INF ECTION P R EVENTION
Advantages of quaternary ammonium compounds
There is considerable evidence that contaminated surfaces and the untreated hands of healthcare professionals contribute to the spread of nosocomial pathogens within the hospital setting. Tim Sandle discusses the advantages of quaternary ammonium compounds for ward disinfection and infection control.
Healthcare‐associated infections present a serious and ever-present source of morbidity and mortality. Within the hospital setting, the risk needs to be addressed through an effective infection control strategy, which must include surface cleaning and disinfection, glove disinfection, and hand sanitisation. These measures should be observed by healthcare professionals for the personal hygiene, decontamination of the ward and for treating equipment and surfaces in-between patients. With the latter step, this is additionally important since many patients will be asymptomatic carriers of infectious agents. While many of the microorganisms against which these measures are targeted will not pose a risk to the general populace under normal circumstances, risks exist should these organisms enter the blood or tissues and there are enhanced concerns with immunocompromised patients. Central to the infection control strategy is the selection and use of an appropriate disinfectant.1
An ideal disinfectant will have
a broad spectrum of activity and a relatively short contact time.2
A suitable disinfectant,
which meets these objectives, is a blend of quaternary ammonium compounds. As an additional advantage, formulations can be supplemented with detergents to improve cleanability. Quaternary ammonium compounds (QAC) are a type of disinfectant common to a range of healthcare settings, including hospital environments, as described in the US Centers for Disease Control and
Prevention (CDC) ‘Guideline for Disinfection and Sterilization in Healthcare Facilities’.3 These compounds have a strong bactericidal action through the inactivation of bacterial cell enzymes, the denaturation of essential cell proteins, and disruption of the cell membrane (this includes bactericidal efficacy against organisms like multidrug-resistant Staphylococcus aureus, vancomycin- resistant Enterococcus, and Pseudomonas aeruginosa).4
are effective against fungi5
In addition, QAC products and viruses6
(including the coronavirus responsible for COVID-19).
This review article considers the use and application of QACs in healthcare facilities, at the hospital ward level, and provides an overview of the mode of action together with some of the technical challenges presented by this type of disinfectant.
Quaternary ammonium compounds are generally very stable, mostly unaffected by pH levels, and, once applied, they remain effective on a surface for a prolonged time.
DECEMBER 2021
Infection control objectives Cleaning and disinfection are integral elements of good hygiene practice within the hospital ward and for personnel to observe. In particular, surfaces must be rendered clean and decontaminated between patients in order to minimise the risks that can arise from patient-to-patient and patient-to-staff infection. The focus on surfaces includes the necessity of paying particular attention to ‘high’ or ‘hot’ touch items, such as taps, light switches, door handles and so on. Effective cleaning and disinfection practices need to be extended to high traffic areas. There is considerable scientific evidence that improving surface cleaning and disinfection reduces healthcare‐associated infections.7 Attention must also be paid to the hands of healthcare workers, since a high proportion of healthcare‐associated infections are attributed to cross‐infection via the hands of healthcare personnel. Recommended time points for skin antisepsis include before contact with patients, before performing aseptic procedures, after exposure to body fluids, following contact with patients and contact with patient surroundings.8 The purpose of applying a disinfectant
WWW.CLINICALSERVICESJOURNAL.COM l 21
▲
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56
