ElderHealth Resources Inc Dirt Behind... · Factors Affecting Disinfectants ¾Prior cleaning of a...
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ElderHealth ElderHealth Resources Inc Resources Inc Conference for Foot Care Nurses Conference for Foot Care Nurses The Dirt Behind Cleaning & Disinfection Nicole Kenny, HBSc Assoc Chem Director of Professional & Technical Services Virox Technologies Inc Phone: 1-800-387-7578 x118 Email: [email protected] Chicago Tribune (2000) Chicago Tribune (2000) 75% of an estimated 103 000 patient 75% of an estimated 103 000 patient deaths linked to HAIs deaths linked to HAIs Due to unsanitary facilities, unwashed Due to unsanitary facilities, unwashed hands & dirty instruments hands & dirty instruments Found that hospital cleaning staff were Found that hospital cleaning staff were inadequately trained & cuts cleaning inadequately trained & cuts cleaning budgets budgets Legal Issues in Patient Safety Legal Issues in Patient Safety 2003: Cdn hospitals notified >900 patients that 2003: Cdn hospitals notified >900 patients that improper sterilization of equipment may have improper sterilization of equipment may have exposed them to HIV, Hepatitis and other exposed them to HIV, Hepatitis and other diseases. $150M class action lawsuit filed diseases. $150M class action lawsuit filed alleging negligence in failing to meet adequate alleging negligence in failing to meet adequate sterilization standards. sterilization standards. Government ordered a province Government ordered a province- wide audit of wide audit of hospital infection hospital infection- control practices control practices Healthcare Quarterly Vol. 8, Special Issue Healthcare Quarterly Vol. 8, Special Issue October 2005 October 2005 Legal Issues in Patient Safety Legal Issues in Patient Safety 2004: Class action lawsuit filed on behalf of 2004: Class action lawsuit filed on behalf of patients who contracted SARS in hospitals patients who contracted SARS in hospitals during the second wave of the outbreak. Claim during the second wave of the outbreak. Claim alleges that public health officials failed to alleges that public health officials failed to maintain sufficiently rigorous infection maintain sufficiently rigorous infection- control control precautions. precautions. In context of nosocomial infection, patients may In context of nosocomial infection, patients may claim harm simply from exposure to a risk of claim harm simply from exposure to a risk of infection & need not establish that they did, in infection & need not establish that they did, in fact, acquire an infection fact, acquire an infection Healthcare Quarterly Vol. 8, Special Issue Healthcare Quarterly Vol. 8, Special Issue October 2005 October 2005 Patient Disclosure Patient Disclosure Canadian law clearly establishes a positive duty Canadian law clearly establishes a positive duty on care providers to inform patients of errors that on care providers to inform patients of errors that occur during their care occur during their care When care providers realize that patients may When care providers realize that patients may have been exposed to infection from equipment, have been exposed to infection from equipment, other patients or healthcare workers, a legal other patients or healthcare workers, a legal obligation may arise to contact patients to warn obligation may arise to contact patients to warn them of the risk and provide advice regarding them of the risk and provide advice regarding appropriate follow appropriate follow- up testing and care. up testing and care. Effects of Germicides on Effects of Germicides on Microorganisms Microorganisms HCWs take for granted the action of HCWs take for granted the action of disinfectants without fully understanding disinfectants without fully understanding mechanism of action mechanism of action Differences in the action of antimicrobial Differences in the action of antimicrobial ingredients ingredients Differences depending on concentration of Differences depending on concentration of chemical used chemical used Infection Control Today Infection Control Today Cleaning & Disinfecting: The Effects of Germicides on Microorgan Cleaning & Disinfecting: The Effects of Germicides on Microorganisms isms Feb 2004 Feb 2004
Transcript of ElderHealth Resources Inc Dirt Behind... · Factors Affecting Disinfectants ¾Prior cleaning of a...
ElderHealthElderHealth Resources IncResources IncConference for Foot Care NursesConference for Foot Care Nurses
The Dirt Behind Cleaning & Disinfection
Nicole Kenny, HBSc Assoc ChemDirector of Professional & Technical Services
Virox Technologies IncPhone: 1-800-387-7578 x118
Email: [email protected]
Chicago Tribune (2000)Chicago Tribune (2000)
75% of an estimated 103 000 patient 75% of an estimated 103 000 patient deaths linked to HAIs deaths linked to HAIs Due to unsanitary facilities, unwashed Due to unsanitary facilities, unwashed hands & dirty instrumentshands & dirty instrumentsFound that hospital cleaning staff were Found that hospital cleaning staff were inadequately trained & cuts cleaning inadequately trained & cuts cleaning budgetsbudgets
Legal Issues in Patient Safety Legal Issues in Patient Safety 2003: Cdn hospitals notified >900 patients that 2003: Cdn hospitals notified >900 patients that improper sterilization of equipment may have improper sterilization of equipment may have exposed them to HIV, Hepatitis and other exposed them to HIV, Hepatitis and other diseases. $150M class action lawsuit filed diseases. $150M class action lawsuit filed alleging negligence in failing to meet adequate alleging negligence in failing to meet adequate sterilization standards.sterilization standards.Government ordered a provinceGovernment ordered a province--wide audit of wide audit of hospital infectionhospital infection--control practicescontrol practices
Healthcare Quarterly Vol. 8, Special IssueHealthcare Quarterly Vol. 8, Special IssueOctober 2005October 2005
Legal Issues in Patient SafetyLegal Issues in Patient Safety2004: Class action lawsuit filed on behalf of 2004: Class action lawsuit filed on behalf of patients who contracted SARS in hospitals patients who contracted SARS in hospitals during the second wave of the outbreak. Claim during the second wave of the outbreak. Claim alleges that public health officials failed to alleges that public health officials failed to maintain sufficiently rigorous infectionmaintain sufficiently rigorous infection--control control precautions.precautions.In context of nosocomial infection, patients may In context of nosocomial infection, patients may claim harm simply from exposure to a risk of claim harm simply from exposure to a risk of infection & need not establish that they did, in infection & need not establish that they did, in fact, acquire an infectionfact, acquire an infection
Healthcare Quarterly Vol. 8, Special IssueHealthcare Quarterly Vol. 8, Special IssueOctober 2005October 2005
Patient DisclosurePatient Disclosure
Canadian law clearly establishes a positive duty Canadian law clearly establishes a positive duty on care providers to inform patients of errors that on care providers to inform patients of errors that occur during their care occur during their care When care providers realize that patients may When care providers realize that patients may have been exposed to infection from equipment, have been exposed to infection from equipment, other patients or healthcare workers, a legal other patients or healthcare workers, a legal obligation may arise to contact patients to warn obligation may arise to contact patients to warn them of the risk and provide advice regarding them of the risk and provide advice regarding appropriate followappropriate follow--up testing and care.up testing and care.
Effects of Germicides on Effects of Germicides on MicroorganismsMicroorganisms
HCWs take for granted the action of HCWs take for granted the action of disinfectants without fully understanding disinfectants without fully understanding mechanism of actionmechanism of actionDifferences in the action of antimicrobial Differences in the action of antimicrobial ingredientsingredientsDifferences depending on concentration of Differences depending on concentration of chemical usedchemical used
Infection Control TodayInfection Control TodayCleaning & Disinfecting: The Effects of Germicides on MicroorganCleaning & Disinfecting: The Effects of Germicides on Microorganismsisms
Feb 2004Feb 2004
Basic FactsBasic Facts
Disinfectants are the backbone of Infection Disinfectants are the backbone of Infection ControlControl>8000 Products registered in the U.S. & >8000 Products registered in the U.S. & CanadaCanada50% of which are used for Healthcare 50% of which are used for Healthcare Infection ControlInfection ControlThere are 300 different active chemistriesThere are 300 different active chemistries
14 are in 95% of the disinfectant products14 are in 95% of the disinfectant products
On the Same PageOn the Same PageTerminology, Definitions, Terminology, Definitions,
Common Words, GuidelinesCommon Words, Guidelines
Major Groups Of MicrobesMajor Groups Of Microbes
Viruses (enveloped)Viruses (enveloped)Bacteria (Bacteria (Gram +Gram +veve & Gram & Gram --veve))FungiFungiViruses (nonViruses (non--enveloped)enveloped)MycobacteriaMycobacteriaProtozoaProtozoaBacterial SporesBacterial Spores
Most Susceptible
Least Susceptible
Process for Choosing a DisinfectantProcess for Choosing a Disinfectant
Once the device has been defined determine the Disinfection Process
Choose the CORRECTProduct
Consider the Device Classification(According to Spaulding)
Process for Choosing a DisinfectantProcess for Choosing a Disinfectant
Sterilization
High LevelDisinfection
Intermediate Level Disinfection
Low LevelDisinfection
Critical Devices*
Semi-Critical Devices
Non-Critical Devices
*Foot Care Instruments defined as critical according to CCDR Vol. 23S8 (Dec 1997) Infection Control Guidelines: Foot Care by Health Care Providers
Process for Choosing a DisinfectantProcess for Choosing a Disinfectant
Sterilization
High LevelDisinfection
Intermediate Level Disinfection
Low LevelDisinfection
Sanitizing
EnvironmentalSurfaces
CleaningCleaningThe removal of adherent The removal of adherent visible soil, blood, protein visible soil, blood, protein substances (tissue) and other substances (tissue) and other debris from surfaces by debris from surfaces by mechanical or manual mechanical or manual processprocessGenerally accomplished with Generally accomplished with water and detergentswater and detergentsRemoves or eliminates the Removes or eliminates the reservoirs of potential reservoirs of potential pathogenic organismspathogenic organisms
Criteria for Low Level DisinfectionCriteria for Low Level Disinfection
Bactericidal: effective against Vegetative bacteria: Bactericidal: effective against Vegetative bacteria: > 6 Log> 6 Log1010 reduction reduction
Staphylococcus aureus, Pseudomonas aeruginosa, Staphylococcus aureus, Pseudomonas aeruginosa, Salmonella cholerasiusSalmonella cholerasius
General Virucide: effective against the Sabin strain General Virucide: effective against the Sabin strain of Polio virus Type 1 (Hydrophilic virus), criterion is of Polio virus Type 1 (Hydrophilic virus), criterion is > 3 Log> 3 Log1010 reductionreductionVirucidal: effective against targeted viruses Virucidal: effective against targeted viruses (enveloped or non(enveloped or non--enveloped), criterion is > 3 enveloped), criterion is > 3 LogLog1010 reductionreductionFungicidal: effective against criterion is > 5 LogFungicidal: effective against criterion is > 5 Log1010
Trichophyton mentagrophytesTrichophyton mentagrophytes
Criteria for Intermediate Level Criteria for Intermediate Level DisinfectionDisinfection
Bactericidal: criterion is > 6 LogBactericidal: criterion is > 6 Log1010 reduction reduction General Virucide: criterion is > 3 LogGeneral Virucide: criterion is > 3 Log1010reduction against Polioreduction against PolioVirucidal: criterion is > 3 LogVirucidal: criterion is > 3 Log1010 reduction reduction against specific virusesagainst specific virusesFungicidal: effective against Fungicidal: effective against Trichophyton Trichophyton mentagrophytesmentagrophytes, criterion is > 5 Log, criterion is > 5 Log1010
Tuberculocidal: effective against Tuberculocidal: effective against Mycobacteria terraeMycobacteria terrae, criterion is > 4 Log, criterion is > 4 Log1010
Criteria for High Level Disinfection Criteria for High Level Disinfection & Sterilization& Sterilization
Fungicidal: effective against Fungicidal: effective against Trichophyton Trichophyton mentagrophytesmentagrophytes, criterion is > 5 Log, criterion is > 5 Log1010
Tuberculocidal: effective against Tuberculocidal: effective against Mycobacteria terraeMycobacteria terrae, criterion is > 6 Log, criterion is > 6 Log1010
Sporicidal: effective against Sporicidal: effective against Bacillus Bacillus subtilissubtilis && Clostridium sporogenesClostridium sporogenes, criterion , criterion is > 6 Logis > 6 Log1010
Foot Care by Health Care Foot Care by Health Care ProvidersProviders
Overall goal of infection prevention practices for Overall goal of infection prevention practices for foot care is to eliminate the risk of transmission of foot care is to eliminate the risk of transmission of pathogens between clients and between clients pathogens between clients and between clients and the health care workerand the health care worker
All foot care equipment for reAll foot care equipment for re--use must be capable of use must be capable of being cleanedbeing cleanedSingleSingle--use items should be discarded after every use use items should be discarded after every use (or dedicated to patient)(or dedicated to patient)All instruments used in foot care must be sterile All instruments used in foot care must be sterile before use on a clientbefore use on a clientRecommended methods of sterilization include: dry Recommended methods of sterilization include: dry heat, autoclave or chemosterilizationheat, autoclave or chemosterilizationHandwashing is the single most important procedure Handwashing is the single most important procedure for preventing infectionsfor preventing infections
Foot Care by Health Care Foot Care by Health Care ProvidersProviders
NonNon--sterile gloves should be worn throughout sterile gloves should be worn throughout proceduresproceduresGloves must be changed for each patientGloves must be changed for each patientIf a foot basin is used it should be washed & If a foot basin is used it should be washed & dried (and disinfected) between clients dried (and disinfected) between clients Blades must not be reBlades must not be re--used between clientsused between clients
PIDAC Best Practices for Cleaning, PIDAC Best Practices for Cleaning, Disinfection and Sterilization in All Disinfection and Sterilization in All
Health Care SettingsHealth Care SettingsIt is strongly recommended that reprocessing It is strongly recommended that reprocessing should be performed in a centralized area that should be performed in a centralized area that complies with the physical & human resource complies with the physical & human resource requirements for reprocessing:requirements for reprocessing:
Clear separation between soiled & clean areasClear separation between soiled & clean areasEasy access to hand hygiene facilitiesEasy access to hand hygiene facilitiesEasy access to emergency suppliesEasy access to emergency suppliesArea for donning/doffing PPEArea for donning/doffing PPEReprocessing area is routinely cleanedReprocessing area is routinely cleanedAdequate ventilation, temperature & humidity Adequate ventilation, temperature & humidity requirements must be metrequirements must be metWater used in processing area should be tested & Water used in processing area should be tested & free of contaminantsfree of contaminants
Disinfectants:Disinfectants:Desired Traits & Limiting Desired Traits & Limiting
FactorsFactorsWhat’s in your bottle?
Existing Technologies Existing Technologies ““FAILFAIL”” in one or in one or more of the key decision making criteria more of the key decision making criteria when selecting a cleaner/disinfectant.when selecting a cleaner/disinfectant.
Cleaning EfficacyCleaning EfficacyDisinfection CapabilityDisinfection CapabilityPersonal Health & SafetyPersonal Health & SafetyEnvironmental ResponsibilityEnvironmental Responsibility
Marketplace overviewMarketplace overview RegistrationRegistration
Government registered by Health Government registered by Health Canada (DIN)Canada (DIN)Easy to Use with clear label instructionsEasy to Use with clear label instructions
MicrobiologicalMicrobiologicalBroadBroad--Spectrum Germicidal ActivitySpectrum Germicidal ActivityFast ActingFast ActingNot Readily Neutralized in Organic or Not Readily Neutralized in Organic or Inorganic MatterInorganic MatterMicroorganism Resistance will not developMicroorganism Resistance will not develop
ChemicalChemical
Safe to TransportSafe to TransportLong Shelf LifeLong Shelf Life
Improper or prolonged storage of disinfectants may Improper or prolonged storage of disinfectants may lead to growth of bacteria in themlead to growth of bacteria in them
Safe & Easy to StoreSafe & Easy to StoreImproper storage of disinfectants may lead to Improper storage of disinfectants may lead to explosions or firesexplosions or fires
NonNon--Corrosive & Material CompatibleCorrosive & Material CompatibleUsing the wrong type or level of disinfectant may Using the wrong type or level of disinfectant may cause corrosion or other damage to expensive items cause corrosion or other damage to expensive items such as flexible endoscopessuch as flexible endoscopes
ToxicologicalToxicologicalNonNon--Toxic to humans & animalsToxic to humans & animalsNonNon--Allergenic & nonAllergenic & non--sensitizingsensitizingNonNon--Hormone disruptionHormone disruption
Certain microbicidal chemicals or their breakdown Certain microbicidal chemicals or their breakdown products can disrupt hormone function in humans & products can disrupt hormone function in humans & animalsanimals
Safe for the User and PatientSafe for the User and PatientExposure to cleaner & disinfectant vapours may Exposure to cleaner & disinfectant vapours may cause respiratory sensitizationcause respiratory sensitizationImproperly rinsed endoscopes or other devices may Improperly rinsed endoscopes or other devices may release residues of disinfectants into body cavityrelease residues of disinfectants into body cavity
EnvironmentalEnvironmentalEnvironmentally sound (Biodegradable) Environmentally sound (Biodegradable)
EnvironmentallyEnvironmentally--stable sanitizers & disinfectants can stable sanitizers & disinfectants can contaminate food or water (groundwater & surface contaminate food or water (groundwater & surface water)water)
No Active Residual ChemistryNo Active Residual ChemistryGood Air QualityGood Air Quality
Free of any pungent smell Free of any pungent smell No Volatile Organic Compounds (VOCs)No Volatile Organic Compounds (VOCs)Use of gaseous or volatile products may negatively Use of gaseous or volatile products may negatively affect indoor air qualityaffect indoor air qualityFragrance FreeFragrance Free
Factors Affecting DisinfectantsFactors Affecting DisinfectantsPrior cleaning of a surface or devicePrior cleaning of a surface or device
Cleaning MUST precede disinfection & sterilization Cleaning MUST precede disinfection & sterilization proceduresproceduresCleaning residues can interfere with the activity of Cleaning residues can interfere with the activity of some disinfectantssome disinfectantsChemical sterilants can be relied on to produce Chemical sterilants can be relied on to produce sterility only if adequate cleaning occurssterility only if adequate cleaning occurs
Organic load on the surface or deviceOrganic load on the surface or deviceSoil can provide a protection barrier for microbesSoil can provide a protection barrier for microbesSoil can neutralize many of the disinfectant Soil can neutralize many of the disinfectant chemistrieschemistries
Factors Affecting DisinfectantsFactors Affecting Disinfectants
Type & level of microbial load on the surface or Type & level of microbial load on the surface or devicedevice
Mechanism of action differs for each chemistry Mechanism of action differs for each chemistry (surface actives, cell components)(surface actives, cell components)
Water QualityWater QualityMany chemistries can be neutralized when diluted Many chemistries can be neutralized when diluted with hard waterwith hard water
Concentration of the chemicalConcentration of the chemicalImproper dilution can lead to a false sense of securityImproper dilution can lead to a false sense of security
Factors Affecting DisinfectantsFactors Affecting Disinfectants
Exposure time of the surface or device to Exposure time of the surface or device to the chemicalthe chemical
Contact time must be adhered to in order to Contact time must be adhered to in order to achieve desired level of disinfectionachieve desired level of disinfectionSurface or device must remain wet Surface or device must remain wet
Physical configuration of the object Physical configuration of the object (crevices, hinges etc)(crevices, hinges etc)
Difficult to remove debris or ensure Difficult to remove debris or ensure disinfectant comes in contact with all areas of disinfectant comes in contact with all areas of a surface or devicea surface or device
Factors Affecting DisinfectantsFactors Affecting DisinfectantsTemperatureTemperature
Effectiveness is enhanced or hindered by various temperature levelsHigher temperatures can accelerate the evaporation of volatiles which can reduce the concentration & effectiveness
pHpHSome products need to be activated prior to useChanges to pH can decrease (neutralize) some chemistries
Storage & ShelfStorage & Shelf--lifelifeMust consider how products are stored (too cold or hot)Efficacy of product decreases once diluted
The ChemistriesThe Chemistries
NAME THAT CHEMISTRY!?!
Next Slide
What Do the following chemicals have in common?NN--Alkyl (40% C12, 50% C14, 10% C16) dimethyl Alkyl (40% C12, 50% C14, 10% C16) dimethyl
benzyl ammonium chloridebenzyl ammonium chloride33--(trimethoxysilyl) (trimethoxysilyl) propyldimethyloctadecylpropyldimethyloctadecyl
ammonium chlorideammonium chlorideNN--Alkyl (68% C12, 32% C14) dimethyl Alkyl (68% C12, 32% C14) dimethyl ethylbenzylethylbenzyl
ammonium chlorideammonium chlorideBenzalkonium chlorideBenzalkonium chloride
They are all QUATERNARY AMMONIUM COMPOUNDS!
Quaternary Ammonium Quaternary Ammonium CompoundsCompounds
Advantages:Advantages:Bactericidal, Fungicidal, Virucidal (enveloped) with a minimum contact time of 10 minutesGenerally non-irritating to hands & non-corrosive to surfacesUsually has detergent propertiesLow Toxicity profileStable in concentrate and use dilutionNewer generations are relatively stable in the presence of organic matter
Quaternary Ammonium Quaternary Ammonium CompoundsCompounds
Disadvantages:Disadvantages:Not sporicidal, generally not tuberculocidal or virucidal against non-enveloped virusesNot effective against BiofilmsDO NOT use to disinfect InstrumentsLeaves Residual Active Chemistry on Environmental Surfaces
Quaternary Ammonium Quaternary Ammonium CompoundsCompounds
Disadvantages:Disadvantages:Repeated uses increase residue build up on surfaces which may lead to increase resistance to susceptibility to antimicrobials inside health settingsFormulations may contain APEs or NPEs (hormone disrupting chemicals)Non-Biodegradable
NAME THAT CHEMISTRY!?!
Next Slide
What do the following chemicals have in common?EthanolEthanolIsopropanolIsopropanolMethanolMethanolAlcohol AnhydrousAlcohol Anhydrous
They are all ALCOHOLS
AlcoholsAlcoholsAdvantages:Advantages:
Broad-spectrum effectiveness: bactericidal, tuberculocidal, fungicidal and virucidalContact time for Ethanol is1 to 3 minutesContact time for Isopropanol is 5 to 10 minutes (generally added to Quats)No Active Chemical ResidueNon Staining
AlcoholsAlcoholsDisadvantages:Disadvantages:
Evaporation may diminish concentration therefore contact time is difficult to achieve unless items are immersedInactivated by organic materialPoor cleaners, not appropriate for use on Environmental SurfacesNot sporicidal
AlcoholsAlcoholsDisadvantages:Disadvantages:
Volatile, flammable and must be stored in well-ventilated areaUse in the OR is contraindicatedProlonged exposure may cause dry skin & skin irritationCompatibility issues with glues & plasticsMay affect indoor air quality due to VOCs
NAME THAT CHEMISTRY!?!
Next Slide
What do the following chemicals have in common?ChloropheneChloropheneChloroxylenolChloroxylenolPP--terttert--amylphenolamylphenol Potassium saltPotassium saltOO--phenylphenolphenylphenolOO--benzylbenzyl--pp--chlorophenolchlorophenol
They are all PHENOLS / PHENOLICS
Phenols & PhenolicsPhenols & Phenolics
Advantages:Advantages:Commercially available with added detergents to provide cleaning & disinfectingBroad-Spectrum antimicrobial (bactericidal, tuberculocidal, fungicidal & virucidal) with a 5 to 10 minute contact timeStable in both concentrate and use dilutionsTolerance for organic load and hard water will depend on formulationGenerally regarded as biodegradable
Phenols & PhenolicsPhenols & PhenolicsDisadvantages:Disadvantages:
Poor cleaning efficacyNot SporicidalContraindicated for use around childrenNot recommended for use on Food Contact SurfacesResidual disinfectant may cause tissue irritationPungent Odour (Volatile)
Phenols & PhenolicsPhenols & PhenolicsDisadvantages:Disadvantages:
High Toxicity (listed on the Canadian Toxic Substance List & the EPA National Priority Lists)Phenols have limited use in Educational & Food Preparation settings because of their restrictions due to the toxicityPotential toxicity (skin, brain, kidneys, liver & lungs) from o-phenylphenol (listed as a carcinogen), o-benzyl-p-chlorophenol & ethylene glycol (anti-freeze, listed as a teratogen)
NAME THAT CHEMISTRY!?!
Next Slide
What do the following chemicals have in common?Calcium HypochloriteCalcium HypochloriteSodium HypochloriteSodium HypochloriteChlorine DioxideChlorine DioxideSodium ChloriteSodium Chlorite
They are all CHLORINE COMPOUNDS!
Chlorine & Chlorine CompoundsChlorine & Chlorine Compounds
Advantages:Advantages:Low cost, readily available, Multi-purposeRelatively Fast Acting (average contact time of 10 minutes)Broad-Spectrum Antimicrobial (bacteria, viruses, fungi, protozoa, spores)Effective in removing biofilms (does not kill)Readily available in liquid or solidUse for disinfection Environmental surfaces, toys, sports equipment
Chlorine & Chlorine CompoundsChlorine & Chlorine Compounds
Disadvantages:Disadvantages:Instable, Corrosive & pH dependantInactivated (neutralized) by Organic MatterNo detergent properties Irritant to skin & mucous membranesCompatibility issue with metals, rubber & material
Chlorine & Chlorine CompoundsChlorine & Chlorine CompoundsDisadvantages:Disadvantages:
Use in well-ventilated areasHigh Toxicity, kills all forms of aquatic lifeChlorine disinfection by-products cause adverse developmental & reproductive effects including spontaneous abortion
NAME THAT CHEMISTRY!?!
Next Slide
What do the following chemicals have in common?
DihydrogenDihydrogen dioxidedioxideHydrogen dioxideHydrogen dioxideDioxidaneDioxidane
They are all synonymous for Hydrogen Peroxide!
Hydrogen PeroxideHydrogen Peroxide
Advantages:Advantages:Environmentally safeBroad-spectrum antimicrobial (bacteria, viruses, mycobacteria, fungi, spores)Effective against biofilmsStable in presence of organic matterNon-stainingNo Active Chemical Residue
Hydrogen PeroxideHydrogen Peroxide
Disadvantages:Disadvantages:Can be corrosive to soft metals aluminum, copper, brass, zinc, mild & galvanized steelHigh concentration has strong pungent odour (>20%)High concentration may cause chemical burnsCan be explosive at high concentrations
Accelerated Hydrogen PeroxideAccelerated Hydrogen PeroxideAdvantages:Advantages:
Fast acting broad-spectrum antimicrobial (bacteria, viruses, mycobacteria, fungi, spores)Contact times ranging from 30 seconds to 20 minutes depending on level of disinfection Effective against biofilmsExcellent cleaning efficacyExcellent Health & Safety profile
Accelerated Hydrogen PeroxideAccelerated Hydrogen PeroxideAdvantages:Advantages:
Stable in presence of organic matterNo active chemical residuals Low foam & non-stainingStable in concentrate formVOC freeEnvironmentally friendly (Inherently Biodegradability, Low Aquatic Toxicity)Not manufactured using APEs (ie NPEs)
Accelerated Hydrogen PeroxideAccelerated Hydrogen Peroxide
Disadvantages:Disadvantages:Prolonged exposure should be avoided to soft metals aluminum, copper, brass, zinc, mild & galvanized steel
NAME THAT CHEMISTRY!?!
Next Slide
What do the following chemicals have in common?
GlutaralGlutaral1,51,5--pentanedialpentanedialOrthoOrtho--phthalaldehydephthalaldehydeFormalinFormalin
They are all ALDEHYDES!
OrthoOrtho--phthalaldehydephthalaldehyde
Advantages:Advantages:High level disinfectant in 5 - 12 minsNo activation requiredNon-corrosive to metalsNon-flammableExcellent material compatibility, can be used on lensed instruments and flexible endoscopes
OrthoOrtho--phthalaldehydephthalaldehyde
Disadvantages:Disadvantages:Slow sporicidal activityStains skin, mucous membranes, clothing and environmental surfacesEye irritation with contactNot enough information on ToxicityPotential material incompatibility (anodize aluminum coating dulls)
OrthoOrtho--phthalaldehydephthalaldehyde
Disadvantages:Disadvantages:Restrictions to disposal (dependant on municipality)Instruments must be well rinsed to ensure removal of all chemical residuesContraindication for use on urological instruments due to anaphylaxis
GlutaraldehydesGlutaraldehydes
Advantages:Advantages:Chemical sterilants in 6 - 12 hrsHigh level disinfectant in 10 - 60 minsNon-corrosive to metalsNon-flammableActive in presence of Organic MatterExcellent material compatibility, can be used on lensed instruments and flexible endoscopes
GlutaraldehydesGlutaraldehydesDisadvantages:Disadvantages:
Not suitable or safe for use as a surface disinfectantPre-cleaning is essential (fixative)May corrode or stain high-carbon steel & leave residues on metalsGermicidal activity is affected by pH & dilutionQuestionable ability to kill / remove Biofilms
GlutaraldehydesGlutaraldehydes
Disadvantages:Disadvantages:Extremely irritating to skin & mucous membranes (pungent odour)Special ventilation is requiredLiquid & vapour are recognized as toxic can cause dermatitis (skin), conjunctivitis (eyes), rhinitis & sinusitis (lungs)Gluteraldehyde is a suspected mutagen & carcinogen
ConclusionsConclusions
Disinfectant SelectionDisinfectant Selection
Consider:Consider:EfficacyEfficacySpectrumSpectrumVersatilityVersatilityEase of useEase of useSafety profileSafety profileCostCost
What’s in your bottle?
Disinfectant SelectionDisinfectant Selection
Remember:Remember:Match Product with Match Product with ProtocolProtocol
Surfaces vs InstrumentsSurfaces vs InstrumentsCleaning = 1Cleaning = 1stst stepstepDisinfection = 2Disinfection = 2ndnd stepstepContact Time is Contact Time is MANDITORY!MANDITORY!
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Residuals
Volitale
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Toxic/ Ir
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Substrate
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Environmen
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Narrow-Spec
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Organic Neutra
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Restric
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Quats
Alcohols
Phenolics
Chlorine
Gluteraldehyde
AHP
Virox Technologies Virox Technologies Inc.Inc.
Engineering Engineering Revolutionary Revolutionary
Disinfectants for the Disinfectants for the War Against War Against
MicrobesMicrobes
ReferencesReferencesInfection Control Guidelines: Hand Washing, Infection Control Guidelines: Hand Washing, Cleaning, Disinfection and Sterilization in Health Cleaning, Disinfection and Sterilization in Health Care, Health Canada. Dec 1998, Care, Health Canada. Dec 1998, VolVol 24S824S8Routine Practices and Additional Precautions for Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Preventing the Transmission of Infection in Health Care, Health Canada. July 1999, Health Care, Health Canada. July 1999, VolVol25S425S4Guidelines for Environmental Infection Control in Guidelines for Environmental Infection Control in Healthcare Facilities, CDC. MMWR June 2003, Healthcare Facilities, CDC. MMWR June 2003, VolVol 52, No RR52, No RR--1010Best Practices for Cleaning, Disinfection and Best Practices for Cleaning, Disinfection and Sterilization in All Health Care Settings, PIDAC, Sterilization in All Health Care Settings, PIDAC, May 2006May 2006
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