Reducing the risk of surface damage: compatibility is crucial

Healthcare equipment and surfaces may pose a transmission risk if not adequately decontaminated [1, 2].

The decontamination method depends on the infection risk, which is influenced by frequency and type of contact with the item and the nature of potentially contaminating microorganisms. Physical cleaning removes most infectious agents and organic matter but does not necessarily destroy residual pathogens. Disinfection further reduces viable organisms to safe levels. A range of disinfectants and combination disinfectants that also possess detergent activity are available, but not all are effective against every form of microbe. Disinfectants targeting C. difficile spores, which resist disinfection and remain viable for extended periods [3] need proven sporicidal activity. Poor practice or product performance may result in transference of organisms from contaminated to clean surfaces [4]. It is critical that products are compatible with the materials they are to be used on.

Material compatibility between wipes and healthcare equipment and surfaces is currently a concern within Australia. The Victoria Managed Insurance Authority (VMIA) received reports of cracking and breakages in a number of medical devices, electrical outlets and plastic fittings used in a hospital environment [5]. The Therapeutic Goods Administration (TGA) subsequently issued a medical device safety update highlighting that certain disinfectant wipes and detergents can damage medical devices if the cleaning agent is incompatible with the device’s plastic surface [6]. Similarly in the UK, the Medicines and Healthcare Regulatory Authority (MHRA) alerts highlighted damage to some medical equipment, stating that both detergent and disinfectant wipes can cause damage if incompatible with the polycarbonates and blends (thermoplastics) used in these medical devices [7,8]. Whilst their subsequent alert focused on a small number of specific items of medical equipment, other electronic items may be prone to similar issues resulting in cracked polymer housings (environmental stress cracking) resulting from exposure to cleaning agents and disinfectants [9].

It is important to choose the correct wipe. The advantages in using combined detergent/disinfectants as a ready-to-use wet wipe are clearly evident [10-13]. Using detergent-only wipes means that some organisms will remain and surfaces should always be dried after cleaning [14]. In contrast, combined detergent/disinfectant products should be allowed to air dry to allow for maximum wet (and therefore active) contact between surface and disinfectant [15]. Disinfectant-only wipes (such as alcohol) have no cleaning action and are therefore prone to misuse if cleaning does not occur before disinfection [16]. There is also evidence that detergent/disinfectant wipes are more effective at reducing bacterial burden than detergent-only products – which have also been demonstrated to transfer organisms to multiple surfaces [14]. Ready-to-use disinfectant wipes have been proven to significantly increase cleaning compliance whilst resulting in more rapid and effective processes – with associated cost savings in terms of staff time [17].

It is important to choose equipment that is both constructed from polymers tolerant of the agents required for safe healthcare and wipes that have maximum compatibility from a company that has worked proactively to gain equipment manufacturer approvals. GAMA Healthcare collaborates with manufacturers of healthcare equipment to test compatibility, produce decontamination procedures, and inform polymer choice for new products; you can find a list of equipment for which GAMA products are approved for use at clinell.com/compatibility.

When buying equipment that will need to be decontaminated between uses, the mantra should be “if you can’t clean it, don’t buy it”.

Clinell’s Universal range of surface disinfection products are quaternary ammonium compound (QAC)-based and have a comparatively neutral pH, making them compatible with a broad range of surfaces. Although the QAC benzalkonium chloride was thought to be the cause of a number of incompatibility issues, it is considered by the TGA to be both safe and non-corrosive when used at a concentration of 0.5% or less [6]. Clinell Universal Wipes contain <0.5% benzalkonium chloride, making them compatible with a broad range of materials.

clinell.com.au

Address: GAMA Healthcare Australia Pty Ltd., 31 Progress Street, Mornington, Victoria 3931, Australia.
Tel: +61 (0)3 5976 1555 | Fax: + 61 (0)3 5977 0044 | Email: info@gamahealthcare.com.au

References

1.  Health Protection Scotland, Standard Infection Control Precautions Literature Review: Management of care equipment. 2016, Health Protection Scotland: Glasgow.

2.  Medicines and Healthcare products Regulatory Agency, Sterilization, disinfection and cleaning of medical equipment: guidance on decontamination, from the Microbiology Advisory Committee (the MAC manual), MHRA, Editor. 2010: London.

3.  Suwantarat, N., et al., Quantitative assessment of interactions between hospitalized patients and portable medical equipment and other fomites. American Journal of Infection Control, 2017.

4.  Bergen, L.K., et al., Spread of bacteria on surfaces when cleaning with microfibre cloths. J Hosp Infect, 2009. 71(2): p. 132-7.

5.  Victoria Managed Insurance Authority Disinfectant wipes and detergent used on reusable medical devices with plastic surfaces. Melbourne 2017. https://www.vmia.vic.gov.au/risk/risk-alerts/risk-alert1

6.  Therapeutic Goods Administration. Medical Devices Safety Update, Volume 5, Number 3, May 2017 https://www.tga.gov.au/publication-issue/medical-devices-safety-update-volume-5-number-3-may-2017#a2

7.  Medicines and Healthcare products Regulatory Agency, Ensure detergent and disinfectant wipes are compatible with the device. MD/2013/019, MHRA, Editor. 2013: London.

8.  Medicines and Healthcare products Regulatory Agency, Medical devices in general and non-medical products. MDA/2010/001, MHRA, Editor. 2010: London.

9.  Hoffman, J., et al., ESC of polycarbonate exposed to hospital disinfectants. Society of Plastic Engineers, 2013.

10. Rutala, W.A., D.J. Weber, and Healthcare Infection Control Practices Advisory Committee, Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. 2008, Centres for Disease Control: Atlanta, GA.

11. Rutala, W.A. and D.J. Weber, Disinfectants used for environmental disinfection and new room decontamination technology. Am J Infect Control, 2013. 41(5 Suppl): p. S36-41.

12. Rutala, W.A. and D.J. Weber, Disinfection and sterilization: an overview. Am J Infect Control, 2013. 41(5 Suppl): p. S2-5.

13. Ramm, L., et al., Pathogen transfer and high variability in pathogen removal by detergent wipes. Am J Infect Control, 2015.

14. Berendt, A.E., et al., Three swipes and you're out: how many swipes are needed to decontaminate plastic with disposable wipes? Am J Infect Control, 2011. 39(5): p. 442-3.

15. Sattar, S.A., et al., Disinfectant wipes are appropriate to control microbial bioburden from surfaces: use of a new ASTM standard test protocol to demonstrate efficacy. J Hosp Infect, 20 91(4): p. 319-25.

16. Sehulster, L. and R.Y. Chinn, Guidelines for Environmental Infection Control in Health-Care Facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Morb Mortal Wkly Rep, 2003. 52(RR10): p. 1-42.

17. Wiemken, T.L., et al., The value of ready-to-use disinfectant wipes: compliance, employee time, and costs. Am J Infect Control, 2014. 42(3): p. 329-30.