APIC Guideline for Selection and Use of Disinfectants

31 Pages·02.64 MB·English

AJIC
314 APIC Guideline
August 1996
this guideline, entitled “Guideline for Handwash- BACTERIALSPORES
ing and Hospital Environmental Control, 1985,” Bacillus subtilis
was published in .November 1985.2 This latter 4
guideline did not recommend chemical germi- MYCOBACTERIA
cides that were formulated for use on medical
Mycobacterium tuberculosis
equipment or environmental surfaces in health
a
care facilities. Rather, the revised CDC guideline
NONLIPID OR SMALLVIRUSES
focused on strategies for disinfection and steril-
ization of medical (equipment used in the health polio virus
care setting. 4
The purpose of this revised Association for FUNGI
Professionals in Infection Control and Epidemi-
Trichophyton spp.
ology, Inc. (APIC) Guideline, which is an updated
version of previous publications,3-6 is to assist
VEGETATIVE BACTERIA
health care professi~onals in their decisions involv-
ing the judicious selection and proper use of Pseudomonas aeruginosa
specific disinfectants. In the preparation of this Staphylococcus aureus
guideline, articles in the scientific literature were JJ
used to augment the manufacturers’ label claims
LIPID OR MEDIUM-SIZED VIRUSES
because these claims were not consistently verifi-
herpes simplex virus
ables7 Disinfectant failures noted at variance to
hepatitis B virus
label claims may be caused by deficiencies in
testing methods7 or by improperly conducted human im munodeficiency vir us
tests8 In addition, in-use testing has not been
incorporated into all Environmental Protection Fig. 1. Descending order of resistance to germicidal
Agency (EPA) methods (e.g., Association of Offi- chemicals. This hierarchy considers broad classifications of
cial Analytical Chemists [AOAC] tuberculocidal microbial categories. It is considered a rough guide to
activity test), and fa:ilures have been demonstrated general susceptibility of microorganisms to disinfectants.
when some disinfectants are subjected to condi- Adapted from Favero MS, Bond WV Chemical disinfection
tions, such as dilution, age, and presence of of medical and surgical materials. In: Block SS, ed.
organic matter, that challenge their antimicrobial Disinfection, sterilization and preservation. 4th ed. Philadel-
activity.g It should also be recognized that EPA phia: Lea & Febiger, 1991:621.
registration claims are based on microbicidal
efficacy data submitted by manufacturers. The many or all pathogenic microorganisms, with the
EPA does not independently test disinfectants exception of bacterial spores, from inanimate
before their registration, but in 1990 the EPA objects. In health care settings, this is generally
resumed postregistration testing of chemical ster- accomplished by the use of liquid chemicals or wet
ilants to ensure that they satisfy their registered pasteurization. The efficacy of disinfection is
label claims. affected by a number of factors, each of which may
nullify or limit the efficacy of the process. Some of
the factors that have been shown to affect disin-
DEFINITIONS fection efficacy are the previous cleaning of the
For the purpose of this guideline, the following object, the organic load on the object, the type
definitions will be used: (Fig. 1) and level of microbial contamination, the
Sterilization is the complete elimination or concentration of and exposure time to the germi-
destruction of all forms of microbial life. It is cide, the physical configuration of the object (e.g.,
accomplished by either physical or chemical crevices, hinges, lumens), and the temperature
processes. Steam under pressure, dry heat, low and pH of the disinfection process. More extensive
temperature sterilization processes (ethylene ox- consideration of these and other factors that affect
ide [ETO] gas, plasma sterilization) and liquid both disinfection and sterilization may be found in
chemicals are the principal sterilizing agents several references. 3, 6t lo-l3 Chemical disinfectants
used. The term sterilization is intended to convey can be classified by several schemes. This guide-
an absolute meaning, not a relative one. line uses the terminology used by the CDC’s
Disinfection describes a process that eliminates “Guideline for Handwashing and Hospital Envi-