In the world of cleaning and disinfection, the science or proof some people rely on cannot keep up with the myriad of new products or processes that enter the market place. Does this mean that one should not consider changing products or processes until such time as there is statistically significant information published about these new products or processes? Most definitely not!
Let’s consider the pre-moistened disinfectant wipe. Are they new to the market? NO. Have they been used successfully at many facilities across the globe? YES. To ensure a successful infection prevention program, do we need to consider how to use them correctly to ensure the desired outcome? MOST DEFINITELY!
In a recent infection prevention and control guideline for environmental cleaning and disinfection the following statement was included:
“Disinfectant wipes should be used by the primary care giver for point of care cleaning and disinfecting of patient equipment. They should not be used as a routine cleaning disinfectant tool.”
Admittedly, for the sake of keeping the blog to a reasonable length, I have not included the entire section, however, should you take the time to read the guideline, you will find that it is vague and without any references to support its justification. While I agree wholeheartedly that all disinfectants must be used appropriately, the danger in making such a statement is that there is no strong scientific evidence to conclusively limit the use of pre-moistened wipes at this time. Perhaps instead, there should have been a more detailed discussion about the appropriate use of pre-moistened disinfecting wipes to ensure that they are used in such a fashion as to ensure contact time in accordance to the label is met. Many of the leading pre-moistened wipes available on the market are Quat-alcohol based products with anywhere from 2 to 5 minute contact times. As proven by science, such products will not remain on the surface for the contact time listed on the label as a result of the rapid evaporation rate of alcohol. In fact a study published by Omidbakhsh in 2010 in the Journal of AOAC International investigated the discrepancy between drying time and contact time with respect to product efficacy. Additionally, there have been publications investigating the effects of wipes in contaminating surfaces providing compelling evidence that we want to use 1 wipe for each surface especially if using a weak or slow-acting disinfectant in the wipe where the true chances of achieving disinfection are limited at best.
That said, proper disinfection with such wipes can be achieved with the physical action of wiping provided the disinfectant itself has a good and rapid broad-spectrum microbicidal activity. Therefore, there has to be a change in our thinking with regards to contact time for wipes as opposed to longer contact times needed when just spraying or pouring a liquid on surfaces. Perhaps the conclusion should be that in choosing a pre-moistened disinfectant wipe, one must consider more than just the cost per wipe. There needs to be a more fulsome investigation as to the number of wipes needed to achieve the contact time as listed on the label. We need to review how the wipes will be utilized to ensure that good physical friction will be applied to help in removal of the pathogens from the surface, as well as frequent changing of such wipes to avoid redistributing the removed pathogens. Lastly, one cannot discount the size of the wipe. Certainly, the traditional wipes used in clinical areas for disinfecting patient care items such as BP Cuffs or Stethoscopes would not be recommended for use by Environmental Services due to their smaller size, however, most companies specializing in pre-moistened wipes provide larger options (10x10 inches or 12x12 inches) which are more than adequate for cleaning larger surfaces sizes.
Perhaps the use of pre-moistened disinfectant wipes is no different than the use of antibiotics? When prescribing antibiotics you need the right drug at the right concentration for the right length of time. For pre-moistened wipes you need the right claims, the right contact time and the right size to do the job.
So….am I off my rocker?