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Friday, December 6, 2013

Cotton - it absorbs more than just water!

Bath towels, dish cloths, T-shirts and socks made of cotton have one thing in common - absorbency.  Whether it is wicking the water off after we shower, the sweat during and after a workout or wiping up the spills of water or milk we so frequently seem to have at my dinner table, many of us turn to cotton in some form. 

While microfiber is making in-roads, cotton terry cloth towels are still very prevalent as the cloth of choice for cleaning and disinfection within healthcare facilities.  Infection Prevention and the Product Selection Committee spend hours reviewing disinfecting products weeding through the attributes of the various chemistries, ensuring that they have the list of efficacy claims (the kill list) to meet the facilities' needs etc.   However, in focusing on what a product kills is there any consideration as to what impact the materials housekeeping uses to clean with will have on the efficacy of the product?  I think not.

In the October 2013 edition of AJIC, Koenig et al published an article titled "Decreased activity of commercially available disinfectants containing quaternary ammonium compounds when exposed to cotton towels".  As noted in the study poorly cleaned surfaces have been identified as being a potential reservoir for pathogens and may be the cause of many healthcare associated infections.  Numerous studies have shown that effective cleaning (and disinfection) is necessary to reduce the risk of HAIs.  Disinfectants are an important aspect in reduction of pathogens so reduction in performance of a disinfectant could play a significant role in allowing transmission to occur.

The truth is that is the negative impact on efficacy of Quats by either dilution with hard water and/or exposure to cotton cloths has been known for some time.  Koenig et al investigated the reduction of Quat concentration resulted from the use of cotton and microfiber cleaning towels and the impact this reduction would have on disinfectant performance.  The results were indeed scary. 

First the good news, it would appear in this study that exposure to microfiber cloths did not have an impact on the Quat concentration and that the products tested retained their full germicidal efficacy.  Cotton on the other hand did not fare so well.  Exposure of the Quat products tested resulted in a reduction of Quat concentration by 88.9% within 30 seconds of being exposed to cotton!    Excuse ME!?  That would leave only 11.1% of the actual concentration of Quat needed, tested and approved by the EPA to achieve disinfection.  In fact, when the researchers tested the efficacy of the Quat solution after exposure to cotton towels they all failed!  They were unable to meet the level of kill needed to be registered by the EPA as a hospital grade disinfectant. 

I'm not saying that Quats are bad.  BUT, this study certainly highlights the fact that we need to take more into consideration than just what a product kills, what the cost of a product is and what the material compatibility of a product is.  The impact and cost to a facility due to HAIs is very real.  I think Koenig et al have done an excellent job in highlighting the fact that when choosing a disinfectant the process by which a disinfectant will be used must also be taken into consideration and further research into potential interactions between the disinfectant and cloth choose to apply the product also needs to be considered.  Particularly if concerned about reducing HAIs and providing the safest environment for our patients as possible.

If you use Quats at your facility, I hope you'll run down to Environmental Services to see what type of cloth is being used.  Perhaps your current VRE or MRSA outbreak etc is not due to poor cleaning, but due to the fact that while the name of the product may contain the word "Disinfectant" the cleaning process you are using may counteract and inhibit the ability for disinfection to actually occur.

Bugging Off!



  1. Is this also true for other types of disinfectants? For example, is the type of cloths also affecting the use of accelerated hydrogen peroxide disinfectant, such as the Virox products?

  2. How are quats effected by paper towel use, no effect, none known?