---
title: RUST - the new cost of doing business?
description: RUST - the new cost of doing business?
---

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## RUST - the new cost of doing business?

<http://static1.squarespace.com/static/595689fc9de4bbc892200518/t/59568acb5fd63b5f29287826/1498845461890//img.jpg.com/static/595689fc9de4bbc892200518/t/59568acb5fd63b5f29287826/1498843851687/1000w/>

The fodder of many of the Talk Clean To Me blogs are  
 based on comments, questions, emails and conversations Lee and I have with the  
 infection prevention and control community from around the world. The impetus of this is that the conversation  
 we are having at that point in time is not likely an isolated occurrence but  
 that others are asking or pondering over the same question. So when I saw a  
 question posted on an infection prevention chat room about rust on furniture in  
 the OR, it seemed a perfect topic for this week's blog.

So, what is [rust](http://dictionary.reference.com/browse/rust)?   
Most of us would describe rust as a reddish or yellowish-brown flaky  
 coating on a surface and generally associate it with corrosion of  
 metal surfaces. Technically, it is iron oxide that has formed on iron or  
 steel by oxidation, especially in the presence of moisture.  Similar to a cut or abrasion on our skin,  
 once rust has formed there is no protection to the underlying iron. From a surface integrity, this loss of  
 protection can lead to further deterioration, but most importantly, rust cannot  
 be disinfected and provides the perfect habitat to harbour pathogens.

So why is rust becoming a concern to Infection  
 Preventionists?  Well, as in our earlier  
 blogs "[Unintentional Consequences of Improving Infection Prevention](http://talkcleantome.blogspot.ca/2012/02/unintentional-consequences-of-improving.html)"  
 and "[Is the EPA condoning the use of Steroids](http://talkcleantome.blogspot.ca/2012/05/baseball-season-has-started-and-for.html)" in our efforts to  
 strive for ZERO HAIs and annihilate all germs from the environment we are  
 unwittingly causing an epidemic of degrading surfaces.

For some, [targeting zero](http://www.apic.org/Resource_/TinyMceFileManager/Advocacy-PDFs/HFMJan2009WaryeandGranatoTargetZeroHospitalAcquiredInfections.pdf) means using sporicidal agents  
 such as bleach and [peracetic acid](http://talkcleantome.blogspot.ca/2012/11/disinfectant-9-peracetic-acid-weak-acid.html) every day, everywhere. While some facilities may attest that this  
 movement has lead to a reduction in HAIs (C.diff in particular) and thereby a  
 perceived savings in terms of HAIs, what costs have been incurred from a  
 perspective of replacement of medical equipment, furniture and environmental  
 surfaces? 

Choosing a disinfectant is a balancing act. Infection Preventionists must balance the  
 need for an effective disinfectant to minimize HAIs with the safety of the  
 product from an occupational health and safety, materials compatibility and  
 environmental impact perspective.   
[Chlorine](http://talkcleantome.blogspot.ca/2012/03/disinfectant-chemistry-report-card-2-is.html) (bleach) solutions are by nature highly corrosive. They should  
 not be used on surfaces that are prone to rust. Metal surfaces are prone to rust.   
Metal surfaces are found in virtually every room in a hospital; bed  
 frames, wheel chairs, stretchers, the arms of OR lights etc, etc...

As one IP stated (and correctly so) "*rust on  
 equipment cannot be disinfected*".   
But perhaps a more important consideration is what will Joint Commission  
 or CMS think?  Well, as at least one  
 facility found out, CMS does not care for rust. In fact if they find it, they will cite you for it and perhaps more  
 importantly will require you (okay, your facility) to replace, clean or repurpose  
 all equipment that has rust on it. 

As we know, infection prevention and control is  
 multifactorial.   There is no single  
 solution or silver bullet that will solve our HAI woes.  [Hand hygiene](http://talkcleantome.blogspot.ca/2013/04/i-triple-dog-dare-you-to-wash-your-hands.html), [antibiotic stewardship](http://www.idsociety.org/stewardship_policy/) and  
[environmental hygiene](http://www.infectioncontroltoday.com/topics/environmental-hygiene.aspx) all play a role in an effective and successful infection  
 prevention program.  We talk about  
 building a business case for infection prevention programs, and while for most  
 we talk to the cost savings in terms of reduction of HAIs, we cannot ignore  
 incremental costs.   Our business cases  
 may include the justification for increased costs for improved environmental  
 hygiene due to their associated impact on HAIs, however, we cannot forget to  
 consider the incremental costs for replacement or refurbishing of medical  
 devices, equipment, furniture or environmental surfaces.

The "KIS" or "Keep it Simple"  
 principle of one product for everything, while seemingly simplistic, does have  
 unintended consequences.  It works if you  
 are ***only*** weighing the cost of HAIs, however, if you or your facility has a  
 problem with rust or other visually deteriorating surfaces and are not willing  
 to include replacement costs for surfaces, devices and equipment in your annual  
 budget...really, who wants to talk about spending $25,000 on a hospital bed or  
 $5000 - $12,000 on replacing rusty OR lights as part of the consequences of  
 using a corrosive chemistry everywhere, every day. If you're not willing to have that chat as  
 part of your business case, then you may want to consider a multifactorial  
 approach to disinfection by choosing a broad-spectrum disinfectant that can  
 kill the pathogens (bacteria & viruses) that cause the majority of our  
 outbreaks for daily use and a sporicidal agent for targeted use against  
 C.diff. 

Maybe you'll find the best of both worlds?  No rust, no deteriorating surfaces, decreased  
 costs from occupational injury associated with disinfectants AND a significant  
 reduction in HAIs. Now that would be a  
 Win-Win!

*Bugging Off!*

 

 

Nicole

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