Choosing the right cleaning product for patient room sanitation can be a complicated process. You need to consider the advantages and drawbacks of each cleaning chemical. Stringent disinfection reduces the risk of healthcare-associated infections (HAIs). Currently, there are five main EPA-registered chemicals that hospitals use for disinfectants: Quaternary Ammonium, Hypochlorite, Accelerated Hydrogen Peroxide, Phenolics, and Peracetic Acid.

Quaternary Ammonium

Quaternary ammonium compounds are used broadly in routine cleaning. The Centers for Disease Control and Prevention considers quaternary to be a low-level disinfectant effective against most bacteria, enveloped viruses, and some fungi. It’s used in products such as Spartan CDC-10 and is compatible with most hard surfaces. Quaternary ammonium products are best used on non-critical surfaces such as floors, bed-rails, tray tables, blood pressure cuffs, walls, and partitions.

Hypochlorite

Hypochlorites are the most commonly used chlorine disinfectants. Sodium Hypochlorite is commercially available as household bleach. This EPA-registered chemical is stable and fast acting. While generally considered safe, bleach can cause skin and eye irritation. It is corrosive to metal in high concentrations and can discolor fabric. Hypochlorites effectively kill bacteria, fungi, and viruses. Hospitals can use these products for bathrooms, food prep zones, and blood spills. All areas must be pre-cleaned to remove organic matter before disinfection. When using concentrated products, follow strict dilution protocols.

Phenolics

Phenolics have been around for a long time. Sir Joseph Lister used a phenol called carbolic acid as a surgery antiseptic in the 1800’s. The antimicrobial properties of phenol derivatives have improved over time. Phenolics are present in hospitals today. These products are best for disinfection of non-porous surfaces and non-critical devices. Use phenolics with care and follow manufacturers recommendations carefully because improper preparations can be dangerous to newborns. Remember, product residue can irritate skin.

Peracetic Acid

Peracetic acid preparations are rapid-acting disinfectants. They are bactericidal, fungicidal, virucidal, mycobactericidal, and sporicidal. However, Peracetic acid can become unstable when diluted. It can corrode some metals such as copper and brass. Hospitals used Peracetic acid in automated machines to sterilize medical instruments and to disinfect hemodialyzers.

Accelerated Hydrogen Peroxide

Accelerated Hydrogen Peroxide (AHP) is a more recent breakthrough in hospital disinfectants. It is in Oxivir and Alpha HP. These products are a blend of safe, active cleaning agents with hydrogen peroxide. These compounds are safe for the cleaning staff and the environment with the lowest EPA toxicity category of IV. These one-step cleaners disinfect in the presence of organic matter and blood. They are efficient with short dwell times. AHP kills bacteria, viruses, mycobacteria, pathogenic fungi, and blood-borne pathogens.

Choosing the Right Disinfectant

Hospitals should carefully consider the right cleaning product for the job. A meta-analysis published by the Agency for Healthcare Research and Quality identifies the most effective environmental cleaning methods for the prevention of HAIs.

The analysis notes that an effective disinfection protocol should consider these five factors:

• Targeted microbes (hepatitis, HIV, C. Difficile, etc.)
• Surface type (cloth, metal, plastic, etc.)
• Disinfectant compatibility with surfaces and materials
• Cost and ease of use
• Safety of staff and patients

Selecting cleaning chemicals involves multiple stakeholders at the facility, including infection control committees and environmental services. Hospital staff should work together to choose the right disinfectant for each job.