Are we cleaning the right way?

1
Surface Disinfection
Narrowing the Gap between Science, Regulation
Practice
Steve Wollak Account Executive 3M Co. Mary
Brachman RN MS
DisinfectHO-Aug05
2
Are we cleaning/disinfecting the right way?
3
10 Factors Influencing EffectiveCleaning and
Disinfecting

• Proper Procedure/Best Practices
• Type of surface
• Surface orientation/design
• Concentration/Dilution
• Organic Soil Present
• Resistance of Microorganism
• Contact Time of Disinfectant
• Amount of solution used
• Method of application
• Spray Bottle vs. buckets
• - Mop/Bucket vs. Microfiber
• Ventilation, temperature, humidity

4
Are we cleaning the right way?

• Are we set up the right way?
• How we can help SAVE the Environment?

5
Are we cleaning the right way?

• Super Bugs
• - MRSA
• - VRE
• - Norwalk
• Procedures
• - 10 Key Points
• - Contact Time
• Quat Binding

6
MRSA

• Methicillin-resistant Staphylococcus aureus
• Discovered in 1961 in the UK.
• Widespread in hospital settings
• Commonly termed a Superbug
• Superbug
• Strains of bacteria
• Resistant to antibiotics
• Hard to treat
• Causes
• Fever
• Lethargy
• Headaches
• Skin boils or abscesses

• In rare cases can cause pneumonia, blood
  infections,
• toxic shock and death.

7
VRE

• Vancomycin-Resistant Enterococcus
• Discovered in 1985
• Found in the digestive and urinary tracts of some
  humans
• Dangerous to immuno-compromised individuals
• Pass resistant genes to other bacteria
• Resistant to the antibiotic Vancomycin
• While infection of healthy individuals is
  uncommon, it is possible that they could be
  colonized with newly-resistant bacteria.

8
Norwalk

• Norovirus
• Causes around 50 of all gastroenteritis
• Stomach pain
• Diarrhea
• Vomiting
• Considered the most important group of viruses
  associated with this condition
• Today, Norovirus may refer either to the entire
• group of viruses or just Norwalk.

9
10 Key Points

• CDC Guideline Housekeeping Surfaces1
• General Recommendation
• Keep surfaces clean e.g. regular basis, spills,
  visibly soiled (EC II D/S IB)
• Wet dust horizontal surfaces regularly e.g.
  daily, 3x/wk using disinfectant (D/S IB)
• Use
• Detergent or disinfectant, depends on nature of
  soil (EC II)
• Use disinfectant (D/S IB)

10
10 Key Points

• CDC Guideline Housekeeping Surfaces1
• General Recommendation
• Disinfect high-touch more often than minimal
  touch surfaces (EC II)
• Follow mfg. recommendations for use, (EC/DS IB,
  IC), especially dilution (D/S IB)
• Contact time gt 30 seconds (D/S II)

11
10 Key Points

• CDC Guideline Housekeeping Surfaces1
• General Recommendation
• Avoid cleaning methods that produce aerosols or
  disperse dust (EC IB)
• Replace solution
• frequently per facility policy (EC II)
• frequently per facility policy e.g. every 3 rooms
  or lt 60 minutes (D/S IB)

12
10 Key Points

• CDC Guideline Housekeeping Surfaces1
• General Recommendation
• Change decontaminate mop heads
• at least daily, after spill clean up per policy
  (EC II)
• regularly (D/S IB)
• Clean disinfect BBF spills (EC, D/C IB, IC)
• Tuberculocidal (Phenolic), Quat with HIV/HBV
  label claim or Bleach

13
Factors Influencing Cleaning and Disinfecting
Bacterial Spores
C. difficile
Mycobacterium

Tuberculosis

Non-lipid (small) viruses Norwalk Fungi
Atheletes foot Vegetative Bacteria Pseudomonas S
taphylococcus Lipid viruses Hepatitis B
HIV/AIDS SARS
Resistance of Microbes to Disinfectants
ST
HLD
ILD
Hard to Kill
LLD
Easy to Kill
ST-sterilant HLD-high level disinfectant ILD-Inte
rmediate level disinfectant LLD-low level
disinfectant
Favero, MS. In, Block SS. Disinfection,
Sterilization Preservation, 1991
14
Factors Influencing Cleaning and Disinfecting
Contact Time
Time to kill microorganisms on surfaces EPA
testing methodology Vs Pre-cleaned surfaces
15
Testing Disinfectants against Bacteria

• EPA Hard Surface Carrier Test
• 60 Non-porous carriers
• Test organisms - Salmonella, pseudomonas, staph
  aureus
• Organic Soil (5 blood)
• Hard Water
• Requirements 59/60 no growth

16
Time to Kill Organisms on Surfaces
Log10 Reduction
S. aureus
P. aeruginosa
Rutala, W. ICHE 20002133-38
17
Contact Time on Non-Critical Surfaces¹

• Contact time is rarely per label claim exposure
  time 1- 1.5 minutes
• 10 min. contact time require 6 applications
• 6 log reduction in 30 seconds

Rutala, W. APIC 2003
18
Contact Time on Non-Critical Surfaces²

• Low-level disinfection (LLD) for at least 30-60
  seconds is supported by at least 14 scientific
  studies
• 10 minute contact time is meant for EPA
  registration, NOT the time it takes to kill
  microorganisms on pre-cleaned surfaces

Rutala, W. APIC Annual Ed. Conference 2005
19
Disinfectants for Non-critical Surfaces
Germicide Use Concentration
Alcohol 70-90

• Chlorine 5 1100 dilution (sm. spills)
• 110 dilution (lg. spills)

500 ppm
5000 ppm
Phenolic Mfg. use dilution Quat
Mfg. use dilution
Exposure time gt 1 minute
Rutala, W. APIC Ed. Conference 2005
20
Some fabrics and materials have a strong
attraction for the active ingredient in QUATS.
- QUAT preferentially attaches or exhausts to
fabric - - QUAT level in solution is reduced -
- Efficacy of the disinfectant decreases -
Disinfectants are registered with the EPA and
efficacy claims are approved at a specific level
of active ingredients. When the QUAT level is
less than the level approved by the EPA, the
efficacy claims are no longer valid.
QUAT Binding
Quaternary Ammonium Chloride
21
QUAT Binding

• Disinfectants
• How are you using them?
• How do you test them (test kits)?
• How do we know that the surface is clean and
  disinfected (Environmental Monitors)?
• PPM
• Testing done to meet EPA requirements for the
  disinfectant claim
• If it falls below the PPM it is out of spec and
  no longer a disinfectant
• How to calculate ppm QUAT in a Disinfectant
• The EPA registered label specifies the percent
  active
• quaternary ammonium chloride in the
  concentrate.
• Add the total active ingredients and use the
  following equation to determine
• PPM QUAT.
• ( Active)(100)(1dilution) x 1,000,000
  _______ ppm QUAT
• Example 13.238 13.238 26.476
• 26.476 100(3651) x 1,000,000 723 ppm

22
Cleaning Methods
Spray bottle, squirt bottle, or hand pail? Is
one method better than the other?
23
Effectiveness of Disinfection Methods For VRE
No. positive surfaces
Spray Bottle
Bucket

• First 60/376 (16) 0/135
• Second 8/82 (10)
• Third 3/28 (11)
• Fourth 0/10 (0)

Byers. ICHE 199819261
24
Additional Questions

• CJD killing agent Bleach/CDC
• Bactericidal Hand Soap in patient rooms vs.
  green nonbacterial soap no CDC reference as a
  requirement.
• Dispatch not a 3M product

25
Any Questions?

• Steve Wollak 3M Company
• scwollak_at_mmm.com
• 800-925-2674
• LaMotte QAC Test Kit
• 800 344 3100
• www.lamotte.com