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KILL TIME When using disinfectant wipes, often multiple wipes will be required to keep the surface wet for the entire kill time.The fight to prevent surgical site infections (SSIs) starts before the patient comes into the room. Surface disinfection between patients will help to prevent cross-contamination between patients and staff. We all know that before disinfecting, you have to remove any visible residue, such as blood, loose dirt, debris, bodily fluids and other potentially infectious materials (also referred to on some product labels as "gross filth"). That's a given, I hope, along with using appropriate personal protective equipment (PPE) and hand washing before and after wearing gloves. Here's advice on deploying the proper cleaning agents to eradicate potentially infective agents on your surfaces.
1. Know your bugs
What is it you are trying to kill? Are you a GI center with a high probability of Clostridium difficile (C. diff) and Eschericia coli (E. coli)? Are you doing trauma cases where it is routine to have blood or irrigation fluid on the floor and surrounding noncritical equipment (beds, IV poles, ring stands, stretchers, anesthesia carts the list goes on and on)? Do you have a high incidence of patients with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), or are you doing joint replacements at your facility and are concerned about preventing prosthesis-related infections? Are viruses a concern? Are you just concerned in general with doing the best job possible of surface disinfection between cases in the shortest amount of time and have no idea what might be lurking on your surfaces?
Knowing what the probability is of certain bugs that might be more prevalent in your operating rooms, procedure rooms and recovery rooms can help make the decision of which EPA-registered disinfectant or disinfectants you should use. Using one "best" disinfectant might make staff training, compliance and proper usage better versus using multiple agents for different areas.
2. Know your disinfectant kill times
Read the label! Looking at the most common disinfectants in use today (chlorine and chlorine compounds, hydrogen peroxide, quaternary ammonium compounds), we learn that not all disinfectants kill everything in the same time period. Although some EPA-registered hospital disinfectants have different listed kill times depending on the state you are in, the kill times and use sites are listed on the label for each disinfectant. C. diff and Mycobacterium bovis (tuberculosis) tend to require the longest contact times for killing these pathogens. C. diff spores can survive for several months on hard surfaces and only chlorine-based (bleach) disinfectants and high-concentration hydrogen peroxide disinfectants kill spores, with the major difference being the C. diff spore kill claim and faster norovirus kill claim that come along with the bleach-based products. Quaternary ammonium compounds ("quats") with and without isopropyl alcohol tend to require longer contact/kill times. Keep in mind that all disinfectants must be left in contact with the surface for the entire kill time to be effective.
When using disinfectant wipes, often multiple wipes will be required to keep the surface wet for the entire kill time. Train your staff to set a timer at the head of the table, set it to the appropriate length of time needed for proper disinfection and ensure the surface remains wet the entire time. Dispose of the wipes at the end of the process and do not reuse the wipes for other contaminated surfaces.
For a list of products registered
by the EPA as effective against
common pathogens,
visit osmag.net/7FgwWQ.
A commercially available spray disinfectant of the same compound used can assist in keeping larger surfaces wet for the recommended kill time. Let surfaces air dry at the end of the kill time; don't wipe the surfaces with a dry cloth to speed the drying process before the end of the kill time. This will reduce the contact time with the pathogen and reduce the effectiveness of the disinfectant. Quaternary ammonium compounds are less effective when used with materials such as cotton and gauze pads because they absorb the active ingredients, so commercially prepared wipes are best.
INTELLECT AND REASON
Smart Approach to Surface Disinfection
- Consider how an item is used. When cleaning patient equipment and surfaces, think of how they're used and where they have contact with patients and staff. Failing to do so might result in ineffective cleaning. Take the stethoscope, for example. Most staff clean it without thinking about how they interact with it. They diligently clean the diaphragm and the tubing, but rarely does anyone clean the ear tubes (the part that connects the ear tips to the tubing). In most cases staff touch the ear tubes to remove the ear tips from their ears after they've held the diaphragm against the patient. This means the staff's contaminated hands have come into direct contact with the ear tubes. This makes the ear tubes the second-most contaminated part of the stethoscope and also the most likely not to be cleaned.
- Train all staff who do cleaning on how to effectively clean. This means not just your environmental service (EVS) staff. Studies showed that most items were ineffectively cleaned before the introduction of Dazo or Glo Germ or ATP technology. By showing staff what they are missing using this technology, it improves their ability to clean (knowing how much mechanical action is required and what surfaces they routinely miss). Yet most facilities miss training the RN staff and other staff that are also assigned cleaning duties. If we don't train these staff on how to disinfect, we have no reason to expect that they will clean and disinfect items effectively.
- Make a list of who cleans what. Develop lists of who cleans what items in each area in your facility. In my visits to outpatient surgery centers, I'll sometimes ask nurses what upsets them that never gets cleaned. They'll identify an item. I will ask the nurses who cleans it and they'll say EVS. I'll then ask EVS and they say the scrub tech and the scrub tech when queried says the RN. This lets me know no one has cleaned the IV pump in quite a while. If you don't have a list that states the expectations of who cleans what, you can't hold people accountable for not cleaning it.
Mr. Myers ([email protected]) is an infection preventionist III at UC San Diego Health System in San Diego, Calif.
3. Know your surfaces
Are your disinfectants safe to use on all your surfaces? Most ultrasound probes will not tolerate alcohol-based disinfectants, which can dry out the probe and potentially cause cracking and damage. For surfaces like this, contact the manufacturers and ask them to provide in writing what disinfectants can safely be used on your equipment.
When disinfecting hard, non-porous surfaces, you can reduce the remaining organic matter after the disinfection process and reduce streaking and corrosion by wiping the surfaces down with wet disposable cloths. This helps prevent corrosion and removes the salt residue that is the by-product of bleach. Some commercially available preparations have been formulated to minimize the corrosive effect of bleach.
Before you disinfect surfaces contaminated with lots of blood or other infectious materials, remove as much of the visible matter as possible. Disinfection for these areas should use EPA-registered compounds listed as tuberculocidal and with specific label claims for killing Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV).
Stick to your top 2
If you're not happy with your process, request samples of other disinfectants and ask your staff which are easier to use and which they're most likely to use. All disinfectants come with drawbacks: cost, longer kill times than others, odors and respiratory irritation, caustic properties (such as burns on skin, eye irritation, pitting or corrosion of metal surfaces). Using 1 or 2 disinfectants and training your staff how to use them properly and safely will give you the best chance of reducing cross-contamination from surfaces. OSM
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