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, September 27, 2012

Biosecurity Challenges: Can we train an animal to cough into their elbow?

Biosecurity can have different connotations depending on who you are speaking with, but for the purpose of this blog, it means to protect the animal, human and environmental health against the threat of pathogenic microorganisms. From this definition it is important to highlight the fact that the three pillars upon which a biosecurity program should be built are the animal, the environment and the human.   Taking into account the “animal factor” is a key consideration in developing a biosecurity program because diseases can spread from animal to animal, from animal to humans (zoonosis) and, although less frequently, from humans to animals.

In veterinary medicine, as in human medicine, the human factor is crucial. People from different backgrounds are involved with the daily care of animals, that is veterinarians, veterinary nurses, veterinary assistants, veterinary students, cleaning crews, farmers, etc. all of which need to understand and be educated on general biosecurity and more specific biosecurity issues concerning their specific activity. Therefore education and compliance are two very important factors to deliver high levels of care for the animals and to protect humans, thus making a biosecurity program successful.

In the animal world there are many different contagious infectious diseases with the potential to cause outbreaks or serious diseases, not only in a hospital setting, but also in the field.  Infectious disease outbreaks are costly and can have devastating economic effects. Thus education of personnel is a very important factor in preventing outbreaks. While it would be nice to think we can train an animal to cough into their elbow, the reality is it’s not going to happen.  We have to rely on how people are handling the animals.  If properly educated and well trained, people can recognize an infectious disease early and have a biosecurity protocol in place, they can help prevent its spread. Adding to the importance of the human factor is the potential risk of zoonotic diseases. In survey of North America Veterinary Teaching Hospitals, 50 % of the participating institutions reported zoonotic infections; agents included Cryptosporidium parvum, MRSA, Salmonella enterica, among others. A key element of a biosecurity program is that animal care givers learn how to recognize and protect themselves from zoonotic diseases. 

Biosecurity education will also ensure compliance. In this sense, a biosecurity program needs to have the full support of the top level of the organization and trickle down; more importantly everyone should be engaged and understand the importance of biosecurity practices. Thus, multidisciplinary team work is paramount for a biosecurity program to be successful. This means that everyone in the organization involved with the care of animals from the CEO to the cleaning crew should be integral parts of this team, and the importance of their jobs should be highlighted and praised. 

I think that the human factor is paradoxically the most difficult to attain, since it is hard work to educate everyone and more so, even if efforts are made in education, compliance can be less than ideal. It is critical to understand that team work and effective leadership can be the difference between success and failure. 

Looking at the animal factor; animals can become ill with a wide variety of infectious contagious diseases. It is important to understand the difference between an animal being sick with a contagious infectious disease, being colonized or being a carrier.  In a hospital situation, admitting an animal that is sick with an infectious disease (i.e. fever, leukopenia and diarrhea) will prompt immediate placement of that animal in the isolation area, where high levels of biosecurity measures are implemented. More complex is the identification of an animal that can be a carrier of an infectious disease, but not sick at the time of admission.  These animals impose a high risk to a hospital environment. This is why a biosecurity protocol must always be in place and we should never lower our guard when it comes to infectious disease control. International animal travel is a great example of this risk and epitomizes the need for strict surveillance and biosecurity measures.

The environment is a complex issue in veterinary medicine; the reason being that so many different materials and designs are utilized to house and/or transport animals, thus making it difficult to implement standards across the board. The wide array in materials will have a direct impact on measures taken to prevent or mitigate the spread of an infectious disease. More importantly the efficaciousness of disinfectants is correlated to the surface to which it is applied.  For example, it is very hard or even impossible to properly disinfect untreated wood or dirt. Cleaners and disinfectants are best used on surfaces that are non-porous (i.e.  Epoxy painted concrete blocks, stainless steel, tile, etc.). Infectious diseases can also occur at the farm level, where control measures can sometimes be more challenging, especially if a biosecurity plan is not routinely used.

In North America a survey including veterinary teaching hospitals reported that 82 % of the institutions had an outbreak of nosocomial infection and 58 % of the institutions had to restrict patient admissions in order to control the outbreak. This paper did not include data from private veterinary hospitals, thus likely underestimating the overall importance on nosocomial outbreaks in the veterinary environment. The most common agent associated with nosocomial outbreaks, particularly in large animal hospitals, was Salmonella enterica. This is the reason why large animal hospitals utilize active surveillance to detect shedding of this bacteria among hospitalized patients. This highlights the importance of the environment as a source of infectious diseases, making environmental cleaning and disinfection very important.

Environmental cleaning and disinfection along with the use of appropriate products is an integral part of a multidisciplinary biosecurity protocol. That is environmental measures should complement but not replace other important aspects of biosecurity, such as education, hand hygiene, compliance, etc. Disinfectants should be chosen based on their microbicidal spectrum, contact time, compatibility with materials and finally safety.  One of the most serious flaws of disinfectants routinely used in veterinary facilities is a prolonged contact time required for microbial killing. Many disinfectants required microbicidal time of 10 minutes, but dry well before achieving this dwell time, thus creating a false sense of security and increases the risk for susceptible animals or humans at risk to become infected.  Choosing a disinfectant is more than a review of kill claims or price.  One needs to investigate the contact times, the safety profile not only for the animal but for the people who will be using the product and the environment because in rural areas, the run-off from disinfectants is not being routed into sanitary sewer systems for treatment.

Take a look at your biosecurity program to see if there are areas that need to be improved and be sure to give me a call if you successfully train the animals you handle to cough into their elbow!


Dr. Lucas Pantaleon is a Large Animal Board Certified Internal Medicine Specialist.  Dr. Pantaleon worked as the head of Medicine and Biosecurity at an equine hospital in Kentucky and has an ambulatory Internal Medicine Veterinarian in a practice in Kentucky.  He is currently the Director of Technical Services for Ogena Solutions who provide environmentally friendly bio-security products, equipment and protocols.

Friday, September 21, 2012

Disinfectant Chemistry Report Card #8 – Organic Acid Disinfectant

It’s not a wonder why we choose to combine limes with drinks, and lemons with fish or vinegar with fries. It’s all about that strong distinct flavor combined with the tastes of many of our favorite indulgences. The thing common about these additives is that, well they taste awesome, but also that they are all organic acids, a certain category of disinfectant. Acids are typically sorted into two groups: Inorganic acids and organic acids. Inorganic acids are typically known as ‘harsh’ acids and lack a –COOH functional group in its chemical structure. Organic acids are known as ‘carbonic’ acids which contain a    –COOH functional group. When you think “acid” you may revert back to the searing, corrosive substances we see in movies that burn through everything. However, the strength of an acid, and its disinfection characteristics, is largely proportionate to the concentration in which it is encountered. Recently, organic acids have become a newer phenomenon in general hard surface disinfection due to their trendy attributes. However, certain characteristics of organic acids can diminish their disinfection grade point average.

      Organic acids, such as citric acids from lemons, generally lack good cleaning capability and fail to dissolve greasy substance. Further, they do not exhibit detergent like properties because they do not contain polar and non-polar portions within their chain. It is possible to increase the acid concentration to improve cleaning capabilities, however it would sacrifice other key characteristics desired of modern disinfectant products. Overall, in their typical disinfection concentration, organic acids do not exhibit strong cleaning behavior.

      The germicidal efficacy of the various organic acid disinfectants is aslo a detrimental feature. They typically lack a broad spectrum of kill compared to higher level disinfectants such as bleach and hydrogen peroxide. Their mode of disinfection depends on the interaction of dissociated protons with microbial surfaces. Microbial membranes lose integrity in the reaction with free protons in solution. You may be thinking “Hey, wait! Vinegar and acetic acid have been used for hundreds of years as methods of disinfection and sanitization.” However, it is important to note that these only show strength against relatively easy to kill organisms such as pseudomonas. There is no current data that concludes that organic acids bolster a broad spectrum of kill.

      From a safety perspective, the higher the concentration of the acid, the more dangerous it is. For instance, concentrate forms of acetic acid, citric acid and lactic acid are all extremely hazardous and can cause serious health problems to many parts of the body. However, they are safe to consume in the concentrations encountered in some of the foods we enjoy. The concentration of acetic acid in vinegar or citric acid in lemons is typically 4% to 8%. That being said, the safety is mainly dependent on the concentration and the type of organic acid.

      Organic acids cause minimal toxicity in the environment at the concentrations they are used as disinfectants. This is because of their high solubility in water. When introduced into aquatic environments, the acids become diluted and thus less toxic. Furthermore, they cannot bio-accumulate within organisms or the environment because of this high water solubility. Finally, the degradation products of organic acids do not pose any threat to the environment, and are deemed “readily biodegradable” by the EPA.

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

     Speed of Disinfection – C to D

o     Contact times range based on concentration and type of organic acid. They range from 10 minutes to hours for contact time.

     Spectrum of Kill – D

o     This is the most daunting feature of organic acids because there is not enough data to show efficaciousness against a wide variety of both easy and difficult to kill organisms.

     Cleaning Effectiveness – C to D

o     Organic acids do not exhibit high detergency properties, however it is closely tied to the concentration of the product.

     Safety Profile – B to C

o     Organic acids are generally safe compounds as encountered, however they can become hazardous at high concentrations.

     Environmental Profile – A to B

o     These disinfectants are readily biodegradable and easily dissolved in water, making them preferable to the environment.

     Cost Effectiveness – A to B

o     Due to their availability, organic acids are usually cost effective methods; however price increases as concentration rises.

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

 
Bugging Off!

Nicole

Friday, September 14, 2012

Be Spa Safe!

Writing, at least for me cannot be forced.  I’m a “muller”, in that I like to choose a topic, mull it over, have it “speak to me” to get the creative juices going.  This week, the topic I had picked is not speaking to me.  As I have been putting the last minute touches on a presentation I’m giving on Sunday about Infection Prevention in Personal Service Settings it occurred to me why not write a blog on that!  I admit, there are times, when I truly question if in fact I have a brain……

Like any good female, preparation for speaking in front of crowds is not just about what topic will be discussed.  Consideration as to how you’ll look is an absolute must.  The fact that I will be speaking to a group of estheticians and Spa owners who are generally immaculately quaffed, not a hair out of place (and no grey to speak of), expertly manicured hands and feet, tastefully (generally speaking) applied makeup has put me into a bit of a panic.   I have managed to squeeze in a hair appointment, I’m generally capable of applying makeup, I’m hoping it’s not too late in the season to wear my linen suit and the shoes that REALLY pull of the outfit are only peep-toes so…..I should be able to get away with the fact that it was me who painted my toes.

So what does this have with Infection Control in the Personal Services market?  Well, first off, Personal Services spans a large array of services; manicures, pedicures, facials, tattooing, body piercing, acupuncture and barbering or hair salons.  Having brushed up on the infection control practices required for personal services, I can say with CERTAINTY my hairstylist of over 10 years does NOT practice infection control according to the current guideline recommendations.  But, lucky for her, I’m not too worried about picking anything up from the chairs (that’s why you always wash your hands before eating), nor am I too worried about catching something from the brushes/combs or scissors she used.  First, she has never nicked me with her scissors – an obvious sign of her ability!  So the chance of getting a Bloodborne pathogen is pretty low.  While I didn’t see her disinfect the combs or brushes I am actually thankful she does not use Barbicide…it’s never used correctly so the combs and brushes may just as well be rinsed with water and besides, I had lice in public school – no big deal, wash your hair in special shampoo, use a special comb, stay at home for a period of time.   Heck, if I caught lice on Wednesday perhaps I wouldn’t have to work on Sunday! 

As a consumer, what are some of the things you can look for when considering your next pampering treatment in a personal service setting.  Here are the things I look for: 

1. Is the facility clean and organized?

2. Are the tools and work surfaces in good repair?

3. Did I see the personal service worker wash their hands?

4. Are the tools and supplies stored in a clean area?

5. Are creams, lotions, wax etc used in a way that does not contaminate them?

6. Are clean sheets, towels, etc used for each client and paper liners thrown out after each use?

7. Most importantly, ask yourself if you feel comfortable with getting whatever treatment you are looking forward to done.  If what you see or hear is making you uncomfortable…RUN!!!!!

In a nutshell, the infection control requirements for personal services are fairly simplistic.  Clean what needs to be cleaned.  Disinfect what should be disinfected.  Sterilize what needs to be sterile (or just purchase the items as single-use sterile items and for those items that cannot be cleaned, disinfected or sterilized between uses, throw them out!  If you want more detail and a description of what items are used for various “treatments” York Region has a really good pamphlet “Be Spa Safe”.  And yes, I did steal the title of this blog from their pamphlet!

 

Bugging Off!

Nicole

Thursday, September 6, 2012

Slippery When Wet – Proper Cloth Saturation is Key for Adequate Disinfection


This past spring I read an interesting abstract authored by Cynthia J. Larson, Aaron Freeberg and Wendolyn Slattery titled “The Effect of Proper Cloth Saturation on Disinfection of High Touch Surfaces”. Although I sadly didn’t get an opportunity to attend their abstract presentation during this year’s APIC Conference in San Antonio, the abstract presents a straightforward account of their study and the impact cloth saturation can have on the effectiveness of cleaning practices. 

As Nicole and I have lamented time and time again, contact time is important when using disinfectants! If the contact time is not complied with, it’s likely that disinfection is simply not being achieved. Selecting a disinfectant with a rapid and realistic contact time will most certainly make this an easier goal to achieve however, we will still need to use or apply the disinfectant in such a way that its contact time is easily complied with. Not surprisingly, the saturation level of the cloth or wipe used to apply the disinfectant will play a major role in ensuring adequate coverage of the surface. But, when was the last time you incorporated a discussion on cloth saturation into your cleaning and disinfection training? I’ll admit, even I’m guilty of glossing over that detail when I’m assisting with such training sessions. 

The Larson et al. study found that improving the saturation of disinfectant on the cleaning cloths in conjunction with some education on effective cleaning processes did improve environmental monitoring scores by 24% initially and with continued feedback improved them by 55% overall. But, what is the appropriate amount of saturation?? In my opinion, the cloth should be wet with the solution, but not so wet that it is dripping everywhere. It should be sufficiently saturated to provide consistent and even coverage of the surface but not pose any risk to the user because it’s “sloshing” everywhere. The study found that utilizing a cloth and bucket process provided superior saturation when compared with their prior method of pouring the disinfectant solution onto the cloth prior to wiping the surface. We too have found this in practice and will often recommend this application method when feasible. 

What about pre-saturated disinfectant wipes? How do we ensure they are sufficiently saturated? More correctly the question should be: How do we ensure that the disinfectant wipes stay sufficiently saturated? Disinfectant wipe manufacturers have determined exactly how much solution is required to fully saturate their wipe substrate and will manufacture the product with this in mind. With that being said, end-users need to ensure that the wipes remain wet by keeping the canister closed when not in-use. If the canister is left open, the first wipe or two may slowly dry out in which case they should be discarded in favour of a fully saturated wipe when the cleaning and disinfection task is at hand. Likewise, common sense should play into the equation when using disinfectant wipes to clean and disinfect larger surfaces.  A single 6”x7” disinfectant wipe is unlikely to distribute enough solution onto a 4’x8’ table for instance.  In other words, multiple wipes may be required to complete some tasks.

To summarize, a nearly dry cloth or wipe is unlikely to help us effectively clean and disinfect high touch surfaces.  End-users should ensure that their cloth is sufficiently saturated, yet not dripping wet, when cleaning and disinfection in order to provide them with the most likely chance for success.

So, are you going to include mention of cloth saturation in your next environmental cleaning training session? 

Hasta la vista

Lee – The Germinator