Evaluating a New Paradigm for Comparing Surface Disinfection in Clinical Practice
Background: Despite an increasing understanding of the importance of near patient surfaces in the transmission of healthcare associated pathogens, there remains a need to define the relative clinical effectiveness of disinfection interventions.
Methods: A unique system for quantifying bioburden reduction while monitoring the possible impact of differences in cleaning thoroughness was used to compare the clinical effectiveness of a traditional quaternary ammonium compound (QAC) and a novel parecetic acid/hydrogen peroxide disinfectant (ND) as part of terminal room cleaning. Process, the thoroughness of cleaning, was evaluated by fluorescent marker (DAZO) removal. Product, the potency of the disinfectant used, employed aerobic dip slides to assess bioburden removal.
Results: As a result of QAC cleaning, 93 of 237 (40%) of cleaned surfaces confirmed by fluorescent marker (DAZO) removal were found to have complete removal of aerobic bioburden. During the ND phase of the study, bioburden was removed from 211 of 274 (77%) of cleaned surfaces. Since there was no difference in the thoroughness of cleaning with either disinfectant (65.3% and 66.4%) the significant (p<.0001) difference in bioburden reduction can be attributed to better cleaning efficacy with the ND. (See Figure)
Conclusion: In the context of the study design, the ND was 1.93 times more effective in removing bacterial burden than the QAC (p<.0001). Furthermore, the study design represents a new research paradigm in which two such interventions can be compared by concomitantly and objectively analyzing both the product and process variables in a manner that can be used to clinically define the relative effectiveness of all surface disinfectants. This study design will also permit effectively defining the relative clinical efficacy of cleaning and disinfecting materials of non-touch disinfection technologies and self-disinfecting surfaces. Such studies may then begin to objectively clarify best practices for decreasing the risk of pathogen transmission from contaminated surfaces to patients through the use of various cleaning modalities and chemistries while providing guidance for more in-depth clinical studies of cost benefit issues and healthcare associated pathogen transmission prevention.
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J. Ferguson, None
A. Thomasser, Ecolab: Employee, Salary