Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

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Thursday, March 28, 2013

Burnt Bums Call for Ban on Disinfectants

A friend recently forwarded me a link to an article published on the CTV News website asking me to provide my comments about the use of disinfectants in daycares and schools.  The gist of the article is that several children ended up with burnt bottoms after using the washroom at a school in Ontario, Canada.  This was apparently the second incident - 3 months prior a 6 year old girl received severe blisters.

As a result of this incident parents were calling for the school board to ban the use of the disinfectant and asking for answers as to how harmful chemicals can be approved for use around children.  The product in question is a concentrated quaternary ammonium that is diluted prior to use. The school board has verified that the product was diluted correctly but indicated that residue was found on the toilet seats.   According to a professor at the University of Ottawa the cause of the burns was not from with direct contact to the dispensed product  itself, but from the residue left on the toilet seat after the disinfectant was left to air dry.  It is believed that the humidity from the students' skin when in contact with the residue was enough to reconstitute it causing the burns.

As a mother of a four year old who has been in daycare since he was 9 months old, banning the use of disinfectants or sanitizing agents in daycares or schools would be an infection prevention nightmare. Children are germ factories.  They touch everything and their level of personal hygiene is questionable at best!  The use of disinfectants and sanitizing agents is a necessity; however, I would agree that they do not need to be used on every surface.   While a one-product for all, mentality, may simplify training and supply management it is best to use disinfectant and sanitizing agents in a targeted manner on the high-touch surfaces such as faucet handles, toilets, door knobs etc. Keep their use to the areas and the surfaces that need them most. 

Now this doesn't resolve the issue of the burnt bottoms as I do agree we need to use a disinfectant or sanitizing agent, however, it leads us to the next focus of investigating the products that are approved for use in schools.  The Green Schools Initiative in partnership with the Green Purchasing Institute have published a guidance document "Use Safer Disinfectants and Disinfecting Practices" that includes some very salient points when it comes to choosing a disinfectant for use in schools.

1. Consider using registered disinfectants that contain hydrogen peroxide, citric acid or thymol as their active ingredient as these chemicals have safer occupational health and safety and environmental profiles.

2. Avoid disinfectants that contain active ingredients that are known asthmagens such as o-phenylphenol, bleach, quaternary ammonium compounds.

3. Investigate inert ingredients within the formulation to ensure they too are not hazardous.

4. Target the use of disinfectants and sanitizers to areas that require them - high touch surfaces, food contact surfaces etc

5. If using a concentrate, chose products that are available in containers that can be used with automated dilution solutions to ensure products are diluted correctly.

6. Follow manufacturers' Use Instructions - if the product requires a rinse following application, RINSE IT OFF!

7. Avoid the use of disinfectants that are known carcinogens  (State of California lists o-phenylphenol as a chemical known to cause cancer).

While I can't state with certainty what truly caused the burnt bums, if as they suspect the cause was a result of residue left on the seats of the toilets perhaps rather than calling for a ban on the use of  disinfectants and sanitizing agents in schools perhaps the better alternative is to lobby for the use of disinfectants and sanitizing agents that do not leave harmful residues behind.  For example, hydrogen peroxide breaks down into water an oxygen - that sounds pretty safe to me!

Bugging Off!

Friday, March 22, 2013

Disinfectant Chemistry Report Card #12 – Glutaraldehyde - Should it's use be continued?

Glutaraldehyde (GLUT) or 1,5-pentanedial is one the most commonly used disinfectant ingredients from the family of aldehydes. Glutaraldehyde is a biocide with broad spectrum of activity including sporicidal activity. However, it is also a protein fixative, therefore the surfaces soiled with protein based soils like blood must be pre-cleaned with a detergent solution prior to their exposure to glut; otherwise the blood soils will be fixed on the instrument.

Upon introduction in the early 1960's, GLUT was thought to be a safer and more effective replacement to be used in disinfectants particularly due to its efficacy and use for high level disinfection and chemical sterilization.  More recently resistance development has been seen in certain Mycobacteria stains, such as M. chelonei , when used as a 2% solution for endoscope disinfection. The use of glutaraldehyde in the medical sector has revealed serious and wide ranging health risks to operators including dermatitis (allergic reactions to the skin), rhinitis, conjunctivitis and asthma.  Long term exposure to GLUT at use dilutions (2 - 8%) is known to cause irritation of skin and lungs of the end users. Due to such respiratory issues, GLUT must be always used in closed chambers with ventilation. Mutagenicity has been reported in certain strains of salmonella, when exposed to GLUT solutions.

Glutaraldehyde is considered to be readily biodegradable and while its biodegradation products are known to be less toxic, glutaraldehyde itself is highly toxic to algae and moderately toxic to aquatic animals. 

Here’s how we would score Glutaraldehyde on the key decision making criteria:

• Speed of Disinfection – B to C

o High Level Disinfection within 10 - 60 minutes
o Sporicidal contact time required to achieve chemical sterilization is 6 - 12 hrs

• Spectrum of Kill – A

o Achieves disinfection against all microorganisms; bacteria, viruses, fungi, mycobacteria and spores

• Cleaning Effectiveness – N/A

o No detergent properties; in fact due to its fixative nature it can stain proteins to the surface and act as a staining agent.
o High Level Disinfection and Chemical Sterilization requires instruments to cleaned prior to moving to the disinfection or sterilization process

• Safety Profile – D

o Use of glutaraldehyde has revealed serious and wide ranging health risks including dermatitis (allergic reactions to the skin), rhinitis, conjunctivitis and asthma
o Requires special ventilation requirements to ensure exposure limits set by the Occupational Health & Safety Act are not exceeded

• Environmental Profile – D

o Restrictions in disposal
o Concerns with Environmental Toxicity

• Cost Effectiveness – B to C

o Products are available from a number of suppliers

**For more in-depth scientific information about Alcohol and other disinfectant chemistries, stay tuned to www.infectionpreventionresource.com.

Bugging Off!


Thursday, March 14, 2013

The scoop on C.diff poop!

The past Monday, APIC held the 2013 Clostridium difficile Educational and Consensus Conference in Baltimore, MD.   Coming from Toronto, I'll say right off the bat, it was WONDERFUL to spend 3 days at 15-16C (58 - 600F) and the crab cakes were delicious too!

The conference was held over 2 days with the intent to building consensus for C. difficile infection prevention and control by providing a forum for discussion and exploration of how healthcare professionals and government agencies can prevent and control the spread of C. difficile to improve patient outcomes and also unveiled the new Guide to Preventing Clostridium difficile Infections (APIC 2013).   Presentations covered everything from the epidemiology of C. difficile, testing methods for detecting C. difficile, Environmental Cleaning, Hand Hygiene and Antibiotic Stewardship. 

I would be typing forever, if I tried to capture all of the key messages that were presented, so for brevity sake the following summarizes the real "So-What" moments that resonated with me:

1. Alcohol Based Hand Sanitizers should not be used for Hand Hygiene unless  used as an adjunct after washing ones hands with soap and water.

2. Studies comparing differing hand hygiene products found that many fared no better than tap water in removing C. difficile spores and that C. difficile spores are more difficult to remove from hands than other representative spores such as Bacillus sp.

3. Activities around the prevention and control of C. difficile have increased, however we are not seeing a correlating decrease in HAIs.  This could be in part as often times our prevention and control activities may focus on the low hanging fruit and facilities that have been very successful in reducing their C. diff rates have taken a bundle approach tackle all areas responsible for infection and transmission (cleaning, hand hygiene, antibiotic stewardship, surveillance etc).

4. Environmental cleaning has been a primary focus for many facilities, however, it appears that many facilities have not contemplated the role of nursing in cleaning and disinfection. Educating nursing staff on how to clean and disinfect correctly is as important as training housekeeping staff.
5. Antibiotic Stewardship is a MUST!

6. When moving from the EIA (enzyme immunoassays) to NAAT (Nucleic Acid AmplificationTest) test methods you need to expect to see an increase in cases of C. diff.  It's not that the facility has more C. diff, but that the NAAT test method is far more sensitive in identifying C.diff.

7. There is a dog named Cliffe that has been trained to sniff poop and identify whether or not it contains C.diff. I kid you not!

I think Dr. Erik Dubberke summed up the whole premise of infection prevention and control perfectly with a quote from Ralph Waldo Emerson "Do not go where the path may lead, go instead where there is no path and leave a trail". Yes, we have guidelines and best practices, but sometimes in preventing the spread of infection we need to think outside of the box and not be afraid to challenge the norm.

Bugging off!

Friday, March 8, 2013

For the love of education!

As we have tried to highlight through the Talk Clean To Me blog, the Clean Freaks have a passion for educating anyone and everyone when it comes to infection prevention and the use of cleaning and disinfecting chemicals.  One other way we try to support education on a global basis is through an annual sponsorship of Webber Training Inc. The Teleclass Education by Webber Training is an international lecture series on infection prevention and control topics. The objective is to bring the best possible infection prevention and control information; to the widest possible audience; with the fewest barriers to access. 

We wanted to share the list upcoming topics for March and April so that our followers who may not be aware of this incredible program may check it out and of course, we hope join in!

March 11th
Speaker: Dr. Stephen Brecher, PhD, VA Boston Health Care System

March 12th
Speaker: Phenelle Segal, RN, CIC, Infection Control Consulting Services

March 14th
Speaker: Dr. Dick Zoutman, Queen’s University, Canada

March 21st
Speaker: Ginny Lipke RN, MHA, ACRN, CIC , Centers for Disease Control, Atlanta

April 9th
Speaker: Prof. John Boyce, Yale University, Connecticut

April 11th
Speaker: Dr. Shamsuzzoha Babar Syed, WHO African Partnerships for Patient Safety, Geneva

April 18th
Speaker: Martin Kiernan, Southport & Ormskirk Hospital NHS Trust

April 25th
Speaker: Prof. Bill Rutala, University of North Carolina

For more information on Webber Training including upcoming Infection Prevention and Control Teleclasses, please visit www.webbertraining.com
In support of the Webber Training Teleclass program, the PTS Team is giving away an annual membership subscription the 2013 Teleclass line-up.  The first reader to comment back on the Talk Clean To Me blog telling us why you follow the blog and what your favorite blog is so far has been will receive the membership for free!

Bugging Off!

Friday, March 1, 2013

ATTENTION LADIES! There is scientific proof of why men should put the toilet seat down!

I think at some point we have all been in the argument as to who should be the responsible party for putting down the toilet seat.  My stance is of course, that it is the responsibility of the man who lifted it in the first place!  As I am now the only female at home, I think I will be running into a losing battle where 2 votes beat 1 vote every time.... I think however, after reading a study that was published last January in the Journal of Hospital Infection (JHosp Infect. 2012;80:1-5) that I may have found an ace that will give me the upper hand.

The researchers (Best, Sandhoe, and Wilcox) sought to quantify the level of contamination of environmental surfaces, particularly with Clostridium difficile spores, caused by the flushing of a lidless toilet. Toilet facilities in healthcare settings vary widely, but patient/resident toilets are commonly shared and typically do not have lids. When a toilet is flushed without the lid closed, aerosol production may lead to surface contamination within the toilet environment.

Using an inoculum of C. difficile spores representative of the average bacterial load present in Clostridium difficile infection (CDI), they study investigated the level of contamination in the environment after flushing. As one would expect, the highest levels of C. difficile were recovered immediately following flushing, and then declined significantly after 60 minutes and continued to decline over time. The highest bacterial counts were detected at the level of the toilet seat.  But perhaps most interesting they were able to find C.diff at heights of up to 25cm above the toilet seat, and also on the floor and other surfaces surrounding the toilet, demonstrating that water turbulence during flushing can force droplets out of the toilet bowl and into the air. YUCK!

While only one toilet was used for the study, I think it clearly shows the ability for environmental contamination associated with toilet flushing and highlights not only the imperative for hand washing after toilet use, but also the need for frequent cleaning of bathrooms to remove contamination.  There will certainly be differing results based on the type of toilet, but regardless, I think the study demonstrates that when planning renovations or designing new facilities we may want to consider adding toilets that do not create aerosols to the check list for items to consider!

As the study demonstrated, lidless conventional toilets may increase the risk of C. difficile environmental contamination, leading the authors to suggest that their use is discouraged, particularly in settings where CDI is common.   Certainly, if lids are fitted to current toilet models they will help limit the environmental contamination, but will very likely become contaminated themselves up on flushing. 

I'm all for minimizing environmental transmission, but I'm not sure I can handle having to lift the lid of a public toilet now that I know it is going to be contaminated with someone else's stuff. It puts an on-going family joke over pee-pee water to a whole new level!

Bugging Off!

PS - The Association for Professionals in Infection Control and Epidemiology (APIC) is hosting a 2-day conference on March 11th & 12th in Baltimore on Clostridium difficile.  Check it out!  I know I'm attending!