Choosing Surface Disinfectants

by Kathryn Dix

Appropriate use of surface disinfectants can be the determining factor in preserving a patient's health. But so many options exist that it is often difficult to ascertain which product is suitable for your facility.

There are numerous types of disinfectants, which include the following:

Several factors must be considered when choosing a disinfectant. First, how quickly does the disinfectant take effect? What is its scope? Consider whether each product is:

• Bactericidal
• Fungicidal
• Virucidal
• Tuberculocidal

Next, consider the disinfectant's resistance to organics. The category "organics" includes blood, plaque, saliva, and other proteinaceous material. Regardless of this rating, surfaces should be wiped clean before the disinfectant is applied.

Then, determine whether the disinfectant is compatible with the surfaces on which it will be used. Ideally, there will be no change in the function or appearance of the disinfected surfaces. Obviously, avoid products that are corrosive; this is especially imperative if the surfaces are metal. And keep in mind that plastic can be damaged by frequent or extended exposure to alcohol; in a worst-case scenario, the plastic could swell and harden, then become more brittle and apt to break.

Finally, consider the safety of the healthcare workers and patients who will come into contact with the surface. How prone is the disinfectant to penetrate gloves? Is it toxic? Some disinfectants do not break through glove material for five hours, while others can penetrate gloves after only 10 minutes. It is good clinical practice to follow basic precautions regardless of the disinfectant; change gloves after each patient contact, and wash hands after glove use.

For facilities concerned about effectively disinfecting surfaces that have been contaminated by exposure to Human Immunodeficiency virus (HIV) and hepatitis B virus (HBV), guidelines have been established by the Occupational Safety and Health Administration (OSHA).

"Appropriate" registered disinfectants for HIV or HBV that meet the requirement in the standard and are intended to cleanse contaminated surfaces, "provided such surfaces have not become contaminated with agent(s) or volumes of or concentrations of agent(s) for which higher level disinfection is recommended".

The Centers for Disease Control and Prevention (CDC) recommends that when cleaning HIV-contaminated surfaces, walls, floors or other environmental surfaces should be cleansed of soil regularly, and an environmental surface germicide effective against HIV should be used. The CDC suggests using a solution of sodium hypochlorite (1 part to 99 parts water), prepared daily. However, keep in mind that bleach is corrosive to metals, particularly aluminum.

In 1996, the Association for Professionals in Infection Control and Epidemiology (APIC) renewed its guidelines for the selection and use of disinfectants. Recommendations for disinfecting noncritical items -- bedpans, blood pressure cuffs, crutches, bed rails, linens, some food utensils, and patient furniture -- are included below.

• When cleaning noncritical patient-care items, recommended disinfectant solutions are ethyl or isopropyl alcohol, sodium hypochlorite, phenolic germicidal detergent solution, iodophor germicidal detergent solution, or quaternary ammonium germicidal detergent solution. Contact time should be ten minutes or less.
• Infant bassinettes and incubators should not be cleaned with phenolics while they are in use; however, phenolics may be used to terminally clean the beds so long as they are thoroughly rinsed with water and dried before the beds are reused.
• For surfaces and equipment contaminated with HIV or HBV, standard sterilization and disinfection practices are sufficient. Noncritical environmental surfaces that have been contaminated with blood or bloody body fluids should be cleaned first, then disinfected with an EPA-registered disinfectant or detergent. As per usual practice, people cleaning up spills should wear disposable personal protective equipment.
• If a patient with variant Creutzfeldt-Jakob disease (vCJD) comes into contact with noncritical surfaces or items, disinfect the surfaces with bleach (undiluted or up to 1:10 dilution) or 1 N sodium hydroxide for 15 minutes or less.