It's about time

Efficiency and effectiveness continue to be the key factors in evaluating surface disinfectants. Making the right choices and using products properly in high-touch areas of patient rooms can play a key role in reducing potential transmission of many health care-associated pathogens.

To help environmental services teams meet the daily challenges they face in killing the bacteria of greatest threat to patients, manufacturers offer disinfectants that reduce contact time compared with more traditional products, experts say.

"There's a lot more interest in less contact time and that's being driven by inspectors like Joint Commission or the Centers for Medicare & Medicaid Services," says Kirsten Thompson, senior program leader in research and development for Ecolab Inc.'s health care business in St. Paul, Minn. "They want to see that shorter contact time or they want to see the contact time held to a minimum."

"The Centers for Disease Control and Prevention (CDC) say that a good disinfectant will have an efficacy of between three and five minutes," says Mark A. Regna, CHESP, CHCM, CHSP, vice president of sales and marketing at Biomed Protect LLC,

St. Louis, and a former board member with the Association for the Healthcare Environment. "It could be shorter than three minutes but the CDC uses a window of three to five minutes because of the evaporation rate of products. If it goes longer than five minutes, you pretty much have to apply the disinfectant again in order to get the saturation on the surface," he says.

Manufacturers also tout the latest disinfectants as able to combine cleaning and disinfecting in one step, saving time while reducing the number of products ES staff need to carry.

Still, traditional disinfectants with ostensibly longer contact times have their place in the fight against health care-associated infections (HAIs) because of their benefits. For example, products such as quaternary ammonium compounds (quats) and quat and alcohol combinations remain popular because they are effective against a broad range of pathogens and are compatible with several types of surfaces, says Kim LaFreniere, associate research fellow, Clorox Professional Products Co., Oakland, Calif.

The longer contact times are debatable anyway. Even though CDC data show that quats and phenolics remove or kill pathogens in as little as a minute, the Environmental Protection Agency (EPA) requires that users follow the contact time on the product's label, says Thompson.

"People know that it can take care of it in one minute. But they have to follow the law and it's the EPA registration," she says. "If any inspector comes in, they're going to want them to follow the label."

A costly battle

Clostridium difficile (C. diff) has emerged as one of the most prevalent and serious health care-associated infection threats to patient safety and among the most costly to hospitals. A recent report from the CDC says the incidence, mortality and medical costs related to C. diff infections have reached all-time highs.

Studies show C. diff affects more than 7,000 patients in U.S. hospitals each day at an annual cost of approximately $1 billion in additional care. The CDC recommends that clinicians clean patient room surfaces thoroughly with bleach or other EPA-approved sporicidal agents after a patient with C. diff has been treated there.

"Products that contain sodium hypochlorite, such as bleach, are generally effective against a broad range of microorganisms, including C. diff, and have short contact times," says LaFreniere.

Clorox Healthcare just announced last month that its Healthcare Bleach Germicidal Wipes are EPA-registered to kill C. diff spores in three minutes and 51 microorganisms in 30 seconds. The company also offers two EPA-registered products with bleach that kill C. diff spores in five minutes: Dispatch Hospital Cleaner Disinfectant with Bleach and Dispatch Hospital Cleaner Disinfectant Towels with Bleach.

While bleach is commonly used, other sporicidal agents that utilize hydrogen peroxide and peracetic acids are emerging as alternatives against C. diff. Ecolab offers Virasept, the first ready-to-use, EPA-approved hard surface disinfectant to fight C. diff spores.

Virasept works within 10 minutes of application against C. diff and in four minutes or less for a range of other pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Escherichia coli, HIV, hepatitis B, influenza A (H1N1) and Norovirus, says the company.

Its patented, noncorrosive chemistry is formulated for daily cleaning of high-touch room surfaces such as hand rails, telephones, bathroom fixtures, sinks and tray tables without harming the equipment. Virasept cleans, disinfects and deodorizes in one-step, says Ecolab.

After three years of research, BioMed last month released a new surface disinfectant called Sanotracin RTU that provides sporicidal effectiveness by utilizing hydrogen peroxide and peracetic acid, says Regna. The EPA-registered Sanotracin RTU is a surface disinfectant that kills C. diff in just three minutes and a broad spectrum of bacteria on hard and nonporous surfaces in two minutes.

Sanotracin has a verified efficacy rate of 99.9999 percent, according to BioMed. Sanotracin RTU provides sporicidal effectiveness without the use of bleach. It contains no alcohol, requires no rinsing and leaves no film on surfaces.

Without proper cleaning of all surfaces in the patient environment, all claims about advanced disinfection products mean little, says Ruth Carrico, Ph.D., R.N., CIC, associate professor in the division of infectious diseases, University of Louisville (Ky.) School of Medicine.

"It's like if you build a house and you have no foundation. How do you expect that house to stand? It's the same way with fighting HAIs; you need to have environmental services staff who are well-trained, valued and know how to do the basics," she says.

Monitoring is an important step in the cleaning and disinfection process, she adds. A report by researcher Philip C. Carling, M.D., titled "Evaluating hygienic cleaning in healthcare settings: What you do not know can harm your patients" and published in the June 2010 issue of American Journal of Infection Control, reinforces that belief.

Carling wrote that studies show that the use of fluorescent monitoring systems can improve cleaning from as low as 40 percent of near-patient surfaces to up to 82 percent. Studies show that the improvements were associated with an average 68 percent decrease in environmental contamination of high-risk objects, he wrote.

In the market

Clorox Healthcare Hydrogen Peroxide Cleaner Disinfectants are EPA-registered to kill 36 bacteria and viruses in 30 to 60 seconds. Clorox Healthcare Hydrogen Peroxide Cleaner Disinfectant Wipes and Spray recently received EPA-registration to kill four additional antibiotic-resistant organisms.

The products are EPA-registered to kill more than two-thirds of all pathogens related to HAIs, including all ESKAPE pathogens (Enterococcus faecium, S. aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudo­monas aeruginosa, Enterobacter aerogenes) and Norovirus. (The pathogens were given the acronym ESKAPE by infectious disease specialist Louis Rice, M.D., to emphasize that they cause the majority of U.S. hospital infections and effectively "escape" the effects of antibacterial drugs.)

The wipes and spray are ready-to-use, one-step cleaner disinfectants engineered with a patented hydrogen peroxide (H2O2) formula and are recommended for daily surface disinfection facilitywide.

Spartan Chemical Co., Maumee, Ohio, offers hard-surface disinfecting wipes in three fragrances, packaged 125 to a canister, six canisters per case. The wipes, which come in portable dispensers, combat against bacteria and virus cross-contamination on hard, nonporous surfaces such as stainless steel, plastic, metal and in bathrooms. The product is effective against E. coli, P. aeruginosa, Salmonella, MRSA, VRE, vancomycin-resistant S. aureus (VRSA), Pandemic 2009 Influenza A (H1N1), Influenza A2, HIV and Trichophyton mentagrophytes. They also sanitize in seconds against S. aureus, K. pneumoniae and Listeria.

Kimberly-Clark Professional offers the WetTask refillable wet wiping system, which helps to avoid contamination of the wipers and cleaning solution because the synthetic material wipers are disposed one at a time from a closed bucket. The end user adds the preferred disinfectant to the wiper.

The company's Kimtech Prep Wipers for hypochlorite, disinfectants and sanitizers are compatible with quaternary amine and bleach disinfectant solutions.

Spic and Span 3-in-1 All-Purpose Spray and Glass Cleaner from P&G Professional, Cincinnati, cleans and disinfects mirrors, counters and other dry surfaces in a single step when used as directed. Similarly, Comet Disinfecting Bathroom Cleaner cleans and disinfects wet surfaces in one step, when used as directed, without extra products.

Metrex, Orange, Calif., has launched the new ready-to-use CaviCide1, a multipurpose disinfectant-decontaminant cleaner that can be used on hard, nonporous surfaces. The improvements in the latest formulation kill 99.9 percent of bacteria, viruses and fungi in one minute, according to the company. For a sample, visit metrex­.com/­cavicide1.

Finally, ShockWave disinfectant from Fiberlock Technologies, Andover, Mass., is EPA-registered for use on pathogenic organisms, including multidrug-resistant organisms and A-type pandemic strains of influenza. It's a noncorrosive quaternary ammonium chloride-based disinfectant.

Jeff Ferenc is senior editor for Health Facilities Management.