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Technical Report Micro-Scientific Industries An
Objective Look at Disinfectant Selection Don’t
Be Fooled by Smoke and Mirrors- You be the Judge J.
Wagner, November 2003 Illusionists are able to fool
their audiences through the use of smoke and mirrors in order to make
the audience believe they see something that in reality is not there.
The same holds true for some, but certainly not all, producers
and marketers of disinfectant products. In the context of the use of
disinfectants intended for the destruction of disease causing
microorganisms in the healthcare facility this can and does frequently
present a dangerous, life threatening situation for patients, healthcare
professionals and the families of healthcare professionals. Man has long known that certain
microorganisms exist that produce deadly infections in humans.
Certain individuals are especially susceptible; the aged, the
very young, those with compromised immune systems, patients, surgical
patients along with healthcare caregivers who attend to them to name a
few. Pathogenic (disease-causing) microorganisms exist in
and on environmental surfaces within the healthcare facility.
Just how these dangerous, microscopic living things come to exist
within the health care facility is no mystery. Introduce hundreds of sick people, some infected with
infectious diseases, others with compromised immune systems and add
maybe another hundred people into a large box. Lets call the box a
hospital. Add to this all
of the movement that takes place, all day long, within the box.
Nurses going from room to room, x-ray technicians pushing
machines into rooms and through the hallways, dietary delivering and
picking up food trays between patients, physicians making rounds,
respiratory therapists traveling around treating patients with
respiratory infections, lab personnel going from patient to patient
drawing blood not to mention the invasion of visitors and others such as
sales representatives and delivery personnel entering and leaving the
big box. Picture some of these very people coughing and
sneezing, patients bleeding, some suffering with infected weeping,
draining wounds and others with infectious diarrhea.
Many are touching bedrails, trays, equipment, doorknobs, elevator
buttons and the like. With
all of the activity, it is like taking the box, turning it upside down
and shaking it up. Somewhere
in this scheme somebody is going to catch something they did not have
before they came in. Infections picked up in a healthcare facility are
referred to as nosocomial infections.
That is, an infection acquired from within the healthcare
facility itself. The
recipient did not have the infection when he came in, but has it now.
And the recipient does not necessarily have to be a patient; it
could be a staff member or visitor. There are a number of ways
pathogens are transmitted. One such mode of transmission is via
contaminated surfaces. Transmission
of infectious microorganisms via this mode is referred to as
cross-contamination. Disinfection procedures are intended to stop the
cross-contamination of pathogens present on surfaces caused by touching
or the spattering of bodily fluids such as blood, saliva and other
excretions or secretions. The
misuse of liquid disinfectants can directly contribute to
cross-contamination. Often
the misuse occurs because the person performing the disinfection
procedure simply misunderstands how the disinfection procedure needs to
be performed to achieve the objective of surface disinfection.
That is the destruction, mitigation or removal of the pathogens
from the surface before they can be transmitted. Some surfaces have a greater propensity to cause
cross-contamination than others. In
particular; equipment surfaces that travel from patient to patient and
between floors such as wheel chairs and stretchers, respiratory therapy
equipment, food carts, medicine carts, portable x-ray machines and
devices used in the treatment of the critically ill or those most
susceptible to infection. Environmental surfaces of concern are bedrails,
patient room doorknobs, toilet seats and sink faucets in that they are
frequently touched by contaminated patient hands and then by nursing,
visitors and other medical professionals and carried to other areas.
Except in the case of blood spatter or spills, floors, walls and
countertops generally require normal housekeeping cleaning and
sanitation only. In all
cases of blood spatter or spills, spot cleaning with the same level
disinfectant used to disinfect equipment surfaces is appropriate for use
on environmental surfaces. Hospital-level disinfectants, tested and registered
by the U.S. Environmental Protection Agency (EPA) provide the best,
safest and most efficacious choice for use in a healthcare facility.
Before entering the marketplace, disinfectants intended for use
in hospitals and other healthcare facilities must undergo a plethora of
scrutiny and scientific testing to attest to their ability to kill those
microorganisms that cause cross-contamination.
The testing required by the U.S. EPA is based on
sound scientific laboratory data. Each
laboratory test performed must adhere to established scientific
principals. The Pesticide
Registration Branch of the U.S. EPA is charged by the Congress to
oversee and regulate disinfectants sold in the US in order to protect
the health and safety of the public at large.
Disinfectants registered for use in healthcare facilities must be
effective, at a minimum, against staphylococcus aureus, pseudomonas
aeuriginosa, salmonella cholerasuis and trichophytom mentagrophytes.
OSHA requires TB and/or at least hepatitis b kill in addition to
the EPA requirements. One
newer generation disinfectant, Opti-Cide3® produced by Micro-Scientific Industries, Inc
has shown, in addition to those listed above, its effectiveness against
hepatitis C virus as well as vegetative Clostridium difficile (c.difficile)
bacteria. This is a real
breakthrough in hospital level disinfection because C.difficile bacteria
have caused a number of outbreaks in US hospitals and long-term care
facilities within the last decade.
The hepatitis C virus is suspected of surviving on certain
surfaces with the potential for cross-contamination.
These new studies have been submitted to the EPA for addition to
the product label and are presently being evaluated. Disinfectants that display an EPA registration number
on their label are approved for sale solely based on the specific
instructions and claims listed on their package label.
One must be cautioned to thoroughly read and fully understand the
information contained on the package label, and just as important, the
lack of information found in product brochures, advertisements and the
statements of salespersons. Although
the EPA attempts to monitor misleading claims, such misleading claims
often sneak through causing the person using a particular product to
misuse it. U.S. EPA labeled
products all contain this required statement; “Using this product
in a manner that is not consistent with its label instructions is a
violation of federal law.” Here
are some examples of misleading information provided by disinfectant
producers through what this author calls the “use of smoke and
mirrors”. A recent ad appeared in a leading publication that
stated, “Our disinfectant kills TB in just one minute”.
This may be true, but what the ad fails to mention is that the
same product requires a 10 - minute contact time in order to kill
staphylococcus, which incidentally causes the vast majority of
nosocomial infections and related deaths of patients in US hospitals.
It also failed to mention that its’ own labeled
“instructions-for- use” require the product to remain wet on the
surface for a full ten (10) minutes before wiping dry.
The key to understanding disinfectant ads and claims,
contrasted with U.S. EPA registered product label claims, is that if a
product requires 30 seconds to kill a particular microorganism and
10-minutes to kill another, the product is in effect a 10-minute
disinfectant. This means
that no matter which targeted microorganism on the label, irrespective
of its individual kill time, the surface must remain wet for a full 10
minutes. The longest
required kill time listed on the U.S. EPA registered label indicates the
minimum amount of time the disinfectant must be in contact with the
surface or instrument to be effective thus making all other claim times
on the product label or advertisements irrelevant.
Smoke and mirrors? You
be the judge. Over the Internet, a company claimed its product is
totally safe and that the ‘EPA does not require it to list a precautionary
warning statement on its label’.
In fact, the products own front label bears the statement “
CAUTION- Keep out of the Reach of Children”.
Smoke and mirrors? You
be the judge. When asked about the statement, the company claimed
it ‘meant other precautionary warnings because all pesticides
are required to bear a warning label’.
The company also claimed on the same website that it killed
certain germs in 3 minutes, but it also failed to state it required 10
minutes to kill staphylococcus and other microorganisms.
The company also failed to mention that its instructions for use
require a 10- minute contact time after the surface has been thoroughly
cleaned. Smoke and mirrors? You be the judge. Producers of pre-moistened surface wipes sold in tubs
frequently forget to warn users the towels may lose their effectiveness
if the canister is not tightly sealed between uses. They also fail to tell users that the wipes may not, and
probably will not keep surfaces wet for the tested contact time.
If the contact time required for effectiveness is listed at 10
minutes on the label, the surfaces must remain wet for the full 10
minutes in order to work. Not
all facilities can use pre-moistened wipes due to the individual room
temperature, humidity in the room and the ventilation or air exchanges.
Facilities must take into account a number of factors before deciding
which disinfectant is appropriate for use in their facility. The best way to determine whether the use of a
pre-moistened wipe is appropriate for use in a [particular facility is
to test them. Simply test
by wiping an area of about 3 square feet in size.
Time how long the surface stays wet.
If it is less than the labeled contact time of the product you
are testing, you need to select another method of disinfection.
If the surface stays completely wet for the entire time,
you are in good shape. It
is just that simple. To add to the problem, some producers of
disinfectants continue to depend on outdated information, which in the
past relied solely on information long disproved through science or
objective use of products. One
such example is that at one time it was believed, by even the most
authoritative experts, that disinfects could be judged in regards to
their ability to kill microorganisms based solely on the active
ingredients listed on a label. It was believed that quaternary ammonium
compounds (quats) could only kill certain microbes, while phenols could
kill others. This is simply
not true. As a mater of
fact, both of these agents are equally lethal.
Their ability to kill is derived from the synergistic activity
and total combined efforts of the entire formulation. A simple explanation lies in that there is distinct
difference in the end result when a bullet is simply hand thrown or
fired from a gun. The bullet represents the active ingredient while the
bullet and gun together represent the entire process. The total formulation as a whole determines whether a
disinfectant is going to perform according to the desired results.
This is why different disinfectant brands, even those that list
the same active ingredients, are able to produce differing results.
It is also for this very reason the U.S. EPA requires each
disinfectant to be individually and independently tested on its own
individual merits prior to registration. Finally; a word regarding disinfectants and their
effectiveness against microorganisms that have developed a resistance to
antibiotics such as Methicillin Resistant Staphylococcus aureus (MRSA);
Antibiotic resistant microorganisms are not resistant to U.S. EPA
registered surface disinfectants. The
mechanism by which surface disinfectants attack and kill microorganisms
is completely different in the way in which microbes are attacked by
antibiotics.
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