how to select an ideal disinfectant

8/13/2019 How to Select an Ideal Disinfectant

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2003: CDN Hospitals notified >900 patientsthat improper sterilization of equipmentmay have exposed them to HIV, Hepatitis

and other diseases. $150M class actionlawsuit filed alleging negligence in failing tomeet adequate sterilization standards.

Government ordered a province-wide

audit of hospital infection-control practices

Healthcare Quarterly Vol. 8, Special Issue

October 2005


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Canadian law clearly establishes a positiveduty on care providers to inform patients oferrors that occur during their care

When care providers realize that patientsmay have been exposed to infection fromequipment, other patients or healthcare

workers, a legal obligation may arise tocontact patients to warn them of the riskand provide advice regarding appropriatefollow-up testing and care.


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The removal of adherentvisible soil, blood, proteinsubstances (tissue) andother debris from surfacesby mechanical or manualprocess

Generally accomplishedwith water and detergents

Removes or eliminates thereservoirs of potentialpathogenic organisms


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Viruses (enveloped)

Bacteria (Gram +ve & Gram -ve)

Fungi Viruses (non-enveloped)

Mycobacteria

Protozoa

Bacterial Spores

MostSusceptible

Least

Susceptible


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Once the device has been defined

determine the Disinfection Process

Choose the CORRECT

Product

Consider the Device Classification(According to Spaulding)


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Sterilization

High Level

Disinfection

Intermediate

Level Disinfection

Low Level

Disinfection

Critical Devices*

Semi-CriticalDevices

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


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refers to the level of disinfection requiredwhen processing noncritical items or someenvironmental surfaces and kills mostvegetative bacteria and some fungi as wellas enveloped viruses but not mycobacteriaor bacterial spores.


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refers to disinfectant that kills vegetativebacteria, most viruses and most fungi butnot resistant bacterial spores.


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refers to a process which destroysvegetative bacteria, mycobacteria, fungi,enveloped and non-enveloped viruses, butnot necessarily bacterial spores


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refers to the chemical disinfection processthat destroys all forms of microbial lifeincluding bacteria, viruses, spores andfungi.


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LLD ILD HLD ChemicalSterilants

Enveloped Viruses 3 Log /99.9%

3 Log /99.9%

VegetativeBacteria

6 Log /99.9999%

6 Log /99.9999%

Fungi 5 Log /99.999%

5 Log /99.999%

5 Log /99.999%

5 Log /99.999%

Non-EnvelopedViruses

3 Log /99.9%

3 Log /99.9%

Mycobacteria 4 Log / 99.99% 6 Log /99.9999%

6 Log /99.9999%

Spores 6 Log /99.9999%

6 Log /99.9999%


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Whats in your bottle?


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Disinfectants are the backbone ofEnvironmental Infection Control

>8000 Products registered in the U.S. &Canada

50% of which are used for HealthcareInfection Control

There are 300 different active chemistries 14 are in 95% of the disinfectant products

6 are the most common


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Detergency properties for cleaning

Not Readily Neutralized in Organic orInorganic Matter

Microorganism Resistance will not develop Broad-Spectrum & Fast Acting Germicidal

Activity


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Alcohols Chlorine Phenolics QUATs AHP

Must havegood cleaningability toremoveorganic soilload onsurface.

Alcohols arenoteffectivecleanersas they do notcontaindetergency

Properties

Chlorine canbeinactivated bya soilload and donotcontain

detergencyProperties

Phenolics areineffectivecleaners

QuaternaryAmmoniaCompoundsare noteffectivecleaners

AHP contains acombination ofsuperiorsurfactantsthat areproveneffective

cleaners insynergy withH2O2

Is effective in asoil load.

Testing is donewith no soil

load.

Neutralized bysoil.

Testing is donewith a soil load

Testing isgenerally done

without a soilload.

Testing is donewith a soil load.

Will not lead todevelopmentof resistantorganisms

Activeingredientevaporates


Leaves activeingredientresidual onsurface


Activeingredienthydrogenperoxide

evaporatesfrom surface


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VegetativeBacteria

YES3 min to 10 min

YES10 min

YES5 min to 10 min

YES3min to 10 min

YES30 sec to 20min

EnvelopedViruses

YES3 min to 10 min

YES10 min

YES3 min to 10 min

YES3 min to 10 min

YES1 min to 5 min

Fungi YES3 min to 10 min

YES10 min

YES3 min to 10 min

YES3 min to 10 min

YES3 min to 5 min

Non-EnvelopedViruses

NO YES10 min

YES / NOProductSpecificReview label3 min to 10 min

NO YES1 min to 5 min

Mycobacteria YES3 min to 10 min

YES10 min

YES3 min to 10 min

ONLY WITHSOLVENT ORALCOHOL3 min10 min

YES1 min to 5 min

BacterialSpores

NO YES10 min

NO NO YES10 min


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OPA Gluteraldehyde AHPFungi YES

10 minYES20 min45 min

YES5 min20 min

Mycobacteria YES10 min

YES20 min45 min

YES5 min20 min

Bacterial Spores YES32 hours

YES812 hours

YES20 min6 hours


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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 expensiveitems such as flexible endoscopes


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Does not havestoragelimitations

Flammable Highlyreactive withotherchemicalscreating toxicby-products

Toxicity posesrisk for waterand foodcontamination.Cannot beused around

children

Caution withproducts thatcontainsolvents oralcohols

Non-flammable orcombustible

Realistic Shelflife and stabilty

Readilyevaporatesdecreasingconcentration

Readilydegradesonce open,dilutedproduct must

be made freshdaily

Relativelystable in bothconcentrationand UseDilution

Relativelystable in bothconcentrationand UseDilution

Stable inconcentrateand UseDilution

Compatible witha wide variety ofsurfaces andmaterials

Concerns withplastics andglues

Concerns withstainless steeland fabricmaterials

Concerns withresidue buildup on vinyl

Concerns withresidue buildup or Quatburn on someflooring and

vinyl

Concerns withprolongedexposure tocopper andbrass


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OPA Gluteraldehyde AHP

Does not have storagelimitations


Do not store at elevatedtemperatures and keepaway from ignition sources.


Realistic Shelf life andstability

Shelf life decreasesto 75 days oncebottle is opened

Once activated shelf liferapidly decreases

Shelf life does notdecrease onceopened

Compatible with a widevariety of surfaces andmaterials

Concerns withplastics and glues

Concerns with residuebuild up on vinyl

Concerns withprolonged exposure tocopper and brass


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Non-Toxic to humans & animals Non-Allergenic & non-sensitizing Non-Hormone disruption

Certain microbicidal chemicals or theirbreakdown products can disrupt hormonefunction 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 bodycavity


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Indoor AirQuality (VOCs)

Contains highlevels of VOCswhichcontribute topoor indoor air

quality

Creates highlevels of VOCsthroughreactions withsurface and

soil load

Contain VOCs;Toxicity posesrisk for waterand foodcontamination

Contain VOCs; Contains noVOCs

Does notcontainhormonedisrupting orcarcinogenic

chemicals

Does notcontain APEs /NPEs

Highlyreactivecreating toxic/carcinogenic

by-products

PhenolicCompoundshave beenfound to becarcinogenic

Manyformulationscontain APEs /NPEs

Does notcontainAPEs/NPEs ;is notcarcinogenic

Will not lead todevelopment ofresistantorganisms





Activeingredienthydrogenperoxideevaporates

from surface


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Indoor Air Quality(VOCs)

Contains high levels ofVOCs which contributeto poor indoor airquality

Contain VOCs; Requiresspecial ventilation

Contains no VOCs

Adverse Reactions toResidues left on surfacesafter reprocessing

Residues have lead toanaphylactic reactions

Anaphylactic reactionsto both vapours andresidues

No Active Residue lefton surface

Will not lead todevelopment of resistantorganisms

Leaves activeingredient residual onsurface

Leaves activeingredient residual onsurface

Active ingredienthydrogen peroxideevaporates fromsurface


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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


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Positiveenvironmentalprofile includingindoor airquality.

Contains highlevels of VOCswhichcontribute topoor indoor airquality

Creates highlevels of VOCsthroughreactions withsurface andsoil load

Contain VOCs;Toxicity posesrisk for waterand foodcontamination

Contain VOCs;often containhormonedisruptors

Contains noVOCs and nohormonedisruptors

Will not lead todevelopment ofresistantorganisms





Activeingredienthydrogenperoxideevaporatesfrom surface

Carries EcoLogoor Green SealCertification

Does not meetcertificationcriteria

Does notmeetcertificationcriteria

Does not meetcertificationcriteria

Only1 productmeetsCanadas

EcoLogocriteria

Receivedcertificationsby EcoLogoand GreenSeal


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Positive environmentalprofile including indoorair quality.

Contains high levelsof VOCs whichcontribute to poorindoor air quality

Contain VOCs;requires specialventilation

Contains no VOCs;does not requirespecial ventilation

Restrictions to Disposal Restrictions in disposal Restrictions in disposal Can be disposed intomunicipal wastewater


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Clearly outlines the requirements of whatmust 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 cautionarystatements


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Label requirements continued: Claims Area or Site of Use Directions for Use

Specific directions for preparing in-usedilution including ratios or metric units

Reference to level of hardness of productdiluent at time of testing

Pre-cleaning or cleaning requirements Contact Times Temperature Stability of diluted or in-use product


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Label requirements continued:

Rinse procedures

Directions for Use for intended use againstbloodborne pathogens

Reference to PPE

Directions for disposal of infectious waste


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Remember:

Match Product withProtocol

Surfaces vsInstruments

Cleaning = 1ststep

Disinfection = 2nd

step Contact Time is

MANDATORY!


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Infection Control Guidelines: Hand Washing,

Cleaning, Disinfection and Sterilization in HealthCare, Health Canada. Dec 1998, Vol 24S8

Routine Practices and Additional Precautions forPreventing the Transmission of Infection in Health

Care, Health Canada. July 1999, Vol 25S4Guidelines for Environmental Infection Control in

Healthcare Facilities, CDC. MMWR June 2003,Vol 52, No RR-10

Best Practices for Cleaning, Disinfection andSterilization in All Health Care Settings, PIDAC,May 2006


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Block S. Disinfection. Sterilization, andPreservation, 5thEd. 2001

Mayhall CG. Hospital Epidemiology and

Infection Control, 3rdEd. Philadelphia.Lippincott Williams & Wilkins, 2004:1473-1522

Cokendolpher JC & Haukos JF. The PracticalApplications of Disinfection and Sterilization

in Health Care Facilities, Chicago. AmericanHospital Association, 1996: 47-59

Rutala WA. APIC Guideline for Selection andUse of Disinfectants AJIC 1990:17(2) 99-117


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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 CommonlyUsed Surface Disinfectants: Alcohol-, Phenol-,

Chlorine- and Quat Disinfectants.www.infectioncontroltoday.com/articles/0b1feat2.html

Russel AD. Glutaraldehyde: Current Status and

Uses. Inf Con & Hosp Epi 1994;15 (11) 724-733Rutala WA. Sporicidal Activity of Chemical

Sterilants Used in Hospitals. Inf Con & Hosp Epi1993; 14(12) 713-718
http://www.infectioncontroltoday.com/articles/0b1feat2.htmlhttp://www.infectioncontroltoday.com/articles/0b1feat2.htmlhttp://www.infectioncontroltoday.com/articles/0b1feat2.htmlhttp://www.infectioncontroltoday.com/articles/0b1feat2.html


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Rutala WA & Weber DJ. The benefits ofsurface disinfection. AJIC 2004;32(4) 226-229

Woldkoff P et al. Risk in cleaning: chemical

and physical exposure. Sci of Total Env1995:215:135-156

Sattar SA. Current issues in testing, selectionand use of microbicides in infection control:

a critical review. AICJ 2004;9(3):84-100Health Canada. Therapeutic Products

Programme Guidelines: Disinfectant Drugs.Fall 1999


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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 byHealth Care Providers. http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.html
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.htmlhttp://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.htmlhttp://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.htmlhttp://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.htmlhttp://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.htmlhttp://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.htmlhttp://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.htmlhttp://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.htmlhttp://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.htmlhttp://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s8/fcindexe.html

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