Vendor Viewpoint: The Gold Standard of Disinfection

Vendor Viewpoint is a platform for our advertising partners to expound upon future directions in technologies, vehicles, accessories, educational offerings, and other products EMS providers rely on to perform their jobs. EMS World’s editorial staff does not endorse or promote any products or companies discussed in this column.

Today, in the face of a continuing pandemic where pathogens are odorless, colorless, and pose hidden danger, EMS scenes, squads, stations, and staff are all elements that can jeopardize safety. EMS responders must treat sick patients in close proximity and high-touch environments. Discerning accurate information about secondary-exposure threats is challenging. Providers must know the facts about pathogen control and have access to effective tools to mitigate their spread.

Chemical Cleaners and Disinfectants

As emergency services evolved, so did standards for cleaning and preparing equipment for the next call. Quats (quaternary ammonium compounds) and chlorine products were commonly used for cleaning blood, mucus, and other bodily fluids. Although chemical products still have a place in our cleaning protocols, we need to consider their adverse effects on equipment and staff. Chemical cleaners have extended dwell times (wet contact time requirements) to disinfect effectively. Crews should know “cleaning” is not the same as disinfecting. Cleaning merely removes the visible organic matter, whereas disinfection actually disables pathogens.

Sprays, wipes, foggers, and mechanical delivery systems all have benefits and drawbacks. For example, accelerated hydrogen peroxide (AHP) solutions have significant benefits. AHP has a quick dwell time and is very stable, safe for staff, and extremely effective on common pathogens. However, even with quality chemicals, manual cleaning is only 50% effective on high-touch surfaces, with 34%–36% of surfaces being missed completely.^1,2 There are a multitude of factors related to why chemicals alone are not enough to properly disinfect and why secondary systems, such as ultraviolet-C (UV-C), are required to safely and effectively mitigate pathogen transfer.

UV-C

Since well before COVID-19, UV-C radiation has been a go-to solution for disinfection, including as an effective treatment in water and HVAC systems. Today mobile UV-C systems that address surface disinfection are a required adjunct to manual cleaning efforts in many emergency services. The pandemic rapidly created a greater need for UV-C, and with the availability of governmental financial assistance, there’s been a surge of unproven devices available. Buyer beware—not all UV-C systems are created equal.

UV-C’s germicidal effectiveness at 254 nm is what many UV-C imposters lean on to convince you their devices disinfect surfaces. The truth is lots of factors go into proper UV-C exposure that destroys pathogens. Third-party antimicrobial efficacy testing and white papers are musts with any UV-C equipment considered for purchase. Don’t just rely on generic data in support of UV-C against pathogens—not all devices work the same.

The “line of sight and distance” physics around UV-C make many of the vertical-geometry, exposed-bulb systems limited in their ability to properly disinfect high-touch horizontal surfaces. Vertical-only systems require significantly longer exposure times. As a result other surfaces in proximity can be overexposed and subject to degradation. Plus, these systems require frequent cleaning to remove dirt and dust that prohibits UV-C from leaving the bulb, reducing effectiveness.

Low-wattage systems (commonly 35 watts) with standard bulbs have a difficult time emitting high-fluence UV-C in the germicidal realm that can reach any surface at a reasonable distance from the bulb. Horizontal surfaces (the most touched) are barely exposed to an effective dose as vertical-bulb systems are seriously challenged to disinfect in any reasonable time—a problem for emergency responders. Fixed or retrofitted systems are expensive, unproven, and limited to single vehicles. Alternatively, portable systems can be used in multiple vehicles and around headquarters, and some can reposition the light both horizontally and vertically to get the dose close and minimize shadows.

The takeaway for hard-surface disinfection: Ensure UV-C equipment is certified, portable, and multipositional to get the best value and optimal effectiveness.

Following the guidance of the Centers for Disease Control and Prevention (CDC), the only way to effectively reduce pathogen exposure risk is by establishing a multistep process.³ Disinfection is not a substitute for cleaning, and cleaning alone is not disinfecting. These 3 steps represent the gold standard to improve EMS safety and efficacy:

• Cleaning (quats, chlorine, peracetic acid);
• Disinfectants (accelerated hydrogen peroxide);
• Augmented disinfection (certified UV-C system).

Conclusion

Emergency responders will always face risk. To help mitigate it, it’s important that technology be implemented into cleaning and disinfection protocols. Knowing what to ask can have a significant impact on purchasing decisions and product satisfaction. 

References

1. Havill NL. Best practices in disinfection of noncritical surfaces in the health care setting: creating a bundle for success. Am J Infect Control. 2013; 41(5 Suppl): S26–30. doi: 10.1016/j.ajic.2012.10.028

2. Weber DJ, Anderson D, Rutala WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis. 2013; 26(4): 338–44. doi: 10.1097/QCO.0b013e3283630f04

3. Anderson DJ, Knelson LP, Moehring RW, et al; CDC Prevention Epicenters Program. Implementation Lessons Learned From the Benefits of Enhanced Terminal Room (BETR) Disinfection Study: Process and Perceptions of Enhanced Disinfection with Ultraviolet Disinfection Devices. Infect Control Hosp Epidemiol. 2018; 39(2): 157–63. doi: 10.1017/ice.2017.268

Thomas Spape, MBA, is a strategic specialist with Daylight Medical in Middleburg Heights, Ohio. He is a retired fire/EMS chief officer from the greater Cleveland area with more than 30 years of experience in the emergency services.