DIV18/20: Protecting Lives With Infection Prevention Innovation (18 October 2018)

Issue Date: 18 October 2018
Ref: DIV18/20


Protecting Lives With Infection Prevention Innovation

Around 80 per cent of all infectious diseases are spread by personal contact or touching a contaminated surface. In healthcare these can range from hospital acquired infections such as MRSA and C. diff to infections common in any setting, such as Influenza and Norovirus. Personal hand hygiene and surface disinfection (or sanitising) are therefore the two single most significant factors in preventing infections.

With bacteria, for example, more than 3000 different types can live on the average person’s hands and about 100,000 can live on each square centimetre of skin. Many of these are completely harmless but just a few of the wrong type can quickly lead to illness. One bacterium can multiply to over four million in eight hours, so it is clear that keeping hands and surfaces clean is critical to preventing the chain of infection.

We have known this for a long time and all learn as children to wash our hands before eating and after going to the toilet. Despite this it seems many people continue to ignore this most basic act of personal hygiene. 

Hand hygiene products in healthcare settings need to be effective yet gentle because they will be used frequently during the day. Modern formulations incorporate highly effective biocidal ingredients as well as emollients that help preserve the skin’s natural protective barrier and keep hands soft. Leading suppliers offer a choice and are able to recommend the best option for any particular setting.

In addition to the choice of product, it is critical to select dispensing equipment that is easy to use and reliable and which supports high levels of compliance. In healthcare and other settings there has been a recent trend towards electronic dispensers which offer touchless operation, usage tracking and low-product alerts. These benefits are ideal in healthcare settings but there is a risk that the batteries (these devices’ usual power source) will be depleted which can lead to dispensers becoming inoperable. The latest devices now offer hybrid performance which enables them to switch from automatic to manual operation in the event of power failure, ensuring ongoing availability of products until cleaning teams have time to replace the batteries.

Electronic dispensers can support remote monitoring and other features that allow operators to count the number of times they have been used. In a healthcare setting, where usage patterns tend to be predictable, any deviation from the norm can suggest under or over use so that supervisors can identify when compliance may have been compromised and when additional staff training could be useful. Another feature of these modern dispensers is the ability to issue alerts when their batteries or product pouches need replacing. This enables operators to respond in good to time to maintain product availability and machine operability. 

The other critical component of healthcare hygiene is the removal of potential sources of infection from surfaces, especially those that are likely to be touched frequently. In healthcare this includes beds, furniture, light switches and hand-held devices. Bed rails, for example, are touched around 250 times a day, according to studies, yet are cleaned only once or twice a day.

Cleaning professionals have traditionally chosen disinfectants with chlorine as the active ingredient (usually as bleaches) for hard surfaces. While widely used, they have some drawbacks that can limit their usefulness. Alternative formulations with Accelerated Hydrogen Peroxide (AHP) as the active ingredient – such as Diversey’s Oxivir range - offer numerous advantages with fewer limitations.

The key requirement from any disinfectant in healthcare settings is efficacy - to prevent the introduction of potentially harmful pathogens and infections. Problem pathogens, such as Norovirus and rhinovirus, might not be killed by conventional disinfectants. Contact times must be realistically short so that pathogens are killed before the surface dries. Disinfectants with long contact times may require reapplication to ensure pathogens are killed. 

Disinfectants containing AHP are highly effective against a wide range of viruses, spores, yeasts, and fungi found in healthcare, including C. diff, MRSA, Norovirus, E. coli, and Pseudomonas aeruginosa. This broad-spectrum efficacy has been tested to the latest EN standards. This simplifies cleaning processes because just one product is needed. Using numerous alternative products to achieve the same level of performance adds complexity.

Products with AHP have been tested and shown to kill viruses such as Norovirus in up to 30 seconds and the most persistent spores such as C. diff in one minute. This is one of the reasons why this type of disinfectant was the product of choice at hospitals and care homes during the Ebola virus outbreak in 2014. Traditional products are generally not very effective on spores and require significantly longer contact times. Chlorine-based products can take up to 30 minutes. Aside from any productivity issues, chlorine-based products are only effective while wet which means efficacy will be lost if they dry within the specified contact time. Many AHP products disinfect as they dry which, with their shorter contact time, removes this limitation.

Products containing AHP offer additional benefits that simplify day-to-day cleaning operations. With more cleaning taking place while patients are present, processes must be safe and efficient, so as not to create an unpleasant environment or put patients at risk. 

AHP degrades to oxygen and water alone shortly after use which helps make formulations containing it safer to use. Chlorine-based products are suspected of aggravating asthma and other respiratory problems and forming chlorine compounds in the atmosphere. This is one of the reasons why these disinfectants are being replaced by alternative products. Another is that many AHP-based formulations have no safety classification whereas chlorine-based products usually carry a hazard symbol.

Some of the very latest techniques for infection prevention utilise the UV-C (ultra-violet type C) technology to avoid chemicals altogether. Studies have shown that UV-C lowered the infection rate for target organisms from 51.3 to 33.9 per 10,000 exposure days for rooms cleaned with traditional disinfectants. UV-C works by disrupting the DNA of the pathogens it reaches which prevents them from causing infections. UV-C systems can disinfect large areas quickly and are ideal for settings where traditional chemical cleaning is cumbersome and complex, such as when lots of equipment is present. Similar systems are available to disinfect quickly and safely small items such as mobile devices, which some studies have shown can harbour more pathogens than a toilet seat.

It is clear that cleaning teams in the healthcare sector now have a wider choice of products with which to implement highly effective infection prevention strategies to protect the lives of patients and those who care for them.