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Surface Disinfection

Surface Disinfection. Narrowing the Gap between Science, Regulation & Practice. Steve Wollak – Account Executive – 3M Co. Mary Brachman RN MS. DisinfectHO-Aug’05. Are we cleaning/disinfecting the right way?. 10 Factors Influencing Effective Cleaning and Disinfecting.

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Surface Disinfection

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  1. Surface Disinfection Narrowing the Gap between Science, Regulation & Practice Steve Wollak – Account Executive – 3M Co. Mary Brachman RN MS DisinfectHO-Aug’05

  2. Are we cleaning/disinfecting the right way?

  3. 10 Factors Influencing EffectiveCleaning and Disinfecting • Proper Procedure/Best Practices • Type of surface • Surface orientation/design • Concentration/Dilution • Organic Soil Present • Resistance of Microorganism • Contact Time of Disinfectant • Amount of solution used • Method of application – Spray Bottle vs. buckets - Mop/Bucket vs. Microfiber • Ventilation, temperature, humidity

  4. Are we cleaning the right way? Are we set up the right way? How we can help SAVE the Environment?

  5. Are we cleaning the right way? Super Bugs - MRSA - VRE - Norwalk Procedures - 10 Key Points - Contact Time Quat Binding

  6. MRSA Methicillin-resistant Staphylococcus aureus • Discovered in 1961 in the UK. • Widespread in hospital settings • Commonly termed a “Superbug” • Superbug: • Strains of bacteria • Resistant to antibiotics • Hard to treat • Causes • Fever • Lethargy • Headaches • Skin boils or abscesses • In rare cases can cause pneumonia, blood infections, • toxic shock and death.

  7. VRE Vancomycin-ResistantEnterococcus • Discovered in 1985 • Found in the digestive and urinary tracts of some humans • Dangerous to immuno-compromised individuals • Pass resistant genes to other bacteria • Resistant to the antibiotic Vancomycin While infection of healthy individuals is uncommon, it is possible that they could be colonized with newly-resistant bacteria.

  8. Norwalk Norovirus • Causes around 50% of all gastroenteritis • Stomach pain • Diarrhea • Vomiting • Considered the most important group of viruses associated with this condition Today, Norovirus may refer either to the entire group of viruses or just Norwalk.

  9. 10 Key Points CDC Guideline Housekeeping Surfaces1 General Recommendation • Keep surfaces clean e.g. regular basis, spills, visibly soiled (EC II; D/S IB) • Wet dust horizontal surfaces regularly e.g. daily, 3x/wk using disinfectant (D/S IB) • Use: • Detergent or disinfectant, depends on nature of soil (EC II) • Use disinfectant (D/S IB)

  10. 10 Key Points CDC Guideline Housekeeping Surfaces1 General Recommendation • Disinfect “high-touch” more often than “minimal touch” surfaces (EC II) • Follow mfg. recommendations for use, (EC/DS IB, IC), especially dilution (D/S IB) • Contact time > 30 seconds (D/S II)

  11. 10 Key Points CDC Guideline Housekeeping Surfaces1 General Recommendation • Avoid cleaning methods that produce aerosols or disperse dust (EC IB) • Replace solution: • frequently per facility policy (EC II) • frequently per facility policy e.g. every 3 rooms or < 60 minutes (D/S IB)

  12. 10 Key Points CDC Guideline Housekeeping Surfaces1 General Recommendation • Change & decontaminate mop heads: • at least daily, after spill clean up & per policy (EC II) • regularly (D/S IB) • Clean & disinfect BBF spills (EC, D/C IB, IC): • Tuberculocidal (Phenolic), Quat with HIV/HBV label claim or Bleach

  13. Factors Influencing Cleaning and Disinfecting Bacterial Spores C. difficile Mycobacterium Tuberculosis Non-lipid (small) viruses Norwalk Fungi Atheletes foot Vegetative Bacteria Pseudomonas Staphylococcus Lipid viruses Hepatitis B HIV/AIDS SARS Resistance of Microbes to Disinfectants ST HLD ILD Hard to Kill LLD Easy to Kill ST-sterilant HLD-high level disinfectant ILD-Intermediate level disinfectant LLD-low level disinfectant Favero, MS. In, Block SS. Disinfection, Sterilization & Preservation, 1991

  14. Factors Influencing Cleaning and Disinfecting Contact Time Time to kill microorganisms on surfaces: EPA testing methodology Vs Pre-cleaned surfaces

  15. Testing Disinfectants against Bacteria EPA Hard Surface Carrier Test • 60 Non-porous carriers • Test organisms - Salmonella, pseudomonas, staph aureus • Organic Soil (5% blood) • Hard Water • Requirements – 59/60 no growth

  16. Time to Kill Organisms on Surfaces Log10 Reduction S. aureus P. aeruginosa Rutala, W. ICHE 2000;21:33-38

  17. Contact time is rarely per label claim; exposure time 1- 1.5 minutes 10 min. contact time require 6 applications 6 log reduction in 30 seconds Contact Time on Non-Critical Surfaces¹ Rutala, W. APIC 2003

  18. Low-level disinfection (LLD) for at least 30-60 seconds is supported by at least 14 scientific studies 10 minute contact time is meant for EPA registration, NOTthe time it takes to kill microorganisms on pre-cleaned surfaces Contact Time on Non-Critical Surfaces² Rutala, W. APIC Annual Ed. Conference; 2005

  19. Disinfectants for “Non-critical” Surfaces Chlorine 5% 1:100 dilution (sm. spills) 1:10 dilution (lg. spills) Germicide Use Concentration Alcohol 70-90% 500 ppm 5000 ppm Phenolic Mfg. use dilution Quat Mfg. use dilution Exposure time > 1 minute Rutala, W. APIC Ed. Conference 2005

  20. QUAT Binding Some fabrics and materials have a strong attraction for the active ingredient in QUATS.- QUAT preferentially attaches or exhausts to fabric -- QUAT level in solution is reduced - - Efficacy of the disinfectant decreases - Disinfectants are registered with the EPA and efficacy claims are approved at a specific level of active ingredients. When the QUAT level is less than the level approved by the EPA, the efficacy claims are no longer valid. Quaternary Ammonium Chloride

  21. QUAT Binding Disinfectants: • How are you using them? • How do you test them (test kits)? • How do we know that the surface is clean and disinfected (Environmental Monitors)? PPM • Testing done to meet EPA requirements for the disinfectant claim • If it falls below the PPM it is out of spec and no longer a disinfectant How to calculate ppm QUAT in a Disinfectant The EPA registered label specifies the percent active “ quaternary ammonium chloride” in the concentrate. Add the total active ingredients and use the following equation to determine PPM QUAT. (% Active)÷(100)÷(1+dilution) x 1,000,000 = _______ ppm QUAT Example – 13.238% + 13.238% = 26.476% 26.476% ÷100÷(365+1) x 1,000,000 = 723 ppm

  22. Cleaning Methods: Spray bottle, squirt bottle, or hand pail? Is one method better than the other?

  23. First 60/376(16%) 0/135 Second 8/82 (10%) Third 3/28 (11%) Fourth 0/10 (0) Effectiveness of Disinfection Methods For VRE No. positive surfaces Spray Bottle Bucket Byers. ICHE 1998;19:261

  24. Additional Questions • CJD killing agent – Bleach/CDC • Bactericidal Hand Soap in patient rooms vs. “green” nonbacterial soap – no CDC reference as a requirement. • “Dispatch” – not a 3M product

  25. Any Questions? Steve Wollak – 3M Company • scwollak@mmm.com • 800-925-2674 • LaMotte QAC Test Kit • 800 344 3100 • www.lamotte.com

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