This week is the third and final installment of the
dissection of Drs. Rutala and Weber's "Selection of the Ideal Disinfectant". Before I get into
the discussion of the last three sections "SAFETY, EASE OF USE and OTHER
FACTORS", I hope that we can all agree that disinfection of non-critical
environmental surfaces and patient care equipment is key to a successful
infection prevention program.
From Burnt Bums and Occupational Asthma, to the Necessary Evil of PPE and Unintended Consequences of Improving Infection Prevention,
the Talk Clean To Me blog has hit on
numerous topics around the health, safety and surface compatibility (or surface
safety) of disinfectants. As noted in
the article "products should be nontoxic and should not cause harm to
users, patients and visitors." To
meet this criteria, a facility should chose a product with the lowest toxicity
rating, e.g. one that does not require PPE, one that can be used without
restriction, one that is not flammable or combustible and one that will not
cause temporary or permanent harm to staff. Further, we need to look at
disinfectants from their compatibility perspective. By this I do not mean that the product has to
have the longest list of approved medical devices, because the truth is, not
all medical device manufacturers are willing to invest in the time to validate
newer, safer and more effective technologies. Instead look for a product that has been proven to be compatible with a
wide range of materials that are commonly used in the manufacturing of medical
devices and routinely used for the interior environmental surfaces such as
plastics, stainless steel and other materials...like mattress pads.
While focusing on what a product kills is great -
theoretically speaking the ugly truth is that it does not matter one iota what
a product kills if staff cannot tolerate using it and patients complain of the
smell. Never underestimate the odor profile of a product, something that smells
like roses to one person may smell like pig poop to another! The easier the product is to use, the
greater the chance that staff will use it as intended, ensuring compliance is
met. Compliance is the key to ensuring a
successful environmental hygiene program.
For convenience sake as well it is easier to have a product that comes
in various formats such as different sized wipes for the task at hand. Of course in the "ease of use"
perspective, products that have detergency properties to aid in cleaning and
soil removal, are effective in the presence of a soil load, and have an
extended shelf life once diluted and can be used with a number of different
wipe substrates without interaction (e.g. no quat binding) are also areas to
consider.
The last area to consider in choosing a disinfectant are
some of the value added attributes if you will that may come with the product,
such as what training programs the vender will provide. Although these are
generally free, one thing for certain is that maintaining training programs is
an area that all facilities struggle with.
Additionally, do the vendors provide the dilution systems or wall
brackets for wipes free of charge and do they provide a maintenance program for
the dilution systems once installed?
Remember, dilutions systems are like cars and need routine maintenance
to ensure they work. I have seen more
than one facility attribute an outbreak due to poorly maintained dilution
systems. Then there are the questions
such as what does the product cost, how many litres or gallons of product or
how many wipes need to be used. Those
are the easy numbers. As one IP
recently told me "cost avoidance is not holding a lot of water" and
certainly, determining the "soft" or "indirect" costs such
as HAIs avoided or decrease in Occupational Health and Safety claims can be
more difficult to prove, but if you can show how much a facility spent year
over year on HAIs or Occupational Health and Safety issues..those numbers add
up and those numbers are NEVER included in someone's budget!
In the end, the truth is that the perfect disinfectant
does not exist. However, by following
the straight forward recommendations of Drs. Rutala and Weber and looking at
the selection of a disinfectant from a holistic approach - finding the balance
between efficacy and safety, you can be sure that you can find disinfectants in
the market that can suit the needs of your facility and provide the level of
kill you need from a daily infection prevention perspective while meeting the
health and safety needs and concerns of staff to ensure they will use the
product as you had intended, which will have a very real and directional impact
on your HAI rates.
Bugging Off!
Nicole
