Welcome to Gaining Added Assurance in Infection Prevention Jim Gauthier, MLT, CIC
Disclosure Jim is employed by Diversey. His expenses to attend this meeting (travel, accommodation, and salary) are paid by this company. Diversey has had no input into this presentation from a commercial interest. 2
Objectives o Discuss the costs related to bacterial and viral illnesses o Discuss effective cleaning and disinfection o Discuss adjunct (added) steps that can help keep our facilities safe 3
Illness Costs the US Economy $226B Annually Healthcare Associated Approximately 227 Each year, 5-20% of the Infections (HAIs) increase million days of school population gets the flu. cost between $28 and $45 are missed annually The flu alone costs U.S. due to the cold and flu ; billion annually; impacting companies $10.4 billion in 1 in 25 patients in the US parents miss more than direct medical expense and 1 in 9 patients in 123 million work days and $16.3 billion in lost Canada caring for sick children earnings Source: Internet resources and CDC.
The Value of Clean o A relatively modest investment in cleaning and disinfection produces substantial benefits to a business’ bottom line o Cleaning and disinfection can reduce absences by up to 46% o And for healthcare, the prevention of infection is a matter of financial survival Source: CDC and http://www.ashkingroup.com/pdfs/Education/Report%20-%20IAQ%20test%20study%202%20-%20children.pdf
Surfaces in Transmission of Illness Person touches nose or eyes Person picks up pathogen with contaminated fingers and through contaminated fomite becomes infected with pathogen Pathogen falls on fomites e.g. phone, computer Sick person sneezes, coughs and pathogens fall on fomite or get aerosolized Source: Dr. Charles Gerba 6
Contamination of Surfaces Happens Quickly o University of Arizona Study • Contaminated door knob with a non-pathogenic organism After a few hours, they tested 100 surfaces – • light switches, countertops, push buttons, coffee pot handles, faucet handles, phones
Contamination of Surfaces Happens Quickly 60% of surfaces were contaminated! After cleaning with a disinfectant wipe, the organism was removed from more than 80% of the surfaces “The results show that viral contamination of (surfaces) in facilities occurs quickly, and that a simple intervention can greatly help to reduce exposure to viruses” – Charles Gerba 8
Key “Germ” Sources in Offices Number of Germs per Square Inch Source: Dr. Charles Gerba
Key Germ Sources in Schools Figure 1 Top Three Contaminated Sites in All Schools 1.00E+07 4.77E+06 1.70E+06 Total Bacteria/approximate 100 cm sq 8.60E+05 1.00E+06 1.00E+05 1.00E+04 1.00E+03 1.00E+02 Cafeteria Table Computer Mouse Desk Source: Dr. Charles Gerba Presentation
When do We Clean in Healthcare? o General patient rooms o Once per day, sometimes twice, usually morning through afternoon o Operating Rooms o Between cases, end of day o Common Public Areas o Once per day 11
When do We Clean in Offices/Schools? o Generally after hours – late afternoon, nights o Contracted services in some cases 12
What Can Go Wrong in Cleaning and Disinfecting? 13
Germs are Invisible It can be difficult to know if pathogens have been killed. It is impossible to know where the germs are hiding!
Safety Concerns Affect Proper Use Staff is less likely to use disinfectants that can cause eye, skin and respiratory irritation.
Risk from Chemicals Source: PTS, Virox Technologies, Inc.
Harsh On Surfaces and Assets Some disinfectants can damage assets
Some Products Cause Damage
Disinfectant Dries Before Pathogens Die Drying time should be greater or equal to the kill time.
Disinfectant Dries Too Fast Slide Courtesy of Virox Technologies, Inc.
Dry Time vs. Label Contact Time IHP (0.5% H2O2) Omidbakhsh J AOAC Internat 2010;93(6)1-8 23
Compatibility With Cleaning Tools Efficacy diminishes when disinfectants bind with cleaning tools.
Quat Binding Some cleaning tool fabrics, such as cotton and microfiber, are known to bind with quaternary ammonium chlorides (“ quats ”) Known as “ quat binding ”
Quat Binding o Active ingredients (quat) have a tendency to become attracted to, and absorbed into, microfiber and cotton fabrics o Cotton fabrics and most microfibers are negatively charged o Quats are cationic, or positively charged, and are attracted to fabric surfaces which are anionic, or negatively charged o Many non-woven disposable wipes have no charge, and do not demonstrate binding with quats or other disinfectants 26
Quat Binding o CONSEQUENCE: A portion of the quat actives become unavailable to disinfect hard surfaces making the disinfection process ineffective! 27
Impact of Cleaning Tools on Quat Disinfectant Efficacy Study Demonstrated: o Microfiber, cotton and some disposable wipers bind with quat disinfectants reducing the effectiveness of the disinfectant solution Boyce JM et al. Quaternary ammonium disinfectant issues encountered in an environmental services department. ICHE 2015;37(3):340-342
Issues Encountered with Dilutables o Dilution Control Stations may not deliver compliant disinfectants o Water pressure and dispenser design can reduce the effectiveness of dispensers, delivering disinfectants that are out of compliance Boyce JM et al. Quaternary ammonium disinfectant issues encountered in an environmental services department. ICHE 2015;37(3):340-342
Issues Encountered with Dilutable Quats o None of the dispensers tested delivered the 800 parts per million (ppm) of quat active specified on the disinfectant label o 1 station was inoperative o 2 stations contained no concentrated disinfectant o 7 stations delivered quat concentrations <200 ppm o 17 stations delivered 200-400 ppm o 6 stations delivered 400-600 ppm Boyce JM et al. Quaternary ammonium disinfectant issues encountered in an environmental services department. ICHE 2015;37(3):340-342 30
The Importance of Cleaning Tools in the Spread of Germs Source: Dr. Charles Gerba Presentation
What Can Go Wrong in Cleaning and Disinfecting? Who? What? When? How? Without clear roles and responsibilities, equipment and surfaces can be missed.
Roles and Responsibilities: Healthcare Who Cleans What? When?
Validation o Are you Confident? The job has been completed? o o All areas are in compliance? o All surfaces are cleaned? Procedures are followed? o
What Can Go Wrong in Cleaning and Disinfecting? Inaccessible Means Ineffective Disinfectants that are out of sight are out of mind.
Inaccessible o Product Storage o Product Safety o HMIS (Hazardous Material Identification System) rating • Health • Flammability • Physical Hazard • Best is 0/0/0
The Ideal Disinfectant HAI Reduction 37
What is the Ideal Disinfectant? 1. Kill Claims for the most relevant pathogens Broad spectrum Bacteria and hard to kill viruses 2. Fast kill times and acceptable wet contact time to ensure proper disinfection of surfaces Fast acting Remains wet 3. Safety Non-toxic and non-irritating to the user or occupant Compatible with surfaces Nonflammable * Rutala et al. Selection of an Ideal Disinfectant, Infect Cont Hosp Epidem, Vol. 35, No. 7 (July 2014), pp. 855-865
What is the Ideal Disinfectant? 4. Ease of Use • Unaffected by environmental factors, i.e. soil • Easy-to-use • Acceptable odor • Soluble in water • Stable • One-step Disinfectant Cleaner 5. Other factors • Economical – Total Cost • Manufacturer support * Rutala et al. Selection of an Ideal Disinfectant, Infect Cont Hosp Epidem, Vol. 35, No. 7 (July 2014), pp. 855-865 39
Label Claims o Organisms o Gram negative/Gram positive/Enveloped viruses o Non-enveloped Viruses o Fungi o Spores – not as important outside of healthcare 40
Effect of Disinfectants on Microorganisms Organism Type Examples Bacillus anthracis, Clostridium R^ Bacterial Spores Spore difficile Mycobacteria Bacteria M. tuberculosis Small non-enveloped virus Virus Norovirus, Rhinovirus Aspergillus, Penicillium, Fungal spores Fungus Trichophyton E. coli , Klebsiella including CRE, Gram negative bacteria Bacteria Pseudomonas, Acinetobacter Fungi (Vegetative) Fungus Candida Large Virus (non-enveloped) Virus Adenovirus, Rotavirus Staphylococcus including MRSA Gram positive bacteria Bacteria Enterococcus including VRE S* Virus (enveloped) Virus HIV, HBV, HCV, Influenza ^ Resistant * Sensitive Adapted from Rutala et al. ICHE 2014;35(7):862
What Can Go Wrong in Cleaning and Disinfecting? 42
Label Claims o Time to kill Gram positive, negative and enveloped viruses o Time to kill non-enveloped viruses o Time to kill fungus o Wet Contact Time! 43
Keeping Us Safe o Check the SDS on disinfectants and cleaners o Need safe products with minimal residue o San Francisco Department of the Environment 44
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Safer Product Discussion o Good o Hydrogen peroxide o Caprylic Acid o Citric Acid o Lactic Acid o Worrisome o Bleach o PAA o Phenolics o Quats 46
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