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Friday, July 22, 2016

Safety Indifference Syndrome

If you’ve ever heard me speak at a conference you’ve probably heard me say “I don’t care what a product kills if the people who need to use the disinfectant won’t use it!”   In this context, I am not talking to the fact that environmental services or nursing staff are cutting corners or flagrantly disregarding protocols.  In my experience, if your staff are concerned for their safety in handling a product or perceive in any way that there could be a potential health risk to them, they will either not use the product at all or use the product in such a way that the intended purpose (e.g. reducing HAIs) the product was chosen for in the first place will be negated.

Case in point, with a simple Google search I found the following question posted to a forum. “Hello! I work at a hospital that uses XXXXXX for cleaning. I have heard that they may cause liver damage if used without gloves. I have been researching on line and cannot find any related material on this subject, though my coworkers are intent with their arguments about it.”   I’ve redacted the name of the product because my intent is not to single out specific products, but to make a point that this concern is very real.   All too often we focus on what a product kills with a single aim to stamp out every pathogen known to man from the surface in the fastest contact time possible, but do not always stop to consider the health impact and / or acceptance of the staff tasked to work with said product.

Via Talk Clean to Me, I have written a number of blogs on this topic because it is one that I truly am very passionate about.  But don’t just take my word for it.  Even Drs Rutala and Weber included a discussion on safety within their 2014 article “Selection of the Ideal Disinfectant”.  In my dissection of this article, the Over Easy: Why safety profiles and ease of use will improve disinfection summarized a number of attributes to look for with respect to safety and ease of use.

In the “Is PPE a necessary evil?”  I talked about the economic impact to facilities with respect to Occupational Exposure to chemicals.  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 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?

If that’s not enough proof, “It’s getting harder and harder to breathe”  discussed the fact that several states conduct work related asthma surveillance as part of the Sentinel Event Notification System for Occupational Risks (SENSOR).  The surveillance system in California showed that custodians and cleaners had the highest incidence of work related asthma.  Furthermore, a study by Rosenman et al reported that a cleaning product was 1 or more of the 3 suspected agents identified in 12% of the confirmed cases that they reviewed.  The fact that bleach was the most frequently identified product should not be all that surprising considering that bleach was recently designated an asthma-causing agent by the Association of Occupational and Environmental Clinics. 

I’m not saying that in choosing the disinfectant products we do we are intentionally trying to harm the people we work with.  But it’s a delicate balancing act that we are tasked with to ensure the safety of our patients by minimizing the transmission of HAIs without causing harm to the staff who work in our facility.  The next time you’re looking to change disinfectant products I hope you’ll ask “Does this disinfectant suffer from Safety Indifference Syndrome?” and if you’ve never truly considered the safety of the products being used in your facility, I hope you’ll do a little investigation to see if your disinfectant is indeed suffering from Safety Indifference Syndrome.

Bugging Off!


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