The effectiveness of disinfectant wipes for surface sanitization in hospitals
“Ready-to-use” disinfectant wipes (also known as pre-impregnated disinfectant wipes) are widely used in the food industry and in household settings. Their use in hospitals and patient care facilities for the decontamination of medical devices and surfaces is constantly increasing due to their extreme practicality. The effectiveness of disinfectant wipes can vary depending on several factors, including the active ingredients, the type of target microorganisms, and how they are used.
However, studies have highlighted that the use of disinfectant wipes has limitations due to the wide range of variables that affect the disinfection performance of disinfectant-impregnated wipes in hospitals. First, it is important to distinguish between products intended for use on hands and those designed for disinfecting surfaces. This is because the composition of the two types of wipes differs. For example, KLINTENSIV® – Hand disinfectant wet wipes can be used for hand sanitizing in various environments, from hospitals to public places. They are specifically designed to destroy bacteria and viruses, helping to prevent the spread of infections.
Infections associated with the transfer of nosocomial pathogens from high-touch surfaces and medical devices are responsible for significant patient morbidity, mortality, and economic costs. More recently, evidence shows that nosocomial pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), norovirus, Clostridium difficile, vancomycin-resistant Enterococcus, and Acinetobacter species, etc., spread by patients can contaminate surfaces at concentrations sufficient for transmission, surviving for long periods and persisting despite attempts to eliminate them.
Effective cleaning and disinfection practices, such as chemical disinfection, thermal disinfection, and ultraviolet germicidal irradiation, etc., play an essential role in preventing cross-contamination and spread. Of all surface disinfection approaches, the use of chemical disinfectants is widespread in the food industry, hospitals, and healthcare centers due to their ease of application and broad spectrum of microbicidal activity. Regarding the practical application of disinfectants, “ready-to-use” (RTU) disinfectant wipes are increasingly accepted for the decontamination of high-touch surfaces due to their convenient implementation and reliable performance. KLINTENSIV® – Surface disinfectant wet wipes
Disinfectant-impregnated wipes are, in principle, pieces of textile or cellulose material saturated with diluted disinfectant, as well as other chemicals such as surfactants, preservatives, enzymes, and fragrances, etc. When two materials meet, the interaction between them is not negligible and often influences their initial function.
Factors that could influence the effectiveness of the disinfection process focus on the following aspects: the wipe, the disinfectant, the application method, the interaction between them, as well as the wiping strategy and storage time. Reviewing studies on effectiveness in clinical practice, experts believe that more attention must be paid to this subject. The review also highlights the need to improve testing standards for the decontamination efficacy of disinfectant wipes, as this is an important validation step before disinfectant-impregnated wiping products are launched on the market and subsequently used in hospitals.
The disinfection process of a disinfectant-impregnated wipe can be divided into two parts that constitute the overall decontamination activity. One part is related to the microorganisms removed by the wipe itself through mechanical action. The other part is related to the active microbicidal action of the disinfectant solution released by the wipe onto the surface. From this perspective, it is always recommended to use only products approved by an authorized institution, specifically the Ministry of Health through the National Commission for Biocidal Products.
Composition of a disinfectant wipe
Disinfectant wipes are mostly made of textile materials, including but not limited to cellulosic fibers (cotton, wood pulp, viscose, lyocell) and thermoplastic fibers (polyethylene terephthalate and polypropylene). Especially for single-use wipes, the raw materials are normally inexpensive, such as cellulosic fibers and polyolefin fibers. Cellulosic fibers are used to ensure high water retention and storage capacities, and polyolefin fibers are responsible for high tensile strength, abrasion resistance, and solvent resistance. Most surface disinfectant wipes on the market are made from blends of polyester and viscose/wood pulp fibers.
Wipes offer an effective way to clean, combining the mechanical action of wiping with disinfecting properties. By simply wiping surfaces, they can remove organic debris and dirt, contributing to a deeper clean and the elimination of pathogens. An example of a surface disinfectant wipe is KLINOMED WIPES®, which provides a convenient and effective solution for sanitizing various surfaces. This type of wipe is designed to eliminate bacteria, viruses, and other pathogenic microorganisms from surfaces, helping to prevent the spread of infections.
Also, microorganisms can be mechanically removed by the wipe. However, care must be taken regarding the transfer of microorganisms to other parts of the surface. The removal of the microorganism depends on the inherent properties of the wipe material, such as surface energy, fabric structure, and fiber types, as well as the applied pressure force, the geometry of the mechanical action, the number of passes, and the type of microorganism adhesion mechanism.
As previously mentioned, it is important to also consider that during the wiping action, some microorganisms might be transferred to another location on the treated surface instead of being eliminated. This transfer depends on the retention capacity of the wipe and the bactericidal activity of the disinfectant absorbed in the wipe.
The disinfectant solution released by the wipe onto the target surface is primarily responsible for the bactericidal activity. The amount and concentration of the active ingredient and the amount of solution remaining on the surface are important indicators of effectiveness and depend on the interaction between the wipe and the disinfectant. Also, the amount of solution released depends largely on the absorbent property of the wipe. Without a doubt, the wipe plays an important role in the decontamination of the target surface.
The disinfectant – the main active agent
The disinfectant, as the main constituent for the disinfection action, has a crucial impact on the decontamination process. The antimicrobial activity of disinfectants occurs in two different ways: growth inhibition (e.g., bacteriostatic, fungistatic) and lethal action (sporicidal, bactericidal, fungicidal, and virucidal effects). Disinfectants comprise a wide variety of active chemical agents (biocides). The active substances found on the market are generally alcohols, chlorine, aldehydes, peroxygen compounds, and quaternary ammonium compounds. Each type of disinfectant presents certain advantages and disadvantages that allow, or do not allow, its use in wipes.
Alcohol is inexpensive and easy to obtain, allowing for effective surface wetting with a rapid bactericidal effect, without bacteriostatic action, and without relevant toxicity issues. However, it is highly flammable, corrosive to metals, ineffective in the presence of organic debris, and tends to swell and harden rubber and certain types of plastics. It is not sporicidal and has low efficacy regarding the inactivation of certain types of viruses. Furthermore, due to its high volatility, it is difficult to ensure sufficient contact time in open systems.
Within the chemical family of chlorine compounds, the most used disinfectants are hypochlorite, chlorine dioxide, and chloramine-T trihydrate. Hypochlorite is the most used of the chlorine disinfectants, especially due to its low cost and rapid mode of action. It presents a broad bactericidal spectrum, no toxic residues, and is not affected by water hardness. However, it is also corrosive to metals (> 500 ppm), easily inactivated by organic matter, irritating, and burning to the skin, eyes, and mucous membranes. It can bleach and yellow textiles and can become very dangerous in contact with ammonia or acid, due to the generation of toxic chlorine gas.
Chlorine dioxide also presents a broad spectrum of biocidal activity, including for mycobacteria, with a short contact time. It offers a longer-lasting bactericidal effect than chlorine due to its high retention of antimicrobial active ingredients, but in the case of long-term use, it can damage the outer plastic layer of some insertion tubes.
Application method: liquid disinfectants vs. disinfectant wipes
When applying surface disinfectant to the target surface, approaches can generally be divided into two groups: 1) without mechanical action, e.g., total immersion and direct spraying – liquid disinfectants – and 2) with mechanical action, e.g., spray-and-wipe, dip-and-wipe, and soak-and-wipe. The main benefit of mechanical action, specifically the use of disinfectant wipes, is the ability to remove organic debris that could hinder the disinfection action.
The “Spray-and-wipe” method begins with a direct spray of the disinfectant solution with an aerosol or trigger sprayer onto the target surface, followed by a wipe of the target surface. The spraying action allows direct contact of the disinfectant solution with the target surface. However, there are several disadvantages, such as potential overspray, difficulty in covering surfaces (the underside of bed rails), and the generation of atomized disinfectant in the air, which can subsequently be breathed in by workers and patients.
The ready-to-use disinfectant wipe is impregnated with disinfectants, antiseptics, surfactants, etc., in a sealed package, ready for use for surface disinfection for up to 1 month (shelf life may be longer). The wipe is designed to be used without any preparation time. Considering compliance, employee time, and costs, wipes are highly recommended for surface disinfection. These products have been tested in many research projects to prove that they possess a good antimicrobial effect under many conditions.
An essential aspect of disinfectant wipes is that they are single-use, thus eliminating the risk of contamination or pathogen transfer caused by their reuse. This feature is crucial in maintaining hygiene and safety in various environments, from households to medical care facilities. However, it is important to mention that despite this feature, longer storage times can increase the probability of loss of the wipes' antimicrobial activity.
In addition, in environments such as hospitals, where infection control is of critical importance, professional disinfectant solutions are preferred. These disinfectants are often more concentrated and can be more effective against a broader spectrum of pathogenic microorganisms. Also, specific procedures and standards can be used to ensure adequate and consistent disinfection throughout the medical institution.
The use of disinfectant wipes and professional disinfectants in combination with appropriate sanitization protocols and procedures contributes to preventing the transmission of nosocomial infections and protecting both medical staff and patients.
