Cleaning and Disinfection For SNC

Cleaning and Disinfection for the Spay-Neuter Clinic : 

Brian A. DiGangi, DVM Maddie’s® Shelter Medicine Program Cornell University bad52@cornell.edu Cleaning and Disinfection for the Spay-Neuter Clinic

Objectives : 

Objectives What does it mean to be clean? What cleaning agents are available? Facility Patient & Surgeon prep Anesthetic equipment

What does it mean to be clean? : 

What does it mean to be clean? Cleaning 1. Physical removal of organic materials 2. Chemical removal of contaminants Disinfection Killing of most contaminants (except spores)

The Dose Effect : 

The Dose Effect The goal is to MINIMIZE the number of pathogens to which our patients are exposed.

Detergents : 

Detergents Must be applied prior to disinfection! Emulsify grease and suspend dirt particles Do not provide adequate disinfection alone Eliminates majority of microorganisms Many disinfectants contain detergents

Biofilms : 

Biofilms “An invisible, tightly adherent residue formed from a complex aggregation of bacteria in an exopolysaccharide matrix.” (Petersen 2008)

Biofilms : 

Biofilms Paulson, DS. Efficacy of preoperative antimicrobial skin preparation solutions on biofilm bacteria. AORN Journal 81(3) 492-501, 2005

Disinfection: What are the choices? : 

Disinfection: What are the choices? Physical Agents Heat Radiation Chemical Agents Alcohols Biguanides Bleach Oxidizing Agents Quaternary Ammonium Compounds

Bleach : 

Bleach Sodium hypochlorite Broad spectrum bactericidal Virucidal Sporicidal Fungicidal

Bleach : 

Bleach Use at 1:32 dilution 1:10 dilution sporicidal Corrosive Respiratory irritation Mix fresh every day Very unstable in water

Bleach : 

Bleach For household bleach (5.25% NaOCl): Spray bottles Mix 1 ounce of bleach (30ml) with 32 oz. water Mop buckets Mix 1/2 cup of bleach with 1 gallon of water 21 ÷ % NaOCl = ounces of bleach per gallon of water

Bleach : 

Bleach Inactivated by organic debris soap/detergent light

Oxidizing Agents : 

Oxidizing Agents Potassium peroxymonosulfate (Trifectant®, Virkon S®) Broad spectrum bactericidal Virucidal

Oxidizing Agents : 

Oxidizing Agents Trifectant® and Virkon S® contain detergents Some efficacy in presence of organic debris Stable for 7 days Cost ~ 61¢ per gallon

Remember… : 

Remember… OR OR Bleach or Trifectant® are the only disinfectants that can kill non-enveloped viruses!

Quaternary Ammonium Compounds : 

Quaternary Ammonium Compounds Roccal®, Parvosol®, Kennel-Sol®, etc. Gram positive bactericidal Limited Gram negative efficacy Enveloped viruses only Some fungicidal activity

Quaternary Ammonium Compounds : 

Many contain detergents Must be diluted according to manufacturer’s directions Inactivated by Organic debris Soap/anionic detergents Hard water Quaternary Ammonium Compounds

The Doctor and the Patient : 

The Doctor and the Patient Alcohol Chlorhexidine Povidone Iodine Brushless Scrubbing

Alcohols : 

Alcohols Ethanol Broad spectrum bactericidal Virucidal Fungicidal Isopropanol Broad spectrum bactericidal Enveloped viruses only Fungicidal

Alcohols : 

Alcohols Concentrations of 70-90% most effective Water required to denature proteins Ineffective in presence of organic debris

Alcohols : 

Alcohols Alcohol rinse Not recommended as pre-surgical scrub Prevents appropriate contact time Reduces residual action of iodophors Exacerbates hypothermia Remove excess scrub with warmed tap water, saline or dry sterile gauze

Surgeon Preparation : 

Surgeon Preparation “A properly performed hand and arm scrub…is required prior to performing surgical procedures, except for routine castrations.” – ASV S-N Task Force

Surgeon Preparation : 

Surgeon Preparation In general… First scrub of the day should be a minimum of 5 minutes Subsequent scrubs should be between 2 and 5 minutes Repeat scrub whenever a break in aseptic technique occurs

Chlorhexidine : 

Chlorhexidine Broad spectrum bactericidal 4% for surgical antisepsis 2 days residual activity Active in presence of some organic material Inactivated by soap Requires 3 minutes contact time!

Povidone-Iodine : 

Povidone-Iodine Broad spectrum bactericidal Enveloped viruses only Activity reduced by Organic matter Alcohol rinse 7.5-10% solution recommended (0.25-1% available iodine)

Brushless Scrubbing : 

Brushless Scrubbing Scrub brushes are associated with… Increased shedding of skin cells Increased microbial skin counts Increased risk of infection Increased transmission of infection

Brushless Scrubbing : 

Brushless Scrubbing Howe et al (2006) A 1.5 to 2 minute application of a brushless 61% ethanol and 1% CHG reduced bacterial counts as much as a 6 minute scrub with 2% CHG at one minute Mulberry et al (2001) Application of a brushless 61% ethanol and 1% CHG had significantly greater microbial reduction than two 3 minute scrubs with 4% CHG solution or 61% alcohol alone at 6 hours

Brushless Scrubbing : 

Brushless Scrubbing Park et al (2006) A brushless CHG/ethanol emollient resulted in greater reduction of microbial counts than 7.5% PVI at 1 minute and end of Day 1 Skin condition was significantly better for the brushless product after Day 5 Hobson et al (1998) A 3 minute application of 70% ethanol, surfactant, & emollients resulted in a significant reduction in CFU’s over a 10 minute scrub with 7.5% PVI and a 6 minute scrub with 4% CHG

Brushless Scrubbing : 

Brushless Scrubbing Must be preceded by washing with soap and water! Cost ~2 times as much as 4% CHG ~6 times as much as 7.5% PVI Time savings? Use when limited water supply?

Anesthetic Equipment : 

Anesthetic Equipment In between every patient… All equipment with direct patient contact (exam tables, ET tubes, laryngoscope blades, pulse ox, esoph. stethoscopes, thermometers)

Anesthetic Equipment : 

Anesthetic Equipment At least once per week… Anesthetic breathing circuits Dome and 1-way valves and absorbent canisters

Anesthetic Equipment : 

Anesthetic Equipment Soap and water…scrub thoroughly! Potassium peroxymonosulfate Do not use on metal for more than 10 minutes Bleach Solution (1:32) Rinse and dry thoroughly before use!

Ancillary Equipment : 

Ancillary Equipment

Laundry : 

Laundry Washing Hot water cycle ½ to 1 cup bleach Do not overload! Drying High heat cycle or sunlight Do not overload! Discard heavily contaminated items or those known to be exposed to infectious disease

Hand Washing : 

Hand Washing Use soap and water. Rub hands for 20 seconds. Dry with paper towel. Use towel to turn off faucet.

Sometimes you just need to throw it out… : 

Sometimes you just need to throw it out…

Slide 37: 

Brian A. DiGangi, DVM Maddie’s® Shelter Medicine Program Cornell University bad52@cornell.edu