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Friday, February 10, 2012

The Unintentional Consequences of Improving Infection Prevention

Would you select a single cleaning product to use on all surfaces in your home? One product to clean your stainless steel fridge, hardwood dining table, glass coffee table and leather sofa? If I were to hazard a guess, I would assume you’ve all responded with a resounding, “NO!!”. Am I right?

It seems obvious, why would we ever consider something so impractical as to expect a single chemical to be compatible with those various surfaces. So why is it that we have this expectation when disinfectants are used in commercial settings such as healthcare? The sad state of affairs is that disinfectants are expected to be 100% compatible with all surface materials and devices that they may be applied to. In reality, that is a chemical impossibility. Particularly so, when you factor in that disinfectants need to be formulated to kill the various classes of microorganisms in rapid and realistic contact times. No disinfectant is ever going to be compatible with every surface material we encounter in the vast world of healthcare.

So what then of compatibility issues that may crop up from the use of disinfectants? Well as the title implies, these are often the unintentional consequences of improving infection prevention. With the increasing prevalence of antibiotic resistant pathogens and more virulent strains of various microorganisms, the focus has shifted from being reactive in nature to that of a proactive, preventative position. With this comes the use of potentially more aggressive disinfectant chemistries to address these troublesome pests on an ongoing basis. As identified by the CDC and Ontario’s Provincial Infectious Disease Advisory Committee (PIDAC), disinfectants should ideally be effective against a broad spectrum of microorganisms, elicit this effect in a rapid and realistic contact time, remain safe to use (non-toxic and non-irritating) and carry wide material compatibility. The disinfectants that perform equally well across all criteria will prevail. However, compatibility issues are likely to still be encountered despite following PIDAC and CDC’s recommendations for the reasons listed earlier. What then?

Speaking from experience, it is often more than a case of “Solution A” being incompatible with “Surface B”. In the vast majority of situations, it is the process with which that disinfectant is used on that surface that determines if any ill effects are encountered. It is this process, or the art of cleaning and disinfecting as one might call it, that may need to be modified to mitigate the issue.

In those rare cases where the disinfectant solution is in fact incompatible with the surface material, alternatives to both(surface or disinfectant) should be investigated. The alternative selected should be based upon which choice reduces the level of compromise needed. Will a different surface or device serve the same purpose without the disinfectant needing to be changed? Or, if the disinfectant needs to change, can the alternative fulfill the same performance and safety profiles? Or, is it a case where the alternatives require too great a compromise and the “incompatibility” becomes a cost of doing business in today’s world?

If you were faced with such a situation, how would you address it?

The Germinator

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