Cleaning vs. Disinfecting Surfaces. Disinfectant Ingredient FAQ. Clothes Hands Dishes Surfaces. Learn More. About Ingredients. Ingredient Safety Initiative. Germs are most often spread by hands through person-to-person contact. Germs can enter our bodies through the mouth, nose, eyes and breaks in the skin without our even knowing we've been infected. Poor personal hygiene by foodhandlers is the second leading cause of foodborne illness. An estimated 60 million days of school and 50 million days of work are lost annually because of the common cold.
Some 5. Germs can be transferred from inanimate surfaces to hands and vice-versa. Some germs can live on dry surfaces such as toys for several hours and moist surfaces like bathroom sinks for up to three days. Salmonella can survive freezing and can survive on dry surfaces for at least 24 hours. The use of powders, composed of a mixture of a chlorine-releasing agent with highly absorbent resin, for disinfecting spills of body fluids has been evaluated by laboratory tests and hospital ward trials.
The inclusion of acrylic resin particles in formulations markedly increases the volume of fluid that can be soaked up because the resin can absorb — times its own weight of fluid, depending on the fluid consistency. One problem with chlorine-releasing granules is that they can generate chlorine fumes when applied to urine Formaldehyde is used as a disinfectant and sterilant in both its liquid and gaseous states.
Liquid formaldehyde will be considered briefly in this section, and the gaseous form is reviewed elsewhere The aqueous solution is a bactericide, tuberculocide, fungicide, virucide and sporicide 72, 82, OSHA indicated that formaldehyde should be handled in the workplace as a potential carcinogen and set an employee exposure standard for formaldehyde that limits an 8-hour time-weighted average exposure concentration of 0.
The standard includes a second permissible exposure limit in the form of a short-term exposure limit STEL of 2 ppm that is the maximum exposure allowed during a minute period Ingestion of formaldehyde can be fatal, and long-term exposure to low levels in the air or on the skin can cause asthma-like respiratory problems and skin irritation, such as dermatitis and itching.
For these reasons, employees should have limited direct contact with formaldehyde, and these considerations limit its role in sterilization and disinfection processes. Formaldehyde inactivates microorganisms by alkylating the amino and sulfhydral groups of proteins and ring nitrogen atoms of purine bases Varying concentrations of aqueous formaldehyde solutions destroy a wide range of microorganisms.
Four percent formaldehyde is a tuberculocidal agent, inactivating 10 4 M. The formaldehyde solution required 2 hours of contact to achieve an inactivation factor of 10 4 , whereas glutaraldehyde required only 15 minutes. For these reasons and others—such as its role as a suspected human carcinogen linked to nasal cancer and lung cancer , this germicide is excluded from Table 1. When it is used, , direct exposure to employees generally is limited; however, excessive exposures to formaldehyde have been documented for employees of renal transplant units , , and students in a gross anatomy laboratory Formaldehyde is used in the health-care setting to prepare viral vaccines e.
To minimize a potential health hazard to dialysis patients, the dialysis equipment must be thoroughly rinsed and tested for residual formaldehyde before use. Paraformaldehyde, a solid polymer of formaldehyde, can be vaporized by heat for the gaseous decontamination of laminar flow biologic safety cabinets when maintenance work or filter changes require access to the sealed portion of the cabinet.
Glutaraldehyde is a saturated dialdehyde that has gained wide acceptance as a high-level disinfectant and chemical sterilant Aqueous solutions of glutaraldehyde are acidic and generally in this state are not sporicidal. Once activated, these solutions have a shelf-life of minimally 14 days because of the polymerization of the glutaraldehyde molecules at alkaline pH levels.
This polymerization blocks the active sites aldehyde groups of the glutaraldehyde molecules that are responsible for its biocidal activity. Novel glutaraldehyde formulations e.
However, antimicrobial activity depends not only on age but also on use conditions, such as dilution and organic stress. However, two studies found no difference in the microbicidal activity of alkaline and acid glutaraldehydes 73, The biocidal activity of glutaraldehyde results from its alkylation of sulfhydryl, hydroxyl, carboxyl, and amino groups of microorganisms, which alters RNA, DNA, and protein synthesis.
The mechanism of action of glutaraldehydes are reviewed extensively elsewhere , The in vitro inactivation of microorganisms by glutaraldehydes has been extensively investigated and reviewed , Spores of C. Microorganisms with substantial resistance to glutaraldehyde have been reported, including some mycobacteria M. Two percent alkaline glutaraldehyde solution inactivated 10 5 M. However, subsequent studies 82 questioned the mycobactericidal prowess of glutaraldehydes. Suspensions of M. The rate of kill was directly proportional to the temperature, and a standardized suspension of M.
An FDA-cleared chemical sterilant containing 2. Several investigators 55, 57, 73, 76, 80, 81, 84, have demonstrated that glutaraldehyde solutions inactivate 2. Glutaraldehyde is commonly diluted during use, and studies showed a glutaraldehyde concentration decline after a few days of use in an automatic endoscope washer , This emphasizes the need to ensure that semicritical equipment is disinfected with an acceptable concentration of glutaraldehyde.
Data suggest that 1. Chemical test strips or liquid chemical monitors , are available for determining whether an effective concentration of glutaraldehyde is present despite repeated use and dilution.
The frequency of testing should be based on how frequently the solutions are used e. The bottle of test strips should be dated when opened and used for the period of time indicated on the bottle e. The results of test strip monitoring should be documented. The glutaraldehyde test kits have been preliminarily evaluated for accuracy and range but the reliability has been questioned To ensure the presence of minimum effective concentration of the high-level disinfectant, manufacturers of some chemical test strips recommend the use of quality-control procedures to ensure the strips perform properly.
In December , EPA issued an order to stop the sale of all batches of this product because of efficacy data showing the product is not effective against spores and possibly other microorganisms or inanimate objects as claimed on the label Other FDA cleared glutaraldehyde sterilants that contain 2. Glutaraldehyde is used most commonly as a high-level disinfectant for medical equipment such as endoscopes 69, , , spirometry tubing, dialyzers , transducers, anesthesia and respiratory therapy equipment , hemodialysis proportioning and dialysate delivery systems , , and reuse of laparoscopic disposable plastic trocars Glutaraldehyde is noncorrosive to metal and does not damage lensed instruments, rubber.
Glutaraldehyde should not be used for cleaning noncritical surfaces because it is too toxic and expensive. Colitis believed caused by glutaraldehyde exposure from residual disinfecting solution in endoscope solution channels has been reported and is preventable by careful endoscope rinsing , Healthcare personnel can be exposed to elevated levels of glutaraldehyde vapor when equipment is processed in poorly ventilated rooms, when spills occur, when glutaraldehyde solutions are activated or changed, , or when open immersion baths are used.
Acute or chronic exposure can result in skin irritation or dermatitis, mucous membrane irritation eye, nose, mouth , or pulmonary symptoms , Epistaxis, allergic contact dermatitis, asthma, and rhinitis also have been reported in healthcare workers exposed to glutaraldehyde , Glutaraldehyde exposure should be monitored to ensure a safe work environment.
The silica gel tube and the DNPH-impregnated cassette are suitable for monitoring the 0. The passive badge, with a 0. ACGIH does not require a specific monitoring schedule for glutaraldehyde; however, a monitoring schedule is needed to ensure the level is less than the ceiling limit. For example, monitoring should be done initially to determine glutaraldehyde levels, after procedural or equipment changes, and in response to worker complaints Engineering and work-practice controls that can be used to resolve these problems include ducted exhaust hoods, air systems that provide 7—15 air exchanges per hour, ductless fume hoods with absorbents for the glutaraldehyde vapor, tight-fitting lids on immersion baths, personal protection e.
If engineering controls fail to maintain levels below the ceiling limit, institutions can consider the use of respirators e. In general, engineering controls are preferred over work-practice and administrative controls because they do not require active participation by the health-care worker. Court of Appeals , limiting employee exposure to 0. If glutaraldehyde disposal through the sanitary sewer system is restricted, sodium bisulfate can be used to neutralize the glutaraldehyde and make it safe for disposal.
The literature contains several accounts of the properties, germicidal effectiveness, and potential uses for stabilized hydrogen peroxide in the health-care setting. Published reports ascribe good germicidal activity to hydrogen peroxide and attest to its bactericidal, virucidal, sporicidal, and fungicidal properties Tables 4 and 5 The FDA website lists cleared liquid chemical sterilants and high-level disinfectants containing hydrogen peroxide and their cleared contact conditions.
Hydrogen peroxide works by producing destructive hydroxyl free radicals that can attack membrane lipids, DNA, and other essential cell components. Catalase, produced by aerobic organisms and facultative anaerobes that possess cytochrome systems, can protect cells from metabolically produced hydrogen peroxide by degrading hydrogen peroxide to water and oxygen.
This defense is overwhelmed by the concentrations used for disinfection , Hydrogen peroxide is active against a wide range of microorganisms, including bacteria, yeasts, fungi, viruses, and spores 78, Bactericidal effectiveness and stability of hydrogen peroxide in urine has been demonstrated against a variety of health-care—associated pathogens; organisms with high cellular catalase activity e. Synergistic sporicidal effects were observed when spores were exposed to a combination of hydrogen peroxide 5.
Other studies demonstrated the antiviral activity of hydrogen peroxide against rhinovirus The product marketed as a sterilant is a premixed, ready-to-use chemical that contains 7. The mycobactericidal activity of 7. When the effectiveness of 7. No complaints were received from the nursing or medical staff regarding odor or toxicity. A new, rapid-acting Manufacturer data demonstrate that this solution sterilizes in 30 minutes and provides high-level disinfection in 5 minutes This product has not been used long enough to evaluate material compatibility to endoscopes and other semicritical devices, and further assessment by instrument manufacturers is needed.
Under normal conditions, hydrogen peroxide is extremely stable when properly stored e. Corneal damage from a hydrogen peroxide-soaked tonometer tip that was not properly rinsed has been reported Hydrogen peroxide also has been instilled into urinary drainage bags in an attempt to eliminate the bag as a source of bladder bacteriuria and environmental contamination Although the instillation of hydrogen peroxide into the bag reduced microbial contamination of the bag, this procedure did not reduce the incidence of catheter-associated bacteriuria As with other chemical sterilants, dilution of the hydrogen peroxide must be monitored by regularly testing the minimum effective concentration i.
Compatibility testing by Olympus America of the 7. Iodine solutions or tinctures long have been used by health professionals primarily as antiseptics on skin or tissue. Iodophors, on the other hand, have been used both as antiseptics and disinfectants.
FDA has not cleared any liquid chemical sterilant or high-level disinfectants with iodophors as the main active ingredient. An iodophor is a combination of iodine and a solubilizing agent or carrier; the resulting complex provides a sustained-release reservoir of iodine and releases small amounts of free iodine in aqueous solution. The best-known and most widely used iodophor is povidone-iodine, a compound of polyvinylpyrrolidone with iodine.
This product and other iodophors retain the germicidal efficacy of iodine but unlike iodine generally are nonstaining and relatively free of toxicity and irritancy , Several reports that documented intrinsic microbial contamination of antiseptic formulations of povidone-iodine and poloxamer-iodine caused a reappraisal of the chemistry and use of iodophors The reason for the observation that dilution increases bactericidal activity is unclear, but dilution of povidone-iodine might weaken the iodine linkage to the carrier polymer with an accompanying increase of free iodine in solution Iodine can penetrate the cell wall of microorganisms quickly, and the lethal effects are believed to result from disruption of protein and nucleic acid structure and synthesis.
Published reports on the in vitro antimicrobial efficacy of iodophors demonstrate that iodophors are bactericidal, mycobactericidal, and virucidal but can require prolonged contact times to kill certain fungi and bacterial spores 14, , , But what do they actually mean? According to Melissa Homer , chief cleaning officer at home-cleaning franchise MaidPro, sanitizing removes An antibacterial product means it contains ingredients that can help kill or slow the growth of bacteria, though be careful of these, as antibacterial soap is no better than regular soap.
While they are powerful germ-killing agents, disinfectants can not do their jobs properly if they are used on dirty surfaces — because dirt and oil will consume the disinfectant and protect the germs, Homer says. This is why the Centers for Disease Control and Prevention CDC recommends cleaning a surface with soap and water before using a disinfectant.
When buying a disinfectant , you should look for an EPA registration number on the product. These are usually found on the front or back panel of the product label.
The Environmental Protection Agency EPA assigns these numbers to products that have been tested and proven to kill germs. Here are the most common active ingredients in these EPA-registered disinfectants:. Household cleaners with these ingredients may be difficult to find at the store right now, Homer says, and while disinfectants are the most effective at removing germs, maintaining good hand hygiene by washing frequently is also important.
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