Often we allow ourselves to get all worked up about things that, upon closer examination, aren't really that big a deal. We focus on little problems and blow them out of proportion. In the world of infection prevention and control we see this time and time again.
Infection prevention and control is not black and white nor is it one size fits all. It would certainly make our lives easier if it were, but the truth of the matter is that the environmental hygiene processes used to prevent infections will differ from region to region and facility to facility depending on the patient population and underlying disease or pathogen prevalence. As such the selection and use of liquid chemical disinfectants is largely a matter of judgement based on the facilities needs.
Example #1 Sweating over a TB claim
One common misconception with respect to label claims is the purpose of a tuberculocidal claim. Historically, tuberculocidal claims have been used as the benchmark of a product's ability to inactivate a broad-spectrum of pathogens including the far less resistant bloodborne pathogens (e.g. Hepatitis B or C and HIV). It is this broad-spectrum capability that was the original basis for OSHA's regulations for bloodborne pathogens. However OSHA revised its stance in 1991 to specify that disinfectant products that carry efficacy claims against HIV and Hepatitis B (HBV) are indeed appropriate for managing blood and body fluid spills.
EPA registered disinfectants with efficacy claims against HIV and HBV or appropriate for use in cleaning and disinfecting surface that are contaminated with blood and body fluid. Bloodborne pathogens we are concerned with are enveloped EASY TO KILL viruses. EPA registered disinfectant labels include explicit directions for how they can be used against bloodborne pathogens on their EPA approved label.
JUST FOLLOW THEM!
Example #2 Sweating over Multiple Contact Times
Varying times listed on a disinfectant's label for efficacy against various bacteria, viruses, fungi, and mycobacteria causes angst within the Infection Prevention and Control community because it is believed by some that the longest kill time on the product as the required wet/contact kill time. The truth is that surfaces contaminated with organisms such as Candida, non-tuberculosis mycobacteria and other fungi have rarely, if ever, been shown to be a risk factor for healthcare-associated infections. Products with Fungicidal claims can be relevant when supporting a claim for broad-spectrum disinfection and can be of interest in situations such as mold or fungal remediation, however, their relevance to infection prevention and environmental transmission of disease is minimal.
The CDC Guideline for Disinfection and Sterilization in Healthcare Facilities refers to the time necessary to kill bacteria on surfaces (i.e., 1 minute) not the kill time for more difficult to inactivate pathogens such as Mycobacterium tuberculosis which doesn’t even have an environmental surface mode of transmission. When it comes to disease prevalence, experts all agree that the primarily causative organisms are either bacteria or viruses and that the pathogens of concern moving forward will continue to be bacteria or viruses. Vegetative bacteria such as S. aureus, Enterococcus, Eschericihia coli, coagulase-negative Staphylococcus, Pseudomonas aeruginosa, Klebsiella spp, Enterobacter spp, etc and viruses such as Influenza and the more difficult to kill Norovirus are the pathogens that cause the vast majority of healthcare-associated infections. In fact studies have shown these organisms to cause upwards of 85-90% of HAIs. (Rutala 2012)
When choosing a disinfectant product, ask yourself: what is relevant to my facility and my patients? If your surveillance and outbreak data reflects the fact that 90% of your concerns are due to vegetative bacteria and viruses, focus your attention on a disinfectant formulation that provides you with a responsible balance between effectiveness - broad spectrum coverage against gram negative and gram positive vegetative bacteria and both enveloped and non-enveloped viruses; and minimal toxicity – results in greater user compliance.