Environmental Disinfection: New Technologies and Current Issues

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Environmental Disinfection New Technologiesand
Current Issues
May 2014

• Gwenda R. Felizardo, BSN, RN, CIC
• Infection Prevention Consultant
• felizardo2_at_comcast.net
• 253-682-7476

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Disclosure

• Not paid by any company whose products are shown
• Products shown or described are to provide
  illustration examples-not to endorse
• Before using any environmental disinfectant or
  device, review all relevant package inserts on
  use, precautions, indications, contradictions
• Appreciation to William Rutala San Raphael
  Hospital for several slides

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Objectives

• Review the critical aspects of environmental
  microorganism transmission in relation to HAIs
• Describe the various technologies and chemicals
  currently on the market and applicability to the
  ambulatory setting
• Discuss must know resources

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• Colonized or infected host
• Touch
• Person-Supplies-Equipment-Instruments

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Environmental ContaminationEndemic Epidemic
MRSA
A number of healthcare surfaces/devices showed
contamination of 7-40 on items tested. More
identified with endemic contamination.
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Furnishings

• Furnishings should be cleanable, including
  waiting room furniture. Vinyl preferred for chair
  coverings
• Wood furniture cabinet finishes deteriorate
  with cleaning- porous
• Infection Prevention Environmental Services
  should have input into decisions about furniture
  purchases
• Carpet does not belong in health care. It cannot
  be disinfected, looks poorly after a short time,
  difficult to clean

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Carpet
Cloth sofa
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Tears, cracks, holes not cleanable
Mattresses
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Toys

• All toys must be washable or given to child
• Crayons in 4-pack coloring sheets
• Bin for clean toys, child picks one
• Bin for used toys, child places on leaving
• Toys washed with dish soap water, dried

CLEAN
USED
CLEAN
USED
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How long can MRSA live in the environment?
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Environmental Survival of Key Pathogens on Dry
Surfaces

• Acinetobacter baumannii
• Outbreak/sporadic strains 26-27 days
• Norovirus
• 21-40 days
• Clostridium difficile
• Vegetative cells 24 hours
• Spores 5-18 months
• MRSA up to 9 months
• VRE up to 6 months

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How Do I Know What Works Best?

• What organisms does it target?
• How long does it take to destroy organisms?
• Does the method require cleaning first?
• Is it EPA approved for healthcare?
• Is it compatible with surfaces?
• How easy is it to use?
• What does the manufacturer recommend?

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Mechanical Disinfection
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So what is available to clean and disinfect

• New Approaches to Room Contamination
• UV light
• Vapor (peroxide)

Still requires manual cleaning with friction
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UV Room Decontamination

1. Fully automated, self calibrates, activated by
   hand held remote
2. No special room ventilation needed
3. Uses UV-C to decontaminate surfaces
4. Measures UV reflected from walls, ceiling, floors
   calculates time dosage to kill pathogens
5. Will power down and audibly notifies the operator
   
6. Reduces colony counts of pathogens by gt99.9
   within 20 minutes

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Hydrogen Peroxide Vapor
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Comparison of HPV Bleach
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Downsides of UV HPV

• Time
• UV 15-25 minutes for vegetative bacteria and 50
  minutes for C difficile spores
• Nanoscale reflective paint reduces time to 5-10
  minutes
• HPV takes approximately 2.5 hours
• Cost
• Not practical for most AMCs or ASCs

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Self Disinfecting Surfaces

• Heavy metal impregnated surface
• Silver
• Copper
• Reduces bacterial burden
• Costly
• Must still manually clean

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Surface Inhibition Products

• Sharklet Patterned Material
• Film that inhibits bacterial survival, growth,
  transfer and migration through pattern alone.
  Surface is comprised of millions of tiny diamonds
  arranged in a distinct pattern that mimics the
  microbe resistant properties of sharkskin.
• Film applied to surfaces

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Green Cleaning Products

• Cleaning is not disinfecting
• Watch out for terms that say natural disinfectant
  or Eco friendly
• Look for EPA registration number

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Accelerated Hydrogen Peroxide 0.3

• AHP oxidizes as it cleans and disinfects
• Broad spectrum-
• MDRO 30 sec-1 minute
• Norovirus 3 minutes (wipes) spray 1 min
• TB 4-5 minutes
• 5 log reduction (99.9) in 30 sec-5 minutes

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Other Low Level Disinfectants

• Kills/inactivates most bacteria, viruses, fungi
• Appropriate for non critical medical devices and
  environmental surfaces
• Quaternary ammonium compounds (Quats) are low
  level disinfectants
• Quats with alcohol-quick drying and very
  effective
• Cleans and disinfects

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Bleach-Sodium Hypochlorite

• Range 5.24-6.25
• Best used for diarrheal illness Clostridium
  difficile
• At store can be misleading dont rely on the
  Manufacturers name (Clorox). May not contain
  bleach.

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Factors Affecting Cleaning Disinfection

• Cleanliness of the surface
• Amount type of contamination
• How is surface cleaned manual, extractor, steam
• Dilution of cleaner disinfectant
• Contact time of disinfectant
• Manufacturers instructions

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Critical Tips

• MUST USE FRICTION
• Microfiber best-releases even amount
• Use multiple wipes or rags
• Dont overload with debris-makes it ineffective
• Make sure chemical has not expired
• Dilute according to manufacturers instructions

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References

• www.disinfectionandsterilization.org
• 2008 CDC Guideline for Disinfection and
  Sterilization in Healthcare Facilities
• 2003 CDC Guidelines for Environmental Infection
  Control in Healthcare Facilities
• 2003 CDC Hand Hygiene Guideline
• 2008 CDC Isolation Precautions Guideline

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References

• http//www.cdc.gov/mrsa/environment/
• http//www.cdc.gov/HAI/toolkits/Evaluating-Environ
  mental-Cleaning.html
• Elements of a program
• Monitoring Checklist

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Resources

• http//www.epa.gov/pesticides/regulating/nanotechn
  ology.html
• http//www.epa.gov/oppad001/chemregindex.htm

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Handouts

• Cleaning Disinfectant Table
• Environmental Cleaning Guideline
• ASC Cleaning Responsibilities

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Cleaning Disinfectant Solutions Table
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Environmental Cleaning Guideline

• General principles
• What to do
• After each patient visit
• End of day
• Weekly
• Monthly
• Special Event Cleaning
• Bed bugs, body fluid, incontinence

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ASC Cleaning
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Question

• Which chemical agent should be used to disinfect
  an area where blood is on the floor or surface?

• Alcohol
• Quaternary ammonium compound
• Bleach/chlorine
• Glutaraldehyde
• Hydrogen Peroxide
• Phenolic
• All except glutaraldehyde

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Question

• Your boss wants you to purchase a green
  disinfectant from the grocery store. What do you
  do?
• Go to EPA website to see if product is listed
• Pull testing data from the company (if any)
• MSDS
• Studies
• Provide alternative or support what you currently
  are using

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Question

• Do you need to close a room down when it has been
  occupied by a patient with MRSA? This is
  primarily a contact organism.

No, Clean normally
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Question

• What equipment should be disinfected after a
  patient leaves an exam room?
• All equipment surfaces touched or used

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Question

• Patient with influenza or pertussis has occupied
  the exam room. These are droplet diseases. How do
  you clean?
• Clean normally-room does not have to be shut down

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Question

• List 3 strategies that reduce environmental and
  supply contamination?
• Hand hygiene
• Barriers
• Frequent cleaning

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Remember

• It takes a bundle of strategies consistently
  performed at appropriate times to minimize or
  eliminate cross contamination

Your every action has a consequence
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What are you dealing with?