Across the nation, there are at least 7,000 patients with Clostridium difficile (C. diff) infections at any given time with the associated costs estimated to be in the range of $17.6 million to $51.5 million. This is an important consideration in an industry with limited financial resources and increasing regulatory demands.

By choosing the right disinfectant cleaner and cleaning tools, building service contractors can help deter the spread of C. diff in healthcare facilities.

For standard disinfection of non-isolation patient rooms, a quat-based disinfectant is generally adequate to achieve hygiene levels while still being economical and safe on most surfaces. But special attention needs to be given to proper dilution and contact times as these are important considerations for product performance. Also, some wiping materials can bind with the active ingredients of quat-based disinfectant products and diminish their disinfectant properties. BSCs should choose the disinfectant product that has the broadest kill claims (efficacy) and the shortest contact times, and ensure that it is compatible with the wiping materials employed.

For isolation areas not involving C. diff, many standard disinfectants can still be employed as long as they have efficacy against the organism of concern. However, a good practice is to move to an intermediate level disinfectant, such as a hydrogen peroxide or peracetic acid-based product. This change offers the advantage of generally quicker kill times and introduces a different disinfection chemistry and mode of action.

For isolation areas involving C. diff, the best practice is to follow the CDC recommendation of cleaning followed by disinfection with a 1:10 dilution of an U.S. Environmental Protection Agency (EPA)-registered chlorine bleach or the use of an EPA-registered disinfectant cleaner with efficacy against C. diff spores.

As with quat-based disinfectants, care must be taken to ensure that bleach-based products are properly diluted. In the case of healthcare environmental surface cleaning, all chemical products are designed to be diluted with cold water and used at ambient room temperatures.

Bleach-based products have the advantage of being economical and have a familiar odor but can discolor fabrics and can damage many surfaces.
Peracetic acid-based products are safer on surfaces but have a stronger, unfamiliar odor, which patients and staff can find disagreeable. If using bleach, the CDC recommends an EPA registered disinfectant bleach only after the surfaces have been thoroughly pre-cleaned as bleach is not a one-step cleaner-disinfectant product.

Finally, adherence to label recommendations regarding contact times and application is necessary for achieving the required level of surface hygiene.

The method of application can influence how well the surface is cleaned and disinfected. Microfiber wiping cloths are highly efficient at removing soils and microorganisms from surfaces. Controlled experiments have shown that when properly used, microfiber can reduce microbiological levels by up to 99 percent. Therefore, combining compatible microfiber cloths with a disinfectant cleaner greatly enhances cleaning and disinfection. To avoid cross-contamination between patients rooms, cloths should be color-coded and changed out after each room.

Disposable disinfectant wipes offer the same advantage of controlling cross-contamination as microfiber while eliminating the need for laundering.

Disinfection and application will be determined by the needs of the facility and should include such considerations as types of surfaces, ventilation and odor limitations, as well as the turnaround time required for the room or area.

John Thomas is the sales manager and HealthRite specialist for Philip Rosenau Co., Warminster, Pa. John is also a CIMS ISSA Certification Expert (ICE). He can be reached at

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Disinfecting and ATP-Monitoring Commonly Touched Surfaces In Healthcare Facilities