---
title: SOS – Spores on Surfaces!
description: SOS – Spores on Surfaces!
---

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## SOS – Spores on Surfaces!

<http://static1.squarespace.com/static/595689fc9de4bbc892200518/t/59568ace5fd63b5f29287996/1498845253319//img.png.com/static/595689fc9de4bbc892200518/t/59568ace5fd63b5f29287997/1498843854141/1000w/>

A discussion as to the best way to handle environmental  
 contamination by *[Clostridium difficile](http://www.infectionpreventionresource.com/files%5CC%20%20diff%20Fact%20Sheet%205.23.Rev1.pdf)* can be at times the equivalent of  
 watching a soap opera. When it comes to  
 who believes what, who knows best, what is stated in current infection  
 prevention guidelines, newly published peer reviewed articles and of course  
 disinfectant manufacturing sales materials highlights the fact that two  
 seemingly similarly educated people can be complete polar opposites!  While I’ve never been involved in a  
 discussion that has come to fisty-cuffs, I do have two pairs of 16oz boxing  
 gloves that I’d gladly provide if it would help come to a consensus!

I think with advancement and by this I mean our ability  
 to manufacture “better” disinfectants, our ability to improve test methods both  
 for disinfectant product efficacy but also for clinical specimen sampling and  
 disease diagnosis we become so enlightened with all the “new” stuff we forget  
 the importance of the basics.  I think we  
 often need to be reminded of the basics.

While there is sufficient published science to support  
 that sodium hypochlorite at the correct dilution and contact time has the  
 ability to kill C.diff spores, it has not been until recent years that Health  
 Canada or the US EPA has approved a method to allow for actual label claims  
 against C.diff.  We can now choose from  
[sodium hypochlorite](http://www.talkcleantome.blogspot.ca/2012/03/disinfectant-chemistry-report-card-2-is.html), [hydrogen peroxide](http://www.talkcleantome.blogspot.ca/2012/05/disinfectant-chemistry-report-card-4.html) and [peracetic acid](http://www.talkcleantome.blogspot.ca/2012/11/disinfectant-9-peracetic-acid-weak-acid.html) based formulations  
 with registered claims against spores.   
Certainly, from an infection prevention perspective this has meant advancement  
 in practices, but in the quest to find products that can KILL we have lost  
 sight of the importance of physical friction.   
More simply put, we have lost sight of the importance of how CLEANING,  
 how WIPING can and WILL remove spores from the surface.

Let’s be honest, to kill spores we need to increase the  
 concentration of chemical used.  This  
 increase will result in less than stellar occupational health and safety  
 profiles for the products that are being used and will also have a direct  
 impact on the compatibility with the various surfaces the product will be  
 applied. 

The 2010, SHEA-IDSA Guidelines for *Clostridium difficile*  
 states “The efficacy of cleaning is critical to the success of decontamination  
 in general, and thus user acceptability of disinfection regimens is key  
 issue”.   When asked about a product’s  
 ability to kill, I have always stated that I do not care what a product kills,  
 if staff will not use the product as designed by the manufacturer, the label  
 claim is meaningless!  Don’t get me wrong,  
 I am in no way saying that we should not use sporicidal agents in dealing with  
 C. diff.  What I am saying is that we  
 need to consider more that what the product kills, but look at how effective  
 the product is at cleaning (thereby removing spores from the surface) and most  
 importantly, how will the staff that will be using these products daily for  
 long periods of time respond?  A well  
 implemented infection control program requires that the products we choose are in  
 fact used!

It was with this that I was quite excited to read a  
 recently published study by Dr. William Rutala and his research team ([ICHE,2012;33:1255-1258](http://www.ncbi.nlm.nih.gov/pubmed/23143366)).  The study compared  
 the importance of physical removal versus sporicidal inactivation of different  
 cleaning and disinfection chemistries.   
There was what I thought of as several key take home points – or “Ah-Ha”  
 moments.  First, did you know that most  
 studies have quantitated the level of C. diff spore contamination on surfaces  
 to be  <1Log10?  Why then do Health Canada and the US EPA require  
 manufactures to achieve at least a 6 Log10 reduction against C.diff spores in  
 order to make a claim.  If you didn’t  
 already know, a 6 log10 reduction implies we are chemically sterilizing the  
 surface.  If we do not have that level of  
 contamination on surfaces to begin with why do disinfectants need to achieve  
 such a level of kill?  As mentioned  
 earlier, to obtain sporicidal claims we need to increase the concentration of  
 chemical used.  We are creating  
 disinfectant products that have increased occupational risks.  Perhaps if the test method needed to obtain a  
 sporicidal surface claim was adjusted to provide a more realistic level of kill  
 based on actual surface contamination we would have sporicidal products that we  
 could use on a daily basis without the worry of occupational safety or material  
 compatibility issues.

Secondly, and to me most importantly, CLEANING  
 WORKS!  The study showed that wiping  
 environmental surfaces, even with a non-sporicidal agent can eliminate  
 approximately 3 Log10 of* C.difficile* spores. Sporicidal agents provided a 3 Log10 to 6 Log10 reduction depending on  
 formulation and/or application with the most commonly used bleach wipe showing  
 just under a 4 Log10 reduction.

I’m not saying that we shouldn’t use sporicidal  
 agents.  I’ve worked with enough  
 facilities in outbreak situation to know they work. However, have we set the bar to high in terms  
 of what is required with respect to obtaining a registered *C. difficile* claim?  Are we knowingly, exposing our staff to  
 unnecessarily high concentrations of chemicals when as we know the level of  
 contamination on surfaces is significantly lower than the level of kill  
 required to obtain a label claim?   
Knowing that cleaning works, would we be wrong to develop protocols that  
 focus on the physical removal of spores for cleaning of isolation rooms and  
 utilize sporicidal agents for terminal cleaning, for outbreaks or for use on  
 wards with higher endemic levels of C. diff?   
I know facilities that do just that and do it well.

Food for thought, I hope!

*Bugging Off! *

Nicole

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