Not All Disinfecting
Wipes Are Created Equal
Walk into any hospital and look closely at the counter tops of a patient care area. You will likely see an assortment of different canisters with colored tops denoting various low or intermediate-level disinfecting wipes. If you ask the front-line staff about the purpose of each disinfecting wipe, you will likely receive an assortment of responses. But each has a distinct purpose and instructions for use, and improper application can contribute to increased hospital acquired infections.
Generally, wipes are routinely applied throughout a hospital to disinfect surfaces and medical devices, often without following the medical device manufacturer instructions for use (IFUs). So let’s define hospital grade Environmental Protection Agency (EPA) approved low-level or intermediate-level disinfecting wipes for the hospital setting:
Disinfectants are antimicrobial agents designed to inactivate or destroy microorganisms on inert surfaces. Low-level disinfectants kill some viruses and bacteria with a chemical germicide registered as a hospital disinfectant by the EPA. Active ingredients may include quaternary ammonium or phenols.
- Intermediate-level disinfectants
Intermediate-level disinfectants are EPA-registered hospital disinfectants that are effective against TB, vegetative bacteria, fungi and viruses, with some having spore claims. Common active ingredients include 70-90% alcohol, hypochlorite, hydrogen peroxide, phenols, or some quaternary ammonium.For example, low-to-intermediate level disinfection is indicated for reusable, noncritical items that ordinarily come into contact with intact skin or do not touch the patient (refer to Spaulding Classification System). All patient care equipment must be disinfected with a hospital EPA approved disinfectant between each patient use and when visibly soiled.Medical equipment and device surfaces, blood pressure cuffs, and hemodialysis machines can become contaminated with infectious agents and contribute to the spread of healthcare-associated infections. The Occupational Safety and Health Administration (OSHA) requires use of EPA-registered tuberculocidal disinfectants or a hypochlorite solution (diluted 1:10 or 1:100 with water) when bloodborne pathogens other than HBV or HIV are involved.
Review Your Use of Disinfecting Wipes
Given the definitions above, review the wipes that your organization is using and the reasons for your choices:
- Are the disinfectant wipe products used by your organization reviewed and approved by a products review committee prior to purchase and use?
- Are your disinfectant wipes standardized across the organization to minimize multiple products in-use, if not specifically indicated? Use an EPA-registered sporicidal disinfectant in areas with high rates of endemic Clostridium difficile infection or in an outbreak setting. (CDC recommendation).
- Is it a one or two-step product? Are the instructions for use (IFUs) being followed for contact (wet) time?
- What personal protective equipment is required? Is PPE available and in-use?
- Are the disinfectant wipe products being used as indicated on medical equipment, devices, and supplies as specified by the medical equipment or device manufacturer IFUs? Are you using a low-level disinfecting wipe on a device or piece of equipment that requires an intermediate-level disinfecting wipe?
- Use an EPA-registered, hospital grade disinfectant to frequently touched surfaces or objects, using the appropriate contact time as stated by the manufacturer’s instructions for use for COVID-19 in healthcare settings. Refer to List N external icon on the EPA website for EPA-registered disinfectants.
By law, all applicable label instructions on EPA-registered products must be followed. If the end user chooses exposure conditions that differ from those on the EPA-registered products label, the end user assumes liability for any injuries or adverse events resulting from off-label use, and is potentially subject to enforcement action under Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA). (Resource)
Set Yourself Up for Success
It can be a challenge for every user of disinfecting wipes in a hospital setting to understand and keep track of various products and their usage specifications. Infection Preventionists can maintain clarity and increase appropriate usage by adhering to these guidelines:
- Instructions should be posted at the site and made available where equipment and device reprocessing is performed.
- A policy, procedure, and process on low-level and intermediate-level disinfection of patient care equipment and devices should be devised, implemented, audited and sustained. These should detail how often disinfection occurs, who is responsible, and how equipment or devices are distinguished as dirty versus clean.
- Reusable medical equipment must be disinfected between patient use, when visibly soiled, and according to manufacturer’s IFUs.
- Manufacturer’s instructions for reprocessing reusable medical equipment must be readily available and used to establish clear procedural and training content.
- Low or intermediate-level disinfection should included in the Infection Prevention and Control Risk Assessment.
Key related CMS CoP and The Joint Commission Standard/EPs
- CMS CoP §482.42 A-0747
- The Joint Commission Standards | EPs IC.02.02.01 EPs 1,2
TiER1 Healthcare Can Help
TiER1 Healthcare can help your team form a complete approach to providing a safe and effective care environment. Contact us at (513) 241-0142 or firstname.lastname@example.org for a consultation.
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