DECONTAMINATION
from laboratory efficacy tests conducted by manufacturers using some non-standard tests. This can lead to the use of wipes that might not be appropriate for applications in the healthcare environment.28
MICRO-ORGANISM EXAMPLES
Peter Hoffman,
consultant clinical scientist at the Antimicrobial Resistance and Healthcare Infections Reference Unit of Public Health England, provided a practical set of recommendations in his presentation of how best to select disinfectant wipes at the Infection Prevention Society Conference 2013 in London. Hoffman suggested that the company should be able to: l Adequately explain how the formula works by describing the active compounds and outline their relationship with target micro-organisms.
l Ensure that efficacy tests are undertaken on liquid expressed from the wipe, not on solution added to the wipe as some materials may retain the disinfectant.
l Present efficacy data that reflects achievable contact times and conditions, as a disinfectant that only achieves a satisfactory kill after 30 minutes contact is unlikely to be of any practical use in a clinical setting.
l Provide an experienced and reputable microbiologist who can explain the importance of all aspects of the formula and relevant testing.
l Deliver comprehensive training on correct use and best practice.
l Undertake and publish practical user results for their products.
l Comply with current product safety regulations and occupational health considerations and guidelines.
Wipe selection is critical as infection prevention efforts may be compromised if a product is not fit for the intended purpose. The choice of an appropriate product can be a complex process that includes the consideration of scientific information and the interpretation of laboratory test data. Cleaning and disinfection are a fundamental component of any infection prevention and control strategy. Education and training for all healthcare personnel that have to perform this important task is integral to wipe selection. There is now a growing collection of studies that demonstrate the effectiveness of training in improving environmental decontamination.4,6,29
Conclusion
Wipe selection is just as important as the medical device that is chosen. Infection prevention efforts, medical device and patient safety may be compromised if both are not considered in conjunction. This may seem time-consuming. However, it is important to take the time to check that wipes and medical devices are compatible with each other and that both the manufacturers can supply compatibility information. Ultimately, both manufacturers should have a shared vision to protect patients.
Table 1: Spaulding Classification (Spaulding, 1968)4 References
1 MHRA. Sterilization, disinfection and cleaning of medical equipment: Guidance on decontamination from the Microbiology Advisory Committee (the MAC manual): Part 1 principles. London: MHRA; 2010.
2 MHRA. Sterilization, disinfection and cleaning of medical equipment: guidance on decontamination from the Microbiology Advisory Committee (the MAC manual): Part 2 protocols. London: MHRA; 2005.
3 Health Protection Scotland. Standard Infection Control Precautions Literature Review: Management of care equipment Glasgow: HPS; 2016.
4 Spaulding E.H (1968) Chemical disinfection of medical and surgical materials. Philadepldia, Lea & Febiger.
5 Gold K. et al. Cleaning assessment of disinfectant cleaning wipes on an external surface of a medical device contaminated with artificial blood or Streptococcus pneumoniae. Am J Infect Control 2013: 41 (10): 901-907.
6 Rutala W. et al. The benefits of surface disinfection. American Journal of Infection Control 2004 Jun; 32 (4):226-31.
7 Dancer S. The role of environmental cleaning in the control of hospital-acquired infection. Journal of Hospital Infection 2009 Dec; 73 (4):378-85.
8 Dettenkofer M. et al. Does disinfection of environmental surfaces influence nosocomial infection rates? A systematic review. [Review] [30 refs]. American Journal of Infection Control 2004 Apr; 32 (2):84-9.
9 Barker J. Effects of cleaning and disinfection in reducing the spread of Norovirus contamination via environmental surfaces. J Hosp Infect, 2004 58, 42-9.
10 Exner M. et al. 2004. Household cleaning and surface disinfection: new insights and strategies. Journal of Hospital Infection, 56, Supplement 2, 70-75.
11 Bergen L. et al. 2009. Spread of bacteria on surfaces when cleaning with microfibre cloths. Journal of Hospital Infection, 71, 132-137.
12 Xu H. et al. 2014. A randomized, double-blind comparison of the effectiveness of environmental cleaning between infection control professionals and environmental service workers. Am J Infect Control. 1; 43 (3):292-4
13 MHRA Ensure detergent and disinfectant wipes are compatible with the device MDA/2010/001
CSJ
14 Statutory Instrument 2004 No. 3386 The Control of Substances Hazardous to Health (COSH)
58 I
WWW.CLINICALSERVICESJOURNAL.COM
Regulations London: HMSO; 2004
15 MHRA Ensure detergent and disinfectant wipes are compatible with the device MDA/2013/019
16 Hoffman J.M et al. (2013) ESC of polycarbonate Exposed to Hospital Disinfectants. Proceedings, ANTEC 2013. Society of Plastic Engineers.
17 Royal College of Nursing. The selection and use of disinfectant wipes. London: RCN; 2011
18 Rutala W. et al. Guideline for Disinfection and Sterilization in Healthcare Facilities. In: Centers For Disease Control And Prevention (ed.) 2008. Atlanta, GA.
19 Sehulster L. et al. 2003. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 52, 1–42.
20 National Patient Safety Agency 2007. The national specifications for cleanliness in the NHS: a framework for setting and measuring performance outcomes. In: NPSA (ed.). London.
21 Rutala W et al. Disinfection, sterilization, and antisepsis: An overview, Am J Infect Control. 2016 May; 44 5: e1 - e6.
22 Rutala W. et al. Disinfectants used for environmental disinfection and new room decontamination technology. Am J Infect Control. 2013 May; 41(5 Suppl):S36-41.
23 Rutala W. et al. 2013b. Disinfection and sterilization: an overview. Am J Infect Control, 41, S2-5.
24 Berendt A, et al. Three swipes and you’re out: how many swipes are needed to decontaminate plastic with disposable wipes? Am J Infect Control. 2011. 39 (5): p. 442-3.
25 Ramm L. et al.
2015.Pathogen transfer and high variability in pathogen removal by detergent wipes. Am J Infect Control. Jul 1; 43 (7):724-8.
26 Lopez G. et al. (2014) Evaluation of a Disinfectant Wipe Intervention on Fomite-to-Finger Microbial Transfer, Appl Environ Microbiol 80 (10): 3113-3118
27 Wiemken T. et al. 2014. The value of ready-to-use disinfectant wipes: compliance, employee time, and costs. Am J Infect Control, 42, 329-30.
28 Siani H. et al. 2011. Efficacy of “sporicidal” wipes against Clostridium difficile. American Journal of Infection Control, 39, 212-218.
29 Quinn M. et al. (2015). “Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention.” Am J Infect Control.
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