Making the Case for a Hands-Free, Fogging Disinfectant
Choosing a disinfectant for a facility is challenging because each facility has its own unique and diverse requirements. The option selected has to be adaptable to various configurations of patient care settings, compatible with other disinfectants currently in use, easy to use, and non- toxic to the environment and staff. Recently, a variety of hands-free systems became available on the market. These devices include the following: ultraviolet systems known as UV-C, highly concentrated peroxide fogging units, and systems which use lower concentration peroxide mixed with peracetic acid or silver ions. Complicating matters further, there are also other systems which take liquid wipe disinfectants and disperse them through the use of foggers and sprayers.
Other considerations that make it difficult for the end-user is determining the EPA status of the disinfectant system and whether or not it is cleared for use as a hospital disinfectant, as well as their sporicidal status. Disinfectants used as liquid wipe agents are not EPA cleared to be dispersed through foggers or sprayers. Also, UV-C systems as a group are not cleared by the EPA. Additionally, UV-C systems are dependent on positioning of unit, whether the wave length is correct, pulsing or direct, and whether distance and line of sight are appropriately maintained. The UV-C units are quite varied and most are quite costly in the $ 80-120,000 plus range. Since the units are not cleared by the EPA, efficacy studies are largely left to manufacturers or to the end-user. Few studies reflect controlled trials.
Spray and wipe systems, if used properly, can be effective but do not guarantee complete removal of offending MDRO organisms in an Operating Room or patient room since crevices and corners are often left untouched.
The high level peroxide systems are effective but take up to two hours per room for disinfection and require extensive room preparation. The chemicals are toxic and must be carefully monitored. They also cause oxidation of metals. Their costs are similar to UV-C units.
Lower concentration peroxide units are often mixed with other agents for increasing efficacy. These units leave a smell or leave silver ions in the environment. The rooms also need to be sealed before use. Costs are about one third of high concentration peroxide robots and UV-C systems.
TOMI Environmental Services, Inc. (Frederick, MD) offers a unique approach for a hands-free system with the SteraMistTM system. A solution of 7.8% peroxide is converted to active OH radicals using a cold plasma arc. This process is known as Binary Ionization Technology (BIT)TM. These radicals kill on contact and take 7 minutes with the hand held Surface unit and 20 minutes with the Environmental unit to kill and disperse. EPA cleared as a hospital grade disinfectant, the process is microbicidal for all major pathogens such as MRSA/SA, Pseudomonas, H1N1, Norovirus, Salmonella, and C. difficile. There is minimum need for protective PPE. The solution leaves no residue and leaves a clean smell. It also kills many species of mold. All equipment and other items can be left in the rooms during treatment and the process does not damage sensitive electronic equipment, plastics or fabrics. The system kills on contact and lowers the endemic load of pathogens wherever used reducing the chance of MDRO transmission and resulting HAI’s.
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