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Rutala WA, Donskey CJ, Weber DJ. Disinfection and sterilization: New technologies. Am J Infect Control 2023; 51:A13-A21. [PMID: 37890943 DOI: 10.1016/j.ajic.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Adherence to professional guidelines and/or manufacturer's instructions for use regarding proper disinfection and sterilization of medical devices is crucial to preventing cross transmission of pathogens between patients. Emerging pathogens (e.g., Candida auris) and complex medical devices provide new challenges. METHODS A search for published English articles on new disinfection and sterilization technologies was conducted by Google, Google scholar and PubMed. RESULTS Several new disinfection methods or products (e.g., electrostatic spraying, new sporicides, colorized disinfectants, "no touch" room decontamination, continuous room decontamination) and sterilization technologies (e.g., new sterilization technology for endoscopes) were identified. CONCLUSIONS These technologies should reduce patient risk.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - Curtis J Donskey
- Geriatric Research, Education and Clinical Care, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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3
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Huang J, Park GW, Jones RM, Fraser AM, Vinjé J, Jiang X. Efficacy of EPA-registered disinfectants against two human norovirus surrogates and Clostridioides difficile endospores. J Appl Microbiol 2022; 132:4289-4299. [PMID: 35279925 PMCID: PMC9119914 DOI: 10.1111/jam.15524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 11/27/2022]
Abstract
AIMS To determine the efficacy of a panel of nine EPA-registered disinfectants against two human norovirus (HuNoV) surrogates (feline calicivirus [FCV] and Tulane virus [TuV]) and Clostridioides difficile endospores. METHODS AND RESULTS Nine EPA-registered products, five of which contained H2 O2 as active ingredient, were tested against infectious FCV, TuV and C. difficile endospores using two ASTM methods, a suspension and carrier test. Efficacy claims against FCV were confirmed for 8 of 9 products. The most efficacious product containing H2 O2 as ingredient achieved a >5.1 log reduction of FCV and >3.1 log reduction of TuV after 5 min, and >6.0 log reduction of C. difficile endospores after 10 min. Of the five products containing H2 O2 , no strong correlation (R2 = 0.25, p = 0.03) was observed between disinfection efficacy and H2 O2 concentration. Addition of 0.025% ferrous sulphate to 1% H2 O2 solution improved efficacy against FCV, TuV and C. difficile. CONCLUSION Disinfectants containing H2 O2 are the most efficacious disinfection products against FCV, TuV and C. difficile endospores. Product formulation, rather than the concentration of H2 O2 in a product, impacts the efficacy of a disinfection product. SIGNIFICANCE AND IMPACT OF STUDY H2 O2 -based disinfectants are efficacious against surrogate viruses for HuNoV and C. difficile endospores.
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Affiliation(s)
- Jinge Huang
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, South Carolina, USA
| | - Geun Woo Park
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachael M. Jones
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Angela M. Fraser
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, South Carolina, USA
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xiuping Jiang
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, South Carolina, USA
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Tyan K, Zuckerman JM, Cutler C, Modupe K, Ray D, Marmolejo L, Kang J. A multiphase intervention of novel color additive for bleach disinfectant wipes improves thoroughness of cleaning in an academic medical center. Am J Infect Control 2022; 50:469-472. [PMID: 34793887 DOI: 10.1016/j.ajic.2021.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
Surface disinfection is critical for preventing health care-associated infections; however, sustaining high-quality cleaning technique is challenging without constant feedback and training of staff. A novel color additive to bleach wipes, Highlight, indicates where surfaces have been wiped and fades to colorless to provide real-time visual feedback of cleaning. In a multiphase interventional study, Highlight reduced failure rates of cleaning based on fluorescent marker removal (15.0%-4.5%) and adenosine triphosphate bioluminescence assay (3.6%-2.5%).
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Affiliation(s)
- Kevin Tyan
- Kinnos Inc., Brooklyn, NY; Harvard Medical School, Boston, MA.
| | | | | | - Kunle Modupe
- Hackensack University Medical Center, Hackensack, NJ
| | - Dennis Ray
- Hackensack University Medical Center, Hackensack, NJ
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6
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Elliott VS, Jackson J, Santen SA, Richardson J, Heckman K, Hammoud MM. Triple Challenge: How Medical Students May Solve 3 Long-Standing Problems Bedeviling Health Systems and Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1643-1649. [PMID: 33983139 DOI: 10.1097/acm.0000000000004159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Medical education and the health system must address challenges that, despite significant effort, seem unsolvable. Health systems science (HSS)-the fundamental understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery-is increasingly being recognized as a potential source of solutions to these challenges. In this article, the authors review the 43 abstracts submitted to the American Medical Association Accelerating Change in Medical Education 2018 Health Systems Science Student Impact Competition that aligned with the goals of HSS. Their qualitative review identified 3 long-standing problems in medicine and medical education that were frequently addressed by the submissions: improving care for those with mental illness (5 submissions), improving diversity in medicine (4 submissions), and improving teamwork and interprofessional education (4 submissions). The authors extracted lessons learned from these abstracts. Many of the projects detailed in this article continue to make an impact at multiple levels. While not all projects were scientifically rigorous enough to be published on their own and the quality of the data presented in the abstracts varied widely, many provide innovative ideas for potentially solving long-standing problems that may have been overlooked or not considered sufficiently. These projects and their subsequent analysis demonstrate that not only do medical students make significant impacts on the health system, patients, and other health professionals when equipped with HSS skills, working in health care teams, and advised by mentors, but they also may be able to address some of medicine's and medical education's long-standing challenges. The fresh perspective and high energy of medical students are valuable and should be nurtured and encouraged.
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Affiliation(s)
- Victoria Stagg Elliott
- V.S. Elliott is technical writer, Medical Education Outcomes, American Medical Association, Chicago, Illinois
| | - Jasmyne Jackson
- J. Jackson is a resident, Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts
| | - Sally A Santen
- S.A. Santen is senior associate dean and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, and consultant, American Medical Association, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-8327-8002
| | - Judee Richardson
- J. Richardson is director of research and evaluation, Medical Education Outcomes, American Medical Association, Chicago, Illinois
| | - Kevin Heckman
- K. Heckman is director of product development, Medical Education Outcomes, American Medical Association, Chicago, Illinois
| | - Maya M Hammoud
- M.M. Hammoud is professor of obstetrics and gynecology and learning health sciences, Michigan Medicine, Ann Arbor, Michigan, and consultant, American Medical Association, Chicago, Illinois
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7
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Efficacy of Three Commercial Disinfectants in Reducing Microbial Surfaces' Contaminations of Pharmaceuticals Hospital Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020779. [PMID: 33477614 PMCID: PMC7831293 DOI: 10.3390/ijerph18020779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022]
Abstract
To evaluate and validate the efficacy of disinfectants used in our cleaning procedure, in order to reduce pharmaceutical hospital surfaces' contaminations, we tested the action of three commercial disinfectants on small representative samples of the surfaces present in our hospital cleanrooms. These samples (or coupons) were contaminated with selected microorganisms for the validation of the disinfectants. The coupons were sampled before and after disinfection and the microbial load was assessed to calculate the Log10 reduction index. Subsequently, we developed and validated a disinfection procedure on real surfaces inside the cleanrooms intentionally contaminated with microorganisms, using approximately 107-108 total colony forming units per coupon. Our results showed a bactericidal, fungicidal, and sporicidal efficacy coherent to the acceptance criteria suggested by United States Pharmacopeia 35 <1072>. The correct implementation of our cleaning and disinfection procedure, respecting stipulated concentrations and contact times, led to a reduction of at least 6 Log10 for all microorganisms used. The proposed disinfection procedure reduced the pharmaceutical hospital surfaces' contaminations, limited the propagation of microorganisms in points adjacent to the disinfected area, and ensured high disinfection and safety levels for operators, patients, and treated surfaces.
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8
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Tyan K, Levin A, Avalos-Pacheco A, Plana D, Rand EA, Yang H, Maliszewski LE, Chylek LA, Atta L, Tye MA, Carmack MM, Oglesby NS, Burgin S, Yu SH, LeBoeuf NR, Kemp JM. Considerations for the Selection and Use of Disinfectants Against SARS-CoV-2 in a Health Care Setting. Open Forum Infect Dis 2020; 7:ofaa396. [PMID: 32989420 PMCID: PMC7499694 DOI: 10.1093/ofid/ofaa396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/26/2020] [Indexed: 01/02/2023] Open
Abstract
Proper disinfection using adequate disinfecting agents will be necessary for infection control strategies against coronavirus disease 2019 (COVID-19). However, limited guidance exists on effective surface disinfectants or best practices for their use against severe acute respiratory coronavirus 2. We outlined a process of fully characterizing over 350 products on the Environmental Protection Agency List N, including pH, method of delivery, indication for equipment sterilization, and purchase availability. We then developed a streamlined set of guidelines to help rapidly evaluate and select suitable disinfectants from List N, including practicality, efficacy, safety, and cost/availability. This resource guides the evaluation of ideal disinfectants amidst practical considerations posed by the COVID-19 pandemic.
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Affiliation(s)
- Kevin Tyan
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Adriane Levin
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Alejandra Avalos-Pacheco
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Deborah Plana
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences & Technology, Cambridge, Massachusetts, USA
- Harvard Ludwig Cancer Research Center and Department of Systems Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Eleanor A Rand
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Harvard University Department of Systems Biology, Cambridge, Massachusetts, USA
| | - Helen Yang
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura E Maliszewski
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Program in Therapeutic Science, Cambridge, Massachusetts, USA
- Laboratory of Systems Pharmacology, Department of Systems Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lily A Chylek
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Laboratory of Systems Pharmacology, Department of Systems Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lyla Atta
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark A Tye
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Harvard University Graduate School of Arts and Sciences, Cambridge, Massachusetts, USA
- Massachusetts General Hospital Center for Systems Biology, Boston, Massachusetts, USA
| | - Mary M Carmack
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - N Synclaire Oglesby
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Program in Therapeutic Science, Cambridge, Massachusetts, USA
| | - Susan Burgin
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Sherry H Yu
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nicole R LeBoeuf
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jacqueline M Kemp
- Greater Boston Pandemic Fabrication Team (PanFab) c/o Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Rutala WA, Weber DJ. Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: A bundle approach. Am J Infect Control 2019; 47S:A96-A105. [PMID: 31146858 DOI: 10.1016/j.ajic.2019.01.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Over the past decade, there is excellent evidence in the scientific literature that contaminated environmental surfaces and noncritical patient care items play an important role in the transmission of several key health care-associated pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter, norovirus, and Clostridium difficile. Thus, surface disinfection of noncritical environmental surfaces and medical devices is one of the infection prevention strategies to prevent pathogen transmission. This article will discuss a bundle approach to facilitate effective surface cleaning and disinfection in health care facilities. A bundle is a set of evidence-based practices, generally 3-5, that when performed collectively and reliably have been proven to improve patient outcomes. This bundle has 5 components and the science associated with each component will be addressed. These components are: creating evidence-based policies and procedures; selection of appropriate cleaning and disinfecting products; educating staff to include environmental services, patient equipment, and nursing; monitoring compliance (eg, thoroughness of cleaning, product use) with feedback (ie, just in time coaching); and implementing a "no touch" room decontamination technology and to ensure compliance for patients on contact and enteric precautions. This article will also discuss new technologies (eg, continuous room decontamination technology) that may enhance our infection prevention strategies in the future.
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Affiliation(s)
- William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC
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