Transcript Environmental Disinfection: New Technologies and Current

Environmental Disinfection:
New Technologies
and Current Issues
May 2014
Gwenda R. Felizardo, BSN, RN, CIC
Infection Prevention Consultant
[email protected]
253-682-7476
Disclosure
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Not paid by any company whose products are
shown
Products shown or described are to provide
illustration examples-not to endorse
Before using any environmental disinfectant
or device, review all relevant package inserts
on use, precautions, indications,
contradictions
Appreciation to William Rutala & San Raphael
Hospital for several slides
Objectives
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Review the critical aspects of environmental
microorganism transmission in relation to HAIs
Describe the various technologies and chemicals
currently on the market and applicability to the
ambulatory setting
Discuss must know resources
Colonized or infected host
Touch
Person-Supplies-EquipmentInstruments
Environmental Contamination
Endemic & Epidemic MRSA
A number of healthcare surfaces/devices showed contamination
of 7-40% on items tested. More identified with endemic
contamination.
Furnishings
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Furnishings should be cleanable, including waiting
room furniture. Vinyl preferred for chair coverings
Wood furniture & cabinet finishes deteriorate with
cleaning- porous
Infection Prevention & Environmental Services
should have input into decisions about furniture
purchases
Carpet does not belong in health care. It cannot be
disinfected, looks poorly after a short time, difficult
to clean
Carpet
Cloth sofa
Mattresses
Tears, cracks, holes
not cleanable
Toys
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All toys must be washable or given to child
Crayons in 4-pack & coloring sheets
Bin for clean toys, child picks one
Bin for used toys, child places on leaving
Toys washed with dish soap & water, dried
How long can MRSA live in the
environment?
Environmental Survival of Key
Pathogens on Dry Surfaces
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Acinetobacter baumannii
 Outbreak/sporadic strains 26-27 days
Norovirus
 21-40 days
Clostridium difficile
 Vegetative cells 24 hours
 Spores 5-18 months
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MRSA up to 9 months
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VRE up to 6 months
How Do I Know What Works
Best?
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What organisms does it target?
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How long does it take to destroy
organisms?
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Does the method require cleaning first?
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Is it EPA approved for healthcare?
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Is it compatible with surfaces?
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How easy is it to use?
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What does the manufacturer recommend?
Mechanical Disinfection
So what is available to clean
and disinfect
New Approaches to Room Contamination
 UV light
Still requires
manual cleaning
 Vapor (peroxide)
with friction
UV Room Decontamination
1. Fully automated, self calibrates, activated by hand
held remote
2. No special room ventilation needed
3. Uses UV-C to decontaminate surfaces
4. Measures UV reflected from walls, ceiling, floors &
calculates time & dosage to kill pathogens
5. Will power down and audibly notifies the operator
6. Reduces colony counts of pathogens by >99.9%
within 20 minutes
Hydrogen Peroxide Vapor
Comparison of HPV & Bleach
Downsides of UV & HPV
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Time
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UV= 15-25 minutes for vegetative bacteria
and 50 minutes for C difficile spores
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Nanoscale reflective paint reduces time to 5-10
minutes
HPV =takes approximately 2.5 hours
Cost
Not practical for most AMCs or ASCs
Self Disinfecting Surfaces
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Heavy metal impregnated surface
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Silver
Copper
Reduces bacterial burden
Costly
Must still manually clean
Surface Inhibition Products
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Sharklet Patterned Material
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Film that inhibits bacterial survival, growth,
transfer and migration through pattern alone.
Surface is comprised of millions of tiny
diamonds arranged in a distinct pattern that
mimics the microbe resistant properties of
sharkskin.
Film applied to surfaces
Green Cleaning Products
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Cleaning is not disinfecting
Watch out for terms that say natural
disinfectant or Eco friendly
Look for EPA registration number
Accelerated Hydrogen
Peroxide 0.3%
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AHP oxidizes as it cleans and disinfects
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Broad spectrum
MDRO 30 sec-1 minute
Norovirus 3 minutes (wipes) spray 1 min
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TB 4-5 minutes
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5 log reduction (99.9%) in 30 sec-5 minutes
Other Low Level
Disinfectants
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Kills/inactivates most bacteria, viruses, fungi
Appropriate for non critical medical devices and
environmental surfaces
Quaternary ammonium compounds (Quats) are
low level disinfectants
Quats with alcohol-quick drying and very
effective
Cleans and disinfects
Bleach-Sodium Hypochlorite
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Range 5.24%-6.25%
Best used for diarrheal illness &
Clostridium difficile
At store can be misleading –don’t
rely on the Manufacturers name
(Clorox). May not contain bleach.
Factors Affecting Cleaning
& Disinfection
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Cleanliness of the surface
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Amount & type of contamination
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How is surface cleaned: manual,
extractor, steam
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Dilution of cleaner & disinfectant
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Contact time of disinfectant
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Manufacturer’s instructions
Critical Tips
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MUST USE FRICTION
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Microfiber best-releases even amount
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Use multiple wipes or rags
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Don’t overload with debris-makes it ineffective
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Make sure chemical has not expired
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Dilute according to manufacturer’s instructions
References
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www.disinfectionandsterilization.org
2008 CDC Guideline for Disinfection and
Sterilization in Healthcare Facilities
2003 CDC Guidelines for Environmental Infection
Control in Healthcare Facilities
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2003 CDC Hand Hygiene Guideline
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2008 CDC Isolation Precautions Guideline
References
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http://www.cdc.gov/mrsa/environment/
http://www.cdc.gov/HAI/toolkits/EvaluatingEnvironmental-Cleaning.html
 Elements of a program
 Monitoring Checklist
Resources
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http://www.epa.gov/pesticides/reg
ulating/nanotechnology.html
http://www.epa.gov/oppad001/che
mregindex.htm
Handouts
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Cleaning & Disinfectant Table
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Environmental Cleaning Guideline
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ASC Cleaning Responsibilities
Cleaning & Disinfectant Solutions
Table
Environmental Cleaning
Guideline
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General principles
What to do
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After each patient visit
End of day
Weekly
Monthly
Special Event Cleaning
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Bed bugs, body fluid, incontinence
ASC Cleaning
Question
Which chemical agent should be used to
disinfect an area where blood is on the
floor or surface?
1.
2.
3.
4.
5.
6.
Alcohol
Quaternary ammonium compound
Bleach/chlorine
Glutaraldehyde
Hydrogen Peroxide
Phenolic
All except glutaraldehyde
Question
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Your boss wants you to purchase a “green”
disinfectant from the grocery store. What do you
do?
Go to EPA website to see if product is listed
Pull testing data from the company (if any)
MSDS
 Studies
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Provide alternative or support what you
currently are using
Question
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Do you need to close a room down
when it has been occupied by a
patient with MRSA? This is primarily
a contact organism.
No, Clean normally
Question
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What equipment should be disinfected
after a patient leaves an exam room?
All equipment & surfaces touched or used
Question
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Patient with influenza or pertussis
has occupied the exam room. These
are droplet diseases. How do you
clean?
Clean normally-room does not have to be
shut down
Question
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List 3 strategies that reduce environmental
and supply contamination?
Hand hygiene
Barriers
Frequent cleaning
Remember
It takes a bundle of strategies
consistently performed at
appropriate times to minimize or
eliminate cross contamination
What are you dealing with?