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Fighting HAI’s with Environmental Hygiene
Rémi Charlebois, M.Sc., Mcb.A., RMCCM
Objectives• Review the burden of HAI’s• Understand the importance of disinfection• Get to know the best practices in environmental hygiene• Investigate what makes a good disinfectant • Overview validation procedures
The Burden of HAI’s• 4th leading cause of death in Canada• Touches 1 out of every 9 patient• 200,000 HAI’s/year• Killing around 12,000 Canadians every year• Cost estimated around 1 billion of dollars• Patient with HAI’s spent on average
8.9 more days in the hospital
• Over 70% of HAI’s could be prevented*!
*Umscheid et al ICHE 2011
Infection route• Contact transmission• Droplet transmission• Airborne transmission• Common vehicle transmission• Vector-borne transmission
It’s all about good practices
• Reducing infection is much more than just disinfecting and washing your hands
• It takes an integrated approach involving every person surrounding the patients at a different degree
• When it comes to disinfection it takes trained personnel, the right product used with the appropriate procedures and completed with an efficient validation technique
Why do we disinfect?• Prior room occupancy as a risk factor for pathogen acquisition
Prior occupant Risk factor Reference
VRE 81.7 Martinez 2003MRSAVRE
1.41.4
Huang 2006
VRE 3.8 Drees 2008CDI 2.3 Shaughenessy 2011PseudomonasAcinetobacter
2.34.2
Nseir 2011
Why do we disinfect?
Alfa et al. AJIC 2016
Why do we disinfect• Reduced hand contamination through the use of a sporicidal
disinfectant
Sirishia Kundrapu S. et al. ICHE 2012
Using the right productWhen it comes to disinfection there are so many choices!
Key factors when considering a product:-Spectrum of action-Contact time-Toxicity-Surface compatibility-Ease of use-Stability-Cleaning properties
Resistance to disinfection
Resistant
Prions
Bacterial spores
Coccidia
Mycobacteria
Non-lipid virus
Fungi
Gram – bacteria
Gram + bacteria
Lipid viruses
Susceptible
Hydr
ogen
Per
oxid
e
Blea
ch 5
,000
pp
m
Qua
ts
Contact time• Time for which the surface has to remain in contact with the
disinfectant• Sometimes it is necessary to re-wet the surface• Mandatory 10 min unless efficacy data was submitted to HC
Surface compatibilityShould not corrode metallic surfaces and should not accelerate the
deterioration of materials
Ease of use• Ready to use wipes• Ready to use disinfectant-cleaner
Leads to better complianceMore reliable in the event of an outbreak
If you use a concentrated product make sure to validate your dilution system/procedures
StabilityAffected by: • Light• Hard water• High temperature• Time
Cleaning properties• Cleaning is achieved through the use of a tension active agent• Quats are by definition surfactants• Other disinfectant needs to be supplemented in surfactants• Surfactants help the disinfection process by better wetting the
surface, facilitating the achievement of the contact time.• Good tensioactive agent might help in the removal of biofilm and
stubborn dirt/stain
Cleaning properties
Hydrophilic head and hydrophobic tail helps to solubilize dirt
Wettability
With surfactant Without surfactant
Using the right tool• Cotton has high chemical binding properties
• Quat binding• Oxidant degradation (ie. Peroxide)
• Microfibers have low chemical binding properties• Microfibers are more efficient at cleaning• What are your ready-to-use wipes made of?
High-touch, low-touch, no-touch• Most common high-touch surfaces include bed rail, bed surface,
supply carts, overbed table and intravenous pump• Low-touch would be everything that is reachable and can be touch• Daily disinfection of high touch surface is associated with a reduction
in infection
The challenge• Clostridium difficile is one of the toughest challenge faced in
environmental hygiene• Spores are one of the most resistant biological structure • Some bacillus spores are known to be 250 million years old and still
viable• Bleach at 0.5% (5,000 ppm) or product with a claim such has 4.5%
hydrogen peroxide are the most efficient technology to get rid of C.diff
Best practice• 1 wiping side / surface • Never ever resoak a cloth• Use microfiber when possible
Best practice• Dilute concentrated disinfectant with room temperature water• Use disinfectant with a DIN number• Use broad spectrum disinfectant• Never mix chemicals• Do not use a sprayer• Wear gloves
Validation• Visual inspection (Hotel clean)• ATP• UV – fluorescent marker• Surface culture• Audit (Hawthorne effect)• Quality objectives (Pygmalion effect)
www.ramblingsaboutdisinfection.com
Questions?
''Let’s declare war on infectious diseases!'‘
Contact info: [email protected]