The COVID-19 pandemic has created unprecedented and continuing difficulties for healthcare providers, health systems, and patients alike. With any novel pathogen such as SARS-CoV-2, the virus that causes COVID-19, public health professionals, and healthcare providers continuously evolve their approach to the pandemic response. During times of increased focus on certain infection control practices such as hand hygiene agents and environmental disinfectants, challenges to the supply chain can rapidly emerge. Still, they can be addressed by implementing a robust pandemic response plan to facilitate appropriate product substitutions.

The Centers for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA) have released extensive guidance regarding the use of EPA-registered disinfectants during the ongoing COVID-19 pandemic. In addition, the EPA created a specific list, List N. Disinfectants for Coronavirus (COVID-19). This is a list of EPA-registered disinfectants that are deemed effective against SARS-CoV-2. The use of products on this validated list from the EPA provides healthcare users an additional level of assurance of efficacy against the virus that causes COVID-19.

Many disinfectant manufacturers offer the same active ingredient formulations in multiple product formats (ready-to-use wipes, liquids, sprays, etc.), which can mitigate any significant impacts for healthcare facilities during pandemic scenarios. Similar to stockpiling certain medical equipment and supplies such as Personal Protective Equipment (PPE), it would be advisable for healthcare facilities to have a comprehensive pandemic plan in place to address increased environmental disinfection needs across the healthcare continuum of care.

Analogous to the CDC’s approach to the use of PPE, a comparable process can easily be created for identifying appropriate disinfectant product substitutes during a pandemic crisis. As such, a three-tiered approach can be implemented to include:

When selecting product substitutes, healthcare users should consult the EPA’s master label for the product being evaluated, review any technical information on surface compatibility, as well as carefully review the product’s Safety Data Sheet (SDS). The intended location of use for the product can also impact the ideal product to be used such as inpatient vs. outpatient settings where risks would be substantially different. Certain inert or inactive ingredients, for example, may increase the risk for equipment degradation, so healthcare users should contact the disinfectant manufacturers and request a complete listing of all product ingredients and information on known equipment compatibility with commonly found surfaces and medical devices used in healthcare settings. Healthcare users of disinfectants should also consult the product instructional manual from the medical equipment manufacturer for specific cleaning and disinfection instructions.

When forced to select alternative disinfectants or disinfectant chemistries, Infection Preventionists and Environmental Services Leaders should evaluate these substitutes in terms of three primary criteria:

The COVID-19 pandemic continues to place significant strains on our healthcare systems and providers. Infection control practices such as disinfection, hand hygiene, and the appropriate use of PPE remain important aspects of decreasing the spread of SARS-CoV-2. Disinfectant manufacturers are the primary sources of expertise in the areas of product formulation, product format, contact times, material compatibility, and product safety. Infection Preventionists and EVS Leaders should closely collaborate with their preferred disinfectant manufacturer and medical suppliers on pandemic preparedness needs and the most appropriate product substitutions.

Moreover, many disinfectant manufacturers have created product substitution tools that can help ensure that all new products utilized within a facility will continue to meet the stringent infection control needs as identified by the Infection Prevention and Control Team. Pandemics require a collaborative, transparent, and highly communicative approach to overcome their impacts. While the healthcare industry continues to face challenges, it is certainly possible to maintain a safe standard of care related to environmental cleaning and disinfection by following a standardized approach.

For additional information:

Dr. Hudson Garrett Jr. is a paid consultant for Clorox Healthcare.

The dynamics of healthcare disinfection are constantly changing, especially as a result of the ongoing COVID-19 pandemic. Given the large volume of environmental surfaces that can become contaminated during the routine delivery of clinical care, healthcare facilities are constantly evaluating the most efficient solutions for large-scale disinfection.

There are multiple different modalities that healthcare providers and Environmental Services (EVS) technicians can use to disinfect commonly contaminated environmental surfaces. Most notably, ultraviolet (UV) light devices and electrostatic sprayers are being used on a large scale across the United States to combat potential COVID-19 transmission. Both of these solutions afford the ability to more effectively and easily disinfect large surface areas, especially for terminal turnover of patient care environments.

Healthcare facilities may even use a combination of these different types of devices across the health system to meet specific disinfection needs. During pandemics like the COVID-19 pandemic in high-flow patient settings such as Emergency Departments, room turnover time is a key metric for healthcare delivery efficiency. The use of technologies such as UV devices or electrostatic sprayers can be extremely beneficial as part of an overall Environment of Care and Infection Prevention and Control program.

When using these types of technologies, users should receive specific training on the appropriate use of the technology prior to deploying it in the facility. Additionally, both UV devices and electrostatic sprayers require the patient care room to be unoccupied to maintain patient safety while the technologies are being used. The healthcare marketplace is filled with various different devices that each have unique capabilities. When selecting an electrostatic device, healthcare and EVS leaders should evaluate all technologies using a standardized approach which includes a review of:

Novel technologies such as UV devices and electrostatic sprayers are important aspects of a comprehensive Environment of Care program and the reduction of healthcare-associated infections. These technologies must be carefully evaluated prior to use, implemented and used according to the manufacturer’s instructions for use, and then environmental monitoring principles should be followed in accordance with the recommendations from the Centers for Disease Control and Prevention. Whether during a pandemic or for regular disinfection purposes, electrostatic sprayer technologies are playing a larger role in the reduction of cross transmission across both healthcare and non-healthcare sectors.

For additional information:

Dr. Hudson Garrett Jr. is a paid consultant for Clorox Healthcare.

The following is an abridged article featured in the December 2020 issue of Healthcare Hygiene Magazine (see page 32).

As a healthcare provider that is part of a Regional COVID-19 response team, I have sadly seen the direct and indirect impacts of the ongoing threat posed by COVID-19. Countless lives have been directly or indirectly impacted including those of many healthcare providers at the front lines and healthcare executives charged with leading their organizations during challenging pandemic times. This ongoing pandemic is not expected to cease anytime soon, and the upcoming fall and winter respiratory infections season could potentially produce a new dilemma with concurrently circulating infectious pathogens such as Influenza, RSV, Rhinovirus, and SARS-CoV-2, the novel coronavirus that causes COVID-19. Due to this concurrent circulation of respiratory viruses during the Fall and Winter, it is all the more important for healthcare facilities to not succumb to infection prevention fatigue and maintain an appropriate level of vigilance to the core practices of infection prevention and control.  

The Centers for Disease Control and Prevention (CDC) has identified several core recommendations that can dramatically reduce the potential risk for the transmission of respiratory viruses. Below are several key steps that healthcare providers and infection prevention professionals should take to reduce the transmission of infectious respiratory illnesses:

Each of the steps referenced above plays a pivotal role in reducing the potential transmission of infectious respiratory viruses, keeping patients and healthcare providers safe, and also ensuring the continuity of clinical care operations. Every stakeholder in the healthcare delivery system must play an active role in recognizing and preventing the spread of these common respiratory pathogens. Through interprofessional collaboration, the use of efficacious infection prevention products such as disinfectants, hand sanitizers, and PPE, we can help effectively curb the transmission of respiratory illnesses.

For additional information:

To learn more about the EPA List N, visit: https://www.epa.gov/pesticide-registration/list-n-disinfectants-coronavirus-covid-19.

Dr. Hudson Garrett Jr. is a paid consultant for Clorox Healthcare.

Many infection preventionists regularly utilize clinical guidelines to guide their daily practice, but have you ever wondered how these national guidelines are developed? Many of the policies and practices that are used in infection prevention and control are developed by multidisciplinary groups whom create evidence-based guidelines. The Centers for Disease Control and Prevention (CDC) Division of Healthcare Quality Promotion is primarily responsible for authoring evidence-based guidelines and guidance documents specifically to assist healthcare facilities and providers in reducing Healthcare-Care Associated Infections (HAIs). To aid the CDC in developing evidence-based guidance to the healthcare community, CDC and the Department of Health and Human Services (HHS) maintain the Healthcare Infection Control Practices Advisory Committee (HICPAC), which is a group of federally appointed healthcare experts who are charged with providing the CDC staff with strategic guidance on a wide variety of infection prevention and control challenges across the healthcare continuum of care. In addition to the voting members of the committee, there are also representatives from 21 clinical organizations which do not hold voting power. A senior member of CDC’s staff, the Designated Federal Official, serves as the official committee Secretary and official government representative to the group. This committee provides input not only to the CDC, but also to HHS. HICPAC is an extremely influential body that has tremendous impacts on the infection prevention and control community through the release of guidelines, guidance documents, and position statements that are viewed as the gold standard for both clinical practice as well as liability. These documents and recommendations are used widely in the infection prevention field and serve as the basis for many policies and procedures used in both inpatient and outpatient healthcare facilities.

As an infection preventionist, it’s critical to closely monitor the ongoing work that is being performed by HICPAC. Most HICPAC documents are sent out for official public comment prior to being finalized by the committee, and all healthcare professionals are encouraged to submit written comments along with supporting evidence. Engaging in this guideline creation and review process is a core responsibility of every infection prevention professional.

HICPAC typically meets 3–4 times per year formally, but members of the committee regularly interact through working group meetings. The in-person meetings are hosted at the CDC Headquarters in Atlanta, Georgia and the meetings are open to the public. All infection preventionists should attempt to participate in HICPAC meetings remotely by registering for the webcast of the event. Space is limited for the webcast, so it is imperative to register early to secure your reservation for each meeting. All of the HICPAC presentations as well as minutes are published on the HICPAC website within ninety days of the meeting concluding.  The many documents produced by HICPAC are routinely used by other regulatory and accreditation agencies to define standards of care and for documentation of compliance of the current CDC recommendations.

To learn more about HICPAC or to register for upcoming meetings, click here. To view the current CDC HICPAC Guidelines and Guidance documents, click here.

Dr. Hudson Garrett Jr. is a paid consultant for Clorox Healthcare.

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