SASKPICSASKPIC

Taking the Mystery out of Chemical Disinfection

Nicole Kenny, BSc, Assoc ChemDirector of Professional & Technical Services

Virox Technologies IncPhone: 1-800-387-7578 x118

Email: nkenny@virox.com

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 products6 are the most common6 are the most common

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

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

Computer Keyboards May Computer Keyboards May Harbor Harmful BacteriaHarbor Harmful Bacteria

Harmful bacteria can survive for prolonged periods Harmful bacteria can survive for prolonged periods on keyboards & keyboard covers (VRE & MRSA: 24 on keyboards & keyboard covers (VRE & MRSA: 24 hrs, PSAE: 1hr)hrs, PSAE: 1hr)More contact with contaminated keyboard increase More contact with contaminated keyboard increase likelihood of transmitting bacteria to hands (MRSA: likelihood of transmitting bacteria to hands (MRSA: 42% 42% -- 92%, VRE: 22% to 50%, PSAE: 9% to 18%)92%, VRE: 22% to 50%, PSAE: 9% to 18%)Hand Hygiene important helps cut down on Hand Hygiene important helps cut down on transmissiontransmissionCleaning & Disinfection of keyboards & keyboard Cleaning & Disinfection of keyboards & keyboard covers helps decrease contaminationcovers helps decrease contamination

Infection Control TodayInfection Control TodayComputer Keyboards May Harbor Harmful Bacteria;Computer Keyboards May Harbor Harmful Bacteria;

Experts Advise to Use Disinfectant and Wash Your HandsExperts Advise to Use Disinfectant and Wash Your HandsApril 2005April 2005

On the Same PageOn the Same PageTerminology, Definitions, Terminology, Definitions,

Common WordsCommon Words

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

Typically, the more resistant the pathogen, the Typically, the more resistant the pathogen, the more toxic the disinfectant needs to bemore toxic the disinfectant needs to be……

BACTERIA WITH SPORES (Bacillus subtilis, Clostridiu, tetani, C. difficile C. botulinum)

Chemical Sterilant PROTOZOA WITH CYSTS (Giardia lamblia, Cryptosporidium parvum)

MYCOBACTERIA (Mycobacterium tuberculosis M. avium-intracellulare, M. chelonae

NON-ENVELOPED VIRUSES (coxsackieviruses, polio viruses, rhinoviruses, rotaviruses, Norwalk virus, hepatitis A virus

Intermediate

&High Level FUNGI (Candida species, cryptococcus species, Aspergillus species, Dermatophytes) VEGETATIVE BACTERIA (Staphylococcus aureus, Salmonella typhi, Pseudomonas aeruginosa, coliforms)

Low Level Disinfection ENVELOPED VIRUSES (Herpes simplex, varicella-zoster virus, cytomegalovirus, Epstein-Barr virus, Measles virus, Mumps virus, Rubella virus, Influenza virus, Respiratory syncytial virus, Hepatitis B and C viruses, Hantaviruses, and Human immunodeficiency virus)

AH

P

Hard

Easy

Kill

•Glutaraldehyde•Ethylene oxide•Phenolics•Alcohol Blends•Iodine•Bleach/Chlorine•Quat/phenol Blends•Quat/Alcohol Blends•Quat as active•Peracids

High Toxicity

Low Toxicity

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/Surface 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

Sanitizing Environmental Surfaces

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 SanitizingCriteria for Sanitizing

A process that reduces microorganisms on A process that reduces microorganisms on surfaces to a safe levelsurfaces to a safe level

Food Contact Surfaces:Food Contact Surfaces: reduction of surrogate reduction of surrogate bacterial strains by more than 5bacterial strains by more than 5--loglog1010 in the presence in the presence of 5% bovine serum of 5% bovine serum NonNon--Food Contact Surfaces:Food Contact Surfaces: reduction of surrogate reduction of surrogate bacterial strains by more than 3bacterial strains by more than 3--loglog1010

Vegetative Bacteria such as E. coli, Vegetative Bacteria such as E. coli, Staphylococcus, Pseudomonas and other Staphylococcus, Pseudomonas and other common food borne bacteria can be usedcommon food borne bacteria can be used

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

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

Positive ChangesPositive Changes

““It is cheaper & more effective to prevent It is cheaper & more effective to prevent environmental & health damage than to environmental & health damage than to attempt to manage or cure it. Prevention attempt to manage or cure it. Prevention requires examining the entire life cycle of requires examining the entire life cycle of products. It encourages the exploration products. It encourages the exploration of safer alternatives and the of safer alternatives and the development of cleaner products, development of cleaner products, technologies & workplaces.technologies & workplaces.””

-- Preventing Occupational & Environmental CancerPreventing Occupational & Environmental Cancer-- A strategy for TorontoA strategy for Toronto

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

Purchasing & TrainingPurchasing & TrainingCost EffectiveCost Effective

Consider the ShelfConsider the Shelf--life of product once diluted life of product once diluted (i.e. 24hrs vs 30 days)(i.e. 24hrs vs 30 days)Consider cost at Use Dilution ($/L of product)Consider cost at Use Dilution ($/L of product)Decisions on purchasing disinfectants may be made Decisions on purchasing disinfectants may be made entirely based on cost which can lead to choosing an entirely based on cost which can lead to choosing an inappropriate productinappropriate product

Training SupportTraining SupportPersonnel responsible for using disinfectants may not Personnel responsible for using disinfectants may not receive any training or inadequate instruction in the receive any training or inadequate instruction in the preparation, use, storage and disposal of the preparation, use, storage and disposal of the formulation in useformulation in use

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

QuatQuat--Alcohol BlendsAlcohol Blends

Surface products on the market that Surface products on the market that contain a combination of Quats & Alcohol contain a combination of Quats & Alcohol (IPA)(IPA)Addition of IPA allows for efficacy against Addition of IPA allows for efficacy against Mycobacteria (TB Claim)Mycobacteria (TB Claim)These products have the same These products have the same Advantages & Disadvantages for both Advantages & Disadvantages for both Quats and Alcohols Quats and Alcohols

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:Unstable, Corrosive & pH dependantInactivated (neutralized) by Organic MatterNo detergent properties Irritant to skin & mucous membranesCompatibility issue with metals, rubber & fabric materials

Chlorine & Chlorine CompoundsChlorine & Chlorine CompoundsDisadvantages:Disadvantages:

Use in well-ventilated areasHigh Toxicity, especially on 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 burns (>20%)Can be explosive at high concentrations (>20%)

Accelerated Hydrogen PeroxideAccelerated Hydrogen PeroxideAdvantages:Advantages:

Fast acting broad-spectrum antimicrobial (bacteria, viruses, mycobacteria, fungi, spores) for environmental surfaces and instrumentsContact 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 (EcoLogo and Green Seal Approved formulas)Not manufactured using APEs (ie NPEs)

Accelerated Hydrogen PeroxideAccelerated Hydrogen Peroxide

Disadvantages:Disadvantages:Not recommended for use on soft metals aluminum, copper, brass, zinc, anodized aluminum and carbon steelSurface disinfectants do not contain solvents

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!

SSuummmmaarryy

Germici

de Type

Active

Residuals

Volitale

Organic Compounds

Toxic/ Ir

ritant

Substrate

Impact

Poor Cleaning

Environmen

tal issu

es

Narrow-Spectr

um Germ

icide

OrganicNeutra

lizatio

n

Restric

tions I

n Use

Iodine

Alcohols

Phenolics

Chlorine

Quats

AHP

SSuummmmaarryy

Germicide Type

Active Residuals

Volitale Organ

ic Compound

Toxic / Irrita

nt

Substrate Im

pact

Poor Cleaning

Environmental is

sues

Narrow-Spectru

m Germicide

Organic Neutralizatio

Restrictio

ns In Use

Peracetic Acid

OPA

Glutaraldehyde

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, March 2006March 2006

ReferencesReferencesBlock S. Disinfection. Sterilization, and Block S. Disinfection. Sterilization, and Preservation, 5Preservation, 5thth Ed. 2001Ed. 2001MayhallMayhall CG. Hospital Epidemiology and CG. Hospital Epidemiology and Infection Control, 3Infection Control, 3rdrd Ed. Philadelphia. Lippincott Ed. Philadelphia. Lippincott Williams & Wilkins, 2004:1473Williams & Wilkins, 2004:1473--15221522CokendolpherCokendolpher JC & JC & HaukosHaukos JF. The Practical JF. The Practical Applications of Disinfection and Sterilization in Applications of Disinfection and Sterilization in Health Care Facilities, Chicago. American Health Care Facilities, Chicago. American Hospital Association, 1996: 47Hospital Association, 1996: 47--5959Rutala WA. APIC Guideline for Selection and Rutala WA. APIC Guideline for Selection and Use of Disinfectants AJIC 1990:17(2) 99Use of Disinfectants AJIC 1990:17(2) 99--117117

ReferencesReferencesBessemsBessems E. The effect of practical conditions on E. The effect of practical conditions on the efficacy of disinfectants. the efficacy of disinfectants. IntInt BiodeterBiodeter &&BiodegBiodeg 1998:1771998:177--183183Crawford L et al. A Comparison of Commonly Crawford L et al. A Comparison of Commonly Used Surface Disinfectants: AlcoholUsed Surface Disinfectants: Alcohol--, Phenol, Phenol--,,ChlorineChlorine-- and Quat Disinfectants. and Quat Disinfectants. www.infectioncontroltoday.com/articles/0b1feat2www.infectioncontroltoday.com/articles/0b1feat2.html.htmlRusselRussel AD. Glutaraldehyde: Current Status and AD. Glutaraldehyde: Current Status and Uses.Uses. InfInf Con & Hosp Con & Hosp EpiEpi 1994;15 (11) 7241994;15 (11) 724--733733Rutala WA. Sporicidal Activity of Chemical Rutala WA. Sporicidal Activity of Chemical Sterilants Used in Hospitals. Sterilants Used in Hospitals. InfInf Con & Hosp Con & Hosp EpiEpi1993; 14(12) 7131993; 14(12) 713--718718

ReferencesReferencesRutala WA & Weber DJ. The benefits of surface Rutala WA & Weber DJ. The benefits of surface disinfection. AJIC 2004;32(4) 226disinfection. AJIC 2004;32(4) 226--229229WoldkoffWoldkoff P et al. Risk in cleaning: chemical and P et al. Risk in cleaning: chemical and physical exposure. physical exposure. SciSci of Total Env of Total Env 1995:215:1351995:215:135--156156Sattar SA. Current issues in testing, selection Sattar SA. Current issues in testing, selection and use of microbicides in infection control: a and use of microbicides in infection control: a critical review. AICJ 2004;9(3):84critical review. AICJ 2004;9(3):84--100100Health Canada. Therapeutic Products Health Canada. Therapeutic Products ProgrammeProgramme Guidelines: Disinfectant Drugs. Fall Guidelines: Disinfectant Drugs. Fall 19991999

ReferencesReferences

Degussa, Hydrogen Peroxide: Properties, Degussa, Hydrogen Peroxide: Properties, Handling and ApplicationHandling and ApplicationHugo, Inhibition and destruction of the Hugo, Inhibition and destruction of the microbial cellmicrobial cellAscenzi, Handbook of disinfectants and Ascenzi, Handbook of disinfectants and antisepticsantiseptics