Reducing the risk of surface damage: compatibility is crucial

Healthcare equipment helps deliver care and improves patient outcomes. However, it may pose an infection transmission risk if not adequately decontaminated¹.

Choice of decontamination method depends on infection risk — associated with frequency and type of contact with the item — and the potentially contaminating microorganism. Cleaning physically removes the majority of infectious agents and organic matter but does not necessarily destroy any residuals. Disinfection further reduces viable organisms to safe levels; however, some agents (spores) remain active².

Disinfectants are available as single substance or combination products. Combinations minimise risk of survival by employing multiple mechanisms. Choice depends on intended efficacy: if spores of C. difficile are targeted, products should have proven sporicidal activity. Incorrect use may result in transference of organisms to clean surfaces^3-5. Products used for cleaning and disinfecting equipment must be compatible with the materials. In the UK, the MHRA (MDA/2010/001⁶) stated that failure to follow manufacturer’s decontamination instructions should be considered ‘off-label’ use; only products sanctioned by manufacturers and supplied by employers should be used.

A further alert⁷ highlighted damage to tympanic thermometers, patient monitors, infusion pumps and other devices, stating that both detergent and disinfectant wipes can damage equipment if incompatible with the surface plastics. Damaged surfaces compromise the ability to decontaminate adequately and may affect functionality. Staff were instructed to report to relevant authorities and manufacturers if the equipment manufacturer’s decontamination instructions were inadequate. The alert also recommended identification of decontamination processes, including use of detergent or disinfectant wipes on plastic surfaces, and requesting compatible processes in accordance with manufacturer’s instructions.

Wipes are routinely used to decontaminate both equipment and environmental surfaces, as they are a convenient and rapid means of cleaning and disinfection. In the UK Royal College of Nursing (RCN) guidance on selection and use of wipes⁸, a key recommendation was that collaboration between stakeholders should take place to investigate development of realistic standard test methods for compatibility, reflecting real-life application of wipe products to support selection and purchase.

Three categories of wipes exist: detergent wipes for general-purpose cleaning of visibly soiled areas, disinfectant-only wipes and combination disinfectant/detergent wipes for the removal/reduction of microorganisms. Disinfectant-only wipes (such as alcohol) are rarely used in the UK, as they have no cleaning action and are therefore prone to misuse if cleaning does not happen. They are not sporicidal and can damage equipment (rubbers and plastics) with prolonged use⁹.

If using detergent wipes, some organisms will remain on the surface; surfaces should always be dried after cleaning, to remove more organisms and because moisture facilitates microbial growth^10,11. In contrast, detergent/disinfectant products should air dry to allow maximum wet (and therefore active) contact between surface and disinfectant.

In addition to the growing evidence that use of disinfectants should be more widely considered, there is evidence of further benefits of using detergent/disinfectants as a ready-to-use wet wipe^12-14. Evidence shows that detergent/disinfectant wipes are three times more effective at reducing bacterial burden than detergent-only products — which have also been demonstrated to transfer organisms to multiple surfaces^15,16. There is evidence that good surface disinfection reduces microbial transfer to fingertips¹⁷. 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 time¹⁸.

Cracked polymer housings (known as environmental stress cracking) may occur three to four months after use in healthcare environments¹⁹. It’s therefore important to choose equipment that is constructed from polymers tolerant of the detergents and disinfectants required for safe healthcare. As healthcare providers, our mantra should be “if you can’t clean it, don’t buy it”.

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References

1. Health Protection Scotland. Standard Infection Control Precautions Literature Review: Management of care equipment Glasgow: HPS; 2016
2. MHRA. Sterilization, disinfection and cleaning of medical equipment: Guidance on decontamination from the Microbiology Advisory Committee (the MAC manual): Part 1 principles. London: MHRA; 2010.
3. Exner M. et al 2004. Household cleaning and surface disinfection: new insights and strategies. Journal of Hospital Infection, 56, Supplement 2, 70-75.
4. Bergen L. et al. 2009. Spread of bacteria on surfaces when cleaning with microfibre cloths. Journal of Hospital Infection, 71, 132-137.
5. Xu H. et al 2014. A randomized, double-blind comparison of the effectiveness of environmental cleaning between infection control professionals and environmental service workers. Am J Infect Control. 1;43(3):292-4
6. MHRA Ensure detergent and disinfectant wipes are compatible with the device MDA/2010/001
7. MHRA Ensure detergent and disinfectant wipes are compatible with the device MDA/2013/019
8. Royal College of Nursing. The selection and use of disinfectant wipes. London: RCN; 2011
9. Rutala W. et al. Guideline for Disinfection and Sterilization in Healthcare Facilities. In: Centers For Disease Control And Prevention (ed.) 2008. Atlanta, GA.
10. Sehulster L. et al. 2003. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 52, 1–42.
11. National Patient Safety Agency 2007. The national specifications for cleanliness in the NHS: a framework for setting and measuring performance outcomes. In: NPSA (ed.). London.
12. Rutala W. et al. Disinfection, sterilization, and antisepsis: An overview Am J Infect Control. 2016 May;44 5: e1 - e6
13. Rutala W. et al. Disinfectants used for environmental disinfection and new room decontamination technology. Am J Infect Control. 2013 May;41(5 Suppl):S36-41
14. Rutala W. et al. 2013b. Disinfection and sterilization: an overview. Am J Infect Control, 41, S2-5.
15. Berendt A. 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.
16. Ramm L. et al. 2015.Pathogen transfer and high variability in pathogen removal by detergent wipes. Am J Infect Control. Jul 1;43(7):724-8
17. Lopez G. et al. (2014) Evaluation of a Disinfectant Wipe Intervention on Fomite-to-Finger Microbial Transfer Appl Environ Microbiol 80(10): 3113-3118
18. Wiemken T. et al 2014. The value of ready-to-use disinfectant wipes: compliance, employee time, and costs. Am J Infect Control, 42, 329-30.
19. Hoffman J.M et al (2013) ESC of polycarbonate Exposed to Hospital Disinfectants. Proceedings, ANTEC 2013. Society of Plastic Engineers.