Neutral detergent vs chemical disinfectant. Let’s look beneath the surface.

A clean healthcare environment is an important part of an infection prevention and control (IPC) programme¹. A growing body of evidence suggests that the transmission of pathogens from surfaces and equipment in a patient’s surroundings contributes to the increasing problem of healthcare associated infection (HAI)². A wide range of decontamination technologies, methods and products are currently available³; however, there is much debate in the literature as to which is the optimal method and more evidence is required before a consensus can be met⁴. This article explores the use of a neutral detergent and a chemical based disinfectant for surface decontamination.

Factors that influence successful removal of pathogens from surfaces.

The increase in multi-drug resistant organisms, novel pathogens and emerging infectious diseases has led to a growth in research looking at the efficacy of environmental decontamination in the healthcare setting. The success of an environmental cleaning program is not so much related to the product(s) used as to other factors involved^5,6 including the following:

• Level of training provided to cleaning personnel
• Variation in cleaning personnel performance
• Monitoring of cleaning practices
• Bio-burden of the surface
• Properties of surface being cleaned
• Frequency the surface is touched e.g. high-touch surfaces
• Adherence to manufacturer recommendations for correct product use
• Resistance of bacteria and other pathogens to routine cleaning and/or disinfection
   

What most studies have concluded is that human factors play the most important part in effective decontamination of the environment.

Choosing a neutral detergent or disinfectant.

Otter⁷ provides this description of the difference between cleaning and disinfection; “cleaning is the removal of soil and contaminants from surfaces, whereas disinfection relates to the inactivation of pathogens by use of a disinfectant”. The choice of cleaning agent is very much an independent one and relevant to the local situation. Different products may be suitable for different situations within the same facility; for example, some facilities may use a neutral detergent for everyday routine cleaning but change to a disinfectant in the event of an outbreak.

The topic of whether routine environmental cleaning should be undertaken with a neutral detergent or a disinfectant remains a controversial one in the literature⁶. Dancer cautions against reaching for the disinfectant as a fear reaction to pathogens without considering all the pros and cons⁴. Other authors suggest that with rise in antimicrobial resistant organisms, clostridium difficile infections and other outbreaks associated with an environmental source, warrants a disinfectant for everyday use in healthcare.

Neutral detergent.

For cost-effective regular, everyday cleaning of healthcare surfaces, a neutral detergent is a good cleaning agent to choose. The detergent will remove dirt and contaminants that can harbour pathogens and if the facility has a satisfactory standard of routine cleaning, then regular removal of dirt and dust should minimise the build-up of bacteria and viruses and the formation of a biofilm. However, detergent solutions have been known to become contaminated with bacteria if not changed frequently which results in the cleaning process actually spreading these pathogens around the environment instead of removing them.

This risk can be eliminated by using pre-moistened wipes and changing them as per manufacturer recommendations. The quality and size of the cloth will also impact the effectiveness of the wipe and should be taken into account. In addition to the cost savings, another reason for using a neutral detergent is the environmental benefit. Disinfectants are chemicals, so a detergent will nearly always be less toxic than a disinfectant. This is important also for those areas where staff may be sensitive to chemicals often found in surface disinfectants.

Disinfectants.

There are several indications when a disinfectant would be the product of choice, primarily in situations of high levels of contamination. Disinfectants reduce higher bacterial counts than detergents but the product still relies on the removal of organic soil to be effective.

Most IPC experts recommend using a disinfectant to decontaminate the room after the discharge of a patient who had been colonised or infected with MRO or other infectious disease. Multiple studies have demonstrated that a patient is at a higher risk of MRO acquisition if they were admitted to a room previously occupied by a patient positive for MRO. A disinfectant product is also used when there is persistent contamination with a pathogen, such as during an outbreak or when the area has endemic rates of disease. Additionally, there are some pathogens which have potential resistance to detergent-based cleaning including C. difficile, MROs, and norovirus. Aside from the potential environmental toxicity issues, one of the draw-backs of disinfectants is that they require a minimum contact time to kill the pathogens. In practice this is not always achieved which may compromise their efficacy.

Summary.

In summary, there are positive and negative aspects to using both detergents and disinfectants. The user must determine their own environmental climate, the risks for HAI and choose their products accordingly. Remember, it is not only the product that matters but how it is used.

Introduction to the Author.

Ruth Barratt is an Infection Prevention and Control Consultant and Health Quality Advisor RN, BSc, MAdvPrac (Hons), CICP-E. Ruth provides advice and training to Reynard Health Supplies concerning the needs of infection prevention and control professionals and developments in the industry.

About.

Ruth originally trained as a registered nurse in the UK but preventing infections has been her specialised field of work in NZ and Australia for over 20 years. She obtained her Masters in Infection Control and Prevention through Griffith University and is currently undertaking a PhD at the University of Sydney — again in the area of infection prevention.

References.

1. Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC; 2017.

2. Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010; 38(suppl): S25-S33.

3. Boyce JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrobial Resistance & Infection Control. 2016;5(1):10.

4. Dancer, S. J. (2016). Dos and don’ts for hospital cleaning. Current Opinion in Infectious Diseases, 29(4), 415–423.

5. Mitchell, Brett G. et al. Variation in hospital cleaning practice and process in Australian hospitals: A structured mapping exercise. Infection, Disease & Health 2017; 22(4):195 – 202.

6. Doll M, Stevens M, Bearman G. Environmental cleaning and disinfection of patient areas. International Journal of Infectious Diseases: 2018; 67:52-57

7. Otter JA, Yezli S, French GL. The Role Played by Contaminated Surfaces in the Transmission of Nosocomial Pathogens. Infect Control Hosp Epidem. 2011;32 (7)0