EOL Tech Talk: Surface Disinfectants
Edition: November 2008 - Vol 16 Number 11
Editor's note: EOL Tech Talk: Know your products. Here's the how and why the technologies you sell perform the way they do - and how to present them to your customers. For Web-based training on a wide variety of products, visit EOL Precise Selling (EOLPreciseSelling.com), the industry's first Web-based training center.
Physician customers generally know the importance of germ-free surfaces in their practices, particularly with overall heightened awareness of the increased prevalence of multi-drug resistant organisms, healthcare-acquired infections and Clostridium difficile outbreaks. But, it's up to their distributor reps to help them select the most appropriate products for their practice.
Helping customers choose among sprays, concentrates, foams or wipes, or high-, intermediate- and low-level disinfectants requires that reps know how their practices operate. Some physician offices lack appropriate storage or counter space to house disinfectants, or they store products in inaccessible areas. Often, healthcare workers have hectic schedules, which make it difficult for them to comply with surface disinfectant guidelines. In other cases, an overzealous staff may overspray or over-aerosolize, which is harmful to their and their patients' health.
Distributor reps should consider the following when helping physicians select the right intermediate-level disinfectants:
Is the product EPA-approved, hospital-grade, intermediate-level?
Does the brand meet OSHA's bloodborne pathogen standard? Is the product tuberculocidal? Can it inactivate HBV or HIV? (If bloodborne pathogens are suspected to be present, personal protection equipment is recommended.)
Is a formula nontoxic and safe for the user and patients?
Is the product safe to transport and store? Is it nonflammable? How long is the shelf life?
Is a product compatible with the surface materials at the practice? Is it noncorrosive?
Will wipes keep surfaces wet for the recommended surface contact time?
Is the product considered both a cleaner and disinfectant?
A new market
Competition for improved products with faster, more efficient kill times continues to drive the market. New, more accessible packaging is available, such as adhesive flat packs. Surface disinfectant wipes continue to grow in popularity, due to their convenience and concerns about using aerosols.
Surface disinfectants are designed to treat non-porous surfaces. Standard infection control guidelines dictate that visibly dirty surfaces must be wiped clean prior to disinfecting in order for the product to work effectively. And, the user should always read product labels, as some chemicals can damage or discolor surfaces.
All surface disinfectants intended for use in healthcare settings must be registered with the Environmental Protection Agency (EPA). EPA-registered products should kill pseudomonas, staphylococcus and salmonella, as well as tuberculosis and hepatitis B virus. Physicians and healthcare staff should evaluate the active ingredients used in various surface disinfectants, since different patient care areas have different requirements. When products are used incorrectly, they may be less effective.
Categories of disinfectants
Surface disinfectants are grouped according to their make-up and capabilities.
1. Phenolic compounds
These low- to mid-level surface disinfectants are designed for non-critical and semi-critical areas. These compounds are not ideal for use in healthcare settings, as they are highly toxic, flammable and corrosive. They tend to leave a residual film that can damage some surfaces and cause skin irritation.
These are generally considered outdated and are not consistently effective. However, they emit minimal odor and are non-corrosive and inexpensive. They can be used for disinfecting non-critical and semi-critical areas.
3. Chlorine and chlorine compounds
While chlorine compounds are effective disinfectants, they tend to corrode many metal surfaces and bleach color. They are highly toxic and may act as a skin and inhalation irritant.
These are active against all types of vegetative bacteria and fungi. They can be used to disinfect some non-critical and semi-critical items. But, because they evaporate quickly, it is difficult to obtain wet contact times for surface disinfecting.
5. Quaternary ammonium compounds
These are the most commonly used of hard-surface disinfectants. Quaternary disinfectants are odorless, non-corrosive, stable in high temperatures and have low toxicity and low skin irritation.
6. Quaternary ammonium/alcohol based disinfectants
The alcohol in these products causes them to quickly dissipate, leaving little or no residue. Disinfectants with less than 20 percent alcohol do not damage surfaces, whereas those with over 20 percent alcohol do damage surfaces. However, higher alcohol concentrations provide faster kill times.
7. Surface disinfectant wipes
Wipes are convenient and easy to use, but different brands contain different chemicals, so they vary in their use and effectiveness. They are useful for cleaning surfaces that cannot be immersed in liquids.
The most commonly used, quaternary ammonium compounds, are recommended for use for semi-critical and non-critical devices, as well as in the presence of bloodborne pathogens. They have a broad range of effectiveness, including bactericidal, tuberculocidal, fungicidal and virucidal. In addition, they do not stain surfaces and leave no active chemical residue.
Quaternary surface disinfectants may contain a high or low percentage of alcohol. Products containing over 20 percent alcohol are considered high-alcohol disinfectants. These are more flammable and must be stored in well-ventilated areas. On one hand, higher alcohol wipes provide faster kill times. In general, however, prolonged exposure to high-alcohol disinfectants may disrupt adhesives or damage seals, as well as cause some plastics to swell and harden and break more easily. Also, alcohol is a fixative on blood. As such, it evaporates quickly and may not accomplish its contact time, even if it is a short one. And, evaporation may diminish concentration levels, making contact times more difficult to achieve unless items are immersed.
Low-level alcohol products include those containing less than 20 percent alcohol. Quaternary/low-level alcohol combination solutions reportedly achieve both cleaning/decontamination and disinfection, and they are not known to damage surfaces or instruments. Low-alcohol wipes are available with tuberculocidal claims as low as three- to five-minutes.
How to sell
Prior to visiting a physician practice or hospital, reps should find out what surface disinfectants currently are being used. Materials managers at hospitals should have this information. When selling to hospitals, reps should inquire about GPO affiliations and distributor partnerships. They should also learn who the infection control contact or nurse is and schedule a meeting with that individual. Some important selling tools to bring along on the call include:
Sell sheets, brochures, wall charts and catalogs
Technical bulletins and material safety data sheets.
Upon meeting with the infection control nurse, physician or office manager, reps should ask about their concerns or issues with current products and confirm that they meet OSHA bloodborne pathogen standards. If selling to hospitals, they should find out if the customer is using the same surface disinfectant to decontaminate IV pumps, and learn who oversees this (e.g., nursing staff or the central processing department). Also, reps should discuss the importance of vancomycin-resistant enterococci (VRE) and methicillin-resistant staphylococcus (MRSA) in hospitals.
When discussing their products, reps should point out their kill times and effectiveness against microorganisms. They can also discuss the convenience and safety of wipes (e.g., avoid excessive aerosol spray). They should not leave without learning if the customer has questions or concerns about a particular product.
It is essential for reps to provide hands-on in-service, and to specify the amount of product he or she will provide and the timeframe for a trial use at the practice. Even more important, ask for the order and follow ups.
Repertoire would like to acknowledge the contribution of Metrex (Orange, Calif.) to this article.