Do We Know What We Are Doing? Chemicals Used for Cleaning, Sanitization, and Disinfection:

Chemicals Used for Cleaning, Sanitization, and Disinfection: Do We Know What We Are Doing?

Maintaining cleanliness in healthcare settings is not just a best practice—it's a matter of patient safety and infection control. From hospitals to clinics, every facility strives to ensure surfaces are free from harmful microorganisms. But are we truly getting it right? While most organizations excel in stocking antimicrobial products, challenges persist when it comes to their proper use.

Let’s delve into the nuances of cleaning, sanitizing, and disinfecting, and uncover common pitfalls that can undermine efforts in maintaining a safe environment.

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The Basics: Defining the Terms

• Cleaning: Removes dirt, germs, and impurities from surfaces but does not necessarily kill them.
• Sanitizing: Reduces germs to safe levels, lowering the risk of infection.
• Disinfecting: Destroys most germs on surfaces using EPA-approved products.

These processes build upon one another, but effectiveness relies heavily on human practices, chemical knowledge, and adherence to protocols.

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The Challenges: What’s Going Wrong?

1. The Human Factor: "Out of Sight, Out of Mind"

Disinfecting efficacy is often invisible to the naked eye. Through audits using markers visible under black light, our inspections reveal that up to 70% of critical areas remain contaminated despite appearing clean.

The gap between visible and effective cleaning highlights a need for improved training and accountability. For a more scientific approach swabbing and sending samples to the lab to check on aerobic bacteria, fungi and MRSA can provide indications of efficacy.

2. The Right Chemical in the Wrong Hands

Chemical products are often mishandled due to insufficient training. Janitorial staff frequently misunderstand:

• Usage instructions: Dwell times, dilution ratios, and compatible cleaning tools are often overlooked.
• Chemical-specific  requirements: For example, quaternary ammonium compounds (quats) are highly effective but lose potency when misused, such as with incompatible materials.

The result? A wasted investment in high-grade products and an increased risk of incomplete disinfection.

3. Dwell Times: The Overlooked Key

"Dwell time" refers to how long a disinfectant needs to remain wet on a surface to be effective. However, in most facilities, this step is rushed. A standout example of proper execution occurred during our inspection of FIFA World Cup facilities in Doha, where we observed airport staff meticulously adhere to dwell times, leaving surfaces wet for the prescribed duration before wiping.

4. "Pick and Mix": A Recipe for Disaster

Mixing chemicals without understanding their properties can lead to hazardous reactions. For example:

• Bleach + Ammonia = Chloramine gas (toxic to humans).
• Always follow the product instructions and avoid playing "chemical engineer." Decisions on the type of chemicals being used is often chosen by way of aromatics of the chemical.

Understanding Quats: The Hidden Challenges

Quaternary ammonium compounds, or "quats," are widely used in disinfectants but can become ineffective due to quat binding. Here’s what you need to know:

‍What Is Quat Binding?

Quats are positively charged ions that target and disrupt negatively charged microbial membranes. However:

• Negatively charged cleaning tools (e.g., microfiber cloths) can absorb quats.
• This educes the disinfectant's parts per million (ppm) concentration, rendering it noncompliant and ineffective.

‍How to Avoid Quat Binding

1. Review Your Cleaning Methods:
    
   • Avoid soaking cloths in quat solutions for prolonged periods.
    
   • Select disposable or non-woven wipes to prevent charge-based interference.
 
2. Adopt Best Practices:
    
   • Spray  and Wipe: Apply disinfectant directly to the surface, allow for proper dwell time, then wipe with a neutral cleaning tool.
    
   • Test Solutions: Use quat test strips to ensure appropriate concentration levels before use.

Key Takeaways for Safer Practices

To truly improve cleaning, sanitizing, and disinfection in healthcare settings, we need:

1. Enhanced Training: Equip staff with the knowledge to use chemicals properly, focusing on dwell times, dilution, and tool compatibility.
2. Audits and Accountability: Regular inspections, like black-light audits, can  reveal unseen lapses and drive improvements. For more robust testing, consider obtaining microbiological swabs and sending these to the lab for analysis and comparison to a baseline.
3. Better Tools and Procedures: Switch to non-woven or disposable materials, and implement clear, user-friendly protocols.
4. Chemical  Safety Awareness: Educate teams on improper mixing and handling risks.

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The Bottom Line

Cleaning, sanitization, and disinfection effectiveness goes beyond merely using the right products; it demands attention to detail, proper training, and adherence to protocols. By addressing these challenges, we can ensure not just a visibly clean environment but one that genuinely safeguards health and safety.

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