Bacteria, or more specifically killing them, has taken center stage in the news recently; outbreaks of anthrax have led to calls for the U.S. Postal Service to irradiate mail; individuals are told to wash their hands frequently; and, as of press time, the Environmental Protection Agency (EPA) is recommending flooding a contaminated Senate building with chlorine dioxide gas to kill anthrax and its spores.

In most situations building service contractors will encounter, however, the threat isn’t anthrax; it’s mold, staph and even the common cold — everyday germs that, if left unchecked, can sicken many.

Even in normal circumstances, reducing microbial contamination in a building is necessary to keeping its occupants healthy — and keeping them on the job.

“We’re dealing with people who make $100,000 to $250,000 or more a year, and downtime is expensive,” says James Thompson, owner of A-1 Building Services, a medical and commercial cleaning contractor in Portage, Mich. “But in non-medical facilities especially, people aren’t prepared to discuss disinfection.”

To help educate customers regarding cleaning for health, he breaks down the financial impact of an illness in a highly paid executive. For instance, just one sick day taken by a top-level official can mean thousands of dollars lost to sick pay, lost productivity, cancellations, fewer sales and so on.

When BSCs think of disinfection, hospitals, food-prep surfaces and restrooms come to mind, but Thompson says it’s important to examine common, everyday items that multiple people will handle frequently. For instance, Thompson’s staff will disinfect light switches, telephones and doorknobs, especially those in common areas, every day.

But the need to control contamination must be balanced with the need to keep building occupants, and the environment, safe. Disinfectants, by their nature, are designed to kill, and some can have harmful fumes or can irritate skin and eyes.

“People are more and more concerned about indoor air quality and [volatile organic compounds],” Thompson says. “So it’s important to select the proper product without overkill.”

It’s vital, he says, to identify the effects each chemical will have on surfaces, and on the indoor environment, especially in medical facilities where people might already be suffering from respiratory distress.

In offices and other non-medical buildings, Thompson uses basic disinfectants; in hospitals, he uses more sophisticated chemicals, including phenols. However, he limits his use of phenols because of the potential for fumes.

Common disinfection mistakes
Distributor information and ongoing training have helped keep A-1’s operational errors to a minimum, but certain mistakes keep popping up in most BSCs’ disinfection programs, Thompson says.

For instance, many janitors, in the interest of saving time, tend to skip steps or use the wrong amount of a chemical.

“Employees tend to see organic contamination such as dirt, and think they can spray disinfectant on it and that’ll kill it,” Thompson says. “But those are two separate steps — you need a cleaner, then a disinfectant.”

Also, employees need to be trained, repeatedly, to follow label instructions. Often, a worker will add extra concentrate to a solution, assuming that twice as much will kill twice as many microbes, twice as fast. Instead, a chemical in too high a concentration at best may be ineffective or may need to be removed and reapplied; at worst, it can injure the worker, damage the surface or release harmful fumes.

In addition, again in the interest of speed, workers tend to remove the chemical too quickly.

“Make sure the chemical has a proper dwell time. People want to hurry up, but most chemicals need 10 minutes to be effective,” he says.

Also, janitors tend to use too little liquid when disinfecting floors, in order to speed up dry times. But floors need the same dwell times, so cleaners should apply the mopping compound liberally, so it doesn’t evaporate too quickly.

“The biggest thing is having employees realize their responsibility” in keeping a facility as clean as possible, says Thompson. “Sometimes, a cleaner will look at an exam room, and it doesn’t appear as though it was used that day. But we clean everything, every day, no matter what.”

Put it in writing
Even in general office facilities, Thompson has very strict, written protocols for disinfection. The Minnesota Technical Assistance Program (MnTAP), a service that helps businesses in the state reduce pollution and waste and improve health, suggests every company have a such written procedures. MnTAP recommends including the following steps:

1. Conduct general surface cleaning to remove dirt and debris.

2. Because disinfectants are designed to kill, they are toxic. Determine if a lesser level of clean is sufficient. Does an item truly need to be disinfected or is cleaning sufficient? General surface cleaning can be accomplished by washing with a detergent, rinsing and thoroughly drying.

3. Know the target microbes you need to kill.

4. Choose a disinfectant that has high efficacy and is less toxic to employees and the environment. Disinfectants that act by oxidizing such as hydrogen peroxide or peracetic acid create fewer by-products than quaternary compounds or chlorine. Hydrogen peroxide and peracetic acid also generally are more effective against all types of microbes and are not as easily inactivated by organic matter.

5. To protect workers from concentrated solutions, determine what equipment is necessary to ensure proper dilutions and easy use.

Calibrate dispensing equipment carefully and often—at least every time a new container of disinfectant is opened. When calibrating, check the equipment for leaks and malfunctions. Equipment can be calibrated with water instead of the chemical to prevent waste.

All disinfectants have a concentration at which they achieve their maximum ability to disinfect. Thus, concentrates need to be measured before being going in a dilution tank.

Mix only the amount needed; do not mix a gallon if you only need a quart.

Make sure diluted disinfectant is labeled with the name, date and initials of whoever is diluting the solution to better track the expiration date of the dilution (outdates). Check manufacturer’s instructions for an outdate and how to protect from inappropriate uses.

6. More concentrated disinfectants do not necessarily react more quickly or effectively. Follow label directions carefully. They provide information on proper timing and application.

7. Train staff and clearly post the procedure at the disinfectant dispensing station.

8. Keep containers closed when not in use. Check containers regularly for leaks, breaks, rust or other corrosion.

Also, BSCs need to be aware of their chemical inventory and storage. Here are some suggestions from MnTAP:

  • Avoid spills. When spills do occur, clean them up immediately. Ensure that spilled residues are managed properly—refer to the product’s material safety data sheet (MSDS).
  • Make sure disinfectants are stored in compatible containers. For example, corrosives should not be kept in metal or stainless steel containers.
  • Use drip pans under spouts to catch and contain drips.
  • Minimize the transfer of disinfectants from container to container. Use pumps and spigots instead of pouring to decrease the likelihood of spills or skin contact.
  • Maintain appropriate inventory. Only order and stock what is needed to avoid unnecessary disposal of excess or outdated disinfectants.
  • Dispose of waste properly. Unused disinfectant concentrates may be considered hazardous waste. Check with the MSDS and with local authorities to find out what to do with hazardous waste.

A word on word choice
Before instituting a disinfection program, check the terminology in the cleaning contract, as well as the labels of the product you intend to use.

The U.S. Environmental Protection Agency (EPA) classifies all registered antimicrobial products into three categories:

Sanitizers reduce but do not necessarily eliminate all the microorganisms on a surface. Microbes must be reduced by at least 99.9 percent on treated surfaces.

Disinfectants destroy or irreversibly inactivate infectious organisms, but not necessarily their spores.

Sterilizers eliminate all forms of bacteria, fungi and viruses, and all spores.

In most cases, general cleaning or sanitizing is enough; indeed, when most BSCs talk about “disinfecting” a surface, they most likely actually are “sanitizing.”

Regardless of what procedures a company follows, contractors must make sure they’re using properly registered products, says James C. Wright, president of Wright & Sielaty, P.C., a law firm dedicated to chemical regulation in Lake Ridge, Va.

If a product makes any antimicrobial claims, it must be registered with the EPA. For a hand-washing product, there’s no label, so BSCs should consult with the manufacturer. However, for other disinfectants and sanitizers, look on the label for “EPA Reg. No. XXX-XXX.” (The number can be in two or three parts.) If an allegedly “antimicrobial” product doesn’t have this information, it may be illegal.

In that case, return the product to a distributor. Often, says Wright, distributors aren’t even aware the product is illegal. If the distributor won’t take the product back, consider contacting the manufacturer or the EPA.

Although the EPA won’t usually go after an end user, a contractor could be held liable for any injuries resulting from an unregulated product, says Wright.

“If [contractors] act in good faith with the authorities, they won’t get in trouble,” Wright says.

by Stacie H. Whitacre, Managing Editor (Information from “Disinfection Best-Management Practices.” Used with permission of the Minnesota Technical Assistance Program.)

A disinfection success story
The Small Animal Hospital at the University of Minnesota, which provides care mainly for dogs and cats, was concerned about its disinfection procedure.

Chemical disinfection at the small animal hospital is critical because the bacteria-carrying particles on the floor, cages, kennels and surgical tables could reach an animal’s open wound and cause infection.

In one year, the hospital received 23,342 cases and performed 4,587 surgeries. The number of cases they treat increases every year. This increase in cases results in more disinfectant use and waste. The hospital wanted to see if they could reduce their use of disinfectants while maintaining strict disease control.

A intern with the Minnesota Technical Assistance Program (MnTAP) reviewed the hospital’s procedures and evaluated their disinfection by sampling microorganisms. She worked with the hospital staff and identified the following improvement opportunities:

  • More training. Proper disinfection procedures were not well understood because staff were not adequately trained.
  • Post instructions. No written instructions were posted for proper procedures. Staff used their own judgment.
  • •Proper disinfectant use. Staff sometimes used the wrong dilution and selected less-than-ideal disinfectants.
  • Understanding disinfection. Staff mistakenly believed that using a higher concentration results in more effective cleaning.

The lack of procedures led to excess disinfectant use, costing more than $5,000 a year. The clinic was not achieving its desired level of disinfection and had increased chemical loss to the wastewater. As a result of the intern’s research, the veterinary hospital developed and posted a written procedure, and trained its staff how to follow it. The hospital also instituted pre-cleaning and using the appropriate dilution. No increase in infections has been noticed.

From: “Disinfection Best-Management Practices,” published online. Reprinted with permission from the Minnesota Technical Assistance Program.




POSTED ON: 11/1/2001