In healthcare facilities, environmental surfaces are susceptible to contamination with healthcare-associated pathogens, many of which can survive on surfaces for prolonged periods and contribute to the spread of infections.
Careful cleaning and disinfection are essential for reducing the risk of infection and promoting patient safety. For this reason, healthcare facilities are required to disinfect all visibly and potentially contaminated surfaces. Seems simple enough, right? Well, not quite. EVS Directors and their frontline team members face a range of challenges when it comes to developing and executing proper surface disinfection protocols. Not the least of which is selecting cleaning and disinfecting products that are effective against high-concern pathogens but safe for use on common healthcare surfaces and equipment.
All commercially available healthcare cleaning and disinfectant products have the potential to cause compatibility issues if used improperly, which can have serious consequences. According to an ECRI Institute report on health technology hazards, “use of cleaning agents or cleaning practices that are incompatible with the materials used in a medical device’s construction, or that are otherwise inappropriate for the device’s design, can cause the device to malfunction or to fail prematurely, possibly affecting patient care.”1 The proper care of healthcare surfaces can also impact budgets, patient satisfaction scores and public perceptions.
Balancing compliant cleaning and disinfection with the need to safeguard surfaces and equipment can seem daunting. For many overburdened and under-resourced EVS teams, simply maintaining a clean and safe healthcare environment can feel like an uphill battle. A recent survey showed that 62 percent of EVS Directors report “needing to do more, with less” staff2, and studies have shown that manual cleaning and disinfection practices are often suboptimal, with only approximately 50 percent of hospital surfaces adequately disinfected during terminal cleaning protocols3. Common frustrations with surface disinfectants like residue, plastic fatigue, corrosion and discoloration only add to these challenges.
Navigating the balance between infection prevention and surface safety is possible, but it requires cooperation from a range of stakeholders, and thoughtful product selection.
Convening Key Stakeholders
The majority of healthcare disinfectant decision-makers cite disinfectant residue as one of the factors leading to the decline of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) cleanliness scores and audit scores.4 While surface compatibility is increasingly a top priority for all decision-makers involved in the selection of healthcare disinfectants4, it is important to consider each stakeholders’ point-of-view and understand their role in the evaluation process. For example:
• Healthcare Designers: Healthcare designers are responsible not only for making facilities look their best, but also for designing environments and selecting materials that are easily cleaned and can be maintained in accordance with best practices for infection prevention and control.
• Infection Control Committees: Infection control committees and IP teams ensure that the cleaning and disinfecting products selected kill pathogens of concern and are suitable for use on surfaces throughout the facility.
• Medical Equipment Manufacturers: Equipment manufacturers provide cleaning and care guidelines outlining recommendations, warning statements and warranty information, including what types of disinfectants should be used on their products.
• Healthcare Disinfectant Manufacturers: Disinfectant manufacturers develop products designed to meet healthcare facilities’ infection prevention needs and work to balance disinfection power with surface compatibility.
• Frontline EVS Team Members: EVS professionals are tasked with implementing new products and procedures and look for solutions that are easy and efficient to use and effective against pathogens of concern. Cleaner-disinfectants that are compatible with a wide range of surfaces and equipment can help them streamline protocols by eliminating the need for multiple products, which can save budget and reduce the risk of user error.
Purchasing decision makers need to consider all of these perspectives when evaluating new cleaning and disinfecting products to ensure they find a solution with the right characteristics to meet their facility’s individual needs.
Selecting the Right Product for Your Facility
There are many factors to consider when selecting healthcare surface disinfectants. In a commentary published in Infection Control and Hospital Epidemiology, Dr. William Rutala and colleagues described key considerations for selecting the optimal disinfectant for decontamination of environmental surfaces in the healthcare setting.5 While I highly recommend reading their article in full, below are a few key characteristics and questions to keep in mind with regard to disinfectant efficacy and surface compatibility:
• Disinfectant Efficacy:
o Kill Claims: Does the product kill the most prevalent healthcare pathogens? Select products that are Environmental Protection Agency-registered to kill the most prevalent healthcare pathogens that commonly cause infections and outbreaks and offer broad spectrum disinfection efficacy.
o Kill Times: How quickly does the product kill prevalent healthcare pathogens? Select the product with the fastest kill times to ensure the product is capable of disinfecting quickly. Products with short contact times (e.g., 30 seconds – three minutes) help ensure compliant usage and faster room turnover.
o Wet Time: Are the product kill times less than or equal to its wet time? If the product evaporates from the surface before the kill time is achieved, it may not be effective. The best disinfecting products have a wet-contact time greater than or equal to kill times listed on their label. Select the product that can keep surfaces visibly wet for the longest kill time on its label.
• Surface Compatibility: Is the product compatible with surfaces and equipment in your facility? It’s a deceptively simple question, but one that is critical for determining the right product for your facility and ensuring successful implementation. We recommend a four-step approach:
o First, learn the surfaces in your facility. What surfaces do you need to disinfect? Are they polymers like laminate, acrylic, vinyl or polyurethane or stainless steel or another material? Most patient care areas include a range of materials. Knowing the surfaces in your facility is the best way to ensure they are maintained appropriately.
o Take the time to read the cleaning and care guides. These documents are the “go to” source for important manufacturer recommendations, warning statements and warranty information, but they can be dense. Searching for care instructions like “clean” or “disinfect,” active ingredients and product names can help you find the information you need more quickly.
o Evaluate the compatibility of the selected disinfectant. Look for cleaner-disinfectants that are designed to be compatible with a wide range of hard, non-porous surfaces. Check the product labels for use sites and if you’re not sure about something, reach out to the manufacturer. They should be able to provide additional information and technical resources on compatibility.
o Establish and reinforce standardized cleaning and disinfection protocols. Once you have the right products, protocols and training become the keys to ensuring compliance. Make sure your team is trained on how and where to use the product. Tools and reference guides can help promote compliance after initial training and checklists are a good way to measure success and identify areas for further training.
Partnering for Long-Term Success
A recent survey of healthcare disinfectant decision makers showed that 92 percent rely on the equipment manufacturer’s disinfectant recommendations when selecting disinfectants.4 Even so, finding the right product and protocol for your facility can be a lot of work, so disinfectant manufacturers are taking new steps to help streamline the process. For example, through the Clorox Healthcare Compatible™ program, Clorox Healthcare works with medical equipment manufacturers to evaluate and test compatibility across its portfolio of disinfectants on common surfaces and equipment. Clorox Healthcare also provides educational resources for healthcare facilities to help them navigate surface compatibility challenges and identify products and protocols to prevent infections and protect surfaces and equipment.
Surface damage is a preventable problem, and partnership with internal and external stakeholders involved in these decisions is the best way to ensure long-term success. From the hospital design team to infection preventionists and environmental services teams, everyone plays a role in safeguarding healthcare surfaces. With the right partners, it’s easier than ever to get the information you need and find the right products for your facility.
1“Top 10 Health Technology Hazards for 2017.” ECRI Institute. Accessed 1 Mar., 2017.
2IPSOS Public Affairs – Cleaning Industry Insights Survey 2015.
3Bhalla A, Pultz NJ, Gries DM, et al. Infection Control Hospital Epidemiology. 2004 Feb;25(2):164–7.
4Online survey of 208 healthcare disinfectant decision makers, April 2017.
5Rutala WA, Weber DJ. “Selection of the Ideal Disinfectant.” Infection Control and Hospital Epidemiology, 2014 35.7:855-865.
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