The main objective of this webinar will be to review the basics of cleaning and disinfection : The updated burden of HAI’s in Canada Why do we disinfect Best practices in cleaning and disinfection Using the right product Validation technique * Garantie et exclusion de garantie. Les informations présentées dans le cadre du présent webinaire sont fournies telles quelles. Aucune représentation ou garantie ne vous est adressée concernant quelque aspect que ce soit. Lalema NE DONNE AUCUNE GARANTIE, EXPRESSE OU IMPLICITE, ET DÉCLINE TOUTE GARANTIE IMPLICITE DE QUALITÉ MARCHANDE OU D'ADAPTATION À UN USAGE PARTICULIER. Lalema NE PEUT ÊTRE TENU RESPONSABLE POUR QUELQUES DOMMAGES, BLESSURES OU RESPONSABILITÉS DIRECTS OU INDIRECTS PROVENANT DE L'APPLICATION EN TOUT OU EN PARTIE OU DE LA NON-APPLICATION DES AVIS, RECOMMANDATIONS ET CONCLUSION VERBALS OU ÉCRITS, INCLUANT SANS S’Y LIMITER LES DOMMAGES ACCIDENTELS, CONSÉCUTIFS OU SPÉCIAUX. Limitation de responsabilité. Lalema ainsi que son personnel NE PEUVENT EN AUCUN CAS ÊTRE TENUS RESPONSABLES DE TOUTE PERTE DE PROFITS, D'ÉCONOMIES PERDUES, DE DONNÉES PERDUES OU D'AUTRES DOMMAGES SPÉCIAUX, ACCESSOIRES, INDIRECTS OU CONSÉCUTIFS RELATIVEMENT AU PRÉSENT WEBINAIRE, MÊME SI ELLE A ÉTÉ AVISÉE PRÉALABLEMENT DE LA POSSIBILITÉ DE CES DOMMAGES.

1. Fighting HAI’s with
Environmental Hygiene
Rémi Charlebois, M.Sc., Mcb.A., RMCCM

2. 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

3. 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

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

5. 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

6. Why do we disinfect?
• Prior room occupancy as a risk factor for pathogen acquisition
Prior occupant Risk factor Reference
VRE 81.7 Martinez 2003
MRSA
VRE
1.4
1.4
Huang 2006
VRE 3.8 Drees 2008
CDI 2.3 Shaughenessy 2011
Pseudomonas
Acinetobacter
2.3
4.2
Nseir 2011

7. Why do we disinfect?
Alfa et al. AJIC 2016

8. Why do we disinfect
• Reduced hand contamination through the use of a sporicidal
disinfectant
Sirishia Kundrapu S. et al. ICHE 2012

9. Using the right product
When 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

10. Resistance to disinfection
Resistant
Prions
Bacterial spores
Coccidia
Mycobacteria
Non-lipid virus
Fungi
Gram – bacteria
Gram + bacteria
Lipid viruses
Susceptible
HydrogenPeroxide
Bleach5,000ppm
Quats

11. 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

12. Surface compatibility
Should not corrode metallic surfaces and should not accelerate the
deterioration of materials

13. Ease of use
• Ready to use wipes
• Ready to use disinfectant-cleaner
Leads to better compliance
More reliable in the event of an outbreak
If you use a concentrated product make sure to
validate your dilution system/procedures

14. Stability
Affected by:
• Light
• Hard water
• High temperature
• Time

15. 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

16. Cleaning properties
Hydrophilic head and hydrophobic tail helps to solubilize dirt

17. Wettability
With surfactant Without surfactant

19. 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?

20. 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

21. 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

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

23. 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

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

25. www.ramblingsaboutdisinfection.com

26. Questions?
''Let’s declare war
on infectious diseases!'‘
Contact info: rcharlebois@lalema.com