William A. Rutala_ISHAIs 2015

Selection of an Ideal Disinfectant William A. Rutala, Ph.D., M.P.H. Director, Hospital Epidemiology, Occupational Health and Safety, UNC Health Care; Research Professor of Medicine and Director, Statewide Program for Infection Control and Epidemiology, University of North Carolina at Chapel Hill, NC, USA Disclosure: West CIDEIM

William A. Rutala_ISHAIs 2015

LECTURE OBJECTIVES Review the role of the environment in transmission of nosocomial pathogens Review the properties of an ideal disinfectant Review the key considerations for selecting the ideal disinfectant

       

Kill Claims Kill and wet-contact time Safety Ease of use Other factors CIDEIM

William A. Rutala_ISHAIs 2015

DISINFECTION AND STERLIZATION 

EH Spaulding believed that how an object will be disinfected depended on the object’s intended use. CRITICAL - objects which enter normally sterile tissue or the vascular system or through which blood flows should be sterile.  SEMICRITICAL - objects that touch mucous membranes or skin that is not intact require a disinfection process (high-level disinfection [HLD]) that kills all microorganisms but high numbers of bacterial spores.  NONCRITICAL -objects that touch only intact skin require lowlevel disinfection. 

CIDEIM

William A. Rutala_ISHAIs 2015

CIDEIM

William A. Rutala_ISHAIs 2015

Processing “Noncritical” Patient Care Objects

Classification:

Noncritical objects will not come in contact with mucous membranes or skin that is not intact. Object: Can be expected to be contaminated with some microorganisms. Level germicidal action: Kill vegetative bacteria, fungi and lipid viruses. Examples: Bedpans; crutches; bed rails; EKG leads; bedside tables; walls, floors and furniture. Method: Low-level disinfection CIDEIM

William A. Rutala_ISHAIs 2015

Low-Level Disinfection for “Noncritical” Objects Exposure time > 1 min

Germicide Use Concentration Ethyl or isopropyl alcohol 70-90% Chlorine 100ppm (1:500 dilution) Phenolic UD Iodophor UD Quaternary ammonium UD Improved hydrogen peroxide 0.5%, 1.4%

______________________________________________________ UD=Manufacturer’s recommended use dilution CIDEIM

William A. Rutala_ISHAIs 2015

LECTURE OBJECTIVES Review the role of the environment in transmission of nosocomial pathogens Review the properties of an ideal disinfectant Review the key considerations for selecting the ideal disinfectant

       

Kill Claims Kill and wet-contact time Safety Ease of use Other factors CIDEIM

William A. Rutala_ISHAIs 2015

CIDEIM

William A. Rutala_ISHAIs 2015

ENVIRONMENTAL CONTAMINATION LEADS TO HAIs  There is

increasing evidence to support the contribution of the environment to disease transmission  This supports comprehensive disinfecting regimens (goal is not sterilization) to reduce the risk of acquiring a pathogen from the healthcare environment/equipment CIDEIM

William A. Rutala_ISHAIs 2015

KEY PATHOGENS WHERE ENVIRONMENTIAL SURFACES PLAY A ROLE IN TRANSMISSION MRSA  VRE  Acinetobacter spp.  Clostridium difficile  Norovirus  Rotavirus  SARS 

CIDEIM

William A. Rutala_ISHAIs 2015

ENVIRONMENTAL CONTAMINATION ENDEMIC AND EPIDEMIC MRSA

Dancer SJ et al. Lancet ID 2008;8(2):101-13 CIDEIM

William A. Rutala_ISHAIs 2015

ENVIRONMENTAL SURVIVAL OF KEY PATHOGENS ON HOSPITAL SURFACES Pathogen S. aureus (including MRSA) Enterococcus spp. (including VRE) Acinetobacter spp. Clostridium difficile (spores) Norovirus (and feline calicivirus) Pseudomonas aeruginosa Klebsiella spp.

Survival Time 7 days to >12 months 5 days to >46 months 3 days to 11 months >5 months 8 hours to >2 weeks 6 hours to 16 months 2 hours to >30 months

Adapted from Hota B, et al. Clin Infect Dis 2004;39:1182-9 and Kramer A, et al. BMC Infectious Diseases 2006;6:130 CIDEIM

William A. Rutala_ISHAIs 2015

Thoroughness of Environmental Cleaning Carling et al. Am J Infect Control. 2013;41:S20-S25 100

DAILY CLEANING

% Cleaned

80

TERMINAL CLEANING

>110,000 Objects

60

40

20

Mean = 32%

0 HEH IO W OT H OPE NIC U AH SG ER RA TIN OSP HO HO G SP SP RO

OM S

EM ICU AM MD LO N DIA SV BC LYS CLI DAI GT EHI H N IS L E E IC Y RM MO CLE S

CIDEIM

William A. Rutala_ISHAIs 2015

Mean proportion of surfaces disinfected at terminal cleaning is ~30%

CIDEIM

William A. Rutala_ISHAIs 2015

FREQUENCY OF ACQUISITION OF MRSA ON GLOVED HANDS AFTER CONTACT WITH SKIN AND ENVIRONMENTAL SITES No significant difference on contamination rates of gloved hands after contact with skin or environmental surfaces (40% vs 45%; p=0.59)

Stiefel U, et al. ICHE 2011;32:185-187 CIDEIM

William A. Rutala_ISHAIs 2015

TRANSMISSION MECHANISMS INVOLVING THE SURFACE ENVIRONMENT

Rutala WA, Weber DJ. In:”SHEA Practical Healthcare Epidemiology” (Lautenbach E, Woeltje KF, Malani PN, eds), 3rd ed, 2010. CIDEIM

William A. Rutala_ISHAIs 2015

ACQUISITION OF MRSA ON HANDS AFTER CONTACT WITH ENVIRONMENTAL SITES

CIDEIM

William A. Rutala_ISHAIs 2015

ACQUISITION OF MRSA ON HANDS/GLOVES AFTER CONTACT WITH CONTAMINATED EQUIPMENT

CIDEIM

William A. Rutala_ISHAIs 2015

TRANSFER OF MRSA FROM PATIENT OR ENVIRONMENT TO IV DEVICE AND TRANSMISSON OF PATHOGEN

CIDEIM

William A. Rutala_ISHAIs 2015

EVALUATION OF HOSPITAL ROOM ASSIGNMENT AND ACQUISITION OF CDI   



Study design: Retrospective cohort analysis, 2005-2006 Setting: Medical ICU at a tertiary care hospital Methods: All patients evaluated for diagnosis of CDI 48 hours after ICU admission and within 30 days after ICU discharge Results (acquisition of CDI) Admission to room previously occupied by CDI = 11.0%  Admission to room not previously occupied by CDI = 4.6% (p=0.002) 

Shaughnessy MK, et al. ICHE 2011;32:201-206

CIDEIM

William A. Rutala_ISHAIs 2015

Increased Risk of Acquisition of HA Pathogen from Prior Room Occupant~120% MRSA (Huang S, 2006) VRE* (Dress M, 2008) VRE (Huang S, 2006) MDR Pseudomonas (Nseir S, 2011) VRE^ (Drees M, 2008) C. diff (Shaughnessy M, 2011) MDR Acinetobacter (Nseir S, 2011) 0

0.5

1

1.5

2

2.5

3

* Prior room occupant infected; ^Any room occupant in prior 2 weeks infected

3.5

4

CIDEIM

William A. Rutala_ISHAIs 2015

TRANSMISSION MECHANISMS INVOLVING THE SURFACE ENVIRONMENT

Rutala WA, Weber DJ. In:”SHEA Practical Healthcare Epidemiology” (Lautenbach E, Woeltje KF, Malani PN, eds), 3rd ed, 2010. CIDEIM

William A. Rutala_ISHAIs 2015

ACQUISITION OF C. difficile ON PATIENT HANDS AFTER CONTACT WITH ENVIRONMENTAL SITES AND THEN INOCULATION OF MOUTH

CIDEIM

William A. Rutala_ISHAIs 2015

ALL “TOUCHABLE” (HAND CONTACT) SURFACES SHOULD BE WIPED WITH DISINFECTANT “High touch” objects only recently defined (no significant differences in microbial contamination of different surfaces) and “high risk” objects not epidemiologically defined.

CIDEIM

William A. Rutala_ISHAIs 2015

LECTURE OBJECTIVES Review the role of the environment in transmission of nosocomial pathogens Review the properties of an ideal disinfectant Review the key considerations for selecting the ideal disinfectant

       

Kill Claims Kill and wet-contact time Safety Ease of use Other factors CIDEIM

William A. Rutala_ISHAIs 2015

PROPERTIES OF AN IDEAL DISINFECTANT Rutala, Weber. Infect Control Hosp Epidemiol. 2014;35:855-865



        

 

Broad spectrum-wide antimicrobial spectrum Fast acting-should produce a rapid kill Remains Wet-meet listed kill/contact times with a single application Not affected by environmental factors-active in the presence of organic matter Nontoxic-not irritating to user Surface compatibility-should not corrode instruments and metallic surfaces Persistence-should have sustained antimicrobial activity Easy to use Acceptable odor Economical-cost should not be prohibitively high Soluble (in water) and stable (in concentrate and use dilution) Cleaner (good cleaning properties) and nonflammable CIDEIM

William A. Rutala_ISHAIs 2015

PROPERTIES OF AN IDEAL SURFACE DISINFECTANT



Broad spectrum 



Fast acting 



Should have a wide antimicrobial spectrum, including kill claims for all pathogens that are common causes of HAIs and outbreaks

Should have a rapid kill and short kill/contact time listed on the label

Remains wet 

Should keep surfaces wet long enough to meet listed kill/contact times with a single application or meet wet times recommended by evidence-based guidelines (60 seconds) Rutala WA, Weber DJ. Infect Control Hosp Epidemiol 2014;35:855-865 CIDEIM

William A. Rutala_ISHAIs 2015

PROPERTIES OF AN IDEAL SURFACE DISINFECTANT



Not affected by environmental factors 



Nontoxic 



Should be active in the presence of organic matter (e.g., blood, sputum, feces) and compatible with soaps, detergents, and other chemicals encountered in use Should not irritating to the user, visitors, and patients. Should not induce allergic symptoms (especially asthma and dermatitis). The toxicity ratings for disinfectants are danger, warning, caution, and none. Ideally choose products with the lowest toxicity rating.

Surface compatibility 

Should be proven compatible with common healthcare surfaces and devices

Rutala WA, Weber DJ. Infect Control Hosp Epidemiol 2014;35:855-865 CIDEIM

William A. Rutala_ISHAIs 2015

PROPERTIES OF AN IDEAL SURFACE DISINFECTANT



Persistence 



Easy to use 



Should be available in multiple forms, such as wipes (large and small), sprays, pull tops, and refills; directions for use should be simple and contain information about personal protective equipment as required

Acceptable odor 



Should have sustained antimicrobial activity or residual antimicrobial effect on the treated surface

Should have an odor deemed acceptable by users and patients

Solubility 

Should be soluble in water Rutala WA, Weber DJ. Infect Control Hosp Epidemiol 2014;35:855-865 CIDEIM

William A. Rutala_ISHAIs 2015

PROPERTIES OF AN IDEAL SURFACE DISINFECTANT



Economical 



Stability 



Should be stable in concentrate and use dilution

Cleaner 



Costs should not be prohibitively high but when considering the costs of a disinfectant one should also consider product capabilities, cost per compliant use, etc.

Should have good cleaning properties

Nonflammable 

Should have a flash point above 150oF

Rutala WA, Weber DJ. Infect Control Hosp Epidemiol 2014;35:855-865 CIDEIM

William A. Rutala_ISHAIs 2015

LOW-LEVEL DISINFECTION FOR NONCRITICAL EQUIPMENT AND SURFACES

Germicide

Exposure time > 1 min

Use Concentration

Ethyl or isopropyl alcohol 70-90% Chlorine 100ppm (1:500 dilution) Phenolic UD Iodophor UD Quaternary ammonium UD Improved hydrogen peroxide 0.5%, 1.4% ____________________________________________________ UD=Manufacturer’s recommended use dilution CIDEIM

William A. Rutala_ISHAIs 2015

How about Non-Germicidal Detergents for Surface Cleaning?

CIDEIM

William A. Rutala_ISHAIs 2015

Justification for Using a Disinfectant for Non-Critical Surfaces



    

Surfaces may contribute to transmission of epidemiologicallyimportant pathogens such as MRSA, VRE, C. difficile, MDRAcinetobacter, others Disinfectants prevent HAIs Disinfectants are more effective than detergents in reducing contamination on surfaces Detergents become contaminated and result in seeding the patient’s environment with bacteria Disinfection of non-critical patient care items and equipment is recommended for patients on isolation Disinfectants may have persistent antimicrobial activity

CIDEIM

William A. Rutala_ISHAIs 2015

CIDEIM

William A. Rutala_ISHAIs 2015

Does Improving Surface Cleaning and Disinfection Reduce Healthcare-Associated Infections? Donskey CJ. AJIC. May 2013

“As reviewed here, during the past decade a growing body of evidence has accumulated suggesting that improvements in environmental disinfection may prevent transmission of pathogens and reduce HAIs. Although, the quality of much of the evidence remains suboptimal, a number of high-quality investigations now support environmental disinfection as a control strategy” CIDEIM

William A. Rutala_ISHAIs 2015

Alfa et al. AJIC 2015;43:141-146

CIDEIM

William A. Rutala_ISHAIs 2015

Justification for Using a Disinfectant for Non-Critical Surfaces



    

Surfaces may contribute to transmission of epidemiologicallyimportant pathogens such as MRSA, VRE, C. difficile, MDRAcinetobacter, others Disinfectants prevent HAIs Disinfectants are more effective than detergents in reducing contamination on surfaces Detergents become contaminated and result in seeding the patient’s environment with bacteria Disinfection of non-critical patient care items and equipment is recommended for patients on isolation Disinfectants may have persistent antimicrobial activity

CIDEIM

William A. Rutala_ISHAIs 2015

Transfer of C. difficile Spores by Nonsporicidal Wipes Cadnum et al. ICHE 2013;34:441-2 

Detergent/nonsporicidal wipes transfer or spread microbes/spores to adjacent surfaces; disinfectants inactivate microbes

CIDEIM

William A. Rutala_ISHAIs 2015

LOW-LEVEL DISINFECTION FOR NONCRITICAL EQUIPMENT AND SURFACES

Germicide

Exposure time > 1 min

Use Concentration

Ethyl or isopropyl alcohol 70-90% Chlorine 100ppm (1:500 dilution) Phenolic UD Iodophor UD Quaternary ammonium UD Improved hydrogen peroxide 0.5%, 1.4% ____________________________________________________ UD=Manufacturer’s recommended use dilution CIDEIM

William A. Rutala_ISHAIs 2015

Quaternary ammonium compounds

(e.g., didecyl dimethyl ammonium bromide, dioctyl dimethyl ammonium bromide) Rutala, Weber. Am J Infect Control 2013;41:S36-S41

Advantages 

     

Bactericidal, fungicidal, virucidal against enveloped viruses (e.g., HIV) Good cleaning agents EPA registered Surface compatible Persistent antimicrobial activity when undisturbed Inexpensive (in dilutable form) Not flammable

Disadvantages  





 

Not sporicidal In general, not tuberculocidal and virucidal against non-enveloped viruses High water hardness and cotton/gauze can make less microbicidal A few reports documented asthma as result of exposure to benzalkonium chloride Affected by organic matter Multiple outbreaks ascribed to contaminated benzalkonium CIDEIM chloride

William A. Rutala_ISHAIs 2015

Sodium Hypochlorite Rutala, Weber. Am J Infect Control 2013;41:S36-S41

Advantages          

Bactericidal, tuberculocidal, fungicidal, virucidal Sporicidal Fast acting Inexpensive (in dilutable form) Not flammable Unaffected by water hardness Reduces biofilms on surfaces Relatively stable (e.g., 50% reduction in chlorine concentration in 30 days) Used as the disinfectant in water treatment EPA registered

Disadvantages   





  

Reaction hazard with acids and ammonias Leaves salt residue Corrosive to metals (some ready-to-use products may be formulated with corrosion inhibitors) Unstable active (some ready-to-use products may be formulated with stabilizers to achieve longer shelf life) Affected by organic matter Discolors/stains fabrics Potential hazard is production of trihalomethane Odor (some ready-to-use products may be formulated with odor inhibitors). Irritating at high concentrations.

CIDEIM

William A. Rutala_ISHAIs 2015

Alcohol Rutala, Weber. Am J Infect Control 2013;41:S36-S41

Advantages  

  



Bactericidal, tuberculocidal, fungicidal, virucidal Fast acting Non-corrosive Non-staining Used to disinfect small surfaces such as rubber stoppers on medication vials No toxic residue

Disadvantages          

Not sporicidal Affected by organic matter Slow acting against non-enveloped viruses (e.g., norovirus) No detergent or cleaning properties Not EPA registered Damage some instruments (e.g., harden rubber, deteriorate glue) Flammable (large amounts require special storage) Evaporates rapidly making contact time compliance difficult Not recommended for use on large surfaces Outbreaks ascribed to contaminated alcohol

CIDEIM

William A. Rutala_ISHAIs 2015

Phenolics Rutala, Weber. Am J Infect Control 2013;41:S36-S41

Advantages  Bactericidal, tuberculocidal, fungicidal, virucidal  Inexpensive (in dilutable form)  Non-staining  Not flammable  EPA registered

Disadvantages  Not sporicidal  Absorbed by porous materials and irritate tissue  Depigmentation of skin caused by certain phenolics  Hyperbilirubinemia in infants when phenolic not prepared as recommended

CIDEIM

William A. Rutala_ISHAIs 2015

Improved Hydrogen Peroxide Rutala, Weber. Am J Infect Control 2013;41:S36-S41

Advantages  

 

   



Bactericidal, tuberculocidal, fungicidal, virucidal Fast efficacy Easy compliance with wet-contact times Safe for workers (lowest EPA toxicity category, IV) Benign for the environment Surface compatible Non-staining EPA registered Not flammable

Disadvantages  More expensive than most other disinfecting actives  Not sporicidal at low concentrations

CIDEIM

William A. Rutala_ISHAIs 2015

LECTURE OBJECTIVES Review the role of the environment in transmission of nosocomial pathogens Review the properties of an ideal disinfectant Review the key considerations for selecting the ideal disinfectant

       

Kill Claims Kill and wet-contact time Safety Ease of use Other factors CIDEIM

William A. Rutala_ISHAIs 2015

Key Considerations for Selecting the Ideal Disinfectant for Your Facility Rutala, Weber. Infect Control Hosp Epidemiol. 2014;35:855-865

Consideration

Question to Ask

Kill Claims

Does the product kill the most prevalent healthcare pathogens

Kill Times and WetContact Times

How quickly does the product kill the prevalent healthcare pathogens. Ideally, contact time greater than or equal to the kill claim.

Safety

Does the product have an acceptable toxicity rating, flammability rating

Ease-of-Use

Odor acceptable, shelf-life, in convenient forms (wipes, spray), water soluble, works in organic matter, one-step (cleans/disinfects)

Other factors

Supplier offer comprehensive training/education, 24-7 customer support, overall cost acceptable (product capabilities, cost per compliant use, help standardize disinfectants in facility)

Score (1-10)

Note: Consider the 5 components shown, give each product a score (1 is worst and 10 is best) in each of the 5 categories, and select the product with the highest score as the optimal choice (maximum score is 50).

CIDEIM

William A. Rutala_ISHAIs 2015

SELECTION OF THE IDEAL SURFACE DISINFECTANT Kill Claims Disinfectants used in hospitals should be EPA registered  Hospital disinfectant must show activity against Salmonella, Pseudomonas and S. aureus  Label are very specific about their kill claims (1-10 min contact time)  Does the product kill the most prevalent healthcare pathogens including those that  Cause most HAIs  Cause most outbreaks  Are of concern in your facility 

CIDEIM

William A. Rutala_ISHAIs 2015

MOST PREVALENT PATHOGENS CAUSING HAI



Most prevent pathogens causing HAI (easy to kill)         

S. aureus (15.6%) E. coli (11.5%) Coag neg Staph (11.4%) Klebsiella (8.0%) P. aeruginosa (8.0%) E. faecalis (6.8%) C. albicans (5.3%) Enterobacter sp. (4.7%) Other Candida sp (4.2%)



Common causes of outbreaks and ward closures (relatively hard to kill)  

 

C. difficile spores Norovirus Rotavirus Adenovirus

CIDEIM

William A. Rutala_ISHAIs 2015

CIDEIM

William A. Rutala_ISHAIs 2015

CIDEIM

William A. Rutala_ISHAIs 2015

Key Considerations for Selecting the Ideal Disinfectant for Your Facility Rutala, Weber. Infect Control Hosp Epidemiol. 2014;35:855-865

Consideration

Question to Ask

Score (1-10)

Kill Claims

Does the product kill the most prevalent healthcare pathogens

10, 8

Kill Times and WetContact Times

How quickly does the product kill the prevalent healthcare pathogens. Ideally, contact time greater than or equal to the kill claim.

Safety

Does the product have an acceptable toxicity rating, flammability rating

Ease-of-Use

Odor acceptable, shelf-life, in convenient forms (wipes, spray), water soluble, works in organic matter, one-step (cleans/disinfects)

Other factors

Supplier offer comprehensive training/education, 24-7 customer support, overall cost acceptable (product capabilities, cost per compliant use, help standardize disinfectants in facility)

Note: Consider the 5 components shown, give each product a score (1 is worst and 10 is best) in each of the 5 categories, and select the product with the highest score as the optimal choice (maximum score is 50).

CIDEIM

William A. Rutala_ISHAIs 2015

SELECTION OF THE IDEAL SURFACE DISINFECTANT Kill and Wet-Contact Time  How

quickly does the product kill the prevalent healthcare pathogens?  Does the product keep surfaces visibly wet for the kill times listed on its label?

CIDEIM

William A. Rutala_ISHAIs 2015

Kill Times for Most Prevalent Pathogens Each disinfectant requires a specific time it must remain in contact with the microbe to achieve disinfection. This is known as the kill time or contact time  Some disinfectants may have a kill time for bacteria of 1m, which means bacteria on label disinfected in 1m  Other low-level disinfectants, often concentrated formulas require dilution, are registered by the EPA with contact time of 10m  Such a long contact time is not practical 

CIDEIM

William A. Rutala_ISHAIs 2015

Key Considerations for Selecting the Ideal Disinfectant for Your Facility Rutala, Weber. Infect Control Hosp Epidemiol. 2014;35:855-865

Consideration

Question to Ask

Kill Claims

Does the product kill the most prevalent healthcare pathogens

Kill Times and WetContact Times

How quickly does the product kill the prevalent healthcare pathogens. Ideally, contact time greater than or equal to the kill claim.

Safety

Does the product have an acceptable toxicity rating, flammability rating

Ease-of-Use

Odor acceptable, shelf-life, in convenient forms (wipes, spray), water soluble, works in organic matter, one-step (cleans/disinfects)

Other factors

Supplier offer comprehensive training/education, 24-7 customer support, overall cost acceptable (product capabilities, cost per compliant use, help standardize disinfectants in facility)

Score (1-10) 10, 8

Note: Consider the 5 components shown, give each product a score (1 is worst and 10 is best) in each of the 5 categories, and select the product with the highest score as the optimal choice (maximum score is 50).

CIDEIM

William A. Rutala_ISHAIs 2015

SELECTION OF THE IDEAL SURFACE DISINFECTANT Safety  Does

the product have an acceptable toxicity rating (danger, warning, caution, none)?  Does the product have an acceptable flammability rating?  Is a minimum level of personal protective equipment required?  Is the product compatible with the common surfaces in your facility? CIDEIM

William A. Rutala_ISHAIs 2015

DISINFECTANTS AND HEALTHCARE PERSONNEL SAFETY



Environmental (Low Level) disinfectants: Risks   



Environmental disinfectants: Protection for HCP  



Skin irritation (dermatitis) Allergies (including asthma) Rarely reported in US Proper PPE by HCP (gloves, gowns) Training for proper use and disposal

Training and PPE minimize risk

CIDEIM

William A. Rutala_ISHAIs 2015

Occupational Exposures to Disinfectants at UNC Health Care









In regard to skin or respiratory irritation and allergies in HCP, most studies refer to glutaraldehyde or formaldehyde; these products are not recommended for use on noncritical surfaces Surface disinfection in US generally accomplished by QUAT, phenolic, improved HP and chlorine We are evaluating all chemical exposures for ten years (20032012, ~9500 employees) and have rarely seen an employee in OHS with chronic respiratory complaint related to a low-level disinfectant (~30M persons days of exposure [Weber, Rutala, Consoli. 2013. Unpublished data]) Need well-designed immunologic evaluations of randomly selected HCP and controls, not case series without controls CIDEIM

William A. Rutala_ISHAIs 2015

Key Considerations for Selecting the Ideal Disinfectant for Your Facility Rutala, Weber. Infect Control Hosp Epidemiol. 2014;35:855-865

Consideration

Question to Ask

Kill Claims

Does the product kill the most prevalent healthcare pathogens

Kill Times and WetContact Times

How quickly does the product kill the prevalent healthcare pathogens. Ideally, contact time greater than or equal to the kill claim.

Safety

Does the product have an acceptable toxicity rating, flammability rating

Ease-of-Use

Odor acceptable, shelf-life, in convenient forms (wipes, spray, surface area wet for 1-2m; wipe not torn easily or fall apart), water soluble, works in organic matter, one-step (cleans/disinfects)

Other factors

Supplier offer comprehensive training/education, 24-7 customer support, overall cost acceptable (product capabilities, cost per compliant use, help standardize disinfectants in facility)

Score (1-10)

8, 9

Note: Consider the 5 components shown, give each product a score (1 is worst and 10 is best) in each of the 5 categories, and select the product with the highest score as the optimal choice (maximum score is 50).

CIDEIM

William A. Rutala_ISHAIs 2015

SELECTION OF THE IDEAL SURFACE DISINFECTANT Ease of Use   

   

Is the product odor acceptable? Does the product have an acceptable shelf life? Does the product come in convenient forms to meet your facility’s needs (refills, sprays, liquids; surface area wet for 12m; wipe not torn easily or fall apart)? Does the product work in the presence of organic matter? Is the product water soluble? Does the product clean and disinfect in a single step? Are the directions for use simple and clear? CIDEIM

William A. Rutala_ISHAIs 2015

Key Considerations for Selecting the Ideal Disinfectant for Your Facility Rutala, Weber. Infect Control Hosp Epidemiol. 2014;35:855-865

Consideration

Question to Ask

Kill Claims

Does the product kill the most prevalent healthcare pathogens

Kill Times and WetContact Times

How quickly does the product kill the prevalent healthcare pathogens. Ideally, contact time greater than or equal to the kill claim.

Safety

Does the product have an acceptable toxicity rating, flammability rating

Ease-of-Use

Odor acceptable, shelf-life, in convenient forms (wipes, spray), water soluble, works in organic matter, one-step (cleans/disinfects)

Other factors

Supplier offer comprehensive training/education, 24-7 customer support, overall cost acceptable (product capabilities, cost per compliant use, help standardize disinfectants in facility)

Score (1-10)

10, 7

Note: Consider the 5 components shown, give each product a score (1 is worst and 10 is best) in each of the 5 categories, and select the product with the highest score as the optimal choice (maximum score is 50).

CIDEIM

William A. Rutala_ISHAIs 2015

SELECTION OF THE IDEAL SURFACE DISINFECTANT Other Factors Does the supplier offer comprehensive training and ongoing education, both in person and virtual?  Does the supplier offer 24-7 customer support?  Is the overall cost of the product acceptable (considering product capabilities, cost of infections that may be prevented, and cost per compliant use?  Can the product help standardize disinfectants in your facility? 

CIDEIM

William A. Rutala_ISHAIs 2015

Key Considerations for Selecting the Ideal Disinfectant for Your Facility Rutala, Weber. Infect Control Hosp Epidemiol. 2014;35:855-865

Consideration

Question to Ask

Kill Claims

Does the product kill the most prevalent healthcare pathogens

Kill Times and WetContact Times

How quickly does the product kill the prevalent healthcare pathogens. Ideally, contact time greater than or equal to the kill claim.

Safety

Does the product have an acceptable toxicity rating, flammability rating

Ease-of-Use

Odor acceptable, shelf-life, in convenient forms (wipes, spray), water soluble, works in organic matter, one-step (cleans/disinfects)

Other factors

Supplier offer comprehensive training/education, 24-7 customer support, overall cost acceptable (product capabilities, cost per compliant use, help standardize disinfectants in facility)

Score (1-10)

8, 7

Note: Consider the 5 components shown, give each product a score (1 is worst and 10 is best) in each of the 5 categories, and select the product with the highest score as the optimal choice (maximum score is 50).

CIDEIM

William A. Rutala_ISHAIs 2015

Key Considerations for Selecting the Ideal Disinfectant for Your Facility Rutala, Weber. Infect Control Hosp Epidemiol. 2014;35:855-865

Consideration

Question to Ask

Score (1-10)

Kill Claims

Does the product kill the most prevalent healthcare pathogens

10, 8

Kill Times and WetContact Times

How quickly does the product kill the prevalent healthcare pathogens. Ideally, contact time greater than or equal to the kill claim.

10, 8

Safety

Does the product have an acceptable toxicity rating, flammability rating

8, 9

Ease-of-Use

Odor acceptable, shelf-life, in convenient forms (wipes, spray), water soluble, works in organic matter, one-step (cleans/disinfects)

10, 7

Other factors

Supplier offer comprehensive training/education, 24-7 customer support, overall cost acceptable (product capabilities, cost per compliant use, help standardize disinfectants in facility)

8, 7 46, 39

Note: Consider the 5 components shown, give each product a score (1 is worst and 10 is best) in each of the 5 categories, and select the product with the highest score as the optimal choice (maximum score is 50).

CIDEIM

William A. Rutala_ISHAIs 2015

LECTURE OBJECTIVES Review the role of the environment in transmission of nosocomial pathogens Review the properties of an ideal disinfectant Review the key considerations for selecting the ideal disinfectant

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Kill Claims Kill and wet-contact time Safety Ease of use Other factors CIDEIM

William A. Rutala_ISHAIs 2015

Selection of the Ideal Disinfectant Conclusions

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Disinfection of noncritical environmental surfaces/equipment is an essential component of Infection prevention Disinfection should render surfaces and equipment free of pathogens in sufficient numbers to cause human disease While the perfect disinfecting agent may not exist, a careful process of selection and use are necessary to reduce harm to patients and staff When determining the optimal disinfecting product, consider the 5 components (kill claims/time, safety, ease of use, others) Select the product with the highest score as the best choice for your healthcare facility CIDEIM

William A. Rutala_ISHAIs 2015

THANK YOU! www.disinfectionandsterilization.org

CIDEIM