Attachment E

 

Disinfection Issues and Literature

 

I.       Support for Surface Disinfection

 

A.      Prevention of Surface-to-Human Transmission of Rotaviruses by Treatment with Disinfectant Spray [Abstract attached]

 

The study examines the effect of Lysol disinfectant on preventing the transmission of rotaviruses.  Consumption of the rotavirus that was sprayed with Lysol Disinfectant by 14 subjects caused no infection, whereas 13 of 14 subjects who consumed the unsprayed virus became infected.

 

B.      Fecal Coliforms on Environmental Surfaces in Two Day Care Centers [Abstract attached]

 

Disinfection of inanimate objects, in addition to good handwashing, may be important in controlling the spread of enteric diseases in day care centers.

 

C.     Chemical Disinfection to Interrupt Transfer of Rhinovirus Type 14 from Environmental Surfaces to Hands [Abstract attached]

 

Rhinoviruses can survive on environmental surfaces for several hours under ambient conditions.  Hands can become contaminated after contact with such surfaces, and self-inoculation may lead to infection.  Whereas hand washing is crucial in preventing the spread of rhinovirus colds, proper disinfection of environmental surfaces may further reduce rhinovirus transmission.

 

D.     Chemical Disinfection of Hepatitus A Virus on Environmental Surfaces [Abstract attached]

 

Outbreaks of hepatitis A are frequently associated with eating establishments, hospitals, day-care centers, and schools.  Chemical disinfection of environmental surfaces and hand antiseptics are relied upon to prevent and control such outbreaks.

 

E.      An outbreak of hepatitis A:  school toilets as a source of transmission

 

An outbreak of hepatitis A associated with a Middle school involved 23 cases; 17 were pupils attending the Middle school, one was a teacher, one was a relative of a case, and four were from the associated First school, of whom three had sibilings in the Middle school.  A questionnaire survey and salivary IgG and IgM anti-HAV testing of the pupils demonstrated a statistically significant association between the infection and the use of a changing room toiler for defecation.

 

F.      The Science Behind Lysol:  Relevance for Schools

Journal of School Nursing, Joseph R. Rubino, MA; and Donna Gaber, MT

 

In the last 15 to 20 years, studies have shed some light on the hidden pathways pathogens traverse, and have demonstrated that handwashing and surface disinfection are effective ways to reduce the transmission of many communicable diseases in children.

The pathogens that case colds, as well as those responsible for other common ailments such as influenza and gastroenteritis, are often transmitted by hand-to-hand and surface-to-hand contact.

Many rotavirus infected samples came from moist surfaces, such as drinking fountains, toilet and sink handles, toys, and a water play table.

These findings suggest that hard surfaces in schools and daycare centers act as virus reservoirs.

 

G.     Role of Surface Disinfection and Hand Hygiene in Reducing Illness

Journal of School Nursing, Lorraine M. Harkavy, RN, MS, CIC

October 2002

 

Bathrooms are hot spots of contamination, and studies suggest a strong relationship between bathroom sanitation and incidence of infection.

 

H.  Highlights from ‘The Benefits of Surface Disinfection’

Data Source:  William A. Rutala, Ph.D., M.P.H.[1]

Professor, Division of Infectious Diseases, Department of Medicine
University of North Carolina at Chapel Hill

http://disinfectionandsterilization.org/

 

i.  Introduction

 

ii.  Benefits of Surface Disinfection

Surfaces may contribute to transmission of epidemiologically important microbes (e.g., VRE[2], MRSA[3], C. difficile[4])

 

Pathogens implicated in transmission via contaminated noncritical surfaces:

 

In experimental settings, treatment of surfaces with germicide has been found to interrupt transmission

 

Studies demonstrating reduced transmission with improved disinfection

 

iii.  Disinfectants are more Effective in Reducing Microbial Load

Soap and Water Microbial Load Reduction – 80.4%

Phenol Load Reduction – 99.0%

 

Detergents become contaminated and result in seeding the patients environmental with bacteria

 

Table  SEQ Table \* ARABIC 1:  Microbial Contamination of Mop Water

 

Soap

(CFU/mL)

Phenol

(CFU/mL)

Before Cleaning

10

20

After Cleaning 1/3 of Ward

650

10

After Cleaning 2/3 of Ward

15,000

30

After Cleaning Complete Ward

34,000

20

 

 

 

 


 

II.    Referenced Abstracts

 

 

 

 

 


III.  Literature regarding Antibiotic Resistance Resulting from Disinfection

 

A.     Use of Germicides in the Home and the Healthcare Setting:  Is There a Relationship Between Germicide Use and Antibiotic Resistance?

 

To date, there is no evidence that using recommended antiseptics or disinfectants selects for antibiotic-resistant organisms in nature.  Disinfectants and antiseptics should be used when there are scientific studies demonstrating benefit or when there is a strong theoretical rationale for using germicides.

 

 

 


 

IV.  Green Cleaning Policies Inclusion of Routine Disinfection

 

A.      State of Illinois:  Green Cleaning Schools Act

 

 


 

B.      New York State Office of General Services – Green Cleaning Guidelines for Schools

 

Category #37:

The Guidelines should restrict the use of disinfectant/sanitization cleaning products.

 

State Response: 

OGS recognizes that disinfectants and sanitizers must be used in certain areas and circumstances in schools.  A new section (entitled Related Rules and Guidelines) has been added to the OGS Guidelines to clearly explain where existing regulations and guidance require the use of a disinfectant or sanitizer.  The Guidelines do not establish criteria for environmentally sensitive disinfectants or sanitizers.

 

The public health benefit of using disinfectants and sanitizers as part of routine cleaning is a controversial topic.  Cleaning with soap or detergent and water removes large numbers of microorganisms from surfaces (Sehulster et al., 2004).  Furthermore, cleaning is a necessary first step to sanitization or disinfection because many soils will reduce the effectiveness of a sanitizer or disinfectant.  Unless disinfectant cleaners are used according to the label requirements for use as a sanitizer/disinfectant, the product could be providing no antimicrobial function and only contributing to an increased, unnecessary load of antimicrobial agent to the environment.  These label requirements require that a surface first be cleaned and then kept wet with a fresh solution of the product for several minutes to sanitize the surface.  In schools, routine sanitization of all floors is not considered necessary.  Thus, the OGS Guidelines permit the routine use of disinfectant cleaning products in bathrooms and permit the necessary uses of disinfectants in other situations, as covered in regulations and guidance described in the Guidelines.

 

A particular product or process was suggested as an effective disinfectant and cleaning solution. To be sold or used in NYS, any product that makes a disinfecting or sanitizing claim must be registered by USEPA and by NYSDEC or contain active ingredients that are exempt from such registration.  When used, the label precautions and use instructions must be strictly followed.  These concepts are clearly explained in guidance presented in Section III.C of the OGS Guidelines.

 

C.     Healthy Schools Campaign’s Quick & Easy Guide to Green Cleaning in Schools Author

Steve Ashkin, president of The Ashkin Group, is the author of Healthy Schools Campaign's Quick & Easy Guide to Green Cleaning in Schools and a leader in the effort to green the cleaning and maintenance industry. (http://www.healthyschoolscampaign.org/campaign/green_clean_schools/ask_steve.php#7)

Q: How do you select a green disinfectant when they're aren't any certifications?

A. Disinfectants can be a very valuable part of a green cleaning program in our effort to create healthier buildings. The trick is to use them only where necessary to prevent overuse and to select the "greenest" product for the job.

Unlike some of the other categories of products where there is a certification program (i.e. Green Seal) that makes selection easier, there are NO certification programs for specifically for disinfectants. Thus, you'll need to apply the definition of "green" to help you make a "greener" selection.

Green is defined by Presidential Executive Order 13101 as a "product that reduces the impact on health and the environment compared to similar products." Thus, in lieu of a certification program you’ll need to compare attributes of the product itself. Those attributes includes:

- The active ingredient: Some, like chlorine or phenolic compounds, have greater health and environmental risks compared to quaternary ammonium compounds (quats) and hydrogen peroxide, which would be greener alternatives.

- pH: Some disinfectants have a pH at the extreme end of the spectrum (closer to 0 or 14), which typically makes them much more corrosive (causes burns) to eyes and skin. If this is the case with the current product, a greener alternative would be to select an alternative with a more neutral pH (closer to 7).

- Fragrance: Many disinfectants have extremely strong fragrances that can cause respiratory irritation and trigger asthmatic episodes. If this is the case with the current product, a greener alternative would be to select a product with less fragrance.

- VOCs: Some disinfectants include other ingredients such as solvents that can result in a high percentage of volatile organic compounds (VOCs) which, like fragrances, can cause respiratory irritation and trigger asthmatic episodes. In addition, VOCs contribute to environmental issues such as smog formation. If this is the case with the current product, a greener product would be one with no or low VOCs.

- Other ingredients: Some disinfectants use 2-butoxyethanol as a solvent -- which is absorbed through the skin and can cause a host of health problems, including reproductive problems and attacks major organs. If this is the case with the current product, a greener product would be one with no 2-butoxythanol (butyl-free).

I hope this gives you a sense of how we approach "green" disinfectants, as well as other product categories when we can't simply suggest that they look for certified products. And for the record, it is NOT the certification that makes it green. Certification simply means that somebody else already has gone through the above exercise, which means they have simplified the purchasing process.

 


 

[1] In addition to being a Professor for the Division of Infectious Diseases at the University of North Carolina's School of Medicine, Dr. Bill Rutala serves as the Director of Hospital Epidemiology, Occupational Health and Safety Program at the University of North Carolina Hospitals. He is also Director and co-founder of the North Carolina Statewide Program for Infection Control and Epidemiology at the UNC School of Medicine and a retired Colonel with the U.S. Army Reserve. Dr. Rutala is certified in infection control. He is an advisor to the Centers for Disease Control and Prevention (a former member of the Healthcare Infection Control Practices Advisory Committee), the Food and Drug Administration (a member of the General Hospital and Personal Use Devices Panel), the U.S. Environmental Protection Agency (a member of the Scientific Advisory Panel on Antimicrobial Research Strategies for Disinfectants) and the Federal Trade Commission.

[2] Enteroccocci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections. Vancomycin is an antibiotic that is often used to treat infections caused by enterococci. In some instances, enterococci have become resistant to this drug and thus are called vancomycin-resistant enterococci (VRE). Most VRE infections occur in hospitals.

[3] MRSA:  Staphylococcus aureus, often referred to simply as "staph," is a type of bacteria commonly carried on the skin or in the nose of healthy people. Sometimes, staph can cause an infection. Staph bacteria are one of the most common causes of skin infections in the United States. Most of these skin infections are minor (such as pustules and boils) and can be treated without antibiotics. However, staph bacteria also can cause serious infections (such as surgical wound infections, bloodstream infections, and pneumonia).

[4] Clostridium difficile [klo-STRID-ee-um dif-uh-SEEL] is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis.

 


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