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Infection Control

Solving The Disinfecting Conundrum

September 19, 2010
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We live in an era of increasing antibiotic resistance. Bacterial infections once easily cured by penicillin now resist whole classes of antibiotics.

Terms like "multi-drug resistant" and "extremely drug resistant" are new, but have quickly become common in hospitals.

The proximate causes of most antibiotic-resistant infections are invasive medical devices and compromised immunity, but how do the bacteria spread from one person to the next?

Obviously, environmental surfaces play a major role.

Infected patients and colonized staff interact with the hospital environment in hundreds of ways every day: An infected patient contaminates his bedding, which in turn contaminates his bedrail; a colonized nurse removes a difficult bandage, stopping to adjust the room lighting; a rushed doctor grabs a doorknob, then remembers he or she forgot to wash their hands after checking on a problematic catheter; and so on.

Patients and hospitals can no longer depend on new antibiotics to solve infection problems.

Large pharmaceutical companies, the traditional pipeline, simply aren''t investing in antibiotic discovery as in years past because the research commitment necessary to identify and exploit uniquely bacterial cellular targets is costly and increasingly fruitless.

A quick assessment of drug company ads will confirm this — pharmaceutical research dollars go to long-term, chronic conditions amenable to daily medication.

Since breakthrough cures for antibiotic-resistant infections aren''t likely to come any time soon, it is necessary to take a fresh look at hospital surface disinfection.

Beyond the widely publicized need for handwashing, prevention and control of surface-transmitted infections begins and ends with disinfection.

However, traditional disinfection technologies have drawbacks that limit their effectiveness when it comes to controlling the spread of germs in the hospital environment.

"What?" you remark. "I thought that disinfectants registered with the U.S. Environmental Protection Agency (EPA) were very efficacious."

EPA-registered disinfectants are efficacious — when used in accordance with label instructions.

Use instructions for disinfection found on common U.S. hospital disinfectants read like this: "Pre-clean the surface to remove gross filth — spray and then wipe clean. Then, thoroughly wet the surface and let the product stand for 10 minutes."

Pre-cleaning followed by disinfection for the full contact time specified on the label is how surfaces in a hospital should be disinfected.

Anyone who aspires to improve hospital infection control will benefit from assessing the actual state of compliance.

All too often, cleaning staff do not pre-clean or thoroughly wet surfaces, and many hospital surfaces do not stay wet for the full contact time specified on the label.

Frequency of surface disinfection is also important.

A critical question in any hospital is: "How often does a given high-touch surface actually get disinfected?"

Let us be honest with ourselves about preventing surface transmission of antibiotic-resistant bacteria in hospitals.

Are current practices working as well as we would like? Are infection rates dropping? Is it practical to keep a vertical surface "thoroughly wet" for 10 minutes?

The truth is that there is a great difference between how we hope hospital surfaces are disinfected and how they are actually disinfected in most hospitals.

Choosing The Right Tool

A few measures can improve compliance with best practice surface disinfection procedures.

First, the organization can be restructured so cleaning staff can report directly to trained infection prevention — "infection control" personnel; at the least, environmental services staff can begin a direct dialog with infection prevention specialists to determine how to achieve a more cooperative, interdependent relationship.

Second, the cleaning staff can learn about the strengths and weaknesses of the different products they use, especially with respect to disinfection.

Cleaning staff should know enough to avoid common pitfalls of surface disinfection such as the overuse of properly prepared disinfectant solutions.

Research shows that the resulting depletion of the active ingredient leads to cross contamination of adjacent surfaces.

The final, and probably easiest, way to increase compliance is to provide the cleaning staff with a tool that makes foolproof surface disinfection easy.

The optimal surface disinfectant for the hospital environment would have these qualities:

  • Easy to use

  • Disinfects a surface quickly — three to five seconds

  • Kills a broad range of pathogens without "gaps" in the efficacy spectrum

  • Reduces the potential for cross contamination of adjacent surfaces

  • Non-toxic

  • Psychologically acceptable to use around patients

  • No health risk to sensitive populations — asthmatics, patients with chemical sensitivities, etc.

  • Frequent use will not damage surfaces

  • Effective on three-dimensional and vertical surfaces

  • Safe for cleaning staff, even for long-term use.

There is a new surface disinfection technology that provides all of these qualities.

It is a device rather than a chemical; it is a commercial steam vapor system outfitted specifically for surface disinfection.

Commercial steam vapor systems provide many advantages, but they must be individually validated for surface disinfection because a steam vapor system''s germ-killing power depends on many factors: The moisture content of the steam; its temperature at the tool-surface interface; and tool surface area.

A leading manufacturer of commercial steam vapor systems recently completed extensive surface disinfection efficacy testing at three established, independent laboratories.

A realistic test system was designed for all studies, many of which were done entirely in duplicate.

High initial microbial concentrations were used and dried onto a mix of porous and non-porous surfaces.

Study results show that the system rapidly kills viruses, fungi and antibiotic-resistant bacteria, providing a sanitizing benefit within two seconds of surface contact and disinfecting surfaces within five seconds.

In the hands of trained cleaning staff, commercial steam vapor systems have many advantages.

Most systems are chemical-free, safe to use around patients, quiet and portable.

Since targeted heat, not chemicals, is the "active ingredient," disinfection is exceedingly fast and broad-spectrum.

There is no specter of chemical cross resistance to antibiotics, surfaces do not become sticky, stain or discolor over time and staff can disinfect as frequently as necessary without long-term chemical exposure concerns.

Since pre-cleaning is not required and the contact times necessary for disinfection are on the order of seconds, rather than minutes, staff compliance is naturally less of an issue for a commercial steam vapor system.

Additionally, commercial steam vapor systems afford a key advantage: The steam cleaning tool remains very hot, so the potential for surface-to-surface or room-to-room cross contamination is greatly reduced.

This is in sharp contrast to the traditional "spray and wipe" approach, which recent studies suggest can actually spread pathogens from one surface to the next if the disinfectant becomes overused or is inadvertently inactivated.

Visualizing The Change

Just as there is no breakthrough cure for multi-drug resistant infections in sight, there is no disinfectant likely to be developed soon that will provide the unique benefits of a steam vapor system.

Available technologies to improve infection control practices in the near future may look, smell and feel different from traditional chemical solutions.

The unique qualities of commercial steam vapor systems can be harnessed to create a hospital surface disinfection regimen that will help stop the spread of pathogens.

The optimal plan will be determined through careful scientific research, but it will certainly capitalize on the ability of commercial steam vapor systems to be used seamlessly around patients and frequently on high-touch, often vertical, surfaces.

In one scenario, a member of the hospital cleaning staff would be tasked with ongoing "hot spot" disinfection while another would be responsible for terminal cleaning and disinfection with a commercial steam vapor system, possibly in conjunction with traditional cleaners as appropriate.

The first staff member would move in a cyclical fashion from wing to wing or floor to floor on an ongoing basis.

This person would focus on disinfecting surfaces such as doorknobs, light switches, bedrails in patient rooms and other high-touch surfaces.

Meanwhile, the second staff member would focus on deep cleaning and disinfection of a broader group of surfaces between room changeovers.

There would be many advantages to such an approach. Foremost, the repetitive disinfection of the high-touch surfaces would dramatically decrease transmission of pathogens throughout the hospital.

Traditionally, such surfaces are cleaned once a day or once a week. Considering the rate at which these surfaces are touched, once a day or week is wholly inadequate.

By using a steam vapor system, high-touch surfaces can be disinfected on an hourly basis without damage to the surface, chemical irritation to sensitive populations or long-term risks to staff.

Time To Take Action

It is time to take action and be open with respect to how we think about preventing pathogen transmission by hospital surfaces.

Hospital surfaces are cleaned to enhance appearance and preserve functionality. They''re disinfected to prevent infections.

Chemical disinfectants have prevented many infections, but they can be irritating to patients and dangerous to staff.

In addition, they are not used in hospitals as intended. As such, chemical disinfectants may not provide the kind of disinfection that is needed in this era of increasing antibiotic resistance.

Commercial steam vapor systems represent a new approach to infection control that is environmentally friendly, chemical-free, broadly active and rapidly efficacious.

Steam for surface disinfection has major advantages with respect to minimizing the chances of cross contamination from one surface to the next and can be used to great effect on vertical and three-dimensional high-touch surfaces repetitively throughout the day, without damage.

If you are interested in infection control, consider steam vapor from an objective, scientific perspective.

It is a new technology with the potential to reduce pathogen transmission within your facility.

The impact to human health may well be worth the time and contemplation invested.

Dr. Benjamin Tanner is the principal of Antimicrobial Test Laboratories, an independent testing facility specializing in the research and development of antimicrobials, including disinfectants. Dr. Tanner holds a B.S. in Molecular Biology and a Ph.D. in Microbiology and Immunology from the University of Arizona, where he studied environmentally mediated disease transmission and assessed infection risks for workers.

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