Healthcare-associated
infections (HAIs) remain an important source of morbidity and mortality with an
estimated 1.7 million infections and 99,000 deaths annually. A major source of
nosocomial pathogens is thought to be the patient’s endogenous flora, but an
estimated 20-40% of healthcare-associated infections have been attributed to
cross-infection via the hands of healthcare personnel. Contamination of the hands of healthcare
personnel could in turn result from either direct patient contact or indirectly
from touching contaminated environmental surfaces. Healthcare personnel have
frequent contact with the environmental surfaces in patients’ rooms providing
ample opportunity for contamination of gloves and/or hands. Two recent studies demonstrated that contact
with the environment was just as likely to contaminate the hands of healthcare
workers as was direct contact with the patient. Donskey has reviewed the scientific literature
and found that improving surface cleaning and disinfection reduces
healthcare-associated infections (Am J Infect Control 2013: 41:S12-S19). Another recent paper showed that daily
disinfection of surfaces (versus standard cleaning surfaces when visibly
soiled) with a sporicidal disinfectant in rooms of patients with Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) reduced
acquisition of pathogens on gloved hands after contact with room surfaces. While disinfectants are used to prevent transmission
of pathogens from both noncritical and semicritical items, the purpose of this
brief article is to assist the user in the selection of the optimal
disinfectant for use with environmental
surfaces and noncritical patient care items (devices that contact only intact skin
such as stethoscopes). The same
characteristics for an ideal low-level disinfectant would be used for
high-level disinfectants; however, the contact time would be longer and
antimicrobial spectrum would be broader (e.g., may include C. difficile spores). To
date, the perfect product for healthcare disinfection has not been introduced;
however, there is a wide array of disinfectants that offer a range of
characteristics.
While the process of selecting an optimal healthcare
disinfectant used for low-level disinfection of noncritical items is
commonplace in healthcare facilities there are no papers in the peer-reviewed
literature on this topic. Disinfectant
selection, or the product, is one of the two components essential for effective
disinfection. The other component, the practice, is the thorough application such
that the disinfectant contacts all surfaces, as well as proper training of
hospital staff (especially environmental services and nursing) and adherence to
the manufacturer’s label instructions (except in the cases where an institution
may prepare a formal risk assessment to follow alternate contact times such as
≥1 minute for vegetative bacteria). The combination of product and practice
results in effective surface disinfection, or the reduction of patient risk,
and improved patient outcomes. The five key considerations when selecting a
disinfectant are summarized below. When determining the optimal disinfecting
product for surface disinfection in your facility, consider the five components
below (Table), give each product a score (e.g., 1 is worst to 10 is best) in
each of the five categories and select the product with the highest score as
the optimal product choice (maximum score is 50).
Table. Key Considerations for
Selecting the Optimal Disinfectant for Your Facility.
Consideration
|
Questions to Ask
|
Score (1-10)
|
Kill
Claims
|
Does the product kill the most prevalent healthcare
pathogens, including those that:
|
|
Kill Times
and
Wet-Contact Times |
|
|
Safety
|
|
|
Ease-of-Use
|
|
|
Other
factors
|
|
