The rise and rise of AHP disinfectants

Low odour, sustainable, biodegradable yet powerful alternatives to bleach and quaternary ammonium compounds are now available in Australia. The benchmark product in that space is Accelerated Hydrogen Peroxide (AHP). AHP has dual high safety and efficacy profiles and should be considered for surface disinfection at the point of care.

Diversey Care now has two premium disinfectants containing Accelerated Hydrogen Peroxide (AHP). Oxivir^® Tb is the benchmark standard-dose AHP disinfectant for high-touch surfaces at the point of care. The brand new high-dose AHP product, Sporicide Plus^TM, is indicated for C. difficile.

Rutala and Weber (ICHE, 2014) illustrate a hierarchy of microbial resistance to disinfectants. If a high level disinfectant is able to kill a highly resistant microbe such as Mycobacterium Tuberculosis (Tb), it follows that it would very easily kill a weak, friable, fragile microbe such as Varicella Zoster Virus.

Oxivir^® Tb does kill Tb, which explains that abbreviation’s inclusion as part of Oxivir^® Tb’s title. Using Rutala’s hierarchy, Oxivir^® Tb kills microbes at the top of the hierarchy and it follows that Oxivir^® Tb also kills the more fragile microbes at the bottom of the hierarchy.

Rutala and Weber (ICHE, 2014) describe the five criteria for choosing the ideal disinfectant:

1. Kill claims — Oxivir^® Tb has 27 label efficacy claims (AUST R 164850);
2. Fast kill times — Oxivir^® Tb is virucidal and bactericidal in 1 minute;
3. Safety — Oxivir^® Tb is safe on surfaces, fabrics and people. PPE is not required;
4. Ease of Use — Oxivir^® Tb is available in liquid, wipe and concentrate variants;
5. Training & Support — Diversey Care provides a high level of educational support.

There is clear evidence (Mitchell 2015, Otter 2013 and others) that the most contaminated surfaces are those close to the patient, and that the risk of cross-infection is higher if a new patient is admitted into a bed previously occupied by an infected patient.

But Kundrapu S. et al (ICHE, 2012, 33:10 p1039) found that most cleaners (>90%) do not clean the bedrails or areas adjacent to the patient. Cleaners in that study either wanted to avoid bothering the patient, or they assumed that such close-quarter equipment cleaning was a Nursing function.

Dancer, SJ (CMR 2014, p682) suggests that removing pathogens from handles, switches, buttons, knobs and other frequently touched (and often forgotten) sites is more likely to have an impact on patient transmission than cleaning inaccessible surfaces such as shelves, ledges, walls and window panes.

Unfortunately there is no magic bullet. Different areas in different hospitals have different levels of risk. Moore G. et al (ICHE, 2013) found that in a general ward, the most likely areas of superbug contamination were the showers and toilets. But in ICU, the most contaminated areas were the bed rails and the "areas near the patient with high levels of staff contact."

The following approach may be of value:

1. Oxivir^® Tb wipes are ideal for high-touch surfaces at the point of care (Alfa M.J. et al, AJIC, 2015);
2. Sporicide Plus^TM wipes are indicated where there is a high index of suspicion of C. difficile spores (hospitalised patient on antibiotics with symptomatic diarrhoea);
3. Components of a "bundle" approach with elements such as microfibre and UV light are appropriate for other areas (Weber D.J. et al, AJIC, 2010).

The selection of the right disinfectant is very important because some ingredients, such as AHP, are compatible with many surfaces (biodegrading to just oxygen and water) whilst others may be incompatible with valuable surfaces such as stethoscopes and monitors.

Rutala’s & Weber’s (ICHE, 2014) criteria for choosing the correct disinfectant is an excellent reference point for determining the most appropriate disinfectant for your hospital.

For more information, please visit www.vericlean.com.au or call Diversey Care on 1800 647 779.