41
Spray, wipe, spray (until dry)
4.41
Disposable wipe with QUAT
4.55
Control: detergent
2.88
It appears that not only is disinfectant use
important but how often is important
Daily disinfection vs clean when soiled
Daily Disinfection of High-Touch Surfaces
Kundrapu et al. ICHE 2012;33:1039
Daily disinfection of high-touch surfaces (vs cleaned when soiled) with sporicidal
disinfectant (PA) in rooms of patients with CDI and MRSA reduced acquisition of
pathogens on hands after contact with surfaces and of hands caring for the patient
Justification for Using a Disinfectant for
Non-Critical Surfaces
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Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Disinfectants may have persistent antimicrobial activity
Transfer of C. difficile Spores by
Nonsporicidal Wipes
Cadnum et al. ICHE 2013;34:441-2
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Detergent/nonsporicidal wipes transfer or spread microbes/spores to
adjacent surfaces; disinfectants inactivate microbes
EFFECTIVENESS OF DISINFECTANTS
AGAINST MRSA AND VRE
Rutala WA, et al. Infect Control Hosp Epidemiol 2000;21:33-38.
Bacterial Contamination of Water With and
Without a Disinfectant
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Detergent become contaminated and result in seeding the patient’s
environment with HA pathogens. Ayliffe et al. Brit Med J. 1966;2:442-5
Justification for Using a Disinfectant for
Non-Critical Surfaces
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Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation-CDC 2007 and OSHA 1991
Disinfectants may have persistent antimicrobial activity
QUATS AS SURFACE DISINFECTANTS
WITH PERSISTENT ACTIVITY
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Study of computer keyboards:
Challenge with VRE or P.
aeruginosa
Keys wiped with alcohol or
quats (CaviWipes, Clorox
Disinfecting Wipes, or SaniCloth Plus)
Persistent activity when not
removed
Rutala WA, White MS, Gergen MF,
Weber DJ. ICHE 2006;27:372-77.
Justification for Using a Disinfectant for
Non-Critical Surfaces
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Surfaces may contribute to transmission of epidemiologically-important
pathogens such as MRSA, VRE, C. difficile, MDR-Acinetobacter, others
Disinfectants prevent HAIs
Disinfectants are more effective than detergents in reducing
contamination on surfaces
Detergents become contaminated and result in seeding the patient’s
environment with bacteria
Disinfection of non-critical patient care items and equipment is
recommended for patients on isolation
Disinfectants may have persistent antimicrobial activity
LECTURE OBJECTIVES
•
Disinfectants
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•
Knowledge and controversies
Detergents
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Knowledge and controversies
• Microfiber

Knowledge and controversies
Justifications Used by Some for Using a
Detergent for Non-Critical Surfaces
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Environmental surfaces and noncritical patient care items contribute
minimally to healthcare-associated infections
No difference in HAI rates when surfaces are cleaned with detergents
versus disinfectants
Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)
Costs
Occupational health exposure issues
Use of antiseptics and disinfectants may select for antibiotic resistant
bacteria
Less environmental impact
Justifications Used by Some for Using a
Detergent for Non-Critical Surfaces
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Environmental surfaces and noncritical patient care items contribute
minimally to healthcare-associated infections
No difference in HAI rates when surfaces are cleaned with detergents
versus disinfectants
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Contaminated surfaces provide an important potential source for transmission of
HA pathogens. Greater than 20 studies have demonstrated that environmental
disinfection interventions can end outbreaks or decrease incidence of HAIs
Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)
Costs, occupational health exposure issues, less environmental impact
Use of antiseptics and disinfectants may select for antibiotic resistant
bacteria
Justifications Used by Some for Using a
Detergent for Non-Critical Surfaces
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Environmental surfaces and noncritical patient care items contribute
minimally to healthcare-associated infections
No difference in HAI rates when surfaces are cleaned with detergents
versus disinfectants
Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)
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Given the high prevalence of epidemiologically-important pathogens in most
countries in the world and that routine screening is rarely conducted, we should
employ disinfectants for all hospitalized patients as unsuspected colonization is
a routine occurrence
Costs, occupational health exposure issues, less environmental impact
Use of antiseptics and disinfectants may select for antibiotic resistant
bacteria
Justifications Used by Some for Using a
Detergent for Non-Critical Surfaces
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Environmental surfaces and noncritical patient care items contribute
minimally to healthcare-associated infections
No difference in HAI rates when surfaces are cleaned with detergents
versus disinfectants
Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)
Costs-approx same QUAT-$0.16-0.20/use gal ($20/1:128dil) vs detergent$0.23/use gal ($15/1:64dil)
Occupational health exposure issues
Use of antiseptics and disinfectants may select for antibiotic resistant
bacteria
Less environmental impact
Justifications Used by Some for Using a
Detergent for Non-Critical Surfaces
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Environmental surfaces and noncritical patient care items contribute
minimally to healthcare-associated infections
No difference in HAI rates when surfaces are cleaned with detergents
versus disinfectants
Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)
Costs
Occupational health exposure issues
Use of antiseptics and disinfectants may select for antibiotic resistant
bacteria
Less environmental impact
Occupational Exposures to Disinfectants
at UNC Health Care
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In regard to skin or respiratory irritation and allergies in HCP, most studies
refer to glutaraldehyde or formaldehyde, these products are not
recommended for use on noncritical surfaces
Surface disinfection in US generally accomplished by QUAT, phenolic,
improved HP and chlorine
We are evaluating all chemical exposures for ten years (2003-2012, 9500
employees) and have rarely seen an employee in OHS with chronic
respiratory complaint related to a low-level disinfectant (~30M persons
days of exposure [Weber, Rutala, Consoli. 2013. Unpublished data])
Need well-designed immunologic evaluations of randomly selected HCP
and controls, not case series without controls
Justifications Used by Some for Using a
Detergent for Non-Critical Surfaces
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Environmental surfaces and noncritical patient care items contribute
minimally to healthcare-associated infections
No difference in HAI rates when surfaces are cleaned with detergents
versus disinfectants
Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)
Costs
Occupational health exposure issues
Use of antiseptics and disinfectants may select for antibiotic resistant
bacteria
Less environmental impact
Is There A Relationship Between Germicide Use
and Antibiotic Resistance
Weber DJ, Rutala WA. ICHE 2006;27:1107-1119
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Possible to develop mutants in the laboratory with reduced susceptibility to
disinfectants and antiseptics ( 1ppm to 4ppm, triclosan) that demonstrate
decreased susceptibility or resistance to antibiotics.
Concentration of triclosan used in practice greatly exceed the MICs
observed (4 vs 2000-20,000ppm), the clinical relevance is questionable
To date no evidence that using antiseptics or disinfectants selects for
antibiotic-resistant organisms or that mutants survive in nature
Antibiotic-resistant bacteria are as susceptible to germicides as antibioticsusceptible strains
Germicides should be used where there are scientific studies
demonstrating benefit
Justifications Used by Some for Using a
Detergent for Non-Critical Surfaces
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Environmental surfaces and noncritical patient care items contribute
minimally to healthcare-associated infections
No difference in HAI rates when surfaces are cleaned with detergents
versus disinfectants
Use disinfectants for epidemiologically-important pathogens (MRSA, VRE)
Costs
Occupational health exposure issues
Use of antiseptics and disinfectants may select for antibiotic resistant
bacteria
Less environmental impact
Environmental Impact
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Bleach
Reacts with soils, bacteria and stains; 95-98% rapidly breaks
down to salt and water; remaining 2-5% treated by sewer and
septic systems
 Does not contaminate ground water because it does not survive
sewage treatment
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QUATs
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Almost completely degraded in sewage sludge
How About “Green” Products?
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Today, the definition of green is unregulated
It can mean:
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Sustainable resources/plant-based ingredients
Free of petrochemicals
Biodegradable
No animal testing
Minimal carbon footprint
Traded fairly
It can, but does not always mean “safer”
Efficacy of “Green” Products to
Inactivate MDR Pathogens
Rutala, Gergen, Weber. Unpublished results. 2013
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No measurable activity against A. baumannii, A.
xyloxidans, Burkholderia cenocepacia, K. pneumoniae,
MRSA and P. aeruginosa, VRE, Stenotrophomonas
maltophilia
LECTURE OBJECTIVES
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Disinfectants
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Knowledge and controversies
Detergents
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Knowledge and controversies
• Microfiber
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Knowledge and controversies
Wipes
Cotton, Disposable, Microfiber, Cellulose-Based, Nonwoven Spunlace
Wipes
Cotton, Disposable, Microfiber, Cellulose-Based, Nonwoven Spunlace
Wipe should have sufficient wetness to achieve the disinfectant contact time.
Discontinue use of a disposable wipe if it no longer leaves the surface visibly
wet for > 1m
Microfiber Cloth/Wipe/Pads
Microfiber Cleaning
• Pad contains fibers (polyester and polyamide) that provide a
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cleaning surface 40 times greater than conventional string mops
Proposed advantages: reduce chemical use and disposal
(disinfectant solution not changed after every third room, clean
microfiber per room [washing lifetime 500-1000x]); light (~5 lb less
than string mop) and ergonomic; reduce cleaning times.
Does the microfiber provide the same or better removal of
microorganisms on surfaces?
Efficacy of Different Microfiber Cloths at
Removing Surface Microorganisms
Smith et al. J Hosp Infect 2011;78:182-186
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Mean log10 reduction ~2. Overall mean differences in the performance of
individual, reusable cloths showed a log10 reduction of <1.
Mean Number of C. difficile Removed from
Laminate on Repeat Washings of Cloths
Smith et al. J Hosp Infect 2011;78:182-186
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Mean log10 reduction was >2. The performance of the reusable cloths
improved initially, but then slightly declined after 150 washes
Effectiveness of Microfiber Mop
(Rutala, Gergen and Weber, Am J Infect Control, 2007;35:569)
Disinfectant-regular mop
95%
Disinfectant-microfiber system
95%
Disinfectant-microfiber mop and regular
mop bucket
Detergent-regular mop
88%
Detergent-microfiber system
95%
Detergent-microfiber mop and regular
mop bucket
78%
68%
Microfiber Efficacy and Use
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> 2 log10 reduction for microbial removal. Smith et al. JHI. 2011;78:182
Currently, we use the microfiber mops for the floors with a disinfectant. We
use several cotton, wiping cloths per room for elevated surfaces but are
transitioning to microfiber cloths
We use a disinfectant because cleaning cloths such as microfiber or cotton
can disperse microorganisms when a disinfectant is not incorporated or is
depleted
The ability of cotton/microfiber to retain QUATs ensures that microbes in contact
with cloth/pad are also in contact with QUAT and will not redeposit on surface
Instructions on preparation, use, and washing should be followed to maximize
cloth performance
Microbial Contamination of
Reusable Cleaning Cloths
Sifuentes et al. AJIC. Epub. 2013
Microfiber towels harbor greater numbers of bacteria
compared with the cotton towels
Microbial Contamination of Reusable
Cleaning Cloth
Rutala, Gergen, Weber. AJIC 2007;35:569
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Hospital laundering practices should be assessed to
ensure they are sufficient to remove all viable
microorganisms from microfiber
Microfiber may have special laundering processes (may
exclude bleach, fabric softeners, wash temperatures
<200oC and drying less <140oC)
Our assessment of our routine laundering cycle showed
no microorganisms recoverable.
Wipes
Cotton, Disposable, Microfiber, Cellulose-Based, Nonwoven Spunlace
Optimizing Disinfectant Application in
Healthcare Facilities
KD MacDougall, C Morris. Infection Control Today. June 2006
Significant decline in the concentration of QUAT when cotton rags or
cellulose-based wipers were compared to nonwoven spunlace wipers
Optimizing Disinfectant Application in Healthcare Facilities
KD MacDougall, C Morris. Infection Control Today. June 2006
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Do different wipes provide a higher active QUAT concentration: yes
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Virgin cotton rags and cellulose-based wipers: 30-70% drop in QUAT
concentration in first 3 hours
Nonwoven spunlace wipers with a fiber content intended to yield QUAT
compatibility: ~10-15% drop
Summary-Nonwoven spunlace wipers maintain the QUAT concentration
released to surface at near target concentration levels. A sharp reduction in
QUAT with cotton, microfiber and cellulose-based wipers (electrostatic
attraction between two oppositely charged ions [quats +,
bacteria/cotton/microfiber -]). The QUAT retained in cotton/microfiber
ensures that microbes in contact with cloth/pad are also in contact with
QUAT and will not redeposit on surface
Effectiveness of Different Wipes and
Solutions in Removing MRSA from Surface
Rutala, Gergen, Weber. Unpublished results. 2013
Even though cotton and microfiber retain QUAT, they provide
equivalent removal/inactivation of MRSA from surface (log10
reduction) as nonwoven spunlace wiper
Solution
Cotton
KC 06411
Microfiber
Cellulose
Sterile Water
3.07
3.22
3.88
2.39
Detergent
2.88
3.08
3.47
3.13
QUAT 1
4.41
4.60
4.51
4.40
QUAT 2
3.76
3.74
3.87
2.75
Objective
Describe emerging knowledge and controversies
related to disinfectants, detergents and microfiber
cleaning products
Disinfectants, Detergents and Microfiber
Summary
• Contaminated surface environment in hospital rooms is important in
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transmission of HA pathogens
Appropriate use of disinfectants prevent transmission of pathogens
and reduce HAIs
Detergents alone do not kill pathogens and can cross-contaminate
the environment
Microfiber cloths are effective in removing microorganisms from
surfaces. To prevent dispersion of microbes we use a disinfectant.
THANK YOU!
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