There are times when writing silly clichés or phrases
that an image randomly pop into my mind of how a blog is going to develop. Last week I closed the "I'll take Kill Claims for $200" by introducing the focus of this week's blog: "Fast Kill Times and Acceptable
Wet-Contact Time To Ensure Proper Disinfection of Non-Critical Surfaces and
Patient Care Equipment," knowing that this week would be "round 2"
or "take 2" in the discussion of the "Selection of the Ideal Disinfectant" paper. The idea of
"take 2" invoked not an image of continuing the dissection of this
article, but a very sobering image of a stopwatch, and the thought that we do
not have the luxury of time in any of the markets that use disinfectants to
have a "take 2" or reapply a product more than once to ensure
disinfection occurs. A very fitting
image for the focus of this blog.
As the title of the section of the article implies, Drs.
Rutala and Weber discuss the merits of contact time as it relates to
disinfection.The focus of Lee's blog
"Dirty to Disinfected in 60 seconds Flat" was entirely focused on
this concept. I could go on ad nauseam
on this topic citing numerous examples of why rapid contact times are
important, but I think Drs. Rutala and Weber summed it up nicely with their
statement "fast kill times are important because they give you confidence
that you are killing the prevalent and most common healthcare-associated
pathogens before the disinfectant solution can dry".
Which leads to the next area of discussion - wet dwell
time. Again, Lee's "Premature Evaporation - Is your disinfectant fulfilling your every need?" blog sums
this discussion up very well and as Drs. Rutala and Weber explain, if a
product evaporates too quickly it will not stay in contact with the organism we
are trying to kill for the amount of time that the product needs. For this reason, the best disinfecting
products will have a wet dwell time that is greater than or equal to the kill
times listed on the label. However, this
does not mean that we need to use the longest contact time as listed on the
label. Many products may have longer
tuberculocidal or fungicidal contact times for Candida as an example. However, surfaces contaminated with Candida,
non-tuberculosis mycobacteria or other fungi have RARELY been shown to be a risk
factor for HAIs. As Drs. Rutala and
Weber highlighted in the first section of this article, vegetative bacteria
cause upwards of 80% of all HAIs and should be the organisms we focus on with
respect to choosing a rapid and effective disinfectant.
The last area in this section that is discussed is around
the concept of persistent or sustained antimicrobial activity of a
disinfectant. Certainly this idea has
merit and considerable interest as the ability for a surface to aid in the
killing or neutralizing of a pathogen would mean that we would have a back up
or "CYA" to act as a fail safe for surfaces that did not get cleaned
and disinfected correctly the first time. While sustained antimicrobial activity may eliminate the problem of
recontamination, current products have limitations such as cost and the fact
that they can be removed by touch or contact. Further, their use has not been demonstrated to have a direct impact on
reduction of HAIs as compared to disinfectants that do not have sustained
antimicrobial activity. Basically, the
idea is intriguing, but needs more evidence to determine if this is an
effective expenditure or not. Personally, if you have some extra money in your budget, you should hire
another housekeeper or two and implement a program to disinfect all high touch
surfaces within your facility twice per day.
Stay tuned for next week's concluding blog that will
focus on "Safety, Ease of Use and Other Factors" to consider when
choosing a disinfectant.
Bugging Off!
Nicole
