October 8, 2013

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March 15, 2013

22Nicole Kenny BSc, Assoc Chem

Director, Professional & Technical ServicesVirox Technologies Inc

CLEAN FREAK. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Editable Conference Name

Get Ready, Set….CLEANGet Ready, Set….CLEAN

Effects of Germicides on Microorganisms

HCWs take for granted…….

• Action of disinfectants without fully understanding mechanism of action

• Differences in the action of antimicrobial ingredients

• Differences depending on concentration of chemical used

Infection Control Today

Cleaning & Disinfecting: The Effects of Germicides on Microorganisms

Feb 2004

Tips and Tricks to choosing the ideal disinfectant

Disinfectant Desired Traits

What’s in your bottle?

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Criteria of an Ideal DisinfectantThe US Centers for Disease Control and Prevention (CDC) and Ontario’s Provincial Infectious Disease Advisory Committee (PIDAC) agree that the following are the critical decision making criteria that should be considered when selecting a disinfectant product:

i. Disinfectant should exhibit germicidal efficacy against a broad spectrum of microorganisms.

ii. Product should exhibit this efficacy in a rapid and realistic contact time.

iii. Product should have good cleaning properties and remain active in the presence of organic matter.

iv. Product should be non-toxic and have low irritancy and allergenic properties.

v. Product should be environmentally preferable and should not damage the environment on disposal.

vi. Product should carry wide material compatibility. It should not cause the deterioration of metallic surfaces, rubber, plastics and other materials.

Strength is NOT always found in numbers

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• Do not get caught in the advertising hype that a product kills X bugs while the closest competition only kills Y

Bacteria

• Gr +ve• Gr –ve• AROs

Viruses

• Enveloped• Non-

Enveloped

Fungi

• Yeasts• Molds

Doors, Keys and Sledgehammers……….

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• Once upon a time, long, long ago there was door. This door was extremely strong, could rebuild itself and seriously maimed or killed anyone who came in contact with it. In the 1800’s, some bright soul invented a sledgehammer. The people were finally able to break the door down and while the door could rebuild itself, it maimed and killed fewer people. Then in the 1940’s a genius developed a key that could unlock the door and everyone thought the story was over. But this was in fact just the beginning of the Lock and Key war. In 1947 the door changed its lock, the key no longer fit, the door became stronger than ever and the people again began to see the importance of using the sledgehammer. The End.

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Dirty to Disinfected... in 60 seconds flat!!!

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• The speed with which a disinfectant can exhibit its killing ability on hapless microorganisms is a critically important necessity

• Disinfectants with long, unrealistic contact times (e.g. 10 mins) require multiple reapplications in order to keep the surface adequately saturated for the requisite period of time

• Disinfectants with a 1-5 minute contact time can be confidently relied upon to effectively disinfect the surface

• A single application of the product will result in the surface being sufficiently wetted for the required period of time which equals dead bugs and no transmission

To Clean or Not To Clean………8© 2013 PTS

• The physical action of cleaning removes dirt that can be used by some pathogens for food, it removes dirt that can harbor pathogens and lead to transmission and if measuring the log reduction of pathogens from a surface after cleaning, cleaning can almost achieve disinfection – at the very least, cleaning renders the surfaces safe

• Cleaning takes time and it takes manpower. Cutting corners by cutting down on the amount of time our cleaning staff have to clean a room or cutting back on the number of cleaning staff we have to clean our facilities is setting people up to fail.

• Cleaning needs to be done right – the first time. Cleaning can save lives

See No Evil.....

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See No Evil….

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• Many of the common cleaning and disinfecting products used at home, in daycares or schools and healthcare facilities are known to leave behind chemical residues

• Not all residues are equal. – If you don’t rinse your dishes after washing them by hand, you may

taste the soap residue, but it’s not going to kill you

– Phenols are known to leave a residue that can cause skin irritation, have been identified as known carcinogens and are not to be used around children

– Quat residues are not considered toxic, but the residues they leave behind can harbour dirt and bugs that were not removed from the cleaning process and build up overtime

Of Frogs and Boys…

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• Endocrine disruptors may be natural phytoestrogens (plants) or synthetic chemicals used in pesticides, medications, dietary supplements, cosmetics, soaps or detergents and commercial and consumer products (e.g. DDT, PCBs, phthalates, bisphenolA, and alkylphenols)

• Effect on male and female reproduction, breast development, cancers, thyroid, metabolism, obesity, & cardiovascular endocrinology

VOCs – the smells and signs of summer12© 2013 PTS

• Volatile organic compounds, often referred to as VOCs, are a large and diverse group of man-made and naturally occurring chemical compounds, both solid and liquid that easily emit vapours or gases.

• Health effects depend on nature of the volatile organic compound, the level of exposure, and length of exposure.

• Long-term exposure to VOCs can cause damage to the liver, kidneys and central nervous system while short-term exposure to can cause eye and respiratory tract irritation, headaches, dizziness, visual disorders, fatigue, loss of coordination, allergic skin reactions, nausea, and memory impairment.

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You Stink!13© 2013 PTS

• Clean does NOT equal the smell of lemons or pine

• The true smell of clean – is no smell at all.

• Removing or killing odour causing bacteria, will eradicate the foul odours we associate with dirty or soiled areas

• Fragrances are often added to compensate for a product’s deficiency in killing odour causing bacteria to mask the original offending odour

• Many commonly used cleaning and disinfectant products often have strong natural odours so fragrances are added to mask the smell of the cleaning chemical

• Chose a fragrance-free, odourless cleaner/disinfectant

How to compare apples to oranges

The Chemistries

Applications: LLD & ILD

• Ready-To-Use or Concentrate– Provision for shelf-life once diluted

• Used on Hard, Non-Porous environmental surfaces or inanimate objects (non-critical devices)– Spray

– Wipe

– Mop & Bucket

• Not generally designed for use as a soaking agent

• No reuse claims, therefore fresh solution to be used after each disinfection cycle

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LLD & ILD Chemistry Report CardBroad

Spectrum of

Efficacy

Realistic Contact Times

Superior Cleaning Efficacy

Safer to Use

Environmental Profile

AHPAHP A to BA to B A A A to B A

QUATsQUATs CC C B B- C+

QUAT/AlcoholsQUAT/Alcohols A to BA to B A to B C C to D B to C

AlcoholsAlcohols BB to Cto C B to C D C B to C

PhenolicsPhenolics B to CB to C C B D C

ChlorineChlorine A to CA to C A to C D B to D C

Applications: HLD & Critical Sporicide

•Generally Ready-To-Use, some may require activation

• Used as an instrument soaking agent–Semi-Critical and Critical Devices–Provision for Re-Use time (ie. 14, 21, 28 days) –Provision for rinsing requirements

• Not designed to be used for disinfection of hard, non-porous environmental surfaces or non-critical medical devices–Do not spray or wipe

Chemistry Report Card

Broad Spectrum

of Efficacy

Realistic Contact Times

Superior Cleaning Efficacy

Safer to Use

Environmental Profile

AHP A to B A A A to B A

PAA B to C A to C C to D B to C A to B

OPA A to D A N/A C D

Glutaraldehyde B to C A N/A D D

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LLDLLD ILDILD HLDHLD CSCS

EnvelopedViruses

3 Log (99.9%)

3 Log (99.9%)

VegetativeBacteria

6 Log (99.9999%)

6 Log (99.9999%)

Fungi 5 Log (99.999%)

5 Log (99.999%)

5 Log (99.999%)

Non-EnvelopedViruses

3 Log (99.9%)

Mycobacteria 4 Log (99.99%)

6 Log (99.9999%)

6 Log (99.9999%)

Spores N/A 6 Log (99.9999%)

6 Log (99.9999%)

Microbial Kill Summary

Tips on Ensuring we Marry Products with Protocols

Top Disinfectant Offences

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Define THIS!

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Define THIS!

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• By definition, a High Level Disinfectant is used for disinfection of Semi-Critical Devices (items that come in contact with mucous membranes or non-intact skin).

• High Level Disinfectants are designed for soaking semi-critical devices

• There is NO such thing as a High Level Disinfectant for environmental surfaces, non-critical devices or toys

“Wax On...Wax Off. Spray On...Wipe Off.” Mr. Miyagi’s Guide to Cleaning and Disinfection.

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• Spraying onto a surface does not assist in this removal, but rather deposits the solution on top of the soil.

• Spraying does not ensure thorough, even coverage of the solution on the surface.

• Spraying atomizes the chemical making it much easier to breathe deeply into the lungs

• Difficult to control precisely where the disinfectant or cleaning solution is being applied when sprayed

• Applying with a wipe or saturated cloth, we are combining the much needed mechanical friction with the detergency attributes of the chemical to achieve optimal results

Maintaining a monogamous relationship

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• Cleaning techniques that need to be used in healthcare facilities is far more complex than we give credit

• Cleaning requires meticulous attention to detail with a well defined and ordered set of procedures (e.g. cleanest to dirtiest)

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The One for All Army

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• Healthcare’s definition of a Silver Bullet:– A single product that kills everything and can be used on all

surfaces floor to ceiling

• Why?– Convenience

– Simplifies training (takes away guess work and worries about lack of communication)

• Pitfall?– Far too many other parameters that will be compromised or

sacrificed to gain that convenience

• Compatibility

• Occupational Health & Safety

The Shiny Surface Syndicate

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• If it’s shiny it must be clean (and free of germs)!

• THE SYNDICATES’ obsession with shiny surfaces leads them to abandon infection control principles in search of the product, Spic & Span and Windex are two of the most commonly use culprits, that leaves the surfaces all sparkly.

• The upside – people believe the environment is safe because it is so shiny

• The downside – using the wrong products puts people at risk for transmitting and acquiring deadly germs.

Disband the Glug-Glug Gang

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• Don’t ignore the label instructions by over or under mixing the cleaners and disinfectants that we intend to use

• Know the dilution, and dilute properly

• Verify that automated dilution systems are working (use the right strip)

• Know what the shelf life is once diluted

• Do not add more because you think the colour is wrong or the product is not foaming enough

• Do not add room deodorizers to make the product smell pretty

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Miss Manners’ Proper Etiquette for Filling Bottles

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• Don’t let Top Off Artists get away!

• By mixing new or fresh with old we could be creating an inferior product

• End result is a bottle that does not have the right concentration of disinfectant because new product has been mixed with old

More Is Better Bandits29© 2013 PTS

• MORE IS BETTER BANDIT believes it if works at the right dilution it will work EVEN BETTER if I add more!

• They also add more because they think the colour looks wrong or the product is not foaming enough

• Runs rampant during pandemics and outbreaks (especially if we are dealing with a new bug) believing that even if they have been told the disinfectant works at a specific dilution and contact time that they annihilate the pesky pathogen by adding more.

• The result often ends in Occupational Health complaints and/or degradation of surfaces being disinfected by using a product that is too concentrated.

The Instruction Ignorers

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• Believe that labels are meant for others to read so will use a disinfectant in the way they THINK it should be used and not how it was INTENDED to be used. –Examples include trying to dilute ready-to-use products meant

for spraying on high touch surfaces into a bucket to clean floors (also known as a Glug-Glug Deviant)

–Using disinfectants meant for disinfecting or chemically sterilizing surgical instruments on surfaces (a subspecies of the One for All Army)

–My all time favorite if it’s a wipe, it must be okay to use for personal hygiene or as a diaper wipe! There are reasons labels exist so READ THEM and most importantly follow the directions!

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The Custodial Chemist

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• This group believes that their collective years as professional cleaners is far more knowledgeable then formulating chemists who have years of higher education and develop the products the Custodial Chemist use.

• The Custodial Chemist is someone who mixes products together in the belief they are making a better product (or simplifying their job).

• Why use a degreaser or glass cleaner followed by a disinfectant when you can mix them together and create a degreaser-disinfectant or the best disinfectant glass cleaner on the market!

The Sink or Swim Squad

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• Whether you call it training, instructing or educating it all comes down to the fact that we CANNOT expect our staff to know how to correctly use the products and tools to do their jobs unless we TEACH them how to use them.

• The examples of misuse and abuse of disinfectants all come down to the fact that if we teach everyone the where’s, what’s, why’s and how’s to using disinfectants and cleaning chemicals we won’t have any stories of how we have seen them used and abused.

ConclusionsHave we learned to read (and

interpret) the fine print?

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Disinfectant Selection

Consider:

• Efficacy

• Spectrum

• Versatility

• Ease of use

• Safety profile

What’s in your bottle?

STOP of the Chemical Abuse!

• Eliminate the All For One Army

• Disband the Glug-Glug Gang & More is Better Bandits

• Sweep up the Shiny Surface Syndicate

• Retrain the Instruction Ignorers & Top-Off Artists

• Cancel the Custodial Chemist Classes

• Don’t Allow the Sink or Swim Squad to Prosper!

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Questions?

Contact Info:

Nicole Kenny

Phone: 1-800-387-7578 x118

Email: nkenny@virox.com

Twitter: @nicolecronkenny

Blog: www.talkcleantome.com

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www.infectionpreventionresource.com