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automated room disinfection approaches for discharge disinfection. However, the national manual doesn’t look beyond chlorine-based disinfectants as a recommendation for environmental hygiene during the application of TBPs. While chlorine-based disinfectants have a role in hospital disinfection, they have several important limitations: l While high levels of biocidal activity, including sporicidal activity, are often assumed for chlorine-based agents, and chlorine as a chemistry has good sporicidal potential, many chlorine-based agents with sporicidal claims are, in fact, not meaningfully sporicidal when tested correctly.11
l Chlorine-based disinfectants are surprisingly susceptible to inactivation through contact with organic soiling – which is obviously common on healthcare surfaces!12
l The environmental profile of chlorine-based disinfectants is poor.13
l Chlorine-based disinfectants have been associated with material compatibility issues, especially related to electronic devices in hospitals.14
l Staff exposure to chlorine-based disinfects has been associated with acute exposure incidents, and long-term health issues including the development of asthma.15
l Only a small proportion of patients who are on TBPs require the use of a sporicidal disinfectant. For the majority of patients on TBPs, who don’t require a sporicidal agent, a non-chlorine disinfectant may be a better choice in terms of stability, safety, and efficacy.
For these reasons, it is important to look beyond chlorine when selecting disinfectants for use in hospitals, both from a national guideline and a local user viewpoint. Several other disinfectants offer good alternative sporicidal options, including peracetic acid and hydrogen peroxide- based chemistries.16, 17 Another key point in the National Infection Prevention and Control Manual is recommendations around the use of wipes for surface disinfection. While the manual does mention the need to disinfect medical devices between patients and the possible use of detergent wipes to deliver SICPs, there is no mention of the use of combined detergent- disinfection wipes in the context of TBPs or for routine surface disinfection. Combined detergent-disinfectant wipes have several advantages over a “bucket” method used to deliver surface cleaning and disinfection agents. Combined disinfectant-detergent wipes remove the need for a two-step process to first clean and then disinfect a surface. This
both improves effectiveness and saves time.18 Using a combined detergent-disinfectant wipe also offers assurance over adequate dosing of biocides, improved surface wetting to achieve the appropriate contact time, and avoids the issue of stock disinfectant solutions becoming contaminated with significant microbes.11, 19 Several studies have shown that switching to a combined detergent-disinfectant wipe results in a reduction of acquisition of HCAI-causing micro-organisms.20, 21
For example, a cluster
randomised crossover study in Israel found that switching from a “bucket” method for delivering a chlorine-based disinfectant to a combined detergent-disinfectant wipe resulted in a significant reduction in the acquisition of multidrug-resistant organisms.21
Similarly, a
before and after study in the UK found that switching from a two-step process (cleaning with detergent and disinfecting with alcohol) to a one step combined detergent and disinfectant wipe resulted in a significant reduction in MRSA acquisition.20 Both the National Standards of Healthcare Cleanliness and the National Infection Prevention and Control Manual offer strategic benefits in
References for this article are available on request.
the delivery of effective surface cleaning and disinfection in England. However, there is a lack of consideration of the limitations of detergents and chlorine-based disinfectants for cleaning and disinfection of hospital surfaces. Future versions of the National Infection Prevention and Control Manual should consider the benefits of sporicidal disinfectants other than chlorine-based products, and reflect the strong evidence for the use of detergent-disinfectant surface wipes.
About the author
The Maylands Building, Maylands Avenue,
Hemel Hempstead Industrial Estate, Hemel Hempstead, Hertfordshire HP2 7TG
T: +44 (0)20 7993 0030 E:
info@gamahealthcare.com
www.gamahealthcare.com
Dr. Philip Norville, Clinical & Scientific Director has worked in IPC since 2012, helping healthcare organisations improve and implement effective infection prevention solutions.
He has a BSc (Hons) in Microbiology, a PhD
in Microbiology (University of Cardiff) and a MSc in Infection Prevention and Control (University of Dundee). Phil also holds an Honorary Lectureship at Cardiff University. His research interests include
environmental hygiene, wet and dry biofilms and human behaviours in IPC.
December 2023 I
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