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 29, 2014

Sustainability through Green Killing


To some, the concept of green disinfectants is an oxymoron.  How can you be green and kill?  Without a doubt there is a group of like minded people who I refer to as The Granola Bunch who advocate and believe that all chemicals are bad and should be banned regardless of their need from an infection control perspective. Now don’t get me wrong – I believe that we need to use chemicals judiciously. Antibacterial hand soaps are not needed for the general public or at home – just use plain soap and water. Nor do disinfectants need to be used everywhere or on everything. There are, however, areas that require the use of disinfectants and cucumber juice, essential oils or other seemingly benign chemicals that claim to have killing properties do not provide the level of efficacy (protection) that are needed. You can however, choose products that use safer, more environmentally friendly chemistries. In Canada you can find certified green disinfectants through the EcoLogo program and in the US, through the Design for Environment program.  The key is to choose a product that provides a balance between its safety (personal and environmental) and efficacy (it can kill what it needs to).

But in choosing Green Killing agents we need to be able to weed out false and misleading environmental claims.  According to the 2010 The Sins of Greenwashing Home and Family edition report from Terrachoice the number of "greener" products available on the market has increased by 73%!  Consumers and companies alike are attracted to the concept of "Green", but without clear definitions of what the environmental benefit is we can fall into the quagmire of "Greenwashing". The 7 Sins of Greenwashing as defined by TerraChoice is a wonderful way to work through the true sustainability or "green" attributes of a product.

1. THE SIN OF HIDDEN TRADE-OFF: suggests that a product is green based on an unreasonably narrow set of attributes without attention to other important environmental attributes.  For example, the use of corn-based ethanol has a larger greenhouse gas footprint than petrochemicals and the use of coconut oil contributes to rainforest habitat destruction. 

2. THE SIN OF NO PROOF: is a claim that cannot be substantiated by easily accessible supporting information or by a reliable third-party certification body.  For example, stating that products are biodegradable.

3. THE SIN OF VAGUENESS: is committed by every claim that is poorly defined or broad that its real meaning is likely to be misunderstood by the consumer.  "All-Natural" for example.  Arsenic, Uranium, Mercury and Formaldehyde are all naturally occurring and most definitely poisonous.  "All-Natural" isn't necessarily "Green"!

4. THE SIN OF IRRELEVANCE: is committed by making a claim that while it may be truthful is unimportant or unhelpful to consumers.  For example, "CFC-Free".  Did you know that CFCs have been legally banned for almost 30 years?  In fact there are no products manufactured using CFCs!

5. THE SIN OF THE LESSER OF TWO EVILS: is committed by claims that may be true within the product category, but distract the consumer from the greater environmental impact of the category as a whole.  While not specific to chemicals, my two favorites are "organic cigarettes" and "fuel-efficient" SUVs.

6. THE SIN OF FIBBING: while infrequent, is committed by making environmental claims that are simply false. For example, Shampoos claimed to be certified organic but research could not find certification support.  My all time favorite example is of a dishwasher detergent claiming it used 100% recycled paper but packaged in a plastic container!?!

7. THE SIN OF WORSHIPPING FALSE LABELS: is committed by a product that, through either words or images, gives the impression of third party endorsement where no such endorsement actual exists - in other words, fake labels.  Any company who promotes their own corporate "Green" Program or using the word "Green" within a product name are two examples of how consumers fall into the trap of worshipping false labels.

Whether it be our homes, offices, schools or healthcare facilities there is strategic importance of environmental sustainability.  We can improve community health.  We can improve public images, streamline facility operations and perhaps most importantly improve financial performance which is obviously good for any business!  If you are looking to "Green" you killing agents, be sure to weed through the quagmire of greenwashing using the 7 Sins as your benchmark or better yet, decide to use only those products that carry third party certification.  Whether you choose EcoLogo, GreenSeal or DfE these programs have been designed to ensure that strict standards are followed in the formulation of cleaning and disinfectant products and require companies to submit proof of the claims they wish to make as part of the certification process.  It's the simple choice!
 


Bugging Off!

Nicole

 

 

 

Friday, May 23, 2014

Brace yourself Halifax! 3 days before IPAC-Canada starts!


Spring is a season many of us look forward to - longer and warmer days, the snow is gone, the birds are back and flowers and trees are budding and blooming!  Allergy sufferers and asthmatics may rue Springs' arrival particularly since this year seems to be incredibly mean to some of us.  But if you're an Infection Preventionist you are probably downright giddy for Spring signifies the arrival of two of the biggest infection prevention and control conferences in North America: IPAC-Canada and APIC.  If you're Canadian, you are probably counting down the hours until you fly off to Halifax to enjoy 5 days of work free, kid free, spouse free educational fun!  If you're like me, you're also probably trying to figure out how to get that last pair of shoes to fit in your suitcase!

The theme of this year's IPAC-Canada conference is "PREVENTION: A Port in Any Storm" and from the agenda, promises to cover virtually every topic of interest to IPs.  What I am thoroughly impressed with is the number of Oral and Poster research presentations!  There are 29 Oral presentations covering topics of Bugs & Drugs, Quality and Process Improvement, Program Evaluation and Cleaning, Disinfection and Sterilizing.   The Cleaning, Disinfection & Sterilization track covers CPE Contamination of Sinks and Drains, Mobile Equipment Cleaning and the study my research team did on the interaction between wipe substrates and disinfectant chemistries.  I summarized the study in the "Disinfection - it's more than the juice you use blog" at the beginning of April.

I am truly impressed by the >190 Research Poster Submissions!  I obviously cannot summarize them all, so here are the top 8 that I will most definitely be checking out! 

1. EFFECTS OF DISINFECTANT WIPES ON SENSITIVE HEALTHCARE SURFACES - concludes that sensitive surfaces present a challenge to disinfection but that there are disinfectants that are effective without causing harm and costly damage.

2. COMPARISON OF TERMINAL CLEANING OF A MEDICAL SURFACE REPAIR PATCH ON HOSPITAL MATTRESSES - we know that mattress material is problematic and prone to degradation from disinfectants.  I'm curious to learn more about this patch.

3. ARE EQUIPMENT DEPOTS THE ANSWER TO QUALITY CONTROL IN CLEANING NON-CRITICAL EQUIPMENT? - having conducted audits of facilities and seen firsthand that shared equipment is not being cleaned and disinfected as it should this one really piques my interest!

4. CLEANING OF ENVIRONMENTAL SURFACES IN OUTPATIENT CLINICS IS LESS THAN PERFECT! - YEP!  I'm certainly interested to learn how they improved outcomes!

5. RESULTS OF AN IPAC-CANADA MEMBERSHIP ENVIRONMENTAL HYGIENE NEEDS ASSESSMENT - I can't wait to hear about this survey!

6. IF IT'S GREEN, IT'S CLEAN! - reviews how one facility went about developing a program to clearly identify if patient care equipment was clean or dirty.

7. TRUE GRIME: OPERATING ROOM CLEANLINESS: BUSTING THE DUST - reviews how a facility improved their cleaning and disinfection practices with the OR department

8. AUTOMATED WHEELCHAIR WASHERS: ARE THEY EFFECTIVE FOR CLEANING/SANITIZING COMMODES? INVESTIGATION AND LESSONS LEARNED - Interesting..with the issues we have in shared equipment not getting cleaned, I would hope that automated washers would be a potential alternative!

For those of you attending IPAC-Canada be sure to find me.  I'd love to catch up or meet you for the first time!  I'll be tweeting so follow me @nicolecronkenny.  If you're not attending be sure to follow #IPACCanada2014 to keep up with what is being said!  The conference as I said promises to cover a wide variety of topics - including a full day Disinfection Symposium on my favorite topic of cleaning and disinfection!



Bugging Off!

Nicole

 

Tuesday, May 20, 2014

HELP!! IT'S HERE!! I need a disinfectant effective against MERS!


While I am likely dating myself, when the first case of MERS was reported to hit the US, followed by a second, and then one emerged in Canada the scene from Poltergeist where Carol Anne Freeling (played by Heather O'Rourke) say's "They're Here!" instantly jumped into my head.  Only for MERS - it was more like "It's Here!"

It was almost exactly a year ago in the "SARS - Was round 2 ten years in the making?" blog that we introduced MERS to our Talk Clean To Me followers.  At that time, there were 18 deaths associated with the virus.  One year later, after a significant spike in cases since March there have now been at least 536 confirmed cases with 145 deaths and while most of the infections are associated with countries in the Middle East cases have been confirmed in numerous countries across Europe and now North America.

But what does this mean to IP's from across North America trying to implement an infection prevention and control program to ensure their facility is protected?  Well, I can say from the 6 hours I spent in the ER with my son yesterday, signs are posted to let people know that visitors are being limited and that if you have recently travelled to the Middle East to please let the triage nurses know.  But what about the environmental hygiene protocol?  Are IPs on the search for products with claims against MERS?  I truly hope not, for they will not find it.

Why?  Well, mainly for the reason that the CDC will likely not allow any labs in the US to have access to the MERS virus for at least a year and perhaps longer.  In talking to one of the labs I was told that "unfortunately, like the SARS virus, MERS is highly pathogenic and we will not be able to acquire the virus because of that. The closest virus we have available is Human Coronavirus."

However, all is not lost, the EPA does have the ability to invoke the Emerging Pathogen Policy for which MERS is the ideal situation, but as MERS has not yet reached Pandemic levels the EPA is not yet willing to invoke it.  While the cases are increasing rapidly and the mortality rate is alarming the reasoning is probably based in part on WHO's recent announcement that while the sharp rise in MERS-CoV cases and the impact of the disease are concerning, it does not yet meet the definition of a public health emergency of international concern.   In weighing the sharp increase in cases since March, especially in Saudi Arabia and the United Arab Emirates, it has been determined that suboptimal infection control practices, made worse by severe overcrowding in emergency departments, have led to a number of secondary infections in hospitals.

So where does that leave those of us in North America where we too appear to have seen secondary transmission to healthcare staff?  Well hopefully, the EPA will come to its senses and invoke the Emerging Pathogen Policy before too many more MERS cases pop up.  In the meantime, we can learn what the policy entails and perhaps put it to use on our own.

The Emerging Pathogen Policy is a guidance document that utilizes an organism hierarchy to identify effective products for use with emerging pathogens and to permit registrants to make limited statements against such pathogens (interesting...Lee and I have been saying this is what should be used at all times!).  Microorganisms can be ranked with respect to their susceptibility to inactivation by disinfectants using the Spaulding Classification where the most difficult to inactivate (e.g., bacterial endospores) are at the top of the model. In contrast, the lowest tier includes those microorganisms generally considered to be most susceptible to inactivation (e.g., enveloped viruses) using virtually any disinfectant routinely used in hospitals.  Of importance is the fact that the Emerging Pathogen Policy applies only to emerging enveloped and non-enveloped viruses. 

To help you provide proof of the rationale you can use for including what disinfectant to use, the following are the criteria the EPA uses for antimicrobial products subject to the Emerging Pathogen Policy:

1. Hospital and general disinfectant products registered with EPA;

2. Have acceptable efficacy data previously submitted to and reviewed by the Agency for an enveloped and/or non-enveloped virus (e.g., HIV and/or Rhinovirus, respectively);

3. For an emerging small non-enveloped virus, have at least one small non-enveloped virus previously listed on the products label. (e.g. Poliovirus);

4. For an emerging large non-enveloped virus, have either one small or large non-enveloped virus previously listed on the product's label. (e.g. Adenovirus);

5. For an emerging enveloped virus, have at least one non-enveloped or enveloped virus previously listed.

HEY! MERS is a Coronavirus..an ENVELOPED virus - if you follow the above rationale, as long as the disinfectant you are currently using has at least a non-enveloped and/or enveloped virus already listed on the label you can consider yourself covered and if the product already carries a claim against Human Coronavirus even better! 


Bugging Off!

Nicole

 

Friday, May 9, 2014

Disinfection Selection Made Easy


As I had alluded to in the opening blog for 2014, this is the year of themes.  The theme for the first quarter (Q1) of 2014 was pretty obvious - pathogens, bugs, or whatever name you would like to give the pesky critters that cause us to lose sleep over managing outbreaks and HAIs.  Have you picked up the theme for Q2?  It's the story of how to choose a disinfectant, or in the very least areas that should and need to be considered outside of focusing on what a product kills and what a product costs so that the most effective environmental hygiene program can be justified to the powers that be.

It's a story that Lee and I have been weaving throughout our blogs since we started back in May of 2011 when we introduced the Talk Clean To Me blog and our mantra of clearing away the haze of smoke and mirrors marketing that surrounds disinfectants.  As Lee discussed in last week's blog "The little devil or the little angel, which do you choose?" developing the business case to justify moving to a new disinfectant is not as easy as one would hope.  The unfortunate truth being that it is more often than not easier to remain as the status quo then trying to be that fish swimming upstream.

Here's where we hope we can help.  For those of you who have seen Lee or I speak, the picture used for this week's blog is a slide that is used in almost EVERY one of our presentations.  If you look back through our blogs, we have written one on virtually every topic: Strength is not always found in numbers, Dirty to Disinfected in 60 seconds flat, To Clean or Not to Clean, Is PPE the necessary evil?, What's in Your Bottle? and The Unintentional Consequences of Improving Infection Prevention, and while we recognize the importance of understanding the theory we have gone to provide the tools to simplify things and help you make the right decision for your facility.

Selection of a disinfectant really can be made as simple as tabling out the desired traits of a disinfectant and adding any criteria that is specific to the needs of your hospital.  You can in turn develop  a rating system that would allow you to more objectively look at the overall picture and how the product answers the needs of your facility - keeping in mind of course that you'll never have a single product for everything...well unless of course you want to be dealing with calls over ruined surfaces due to material compatibility or occupational health and safety complaints associated with occupational injury from inappropriate use of a product!   Here's a snap shot of what my table would look like (click here for the full Disinfectant Product Assessment Tool).



From an evaluation perspective, a Likert Scale can be used that assigns values from 1 to 5 such as the following:



1

2

3

4

5

Product Does Not Meet Needs

Product Somewhat Meets Needs

Neutral

Product Mostly Meets Needs

Product Meets Needs

Upon completion of the full Assessment Tool, you can then calculate a numerical rating:



Voila! You now have a comprehensive and reasonably objective Disinfectant Product Assessment Tool that can be used to compare product to product.  Certainly, bias may come through if say you have a better relationship with one supplier than another or if (as Lee stated last week) you play the part of the Devil by simple inactivity or complacency of not wanting to go through the effort of converting to a safer and more effective disinfectant.  But, if you take the time to work though this assessment tool using the EPA Approved label and product MSDS, you may be surprised by what choice you make!

Bugging Off!

Nicole

Friday, May 2, 2014

The little devil or the little angel, which do you choose?


I think we are all familiar with the visual illustration of a devious little devil and innocent angel perched upon a person’s shoulders representing the opposite positions or choices that person can make related to a certain situation.  What better way to represent the difficulty between choosing right vs. wrong; good vs. evil; or hard vs. easy than having characters that are the embodiment of right (Angel) and wrong (Devil) spouting the virtues of their position in an effort to persuade the person to choose them?  I think we can all picture a time when we’ve been in that predicament.  I would argue however, that most would not realize how many times they’ve chosen the devil. 

Some may choose the “devil” by driving a little more spirited from time to time, while others may opt to enjoy one too many cocktails, but how many of us choose the devil through simple inactivity or complacency??  In other words, the “Devil” presents the easy option.  By simply doing nothing you could be supporting a choice that was ineffective, inaccurate, unsafe or perhaps more costly because the alternative would require effort and time; be difficult to prove and isn’t guaranteed to have a successful outcome.  We may not like to admit it, but we do it.

So how does this relate to infection prevention??  Over the past several months I’ve had the pleasure of meeting and visiting with infection preventionists, environmental service workers and other HCWs across North America and noticed an unfortunately consistent theme.  The easy or simple choice was being made.  The status quo was winning out over more efficacious, safer and more cost effective infection prevention solutions!  The “Devil” was being selected.  Why, because these IP’s and HCW’s were struggling to navigate the product selection process and build an effective business case for anything new.  Often times the metrics by which these organizations were evaluating new products or solutions was flawed. Quite simply, if the product was more expensive than the incumbent solution (higher price per unit of measure), then it was unlikely to be adopted.   The product’s superior ability to perform in real-world conditions wasn’t being considered and most surprisingly, the total operational cost savings that could be attained by utilizing the safer, more efficacious product was also not being considered. The IP was instead forced to choose the Devil because they didn’t have the tools or time available to follow the path of the Angel.

Considering how well known the costs of HAI’s are and their burden on healthcare, it strikes me as common sense that we start considering the TRUE cost of our infection prevention practices and start measuring the savings we can accrue throughout an organization through the use of safer, more realistically effective solutions.  For example, what direct costs are associated with the use of a disinfectant product?  Is PPE a necessary evil? highlighted how many disinfectants require the utilization of PPE, while others do not.  Clearly gloves, goggles and masks carry a direct cost associated with the use of that disinfectant.  Premature Evaporation: Is your disinfectant fulfilling your every desire? identified how some disinfectants fail in keeping the surface wet for their entire contact time and therefore don’t achieve disinfection compliance.  If the surface is not completely disinfected, what direct and indirect costs are potentially associated?  Higher HAI’s?  Citations from CMS or JCO?

As I’ve come to realize, the truth is that the selection of the “Devil” by IP’s or HCW’s is less about complacency and more about a lack of confidence in making the effective business case.  Infection prevention is about collaboration.  Collaborating with colleagues and departments within your facility, but more importantly collaborating with your industry partners in your efforts to implement safer, more efficacious and more cost effective solutions??  Don't forget - we're here to help!

Hasta la vista,

Lee