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.

Our expertise is utilized by Infection Preventionists, Public Health Experts, First Responders, Dentists, Physicians, Nurses, Veterinarians, Aestheticians, Environmental Services professionals and janitorial product distributors to develop more sustainable cleaning and disinfection practices in North America.

Our commitment to providing chemical disinfectant education is more than business, it is a passion.

Friday, April 25, 2014

RUST - the new cost of doing business?

The fodder of many of the Talk Clean To Me blogs are based on comments, questions, emails and conversations Lee and I have with the infection prevention and control community from around the world. The impetus of this is that the conversation we are having at that point in time is not likely an isolated occurrence but that others are asking or pondering over the same question. So when I saw a question posted on an infection prevention chat room about rust on furniture in the OR, it seemed a perfect topic for this week's blog.

So, what is rust?  Most of us would describe rust as a reddish or yellowish-brown flaky coating on a surface and generally associate it with corrosion of metal surfaces. Technically, it is iron oxide that has formed on iron or steel by oxidation, especially in the presence of moisture.  Similar to a cut or abrasion on our skin, once rust has formed there is no protection to the underlying iron. From a surface integrity, this loss of protection can lead to further deterioration, but most importantly, rust cannot be disinfected and provides the perfect habitat to harbour pathogens.

So why is rust becoming a concern to Infection Preventionists?  Well, as in our earlier blogs "Unintentional Consequences of Improving Infection Prevention" and "Is the EPA condoning the use of Steroids" in our efforts to strive for ZERO HAIs and annihilate all germs from the environment we are unwittingly causing an epidemic of degrading surfaces.

For some, targeting zero means using sporicidal agents such as bleach and peracetic acid every day, everywhere. While some facilities may attest that this movement has lead to a reduction in HAIs (C.diff in particular) and thereby a perceived savings in terms of HAIs, what costs have been incurred from a perspective of replacement of medical equipment, furniture and environmental surfaces? 

Choosing a disinfectant is a balancing act. Infection Preventionists must balance the need for an effective disinfectant to minimize HAIs with the safety of the product from an occupational health and safety, materials compatibility and environmental impact perspective.  Chlorine (bleach) solutions are by nature highly corrosive. They should not be used on surfaces that are prone to rust. Metal surfaces are prone to rust.  Metal surfaces are found in virtually every room in a hospital; bed frames, wheel chairs, stretchers, the arms of OR lights etc, etc...

As one IP stated (and correctly so) "rust on equipment cannot be disinfected".  But perhaps a more important consideration is what will Joint Commission or CMS think?  Well, as at least one facility found out, CMS does not care for rust. In fact if they find it, they will cite you for it and perhaps more importantly will require you (okay, your facility) to replace, clean or repurpose all equipment that has rust on it. 

As we know, infection prevention and control is multifactorial.   There is no single solution or silver bullet that will solve our HAI woes.  Hand hygiene, antibiotic stewardship and environmental hygiene all play a role in an effective and successful infection prevention program.  We talk about building a business case for infection prevention programs, and while for most we talk to the cost savings in terms of reduction of HAIs, we cannot ignore incremental costs.   Our business cases may include the justification for increased costs for improved environmental hygiene due to their associated impact on HAIs, however, we cannot forget to consider the incremental costs for replacement or refurbishing of medical devices, equipment, furniture or environmental surfaces.

The "KIS" or "Keep it Simple" principle of one product for everything, while seemingly simplistic, does have unintended consequences.  It works if you are only weighing the cost of HAIs, however, if you or your facility has a problem with rust or other visually deteriorating surfaces and are not willing to include replacement costs for surfaces, devices and equipment in your annual budget...really, who wants to talk about spending $25,000 on a hospital bed or $5000 - $12,000 on replacing rusty OR lights as part of the consequences of using a corrosive chemistry everywhere, every day. If you're not willing to have that chat as part of your business case, then you may want to consider a multifactorial approach to disinfection by choosing a broad-spectrum disinfectant that can kill the pathogens (bacteria & viruses) that cause the majority of our outbreaks for daily use and a sporicidal agent for targeted use against C.diff. 

Maybe you'll find the best of both worlds?  No rust, no deteriorating surfaces, decreased costs from occupational injury associated with disinfectants AND a significant reduction in HAIs. Now that would be a Win-Win!

Bugging Off!

Thursday, April 17, 2014

#FF - Follow Friday

It's been a while since I've done a Friday shout out and seeing as I have not been in the office for the past week and am boarding a plane in about an hour, I thought this would be a perfect week to do it!
I will admit, a couple of these have been mentioned before, but some of their recent blog posts makes them worth mentioning again!
Controversies in Hospital Infection Prevention  is written by ID Docs or Hospital Epidemiologists Eli, Mike and Dan.  Touch on current topics  or newly published in Infection Prevention,  and share articles by other authors that they are worth reading.  They have a recent blog looking a study that had been published about facial hair an infection control risks.  I am not sure I am going to ever be able to kiss a guy with a beard or goatee again!
Hand Hygiene, Infection Prevention and Food Safety Blog by the DEB Group, a leading company in hand hygiene and skin care products, leverages their relationships with experts around the world to provide weekly blogs on topics pertaining to hand hygiene, infection prevention and food safety.  One of their recent blogs was "What is the "Germiest" Profession...I'll let you read it to find out!
If you do not read Huffington Post you should!  There are some great reads and my very good friend Jason Tetro "The Germ Guy" has been very active blogging for them!  Just do a search of his name to put them up!
That’s it for this #FF!  I hope you turn on your inner geek and check out some of these blogs!
Bugging Off!

Thursday, April 10, 2014

Is PPE a necessary evil?

In putting together a "surprise" for the IPAC-Canada and APIC conferences it dawned on me that while Lee & I have talked around the various areas that one should consider with respect to determining the safety profile of a disinfectant chemistry we have not gotten into the nitty-gritty of PPE.   In my travels, I have had many a HCW tell me they use "the CANCER wipe" and that they would NEVER use the wipe without gloves (goggles and in some cases even masks).  However, try as a I may, I have been unable to find a wipe commercially branded under that name. 

It is true that some of the chemicals used in the manufacturing of disinfectants such as phenols and 2-Butoxyethanol are listed by governing bodies as being carcinogens.  It is also true that some chemistries are known sensitizing agents, are known to cause occupational asthma and are known skin, eye or respiratory irritants.  In fact, it is the toxicity (safety) profile that determines what PPE needs to be worn when working with disinfectants.  In later blogs we'll delve into more detail of how safety profiles are determined.  For the purposes of this blog, I want to focus on the concept of HMIS Ratings (Hazardous Materials Identification System) and Precautionary Statements found on EPA or Health Canada registered disinfectants and how they should be interpreted to ensure the safe (and economic) use of disinfectants.

HMIS ratings as you may have surmised help identify the risk of the product in terms of health concerns, flammability and physical hazards which in turn determine what type of PPE a user needs to wear and if there are any specific needs in terms of storage or handling of the disinfectant.  On a MSDS they are represented by a numerical rating system generally as "X/X/X" and are rated from 0 (minimal risk) to 4 (severe hazard).  The health risk is represented by the first number and helps determine what PPE (gloves, goggles and/or respiratory protection) is needed.  For OBVIOUS reasons, the lower the number the better!  A disinfectant with a HMIS rating of 0/0/0 would be considered pretty benign and safe for the user to handle without any form of PPE.

To help illustrate safety differences between disinfectant chemistries the following table summarizes HMIS ratings and PPE requirements for the most commonly used disinfectant wipes:

The need or lack thereof for PPE varies widely.  You'll also note that while a MSDS may indicate that no PPE is required, the EPA label may specify that the product can in fact cause eye irritation or even irreversible eye damage.   In my books, that means eye protection should be worn. 

The economic impact to facilities with respect to Occupational Exposure to chemicals is very real.  A 2010 report by the CDC highlighted that the most common active ingredients responsible for illnesses were Quats (38%), glutaraldehyde (25%), and sodium hypochlorite (18%).  The majority of the types of injuries associated with the use of disinfectants were: 222 as eye injuries, 130 neurologic injuries (headaches etc) and 121 respiratory injuries.  Of particular interest (at least to me) is that only 15% of the time did the injured worker wear eye protection.....how many products listed above require eye protection when using?  How often do you see HCWs (EVS, nurses, clinical therapists etc) wearing eye protection?

The economic burden of occupational injuries and illnesses are sizable, at least as large as the cost of cancer. Particularly if you know what the cost per claim is.   In the US, the cost per claim for eye injuries, neurologic injuries and respiratory injuries are $118,024, $85,012 and $64,495 respectively. Using the numbers from the CDC study that equates to $26,201,328 for eye injuries, $11,051,560 for neurologic injuries and $7,803,895!  That's a whopping $45 MILLION spent over a 5 year period in just 4 US states!

Employers have a legal responsibility to provide a safe working environment.  The use of disinfectants has a direct and very costly impact on worker safety.   In an era where we are constantly talking about the bottom line and focusing on the cost of HAIs, perhaps we should also be considering the cost of Occupational illness and cost of PPE.  Choosing an effective disinfectant with the safest HMIS profile will save your facility a considerable amount of money - particularly when the cost of a pair of gloves can be more than the cost of the wipe the HCW is using to clean and disinfect!


Bugging Off!



Friday, April 4, 2014

Disinfection - It's more than the juice you use!

I must first say that I have an inquisitive mind, which I will admit does get me into trouble upon occasion. I am also a Taurus (bull-headed and stubborn...) and when you mix the two together (much to the chagrin of those around me) you end up with someone who may respond to a question with "because that's the way it is," and yet at the same time does not accept that as an answer to a question that they themselves have posed! 

My inquisitiveness and stubbornness does come in handy when working with a facility to solve a problem related to the use of disinfectants, particularly if the problem is how to manage an outbreak. I am also very fortunate to have a Research Team who loves to solve problems and conduct research studies so that we can improve the available science to support the correct and effective use of disinfectants.

As noted in some of our previous blogs such as Premature Evaporation and Dirty to Disinfected in 60 Seconds, a key component to achieving disinfection compliance is the consideration of the contact time and dry time - disinfectants do evaporate and the faster they evaporate the less likely disinfection will or can be achieved (unless of course you are applying the product to a surface multiple times). We also highlighted in the Monogamous Relationship blog that in order to minimize transfer from surface to surface, the method of how the disinfectant is being applied needs to be considered.

What we did not realize is that the cloth itself can significantly impact the ability to achieve disinfection compliance - and no, I'm not talking about the well known fact that cotton and quat-based disinfectants do not get along.  What I am talking about is the fact that the type of wipe substrate (cotton, microfiber or disposable wipe) can directly impact how the disinfectant is released onto a surface.  The less product that is released, the less likely the appropriate contact time will be met, which means disinfection is not likely to occur. Trust me, we did not believe it until we saw it!

We tested 5 different disinfectant chemistries with 3 different wipe substrates and found that there were distinct differences in how the wipe substrates absorbed the disinfectant, but more importantly there were differences in how they released (or didn't release) the disinfectant back onto the surface as well! We found that the amount of disinfectant needed to saturate the wipe substrate differed significantly, which has direct implications in chemical cost, and of course using a cloth that is not properly wetted is not going to help in the disinfection department because....you guessed it - The surface is not going to stay wet! 

We also found that the way the disinfectant is released from the wipe substrate varied dramatically.  From a disinfection perspective again, this is highly important as a wipe that "dumps" all of its liquid at the start of the cleaning process is not going to provide even distribution of the disinfectant.  The ability for a wipe to have an even metered release (meaning the disinfectant is released from the substrate uniformly over a larger surface area) is going to have a very real and positive impact on disinfection. Similarly to the children's fable of the Hair and the Tortoise, slow and steady wins the race!  A wipe substrate that deposits enough disinfectant to keep the surface wet over a sizeable surface area is going to be the most effective and cost efficient to use.

You may have picked your disinfectant based on its claims or contact time, but in doing so, did you investigate how your chosen product works with the wipe substrate your environmental services staff are using? Those clusters of VRE or MRSA may have resulted from a mismatch between your disinfectant and your wipe substrate!  I've always stated that effective cleaning and disinfection is about marrying product with protocol. I guess I need to change that to marrying product with wipe substrate with protocol!

Bugging Off!