The world of touchless disinfection is growing quickly and there is a lot of varying information available. Taking on a new technology can be daunting. Maybe you have done your homework and you are interested in adding electrostatic sprayers at your facility. Or maybe you have already added them in and still have questions. Below I have laid out some best practice recommendations. Ultimately, there is no one-size-fits-all for acute healthcare settings, but hopefully some of these give you and your team a place to start.
- Educate Internally
Electrostatics, foggers, misters, oh my! You might have these technologies straight in your mind (if not, check out Breaking Down Electrostatic Technology: Everything You Need to Know), but there is a good chance your colleagues are not completely clear on the key differentiators. As with all areas of Infection Prevention and Public Health, education up front can do a lot to mitigate concerns and misinformation. It can also help to identify those on the Environmental Services (EVS) team that will be your key operators and trainers. I recommend leveraging trainings offered by your electrostatic sprayer and/or disinfectant manufacturer. Many offer online training videos and resources to assist you in setting up a plan for initial and ongoing training.
- Confirm your Disinfectant is EPA Approved for Electrostatic Use
This one seems obvious, but I think it is an important reminder. Your electrostatic sprayer manufacturer should provide a list of safe chemicals that have been tested and approved by the United States Environmental Protection Agency (EPA) for use through an electrostatic sprayer. This ensures safety not only for the operators but also for patients and other staff members in the area. Not all devices are created equally. Similarly, not all disinfectants are safe or effective when used through an electrostatic sprayer. If you are not sure if a disinfectant has been approved for electrostatic use, you can look up the Master Label on the EPA website by using the EPA Registration Number.
- Target Your Electrostatic Disinfectant Based on Area
Once you have identified the list of safe EPA-approved chemicals, consider selecting more than one electrostatic disinfectant for your facility. Your decision to use one disinfectant versus another may vary depending on the type of area, surface compatibility, frequency of use, and the number of devices you are planning on employing. The same strategies you use in your protocols now with wipes and trigger sprays should also be considered when you are adding electrostatic sprayers to your arsenal. For example, you may choose to use a sporicidal product in your patient areas where the risk of C. difficile is a concern and then use a more general hospital disinfectant in your lobby and waiting rooms. Your individual risk assessments can also help to drive these decisions.
- Develop a Step-by-Step Protocol
Having a clear and easy-to-understand protocol will help to prevent any potential issues. Here are some suggestions for setting electrostatic sprayer operators up for success in your protocol development:
- Always recommend gathering supplies in advance, performing hand hygiene, and putting on appropriate personal protective equipment (PPE) prior to spraying.
- Have operators remove all linens, paper products and trash from the spray area. I recommend placing a sign outside to indicate that cleaning is in progress. Of note, most products do not recommend use of an electrostatic sprayer while bystanders are in the area. Re-entry time will depend on the disinfectant in use and can be affected by other factors such as air exchange rates, temperature, and humidity.
- Be sure to include a step for cleaning visible soil. Electrostatic sprayers can be an adjunct to routine manual cleaning and disinfection or a stand-alone step if there is no visible soil on the surface.
- Don’t Forget About Spraying Strategy
Make sure to clearly spray target surfaces and avoid just spraying into the air. Stick to one spraying path: clockwise or counterclockwise. Use a zone approach to spray, starting with the far side of the area and working towards the door. Spray using a slow, side-to-side motion, working from high to low surfaces. Stand the appropriate distance from surfaces when spraying. The required distance may vary by electrostatic sprayer. Your goal is to have surfaces wet but not saturated. HINT: If you see dripping or pooling of liquid, you have sprayed too much! Try to maintain a consistent spraying approach with the exception of sensitive electronics and glass or mirrored surfaces. These surfaces may require a wiping step after the contact time has been reached to remove residue and to keep surfaces looking polished.
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:
- Efficacy: Does the device work and inactivate pathogens? Electrostatic sprayers, for example, require a constant power supply in order to equally disperse the germicide, approved by the Environmental Protection Agency (EPA) for use through electrostatic sprayers, onto the surface. When the power supply is variable during the application of the germicide, this can significantly reduce the efficacy of the product. Products that are EPA-approved to use through electrostatic sprayers are validated for efficacy and safety when used through an electrostatic sprayer. Products such as UV devices are only approved for adjunctive use, meaning that they are only to be utilized following a manual cleaning process.
- Safety: Is this device safe to use? What type, if any, of Personal Protective Equipment (PPE) is required for safe handling of the device? How long the product requires the space to be unoccupied can impact the overall room turnover time and the ability for the space to be earning revenue for the healthcare facility. Some disinfectant devices such as foggers, misters, and certain UV devices require the room to remain empty for long periods of time. Disinfectant solutions such as foggers and misters are not the same as electrostatic sprayers and many of these older technologies have extended re-entry times which negatively impact room turnover. Ready-to-use and validated disinfectants that hold EPA registration for use with electrostatic sprayers should ideally be used with electrostatic sprayers to prevent workplace injury and illness and to maximize room throughput.
- Compatibility: Does the use of the device breakdown the commonly found environmental surfaces? Ensuring that the EPA-registered germicide is compatible with the facility’s most common types of environmental surfaces will prevent surface and device degradation. Certain disinfecting solutions such as UV can have cumulative negative impacts on certain environmental surfaces and medical devices leading to surface degradation.
- Regulatory Review and Efficacy Claims: The EPA generally has regulatory authority and oversight for disinfectants and disinfecting devices. While traditional disinfection technologies such as ready-to-use germicidal wipes are strictly regulated by the EPA, this is not true for UV devices. The EPA does not currently require registration for UV devices, which can lead to highly variable efficacy and performance for each UV device in the market. The EPA also does not validate UV manufacturers’ efficacy and safety claims, which can be problematic for healthcare systems. In regard to electrostatic sprayers, some like the Clorox® Total 360® System have met the EPA’s criteria and the germicides approved to use with the system received EPA registration for use with electrostatic sprayers. This validation ensures consistent efficacy, device performance and safety criteria are met. While this is not yet an EPA requirement, electrostatic devices that have met these criteria are tested and proven to effectively meet infection control needs for the Environment of Care program across the entire healthcare continuum of care. Most germicides are not validated to be sprayed through electrostatic sprayer devices, which means that the germicide’s efficacy and safety is no longer validated since the properties of the germicide may change as it passes through the device and onto the treated environmental surface. Users should confirm the chemical they use with an electrostatic sprayer is approved for use with the system.
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:
- U.S. Environmental Protection Agency. Expedited Review for Adding Electrostatic Spray Application Directions for Use to Antimicrobial Product Registrations https://www.epa.gov/pesticide-registration/expedited-review-adding-electrostatic-spray-application-directions-use
- U.S. Environmental Protection Agency. Can I use fumigation or wide-area spraying to help control COVID-19? https:// www.epa.gov/coronavirus/can-i-use-fumigation-or-wide-area-spraying-help-control-covid-19
- U.S. Environmental Protection Agency. Can I apply a product using a method that is not specified in the directions for use? https://www.epa.gov/coronavirus/can-i-apply-product-using-method-not-specified-directions-use
Dr. Hudson Garrett Jr. is a paid consultant for Clorox Healthcare.
When the COVID-19 pandemic began, cleaning and disinfection became top of mind for facilities and the people who occupy those spaces. Many facilities are now required to incorporate daily disinfection into their routine cleaning practice, which often means adding additional frequencies, labor, products and technologies to their operations. Electrostatic sprayers are one such technology that many facilities have turned towards to help meet the demand to disinfect more frequently in less time. Before investing in this technology, it is important to understand what electrostatic spraying is and how it is different from other application methods on the market.
Electrostatic spraying works by charging liquid droplets as they pass through a nozzle. The resulting charged droplets actively seek out surfaces. Once droplets reach their target surface, they stick to the surface and the charge dissipates. Because the droplets all hold the same charge, they repel one another, causing them to spread out and cover surfaces evenly. This enables facilities to apply disinfectants in less time and with better coverage compared to other application methods.
When comparing electrostatic sprayers to other spray technologies like foggers, pump sprayers, and trigger sprayers, there are a few big differences. The main difference is that the disinfectant droplets are charged. Foggers can distribute disinfectants more evenly than a trigger or pump sprayer, but the disinfectant coming out of these devices is uncharged, which means that some surfaces may be missed. Charging disinfectants means that electrostatic sprayers can cover more surfaces in less time. Additionally, electrostatic spraying provides extra assurance that disinfectant will deposit on all sprayed surfaces, including curved or oddly shaped objects that can be difficult to cover with other spray technologies.
Another key difference is droplet size. Trigger and pump sprayers emit large droplets that are generally not respirable meaning that droplets are too large to be inhaled into the lungs. Electrostatic sprayers emit droplets that are slightly smaller than a trigger sprayer but are still above respirable range. Some disinfectants may not require any additional personal protective equipment (PPE) to spray them through an electrostatic sprayer, while others may require PPE. Foggers typically emit very small droplets that fall inside respirable range meaning that inhaled droplets could reach the deep lung. For this reason, humans cannot be present in the room during fogging without extensive PPE and room vents must be sealed prior to fogging. Foggers also typically require long wait times (up to two hours) before people can re-enter a treated room.
There are a number of additional technologies you may encounter when researching electrostatic spray technologies. For example, there are devices that emit UV light to kill pathogens on surfaces, surfaces embedded with antimicrobials, and air purification systems. These devices all have their place and may be a good addition to your disinfection practice. However, it is important to understand the limitations of these technologies before investing. For example, how the device fits into your current operating workflow for cleaning and disinfecting, how you will disinfect the spaces these devices cannot reach, and the staffing requirements for these devices.
In turn, you should always consider the entire process when considering these devices, the potential benefits may not outweigh the cost of adoption and maintenance.
Electrostatic spraying can be a great way to help facilities meet the increased need for disinfection, but it is important to choose the right technology for the right job. When choosing technologies to add to your cleaning and disinfection portfolio, consider the following:
- Decide what areas of your facility could benefit most from those technologies.
- Update your cleaning and disinfection schedule to incorporate the technology in a way that will maximize the benefit.
- Communicate the plan to your supervisors and roll it out to staff as part of a robust training program. Once you have a plan in place, you can communicate your efforts to the people using the facility to give them assurance that you are doing everything you can to help keep the spaces they use safer.
Whichever disinfecting technologies you choose to add to your operation’s inventory, ensure the technology has documented evidence to support its use in practice and has been approved by the EPA for use. Look for studies to demonstrate real world reduction of microorganisms on surfaces. For electrostatic sprayers, make sure the disinfectant you’re using has been approved for use with an electrostatic sprayer by the EPA. Studies will also support EPA-approved claims that appear on disinfectant product labels as well as provide extra assurance that you will get the intended result when using the sprayer in practice.
For more information on the Clorox® Total 360® System, click here.
Ben Walker is a paid consultant for CloroxPro.
“Adjunct disinfection methods such as electrostatics seem to be gaining in popularity. Is a manual cleaning step always required?”
Because Infection Preventionists have oversight of all cleaning and disinfection practices within their facilities, it’s really important to keep current on emerging disinfectant technologies, including new adjunct disinfection technologies. One such technology in high demand given the “new normal” is electrostatic sprayers. In addition to getting disinfectant into nooks and crannies, these devices can disinfect large areas in a very short time. This blog post will provide a brief overview of the technology, how best to employ its use within a healthcare facility, and safety considerations.
Electrostatic Sprayer Technology 101
Despite its growing popularity, electrostatic technology is actually not new. It’s been used for many years in other industries such as agriculture, automotive painting, and spray tanning. In healthcare, this adjunct technology is a new way to apply familiar disinfectants. The device charges the disinfectant droplets as they exit the nozzle where the disinfectant is attracted to the surface/object like a magnet. The end result is a uniform coating of disinfectant that wraps 360 degrees around targeted objects. This makes for a fast and efficient disinfecting process.
Incorporating Electrostatic Sprayer Technology into Current Processes
A study conducted by Bhalla et al (2004) showed that only 50% of healthcare surfaces were properly disinfected with manual cleaning1, creating the need for supplemental disinfectant technologies such as electrostatics. Electrostatic sprayers are intended to be an adjunct to routine manual cleaning and disinfection.
For example, consider using an electrostatic sprayer as a finishing step for terminal cleaning of C. diff, COVID, or other isolation rooms. Other considerations include terminal cleaning of operating rooms, waiting rooms, and transport equipment such as wheelchairs and gurneys.
With that said, much like we use hand sanitizer for much of our hand hygiene opportunities and reserve hand washing for specific times such as removing visible soil or C. diff spores from our hands, we can consider using an electrostatic sprayer in a similar way.
If a surface is not visibly soiled or the area did not house a C. diff patient, a manual cleaning step is not required prior to disinfection so consider using electrostatic sprayer technology in these instances. Consider that operating rooms (OR) are manually cleaned multiple times during the day (e.g., after each procedure), so why couldn’t terminal cleaning of the OR be completed using an electrostatic sprayer to apply the disinfectant?
Additionally, consider objects or areas that are likely not getting cleaned and disinfected as often as we would like because they are large spaces, or difficult to clean, such as waiting rooms or wheelchairs. Electrostatic sprayers are a great option and the Donskey study (2020) provides great evidence to support this. Keep in mind, however, just like our hands, we do still need to periodically perform manual cleaning.
Electrostatic Sprayer Safety
First and foremost, be sure to select EPA-registered products approved for use through an electrostatic sprayer. Use of a disinfectant or sanitizer in a non-approved manner is a violation of federal law. It’s equally important to adhere to the manufacturer’s directions for use (DFUs), including contact time.
Be sure to wear personal protective equipment (PPE) according to both the manufacturer’s DFUs for the selected product and also per Standard Precautions.
We often get asked if it’s safe to use an electrostatic sprayer when other people are in the area being disinfected. In addition to following the manufacturer’s DFUs for both the device and the disinfectant, we recommend that only the operator be present in the room while the device is being used. Another question that frequently gets asked is “what is the room re-entry time after applying the disinfectant?” The answer: there is none!
The Clorox® Total 360® System
Clorox Healthcare offers an electrostatic sprayer technology called the Total 360® System. The table below is quick overview of the current products in our portfolio that can be used with the Total 360 electrostatic sprayer.
|Total 360 Disinfectants||Active Ingredient||Suggested Use Locations||Contact time||Personal Protective Equipment (PPE)|
|Spore10 Defense™ Cleaner Disinfectant||Sodium hypochlorite||Patient care areas where C. diff is a concern (e.g., terminal cleaning, etc)||5 minutes||Eye protection; Wear other PPE in accordance with Standard Precautions.|
|Total 360® Disinfectant Cleaner1||Quaternary ammonium compound||Patient care areas when C. diff is not a concern||2 minutes||Eye protection; Wear an N95 respirator for prolonged use; Wear other PPE in accordance with Standard Precautions.|
|Anywhere® Hard Surface Sanitizing Spray||Sodium hypochlorite||Non-patient care areas such as offices and conference rooms and anywhere that a food safe product is indicated such as the cafeteria.||2 minutes||Eye protection; Wear other PPE in accordance with Standard Precautions.|
Adjunct disinfection technologies such as electrostatic sprayers can be a great addition to your current cleaning and disinfection routines. The technology has been around for many years and it is both safe and efficient.
- Kill C. diff with Clorox Healthcare® Spore Defense™ &Clorox® Total 360® Video
- Clorox® Total 360® System Training Video
- Electrostatic Spray Disinfectant Technology & Clorox Healthcare® Spore Defense™ - Clinical Study
- Donskey, C., et al. (2020). Evaluation of an Electrostatic Spray Disinfectant Technology for Rapid Decontamination of Portable Equipment and Large Open Areas in the Era of SARS-CoV-2. AJIC, 48(8), 951-954.
- Clorox® Total 360® Disinfectant Compatibility Chart
- Evaluating Electrostatic Sprayers for Surface Disinfection White Paper
- Bhalla A., Pultz N.J., Gries D.M. et al. “Acquisition of Nosocomial Pathogens on Hands After Contact With Environmental Surfaces Near Hospitalized Patients.” Infection Control Hospital Epidemiology. 2004 Feb;25(2): 164–7
With the ongoing COVID-19 pandemic and the heightened scrutiny on cleaning and disinfecting, one of the biggest challenges facing professional cleaning managers is cutting through the noise. Dominating the narrative are a slew of mixed, conflicting and false information, regarding the purchase of tools and products that promise miraculous results.
The debate around whether a disinfecting product will kill SARS-CoV-2 has been covered at length. The EPA list of products that are approved for use against the virus can be found here: Environmental Protection Agency's (EPA) announced products were approved for use against SARS-CoV-2 if they met the criteria of list N.
While the microbial efficacy of traditional disinfectant products is fairly straight forward, there are several emerging technologies such as UV lights, electrostatic sprayers, foggers and misters to be aware of as they are not all created equally. Historically, I have maintained a healthy dose of skepticism for seemingly fantastic claims about fantastic new products, including electrostatic sprayers, as I originally did not recognize the need for them or understand the problem they solved for professional cleaning managers.
While electrostatic sprayers are not new, their application to daily cleanin is. It’s for this reason, I’m eager to share this whitepaper on evaluating electrostatic technology devices. It clearly outlines the nuances of why the technology is effective when deployed properly. I don’t expect anyone to take my observations at face value, however, I always apply three basic questions to determine the value for any given organization. Before making a large investment, I encourage you to read the full paper here and use the recommendations below to make the best decision for your cleaning operation.
Practical Evaluation and Application
Is it safe?
The safety of your workers and the building occupants should always be the top considerations when evaluating a new technology.
Due to the COVID-19 pandemic, the scramble is on for cleaning operations to stock up on disinfecting technology. With that comes the deluge of new product innovations with bold promises. Before making the investment, cross-reference kill claims with the Environmental Protection Agency’s (EPA) database. U.S. law requires that any product that claims to kill specific pathogens must be registered with the EPA. While this was somewhat of a black box previously, the EPA has recently published clear guidance on the use of disinfectants through electrostatic sprayers. The rationale for submitting data before market approval is because a product's safety and effectiveness may change based on use.
If a product's label does not include disinfection directions for electrostatic spraying, it means the EPA has not reviewed the data on whether the product is safe and effective when used by this method. Therefore, if you are evaluating an electrostatic sprayer for your facility, be sure to make sure the disinfectant you’re using has been approved for use in an electrostatic sprayer.
Will it work?
Before signing a purchase order for two dozen electrostatic sprayers, take the time to evaluate whether they will be a good fit for your operation. As counterintuitive as it may sound, slow down.
My suggestion is to pilot one machine, with one team, in one area, on a single shift. Some questions to answer include: 1. Who will use the product — is it a customer service tool or deep cleaning tool for a cleaning specialist? 2. Where and on what will it be used? Pilot in places with the most chances for realistic usage. 3. When will the product be used (i.e., will the building be full or empty, will kids be in or out of school)?
Before getting started, make sure everyone on the team is clear on how the unit is used, the areas the unit will be used, and plan to keep a daily log to record usage data.
At a minimum, usage data should include: how much cleaning product was used during the shift, how long the sprayer was in use, and what areas were covered. Compare this with your previous process and make a data-based decision on whether the technology is a good fit for your operation.
What tasks does it improve or replace?
Based on your pilot data, you'll have a good understanding of whether the product will work for you, and how it can benefit your organization. Use the productivity rates from your pilot to drive decision-making to implement the product into your organization moving forward. Include all the other variables you want to account for, adjust workload, update procedures and train personnel to follow them. Make sure everyone in the organization is clear on what has changed, how the new product is going to improve the operations. Do the due diligence before making the change.
My Final Take
In conclusion, as with any new technology, due diligence is my recommendation before making changes to your daily cleaning program. In this modern age of heightened scrutiny on daily cleaning, it is more important than ever to realistically meet the demand while confidently mitigating the worries that come with a pandemic.
The way we clean up our facilities daily may be getting more attention now because of the pandemic. However, we’re still responsible for cleaning up during outbreaks of influenza, norovirus and countless other forms of infectious disease. The process has not changed — the technology however might help make it more manageable.
Ben Walker is a paid consultant for CloroxPro.