Environmental cleaning and COVID-19 containment

A critical infection prevention strategy

chainThe novel coronavirus (SARS-CoV-2), and its symptomatic presentation (COVID-19), are front and center in the minds of healthcare leaders, providers, and professionals. Appropriate precautions as recommended by CDC Infection Prevention and Control Recommendations include to Implement Environmental Infection Control.  This is an area of focus in nearly all healthcare facilities. How does this interrupt the chain of infection? Let’s examine some relevant studies and best practices.

Steps in the process

Per the CDC, cleaning is the removal of foreign material (e.g., soil, and organic material) from objects and is normally accomplished using water with detergents or enzymatic products.

jeshoots-com-__ZMnefoI3k-unsplash-300x262Cleaning should always precede further decontamination or disinfection, as soil remaining on surfaces can act as a shield to reduce or prevent the effectiveness of products used to kill or inactivate microorganisms.  Although many disinfectants claim to clean and kill simultaneously, visibly soiled surfaces should be thoroughly cleaned then disinfected.

The CDC defines disinfection as “a process that eliminates many or all pathogenic microorganisms, except bacterial spores, on inanimate objects.” Each disinfectant has unique characteristics and use instructions.

age-barros-Yx1ZkifiHto-unsplash-350x233For example, the recommended contact time for common disinfectants ranges from 30 seconds to 10 minutes. This can be misleading if you don’t read the use instructions and verify effectiveness against the organism(s) of concern. Microorganisms can vary significantly in their resistance to disinfectants.  

Wiping the disinfectant off the surface too soon, and not complying with contact time requirements, might clean the surface without disinfecting it. Fortunately, the novel coronavirus is relatively susceptible to common disinfectants used in home and healthcare settings. According to an article in Chemical & Engineering News:

Enveloped Virus

“Enveloped viruses like SARS-CoV-2—which rely on a protective lipid coating—are the easiest type to deactivate. …There are a few ways to burst this flimsy shell. Alcohol-based products disintegrate the protective lipids.
Quaternary ammonium disinfectants,
commonly used in health-care and food-service industries, attack protein and lipid structures, thwarting the pathogen’s typical mode of infection. Bleach and other potent oxidizers swiftly break down a virus’s essential components.”

Persistence on surfaces

While most are aware that airborne droplets are a common vector for spread of the novel coronavirus, and coughing or sneezing into your elbow is widespread, when those droplets land on environmental surfaces, they continue to pose a risk.  This underscores the critical nature of frequent and thorough environmental cleaning and disinfection, especially in high traffic areas and on high touch surfaces.

oleksii-m-rmrR-KO0M_8-unsplash-surfacesAn analysis of 22 published studies on the persistence of human and veterinary coronaviruses on inanimate surfaces showed that these viruses can persist on inanimate surfaces like metal, glass or plastic for up to 9 days. They also found evidence that viruses can be efficiently inactivated by surface disinfection procedures with 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite in solution with high purity water.  

Interestingly, alcohol is most effective in a target dilution range of 70-90%, demonstrating better disinfectant activity than pure alcohol.

According to the CDC:

“the most feasible explanation for the antimicrobial action of alcohol is denaturation of proteins. This mechanism is supported by the observation that absolute ethyl alcohol, a dehydrating agent, is less bactericidal than mixtures of alcohol and water because proteins are denatured more quickly in the presence of water.”  

Watch out for surface damage

Some disinfectants are corrosive to metals, hazardous to the environment and staff, and, unless removed by cleaning or rinsing, may behave as fixatives on surfaces, entrapping soil and pathogens.

Healthcare surfaces are subject to heavy use and exposure to all manner of cleaning and disinfection chemicals. Surprisingly, there is no real guidance on which surface materials to incorporate that will withstand the rigors of the healthcare environment. An article in Healthcare Hygiene Magazine (HHM) explains that, “Surface damage is often unseen, cracks, crazing and fissures create perfectly hospitable environments for microbes to harbor and proliferate.”

Best practices and compliance

Searching for IFUUnderstand that IFUs, research (even online), and a bit of common sense all can contribute to safer choices.  There are no shortcuts, so follow best practices, like thorough cleaning followed by disinfection, for the best outcomes.

Chose the right chemistry for your application and remember that more is not necessarily better! The instructions for use and dilution rate on the label deliver the optimal outcome. Joint Commission and other accrediting agencies are looking closely at compliance. And remember, rinsing can go a long way to removing bioburden and residual chemicals from surfaces.

An ounce of prevention

70% Alcohol Spray 129x350In evolving situations like the one we face now, there is often debate about what actions to take and when. Based on the available scientific data, Case Medical is now producing spray bottles of 70% ethanol for our customers as a ready to use surface treatment during this healthcare emergency. 

Hospitals and other healthcare employers have the duty and responsibility to prepare ahead of time to protect staff and patients. The precautionary principle states that we should not wait until we know for sure that something is harmful before we take action to prevent harm, including anticipatory or protective actions. The health and well-being of all healthcare personnel and patients depends upon the diligence of prevention efforts.

To order this product, contact a Case Medical sales representative or contact our customer service team at (201) 313-1999 and use extensions 227, 332, or  234. Reference Part ID CSCHOH24.

NEW! Case Solutions® Alcohol Spray (Part ID CSCHOH24 – 12 x 24 oz bottles)*

  • Case Solutions® Alcohol Spray contains denatured ethyl alcohol in solution with high purity RO water
  • Ideal for cleaning and decontaminating environmental surfaces in healthcare settings

*Each case of 24 oz. bottles includes two trigger sprayers that can be reused as you use the case of product. You may order extra sprayers with Part ID SPRAYER.