There are a wide variety of sterilants and disinfectants available to kill dangerous microbes that can cause hospital-acquired infections (HAIs). It is important to understand what they can and can’t do, and where and how to use them properly.
Product selection: The right tool for the job
Whether the product is intended to disinfect or sterilize surgical instruments, a patient care environment or other items/places within a healthcare facility, the most important factor in product selection is efficacy — does the sterilant or disinfectant work as intended?
“There are many sterilants and disinfectants available and the foremost rationale for choosing one is that it will kill the organisms that you want to eliminate,” said Paul Lorcheim, PE, ClorDiSys Solutions. “For spore-forming organisms like C. diff, you would want a sterilant such as chlorine dioxide, bleach or hydrogen peroxide. For viruses and bacteria, disinfectants such as Lysol or isopropyl alcohol (IPA) are acceptable. For perfect kill, gasses such as chlorine dioxide or formaldehyde will reach and kill every organism. For a quick, effective and chemical-free kill on visible surfaces, UV disinfection technology offers many advantages.”
Susan Hapak, AB MBA, President/Owner, Current Technologies, points to the Centers for Disease Control and Prevention’s (CDC) Guideline for Disinfection and Sterilization in Healthcare Facilities as a comprehensive resource for the selection and proper use of disinfection and sterilization processes.1 Last updated in February 2017, the 161-page Guideline “presents evidence-based recommendations on the preferred methods for cleaning, disinfection and sterilization of patient care medical devices and for cleaning and disinfecting the healthcare environment.”
“One disinfectant isn’t appropriate for all situations,” said Hapak. “Disinfectants should be analyzed for their effectiveness across categories (e.g., spores, viruses, fungi, bacteria, mycobacterium). For example, many hydrogen peroxide disinfectants kill bacteria and viruses in one minute but require much longer to kill fungi (e.g., aspergillus) and don’t kill C. difficile spores. Bleach disinfectants kill microorganisms across all categories quickly, including fungi and spores, but material compatibility can be an issue. CS/SPD should also verify that a product meets an instrument manufacturer’s specifications for pre-cleaning/disinfection.”
Navid Omidbakhsh, PhD, Lead, Early R&D/Research Fellow for ASP, stresses the importance of choosing disinfectants and sterilants that are in compliance with industry standards. He says CS/SPD professionals should also consider how sterilants and disinfectants may impact instruments over their useful life, noting how medical device manufacturers indicate how instruments can be processed to minimize instrument damage in their instructions for use (IFU).
“Effectiveness and compliance with standard guidelines/procedures are the most important considerations when selecting sterilants and disinfectants,” said Omidbakhsh. “By ensuring that instruments are effectively sterilized or disinfected and using appropriate effectiveness monitoring technology, SPDs play a critical role in helping to reduce the incidences of healthcare-acquired infections.”
Improve disinfection and sterilization: a five-step approach
by Paul Green, MS, RN, CPHQ, principal, quality and safety advisory services, Premier Inc.
A complex environment requires a comprehensive approach to improve a
facility’s high-level disinfection and sterilization processes.
- Activate: Leadership alignment is the first step in truly achieving
change. Ensuring that facility leaders are not only aligned, but also held
accountable will help drive direction and improvement. - Review: In order to improve, providers must establish a baseline. The
sterile processing department touches several other departments, so facilities
must take a step back and asses all areas providing procedural services. Think
big picture. - Assess: Facilities need to asses and uncover variation in daily work
across the teams. Leaders should also be looking for improvement strategies in
compliance and understanding regulations. - Evaluate: Understand your accreditation readiness by comparing actual
practice and environmental conditions to current regulations. - Recommend: Move forward with a roadmap in hand that highlights prioritizaed findings and recommendations for improvement. Knowing that sustainability is important, the recommendations providers receive will show them the challenges that may impede regulatory compliance and processes.
Operational impacts: Efficiency and costs
Effective and safe patient care is the top priority among the CS/SPD, clinicians and environmental services staff, and disinfection and sterilization processes are key to reducing the risk of dangerous microbes and related infections. But in today’s healthcare environment, where facilities must deliver higher quality care in a more efficient and cost-effective manner, decision makers must take into account the impact of disinfectants and sterilants on both workflow and budgets.
“Numerous factors enter the equation when selecting sterilants and disinfectants,” said Penny Sabrosky, Educational Consultant for Kem Medical. “Certainly effectiveness and capital costs are primary issues. Contributing factors include operating costs, item compatibility, as well as load volume and turn around times. This can be a daunting decision making process when combined with the presence of ever looming budget constraints.”
As Olivia Lattimore, BHSc., MDRT, Manager, Professional and Technical Services, Virox Technologies, points out, operating rooms (ORs) demand quick turnover times for surgical instruments. Therefore, disinfectants and sterilants should support productivity in the CS/SPD. She states:
“Fast contact times, ready-to-use solutions and products that don’t require activation prior to use not only simplify the disinfection and sterilization process but enable staff compliance, which is of utmost importance when reprocessing medical equipment.”
Elise Tordella, VP, Marketing, PDI Healthcare, says pre-moistened wipes or ready-to-use sprays support workflow efficiency since they can help take the guesswork out of disinfection. She adds that a product’s “contact time” should be easily identifiable to help avoid staff confusion and ensure compliance with the product’s requirements.
“Furthermore, the supplier should provide both education and implementation support, as well as tools or point-of-care accessories, to ensure staff compliance and easy access for the end user,” Tordella adds.
According to Renee Patterson, RDMS, RVT, Clinical Marketing Manager at
CIVCO, with more automated high-level disinfection systems on the market, CS/SPDs can focus on the workflow and cost efficiency benefits of the reprocessor versus the disinfectant used. She states:
“More facilities are moving away from glutaraldehyde and choosing OPA or hydrogen peroxide solutions for faster disinfection times and fewer rinses, as well as to reduce staff safety concerns around glutaraldehyde exposure. Other considerations when selecting a high-level disinfectant include transducer compatibility (check your manufacturer’s IFU), contraindications, ventilation requirements and recommended re-use periods.”
One facility’s story of sterilization standardization
Casey Czarnowski, an SPD Educator in Fargo, ND, explains how his CS/SPD is working to standardize its sterilization processes on a combination of steam and STERIS’s V-PRO Low Temperature Sterilization Systems. He says the consolidation of sterilizer platforms has increased efficiency while reducing costs for his department.
“We use steam sterilization for approximately 90 percent of items, but for those instruments that cannot tolerate high temperatures we have transitioned to V-PRO,” said Czarnowski. “We’ve found V-PRO to be very flexible, with shorter dry times compared to other low-temp sterilization methods.”
Czarnowski said the biggest challenge has been finding manufacturers that have validated their instruments and devices for V-PRO sterilization. He says in some cases clinicians were using older products that had not been validated for V-PRO, so he and his team collaborated with them to help them select comparable newer products that are V-PRO compatible.
“Steris has a V-PRO Wizard with a compatibility matrix on its website, which is simple for my staff to use,” said Czarnowski. “They type in a product number and can quickly find out if the item has been validated with V-PRO or not. Fortunately, we are finding that more and more items are being validated for this modality.”
Staff safety and sustainability
Because disinfectants and sterilants are designed to kill dangerous microbes, they can pose a number of threats to the staff using them. The CDC Guideline for Disinfection and Sterilization in Healthcare Facilities states: “Hazards associated with the use of germicides in healthcare vary from mucous membrane irritation to death.” The CDC categorizes toxicity as acute or chronic. Acute exposure is sudden, while chronic toxicity results from repeated exposure to low levels of the chemical over a prolonged period.1
The results of acute versus chronic exposure to a disinfectant or sterilant can differ. For example, acute exposure to ethylene oxide (EtO) gas may result in respiratory irritation and lung injury, headache, nausea, vomiting, diarrhea, shortness of breath and cyanosis, while chronic exposure has been associated with the occurrence of cancer, reproductive effects, mutagenic changes, neurotoxicity and sensitization.2
Short term (acute) contact with glutaraldehyde liquid and vapor can cause severe eye irritation, skin burns, irritation to the nose, throat and respiratory tract, coughing wheezing, nausea, headaches, drowsiness, nosebleeds and dizziness. Long term (chronic) glutaraldehyde exposure can lead to occupational asthma, skin allergy and chronic eczema.3
“These risks can be costly on both an economic and personal level,” said Lattimore. “Therefore when selecting disinfectants and sterilants, products should have a balance between germicidal efficacy and user safety. Disinfectants and sterilants should be non-toxic, non-irritating and non-sensitizing. Ideally, special ventilation such as fume hoods will not be required. Furthermore, the safety profile of an ideal disinfectant and sterilant will translate to environmental sustainability. Ideal disinfectants and sterilants will not require detoxification, can be poured safely down the drain, and will not damage the environment upon disposal.”
Sabrosky points to The National Institute for Occupational Health and Safety (NIOSH) as a valuable resource for specific recommendations on work related regulations and recommended precautions involving the use of sterilants and disinfectants, such as glutaraldehyde, EtO and hydrogen peroxide. She states:
“Obviously, a thorough understanding of a chemical’s safety data sheet is a must, but it doesn’t stop there. It is extremely important to be aware of and compliant with all federal, state, municipal, and industry enforced regulations pertaining to employee exposure to sterilants and disinfectants.”
New technologies for disinfection and sterilization
As healthcare facilities battle dangerous microbes in an effort to reduce the risk for infection, manufacturers respond with new technologies that facilitate disinfection and sterilization in an effective, efficient, safe and cost-conscious manner. Here are some of the latest technologies on the market for disinfection and sterilization in the healthcare environment.
High-level disinfection
CIVCO’s new ASTRA TEE and ASTRA VR automated high-level disinfection systems for transesophageal and endocavity ultrasound probes help healthcare facilities maintain compliance with automated data logging, consumable tracking and easy-to-follow set-up steps. ASTRA allows the disinfection of two probes at once and standardizes workflow with consistent reprocessing times and no sleep mode. Facilities can also save money with ASTRA. The automated disinfection systems are compatible with three reusable, off-the-shelf high-level disinfectant options: Revital-Ox RESERT, CIDEX OPA and MetriCide OPA.
CIVCO’s new ASTRA TEE and ASTRA VR
CIVCO’s new ASTRA TEE and ASTRA VR
Virox Technologies’ Accelerated Hydrogen Peroxide (AHP)
Virox Technologies’ Accelerated Hydrogen Peroxide (AHP) is a patented disinfectant technology that facilitates productive, safe and sustainable disinfection across multiple applications including hands, surfaces and device reprocessing.
Revital-Ox Resert by STERIS is a high level disinfectant that leverages the power of Accelerated Hydrogen Peroxide providing high level disinfection in eight minutes without compromising the safety of the user. With Revital-Ox Resert, special ventilation is not required. Further, unlike other high level disinfectants, Revital-Ox Resert does not carry any patient contraindications, does not induce dermatitis or respiratory distress nor does it require detoxification and can be poured safely down the drain as it is made with biodegradable ingredients.
Disinfectant sprays
PDI’s Sani-Prime Germicidal Spray is a one-minute bactericidal, virucidal, fungicidal, tuberculocidal surface disinfectant powered by the company’s ACCELOQUAT formulation. ACCELOQUAT is PDI’s next-generation proprietary blend of quaternary ammonium, isopropyl alcohol and ethanol that delivers speed and power without sacrificing surface compatibility.
PDI’s Sani-Prime Germicidal Spray
PDI’s Sani-Prime Germicidal Spray
The Ruhof Biocide Detergent Disinfectant Pump Spray is a ready-to-use quaternary germicide cleaner and disinfectant for use in patient rooms, operating rooms, intensive care unit (ICU) areas, public restrooms or any other area that needs to be disinfected. It is formulated to be highly effective against a broad-spectrum of pathogenic microorganisms, including bacteria, antibiotic resistant bacteria, viruses, fungi, mold and mildew.
The spray can be used on all hard, non-porous inanimate environmental surfaces: floors, walls, metal surfaces, stainless steel surfaces, bathrooms, shower stalls, bathtubs, cabinets, etc. In addition, it deodorizes smelly areas such as garbage storage areas, empty garbage bins and cans, basements, restrooms and other places that are prone to odors caused by microorganisms.
UV-C technology
ClorDiSys Solutions’ Flashbox mini tabletop UV-C chamber is a quick, easy, dry and chemical-free solution that disinfects at a 99 percent kill rate of harmful organisms in mere minutes. UV-C provides a dry, chemical-free, residue-free, waste free method of disinfection effective against bacteria, viruses, fungi and spores. When microorganisms are exposed to UV-C, the nuclei of the cells alter due to photolytic processes and cause cell death. The Flashbox mini is a simple solution at nursing stations for pens, cell phones, tablet computers, stethoscopes and other shared items.
Products for efficacy and safety monitoring
Current Technologies’ Bleach-Rite Test Strips determine if bleach wipes are at disinfection strength, and therefore effective in helping to prevent HAI outbreaks. If the lid of a bleach-wipe canister is left open and evaporation occurs, the wipes may not contain enough solution to disinfect. With the Bleach-Rite Test Strip, the user squeezes the bleach wipe solution onto the strip and then compares it to a color chart. This comparison indicates if the bleach meets the CDC’s recommended 1:10 dilution (.525%); if lower the bleach wipes are not efficacious and should be discarded. It is also helpful in determining if bleach solutions mixed in-house are at disinfection strength.
Kem Medical Products’ Vapor-Trak Hydrogen Peroxide Monitor collects, stabilizes and precisely measures levels of hydrogen peroxide exposure. The badge is affixed to the collar, in the breathing zone, in order to measure personal exposure levels. It can also be placed strategically near a sterilizer to perform area monitoring. The Vapor-Trak Hydrogen Peroxide Monitor is an easy to use, cost efficient method to accurately determine chemical exposure levels and to fully document regulatory compliance.
The STERRAD VELOCITY Biological Indicator (BI) System, exclusively designed for use in STERRAD Systems, is now available in the U.S. and internationally. The BI is the latest addition to ASP’s ecosystem, providing SPDs with an end-to-end, automated sterilization solution. With results in 30 minutes, STERRAD VELOCITY makes it possible for technicians to run a BI in every cycle and know with certainty that proper sterilization conditions have been achieved before instruments are used in patients.
When paired with ASP ACCESS, ASP’s smart information sharing technology, the BI can help CS/SPDs become more efficient and compliant with government and hospital policies. It is the only reader that can communicate BI information to STERRAD Systems, instrument tracking systems and hospital networks, reducing the amount of manual documentation and the potential for human error.
References
1. Guideline for Disinfection and Sterilization, Centers for Disease Control and Prevention (CDC), updated February 15 2017. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines.pdf
2. Occupational Safety and Health Administration (OSHA), Safety and Health Topics: Ethylene Oxide https://www.osha.gov/SLTC/ethyleneoxide/
3. Occupational Safety and Health Administration (OSHA), Healthcare Wide Hazards: Gluteraldehyde https://www.osha.gov/SLTC/etools/hospital/hazards/glutaraldehyde/glut.html
Visit www.hpnonline.com/5-step-approach/ for the sidebar: “Improve disinfection and sterilization: a five-step approach.”
