INF ECTION P R EVENTION
and rotavirus, and respiratory viruses such as influenza virus, noroviruses may remain infectious for up to several weeks. Both noroviruses and other enteric viruses may be transmitted through contaminated surfaces, which is an important factor to consider in environmental transmission.1 Bacteria also demonstrate significant
survival times on hospital surfaces. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) have been shown to survive for days and even weeks on environmental surfaces in healthcare facilities.10
The risk of infection resulting from transmission through contaminated surfaces depends on a number of factors, including the level of shedding of infective particles, their stability on surfaces, resistance to decontamination procedures, and the amount of pathogens required to cause infection.1
Temperature, environmental
humidity and types of surfaces are additional factors affecting risk.1 Pathogen transfer in hospitals can be interrupted by the appropriate cleaning and disinfection of surfaces; with disinfectant wipes having a key role to play.11 Decontamination of surfaces takes place by combining the microbiocidal action of the disinfectant with the physical (mechanical) action of wiping.11
Although wipes may look similar, their composition and subsequent ability to clean and disinfect critical surfaces shows considerable variation. The size, thickness, material composition, layering, formulation, and degree of absorbency of the wipe will determine the quantity of disinfectant retained in and released from it. The physical structure of the wipe also influences the degree of contact it makes with the surface as well as its cleaning of the surface and the capacity it has to pick up and hold soils, microbes, and
particles as the surface is wiped.11 In practice, wiping with a weak or slow-acting disinfectant may not only be ineffective but also possibly spread localised contamination over a wider area.11
The
greater the surface area cleaned with a single wipe, the more soil is acquired and the weaker the disinfectant becomes.11 Nosocomial pathogens vary widely in their susceptibility to surface disinfectants depending on their biology, growth phase, environmental conditions such as relative humidity and air temperature, nature of the surface, and type and level of the associated soil. Therefore, for routine wiping to be effective, it must be designed and executed to cover as wide a variety of commonly encountered pathogens as possible.11 The wipe needs to be capable of both containing and transferring the optimum amount of disinfectant onto the surface to achieve the antimicrobial effect. The EN16615 test is the highest level of testing for antimicrobial 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 is therefore an excellent starting point for wipe selection. A combination of how the surface has been used, its location in the clinical setting, accessibility and contamination of the surface will determine the efficiency of wiping and also the level of contact between the target pathogens and the disinfectant. The surface to be wiped must not only permit direct contact between the pathogens and disinfectant but also allow for an optimum contact time to achieve the desired level of decontamination.11
In general, the ease of decontamination by wiping is directly related to the degree of smoothness of the surface.11
Difficult to
reach or very uneven surfaces may need to be sprayed directly with a disinfectant, rather
than wiped. Spraying requires a number of safety measures to be undertaken to protect the person carrying out the decontamination. It is also worth remembering that surface contamination is rarely uniform and is likely to be concentrated in certain “spots.” Wiping a contaminated surface inevitably dislodges wet or dried microbial contamination and may spread it over a wider area during the decontamination if not killed or inactivated effectively at the point of contact.11 Therefore, it is imperative that the combined action of disinfection and wiping is efficient enough to reduce the pathogen load to as low a level as possible to avoid spreading pathogens over a wider area.11 An additional factor affecting the efficacy
of surface cleaning is the way in which the wipe is used in practice. The type and frequency of wiping action, as well as the pressure exerted during wiping, can profoundly influence the outcome of decontamination.11
These wiping variables
are difficult to control, therefore it is essential that all staff responsible for cleaning and decontamination receive thorough training. There is discussion in terms of
whether, in practice, a single wipe across a contaminated surface is sufficient to deactivate potentially transmissible pathogens. Evidence suggests that two wipes of a surface is more beneficial than a single wipe on a contaminated area. Research has demonstrated that when a single wipe is followed by a second wipe, an extra 1- to 3-log10
reduction in pathogens (viruses and bacteria) is achieved on stainless steel surfaces.1
‘Precleaning before disinfection of
the contaminated surfaces is recommended’ by the researchers.1
Likewise, the Centre for Disease Control
and Prevention (CDC) states that cleaning is the necessary first step of any disinfection process. If a surface is not cleaned first, the disinfection process is compromised.12 Cleaning is a form of decontamination that renders the environmental surface safe to handle by removing organic matter, salts, and visible soils, all of which may interfere with microbial inactivation.12
The efficacy of cleaning and disinfection is determined not only by the intrinsic effectiveness of the method applied but also by the appropriateness of the surfaces treated.1
There have been recommendations that the choice of cleaning materials and the methods employed should focus on the type of surface (including surface sensitivity to detergents) and also its actual location. Reducing the infective load on critical spots such as doorknobs, handles, light switches, and other frequently touched surfaces is more likely to have a profound impact on transmission than disinfecting rarely touched surfaces.1
The CDC recommends taking certain 72 l
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