Use of disinfectants in medical wards with low risk of infection

Cleaning, disinfection, decontamination, and sterilization in medical wards

Decontamination consists of one or more procedures that result in the absence of residual pathogens. Specifically, decontamination can involve: cleaning as a single action; cleaning followed by disinfection; cleaning followed by sterilization.

Sterilization is the process that renders any object or surface free of any living organism.

Disinfection will reduce but not eliminate all organisms, so it is unlikely that the object in question will subsequently cause an infection when used.

The cleaning action removes dirt but does not eliminate pathogens. By removing dirt, cleaning serves three purposes:

• reducing the microbial challenge and increasing the safety margin for disinfection;
• preventing the inactivation of the disinfectant by soil;
• allowing the disinfectant to have access to residual microorganisms on the surface.

Is disinfection mandatory?

In an analysis of the survival duration of microorganisms in the environment, specialists have shown that all clinically relevant pathogens acquired through contact with surfaces remain viable long enough to pose a risk to patients and medical staff.

These pathogens are considered alert organisms. Chemical disinfectants used in the healthcare environment must be capable of killing these alert organisms and thus minimizing the risk of cross-transmission. Although many alert organisms are resistant to antibiotics, there is little evidence that they are harder to kill with disinfectants than sensitive pathogens. The following aspects should be considered:

• alert organisms survive on surfaces in care environments and are easily transferred via contact to medical staff, patients undergoing various treatments, and other surfaces;
• hand hygiene and the use of gloves are not sufficient; the use of a disinfectant is necessary. ALCHOSEPT® – Disinfectant for hands and skin
• alert organisms are not only found in the environment/equipment associated with patients known to be positive. This can be influenced by: 1) the inability to identify all persons at risk in real time; 2) the inability to provide isolation facilities for all patients who present a risk of cross-transmission.

Cleaning: a complex system

Hospital cleaning is a complex system, and complex systems always operate in an inconsistent way; for example, there will always be a resource that is missing, and when additional cleaning is required, available resources are often insufficient. KLINTENSIV® – Concentrated disinfectant detergent

Therefore, on any given day, not everything scheduled for cleaning will be cleaned. Increasing hospital efficiency and occupancy rates means that the number of surfaces that need to be decontaminated and prepared for the next patients increases exponentially. Furthermore, visible cleanliness is an inadequate indicator of the absence of potentially harmful microorganisms.

A study conducted in hospitals found that while cleaning reduced dirt levels by 32% and reduced microbial surface contamination, it did not eliminate pathogens.

Cleaning procedures accompanied by disinfection have demonstrated a significant reduction in pathogens. Disinfection may involve applying a solution or using a disinfectant wipe for surfaces.

Recommendations for environments and equipment with low infection risk

Spaulding established criteria for the sterilization and disinfection of patient care items and equipment, developing three categories: critical, semi-critical, and non-critical. Non-critical items are those designed to come into contact with intact skin. This would include all reusable and environmental surfaces.

Technically, this category includes items that are heavily contaminated, e.g., with feces, which may be inadequately decontaminated by cleaning alone. Disinfection is required for some items in the intermediate category that are contaminated with particularly virulent or easily transmissible organisms.

However, this criterion is impossible to apply because visual inspection cannot determine whether an object or surface meets the definition. There are recommendations mentioning that disinfectants should be considered for cases of infection and/or colonization, when a suspected or known pathogen can survive in the environment and environmental contamination may contribute to the spread of infection.

This recommendation could be seen as supporting the widespread use of disinfectants, given that it is impossible to know all persons who are colonized, and it is easy (and perhaps considered safer) to suspect that everyone is a carrier of viruses and/or microbes. Professional disinfectants for the healthcare system

What is the assessment of disinfectant needs for today?

Logically, the low-risk category can be divided into three subcategories. Firstly, the highest level (low risk I) includes blood spills, where the risk is represented by possible infection. In addition, this category includes the risk of acquiring pathogens from spores that remain latent in the environment. This applies to the environments/equipment of individuals recognized as having an infection at a given time.

This category also includes individuals with a recognized risk of being a carrier of an alert organism. Routine floor disinfection is one of the mandatory requirements for low-risk I environments. DESOGEN® – High-level concentrated disinfectant

The medium-low risk category (low risk II) includes four possible scenarios where cross-transmission from alert organisms cannot be excluded. Obviously, other bodily fluid spills will require decontamination (including disinfection) to negate a risk of cross-transmission. The next two scenarios incorporate a concept familiar to healthcare staff, that of the patient zone; namely, every time equipment enters a patient zone, it must have been cleaned and disinfected, just as before a patient enters a previously occupied patient zone, the environment must have been cleaned and disinfected. Concentrated enzymatic disinfectant detergent for professional use

The purpose of disinfection in this case is to reduce the risks of unrecognized but periodically present cross-transmission. Furthermore, because hands must be decontaminated between entries into patient zones, logically, equipment will require the same treatment. The final scenario within Low Risk II refers to surfaces where sterile equipment will be placed, for example, trolley worktops.

Finally, low risk III contains all other surfaces outside patient zones that are not specified in the previous categories.

Manual cleaning and disinfection of environmental surfaces in healthcare facilities (daily and at patient discharge) are essential elements of infection prevention programs. A mandatory condition is that all selected products be approved by the Ministry of Health – National Commission for Biocidal Products.