Understanding Decontamination SOP’s Cleaning + Disinfection = Decontamination Overview SOP’s Compliance Order of Disinfection Typical SOP’s Disinfectants Types and properties Strengths & weaknesses Wipers Mops Fogs Residue Contact times Compliance www.foamtecintlwcc.com Application techniques Common Questions & Issues Summary SOP Compliance Relies On Proper Use SOP’s list specific Sanitizers, Disinfectants and Sterilants Each type of chemical is optimized for a different task All liquid disinfectants rely on intimate contact with the surface SOP compliance is very dependent on operators www.foamtecintlwcc.com General Order Of Disinfection Disinfect ceilings and walls Clean the area (line clearance) Disinfect equipment (if applicable) Rinse or IPA wipe down of equipment Disinfect floors Allow to air dry Once a month clean and rinse all surfaces www.foamtecintlwcc.com Typical Cleaning SOP Multiple times/day: Sterile IPA on work surfaces and a disinfectant cleaner such as Vesphene or LpHse on the floors Weekly: Complete cleaning with germicide on ceilings, walls and floors Monthly or when action levels call for it: High level sterilants used for complete cleans www.foamtecintlwcc.com www.foamtecintlwcc.com Bleach / H2O2 / Peracetic Acid (Spor-Klenz) Phenolics (LpH, Vesphene) Peroxide and Quats Process NPD, Biocide A & B Alcohols Ease of Use Increased Microbial Efficacy and/or Regulatory Claims Hierarchy of Disinfectants Sanitizers vs. Disinfectants Chemical Type Sanitizers(Sterile Alcohol) Disinfectant Cleaners (Low or Intermediate level Germicides) Sterilants (High Level Germicides) www.foamtecintlwcc.com vs. Sterilants Functionality Offers 2 log reduction, no impact on spores and no residue. Offers 5 log reduction on a soiled surface with moderate residues. 5 log reduction and spore control on clean surfaces. High residues. Summary & Comparison Of Liquid Disinfectants Compiled by University of Virginia Class Recommended Use 70% Isopropyl -Cleaning some Alcohol instruments solution -Cleaning skin -General purpose sanitizer for clean room equipment and work surfaces Chlorine Compounds How They Work -Changes protein structure of microorganism -Presence of water assists with killing action Advantages Comments & Hazards -Flammable -Eye Irritant -Toxic -filtered, sterile IPA very expensive High VOC’s and poor cleaning when sprayed on the surface -Not active when organic matter present -Not active against certain types of viruses -Evaporates quickly -Contact time not sufficient for killing -Spills of human -Free available -Kills hardy viruses -Corrodes metals such -Follow spill body fluids chlorine combines (e.g. hepatitis) as stainless, aluminum procedure and with contents within -Kills a wide range of -Organics may reduce dilution instructions microorganism, organisms activity -Make fresh Bactericidal - Good reaction byproducts -Inexpensive -Increase in alkalinity solutions before use Fungicidal - Good cause its death -Penetrates well decreases bactericidal -Eye, skin and Sporicidal - Good at -Need 500 to 5000 -Relatively quick property respiratory irritant >1000ppm Sodium ppm microbial kill -Unpleasant taste and -Corrosive Hypochlorite -Produce chemical -May be used on food odor -Toxic combination with cell prep surfaces -Tuberculocidal, substances with extended contact -Depends upon time release of -heavy residues hypochlorous acid www.foamtecintlwcc.com -Very low in residue Disadvantages Examples - Sterihol -Bleach solutions (sodium hypochlorite) -Clorox -Cyosan -Purex -NaDCC (sodium dichloroisocyanurate) Summary & Comparison Of Liquid Disinfectants…cont. Compiled by University of Virginia Class Peroxide/ Peroxide & Peracetic Acid Phenolic Compounds Quaternary Ammonium compounds (QUATS) Recommended Use General Housekeeping Bactericidal - Very Good Fungicidal Excellent Virucidal – Excellent Spores- good with extended contact times -30 minutes Bactericidal Excellent Fungicidal Excellent Tuberculodial Excellent Virucidal - Excellent @10 minute contact times How They Work -disrupts cell walls Comments & Hazards -Kills broad range of -Peroxide easily -Pre-cleaning a organisms inactivated by organic requirement -Low residues residues -5 minute contact -Peroxide/Peracetic Peracetic time for Broad acid limited acid/hydrogen Spectrum penetration of residue peroxide hard to use -Not affected by laden surfaces due to unstable hard water solution Good safety and Environmental profile -Gross protoplasmic poison -Disrupts cell walls -Precipitates cell proteins -Low concentrations inactivate essential enzyme systems -Nonspecific concerning bactericidal and fungicidal action -Vesphene/LpH formulated with cleaning surfactants Advantages Disadvantages -Unpleasant odor -Skin and eye irritant -Some areas have -Sensitizer disposal restrictions -Corrosive -Effectiveness reduced -Toxic by alkaline pH, natural soap or organic material -Sporicidal, no High residues -Ordinary -Affects proteins and -Contains a -spores not eliminated -Select from EPA list housekeeping (e.g. cell membrane of detergent to help by all brands, TB of hospital floors, furniture, microorganism loosen soil bacteria, some viruses disinfectants walls) -Releases nitrogen -Rapid action, 5 -Effectiveness -Skin and eye irritant and phosphorous from minute contact times influenced by hard -Toxic Bactericidal cells -Colorless, odorless water -Biocide B has good Excellent -Non-toxic, less -Layer of soap spore activity w/15 Fungicidal - Good corrosive interferes with action minute contact times Virucidal - Good -Highly stable -high in residues (not as effective as -May be used on phenols) food prep surfaces www.foamtecintlwcc.com Examples -Klercide CR Biocide C -Spor-Klenz -Hil-Phene -Lph -Metar -Vesphene -Coverage 258 -End-Bac -Hi Tor -Klercide-CR Biocide A & B Sanitizing Agents/Sterile Alcohol Strengths Low Residue Signature Weaknesses Quick Drying Good Cleaning Performance if applied to wiper www.foamtecintlwcc.com Hard to apply evenly in sufficient volume Very expensive (>when Sprayed to surface) High VOC’s (>when sprayed to surface) Poor removal of disinfectant residue Sterile Alcohol/In Use Reality SOP Objective Sanitize surfaces by removing residues and particles that harbor micro-organisms Rinse surfaces of disinfectant residues www.foamtecintlwcc.com SOP Compliance Issue Current wipers make it difficult to wet the entire surface. Operator to operator nonuniformity To achieve even minimal contact times surfaces are sprayed, then wiped Bleach, Phenolic and Quat residues are not easily removed. Low Level Germicides (Quats)/ Biocide A & B, Coverage Plus Strengths Bactericidal and Fungicidal Some Virucidal activity Non Corrosive and non irritating 5-15 minute contact times www.foamtecintlwcc.com Weaknesses Not Sporicidal and No TB Medium Level of residue Poor cleaning action against biofilms Intermediate Level Germicides (Phenolics/Vesphene, LpH ) Strengths Broad level activityVirucidal, Bactericidal, Fungicidal &Tuberculoid Weaknesses No Spores High residue levels Maintains activity on soiled surfaces Minimum 10 minute contact time Good cleaning action on soiled surfaces Operator Safety Issues www.foamtecintlwcc.com Intermediate Level Germicides(H2O2/Biocide C) Strengths Fast acting Fungicidal, Virucidal & Bactericidal Sporicidal @ 15 minutes No residues Good safety profile www.foamtecintlwcc.com Weaknesses Must be used on a clean, residue free surface No cleaning ability Germicides/Disinfectant CleanersThe Real World SOP Objective Achieve 5 log reduction on clean room surfaces Effective use depends on removing residue buildup www.foamtecintlwcc.com SOP Compliance Issues Microbial reductions rely on achieving label indicated contact times times which are very difficult to achieve with mopping or wiping in high air flow rooms Rinse protocols are not easily met Mopping & Wiping are very operator dependent High Level Germicides Bleach/Spor-Klenz Strengths Broad Level activity including Spores H202/Peracetic acid/ Spor-Klenz are fast acting (5 minute contact times for some organisms) www.foamtecintlwcc.com Weaknesses Long contact times required for spores Bleach has high residue levels and is very corrosive Bleach is a poor cleaner and presents safety issues H2O2/Paracetic acid is concentration dependent so hard to use High Level Germicides/Sterilants In use Reality SOP Objectives Eliminate spore contamination Residue levels must be low www.foamtecintlwcc.com SOP Compliance Issues Bleach, especially is dependent on long contact times Pre-cleaning and rinsing steps are hard to complete Often used more frequently than desirable Applying Disinfectants Via Spray www.foamtecintlwcc.com Spray top to bottom Best wetting of the surface 7-10 minutes or longer Penetrates tight spots and rinses possibly existent contaminants Cleaning: power spray = not optimal Disinfection: light spray = excellent Spraying alone does not clean the surface and residues and particulate can build up Electrical issues need to be considered Applying Disinfectants Via Mopping www.foamtecintlwcc.com Mop top to bottom with overlapping strokes Mopping is a mechanical action on the surface This loosens particulate and residues which removes some of the contaminates While loosening and removing some, it does not remove all Surface wetting is minimal and less than two minutes of contact time is typical Applying Disinfectants Via Wipers Wipe in one direction back to front towards person Cleaning a surface should be done with a damp wipe that soaks up a chemical agent Cleaning is not done with a saturated wipe as contaminants cannot be lifted from the surface Disinfection with a saturated wipe requires the wipe to be wetted and surface to be air dried Wipes need to be changed often www.foamtecintlwcc.com Applying Disinfectants Via Fogging Method for wet fog www.foamtecintlwcc.com Many types of Foggers Fog: 12 x 15 room – two foggers for at least two hours Fogging for startup reduces the bioburden in the area Fogging is an excellent way to regain control of a corrupted area Fogging needs to be done at a droplet size of 25 um (1-2 hours) or gap between droplets can occur Fogging requires a release time (2-3 hours) and does not clean – should be followed with a cleaning Residues Can Be The Undefined Enemy Some SOP’s specify residue levels on surfaces but some specify that the surface is clean Some residues do not show up on a white wiper Some SOP’s call residue removal rinsing www.foamtecintlwcc.com Contact Time=Wet Time Common misconception is that contact time is total time on the surface QC and Management do not understand that operators often do not cover the entire surface www.foamtecintlwcc.com Actually, contact time is the time the surface is wet Operator technique variations can affect contact times Typical Product Claims Sporicidal Agent Sterilant/Sporicidal [B. subtilis (ATCC 19659), C. sporogenes (ATCC 3584)] Bactericidal, Fungicidal, Virucidal . . . . . . . . . . . . . . . . . . . . . . . . . undiluted 5-1/2 hours 20oC Sporicidal – Non-porous Surfaces [B. subtilis (ATCC 19659), C. sporogenes (ATCC 3584)] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . undiluted 30 minutes 20oC Broad Spectrum Disinfectant [S. aureus (ATCC 6538). S. enterica (ATCC 10708)]. . . . . . . . . . undiluted 30 minutes 20oC Tuberculocidal (Mycobacterium bovis BCG) (Clinical Isolate) Mycoplasma gallispeticum (ATCC 15302) *HIV-1** (Clinical Isolate) *Minute virus of mice (Clinical Isolate) *Murine parainfluenza virus type 1 (Sendai) (ATCC VR-907) *Mouse hepatitis virus (Clinical Isolate) www.foamtecintlwcc.com Product Claims . . . Cont. Aspergillus niger (ATCC 16404) . . . . . . . . . . . . . . . . . undiluted 5 minutes 20oC Germicidal Spray Disinfectant [S. aureus (ATCC 6538), S. enterica (ATCC 10708)] . . . . . . . . . . . . . . . . . . . . . . undiluted 5 minutes 20oC Non-food Contact Surface Sanitizer [S. aureus (ATCC 6538), K. pneumonicae (ATCC 4352)] . . . . . . . dilute 50X (1 part to 49 part water) for 5 minutes 21oC www.foamtecintlwcc.com Decontamination Red Flags Overuse of sporicides More frequently than validation indicated Visible cues - If the room doesn’t look clean, it probably isn’t Stained windows Stained tanks Sticky floors Frequency of passing alerts or action levels www.foamtecintlwcc.com Auditing Cleaning Practices Contact Times How are you meeting disinfectant label contact time requirements? What are the contact times as specified by your SOP? Are your practices consistent with your SOP? Are contact times being logged? www.foamtecintlwcc.com Auditing Cleaning Practices Residues How are you removing disinfectant residues from equipment? How are you improving your current practices to remove more residue? Are your cleanroom surfaces as clean as the coupons used to validate your disinfectants? www.foamtecintlwcc.com Typical Compliance Issues SOP Issue Contact Times not being met or spraying required to meet contact times Improved SOP’s CoverMAX/PharmaMOP offer disinfection and cleaning in one step High disinfectant residues Very frequent sporicide rotations www.foamtecintlwcc.com MiraWIPE and Microfiber mops Better cleaning and contact times may reduce the need to rotate in sporicides Summary Having a robust decontamination SOP is critical Improved disinfectant contact times are a major benefit High residue levels are typical and difficult to handle One step cleaning and disinfection is a significant improvement over current practices www.foamtecintlwcc.com