WET CONTACT TIME? Like many other areas of infection prevention, the science supporting surface disinfection is not well understood.

You can't clean and disinfect at the same time. A disinfectant won't do a bit of good if you spray and wipe it on a dirty surface. That should go without saying, but it won't. You can't assume your staff knows that you first have to physically remove gross soil and debris with detergent and mechanical action so the disinfectant can contact the surface. Here are 5 other dangerous misconceptions about surface disinfection that your staff could be carrying around with them.

1. All disinfectants are the same.
Wrong. Two of the most popular types of disinfectants used today, phenolic disinfectants, commonly known as phenols, and quaternary ammonium compounds, commonly known as quats, are very different. For example, you can't use phenolics in neonatal intensive care units and when processing equipment that comes in contact with mucous membranes such as vaginal ultrasound probes. Phenols have been shown to cause hyperbilirubinemia in infants (an abnormally high concentration of bilirubin in the blood) and can be toxic when absorbed into the body when in contact with mucous membranes. Alternatives to phenolics include quats and all other non-phenolic germicidals, such as alcohol-based disinfectant wipes.

To make sure that you're using the right disinfectant, read the labels and heed any warnings. Different disinfectants contain different chemicals. You need to choose the proper disinfectant to meet your purpose. If you want to clean sensitive equipment such as computer screens, you must be aware that many of the quaternium- and alcohol-based products can be harmful to touchscreens.

2. You can use products that claim to kill vegetative forms of C. diff for patients with active CDI disease.
This is a big myth that many manufacturers knowingly perpetuate with misleading claims. Just because a manufacturer claims that its disinfectant can kill the vegetative form of C. diff doesn't mean it can kill C. diff spores. Remember, it's the spores that contaminate the environment in a room and infect a patient. Therefore, you must use a product that specifically is labeled to kill C. diff spores. Currently, the most effective disinfectant for C. diff spores is bleach. Some manufacturers tend to overstate the reach and effectiveness of their product by saying that it kills C. diff. Read the label closely, however, and you'll see that it only kills the vegetative forms. That changes everything — and really means nothing. See, the vegetative form resides in the body. Frankly, you can never kill it. When it's outside the body, it forms a spore.

3. Kill times, contact times and dry times pretty much all mean the same thing.
Products receive their EPA approvals based on the amount of time an organism comes in contact with the disinfectant. Therefore, it's important to comply with the required contact times on the labels of the product. Contact time refers to the amount of time a chemical disinfectant is actively working on the surface you're trying to clean. If the disinfectant dries before the required contact time, the disinfectant hasn't had adequate time to kill the surface organisms that the company claims it will. In this case, you'll need to apply the product more than once to ensure the disinfectant has had adequate time to work.

It's not uncommon for OR staff to confuse contact time with kill time and dry time. The key question: What is the contact time that this chemical must be on that surface in order to kill? And for the clock to be ticking on contact time, the disinfectant must be wet, something that isn't universally understood. Keep in mind that every product has a different contact time. Perhaps we should refer to this as wet contact time.

4. UV light technology is a gimmick.
UV light technology is garnering a lot of attention as another tool to reduce the bioburden in the patient's environment and help prevent healthcare-associated infections (HAIs). If you've been around long enough, you remember when UV lights were used at the entrances to operating rooms and other high-risk areas in hospital settings. This technology has recently been rejuvenated, as it's been proven to be 99.9% effective against the majority of organisms, including C. diff spores. Environmental cleanliness is a high priority for HAI prevention.

Because humans perform most cleaning, there is the risk of error during the process. UV lights are effective adjuncts to manual cleaning, providing as clean a surface as possible for HAI prevention. There's actual science behind UV light: It has the ability to kill organisms that its beams come in contact with. At our hospitals, we use UV lights after we terminally clean our ORs.

WIPES Realize the limitations of disinfectant wipes.

5. Disinfectant wipes are a good way to clean ORs after each case.
Well, sort of. Disinfectant wipes gained popularity quickly due to the convenience factor of wipe methodology. However, we must recognize some limitations. These wipes were developed to quickly and efficiently clean equipment such as glucometers and blood pressure cuffs. They've proven to do this very well. When large surfaces such as OR beds require cleaning, disinfectant wipes may not be the appropriate choice. OR beds have a large surface area to clean and may require so many wipes to do this adequately that they might not be cost effective. If the case was bloody, wipes will not be sufficient to clean the surface adequately. Larger cleaning cloths with more disinfectant product are required to manually remove the organic debris and provide adequate contact time with the surface to obtain optimal cleaning.