Choosing a Disinfectant from a Crowded Field

It's time to clear out stock rooms, standardize products and select a new disinfectant.

By J. Darrel Hicks, Contributing Writer


We should not stay with the tried-and-true disinfectant in today’s world of multi-drug resistant organisms (MDROs). The Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission recently updated recommendations for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. 

Infections caused by MRSA have increased by 41 percent during the COVID-19 pandemic. MRSA causes roughly 10 percent of healthcare-associated infections (HAI) in the United States, according to SHEA. These infections are associated with an increased risk of death. 

Alternate disinfectants used from 2020 to 2022 can have potential impacts on the health and safety of staff, patients and building occupants. It’s time to simplify, standardize and educate all staff who use disinfectants on environmental surfaces and patient care equipment. It also is time to clear out stock rooms and closets and standardize with sporicidal solutions. I recommend these criteria for selecting a new disinfectant: 

First, select appropriate cleaning and disinfection technologies and products. 

Then, convene all stakeholders, including the facility cleaning and disinfection program, environmental services management, infection prevention and control, materials management, and other relevant healthcare personnel in the decision-making process for factors such as: 

  • compatibility with device manufacturer’s instructions for use 
  • contact time 
  • possible health risks 
  • acceptability to staff and patients 
  • effectiveness in decontaminating a surface 
  • impact on overall cleaning efficiency 
  • required expertise and training 
  • kill and prevent rebound of dry surface biofilm 
  • deleterious effect on surfaces or devices due to repeated exposure to a product. 

There are over 10,000 disinfectants registered with the U.S. Environmental Protection Agency (EPA). You need to pick one. Of all these thousands of products, only three chemistries — hypochlorite, peracetic acid/hydrogen peroxide, and sodium di-chloro-iso-cyanurate — are effective against endospore forming bacteria, such as C. diff. 

Start by ensuring the disinfectant addresses the organisms of concern — e.g., C difficile, MRSA, Candida auris, biofilm, norovirus, etc. If it is not listed on the master label, the disinfectant is ineffective against that particular pathogen. 

Next, look at dwell time, determining the length of time the surface must stay wet to kill the specific pathogen. Make sure the dwell time is achievable. Next, review the directions for applying the disinfectant. 

A handful of large manufacturers produce these three basic chemistries, which then are private labeled by scores of companies. Search the EPA registration number on the product’s label to view the master label. 

As of this writing, there are only three EPA-registered products with kill claims for bacteria in biofilm. Ideally, you will select a disinfectant that eliminates all dangerous pathogens and those found in biofilm. 

Sodium Dichloroisocyanurate (NaDCC) is a phenomenon because of it has the unique ability to be more powerful at destroying bacteria, C. auris and viruses, yet it is much safer than those mentioned previously. I am aware of a few NaDCC products that have both biofilm and C. auris claims while having a 0/0/0 hazard rating, a neutral pH, and the EPA’s lowest toxicity category IV. 

J. Darrel Hicks, BA, MESRE, CHESP, Certificate of Mastery in Infection Prevention, is the past president of the Healthcare Surfaces Institute. Hicks is nationally recognized as a subject matter expert in infection prevention and control as it relates to cleaning. He is the owner and principal of Safe, Clean and Disinfected. His enterprise specializes in B2B consulting, webinar presentations, seminars and facility consulting services related to cleaning and disinfection. He can be reached at darrel@darrelhicks.com, or learn more at www.darrelhicks.com. 



September 11, 2023


Topic Area: Infection Control


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