Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

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Wednesday, August 31, 2011

Premature Evaporation: Is your disinfectant fulfilling your every desire?

The use of disinfectants remains the backbone for environmental decontamination and infection control in multiple industries including laboratories, healthcare, educational and institutional settings to name a few. Numerous peer reviewed studies have confirmed that the environment can play a role in the transmission of microorganisms and therefore thorough attention to cleaning and disinfecting is required to minimize this as a source of contamination. Unfortunately, the requirements for the effective use of most disinfectant chemistries are often very difficult to comply with under real-life conditions.


Instructions for the proper use of a disinfectant are indicated on the label of any EPA or Health Canada registered product. Diligent compliance of these instructions is necessary for proper and complete disinfection. This is particularly true of the contact time indicated on the label. The contact time or dwell time is the length of time that the surface must remain wet with the disinfectant in order to achieve the microbicidal kill as indicated on the label. Many would argue that this is the most critical step in the disinfection process. However, current practices generally only allow time for a surface to be wiped once and allowed to air dry. This begs the question – what are the potential implications of this practice when employed with the most commonly used disinfectant chemistries?


In a recent edition of the Journal of AOAC International (Vol. 93, No. 6), Dr. Navid Omidbakhsh, VP of Open Innovation at Virox Technologies Inc., expertly studied the level of kill actually achieved using the practices that are routinely used by disinfectant end users – wipe once and allow the surface to air dry. The study compared six different disinfectant chemistries: a Quaternary Ammonium Compound (Quat), a Quat-Alcohol blend (2 concentrations of alcohol), a Phenol, a Phenol-Alcohol blend, Bleach (Sodium Hypochlorite) and Accelerated Hydrogen Peroxide. Each disinfectant chemistry was tested at its recommended use dilution to determine its performance in the following criteria: drying time and bactericidal activity during that period of time.


First, the drying time of each disinfectant was determined and compared to the product’s label contact times. It was found that all disinfectants dried in less than 5 minutes with alcohol and solvent containing products drying significantly faster (less than 1 minute – some as quickly as 30 sec.). Of the chemistries tested, only a single product actually remained wet for a longer period of time than indicated on the label. Am I the only one that finds this concerning? Certainly any product that dries too quickly can be re-applied, but what are the chances of that actually occurring? Would you be confident that disinfection is being achieved with those types of disinfectants? (Figure 3 in the published study provides excellent visual comparison of the data.)


The second phase of the study tested the realistic microbicidal efficacy of each disinfectant by measuring their effectiveness against 2 key strains of bacteria at the contact time determined in the first phase of the study. For example, it was determined that Bleach dried in 3 min., therefore its bactericidal efficacy was tested at the 3 min contact time rather than the label contact time of 10 min. Not surprisingly, the only chemistry to remain wet for longer than its required contact time was the singular chemistry to achieve full bactericidal efficacy (>6 log reduction) across both strains of bacteria that were tested. The remaining chemistries all fell short of achieving true disinfection. The most alarming of which were the products containing higher concentrations of alcohol (60-70% ethanol blended with quat and/or phenol). These products dried exceedingly quickly (30 sec. or less) and in that period of time elicited minimal germicidal efficacy on the bacteria. Despite remaining wet for upwards of 3 min. the same was also true of the concentrated quat and phenol products that carried 10 min label claims. They only achieved <2 log and <3 log reduction respectively. So our suspicions have been confirmed. Disinfectants that do not remain wet for their entire contact time after a single application do not achieve disinfection. With this knowledge, how will you address the disinfectants that may be in use at your institution? Protocol revision to ensure the disinfectant stays wet for the required period of time? Change of disinfectant to a chemistry/product that does remain wet for the required period of time without major protocol changes? (Refer to Tables 3 & 4 in the study for the complete results.)


In summary, Dr. Omidbakhsh’s study highlights the importance of selecting a disinfectant that will perform under real life conditions. As the study findings illustrate, most disinfectant chemistries are unable to elicit their full and complete effectiveness because they simply do not remain wet on the surface for a sufficient period of time. Rapid and realistic germicidal effectiveness provides end-users with the comfort and confidence that their disinfection needs will be met on a regular basis.


Reference:


Omidbakhsh N. Theoretical and experimental aspects of microbicidal activities of hard surface disinfectants: are their label claims based on testing under field conditions? J of AOAC Int. 2010;93:6:1-8. http://www.virox.com/download.aspx?ItemInfoID=474


Wednesday, August 24, 2011

Stop the Smoke and Mirrors!

Are healthcare-associated infections (HAI) and the substantial economic burden they cause inevitable? Far from it! Many such infections are preventable through better hand hygiene and proper disinfection of high-touch surfaces alone. While poor compliance with hand hygiene remains a perennial problem, my focus here is on problems with disinfection of frequently-touched, hard, non-porous environmental surfaces.


Most disinfectants are marketed for infection control in healthcare settings. Unfortunately though, many such products are either ineffective for the purpose and/or often used improperly. Why?


(1) Government registration: While materials managers and infection preventionists purchase/use only government-registered products, the registration process for environmental surface disinfectants in particular is often based on flawed methods for microbicidal activity. Therefore, the registration number in itself is of limited value.


(2) Contact time: Product labels often require surfaces to remain wet for a minimum of 10 minutes, and many such products may fail with much shorter contact times common under their field use. The argument that such products continue to work though the treated surface may look dry is specious. Even if correct, does this not mean that a high-touch surface still cannot be contacted during that minimum period of 10 minutes? Is that a realistic scenario in a busy healthcare setting?


(3) Soil load: In general, product labels recommend surface precleaning, but without giving lucid directions for it. Precleaning, if indeed carried out, is often quite cursory, possibly leaving a certain level of disinfectant demand on the surface. In case the precleaning is really thorough, that surface may not require any subsequent disinfection! Therefore, testing without any added soil load quite likely over-estimates the microbicidal potential of a given product.


(4) Spectrum of microbicidal activity: Frequently, the testing is against selected Gram-positive and Gram-negative bacteria only, but the label claims ‘broad-spectrum’ activity. The use of this antibiotic-relevant term is totally inappropriate for disinfectants. The correct use of this term must mean a given disinfectant’s ability to inactivate not only vegetative bacteria but viruses and fungi as well, which are common nosocomial pathogens.


(5) Inappropriate surrogates and test organisms: In my view, the disconcertingly common practice of allowing long lists of organisms on product labels has no justification in science. Many listed organisms are relatively fragile outside hosts and thus not known to spread through environmental means. Therefore, the listing of such pathogens clearly contributes to the ‘fear-factor’.


(6) Testing without wiping action: Even though most surfaces are disinfected with wiping, testing and label claims of products used for the purpose rarely entail any wiping action. This is a serious omission. Wiping deposits only miniscule amounts of disinfectant on the target surface with the deposited liquid evaporating almost instantaneously. On the other hand, the mechanical action of wiping can contribute significantly to surface decontamination with a suitable disinfectant.


(7) House-keepers: In spite all the talk about in-service training and routine monitoring of house-keepers, they remain a weak-link in the infection control chain. Such individuals are often the least skilled and educated with limited proficiency in the working knowledge. In addition, poor pay, job insecurity and lack of any tangible recognition of the crucial role they play contribute further to the high rate of staff turn-over. The literature is replete with examples of how a perfectly good disinfectant has been improperly diluted, stored and applied by house-keeping staff. This is akin to having ill-trained and ill-equipped front-line soldiers in a major battle.


This may sound heretical, but I believe that a combination of the above-listed factors may well be inadvertently spreading HAI instead of preventing them by the routine decontamination of environmental surfaces. Obviously, this situation must change soon if we are to successfully combat HAI. Here is what I propose:


a. Actively discourage testing and label claims against the ‘bug-of-the-month’; this current practice is not science-based.


b. Develop better wipe-testing protocols for marketing environmental surface disinfectants with claims incorporating wiping action.


c. Redouble our efforts to develop safer, better and faster-acting microbicides.


d. Harmonize at the global level, testing and registration of hard surface disinfectants to encourage investment in R&D.


e. Improve the training and monitoring of house-keeping staff and better recognize their crucial role in infection control. Without this, all else may be futile.



I’ve given my opinion. I’m curious to know what you think?
Dr. Syed Sattar



SYED A. SATTAR, Ph.D.
Dr. Sattar is the founding Director of the Centre for Research on Environmental Microbiology (CREM), and emeritus professor of microbiology at the University of Ottawa. For over 45 years, he has been studying the fate and environmental spread of infectious agents via water, food, air, hands, environmental surfaces and municipal wastes. A major focus of his current work is to promote the use of safer and more effective chemical and physical agents in environmental control of pathogens.

He has authored several books, monographs and lab manuals, and published >300 research papers, book chapters commissioned reviews and technical reports. He has also delivered over 300 invited lectures worldwide, and presented some 180 papers at national and international scientific meetings. In 2009, Dr. Sattar became the first non-European scientist to receive the Hygieia Medal of The Rudolf Schulke Foundation in its 33-year history.


He is a Registered Microbiologist of the Canadian College of Microbiologists, and a Fellow of the American Academy of Microbiology and a member of the editorial boards of the American Journal of Infection Control and International Journal of Infection Control. He advises the Canadian and U.S. governments on disinfectant test methodologies. Microbicide test methods developed by him now form the basis for several national and international standards.


Wednesday, August 17, 2011

Strength is NOT always found in numbers

We live in a society of excess where we have come to believe that more is always better. I will agree that more is better when it comes to my bank account, the horsepower of my car engine and the size of the fish I just landed. Who doesn’t want to have the biggest fish of the week, weekend or day – especially if there is a friendly competition going on! I do not want to see larger numbers on the scale, my age and my utilities bills and I absolutely draw the line at getting into a “numbers” competition over who has the most claims on a disinfectant label.

Contrary to some companies belief, advertising that a product kills X bugs while the closest competition only kills Y is not relevant and frankly in some cases can be downright dangerous. As Lee and I have been trying to expound with our blogs, there is more than just what the product kills that needs to be taken into account when choosing a disinfectant. You’ll note as illustrated below, there is a hierarchy in the microbial world with respect to the susceptibility of microbes and a disinfectant’s efficacy.

Herein lays the crux of the danger if people are lead to believe that the larger the number of organisms listed on the label the better. An unscrupulous manufacturer can “stack” their label with enveloped viruses and vegetative bacteria – the two easiest to kill classes of microorganisms. They can also “stack” their label with irrelevant organisms, meaning bugs that sound scary, but are in no way spread through contact with contaminated surfaces or medical equipment (i.e. the surfaces that a disinfectant is used on). If we choose a product simply based on the number of organisms it claims to kill without investigating further what those claims are we could be heading down a path to disaster. As end users and decision makers we need to look at the claims and make sure not only that the specific organisms listed are relevant to us but also to ensure that the classes of organisms we are concerned with on a day to day basis at our facilities have been proven effective by the product we choose.

And that my dear friends, is why the number of kill claims on a label is irrelevant. I hope you won’t get caught up in the numbers game the next time you check out a disinfectant!

Next week we launch the first of what will become a monthly Guest Blogger series. The guest bloggers will be respected experts in the field of their respective blog topic and of course the topics will be relevant to the use of chemical disinfectants. We are thrilled that Dr. Syed Sattar has agreed to be our inaugural guest blogger. Dr. Sattar has over 45 years of research experience with a focus of understanding the influence of environmental factors on the survival and dissemination of microbial pathogens. He has published over 200 papers in peer-reviewed journals and conference proceedings as well as several book chapters and we are excited to say that next week’s blog titled “Stop the Smoke and Mirrors” will be the first blog he has written!
Bugging Off!
Nicole

Wednesday, August 10, 2011

Scuff Off!!!

I am constantly amazed by society’s obsession with floors. “Look how shiny that floor is!” “It’s so clean you could eat off of it!” “OMG did you see the scuff marks?!” I was once dragged into a store with a sales rep I was working with – I think it was a Canadian Tire store, but feel free to envision Wal-Mart, Target or any other large box store....and without a word of a lie there were no less than 5 grown men standing in a circle around 2 scuff marks no more than 3 inches long. Picture it: 5 men, 2 scuff marks and 1 highly type A female blocking an isle talking about the best way to remove these pesky little floor blemishes. Suffice it to say the conversation lasted far longer than necessary.


As Lee stated last week, we have been brainwashed to believe that clean is the smell of lemon or pine. I would like to add that we have also been brainwashed to believe that a clean floor free of scuffs equates a safe and risk free hospital environment. There are far better indicators for determining if the healthcare facility you or a loved one is about to be admitted to. Here are a few things I look for: did the nurse/doctor wash their hands before coming into my room and touching me? If I happen to come in through the ER, did the nurse on triage clean the blood pressure cuff and thermometer before slapping it on me and sticking the thermometer in my mouth? Lastly do the high touch surfaces I am most likely to stick my hands on and then inadvertently rub my eye or pop that piece of gum into my mouth after touching look clean? Let’s be realistic, at home we may follow the 5 second rule for eating something off the floor, but would you EVER eat something that has fallen onto a hospital floor? If you answered yes...you are by far, braver than I.


So here’s the truth, bacteria on hospital floors predominantly consist of skin organisms such as coagulase-negative staphylococci, or Bacillus spp.; S. aureus, Acinetobacter spp. and Clostridium spp. can also be cultured. However, the infection risk from contaminated floors is small. Gram-negative bacteria are rarely found on dry floors, but may be present after cleaning or a spill. Nevertheless, these organisms tend to disappear as the surface dries. In general, pathogenic microorganisms do not readily adhere to minimal hand contact surfaces such as floors, walls or ceilings unless the surface becomes moist, sticky, or damaged.


Numerous studies conducted over the years have proven that disinfection of floors offers NO advantage over cleaning with straight detergent with respect to improvement of a facility’s hospital acquired infection rate. A study conducted at a tertiary care hospital comparing multiple units found that the infection rates between units did not differ between those with floors cleaned with a disinfectant and those cleaned with a detergent. In fact, the one unit that did show any appreciable difference was actually one cleaned with detergent! Additionally, no differences were observed in the level of floor contamination.


Makes sense to me! Anyone in infection control should know that microorganism counts on floors reach their pre-disinfection levels within 1 to 2 hrs. This in part is probably the reasoning for infection control guidelines stating that extraordinary cleaning and decontamination of floors is unwarranted.


The next time you see a scuff on the floor I hope you’ll think twice about any association with infection control and instead ask “Hey nurse – did you wash your hands?”


Bugging (or scuffing) Off!
Nicole


Thursday, August 4, 2011

You Stink!!!

Let me ask you a question, what first comes to mind when you think of “clean”? Is it the smell of lemons? The fragrance of pine? Or, the overwhelming odour of chlorine? For many of us, the smell of clean is born out of what our parents used to clean our childhood homes. For me, the smell of vinegar instantly takes me back in time to my mother cleaning the windows in our turn-of-the-century farm house. In a way, we have each been brainwashed to associate a freshly cleaned room or surface with a particular smell. But does it have to be this way? Luckily, no.


In reality, the true smell of clean – is no smell at all. The foul stench we most often associate with dirty or soiled areas is commonly the result of odour causing bacteria. If we are successful in removing or killing this bacterial contamination, the smell will also be eradicated. Unfortunately, many commonly used cleaning and disinfectant products often have strong odours or fragrances associated with them for one of two reasons. Firstly, many products are simply ineffective at completely killing or removing the odour causing bacteria. Therefore, fragrances are added to compensate for this deficiency and to mask the original offending odour. As Nicole expounded in a previous blog posting, the negative aspect of this is that fragrances are key contributors to poor indoor air quality and the development of scent sensitivities in part of our population. So to follow Nicole’s lead, we should avoid the unnecessary use of these types of products whenever feasible. In other cases, the scent of a particular cleaning or disinfecting product is not the result of an added fragrance, but rather the undesirable by-product of the chemical itself. Bleach is a great example. At the concentrations required for thorough disinfection, bleach carries that unmistakable, strong chlorine odour. Depending on the concentration this odour can range from simply annoying to the development of actual respiratory irritation. Fortunately, these two types of cleaning and disinfecting products are not our only options.


There are cleaning and disinfecting products available that will safely and effectively clean/disinfect the environment, thereby eliminating the original odour causing bacteria, without the unneeded or unwanted fragrances or odours of their own. These fragrance-free, odourless cleaners and disinfectants are ideal because they will address the job at hand while causing, or contributing to, the least unwanted side-effects.


Are you ready to make the transition to the smell of clean...MEANS no smell at all?


Hasta la vista!
Lee – The Germinator