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Wednesday, October 2, 2013

A New Claim on the Block?

For years, consumers have been striving to rid their homes of odour eating bacteria.  I'm sure that if you were to check under your sink or where ever you keep your cleaning supplies you would find a spray bottle that claims to kill odours on contact.  If you dig deep enough you may also find something that you can use to clean and sanitize your carpets or other fabrics -  you know the one you bought when you were house training your dog?

The concept of soft surface sanitizing has been around for some time and widely used by us in our homes as a mean to rid ourselves of nasty odours.  However the concept of sanitizing soft surfaces within the healthcare market is relatively new and our focus is not to rid ourselves of offending odours but to try and kill pesky pathogens from surfaces than may contribute to transmission of disease.  First off, infection prevention within healthcare focuses on disinfection of environmental surfaces and patient care equipment.  We need to kill significant numbers of the germs that are the cause for hospital infections such as bacteria, viruses and fungi.   EPA registered disinfectants allow us to do just that.  BUT, EPA registered disinfectants are intended for use on hard, non-porous surfaces (beds, tables, toilets, Infusion pumps etc) that do not absorb disinfectants and can be "easily" cleaned and disinfected (at least according to the EPA definition..).  In designing healthcare facilities great care is taken when choosing finishes and equipment to ensure that we can clean and disinfect thereby effectively minimizing the transmission of germs.

Where then in the realm of infection prevention do soft surfaces fit in?  Well, until recently when researchers started investigating if soft surfaces such as privacy curtains contributed to infection transmission everyone's stance was "change when visibly soiled".  I suppose the ugly truth was we ignored one of the most highly touched surfaces in a patient room because we did not know what to do with it!  The science being published today is showing that pathogenic germs can be found on privacy curtains.  There has not been a study that I am aware that conclusively blames privacy curtains for transmitting infections or being the root cause of an outbreak, but I suppose, if touched enough by HCWs and said HCWs did not clean their hands after touching the environment (privacy curtains count!) then.......it could be plausible. 

Enter stage left, the new claim on the Healthcare block - Soft Surface Sanitizing.  It's important for HCWs to understand, sanitizing DOES NOT equal disinfection.  Sanitizing means you reduce the number of Vegetative Bacteria on a surface usually by 99.9%.  Sanitizing claims DO NOT allow for claims against viruses.  Further, to make such a claim (at least according to the EPA), testing needs to be done on ALL of the soft surfaces you wish to use it on.  The type of fabric may impact the ability of a chemical to kill so testing on 100% cotton or 100% polyester only may not cover the plethora of fabrics we see with in a healthcare facility.

It is important that HCWs, especially those in infection prevention or environmental services understand the distinction between disinfection and sanitizing claims.  Certainly such a claim has merit, but if you choose to implement a product with a soft surface sanitizing claim as part of your infection prevention program do not think that it is the silver bullet for stopping the spread of germs.  Sanitizing will reduce the level of germs of the surface.   But, sanitizing soft surfaces such as privacy curtains does not negate the need for proper hand hygiene or continued vigilance in cleaning and disinfection of environmental surfaces and patient care equipment AND the use of a soft surface sanitizer does not negate the need for laundering! 

In the end, it will be interesting to see if researchers can build the science to conclude that such a claim will in fact make a difference from an infection prevention perspective, but don't get caught in the noise and hype of marketing and advertising.  I've seen data to show that wiping or spraying a privacy curtain can reduce bioburden.  In theory, reduced bioburden on curtains may help to reduce the risk for transmission, but hand hygiene will still by far be the most effective means to reduce transmission.  This New Claim on the Block will certainly "legally" allow chemical manufacturers to paint a pretty picture of how their products can be used and in talking with some healthcare facilities that have been cited for using a "disinfectant intended for use on hard, non-porous surface" on a porous or soft surface you will now be able to state that your product is appropriate for use on soft surfaces.  But, be sure to tell that Joint Commissions auditor that soft surface disinfectants do not exist. 

The question I have is if the new claim on the block will be like the boy band New Kids on the Block?  Will it fizzle out after its moment in the starlight or will it truly make a difference and be an important part of a well managed infection prevention program?  For me, the jury is still out, but I suppose that it is in part as intuitively if you spray any disinfectant onto a soft surface ensuring it is damp and allow the appropriate contact time common sense would dictate that you're going to kill at least some of the germs on the surface would it not?

Bugging Off!


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