DIV17/28: Options for Surface Disinfection in Healthcare Settings (8 February 2018)

Issue Date: 8 February 2018
Ref: DIV17/28

Options for Surface Disinfection in Healthcare Settings
Deborah Bland, Marketing Lead for Healthcare, Diversey, UK & Ireland

One tactic for improving environmental hygiene, the cleanliness of surfaces, in healthcare settings is to use the right disinfectants. However, not all disinfectants are created equally.

Cleaning professionals have traditionally chosen disinfectants with chlorine as the active ingredient (usually as bleaches) for cleaning hard surfaces in care settings. While widely used, there are some drawbacks that can limit their usefulness. Alternative formulations with Accelerated Hydrogen Peroxide (AHP) as the active ingredient offer numerous advantages with few limitations.

The key requirement from any disinfectant in healthcare settings is efficacy - to prevent the introduction of potentially harmful pathogens and infections. These can range from hospital acquired infections such as MRSA and C. diff to infections common in any setting, such as influenza and Norovirus.

Effective surface disinfection is especially important healthcare because patients are likely to be frail and vulnerable. Many of the commonest infections – and plenty of rarer ones – are spread by person-to-person contact and by touching a contaminated surface. Surface disinfection along with effective hand hygiene is therefore the first defence against the introduction and spread of infections.

It is important to select disinfectants capable of killing pathogens of concern. Problem pathogens, such as norovirus and rhinovirus, might not be killed by conventional disinfectants. Contact times must be realistically short so that any 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. It helps to simplify cleaning processes because just one product is needed. Using numerous alternative products to provide the same level of performance adds complexity. 

Disinfectants with AHP are supplied in ready-to-use and ultra-concentrate formats. The latest formulations offer improvements over older products including efficacy at lower concentrations, better cost-in-use and shorter contact times. Depending on the specific formulation, these products are effective against viruses, spores (including C. diff), yeasts and fungi in just one minute, meeting demand for highly effective products with shorter contact or dwell times. 

Traditional products are generally not very effective on spores and require significantly longer contact times. Products with AHP, for example, 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. 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 completed safely and efficiently, 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 consideration for some is that some products with AHP have no safety classification whereas chlorine-based products usually carry a hazard symbol.

Breaking down to water and oxygen alone means products with AHP leave little or no residue on surfaces, helping to promote the appearance of the area being cleaned. They can be used safely on a wider range of surfaces, including wool and other fabrics, with reduced risk of damage. Chlorine based products on the other hand will corrode or degrade many surfaces with regular or prolonged use. Nor can they be used as part of a microfibre system because they bind with the material, severely restricting their disinfection potency.

When correctly specified and used, multipurpose cleaner/disinfectant formulations containing AHP can lower overall cleaning costs by reducing the number of separate products needed. Further savings are achieved because multipurpose formulations simplify procurement processes, minimise storage, and reduce implementation, deployment, and training costs.

Organisations can further reduce costs when using formulations as super-concentrates in conjunction with dispensing or dilution control systems. These ensure solutions for spray bottles, buckets, and cleaning machines are prepared accurately and without waste to the ideal concentration for high performance. They are generally safer because they prevent users from coming into contact with undiluted products.

The easier a product is to use, the greater the chance of cleaning compliance. Products should be accompanied by training aids to support members of diverse cleaning teams. Despite proper training, there are still cleaning and disinfection challenges that may arise. It is therefore important to measure performance to determine if additional training is necessary.

The variety of disinfectants has grown in recent years, as manufacturers have developed solutions for specific daily and problem-solving tasks. It is therefore important to match the product to the specific application. This maximises cleaning performance and reduces inefficiencies, poor results, and the need for repeat cleaning. Reputable manufacturers will provide advice on the most suitable products from their ranges to use in every situation. They should also be able to supply the documentation and evidence with independent test data to support product claims.