HEALTHCARE CLEANING


coronaviruses on different surfaces showed that on inanimate objects the virus can remain viable for up to five days at temperatures of 22-25˚C and relative humidity of 40-50% (typical of air-conditioned indoor environments). The survival time increases further at lower temperatures and under conditions of lower humidity.2


Surface survival times


Environmental surface survival times depend on the type of surface. The genetic material from the coronavirus causing COVID-19 has been found to remain on plastic and stainless steel for up to 72 hours, on copper for four hours, and cardboard for up to 24 hours;3


therefore


the underlying risk of exposure presented to healthcare workers and patients should not be underestimated. Besides good hand hygiene, appropriate cleaning and disinfection of the environment, surfaces, and equipment, associated with patient care is imperative, to minimise the risk of cross-infection.


Public Health England advised in April 2020 that ‘There is evidence from other coronaviruses of the potential for widespread contamination of patient rooms or environments, so effective cleaning and decontamination is vital.’4


‘Enveloped’ viruses


Before considering the most appropriate cleaners and disinfectants for managing coronaviruses, it is worth noting that they are classified as ‘enveloped’ viruses, compared with other viruses, such as rotavirus, or poliovirus, which are termed non-enveloped. Enveloped viruses possess an envelope or outer coating that is composed of a lipid layer (a fat-like substance which is water insoluble). The envelope is needed to help the virus attach to the host cell. Loss of this envelope results in loss of infectivity. Although Public Health England states that: ‘As coronaviruses have a lipid envelope, a wide range of disinfectants are effective’, a study in 2012 examining Human Coronaviruses in relation to environmental resistance and disinfectant strategies strikes a note of caution, warning that despite the accepted fragility of enveloped viruses, they are potentially capable of developing


disinfectant. It applies to areas and situations where disinfection is medically indicated, including patient care in hospitals. A disinfectant which has this EN certification will be effective against enveloped viruses. Therefore, selecting a disinfectant with ‘virucidal efficacy against enveloped viruses’, combined with mention of EN14476 certification, is a useful initial starting point.


Disposable, single-use disinfectant wipes are often a convenient option in the healthcare environment for surface decontamination. Passing the EN14476 test means that the disinfectant solution can kill viruses (for example the virus causing COVID-19). However, what influences the practical application of the wipe is the contact time. This is the time required for the solution to be in contact with pathogens in order to eliminate or inactivate them.


Having selected the most appropriate and efficacious disinfectant, it should be remembered that cleaning is a two-stage process – the first being to clean the surface, which prepares it for the disinfection stage.


significant environmental resistance.5 For example, SARS-CoV has the ability to survive in different environmental conditions (low temperature and high humidity), on different materials found in hospital settings – such as aluminium, sterile sponges, latex surgical gloves, and in biological fluids.5


A ’challenging model’ for prevention This makes human coronaviruses (HCoVs) ‘a challenging model for the development of efficient means of prevention’.5


that: ‘HCoVs are now known to show a significant environmental resistance’. Their survival in different biological fluids such as respiratory secretions or faeces has been proven.


To ensure the efficacy of a disinfectant against viruses, there is a recognised microbiological test against enveloped viruses, according to the European Norm (EN) standard named EN14476 (2013+A2:2019). This European Standard specifies the minimum requirements for the virucidal activity of a chemical


A quick checklist for selecting


n Are they available on NHS contract? n Are they in stock and available for delivery?


Shorter contact times


In practice, this means that a disinfectant wipe could be EN14476 certified, but may require a contact time of five minutes to be effective, compared with another requiring only 30 seconds. A shorter contact time will save time, avoid the need for reapplication, and will help simplify the cleaning / disinfection process.


The study’s authors conclude


Besides the disinfectant content, consideration should also be given to the material of which the wipe is composed, as this is also key to achieving effective disinfection. The composition of the wipe needs to be capable of both containing and transferring the optimum amount of disinfectant onto the surface to achieve the antivirucidal effect. Of particular importance is the ability of the wipe to mop up and hold pathogens, rather than just spreading them over the wiped area. For this, a second test – the EN16615: 2015 test – is the highest level of testing for antimicrobial ‘ready-to-use wipes’ under the recognition of the European Standards committee. The test examines the efficacy of the wipe as a whole, i.e. the wipe plus the disinfectant component. It applies to areas and situations where disinfection is medically indicated. EN16615 includes products that are used in the medical area for disinfecting non- porous surfaces, including surfaces of medical devices by wiping.


hospital disinfectants n Do they conform to EN standards for efficacy? n Are they available in different strengths to disinfect different surfaces? n Do they combine cleaner and disinfectant in a single product as part of a two-stage process?


Are they fit for purpose? When selecting a wipe for the clinical setting, it cannot be assumed that all wipes will have this ‘gold standard’ EN16615 certification. Many wipes will instead have EN14476 certification without EN16615, which should raise the question of whether these wipes are really fit for purpose, especially when infection prevention has never been more important than it is right now.


May 2020 Health Estate Journal 51


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