Fighting HAI’s with Environmental Hygiene

Rémi Charlebois, M.Sc., Mcb.A., RMCCM

Objectives• Review the burden of HAI’s• Understand the importance of disinfection• Get to know the best practices in environmental hygiene• Investigate what makes a good disinfectant • Overview validation procedures

The Burden of HAI’s• 4th leading cause of death in Canada• Touches 1 out of every 9 patient• 200,000 HAI’s/year• Killing around 12,000 Canadians every year• Cost estimated around 1 billion of dollars• Patient with HAI’s spent on average

8.9 more days in the hospital

• Over 70% of HAI’s could be prevented*!

*Umscheid et al ICHE 2011

Infection route• Contact transmission• Droplet transmission• Airborne transmission• Common vehicle transmission• Vector-borne transmission

It’s all about good practices

• Reducing infection is much more than just disinfecting and washing your hands

• It takes an integrated approach involving every person surrounding the patients at a different degree

• When it comes to disinfection it takes trained personnel, the right product used with the appropriate procedures and completed with an efficient validation technique

Why do we disinfect?• Prior room occupancy as a risk factor for pathogen acquisition

Prior occupant Risk factor Reference

VRE 81.7 Martinez 2003MRSAVRE

1.41.4

Huang 2006

VRE 3.8 Drees 2008CDI 2.3 Shaughenessy 2011PseudomonasAcinetobacter

2.34.2

Nseir 2011

Why do we disinfect?

Alfa et al. AJIC 2016

Why do we disinfect• Reduced hand contamination through the use of a sporicidal

disinfectant

Sirishia Kundrapu S. et al. ICHE 2012

Using the right productWhen it comes to disinfection there are so many choices!

Key factors when considering a product:-Spectrum of action-Contact time-Toxicity-Surface compatibility-Ease of use-Stability-Cleaning properties

Resistance to disinfection

Resistant

Prions

Bacterial spores

Coccidia

Mycobacteria

Non-lipid virus

Fungi

Gram – bacteria

Gram + bacteria

Lipid viruses

Susceptible

Hydr

ogen

Per

oxid

e

Blea

ch 5

,000

pp

m

Qua

ts

Contact time• Time for which the surface has to remain in contact with the

disinfectant• Sometimes it is necessary to re-wet the surface• Mandatory 10 min unless efficacy data was submitted to HC

Surface compatibilityShould not corrode metallic surfaces and should not accelerate the

deterioration of materials

Ease of use• Ready to use wipes• Ready to use disinfectant-cleaner

Leads to better complianceMore reliable in the event of an outbreak

If you use a concentrated product make sure to validate your dilution system/procedures

StabilityAffected by: • Light• Hard water• High temperature• Time

Cleaning properties• Cleaning is achieved through the use of a tension active agent• Quats are by definition surfactants• Other disinfectant needs to be supplemented in surfactants• Surfactants help the disinfection process by better wetting the

surface, facilitating the achievement of the contact time.• Good tensioactive agent might help in the removal of biofilm and

stubborn dirt/stain

Cleaning properties

Hydrophilic head and hydrophobic tail helps to solubilize dirt

Wettability

With surfactant Without surfactant

Using the right tool• Cotton has high chemical binding properties

• Quat binding• Oxidant degradation (ie. Peroxide)

• Microfibers have low chemical binding properties• Microfibers are more efficient at cleaning• What are your ready-to-use wipes made of?

High-touch, low-touch, no-touch• Most common high-touch surfaces include bed rail, bed surface,

supply carts, overbed table and intravenous pump• Low-touch would be everything that is reachable and can be touch• Daily disinfection of high touch surface is associated with a reduction

in infection

The challenge• Clostridium difficile is one of the toughest challenge faced in

environmental hygiene• Spores are one of the most resistant biological structure • Some bacillus spores are known to be 250 million years old and still

viable• Bleach at 0.5% (5,000 ppm) or product with a claim such has 4.5%

hydrogen peroxide are the most efficient technology to get rid of C.diff

Best practice• 1 wiping side / surface • Never ever resoak a cloth• Use microfiber when possible

Best practice• Dilute concentrated disinfectant with room temperature water• Use disinfectant with a DIN number• Use broad spectrum disinfectant• Never mix chemicals• Do not use a sprayer• Wear gloves

Validation• Visual inspection (Hotel clean)• ATP• UV – fluorescent marker• Surface culture• Audit (Hawthorne effect)• Quality objectives (Pygmalion effect)

www.ramblingsaboutdisinfection.com

Questions?

''Let’s declare war on infectious diseases!'‘

Contact info: rcharlebois@lalema.com