This Manufacturer Roundtable took the compilation of questions Facility Cleaning Decisions received from in-house custodial professionals and posed them directly to cleaning industry manufacturers. Here are their responses:

Jason Welch
Spartan Chemical Co. Inc.
Maumee, Ohio

Sara Snow
Senior Scientist
Clorox Professional Products Company
Oakland, Calif.

Q: Cleaning processes are just as important as the products used. Could you explain the proper use of chemicals in a health care setting?

Welch — A managed cleaning program is the most effective weapon against HAIs.  Environmental service managers need to ensure that HTPs (High Touch Points) are being properly cleaned and disinfected.

Application is task specific.  In some cases, a direct spray of the surface could be dangerous as it could potentially aerosolize pathogens.  So flooding the surface would be a better method.

The fabric makeup of cloths, mops and other applicators should be selected based on the chemistry of the cleaning solution. Towels or mops that are 100 percent cotton can have a negative impact on quaternary ammonium compounds.  The opposite charges of the materials will cause a drop in the active ingredient. 

Frequency of cleaning is also surface and area specific.   Frequently touched items are going to be cleaned more often than a lobby hallway.

Snow — Cleaning and disinfecting processes will vary based on the situation and the area within the hospital. For example, according to AHE guidelines, sprays should not be used in the operating room, and very specific steps should be followed when cleaning in an intensive-care unit. How the product is used will also vary from product to product, which is why it is so important that staff is trained on the specific product and follows the directions for use listed on the label. There are some commonalities across most cleaning and disinfecting practices, such as working from clean to dirty areas, from top to bottom, and in a clockwise manner. Always check and comply with your facility’s standard procedures.

Q: What is the proper dwell time for cleaners and disinfectants to be effective and why is dwell time important?

Welch — Dr. Wiliam Rutala has answered this question as saying: In order to get EPA clearance of the CDC Guideline it was necessary to insert the sentences "By law, all applicable label instructions on EPA-registered products must be followed. If the user selects exposure conditions that differ
from those on the EPA-registered product label, the user assumes liability from any injuries resulting from off-label use and is potentially subject to enforcement action under FIFRA". There are several points that should be made about this apparent disconnect between label instructions and what studies show to include:
1.    multiple scientific studies have demonstrated the efficacy of hospital disinfectants against pathogens causing healthcare-associated infections with a contact time of at least 1 minute;
2.    the only way an institution can achieve a contact time of 10 minutes is to reapply the surface disinfectant 5-6 times to the surface as the typical dry time for a water-based disinfectant is 1.5-2 minutes and currently,
3.    equally important as disinfectant contact time is the application of the disinfectant to the surface or equipment to ensure that all contaminated surfaces and non-critical patient care equipment are wiped as current studies show,
4.    there are no data that demonstrate improved infection prevention by a 10 minute contact time versus a 1 minute contact time; and
5.    we are not aware of an enforcement action against health care facilities for "off label" use of a surface disinfectant.

Thus, we believe the guideline allows us to continue our use of low-level disinfectants for noncritical environmental surfaces and patient care equipment with a 1 minute contact time. Additionally, all healthcare facilities should reemphasize the thoroughness of cleaning to ensure that all contaminated surfaces are wiped.

Snow — Dwell time is not an issue for simple cleaning products, but it is very important for disinfectants.  The dwell time is the amount of time a product needs to remain wet on the surface in order to kill the microorganisms listed on the label. OSHA requires that users “follow the label instructions regarding the amount of disinfectant and the length of time it must remain wet on the surface.” To meet the dwell time, a product must keep the surface wet long enough to meet the longest kill time on its label. Wet time will vary from product to product, depending on how quickly the formula evaporates from the surface.

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Preventing HAIs With Disinfectants
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Using Cleaning And Disinfecting Wipes In Healthcare