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.

Thursday, May 31, 2012

Is the EPA condoning the use of Steroids?

The baseball season has started and for those of you diehard fans watching your favorite player hitting yet another ball out of the park, like me you may be wondering “How the heck do they do that!” 

Professional sports are a great example of an industry that has perhaps raised the bar too high and set too many unrealistic goals for players to achieve. We wonder who will be the next Barry Bonds.  We get caught in the thrill of watching these talented players and rarely think to ask “How did they get that good, that strong, or that big?” Then we open the front pages of the sports section and hear of yet another steroid scandal. 

The disinfectant world is not unlike professional sports.  There are new bugs cropping up that Infection Prevention and Control, Public Health and Environmental Services expect their disinfectant of choice to kill.  The bar is being raised to unrealistic expectations – kill a greater spectrum of bugs in a shorter contact time.  To meet these demands, disinfectant manufacturers “juice up” or increase the chemical concentration or combination of chemicals in their disinfectant formulations in order to achieve the desired claims.  Like the long term affect steroids can have on a baseball player, “juicing up” a disinfectant formulation means the safety profile of the disinfectant will be compromised. 

Let me give you an example of this.  There is a popular disinfectant brand on the market advertising that in recent years they have knocked their contact time down from 5 minutes to 3 minutes and now 1 minute!  From an infection prevention perspective you may be screaming “FANTASTIC”!  But have you taken the time to look at the MSDS in order to determine how they have performed such a feat?  I have.  It’s “juiced up”, one of the active ingredients has tripled in concentration and they have added a second type of alcohol.  What is the end result?  A 1 minute disinfectant that now carries a HMIS Rating of 2/3/0.  To handle this product you should wear gloves and goggles and the toxicity profile shows it is Toxic by inhalation per OSHA regulations, slightly irritating to eyes and skin, contains material which can cause target organ damage and contains material which both causes and may cause damage to the organs.  That’s just the health effects.  The Flammability rating of 3 indicates the product is highly flammable and should be stored in a segregated and approved area and all possible sources of ignition (spark or flame) should be avoided.  Is this a product you want to use?  Is a one minute contact time so important that we would knowingly choose a product that would put cleaning and nursing staff at risk?

Federal law requires that before selling or distributing a pesticide in the United States, a person or company must obtain registration, or license, from EPA.  Before registering a new pesticide (including disinfectants) or new use for a registered pesticide, EPA must first ensure that the pesticide, when used according to label directions, can be used with a reasonable certainty of no harm to human health and without posing unreasonable risks to the environment.   Herein lays the crux of the problem. 

To generate bactericidal efficacy data, the EPA requires the use of a test method that was introduced in the early 1950’s and is known to have flaws.  In a study recently published in the Journal of AOAC International, titled “Should the AOACUse-Dilution Method be Continued for Regulatory Purposes?” a statistical evaluation of the Use-Dilution Method (UDM) was conducted.  I won’t bore you with the details or formulas used – you can read the study at your own leisure.  Suffice it to say, the study showed that there was a significant disconnect between the probabilities of a pass/fail result when compared to the random testing conducted by the EPA’s Antimicrobial Testing Program.  The difference can in part be attributed to the fact that the method shows significant variability in the numbers of bacteria that adhere to carriers, however, the main cause is in fact highly operator sensitive such as how the lab technician places of the cylinders into the test tubes or places the test specimens for drying as well as any variations in growth conditions.

Further, UDM is not representative of real world conditions, especially for products with rapid evaporation rates (alcohol based products) as the concentration of the active decreases rapidly when exposed to a surface.  UDM provides a much higher ratio of disinfectant volume to surface and does not account for evaporation rate that occurs when used in accordance to the product’s label.  Similarly, the ratio of disinfectant to inoculum is very different than what is encountered in practice and lastly, there is limited ability to include other environmental surfaces which can also alter the outcomes of efficacy capabilities of a given disinfectant.

It is also important to consider the affect development of very robust formulations have from an environmental impact perspective. Globally, users of chemicals are looking for and demanding access to more environmentally friendly products, however, the EPA’s rigid stance and refusal to transition to methodologies that have been shown to be more accurate and consistently reproducible such as Quantitative Carrier Tests impacts both the environment through higher carbon footprints in the production of the disinfectants, unnecessary disposal of higher concentrations of disinfectants by the end user and also increased risk to the user as a result of less favorable health profiles.

By no means am I saying that from an infection prevention perspective we should use inferior products with contact times that are unrealistic.  I am saying that we as a community who uses disinfectants on a daily basis should consider not just what a product kills, but also the safety profile of the product and lobby the EPA for the use of test methods that have been shown to be reproducible, reliable and more accurate than the Use-Dilution Method.  Formulation of disinfectants is a complex process that involves finding the balance between the desired efficacy traits and the desired safety and environmental profile of a product.  The EPA’s mandate is to ensure that the use of disinfectants “can be used with a reasonable certainty no harm to human health and without posing unreasonable risks to the environment”. The use of UDM completely contraindicates this mandate as it forces disinfectant formulators to “juice up” their formulations in order to achieve the kill claims and knowingly decrease the safety profile of the product. 

I hope you’ll consider this the next time someone comes your way with the next “fastest” disinfectant on the market.  A fast kill is a double edged sword.  Are you willing to forego safety for speed knowing that the test methods used to determine efficacy are faulty?

Bugging Off!
Nicole 

Thursday, May 24, 2012

Disinfectant Chemistry Report Card #4 – H2O2 – Should it be our disinfectant go to?

When it comes to hydrogen peroxide, most people think of that little brown bottle available at our local grocery stores.  For me, memories come flooding back from when my mother used it as an antiseptic on my skinned knee.  At the time, the bubbling and foaming that occurred was really quite cool.  Use as an antiseptic is just one application of hydrogen peroxide that demonstrates its well known antimicrobial qualities.

Hydrogen peroxide was first discovered in 1818, but its use as an odour counteractant or disinfectant didn’t begin until 1891.  Still, that makes it one of the oldest known disinfectant chemistries.  Hydrogen peroxide generates hydroxyl radicals – the strongest known oxidant – which attack DNA, membrane lipids, enzymes and other vital cell components to exhibit its germicidal kill.  The end result is hydrogen peroxide’s broad spectrum of potential germicidal activity.   Depending upon its concentration, hydrogen peroxide can be used for applications ranging from use as a preservative to that of a chemical sterilant.  At 25ppm, hydrogen peroxide can inhibit growth of bacteria, while 6% hydrogen peroxide can inactivate bacterial spores – the toughest known microorganisms.  Hydrogen peroxide can also inactivate viruses (both enveloped, non-enveloped), fungi, and mycobacteria.

Believe it or not, hydrogen peroxide also naturally exists in honey and milk as a preservative.  It is available in our saliva as an oxidant, in blood as a part of our immune system against pathogenic microorganisms, and in tissues due to cellular metabolism.

When applied to a surface or item, hydrogen peroxide does not carry any residual activity since it either evaporates from the surface or degrades into its constituent components – water and oxygen.  Furthermore, because it has more than one target site while inactivating microorganisms the potential for bacterial resistance to develop against hydrogen peroxide is essentially non-existent.

The fact that hydrogen peroxide degrades into water and oxygen also makes it an environmentally preferable disinfectant chemistry.

As we have dwelled upon in previous blogs, another very important consideration is a product’s ability to clean and aid in the ability to lift and remove soils from a surface.  Since hydrogen peroxide is an oxidizing agent, it oxidizes organic materials allowing them to be more easily removed from the surface.  For this reason hydrogen peroxide is used in many commercial and consumer cleaning products.

With these key points fresh in your mind, how would you grade standard hydrogen peroxide as a disinfectant chemistry? 

Similar to chlorine based solutions, hydrogen peroxide solutions are utilized within a spectrum of various concentrations.  Taking this into account, here’s how we would score stand-alone hydrogen peroxide solutions on the key decision making criteria:

Speed of Disinfection – B to C

- High concentrations of hydrogen peroxide (6-7%) do carry relatively rapid contact times for the high level disinfection and/or chemical sterilization of medical instruments
- For surface disinfectant applications, standard hydrogen peroxide solutions tend to be quite slow.

Spectrum of Kill – A to C

- Similar to the speed of disinfection, performance in this criteria is tied to the in-use concentration
- 6-7% concentrations can be used as chemical sterilants to eradicate all microbial life; 3% solutions may be used as surface disinfectants or skin antispetics

Cleaning Effectiveness – B

- Hydrogen peroxide oxidizes organic materials allowing them to be more easily removed from the surface.  For this reason hydrogen peroxide is used in many commercial and consumer cleaning products.

Safety Profile – A to B

- This is another parameter largely affected by the in-use concentration of the solution
- Hydrogen peroxide based solutions tend to be safer alternatives to other commercially available disinfectant chemistries
- Concentrations used for surface applications tend to be non-toxic and non-irritating; concentrations used for medical device disinfection, although irritating to eyes and skin, do not carry respiratory irritation profiles as do many disinfectants used in these applications

Environmental Profile – A

- Hydrogen peroxide degrades into water and oxygen making it an environmentally preferable disinfectant chemistry

Cost Effectiveness – B

- Hydrogen peroxide is readily available from various manufacturers and can be found in both concentrated and ready-to-use formats.

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


Hasta la vista

Lee – The Germinator

Thursday, May 17, 2012

Physics of Flying Feces – not for faint folk!

Some of you may have heard my Webber Teleclass with the above title, or my follow up presentation "Portal of Entry: the Missing Link". Both presentations look at how we handle fecal waste in our healthcare facilities and the organisms that are harboured in the patient's feces: I focussed primarily on Vancomycin Resistant Enterococci (VRE), Clostridium difficile (CD), but this list could be expanded to include the Extended Spectrum Beta lactamase (ESBL) organisms and the Carbapenem Resistant Enterobacteriaceae (CRE). All found frequently in fresh (or foul) feces (no more alliteration, I promise!).

In putting these presentations together, I recognized the importance of effective environmental hygiene and the importance of hand hygiene, not just of healthcare providers, but also of patient and families or visitors. Through previous Virox blogs and other journal articles I realize it does not matter what chemical is on a cloth wiping a surface if the surface is not wiped at all, or if the solution does not have the contact time required to kill the possible pathogens. There is no such thing as instantaneous kill; and surfaces with coatings or metals that kill bacteria still require a period of time to be effective. This leaves us with hand hygiene as our last line of defense, so if we pick up a "not quite dead" organism, we can either wash it off or kill it with alcohol based hand rub (ABHR).

Our environmental arsenal now includes sporicidal agents to be used when we have a CD infected patient. I have heard of some facilities that are now using the sporicidal agents on all discharge cleans of patient washrooms, in case the patient was an asymptomatic carrier of CD. This makes sense from a Routine Practices perspective: we don't really know who has what, and what they may share with whom. Don’t worry about the acronyms (MRSA, VRE, CD, ESBL, CRE)…worry about what is happening to the environment (yes, I have a presentation called Acronym Madness). In that presentation I summarize routine practices in 20 words:  "If they are leaking or soiling the environment, limit their movement and protect yourself. If it is dirty, clean it!" These 20 words will encompass Routine Practices and Additional Precautions such as Contact and Droplet. I think the only sign we really need is one for airborne transmitted organisms if we follow these words with dedication and readily available personal protective equipment. If you used a piece of equipment or your hands, they are dirty, clean them!

I have spent over 20 years trying to make hand hygiene so integral to all healthcare providers that it would be performed without thought, but with effectiveness. Demonstrations using finger paint on gloved hands to indicate where someone might miss while lathering their hands has opened many an eye, and even evoked the comment from a first year resident: "Why is it at this point in my career that someone finally showed me I do a lousy job at washing my hands"! We also have the hand wash demonstration where oil is put on staff hands, they wash and we show them where they missed while lathering. I have always hoped for a product whose fluorescence is inactivated by alcohol, so the same demonstration can be used with application of ABHR.

I was thrilled to see the April 2012 American Journal of Infection Control with a paper on patient hand hygiene. We do a great job in our healthcare settings to make it very hard for patients to perform hand hygiene, either keeping the sink against a wall for our mobility impaired patients already in their bed when a meal arrives, or not providing readily assessable ABHR near the patient. Even with ABHR available, if the patient does not have the strength or mobility to depress the plunger, they can't clean their hands. Let's assess our patient's ability to perform hand hygiene and warn staff that this patient may require assistance with hand hygiene. Let's allow a patient who is being moved from wheelchair to bed via a ceiling lift, in preparation for supper, to wash their hands at the room sink before their meal. They will have just moved their wheelchair through our healthcare facility and their hands will have acquired the same bacterial stew as the floors in our hospital's hallways. I don't know about you, but that is something I would not want to feed to myself along with my sandwich.

Control of feces is paramount to many of the acronyms. We have in our arsenal systems that wash and sanitize our bedpans after each use, we have liners which limit the spread of feces during disposal, and we have disposable bedpans that guarantee a single use. We also have older facilities (and newer ones) with none of this and an environment that gets soiled. Each new case of VRE or CD can be traced back to feces being where it should not be, or a surface or hand that was not cleaned effectively. With ESBL and CRE, when it shows up in an infected site, it might just be opportunistic and came from that patient, but it could also have been present where it should not be, in our environment.

The portal of entry for most of my acronyms is the mouth. Careful and effective handling of feces, scrupulous environmental hygiene, and fastidious hand hygiene helps break this link in the Chain of Transmission.


Jim Gauthier, MLT, CIC

Infection Control Professional
Providence Care, Kingston ON
President, CHICA-Canada

Jim Gauthier has been working in the field of Infection Prevention and Control for over 20 years.  He is a Medical Laboratory Technologist by training and loves his bugs so much so that he has written, arranged and performed several catchy tunes such as “I’m so much cleaner” and “Goodbye MRSA”.  Jim is currently an Infection Prevention and Control Practitioner at Providence Care in Kingston ON. He is also the President of CHICA-Canada.






Thursday, May 10, 2012

In the air we breathe…

WARNING!!! The following may be a bit graphic.  If you have a weak stomach you may want to refrain from eating while reading this blog!

Years ago, when I first started down this path of educating on the use of disinfectants for infection prevention I had lunch with a veteran ICP.  We were sitting across from each other (less than 1 meter apart) over soup and salads chatting about transmission of various pathogens.  Being a bit na├»ve, I asked her about the importance of a TB claim on products as I had received several inquiries pertaining to products that carried TB claims for use in populations with high TB prevalence.  Let me tell you, I got schooled on Airborne Transmission that day!

The ICP put down her spoon, looked at me and shook her head….you know the kind of shake you get when someone can’t believe you’ve just said something really, really dumb?  As my ICP friend went on to explain airborne transmission occurs when bacteria or viruses travel on dust particles or on small respiratory droplets that may become aerosolized when people sneeze, cough, laugh, or exhale. They hang in the air much like invisible smoke. They can travel on air currents over considerable distances. With airborne transmission, direct contact with someone who is infected is not necessary to become ill. The amount of exposure necessary varies from disease to disease. With chickenpox, a child could easily catch it from another aisle in a supermarket. With tuberculosis, closer contact and less air circulation are often needed.

She said “Let me put it to you this way.  If I had TB, coughed up a “phlegm-ball”, spit it in your soup and you ate it….you would not catch TB.  The ONLY way you can catch TB is to breathe in enough of the air particles I have exhaled that are carrying TB.  Diseases such as TB that are only transmitted by inhalation of infectious particles carried in the air are not transmitted by touching surfaces or “eating” someone’s phlegm.”

As I learned that day, while some organisms such as Chickenpox can be spread by both contact with the open lesions and via air, there are a number of organisms such as TB that are solely transmitted by air. The best way to avoid airborne infections is to be in a different room from the person who is ill, with a closed door in between. If you need to be in the same room, wearing a mask such as an N95 respirator will help for a brief exposure. Cleaning and disinfecting surfaces in the patient room is still an important part of infection control to keep down the bio-burden levels, but for organisms that are solely transmitted by air, cleaning and disinfection of surfaces does help in stopping or preventing transmission.  Cough etiquette - covering the mouth or nose when coughing or sneezing also decreases droplet spread to some degree as such patients with suspected infections caused by pathogens that are spread by airborne transmission should be given a mask to wear until they can be isolated or if being transported.

I love soup, but even 8 years later, whenever I eat chicken noodle soup, I still recall the story my ICP friend told me and hope no one has spit in my soup!  I know I won’t get TB, but who knows what else I could pick up!


Bugging Off!

Nicole

Friday, May 4, 2012

Keep your droplets to yourself!

“JOHNNY” yells his mother “How many times do I have to tell you to cover your mouth when you cough!”

“Sorry mom!” Johnny yells back….

Growing up, my mom was a nurse.  My brother and I just thought her reflexive “Cover your mouth”, “Wash your hands” was the nagging rite of passage nurse-moms have over their kids.  We rarely responded with a “Yes, mom!”  The usual response from us would be rolling of the eyes, shrugging of the shoulders and yelling “Whatever!”  As an adult, a mom and in a career related to infection prevention and control, I realize my mom’s often repeated phrases to cover our mouths and wash our hands were in fact sound guidance not just to teach us good manners, but to help prevent the transmission of disease. http://www.youtube.com/watch?v=e2QAGVMlns4

So what is the big deal about covering our mouths when we cough or sneeze?  Oral or nasal secretions (snot, saliva, mucous etc) infected with bacteria or viruses that cause the flu, the cold, strep throat and even the PLAGUE can travel on relatively large respiratory droplets when people sneeze, cough, drip, exhale and even speak!  They travel only short distances before settling, usually less than 3 feet, but these droplets are loaded with infectious particles and if they enter the eyes, nose or mouth of another person….well you get disease transmission.   Basically, when some coughs or sneezes directly into your face you’re eating or absorbing their mucous or snot….  Something I try to avoid at all costs!

 

More often, though, fomites (a fancy word for inanimate surfaces) are involved in transmission of disease.  The droplets land on hands, toys, tables, mats, or other surfaces, where they sometimes remain infectious for hours.  Hands (mine, yours, a teacher’s, a doctor’s, a nurse’s) that come in contact with these surfaces (doorknobs, telephones, pens, etc.) pick up the bugs from the surface and become contaminated.  When the “dirty” hand touches the nose or eyes, the infection is able to enter the new person.
Frequent hand hygiene with plain soap and water or the use of alcohol based hand sanitizers can help prevent droplet transmission.  Hand hygiene is most important before eating and before touching the nose or eyes.   However, cleaning or disinfecting commonly touched infected surfaces such as over bed tables, doorknobs, faucet handles, shared toys, mats in daycare and the steering wheels of our cars is also an important preventative step.  If the surface is clean and free of bugs, it will decrease the chance of contaminating your hands and making yourself sick. 

Be honest, do you actually cover your mouth if you sneeze or cough while driving?  When was the last time you cleaned and disinfected your steering wheel?  Do you eat in the car?  Do you know what you have on your hands?  I hope the next time you sneeze or cough no matter where you are you cover your mouth!  Frankly, I don’t need the extra “protein” in my diet!

Bugging Off!


Nicole