Manufacturers Weigh In Certain equipment can increase cleaning effectiveness and reduce the need for and excess use of chemical disinfectants. Brad Drury of Hydro Systems, maker of chemical proportioning and dilu-tion systems, says: “Since correct dilution and application of disinfectant solutions is key to effectiveness, getting the dilution consistently right using an automatic proportioning unit is critical to preventing problems of under or overdilution.” Tom Morrison of Kaivac Inc., maker of no-touch spray-and-vac units, says: “Cleaning is the first line of defense, and by using an Integrated Cleaning and Measurement (ICM) model, you can remove [soil and harmful microbes] and prove it through measurement. If you remove pathogens, along with their food supply, there is no longer a compelling need to use disinfectants routinely as insurance. Using adenosine triphosphate (ATP) devices to meas-ure organic soil remaining on surfaces tells you whether or not the cleaning process is working to remove potentially hazardous microbes and microbe-sustaining organic matter.” Rick Hoverson of Advanced Vapor Technologies says: “The quickness of disinfection by thermal disinfection devices makes compliance with proper protocols easier for cleaning staff, and thus results in infection control ben-efits. Since pre-cleaning is less critical and contact times for disinfection are in seconds, rather than minutes, staff compliance is less of an issue for steam vapor systems, and of course, no chemical disinfectants and side effects are involved.” resistant bacteria or “super germs” that endanger public health. While bacterial-resistance has been proven to develop with antibiotics (they work inside or on the body, and therefore cannot be as immediately lethal as antibac-terial and disinfectant products used outside the body) — generally speaking, antibacter-ial products and disinfectants, unlike antibi-otics, directly kill germs, without the strong possibility of resistance developing. At the risk of oversimplifying, while antibi-otics impair the functioning of germs leav-ing some to survive and develop resist-ance, the consensus among scientists is that disinfectants work somewhat like “sledgehammers” and there is simply noth-ing left alive to develop resistance. Triclosan (used in antibacterial hand soaps and to impregnate certain products) is more controversial and the debate goes on as to its actual ability to create danger-ous antibiotic resistant bacteria with signifi-cant impacts in the real world. With properly-used disinfectants in the context of JanSan operations, bacterial resistance apparently never happens — at least as far as we know. According to Dr. Chuck Gerba, professor of Environmental Microbiology in the Departments of Microbiology and Immunology and Soil, Water and Environmental Science at the University of Arizona, “No resistance to chlorine has ever occurred despite its use for over 100 years. The same can be said for quats. While you do see some tolerance to quats develop by some microorganisms, it still has not prevented the widespread use of quats since they are still effective at the dosages used. Actually, in our studies of disinfectant use in daycare centers we saw a reduction in the number of antibiotic-resistant bacteria in the daycare and a reduction in the antibiotic use among the children. I think the bottom line is that cleaning and disinfectant use saves lives, and actually reduces the use of antibiotics.” According to Benjamin D. Tanner, Ph.D., president, Antimicrobial Test Laboratories, “Cross-resistance to antibiotics from disin-fectants is not easily demonstrable outside of lab settings, but is a possibility nonethe-less. Still, the risks of not disinfecting con-taminated surfaces far exceed any possible cross-resistance risks … cleaning without disinfectants may not solve todayʼs infec-tion control problems (MRSA, VRE, C. diff ) like it helped to solve yesterdayʼs. In fact, it could actually make them worse if pathogens were to be spread around a facility during the cleaning process.” Q: What about the recent report from the Society for General Microbiology stating that disinfectants can make bacteria resistant to treatment? A: The report states, “Chemicals used in the environment to kill bacteria could be making them stronger, according to a paper published in the October issue of the jour-nal Microbiology [reporting on a study by Dr. Kaatz]. Low levels of these chemicals, called biocides, can make the potentially lethal bacterium Staphylococcus aureus remove toxic chemicals from the [bacterial] cell even more efficiently, potentially mak-ing it resistant to being killed by some antibiotics.” The key point, stated later, is this: “At the correct strength, biocides kill bacteria and other microbes. However, if lower levels are used the bacteria can survive and become resistant to treatment.” The moral? Use the right disinfectant and dilution, and apply it correctly. According to Dr. Jay Glasel, professor emeritus in the Department of Microbial, Molecular and Structural Biology at the University of Connecticut Medical/Dental School in Farmington, Connecticut, “Resistance does not develop in bacteria exposed to sufficient doses of biocide … The cautionary tale that the Kaatz paper relates is that biocides used in disinfection to remove Gram-positive microbials should be of sufficient concentration to kill them quickly.” On balance, and in light of current evi-dence, antibacterial and disinfectant prod-ucts have their proper place in our quest to reduce the risk of infection and protect health. Cleaning is still the best first line of defense, but due to the effectiveness of dis-infectants used properly and where need-ed, it is not the only one. CM Allen P. Rathey is president of Boise ID-based InstructionLink/JanTrain. www.cmmonline.com 43
CMM – Archives Jun 2009: 43
