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SURFACE DISINFECTION  :

Is surface disinfection necessary?

The effective use of disinfectants is part of a multi-barrier strategy to prevent health-care-associated infections.  Surfaces are considered noncritical items because they contact intact skin.  Use of noncritical items or contact with noncritical surfaces carries little risk of causing an infection in patients or staff.  Thus, the routine use of germicidal chemicals to disinfect hospital floors and other noncritical items is controversial.  A 1991 study expanded the Spaulding scheme by dividing the noncritical environmental surfaces into housekeeping surfaces and medical equipment surfaces.  The classes of disinfectants used on housekeeping and medical equipment surfaces can be similar.  However, the frequency of decontaminating can vary.  Medical equipment surfaces (e.g., blood pressure cuffs, stethoscopes, hemodialysis machines, and X-ray machines) can become contaminated with infectious agents and contribute to the spread of health-care-associated infections.  For this reason, noncritical medical equipment surfaces should be disinfected with an EPA-registered low- or intermediate-level disinfectant.  Use of a disinfectant will provide antimicrobial activity that is likely to be achieved with minimal additional cost or work.

Five reasons germicidal detergent is required:

Environmental surfaces (e.g., bedside table) also could potentially contribute to cross-transmission by contamination of health-care personnel from hand contact with contaminated surfaces, medical equipment, or patients.  Of the seven reasons to use a disinfectant on noncritical surfaces, five are particularly noteworthy and support the use of a germicidal detergent. 

1.       Hospital floors become contaminated with microorganisms from settling airborne bacteria: by contact with shoes, wheels, and other objects; and occasionally by spills.  The removal of microbes is a component in controlling health-care–associated infections.  In an investigation of the cleaning of hospital floors, the use of soap and water (80% reduction) was less effective in reducing the numbers of bacteria than was a phenolic disinfectant (94%–99.9% reduction).  However, a few hours after floor disinfection, the bacterial count was nearly back to the pretreatment level.

2.       Detergents become contaminated and result in seeding the patient’s environment with bacteria.  Investigators have shown that mop water becomes increasingly dirty during cleaning and becomes contaminated if soap and water is used rather than a disinfectant.  For example, in one study, bacterial contamination in soap and water without a disinfectant increased from 10 CFU/mL to 34,000 CFU/mL after cleaning a ward, whereas contamination in a disinfectant solution did not change (20 CFU/mL).  Contamination of surfaces close to the patient that are frequently touched by the patient or staff (e.g., bed rails) could result in patient exposures.  In a study, using of detergents on floors and patient room furniture, increased bacterial contamination of the patients’ environmental surfaces was found after cleaning (average increase = 103.6 CFU/24cm2).  In addition, a P. aeruginosa outbreak was reported in a hematology-oncology unit associated with contamination of the surface cleaning equipment when non-germicidal cleaning solutions instead of disinfectants were used to decontaminate the patients’ environment and another study demonstrated the role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii.  Studies also have shown that, in situations where the cleaning procedure failed to eliminate contamination from the surface and the cloth is used to wipe another surface, the contamination is transferred to that surface and the hands of the person holding the cloth.

3.       The CDC Isolation Guideline recommends that noncritical equipment contaminated with blood, body fluids, secretions, or excretions be cleaned and disinfected after use.  The same guideline recommends that, in addition to cleaning, disinfection of the bedside equipment and environmental surfaces (e.g., bedrails, bedside tables, carts, commodes, door-knobs, and faucet handles) are indicated for certain pathogens, e.g., enterococci, which can survive in the inanimate environment for prolonged periods.

4.       OSHA requires that surfaces contaminated with blood and other potentially infectious materials (e.g., amniotic, pleural fluid) be disinfected.

5.       Using a single product throughout the facility can simplify both training and appropriate practice.

Clean floors with detergent/disinfectant:

Reasons also exist for using a detergent alone on floors because noncritical surfaces contribute minimally to endemic health-care-associated infections, and no differences have been found in healthcare–associated infections rates when floors are cleaned with detergent rather than disinfectant.  However, these studies have been small and of short duration and suffer from low statistical power because the outcome—healthcare–associated infections—is of low frequency. The low rate of infections makes the efficacy of an intervention statistically difficult to demonstrate.  Because housekeeping surfaces are associated with the lowest risk for disease transmission, some researchers have suggested that either detergents or a disinfectant/detergent could be used.  No data exist that show reduced healthcare–associated infection rates with use of surface disinfection of floors, but some data demonstrate reduced microbial load associated with the use of disinfectants.  Given this information; other information showing that environmental surfaces (e.g., bedside table, bed rails) close to the patient and in outpatient settings can be contaminated with epidemiologically important microbes (such as VRE and MRSA); and data showing these organisms survive on various hospital surfaces; some researchers have suggested that such surfaces should be disinfected on a regular schedule.

Spot decontaminating fabrics:

Spot decontamination on fabrics that remain in hospitals or clinic rooms while patients move in and out (e.g., privacy curtains) also should be considered. One study demonstrated the effectiveness of spraying the fabric with 3% hydrogen peroxide.  Future studies should evaluate the level of contamination on noncritical environmental surfaces as a function of high and low hand contact and whether some surfaces (e.g., bed rails) near the patient with high contact frequencies require more frequent disinfection.  Regardless of whether a detergent or disinfectant is used on surfaces in a health-care facility, surfaces should be cleaned routinely and when dirty or soiled to provide an aesthetically pleasing environment and to prevent potentially contaminated objects from serving as a source for health-care–associated infections.  The value of designing surfaces (e.g. hexyl-polyvinylpyridine) that kill bacteria on contact or have sustained antimicrobial activity should be further evaluated.

Mops to be frequently decontaminated:

Several investigators have recognized heavy microbial contamination of wet mops and cleaning cloths and the potential for spread of such contamination. They have shown that wiping hard surfaces with contaminated cloths can contaminate hands, equipment, and other surfaces have been published that can be used to formulate effective policies for decontamination and maintenance of reusable cleaning cloths. For example, heat was the most reliable treatment of cleaning cloths as a detergent washing followed by drying at 80°C for 2 hours produced elimination of contamination. However, the dry heating process might be a fire hazard if the mop head contains petroleum-based products or lint builds up within the equipment or vent hose (American Health Care Association, personal communication, March 2003).  Alternatively, immersing the cloth in hypochlorite (4,000 ppm) for 2 minutes produced no detectable surviving organisms in 10 of 13 cloths.  If reusable cleaning cloths or mops are used, they should be decontaminated regularly to prevent surface contamination during cleaning with subsequent transfer of organisms from these surfaces to patients or equipment by the hands of health-care workers.  

A new mop cleaning technique…

Some hospitals have begun using a new mopping technique involving microfiber materials to clean floors.  Microfibers are densely constructed, polyester and polyamide (nylon) fibers, that are approximately 1/16 the thickness of a human hair.  The positively charged microfibers attract dust (which has a negative charge) and are more absorbent than a conventional, cotton-loop mop.  Microfiber materials also can be wet with disinfectants, such as quaternary ammonium compounds.  In one study, the microfiber system tested demonstrated superior microbial removal compared with conventional string mops when used with a detergent cleaner (94% vs. 68%).  The use of a disinfectant did not improve the microbial elimination demonstrated by the microfiber system (95% vs. 94%). However, use of disinfectant significantly improved microbial removal when a conventional string mop was used (95% vs. 68%) (WA Rutala, unpublished data, August 2006).  The microfiber system also prevents the possibility of transferring microbes from room to room because a new microfiber pad is used in each room.

See the complete recommendations on sterilizer and disinfection at www.cdc.gov “Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008”.

ATS, Inc. also sterility assurance products – see Supplies.

DID YOU KNOW?

§       Autoclave Testing Service, Inc. is one of the first companies nationwide to offer a Mail-In sterilizer monitoring service using biological indicators.  Serving the healthcare industry throughout the United States and Canada since 1986, we have thousands of satisfied customers.

§       We have on-line test results allowing you to access your results at your convenience!  Your Sterilizer Test Report (STR) is posted on-line upon completion of culturing, offering minimum turn-around time.

§       We have 24-hour test results for Steam sterilizers!

§       We have a comprehensive Glossary of Terms related to the sterile processing area (scroll below to view the Glossary).  This is invaluable information, assisting you with this important area of your facility.

ATS, Inc. now stocks sterilization pouches, sterilizer cleaners, chemical indicator products, sterilizers (new and used), ultrasonic cleaners, water distillers, and more!  (see Supplies).

 
ONLINE STORE:  (SELECT YOUR COUNTRY)          
  Title Description
Biological Indicators (Spore Testing)

 

In-Office and Mail-To-Lab Testing! Verify the sterilization process of all steam sterilizers which include Statim, Midmark, Tuttnauer, Lisa, Mocom and Pelton & Crane sterilizers.

In-Office Testing as low as $1.59/test!

Mail-To-Lab Testing as low as $2.96/week!

Bowie-Dick Tests

 

Bowie-Dick Test Packs should be used daily to evaluate the performance of air-removal (vacuum) system of dynamic pre-vacuum type sterilizers.   Available as test cards or preassembled test packs.  

As low as $2.98 per test!

Chemical Indicators, Class 5 Integrators

 

Internal CI’s should be used within each pouch or package, tray, or container. Class 5 Integrators should be used in conjunction with physical monitoring and biological indicator testing for verifying the efficacy of a sterilization system. (See AAMI ST79:2006) 

Indicator Tape

 

Indicator tapes provide a seal for sterilization packs and an immediate identification of processed items.  Dispensers available for all sizes.

Recordkeeping

 

Recordkeeping is a must for all sterile processing departments.  This ensures accountability and allows operators to trace errors to their source. Tips on sterilizer maintenance and technical advice are included with each book.

Sterilization Crepe Paper

 

Teal green Crepe Paper is compatible with types of sterilization processes including Steam, EO Gas, and Gamma Radiation. Click here to see all sizes!

Sterilization Pouches/Bags

 

Our easy peel-and-seal pouches work with Steam, Chemical Vapor, and Ethylene Oxide Gas sterilization procedures. Choose from 13 different sizes!

Sterilization Tubing

 

Our high quality sterilizer tubing comes in 3 different sizes. Buy in case quantity and save!

Sterilization Wrap

 

Blue non-woven SMS wrap and teal green crepe paper are compatible for most sterilization processes. Click here for available sizes.

Sterilizer Cleaner

 

Click to view all brands of sterilizer cleaner! We stock Duraclean, Omni-Cleaner, Chamber-Brite.

 

GLOSSARY OF TERMS USED:

 

  Full services provider in the United States and Canada for biological indicators, chemical indicators, spore testing, autoclave testing.

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