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.

Our expertise is utilized by Infection Preventionists, Public Health Experts, First Responders, Dentists, Physicians, Nurses, Veterinarians, Aestheticians, Environmental Services professionals and janitorial product distributors to develop more sustainable cleaning and disinfection practices in North America.

Our commitment to providing chemical disinfectant education is more than business, it is a passion.

Wednesday, December 19, 2012

Where did the last 51 weeks go?


WOW!!! It’s hard to believe that this is the last blog for 2012. In looking back through the blogs that were written it is truly amazing to realize just how broad the range of topics was! 

2012 saw the continuation of the Guest Blogger concept with eight (8) different bloggers.  Each is respected in their field and lends their expertise and insight to the Talk Clean to Me Blog on topics pertaining to cleaning and disinfection. We would like thank Mark Heller (Environmental Services Specialist & B2B Consultant), Jason Tetro (The Germ Guy blog), Paul Webber (Webber Training & the global teleclass concept), Darrel Hicks (author of Infection Prevention for Dummies), Jim Gauthier (Infection Prevention & 2012 CHICA Canada President), Rick Wray (Pediatric Patient Safety & Infection Prevention), Dr. Lucas Panteleon (Veterinarian & Animal Infection Prevention), and Professor Ewen Todd (Michigan State University and Guest Blogger on the DEB Hand Hygiene Blog) for their support in 2012! We will continue to introduce you to Guest Bloggers from around the world and also hope to introduce you to some of the blogs we think are worthy of following.

We also introduced a monthly Chemistry Blog in 2012 and will continue to expand our education on chemical actives used for cleaning, sanitizing and disinfection of surfaces, devices and hands in 2013. The focus of the Chemistry Blogs this past year revolved around the actives most found in products uses for surface cleaning and disinfection (Quats, Chlorine, Phenols, Hydrogen Peroxide, Ozone, Alcohols, Silver Dihydrogen Citrate, Organic Acids, Peracetic Acid and Improved Hydrogen Peroxide). Next year, we’ll focus on the chemistries used for hand hygiene and medical device reprocessing and hope our chemical geekiness will in some way lead to frank and educational discussions around the cleaners and disinfectants that we chose and use.

To continue our infection prevention education (a true passion of mine) we will be introducing a “Bug Blog” in 2013. We have from time to time dedicated a blog to a specific bug (i.e., Norovirus, The Cold or Flu etc), based on the time of year or “exciting” events in microbiology (stay tuned for a blog on the new novel Coronavirus!) and for 2013 we want to continue this focus so we not only know about the bug, but better understand how disinfectants “attack” and “kill” the bugs we are concerned with.

Of course, we will be sure to blog about any topic or newly published science that goes with the Talk Clean To Me mandate to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. It’s true, our commitment to providing chemical disinfectant education is more than business, it is a passion!  

We would like to wish you a Happy Holidays and hope that you continue to follow us in 2013!

 

The Clean Freaks

Nicole and Lee

 

Friday, December 14, 2012

Helpful Hints for a Happy, Healthy Holiday!

With Christmas holidays around the corner and almost daily updates on new outbreaks associated with respiratory or gastro nasties, I thought it prudent for the focus of this week’s blog to be on Holiday Infection Prevention.

We are, without a doubt, well into cold and flu season and while we bandy about the terms “cold” and ”flu”, there are certainly more nasties out there than just the cold and flu. The following list is what Public Health Units from across North America are currently seeing in terms of the bugs implicated in some of the outbreaks so far.


Transmission via Direct Contact (when an infected person sneezes mucus directly into the eyes, nose or mouth of another person), Indirect Contact (Hand-to-eye; hand-to-nose; hand-to-mouth transmission from contaminated surfaces or from direct personal contact i.e. shaking hands) and Airborne (when someone inhales the aerosols produced by an infected person coughing, sneezing or spitting);

Symptoms: Influenza is characterized by sudden onset of high fever (38 C-39 C/100 -103 F), cough (typically dry), headache, muscle and joint pain, severe malaise, sore throat and runny nose.  Illness is self-limiting and most people recover within a week. It can be indistinguishable from the common cold in the early stages but the flu can be identified by the high fever and extreme fatigue.


Transmission via Direct Contact (when an infected person sneezes mucus directly into the eyes, nose or mouth of another person), Indirect Contact (Hand-to-eye; hand-to-nose; hand-to-mouth transmission from contaminated surfaces or from direct personal contact i.e. shaking hands) and Airborne (when someone inhales the aerosols produced by an infected person coughing, sneezing);

Symptoms: RSV manifests with the following symptoms: cough (may be croup like or “seal bark” cough), shortness of breath, bluish skin, difficulty breathing, wheezing, stuffy nose, fever, nasal flaring, and rapid breathing.


Transmission via Direct Contact (when an infected person sneezes mucus directly into the eyes, nose or mouth of another person), Indirect Contact (Hand-to-eye; hand-to-nose; hand-to-mouth transmission from contaminated surfaces or from direct personal contact i.e. shaking hands) and Airborne (when someone inhales the aerosols produced by an infected person coughing, sneezing or spitting);

Symptoms: Rhinovirus is characterized by rhinorrhea, blocked nasal passages, sneezing, coughing, sore throat, croup in infants and malaise. The symptoms experienced depend on the number of virus particles replicated. Infected cells produce a molecule called histamine that results in increased nasal secretions.


Transmission via Direct Contact (when an infected person sneezes mucus directly into the eyes, nose or mouth of another person), Indirect Contact (Hand-to-eye; hand-to-nose; hand-to-mouth transmission from contaminated surfaces or from direct personal contact i.e. shaking hands) and Airborne (when someone inhales the aerosols produced by an infected person coughing, sneezing or spitting);

Symptoms: Parainfluenza causes sore throat, stuffy nose, fever, croup, chest pain, cough, shortness of breath, stuffy nose and wheezing


Transmission is Airborne (when someone inhales the aerosols produced by an infected person coughing, sneezing or spitting) can also spread through Indirect Contact (fecal to oral route);

Symptoms: Most infections result in upper respiratory tract infections.  It can also manifest as croup, conjunctivitis, tonsillitis, or ear infections. Adenovirus can also cause gastroenteritis resulting in diarrhea.


Transmission via Direct Contact (caring for or coming in close contact with infected person) and Indirect Contact (hand-to-mouth from contaminated surfaces; eating or drinking contaminated food);

Symptoms: Norovirus causes nausea and vomiting, diarrhea, stomach pain, body aches, fever and headache

Now that we know who we are trying to fight off, what can we do to stay healthy?  Proper hygiene (cleaning and disinfecting hands and surfaces) and practicing social distancing is the primary means to help stop the spread of the bugs we see during “Cold & Flu Season”.  Approximately 80% of infections are transmitted by hands.  Frequent washing of hands with both soap and water or alcohol hand sanitizers is the single most effective way of limiting the spread of the “Cold & Flu Season” bugs.  Hands should be washed after blowing ones nose (and especially after blowing someone else’s nose!) , after covering your mouth after coughing or sneezing, after using the bathroom and most definitely prior to eating or drinking.   Social distancing means reducing the frequency, proximity, and duration of contact between people (i.e. employees, customers and of course small children) to reduce the chances of spreading the “Cold & Flu Season” bugs from person-to-person.   While this is not always possible we can take the opportunity to turn our heads and cover our mouth and nose with our elbows when we cough and sneeze.  Using our elbows to cover our mouth and nose helps to keep our hands free of germs which could spread disease.

 “Cold & Flu Season” bugs can also be spread by touching objects contaminated with the nasties and then transferring the bug from the hands to the nose, mouth or eyes.  High touch hand contact surfaces such as door knobs, light switches, telephones, keyboards etc should be cleaned and disinfected frequently.  During “Cold & Flu Season” you can help stop the spread by cleaning and disinfecting your work areas before going on breaks, lunch and prior to leaving at the end of the day. 

I hope these tips keep you healthy this holiday season!

Bugging Off!

Nicole


And yes, I am extremely happy with my amazing alliteration abilities!  (Ooops!  I did it again! A)

 

Friday, December 7, 2012

SOS – Spores on Surfaces!

A discussion as to the best way to handle environmental contamination by Clostridium difficile can be at times the equivalent of watching a soap opera. When it comes to who believes what, who knows best, what is stated in current infection prevention guidelines, newly published peer reviewed articles and of course disinfectant manufacturing sales materials highlights the fact that two seemingly similarly educated people can be complete polar opposites!  While I’ve never been involved in a discussion that has come to fisty-cuffs, I do have two pairs of 16oz boxing gloves that I’d gladly provide if it would help come to a consensus!

I think with advancement and by this I mean our ability to manufacture “better” disinfectants, our ability to improve test methods both for disinfectant product efficacy but also for clinical specimen sampling and disease diagnosis we become so enlightened with all the “new” stuff we forget the importance of the basics.  I think we often need to be reminded of the basics.

While there is sufficient published science to support that sodium hypochlorite at the correct dilution and contact time has the ability to kill C.diff spores, it has not been until recent years that Health Canada or the US EPA has approved a method to allow for actual label claims against C.diff.  We can now choose from sodium hypochlorite, hydrogen peroxide and peracetic acid based formulations with registered claims against spores.  Certainly, from an infection prevention perspective this has meant advancement in practices, but in the quest to find products that can KILL we have lost sight of the importance of physical friction.  More simply put, we have lost sight of the importance of how CLEANING, how WIPING can and WILL remove spores from the surface.

Let’s be honest, to kill spores we need to increase the concentration of chemical used.  This increase will result in less than stellar occupational health and safety profiles for the products that are being used and will also have a direct impact on the compatibility with the various surfaces the product will be applied. 

The 2010, SHEA-IDSA Guidelines for Clostridium difficile states “The efficacy of cleaning is critical to the success of decontamination in general, and thus user acceptability of disinfection regimens is key issue”.   When asked about a product’s ability to kill, I have always stated that I do not care what a product kills, if staff will not use the product as designed by the manufacturer, the label claim is meaningless!  Don’t get me wrong, I am in no way saying that we should not use sporicidal agents in dealing with C. diff.  What I am saying is that we need to consider more that what the product kills, but look at how effective the product is at cleaning (thereby removing spores from the surface) and most importantly, how will the staff that will be using these products daily for long periods of time respond?  A well implemented infection control program requires that the products we choose are in fact used!

It was with this that I was quite excited to read a recently published study by Dr. William Rutala and his research team (ICHE,2012;33:1255-1258).  The study compared the importance of physical removal versus sporicidal inactivation of different cleaning and disinfection chemistries.  There was what I thought of as several key take home points – or “Ah-Ha” moments.  First, did you know that most studies have quantitated the level of C. diff spore contamination on surfaces to be  <1Log10?  Why then do Health Canada and the US EPA require manufactures to achieve at least a 6 Log10 reduction against C.diff spores in order to make a claim.  If you didn’t already know, a 6 log10 reduction implies we are chemically sterilizing the surface.  If we do not have that level of contamination on surfaces to begin with why do disinfectants need to achieve such a level of kill?  As mentioned earlier, to obtain sporicidal claims we need to increase the concentration of chemical used.  We are creating disinfectant products that have increased occupational risks.  Perhaps if the test method needed to obtain a sporicidal surface claim was adjusted to provide a more realistic level of kill based on actual surface contamination we would have sporicidal products that we could use on a daily basis without the worry of occupational safety or material compatibility issues.

Secondly, and to me most importantly, CLEANING WORKS!  The study showed that wiping environmental surfaces, even with a non-sporicidal agent can eliminate approximately 3 Log10 of C.difficile spores. Sporicidal agents provided a 3 Log10 to 6 Log10 reduction depending on formulation and/or application with the most commonly used bleach wipe showing just under a 4 Log10 reduction.

I’m not saying that we shouldn’t use sporicidal agents.  I’ve worked with enough facilities in outbreak situation to know they work. However, have we set the bar to high in terms of what is required with respect to obtaining a registered C. difficile claim?  Are we knowingly, exposing our staff to unnecessarily high concentrations of chemicals when as we know the level of contamination on surfaces is significantly lower than the level of kill required to obtain a label claim?  Knowing that cleaning works, would we be wrong to develop protocols that focus on the physical removal of spores for cleaning of isolation rooms and utilize sporicidal agents for terminal cleaning, for outbreaks or for use on wards with higher endemic levels of C. diff?  I know facilities that do just that and do it well.

Food for thought, I hope!


Bugging Off!

Nicole

Friday, November 30, 2012

Disinfectant Chemistry Report Card #10 – IMPROVED H2O2 – Have we found the silver bullet?


In May, the Chemistry Blog focused on Hydrogen Peroxide.  Now, you might wonder, why then would we dedicate a second blog to Hydrogen Peroxide.  Aside from the fact that the Improved H2O2 formulations are patented, the primary reasoning is that these formulations truly stand out as unique and novel technologies that warrant further discussion.

Ever since the progression of the medical sciences various chemicals have been used as active ingredients for disinfection and sanitization, with the newer actives being more effective, safer, and easier to use. Currently, the most common disinfectants use quaternary ammonium compounds (QUATS), alcohols, or sodium hypochlorite (bleach) as their active ingredients. The use of above actives imposes various problems such as user hazards, efficacy limitations, and negative environmental effects. Improved Hydrogen Peroxide has successfully tackled all these issues.

Improved Hydrogen Peroxide formulations contain varying levels of Hydrogen Peroxide in combination with anionic and /or non-ionic surfactants (detergents), and other inerts such as chelating agents and wetting agents.  This combination of chemicals works in synergy to provide exceptional cleaning efficiency but most importantly, from an infection prevention perspective, boosts the antimicrobial speed and spectrum of efficacy of hydrogen peroxide.  Improved Hydrogen Peroxide leaves no residues on applied surfaces as it turns into water and oxygen upon drying, and imposes no use or environmental hazards as its use concentrations and decomposition products are very low and thus safe.  In fact, Improved Hydrogen Peroxide formulations have attained the lowest toxicity category as defined by the US EPA.  As Category IV classified compounds they are considered practically non-toxic and non-irritating.

Improved Hydrogen Peroxide products are commercially available through a number of companies in various concentrations ranging from 0.5% to 7% and varying applications.  Such companies have differing marketing terminology for their patented technologies such as “Accelerated Hydrogen Peroxide” or “Activated Hydrogen Peroxide”.  As per the advantages described above, Improved Hydrogen Peroxide is a well-rounded active ingredient that has no limitations in its use at ranges of product types. At concentrations of 0.5% to 1.4%, Improved Hydrogen Peroxide formulations can be used for cleaning and disinfection of environmental surfaces and non-critical devices.  Improved Hydrogen Peroxide formulations with peroxide concentrations higher than 2% can be used as high level disinfectants and chemosterilants; solutions that can be used to submerge semi-critical and critical medical devices. Utilization of Improved Hydrogen Peroxide in hand sanitizers is another new method for skin surface sanitizers. Its use provides superior antimicrobial efficacy without endangering the users by skin sensitization, toxic chemical residue leftover, or risks of oral consumption abuse. Similar to the dermal applications, the use of Improved Hydrogen Peroxide for animal hygiene is also another advantage to produce animal care products that are both safe and effective. Due to generally high compatibility and low corrosiveness of Improved Hydrogen Peroxide, its disinfectant solutions are also used to disinfect a variety of sensitive medical instruments and apparatuses. Improved Hydrogen Peroxide is not limited in its uses; more areas of development are considering its use while its acceptance among the end users is growing due to its advantages.

Depending on application Improved Hydrogen Peroxide formulations are utilized within a spectrum of various concentrations.  Taking this into account, here’s how we would score Improved Hydrogen Peroxide on the key decision making criteria:

• Speed of Disinfection – A to B

o Formulation dependent, surface disinfectants range from 30 second sanitizing to 10 minute disinfection, Sporicidal Surface Disinfectant in 10 minutes, High Level Disinfectants for Instrument disinfection 5 minute disinfection and Chemical Sterilants in 20 minutes.

• Spectrum of Kill – A

o Similar to above, spectrum of kill is formulation dependant

o Depending on the Improved Hydrogen Peroxide formulation they are capable of killing all microorganisms; bacteria, viruses, fungi, mycobacteria and spores.

• Cleaning Effectiveness – A

o Excellent cleaning capabilities as the formulations include a blend of non-ionic and anionic surfactants which are known to provide superior cleaning in conjunction with H2O2 which also aids in cleaning

• Safety Profile – A to B

o At their in-use concentrations, surface disinfectants are non-toxic and non-irritating for users. 

o Instrument disinfectants are non-toxic and do not require special ventilation systems

• Environmental Profile – A

o H2O2 degrades into water and oxygen. 

o Some Improved Hydrogen Peroxide surface formulations have been developed to achieve Eco-certifications such as EcoLogo and EPA’s Design for the Environment (DfE).


**For more in-depth scientific information about Improved Hydrogen Peroxide and other disinfectant chemistries, stay tuned to www.infectionpreventionresource.com.

Bugging Off!
 
Nicole

 

Thursday, November 22, 2012

Hand Washing and Drying to Reduce Microbial Contamination


Everybody’s hands are frequently contaminated with enteric microorganisms, and food workers are no exception. These workers may be even more exposed because of their work with raw food ingredients and their frequent contact with fellow workers and the public.

Unlike hand contamination with staphylococci from the nasopharynx, the enteric bacteria that contaminate the hands of food workers more often are associated with raw foods of animal origin rather than poor personal hygiene after visiting the toilet.

Hand hygiene compliance at the retail food service level is known to be inadequate. Hand hygiene practices of food workers are dependent on the type of work involved and the type and nature of the soil on their hands. Compliance begins with a commitment by management to designate safety as the number 1 concern in the establishment and to introduce regular training programs for safe production of food, as well as when and how to wash hands effectively.

Many people, workers included, feel that their hygiene routines are sufficient because no adverse consequences have been experienced over many years of performing the same procedures. Gross hygiene errors may be in place for a long time in foodservice operations and not be identified until associated illnesses are reported. For instance, two United Kingdom catering facilities (in Scotland and Wales) were thoroughly investigated in public inquiries following large outbreaks with illnesses and deaths. Workers with management acceptance had contaminated cooked meat products.

Washing

Hand washing times of 15 to 30 seconds have been recommended by different agencies around the world. For many years sanitarians have specified that the hands of food service workers should be washed and rinsed in hot water to reduce the risk of cross-contamination and disease transmission. However, the use of water at these temperatures has not been supported by research. Hand washing with water at high temperatures may contribute to skin damage when frequent hand washing is required, and insistence on hot water usage may be a deterrent to hand washing compliance.

To reduce the potential for bacterial transfer, food workers may need to wash their hands for longer than 15 seconds or may need to wash more often. Thorough rinsing is important because this action also removes potential skin irritants and contact sensitizers originating in food, soaps, metals, and facility disinfectants that could lead to dermatitis. Triclosan, triclocarban-trichlorocarbamide, and parachlorometaxylenol-chloroxylenol are commonly used antibacterial hand cleaning agents, however Gillespy and Thorpe found that germicidal soaps were not remarkably more effective than ordinary soap for reducing the numbers of bacteria transferable from the skin to handled objects. Infectious disease outbreaks have also been linked to workers with long or artificial fingernails. Without the regular use of a nail brush, they are very difficult to clean even with appropriate soaps, hand rubs, or gels.

Drying

Hand drying has two effects: removal of moisture through absorption and removal of microorganisms through friction. The friction generated during hand drying is even more important than that generated during washing because the soaping stage has loosened the microorganisms from the skin. The drying stage physically removes microorganisms in a film of water from the skin by wiping and depositing them on a towel. Thus, hand hygiene efficiency is a combination of washing efficiency (soap, water, rubbing, and rinsing) and hand drying.

Although cloth towels are popular because of their rapid drying, they become contaminated through multiple usages, and once pathogens are deposited on towels, they can survive long enough to contaminate the hands of other users. Cellulose fiber is the main material in institutional paper towels, which are usually made of rougher paper than used for domestic paper towels. The coarser the grain of paper used, the more efficient the friction effect will be for organism removal, although harsh, non-absorbent paper towels could discourage their use compared to softer paper. Also, hand-operated paper towel dispensers have their limitations.

In a survey of 12 food processing or food service facilities, researchers found coliforms, E. coli, and S. aureus on paper towel dispenser equipment. Air driers that are used in many communal washrooms allow one user at a time, and that take up to 1 minute to dry the hands, have not been convenient and lead to avoidance or incomplete drying. In several studies, on average people spent 22.5 seconds drying hands, and 41% wiped their hands unhygienically on clothes. Newer fast air flow driers are becoming more widespread, but have yet to be completely evaluated for their sanitary qualities.

Because of the uncertain or limited effectiveness of hand hygiene, multiple hurdles to reduce pathogen contamination and reduce their spread are better than one or two hurdles. When coupled with glove use and proper handwashing, these steps should minimize the opportunities for pathogens to reach the food being prepared.

This blog was originally posted on the DEB Hand Hygiene Blog.
 
 
Prof. Todd is an Adjunct Professor with the Food Science and Human Nutrition Department at Michigan State University.  As a scientist with over 45 years in food safety, in particular relating to foodborne outbreaks, Prof. Todd has written many publications and spoken at national and international meetings. He is currently working on Listeria transfer coefficient and modeling projects, hygiene in child care centers, avoidance of norovirus in elder care facilities, and rapid recall and traceability research in multidisciplinary projects with colleagues at MSU and other universities.
 

 

Friday, November 16, 2012

Tag YOU’RE It!!!

As winter approaches, more and more people start to feel like they’re coming down with “something.” You can always tell when cold and flu season has arrived at our offices because when our team gets together for a meeting, it’s like watching children playing a game of musical chairs.  Everyone is vying to find a seat farthest away from the “sick” person and best of all it’s the “older” colleagues that seem to freak out the most....I suppose that could be due to their declining immune systems.  Today there were three of us “sickies” and without intending we did a darn good job of spreading out and making it virtually impossible for our colleagues to find a spot where they weren’t in some way going to come in contact with us.

In some latest polling information it has been reported that nearly 80 percent of office workers come to work even when they know they are sick. For those that stay home, more than two-thirds return to work when they are still contagious, putting coworkers' health and business productivity at risk. In a typical year, approximately 70 million missed workdays can be attributed to having the flu which can be translated to an estimated $10 billion in lost office productivity.

So how do you know if you have the flu or the common cold?  Both have similar symptoms, so it can be hard to tell the difference. In general, the flu is worse than the common cold. Symptoms such as fever, body aches, tiredness, and cough are more common and intense with the flu. People with colds are more likely to have a runny or stuffy nose.

Unless you have young children where you basically just have to come to terms that if they’re sick, you’re going to be sick, the tricks to avoid catching the flu or cold are pretty simple.

1. Wash your hands!  Wash after you shake hands, after you go to the “facilities” and by gosh WASH BEFORE YOU EAT!
2. Clean and disinfect your workspace! (when was the last time YOU actually wiped down your desk, phone, keyboard or mouse with a disinfectant wipe?)
3. Stay Away!  Coughs and sneezes spread diseases!  Keep your distance from people displaying symptoms – respiratory droplets from coughs and sneezes can spread for up to 6 feet!
4. Get your Flu Shot! (and no, the flu shot will not give you the flu...)

Let’s do a case study:  

One of my colleagues and I were at a conference this week from Sunday to Tuesday. As luck would have it, this also happens to correspond to the first 3 days my cold came on. With the cold viruses, the first 3 days tend to be when you are most infectious and colds generally have an incubation period of 2 – 5 days. To my defense, I covered my mouth when I sneezed or coughed, sat at the end of the rows to try and keep my distance from others and washed my hands or used hand sanitizer CONSTANTLY! Melissa who I was travelling with has started showing signs of a cold (she sat beside me on the plane, at the conference – definitely not 6 feet away from my respiratory droplets regardless of how well I tried to contain them). She’s coming to work. She’s definitely infectious.

Assuming by Monday, several more team members are showing symptoms of a cold, am I to blame? I didn’t come to work while sick – I was away!  It’s Melissa’s fault right?

 

Bugging Off!

Nicole

 
PS – sorry to anyone who attended #SocialintelATL if you’re coming down with a cold.....  

 

Friday, November 9, 2012

Disinfectant Wipes should not be used…..Say WHAT?!

While writing does not always come easy, one of the things I like most about writing the Talk Clean To Me Blog is that I can state my opinion in black and white with the hopes that some may agree and welcome the dialogue that occurs with those of you who think I’m completely off my rocker.
 
In the world of cleaning and disinfection, the science or proof some people rely on cannot keep up with the myriad of new products or processes that enter the market place.  Does this mean that one should not consider changing products or processes until such time as there is statistically significant information published about these new products or processes?  Most definitely not!

Let’s consider the pre-moistened disinfectant wipe.  Are they new to the market?  NO.  Have they been used successfully at many facilities across the globe?  YES.  To ensure a successful infection prevention program, do we need to consider how to use them correctly to ensure the desired outcome?  MOST DEFINITELY!


“Disinfectant wipes should be used by the primary care giver for point of care cleaning and disinfecting of patient equipment. They should not be used as a routine cleaning disinfectant tool.”

Admittedly, for the sake of keeping the blog to a reasonable length, I have not included the entire section, however, should you take the time to read the guideline, you will find that it is vague and without any references to support its justification.  While I agree wholeheartedly that all disinfectants must be used appropriately, the danger in making such a statement is that there is no strong scientific evidence to conclusively limit the use of pre-moistened wipes at this time.   Perhaps instead, there should have been a more detailed discussion about the appropriate use of pre-moistened disinfecting wipes to ensure that they are used in such a fashion as to ensure contact time in accordance to the label is met.   Many of the leading pre-moistened wipes available on the market are Quat-alcohol based products with anywhere from 2 to 5 minute contact times.  As proven by science, such products will not remain on the surface for the contact time listed on the label as a result of the rapid evaporation rate of alcohol.  In fact a study published by Omidbakhsh in 2010 in the Journal of AOAC International investigated the discrepancy between drying time and contact time with respect to product efficacy.  Additionally, there have been publications investigating the effects of wipes in contaminating surfaces providing compelling evidence that we want to use 1 wipe for each surface especially if using a weak or slow-acting disinfectant in the wipe where the true chances of achieving disinfection are limited at best.

That said, proper disinfection with such wipes can be achieved with the physical action of wiping provided the disinfectant itself has a good and rapid broad-spectrum microbicidal activity. Therefore, there has to be a change in our thinking with regards to contact time for wipes as opposed to longer contact times needed when just spraying or pouring a liquid on surfaces. Perhaps the conclusion should be that in choosing a pre-moistened disinfectant wipe, one must consider more than just the cost per wipe. There needs to be a more fulsome investigation as to the number of wipes needed to achieve the contact time as listed on the label.  We need to review how the wipes will be utilized to ensure that good physical friction will be applied to help in removal of the pathogens from the surface, as well as frequent changing of such wipes to avoid redistributing the removed pathogens.  Lastly, one cannot discount the size of the wipe.  Certainly, the traditional wipes used in clinical areas for disinfecting patient care items such as BP Cuffs or Stethoscopes would not be recommended for use by Environmental Services due to their smaller size, however, most companies specializing in pre-moistened wipes provide larger options (10x10 inches or 12x12 inches) which are more than adequate for cleaning larger surfaces sizes. 

Perhaps the use of pre-moistened disinfectant wipes is no different than the use of antibiotics?  When prescribing antibiotics you need the right drug at the right concentration for the right length of time.  For pre-moistened wipes you need the right claims, the right contact time and the right size to do the job.

So….am I off my rocker?

 

Bugging Off!

Nicole

Friday, November 2, 2012

Disinfectant #9: Peracetic acid: Weak acid, Strong Disinfectant?

Peracetic acid (PAA) was first registered as a disinfectant in 1985 by the EPA. PAA is produced by combining acetic acid (vinegar) and hydrogen peroxide.  The result is a peroxide version of acetic acid (vinegar) that has a very distinctive and a pungent vinegary smell.  It is a weak acid compared to acetic acid but can be highly corrosive if not used at the appropriate dilutions. Peracetic acid is a versatile chemical that can be used in a variety of applications with its main use as a disinfectant product in food and beverage processing/producing plants due to the fact that it leaves no harmful residues and decomposes into harmless by-products.

As a cleaner, peracetic performs poorly as it lacks detergency properties.  As alluded to in previous blogs, you may wonder whether increasing the concentration of this acid would benefit its cleaning. The answer in short is: No. A higher concentration would not increase its cleaning abilities and in fact would lead to an increase in corrosiveness.
 
As a germicide, peracetic acid shows fairly strong efficacy against a broad spectrum of pathogens. Like many disinfectants, the temperature, pH and concentration all play a significant role in determining the antimicrobial properties. It is bactericidal at 10ppm, fungicidal at 30 ppm and virucidal at 400 ppm in a 5 minute contact time. Furthermore, it is sporicidal at concentrations of 3000 ppm. It is more effective at slightly higher temperatures and its germicidal activity increases at higher pH ranges. Combinations of PAA and hydrogen peroxide further boost the efficacy profile, as this blend can prevent the formation of biofilms on hard surfaces. The method by which PAA attacks pathogens is through the reaction with the cellular walls. This leads to breakdown of cell membranes and cellular death due to cell content leakage. An issue regarding PAA usage is its stability. In the presence of water, it breaks down quickly. This would have a direct affect on the viability of the product over time.

Peracetic acid’s safety profile can also be closely correlated to its concentration. The higher the concentration, the worse the safety profile is. For example, an in use solution of PAA of 5% has relatively low oral toxicity at this dilution. However, respiratory issues, including occupational asthma development associated with PAA have been reported. Further, it can strongly sensitize respiratory organs and cause mucus membrane inflammation. Furthermore it is important to be weary of skin and eye exposure as it can cause irritation. Overall, peracetic acid proper care needs to be taken in its use.

The environmental profile of peracetic acid once again depends on the concentrations encountered. At high concentrations, it can be toxic. However, in use concentrations do not pose major threats to the environment. Furthermore, PAA is a readily decomposable substance and breaks down to products that are not considered harmful to the environment.

This is how we would rate peracetic acid disinfectants based on the key decision making criteria:

• Speed of Disinfection – B to C

o At a 5 minute contact time for killing bacteria and viruses, peracetic acid is fairly rapid in killing. However it carries a 30 minute sporicidal contact time, which is unrealistic unless used for soaking applications.

• Spectrum of Kill – A to C

o Certain temperatures, pH, and concentrations affect the efficacy of peracetic acid.

o At 3000 ppm, peracetic acid can kill all microbial life whereas at 10 ppm, it only kills bacteria.

• Cleaning Effectiveness – C to D

o Peracetic acid has poor cleaning capabilities.

• Safety Profile – B to C

o Peracetic acid has a safe oral toxicity, however, it is sensitizing to the respiratory tract and irritating to skin and the eyes.

• Environmental Profile – A to B

o Peracetic acid readily decomposes and its primary and secondary products are all deemed non-harmful to the environment.

• Cost Effectiveness – B

o Peracetic acid is readily available from various manufacturers and can be found in both concentrated and ready-to-use formats.




Bugging Off!

Nicole

Wednesday, October 24, 2012

Cleaning’s Role in Preventing Infections


The hospital’s Housekeeping Department is responsible for the regular and routine cleaning of all surfaces and maintaining a high level of hygiene in the facility in collaboration with the Infection Control Committee. The Housekeeping Department’s charge is:
 
1. Classifying the different hospital areas by varying need for cleaning;
2. Developing policies for appropriate cleaning techniques-procedures, frequency, agents used, etc. for each type of room, from highly contaminated to the most clean and ensuring that these practices are followed;
3. Providing appropriate training for all departmental staff both initially and periodically to assess competencies are maintained or when a new technique, product or piece of equipment are introduced;
4. Establishing methods for the cleaning and disinfection of the patient’s bed, mattress and pillow;
5. Determining the frequency for the washing/disinfection of privacy curtains, walls, floors and furniture.

There should be a continuing program for staff training. This program should stress personal hygiene, the importance of frequent and careful washing of hands, and cleaning methods (e.g., sequence of rooms, correct use of equipment, dilution of cleaning chemicals and disinfectants, etc.) Staff should also understand some basic microbiology including the transmission of disease. Staff should also understand the causes of surface contamination and how to limit the cross-transmission of organisms.

On September 18, 2012, the National Public Radio (NPR) aired a segment titled, “Hospitals Fight to Stop Superbugs’ Spread”. Neal Conan, host, interviewed three guests: Maryn McKenna, author, Superbug: The Fatal Menace of MRSA; Dr. Eli Perencevich, professor, University of Iowa Carver College of Medicine; and Dr. Deverick Anderson, co-director, Duke Infection Control Outreach Network.

The topic centered on the so-called “NIH Superbug”, a Klebsiella pneumoniae that resists most antibiotics, recently killed a seventh patient at the National Institutes of Health Clinical Center in Maryland. Similar outbreaks of health care-associated infections spread in hospitals across the country every day.

McKenna said, “KPC and other bugs like it, which are generally known as the highly resistant gram-negatives, they don’t just live on skin. They live on surfaces that other bugs have difficulty surviving on, things that aren’t organic and that have very low nutrients and very low oxygen, like metal, like plastic, like the rails of a bed or the counter that a computer rests on...And we haven’t thought so much about the environment around the patient. It turns out that that’s what janitors know really well, or, to be more polite, building services people or environmental services people. When they go in the room, they’re not actually focusing on the patient; they’re focusing on all the stuff around the patient: the bedrails, the counters, and the call buttons.”

All three guests agreed with scientific studies demonstrating the role that cleaning plays in saving lives. One well-trained, conscientious hygiene specialist (i.e., Housekeeper, Matron, etc.) given the proper tools, time and cleaning chemistry can prevent more infections than a room full of doctors can cure. Environmental surfaces that are clean and disinfected make it a safe environment in which patients can recuperate and go home-without something they didn’t come in with. Cleaning certainly does play a role in preventing infections and saving lives.




J. Darrel Hicks, BA, REH, CHESP
Author of “Infection Prevention for Dummies”
Go to: www.darrelhicks.com to order your FREE copy of “Infection Prevention for Dummies” (just pay S&H) or to see other blogs and articles.

Darrel Hicks is the author of Wiley Publishing's "Infection Control For Dummies", and is nationally recognized as one of the top experts in infection control. Darrel is also the immediate Past President of the IEHA and is an active member in ASHES where he holds the designation of CHESP. Darrel started his career in the management of housekeeping services in 1981. He has worked in hospitals ranging in size from 20-500 beds, and knows what it takes to plan, set goals and provide guidance and consultation to the management team and department(s) staff. He has managed as many as 13 departments and 170 F.T.E.’s at one time in a 3-hospital system. In that healthcare system Darrel had to pioneer and discover ways to save money by cross training staff, job sharing, controlling overtime and putting a system of controls in place.
 



 

Thursday, October 18, 2012

Take the Infection Prevention Challenge!


The third week in October is designated as International Infection Prevention Week (IIPW) around the world. Infection Prevention and Control programs have been widely recognized as a corner stone to preventing and controlling the spread of infections both within the community and within healthcare facilities. IIPW seeks to galvanize an infection prevention movement at the grassroots level because infection prevention is everyone’s business!   Imagine a healthcare setting, a doctor’s office, a school or daycare where everyone performs appropriate hand hygiene before and after providing patient care or after using the loo! Imagine a community where every individual uses proper respiratory etiquette by coughing and sneezing into their elbow or staying home when sick so as not to infect coworkers. The impact on a global level would be staggering!

While IIPW is often focused towards healthcare settings, there is nothing to stop those of us who work in non-healthcare areas to celebrate IIPW. There are numerous fun and educational games or activities that can be tailored to any facility.  A handwashing competition using Glo-Germ (UV reflective goo), regardless of where you work is always entertaining!  We did this a few years ago and the lengths people took to be the best hand washer was pretty amusing. With the increased usage of ATP meters, activities such as “who has the dirtiest cell phone or keyboard” can also open one’s eyes as to the need for cleaning and disinfection of the surfaces we touch and use frequently throughout the day.

So – are you ready to take the Infection Prevention Challenge? Test your Infection Prevention knowledge with the following questions. 

1. Environmental cleaning can play an important role in containing respiratory outbreaks because these viruses may remain infectious on surfaces for _________ hours?

2. What viral pathogen, often isolated from enteric outbreak specimens, has caused significant human disease in various settings such as cruise ships, hospitals and schools? (Also, known as “winter vomiting disease”)

3. Hands should be washed with soap and water when they feel or look dirty, as well as:
a. Before and after personal functions (e.g. toilet use, coughing, sneezing etc)
b. Before and after preparing, serving or placing food in your mouth
c. After touching pets, participating in outdoor activities or handling dirty items (garbage, money etc)
d. All of the above

4. Transmission of pathogens by touching fomites or environmental surfaces is called:
a. Airborne Transmission
b. Contact Transmission
c. Droplet Transmission
d. None of the above

5. The contact time listed on a Health Canada or EPA registered disinfectant’s label indicates the length of time the surface or device must stay wet in order to ensure disinfection has been achieved.
a. True
b. False

Post your answers on the Blog and we’ll let you know how well you did!

 
Bugging Off!

Nicole



 

Thursday, October 11, 2012

Potions, Lotions, Rubs and Scrubs


“I don’t like germs.  That’s why I don’t like to shake hands.  You just never know what that person did with his or her hand right before it was offered to you to shake...... (Donald Trump)”

I couldn’t have said it better myself!  Except, while Mr. Trump like Howie Mandel are advocators of ceasing the “archaic tradition” of hand shaking to avoid germs, my philosophy is “get a grip – go wash your hands.”

For centuries, hand hygiene has been considered an important measure in promoting both public health and good personal hygiene. There is a plethora of scientific evidence to support the fact that careful attention to hand hygiene, lower rates of infectious disease in diverse settings, such as health care facilities, child care centers, and households.  Fancy that, if you remove germs from your hands you can disrupt person-to-person transmission of infectious diseases!  With the increased recognition of the importance of hand hygiene in health care settings, the assortment of hand hygiene products has expanded to include antimicrobial foams, rubs, lotions, wipes, and soaps and with 7 Billion people worldwide, why wouldn’t it?  Hand hygiene products are a very lucrative business to be in.

Similar to the surface disinfectant chemistries we have been delving into over the past year, there are a slew of chemistries traditionally used for hand hygiene.  Like any chemistry, there are also concerns about the toxicity both human and environment as well as resistance development.  As hand hygiene is known to be probably the single most important factor to stopping the spread of disease, development of resistance to the potions, lotions, rubs and scrubs we use to clean our hand is of vital importance.  I would hazard to say more so than even surface disinfectants as the “wash off” products that we use to clean are hands enter the sanitary sewer system and ultimately into the environment at far larger volumes than the surface disinfectants that we wipe on a surface and allow to air dry.

According to the Centers for Disease Control and Prevention (CDC), virtually all significant bacterial infections in the world are becoming resistant to the antibiotic treatment of choice.  “The CDC estimates that, each year, nearly 2 million people in the United States acquire an infection while in a hospital, resulting in 90,000 deaths. More than 70 percent of the bacteria that cause these infections are resistant to at least one of the antibiotics commonly used to treat them.”  Bacterial resistance results in more visits to the doctor, a lengthier illness, the use of more toxic drugs.  It can also mean death.   Similar to antibiotic resistance, the threat of pathogens developing chemical resistance is very real.  There is widespread concern over the development of chemical resistance to the hand hygiene products currently used.

In 2013, we will be delving into each of the hand hygiene actives so for the purposes of this blog I will not be going into “report card” detail.  For what I will refer to as the “wash off” actives the primary chemistries used for hand hygiene include; Quaternary Ammonium Chloride, Chlorhexidine, Parachlorometaxylenol or PCMX (a phenol derivative) and Triclosan. 

If you recall from my “Rub-a-Dub-Dub, there’s a rubber duck in my tub” book review blog in July, Slow Death By Rubber Duck describes in detail an experiment in which the author turned himself into a human guinea pig.  The level of Triclosan in his blood shot up by 3,000%!!!  Triclosan is believed to interfere with thyroid function and is not metabolized by the human body or even by the sewage waste process, making it an almost ubiquitous environmental chemical in water.  In fact, in a study by U.S. Centers for Disease Control and Prevention scientists detected Triclosan in the urine of nearly 75% of those tested (2,517 people ages six years and older).  The European Union classifies Triclosan as irritating to the skin and eyes, and as very toxic to aquatic organisms, noting that it may cause long-term adverse effects in the aquatic environment.  Environment Canada likewise categorized Triclosan as potentially toxic to aquatic organisms, bioaccumulative, and persistent.  In other words, it doesn't easily degrade and can build up in the environment after it has been rinsed down the sink or shower drain.

Suffice it to say, similar to the surface disinfectants we have already investigated, due diligence into the type of hand soap we use needs to be considered.  As we are seeing with surface disinfectants, oxidizing chemistries, especially hydrogen peroxide-based products are expanding because of their exceptional health and safety and environmental sustainability profiles.  H2O2 breaks down into water and oxygen meaning is completely benign if rinsed down the drain and as it does not leave behind any chemistry residue it will not lead to chemical resistance.  While H2O2 is not an active that is widely used for hand hygiene, a product based on hydrogen peroxide was recently launched in Europe and will surely make its way to North America. 

The next time you need to choose a hand hygiene product I hope you’ll take time to consider the type of chemistry the hand soap you choose uses and pick one that will be safer for you, me and the environment!

Bugging Off!

Nicole