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Thursday, September 29, 2011
By now, you are either thinking I am completely off my rocker, or you have deduced that the door is the metaphor for bacteria, the sledgehammer is portraying disinfectants, the key is playing the part of antibiotics and the focus of this blog is whether antibiotic resistance equates to chemical resistance.
The answer to this question is a resounding NO, but rather than take my Coles Notes version for gospel, let’s look at the facts.
Fact #1: Antibiotics have very specific targets where they attack the bacteria just as a lock needs a specific key in order to open. Any changes to the bacteria can make to the target renders the key ineffective.
Fact #2: Antibiotics, while useful, have limits to the concentration that can be used before it will cause harm to the patient. If the bacteria adapts to the therapeutic dose it can become resistant.
Fact #3: The development of antibiotic resistance has been seen to occur within a few years after the introduction of a new antibiotic.
Fact #4: Disinfectants are not specific in their attack, hence a sledgehammer being a perfect metaphor. This makes development of resistance much more difficult.
Fact #5: Disinfectants are used at concentrations far more potent (100 – 10,000 times) than the minimum inhibitory concentration (MIC) making if far more unlikely for bacteria to develop resistance.
Fact #6: Disinfectants have been used for well over 100 years without loss of effectiveness. While there is a hierarchy with respect to some bacteria such as spore-formers or Mycobacteria spp. being less susceptible to chemicals that their gram negative or gram positive cousins, there is no current scientific evidence that supports that antibiotic resistant organisms are more resistant to disinfectants.
In a later blog we will talk further about the development of chemical resistance, but for now we can feel confident that whether we are talking MRSA, VRE, ESBLs, MDR-Pseudo, MDX-TB or CRE the disinfectant you are currently using against the susceptible strains will still be effective against the antibiotic resistant strains.
Thursday, September 22, 2011
In June of 1998 my opinion on the common practice of spraying chemicals (cleaners and disinfectants) was forever changed. I hope my story will change yours.
My facility had a visit from an OSHA Inspector in June of 1998. In the course of the inspection, the OSHA inspector mentioned to me about spray-triggers creating an atomized mist of the disinfectant that was being inhaled into the lungs of my staff. He asked me, “Are you aware that it is an occupational hazard for housekeepers to be breathing disinfectants or other cleaning chemicals into their lungs?” I replied, “Yes, I have read about that happening but it is a rather small population of housekeepers that have developed chronic lung diseases.” That’s when he pointed to the “FREE FROM RECOGNIZED HAZARDS that are causing or likely to cause death or serious physical harm to his employees” in the General Duty Clause.
As I and my facility learned the hard way, the General Duty Clause states: “Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.” This particular OSHA Inspector interpreted this to include the use of disinfectants in particular when they are being sprayed.
When it comes to the use of cleaners and disinfectants we live in a cavalier world where “spray and walk away” is the standard mentality. We are inundated with commercial imagery of spraying chemicals to clean our kitchens, our bathrooms, our carpets and even our laundry. This widespread acceptance of spraying chemicals transitions to schools, office buildings and hospitals. It is commonplace in our homes so why be concerned about spraying at work? While I was aware of some research indicating that spraying chemicals could be a health concern, spraying is still very much an accepted practice in facilities across North American.
Many cleaning agents, including disinfectants, can cause mucosal membrane irritation leading to several respiratory symptoms including rhinitis, cough, and shortness of breath. Epidemiological studies have shown that housekeeping staff are at increased risk of asthma, chronic bronchitis, and other respiratory symptoms.
The end result of my story is that I got educated and the hospital paid a hefty fine. We no longer allow disinfectants or any cleaning chemicals in a bottle with a spray-trigger.
My new mentality towards the use of cleaners and disinfectants is that ANY chemical that states on the label or in the MSDS that “inhalation” is a primary route of entry should be dispensed or applied from a bucket or flip top bottle rather than a bottle with a spray-trigger attached to it. I no longer worry that my housekeepers are breathing something into their lungs that might turn out to be “Breath-taking”. Can you say the same?
J. Darrel Hicks, BA, REH, CHESP
Author of “Infection Prevention for Dummies”
Go to: www.darrelhicks.com to order your FREE copy of “Infection Prevention for Dummies” (just pay S&H) or to see other blogs and articles.
Darrel Hicks is the author of Wiley Publishing's "Infection Control For Dummies", and is nationally recognized as one of the top experts in infection control. Darrel is also the immediate Past President of the IEHA and is an active member in ASHES where he holds the designation of CHESP. Darrel started his career in the management of housekeeping services in 1981. He has worked in hospitals ranging in size from 20-500 beds, and knows what it takes to plan, set goals and provide guidance and consultation to the management team and department(s) staff. He has managed as many as 13 departments and 170 F.T.E.’s at one time in a 3-hospital system. In that healthcare system Darrel had to pioneer and discover ways to save money by cross training staff, job sharing, controlling overtime and putting a system of controls in place.
Wednesday, September 14, 2011
Hasta la vista!
Lee – The Germinator
Wednesday, September 7, 2011
Much to my dismay, the following image is almost iconic in the Canadian Infection Prevention arena. You may be thinking “but a picture tells a thousand words” and while in many cases that may be true, when the picture is flawed, mistakes can occur and in some cases these mistakes can be darn right dangerous!
Before I point out the flaw, let me tell you a true story. Several years ago, I received a call from a Daycare Facility in the midst of a Norovirus outbreak. The Daycare facility had been visited by their local Public Health Inspector and instructed to purchase a High Level Disinfectant to use for cleaning and disinfecting all surfaces and all toys in the facility. Being a contentious Daycare Facility, they followed the instructions of the Public Health Inspector and went out and bought a High Level Disinfectant.
Thankfully, being a contentious Daycare Facility, they READ the label before they use the disinfectant product and when they READ the label of the High Level Disinfectant they bought they could not make heads or tails of how to use for cleaning and disinfection of the surfaces and toys in their facility. Wanting to ensure they used the product correctly, they called me and to make a long story short….I told them they had the wrong product.
I hope by now, you have figured what the flaw is. High Level Disinfectants are NOT intended for use on environmental surfaces, non-critical devices or toys!!!
By definition, a High Level Disinfectant is used for disinfection of Semi-Critical Devices (items that come in contact with mucous membranes or non-intact skin). High Level Disinfectants are designed for soaking semi-critical devices (hence the reason the Daycare Facility could not determine how to use the product for wiping surfaces). Contrary to the much loved image above, there is NO such thing as a High Level Disinfectant for environmental surfaces, non-critical devices or toys. The Public Health Inspector should have instructed the Daycare Facility to purchase a disinfectant that carries a label claim against Norovirus.
The moral of this story, as with any story involving disinfectants is READ the label before you use a product and if you do not understand the label – ask for help. I suppose a second moral would be NEVER, EVER let me hear the words High Level Disinfection in conjunction with environmental surfaces, non-critical devices….or toys!