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, October 29, 2014

Have Wheels? Will travel....including invisible hitchhikers!

In recent years, there has been considerable focus around cleaning and disinfection by environmental services staff (EVS) as we become more in tuned with the risks associated by direct or indirect transmission mission due to a contaminated environment.  EVS have been audited, have received training and feedback and have I am certain been reprimanded for neglecting to clean and disinfect one, two or more high touch surfaces.   I know for fact, some of these surfaces get missed as a result of the pressure they get for trying to turn over rooms as fast as possible.  In the end, I think we would all agree that having a well trained staff, having an auditing and feedback process and a management team that genuinely appreciates the work EVS does as part of a facility's infection prevention program helps to ensure that EVS are doing the best job possible.

At the other end of the scale are the nursing and other clinical staff who utilize patient care equipment - particularly the portable kinds, on wheels, that can easily move from place to place.  While there have been outbreaks associated with contaminated patient care equipment, there has not been as much focus on who cleans said equipment with what frequency or how to audit to ensure that cleaning and disinfection is in fact occurring.  The best example I have of this, and one that I have used for years to highlight the importance of developing roles and responsibilities of who cleans what is what I will refer to as the "case of the poop splattered commode".

Imagine a facility, dealing with a C. diff outbreak, who utilized commodes in semi-private rooms as their way of maintaining private bathrooms.  This facility had an audit program in place using UV reflective markers and was in the process of conducting a clinical study.  In one room, for 5 days the underside of the commode seat was marked and the researcher noted there was fecal matter on the rim of the commode bowl.  For 5 days, the commode did not get cleaned.  There were 5 distinct UV marks that had not been removed or even smeared to show some form of wiping had occurred...  Long story short, when EVS and Nursing were brought together to determine what was going on, EVS stated "a commode is on wheels, therefore is a patient care device that should be cleaned by nursing" and nursing stated "a commode is a toilet, which is a surface that EVS should be cleaning".  Clearly, no one had thought to sit down and define who cleaned what.

It for this reason that Havill et al's study titled "Cleanliness of portable medical equipment disinfected by nursing staff" is so interesting.  This facility has taken the time to clearly define roles and responsibilities for what items need to be cleaned and disinfected between use by nursing and clinical staff.  The researchers sought to find out if they were to audit for cleaning compliance and provide feedback, if like the improvements they had found in their EVS staff could they improve the cleanliness of patient care equipment.

During unannounced visits, mobile medical equipment used for patient's vital signs were sampled using ATP (Adenosine Triphosphate Bioluminescence) as well as environmental cultures.  Sites tested included: the control button on the blood pressure unit, thermometer, BP Cuff, machine handle and pulse oximeter.  The results found that these pieces of patient care equipment were frequently contaminated with organic material as well as aerobic bacteria.  While VRE was not found on any of the sites sampled, MRSA was found on several surfaces.  The study showed there was a wide variation in cleaning compliance despite polices that clearly outlined who was responsible for cleaning and disinfection.  Similar to results found with EVS staff, implementing an auditing program and periodic education of nursing and clinical staff may be beneficial.

Which leads me back to the title of the blog - Have Wheels?  Will Travel.   Do you know the cleaning and disinfection compliance rates for patient care equipment at your facility?  Or better yet....are you confident that everyone knows who is responsible for cleaning and disinfecting what?  You never know where your "dirty commode" may turn up!



Bugging Off!

Nicole

Friday, October 24, 2014

Will you take the Infection Prevention Challenge?

For everyone who organized events for Infection Prevention Week, I hope you were able to educate, engage and enjoy in the fruits of your labors! I thought I would end the week with a little Infection Prevention Trivia  to get people to play along. The first person to respond back via the Talk Clean to Me blog, Twitter (@ViroxAHP and @nicolecronkenny), Facebook (the Virox Corporate page) and the Talk Clean To Me LinkedIn group we'll send you a Talk Clean To Me mug! Good Luck!

 1. True or False: If you wipe a surface and it does not stay wet for the contact time that has been indicated on the disinfectant product label, disinfection is NOT being achieved!

 2. True or False: The amount of liquid being released on a surface and the saturation level of a wipe can be different depending on the type of wipe substrate. 

 3. True or False: Ebolavirus is caused by a non-enveloped virus and is less susceptible to disinfectants. 

 4. What HAI am I Riddle: The main symptoms I show are wounds or sores. I've been a problem in healthcare for 20 years or more. I can live in the nose and reside on the skin. And I cannot be killed with methicillin.

 5. What HAI am I Riddle: I'm one of the worst of the GI infections. I cause diarrhea and vomiting projections. I'm a hard to kill virus found in healthcare and cruise. So you must be wary of the disinfectant you use.

 6. Guess the bug!






7. What's on the inside of a clean nose?


A heartfelt thank you to all of the Infection Preventionists for the work you do in keeping us safe!



Bugging Off!
Nicole


Monday, October 20, 2014

IIPW - A time to celebrate and educate!

The concept of Infection Prevention and Control week was first established in 1986 by President Ronald Reagan, with APIC spearheading the effort to highlight the importance of infection prevention among healthcare professionals, administrators, legislators, and consumers. In Canada, Infection Control Week originated in 1988 to highlight infection control efforts in Canadian hospitals, long-term care facilities and in the community.  Over the years, this week of recognition has vastly expanded to every corner of the globe, including Australia, the United Kingdom, the Middle East, and Southeast Asia.  As the reach of IIPW widens, more patients benefit from safer healthcare practices and reduced threat of healthcare-associated infections.

International Infection Prevention Week (IIPW) falls the third week in October and is an opportunity for infection control professionals to educate staff and the community about the importance of infection prevention and to promote the important work that was being done by infection control professionals in a visible and fun way.  Infection Prevention and Control programs are widely recognized as being both clinically effective and cost-effective in preventing and controlling the spread of infections in health care settings.  Infection Prevention and Control programs protect clients/ patients/ residents and staff alike by preventing infections before they occur. Such prevention results in better clinical outcomes, fewer healthcare associated infections, reduced length of hospital stay, and less antimicrobial resistance, resulting in important cost saving for the health care system.

In keeping with the theme of education the following are a handful of webinar, teleclasses, on-line or media-based events occurring this week or are available as recordings free of charge:
  • Topic:  Updated Ebola Infection Prevention and Control Guidance
    • Date / Time: October 21st, 11am EST
    • Link: http://webinars.apic.org/session.php?id=14754
  • Topic: Ebola Crisis 
    • Date/ Time: October 21st
    • Link: CBC is dedicating the day to Ebola with on-line, radio and television coverage throughout the day 
  • Topic:  Infection Prevention in Outpatient Oncology Settings 
    • Date/ Time: October 23rd, 1:30pm EST
    • Link:  http://www.webbertraining.com/schedulep1.php?command=viewClass&ID=1204 
  • Topic:  Cleaning and Infection Prevention Webinar

  • Topic: Free Webber Training Teleclasses  
    •  Date / Time: Pre-recorded  
    • Link:  https://webbertraining.com/recordingslibraryc4.php 
To get you in the mood for the week here are a couple of Infection Prevention word scrambles and brain teasers.  Are you up to the challenge?
 
 




In keeping with IIPW being a week of education we will be posting blogs on Wednesday and Friday as well.  Stay tuned as you have a chance to win a Talk Clean To Me mug!

Bugging Off!
Nicole

Tuesday, October 14, 2014

Over Easy: Why safety profiles and ease of use will improve disinfection

This week is the third and final installment of the dissection of Drs. Rutala and Weber's "Selection of the Ideal Disinfectant".  Before I get into the discussion of the last three sections "SAFETY, EASE OF USE and OTHER FACTORS", I hope that we can all agree that disinfection of non-critical environmental surfaces and patient care equipment is key to a successful infection prevention program.

From Burnt Bums and Occupational Asthma, to the Necessary Evil of PPE and Unintended Consequences of Improving Infection Prevention, the  Talk Clean To Me blog has hit on numerous topics around the health, safety and surface compatibility (or surface safety) of disinfectants.  As noted in the article "products should be nontoxic and should not cause harm to users, patients and visitors."  To meet this criteria, a facility should chose a product with the lowest toxicity rating, e.g. one that does not require PPE, one that can be used without restriction, one that is not flammable or combustible and one that will not cause temporary or permanent harm to staff. Further, we need to look at disinfectants from their compatibility perspective.  By this I do not mean that the product has to have the longest list of approved medical devices, because the truth is, not all medical device manufacturers are willing to invest in the time to validate newer, safer and more effective technologies. Instead look for a product that has been proven to be compatible with a wide range of materials that are commonly used in the manufacturing of medical devices and routinely used for the interior environmental surfaces such as plastics, stainless steel and other materials...like mattress pads.

While focusing on what a product kills is great - theoretically speaking the ugly truth is that it does not matter one iota what a product kills if staff cannot tolerate using it and patients complain of the smell. Never underestimate the odor profile of a product, something that smells like roses to one person may smell like pig poop to another! The easier the product is to use, the greater the chance that staff will use it as intended, ensuring compliance is met.  Compliance is the key to ensuring a successful environmental hygiene program.  For convenience sake as well it is easier to have a product that comes in various formats such as different sized wipes for the task at hand.  Of course in the "ease of use" perspective, products that have detergency properties to aid in cleaning and soil removal, are effective in the presence of a soil load, and have an extended shelf life once diluted and can be used with a number of different wipe substrates without interaction (e.g. no quat binding) are also areas to consider.

The last area to consider in choosing a disinfectant are some of the value added attributes if you will that may come with the product, such as what training programs the vender will provide. Although these are generally free, one thing for certain is that maintaining training programs is an area that all facilities struggle with.  Additionally, do the vendors provide the dilution systems or wall brackets for wipes free of charge and do they provide a maintenance program for the dilution systems once installed?  Remember, dilutions systems are like cars and need routine maintenance to ensure they work.  I have seen more than one facility attribute an outbreak due to poorly maintained dilution systems.  Then there are the questions such as what does the product cost, how many litres or gallons of product or how many wipes need to be used.  Those are the easy numbers.   As one IP recently told me "cost avoidance is not holding a lot of water" and certainly, determining the "soft" or "indirect" costs such as HAIs avoided or decrease in Occupational Health and Safety claims can be more difficult to prove, but if you can show how much a facility spent year over year on HAIs or Occupational Health and Safety issues..those numbers add up and those numbers are NEVER included in someone's budget!

In the end, the truth is that the perfect disinfectant does not exist.  However, by following the straight forward recommendations of Drs. Rutala and Weber and looking at the selection of a disinfectant from a holistic approach - finding the balance between efficacy and safety, you can be sure that you can find disinfectants in the market that can suit the needs of your facility and provide the level of kill you need from a daily infection prevention perspective while meeting the health and safety needs and concerns of staff to ensure they will use the product as you had intended, which will have a very real and directional impact on your HAI rates.


Bugging Off!
Nicole


Friday, October 3, 2014

Slippery when wet - the importance of contact times

There are times when writing silly clich├ęs or phrases that an image randomly pop into my mind of how a blog is going to develop.  Last week I closed the "I'll take Kill Claims for $200" by introducing the focus of this week's blog:  "Fast Kill Times and Acceptable Wet-Contact Time To Ensure Proper Disinfection of Non-Critical Surfaces and Patient Care Equipment," knowing that this week would be "round 2" or "take 2" in the discussion of the "Selection of the Ideal Disinfectant" paper. The idea of "take 2" invoked not an image of continuing the dissection of this article, but a very sobering image of a stopwatch, and the thought that we do not have the luxury of time in any of the markets that use disinfectants to have a "take 2" or reapply a product more than once to ensure disinfection occurs.  A very fitting image for the focus of this blog.

As the title of the section of the article implies, Drs. Rutala and Weber discuss the merits of contact time as it relates to disinfection.The focus of Lee's blog "Dirty to Disinfected in 60 seconds Flat" was entirely focused on this concept.  I could go on ad nauseam on this topic citing numerous examples of why rapid contact times are important, but I think Drs. Rutala and Weber summed it up nicely with their statement "fast kill times are important because they give you confidence that you are killing the prevalent and most common healthcare-associated pathogens before the disinfectant solution can dry". 

Which leads to the next area of discussion - wet dwell time.  Again, Lee's "Premature Evaporation - Is your disinfectant fulfilling your every need?" blog sums this discussion up very well and as Drs. Rutala and Weber explain, if a product evaporates too quickly it will not stay in contact with the organism we are trying to kill for the amount of time that the product needs.  For this reason, the best disinfecting products will have a wet dwell time that is greater than or equal to the kill times listed on the label. However, this does not mean that we need to use the longest contact time as listed on the label. Many products may have longer tuberculocidal or fungicidal contact times for Candida as an example. However, surfaces contaminated with Candida, non-tuberculosis mycobacteria or other fungi have RARELY been shown to be a risk factor for HAIs.  As Drs. Rutala and Weber highlighted in the first section of this article, vegetative bacteria cause upwards of 80% of all HAIs and should be the organisms we focus on with respect to choosing a rapid and effective disinfectant.

The last area in this section that is discussed is around the concept of persistent or sustained antimicrobial activity of a disinfectant. Certainly this idea has merit and considerable interest as the ability for a surface to aid in the killing or neutralizing of a pathogen would mean that we would have a back up or "CYA" to act as a fail safe for surfaces that did not get cleaned and disinfected correctly the first time. While sustained antimicrobial activity may eliminate the problem of recontamination, current products have limitations such as cost and the fact that they can be removed by touch or contact. Further, their use has not been demonstrated to have a direct impact on reduction of HAIs as compared to disinfectants that do not have sustained antimicrobial activity.  Basically, the idea is intriguing, but needs more evidence to determine if this is an effective expenditure or not. Personally, if you have some extra money in your budget, you should hire another housekeeper or two and implement a program to disinfect all high touch surfaces within your facility twice per day.

Stay tuned for next week's concluding blog that will focus on "Safety, Ease of Use and Other Factors" to consider when choosing a disinfectant.


Bugging Off!
Nicole