In the long-term care sector, we have to address patients who may have been through multiple hospital visits and may have been infected with a wide range of multi-drug resistant organisms. Some of them may arrive still undergoing treatment for infection’ some may not become symptomatic until they have been residents for several days.
In some cases, the MDRO is simply a part of their natural biome, and they are completely asymptomatic. One thing all of these patients have in common is that they will shed bacteria and virus into the environment resulting in surfaces (fomites) with pathogens that can survive for very long periods, sometimes several months. Fomite transmission typically occurs through hand contact with the contaminated surface where a patient’s or healthcare worker’s hand picks up the pathogen and then transfers that to a susceptible individual who subsequently becomes infected.
We typically take a multistage approach to addressing pathogens in the environment and controlling the spread of MDRO; Identifying patients at risk and isolating them, regular surface disinfection, PPE for employees and visitors, rigorous hand hygiene and appropriate antibiotic therapies all play an important role in preventing the spread of infection.
Surface disinfection is one of those key elements, but there are some vital components that you need to know before you establish a disinfection program. In particular, the selection of the disinfectant you will use is a major component. Get that wrong, and it can be expensive.
Broadly, we look at two types of disinfectant: ready to use and concentrates. Ready-to-use disinfectants are convenient and can be effective, but there is a significant cost to pay for that convenience. Typically, ready-to-use products are only provided to clinical staff to save time and effort. Concentrates are shipped to facilities in liquid form and then water is added at an auto-diluter on site. This is far more cost effective and is typically provided to the professional cleaning staff in the environmental services department.
Not all disinfectant concentrates are the same. They should all be EPA-registered, but not all of them will kill the pathogens of concern. Indeed, many do not kill Clostridium difficile (C. diff), one of the most prevalent infectious agents in a long term care facility.
If your disinfectant does not address C. diff on a daily basis, you are placing your patients at increased risk. Many protocells require the use of a sporicidal disinfectant only when there are patients who are showing symptoms of C. diff infection. This is a mistake; over 25% of the population have a gut colonized with C. diff even if asymptomatic.
Quaternary ammonium, or quat-based, disinfectants are not effective against C. diff and in many cases are not applied correctly, resulting in quat binding and ineffective overall disinfection. Unfortunately, until recently the options for sporicidal treatment have been limited to bleach or peroxy acetic acid, both of which have major issues associated with corrosion, health risk to employees, and odor resulting in a reluctance to use these on a daily basis.
Recently a new disinfectant entered the market: NaDCC tablets.
NaDCC tables are a concentrated disinfectant delivered in fast-dissolving tablet form. Simply drop one tablet into a quart of water and a short while later you have your sporicidal disinfectant. The product is pH neutral and is relatively odorless. There are no auto diluters to maintain, and because you are not shipping water, the required volume of tablets is small, saving on shipping, handling and waste.
NaDCC, when used in conjunction with a surfactant, has been shown to be effective against bacteria in biofilms, a major challenge not addressed by several disinfectants. The simple-to-use tablets produce a disinfectant that has broad-spectrum efficacy, killing all the problem bacteria and viruses your long-term care facility must address on a routine basis.
Simple, cost effective and technically effective, you need to know about this option for disinfection. Ask your distributor about NaDCC tablets.
Mark Hodgson, a chemist with a strong background in environmental microbiology and the impact of fomites on patients, has worked in healthcare and infection prevention for over 15 years. He is vice president of Medentech.