| IAQ in Healthcare Environments – Transition | | | | environment because of its tendency to open |
| Healthcare Challenges (Choosing a disinfectant for | | | | pores and dry skin. This can create openings for |
| hospital environments) | | | | microbes to enter the body if not properly |
| As the economy heads further down the slippery | | | | protected. |
| slope of what promises to be a deep recession, | | | | Though high concentration alcohol based |
| and our healthcare infrastructure continues to | | | | disinfectants are generally highly effective against |
| grow and age, it is a natural progression to see | | | | lipophilic viruses they are less active against |
| more and more IAQ professionals turn to what | | | | non-lipid viruses and ineffective against bacterial |
| some believe is a recession resistant market. | | | | spores. Generally alcohol disinfectants are not |
| From ambulatory facilities to long term care, the | | | | used for equipment immersion due to diminishing |
| buildings that make up our healthcare | | | | efficacy as the alcohol volatilizes. Alcohol |
| infrastructure are constantly in need of | | | | disinfectants cannot be used as cleaners thus |
| renovations and repair. This new and promising | | | | making them less effective for practical use on |
| opportunity for IAQ pros offers many long term | | | | many surfaces. Even though some Alcohol based |
| rewards but is not without new and complex | | | | disinfectants can offer a broad spectrum of kill |
| challenges that must be addressed. | | | | claims, it can be difficult to maintain appropriate |
| Every IEP realizes the importance of appropriate | | | | wet contact time due to the rapid evaporation |
| use of antimicrobials, containment barriers and | | | | rate. |
| personal protection. Though often times IEPs find | | | | |
| the regulations and guidelines they encounter in | | | | Chlorine |
| healthcare facilities to be daunting to say the least. | | | | These corrosive oxidizers are known for cidal |
| In traditional remediation environments the focus | | | | action against a wide variety of gram-negative |
| is to ultimately provide an environment free of | | | | and gram-positive bacteria as well as many |
| dangerous pathogens or contaminants. While | | | | viruses. Difficult to work with, these disinfectants |
| attention is give to the methodology, often times | | | | are rapidly neutralized in the presence of organic |
| the end results dwarf the means of acquiring | | | | matter making them less than ideal for healthcare |
| those results. With a host of accepted methods | | | | and remediation environments. |
| to address indoor air quality in businesses, homes | | | | While chlorine disinfectants are currently used in |
| and public spaces the contractor finds themselves | | | | many facilities, future use of halogens is expected |
| able to select from a variety of methods to deal | | | | to decline as options like quats and alcohols |
| with each issue. In the end it is the air clearance | | | | become more abundant with appropriate kill claims. |
| that counts, not so much which method was used | | | | Sodium hypochlorite is known for causing |
| to obtain it. | | | | significant corrosion to metals and other common |
| | | | | materials. Chlorine disinfectants are considered |
| While the end results are just as, if not more | | | | toxic, and in 1994 the Clinton Administration called |
| important in healthcare environments; far more | | | | for the ban of all chlorine and chlorine based |
| attention must be paid to the processes used. | | | | products. |
| As many occupants of a healthcare facility cannot | | | | |
| be moved and are highly susceptible to infection, | | | | Phenol |
| there are very specific guidelines in place that | | | | Phenol is one of the oldest known disinfectants still |
| govern all maintenance, repair and renovation | | | | in use today and is both commercially |
| work in a healthcare facility. Organizations like | | | | manufactured and naturally occurring. Phenols are |
| CDC, APIC and JCAHO have placed standards | | | | often effective for use on vegetative bacterial, |
| that apply to all activities that may have an | | | | lipid containing viruses and Mycobacterium |
| impact on a healthcare environment. This is done | | | | tuberculosis but have limited or no efficacy for |
| with good reason considering the number HAIs | | | | use against spores or non-lipid viruses. While these |
| (Hospital Acquired Infections) reported annually | | | | disinfectants are effective over a relatively large |
| due to airborne pathogens like Aspergillus, which is | | | | PH range, their limited solubility makes product |
| disturbed during common daily maintenance. | | | | residue difficult to clean. These disinfectants |
| Nosocomial infections caused from routine | | | | cannot be used on food contact surfaces and |
| maintenance reach into the hundreds of | | | | often require additional PPE like goggles, face |
| thousands each year. These guidelines and | | | | shields gloves and protective clothing for |
| regulations are enforced in a facility by ICPs or | | | | application. Phenols cannot be used in many parts |
| infection control professionals. | | | | of a healthcare facility like neonatal, pediatric ICU |
| Hospitals continually adapt to new, more stringent | | | | or any infant contact surface due to toxic residue. |
| CMS guidelines limiting what medical treatments | | | | Reports of eye irritation, contact dermatitis |
| are reimbursable through Medicare or Medicaid, | | | | utricaria, and depigmentation of the skin have |
| this has caused hospital administration to look | | | | been tied to phenol and phenol residue contact. |
| more closely at every aspect of infection control | | | | |
| in their facility. Beginning in October of 2008, | | | | Phenols are commonly found in a host of |
| Medicare and Medicaid began limiting payments | | | | consumer products and are not dangerous in very |
| made to facilities for the treatment of | | | | low concentrations. Disinfectant strength phenols |
| preventable nosocomial infections or conditions. | | | | however are considered a health risk by EPA and |
| These new CMS guidelines are driven by Section | | | | NIOSH. OSHA recommendations state that |
| 5001(c) of the Deficit Reduction Act, which could | | | | employee exposure to phenol in the work place |
| mean that as deficits climb the list of | | | | should be controlled to less than 20 mg/cu m in |
| non-reimbursable conditions are likely to grow. | | | | air determined as a time-weighted average |
| Infections like Aspergillosis, which is caused by | | | | (TWA) concentration for up to a 10 hour work |
| airborne A.Fumigatus, are common in healthcare | | | | day or 40 hour work week. The NIOSH guidelines |
| facilities. Aspergillus is one airborne pathogen that | | | | also limit exposure to phenols to 60 mg phenol/cu |
| is commonly disturbed and distributed throughout | | | | m of air as a ceiling concentration for any 15 |
| a facility after maintenance work or renovations. | | | | minute period. Phenols generally enter the blood |
| The argument could be made that Aspergillosis is | | | | stream via ingestion, respiration or skin contact. |
| a preventable condition by ensuring appropriate | | | | NIOSH recommendations are just one indicator of |
| containment and disinfection of disturbed areas. | | | | the need for PPE when using Phenolic |
| Infection control professionals in healthcare | | | | disinfectants. Disinfectants with a concentration of |
| environments have become increasingly diligent in | | | | 1% phenol or greater are considered an extreme |
| monitoring the actions of contractors that work in | | | | skin and inhalation hazard and are moderately |
| their facilities. It is ICP’s responsibility to | | | | combustible. |
| ensure all components of the infection control risk | | | | Containment plays a key roll in infection |
| assessment are adhered to. While these key | | | | prevention. |
| people can complicate the lives of the contractors | | | | While disinfection of surfaces, equipment and |
| working in healthcare facilities they are also | | | | touch points plays one of the most critical roles |
| actively saving lives by doing so. ICP’s will | | | | for infection control in a health care facility; |
| monitor and log details about each project to | | | | another primary responsibility of the IEP working |
| ensure that all compliance issues are being | | | | in a healthcare facility is containment. The |
| addressed. Two primary issues that impact | | | | containment of harmful pathogens and particulate |
| infection control and prevention in healthcare | | | | during work in a healthcare facility is essential, |
| settings are disinfection of contaminated surfaces | | | | especially when working in areas near |
| with broad spectrum EPA registered disinfectants | | | | immunocompromised patients. |
| and appropriate containment of airborne | | | | Regulations set by CDC & Joint Commission |
| particulate and pathogens. | | | | are clear in dictating specific criteria for the |
| | | | | elimination of airborne Aspergillus, asbestos and |
| Choosing the best disinfectant is one way to | | | | dust. A term that IEPs will hear all to frequently |
| ensure the best possible level of microbial control | | | | as they make their transition into a healthcare |
| during any abatement project in a facility. | | | | environment is ICRA or infection control risk |
| Healthcare facilities present the IEP with a unique | | | | assessment. These operating guidelines are critical |
| set of challenges in regards to pathogens beyond | | | | to any maintenance work done in a healthcare |
| the standard fungal and bacterial flora. Many of | | | | facility. APIC has developed guidelines assisting |
| these pathogens can be highly infectious as well | | | | healthcare facilities in developing their ICRA to |
| as drug resistant making them far more | | | | specifically mandate that dust and airborne |
| dangerous to the many immunocompromised | | | | particulate must be contained under negative |
| patients housed in a healthcare facility. When | | | | pressure in Kontrol Kube like containment or by |
| selecting a hospital grade disinfecting it is | | | | using other solid barrier methods. |
| imperative to keep several things in mind. | | | | For many years hospitals were forced to either |
| Does your disinfectant have sufficient kill claims to | | | | temporarily close an entire wing or build |
| address the microbes you might encounter? | | | | temporary solid barriers during mold remediation |
| While no disinfectant can list every possible | | | | or asbestos abatement jobs to prevent airborne |
| organism, it is important to find a disinfectant with | | | | particulate from escaping the work area. In recent |
| the most possible EPA registered kill claims. Look | | | | years a new method of mobile containment has |
| for efficacy data. Disinfectants that do not show | | | | been made available making daily remediation, |
| efficacy & testing data often have few or | | | | repair and renovation faster and far more cost |
| irrelevant kill claims and are not sufficient for the | | | | effective. Kontrol Kube type containment |
| challenges found in healthcare facilities. It is also a | | | | essentially revolutionized the way hospital |
| positive if your disinfectant has EPA approved | | | | maintenance was being done by allowing an IEP to |
| efficacy in the presence of 98% soil load as | | | | quickly roll tools, ladders, chemicals and other |
| opposed to 5% which is required by the EPA. | | | | equipment into a location and then isolate that |
| This higher soil load represents real world | | | | area for the duration of the work. |
| conditions. Beyond fungicidal kill claims, other | | | | Infection control professionals prefer contractors |
| claims that you might require involve infectious | | | | to use methods like portable containment when |
| pathogens like MRSA, E-coli, HIV, Salmonella and | | | | possible for several reasons. Mobile containment |
| Avian Influenza. You may also want to look for a | | | | units are easy to set up and inspect, this not only |
| product that can be used on both porous and | | | | makes use of the unit easier for the IEP but also |
| non-porous surfaces and has disinfectant and | | | | makes the inspection process much faster and |
| sanitizing claims. | | | | efficient for the ICP. Knowing that all materials are |
| Understand what the active ingredients are in | | | | fire rated and meet NFPA 701 is also important |
| your disinfectant | | | | with any sort of temporary barrier material you |
| It is essential to know what type of disinfectant is | | | | use. Fire codes and standards are extremely |
| appropriate. Most common disinfectants are | | | | critical in healthcare situations and are a focal point |
| formulated using Alcohol, Phenol, Chlorine or a | | | | during Joint Commission inspections. |
| Quaternary Amine Base. There are arguments for | | | | When selecting a mobile containment unit be |
| each type of disinfectant and it is important to | | | | sure to consider if the unit is made of durable |
| know the facts about the products you are | | | | components that will hold up under rigorous daily |
| working with. Each has advantages, but some | | | | use. It is also important to know that the unit is |
| have dramatic disadvantages that might make | | | | easily cleaned and is capable of providing all the |
| you think twice about using them. | | | | functionality needed. Will the unit accommodate an |
| Quaternary Ammonium Chloride (Quats) – | | | | eight foot ladder effectively? Does the unit have |
| Examples Shockwave Disinfectant/Sanitizer, IAQ | | | | a solid yet mobile working platform? Is it highly |
| 2000/2500 | | | | adjustable, durable and lightweight? |
| Quats are often considered easier to use and | | | | Disinfectants and Kontrol Kube type containment |
| safer than other disinfectant bases because they | | | | are used in almost every type of daily work an |
| are less corrosive, non-carcinogenic and maintain | | | | IEP might encounter in a healthcare facility; both |
| efficacy for extended periods of time. Not all quat | | | | are key components to any comprehensive |
| based disinfectants are equal though. There are a | | | | infection control plan. For the individual contractor |
| variety of products with EPA registered kill claims | | | | working in a healthcare facility, understanding what |
| ranging from just a few all the way to over 130. | | | | is expected of you could make all the difference |
| In a healthcare environment it is important to | | | | between winning a bid and being passed over. The |
| seek out the latter, as the spectrum of microbes | | | | knowledge and expertise shown while in the |
| likely encountered in a hospital will be much | | | | facility can also ensure future jobs in that facility. |
| broader than in common remediation situations. | | | | As IEPs progress into the healthcare arena to |
| Unlike many other disinfectants quats based | | | | reap the benefits of this relatively protected |
| disinfectants are excellent cleaners making them | | | | market they are not only assuming the role of |
| ideal for surfaces with a large amount of | | | | IAQ professional; they are also assuming the role |
| biomaterial like fungi, blood or human waste. As | | | | of infection control professional helping to maintain |
| many MDROs like C-DIFF, MRSA and VRE are | | | | safe, clean and infection free environments. While |
| transmitted by contaminated bodily fluids and | | | | the challenges they face are unique and in some |
| waste this is an important factor in the equation | | | | cases daunting, the benefits exceed a simple |
| to finding the ideal disinfectant for healthcare | | | | increase in business. When we stop to consider |
| environments. Quats are highly stable and maintain | | | | the impact of the work they do in the facilities |
| efficacy even in the presences of high soil load. | | | | that care for our sick, our elderly and our very |
| This makes them ideal for mold remediation as | | | | young we can see how each of us does our part |
| well as blood or bodily fluid spills. | | | | to win the battle against infection and disease. |
| | | | | With proper education and training, IEPs can make |
| Many IEPs as well as ICPs prefer the use of a | | | | the leap from the private or public sector into the |
| quats because they not only offer a broad | | | | highly lucrative and relatively stable market of |
| spectrum of kill claims, but are easy to work with | | | | healthcare remediation, abatement and repair with |
| and more cost effective than other options. In | | | | ease. Knowing the facts about not only the rules |
| addition most quats do not have the drawbacks | | | | and regulations in healthcare facilities, but also the |
| associated with chlorine, alcohol or phenol based | | | | tools available can help ensure a successful |
| products on the market. | | | | transition into IAQ in healthcare environments. |
| | | | | John Pierson is Manager of Infection Control |
| Alcohol | | | | Products for Fiberlock Technologies, manufacturer |
| While not as user friendly as quats, alcohol based | | | | of Shockwave EPA registered Disinfectant |
| disinfectants are considered by many to be easier | | | | Sanitizer and Kontrol Kube Mobile Containment |
| to use than chlorine or phenol based products. | | | | Solutions, based in Andover, MA. He can be |
| High concentration alcohol based disinfectants can | | | | reached by email at or phone at 800-342-3755 |
| however be dangerous in a healthcare | | | | x236. |