National Nurses United

13 National Nurses United Issues with Disinfectants and Other Cleaning Products Decontamination and disinfection of equipment, linens, surfaces, and other objects is an important environmen- tal component of infection prevention plans. Researchers conducted a review of the published literature from 1987- 2016 and found that fomites continue to be implicated in health care-associated outbreaks. Such fomites include humidifiers,nebulizers, urine-measuring devices, stetho- scopes, thermometers, suction apparatuses, pressure transducers, hand soap/sanitizer dispeners, ultrasound probes/gel, and computer keyboards. It has been estimated that 90% of large hospitals in the U.S. operate at or above capacity. Studies have shown that when hospitals operate over 75% capacity, infection prevention and control programs are seriously com- promised. Such situations prevent effective isolation of patients with MRSA and other infections. High turnover and understaffing make patients more vulnerable and prevent the full evaluation and screening of patients for infections. In many of these outbreaks, control measures can include use of disposable, sterilizable or easy-to-clean/disinfect materials. For outbreaks that involve the aerosolization of bacteria (such as from humidifiers, ventilation sys- tems, laser systems, etc.), humidity and ventilation rate control of the heating, ventilation, and air conditions (HVAC) system is an important prevention measure. The authors of this review conclude: In our review, the main cause of health care-asso- ciated outbreaks was inappropriate disinfection practice for sharing items. Other reviews also noted that medical equipment used in noncritical settings rarely had cleaning protocol and may be involved in frequent transfer of pathogens com- pared to critical settings, suggesting the need for appropriate cleaning and disinfection protocols for patient care items commonly used in daily practice. Cleaning must precede high-level disin- fection or sterilization of any reused patient care items. Thus, assuring disinfectants for noncritical medical equipment in addition to improving thor- oughness of cleaning and disinfection practice is imperative in terms of infection prevention (Kana- mori et al., 2017). While this study makes important contributions, it is important to note that the authors do not recognize the importance of staffing to the disinfection processes. Another issue with disinfectants and other cleaning products is that many of these chemicals are hazardous to users. For example, in a manuscript detailing levels of disinfection and sterilization published by industry researchers, each of the chemical agents they rank as "high level disinfectants" for use in cleaning the most critical items to prevent health care-acquired infections for patients has a significant health hazard. See Table 3. Where use of such chemicals is necessary for infection prevention, employers must also provide protection to employees responsible for cleaning or who may other- wise be exposed to the chemicals. The Nurses' Health Study II found that nurses reported using disinfectants frequently—19% to 88% of nurses reported that they cleaned surfaces with disinfectants at least weekly and 5% to 48% reported using disinfectants 4 to 7 days per week. The most frequently used disinfectants were alco- hol (weekly use 39%), hypochlorite bleach (22%), sprays (20%), quats (14%), peroxide bleach (9%), gluteralde- hyde (7%), and formaldehyde (5%). The Nurses' Health Study II also examined asthma rates among nurses and found that nurses who used disinfec- tants to clean medical instruments, including formal- dehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide and enzymatic cleaners, had a significantly increased risk for poorly controlled (odds were 1.37 times higher than nurse without exposure) or very poorly controlled asthma (odds were 1.88 times higher). Addi- tionally, exposure to such disinfectants is associated with a 22% to 32% increased risk in nurses developing chronic obstructive pulmonary disease (COPD). Screening and Isolation Procedures Other measures can be impactful in preventing health care-acquired infections in patients and exposures to nurses. For example, screening protocols to actively identify patients with MRSA or other potentially asymp- tomatic infections have been shown to be effective. One study examined MRSA surgical site infection rates in patients and found that the rate of post-surgery infection in patients significantly decreased when patients were actively screened, tested, and treated for MRSA prior to surgery. Another study determined that weekly MRSA screening programs effectively reduced infection rates, and that isolation of MRSA-infected patients effectively prevented transmission to other patients. Airborne infection isolation rooms can be an important measure to prevent the spread of TB and other infectious diseases in health care settings. One study determined that the risk of TB infection decreases exponentially with increased room ventilation rates. However, surveys of hospital's isolation rooms show that low numbers func- tion effectively. None of the surveyed hospitals checked the performance of the ventilation systems. Case Study: Contaminated Endoscopes Contaminated endoscopes have become an increasing issue in recent years. Scopes manufactured by Olympus Corp, which make up 85% of the American market, have been implicated in dozens of patient infections and deaths over the past several years. At least 35 patients have died since 2013 as a result of infections from con- taminated endoscopes. Media investigations revealed internal company emails indicating that Olympus knew about issues with the way the scopes were designed that made them essentially impossible to clean.

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