Basic Hygiene Surface Disinfection

Surface hygiene – Protection for patients and staff

Every contact is also an exchange: not only do we catch germs from objects and other people, we also leave them behind ourselves as well. During mundane everyday activities such as using telephones, keyboards or door handles, germs are spread through direct contact with the surfaces. In veterinary practices, unwanted pathogens are often found on floors, work surfaces, sinks, fittings, medical devices, and other surfaces. As such, the prevention potential of professional surface hygiene is high.

The pathway to the patient is short. For this reason, hygienically flawless surface disinfection and cleaning at the veterinary practice and veterinary clinic serves both cleanliness and infection prevention – to protect both patients and staff. 
B. Braun is your competent partner when it comes to minimizing infection risks: both with effective products suitable for everyday use and with its knowledge and consultancy services.

Whether in veterinary clinics, practices, or other veterinary institutions: most of the existing surfaces are constantly in contact with people, patients, and materials. In contrast to human medical facilities, veterinary practices and clinics often experience an increased soiling of surfaces (especially operating tables and floors) and thus an increased risk of contamination/infection for staff and patients. On the one hand, you’ve got visible contamination by blood or secretions, while on the other, you’ve got germs and pathogens that aren’t visible to the naked eye. Professional hygiene management in veterinary medicine therefore naturally also includes almost all areas of a room, and it analyses and determines in which areas cleaning and disinfection is required.

Wipe disinfection for large surfaces

Surface disinfection and cleaning

The aim of surface disinfection is always to reduce the bacterial count and to kill pathogenic and opportunistic pathogenic microorganisms.  

In general, a distinction is made between:

1. Routine or prophylactic disinfection (on surfaces that can be assumed to be contaminated with pathogens without being recognizably contaminated in individual cases)
2. Targeted disinfection (e.g., in the event of visible contamination or the occurrence of special pathogens)
3. Surface disinfection for officially ordered disinfection measures (according to AHL, the EU Animal Health Law and Section 18 of the Infection Protection Act)
    

Division into risk areas

The RKI recommends a division into different risk areas. The intensity and frequency of cleaning and disinfection measures are based on the given risk area. The criteria are:

a) The likelihood of direct contact
b) Possible contamination with pathogens
c) The degree of clinically relevant immunosuppression of the patients

This results in the following classifications:

• Areas with no risk of infection, e.g., corridors and stairwells
• Areas with a possible risk of infection, e.g., treatment rooms, general wards
• Areas with a particular risk of infection, e.g., surgical departments, operating rooms
• Areas with patients who carry pathogens in or on themselves in such a way that there is a risk of further spread in individual cases, e.g., isolation areas
• Areas where there is a particular risk of infection for personnel, e.g., microbiological laboratories, waste disposal (areas)
  

   
Veterinary medicine differs from human medicine in that patients are on the floor and there is also a risk of contamination here.

Patient surroundings and risk areas

The Association of Scientific Medical Societies (AWMF) recommends the following in its hygiene requirements for household cleaning and surface disinfection:

“Patient-facing surfaces with frequent skin/hand contact by patients and staff, as well as surfaces far away from patients with frequent opportunities for contact, should always be cleaned with disinfectant. This applies regardless of whether there is visible contamination or not.” 

Personnel protection

In order to ensure effective protection of the cleaning personnel, the following rules should be observed:

• Cleaning personnel must be properly trained and instructed
• Durable, disinfectant-resistant gloves with an extended sleeve must be worn
• Sufficient ventilation must be ensured when disinfectants are used over a large area
• Respiratory protection may need to be worn under certain circumstances (e.g., if disinfection is ordered by the authorities)

Procedure

Patient surroundings and risk areas (e.g., ICUs and ORs) should be disinfected with a contact time (also known as dwell time) of at least one hour. This also applies to areas that are visibly contaminated. The disinfectant is distributed over the surface with light pressure so that everything is sufficiently wet and moist. 

If there is massive contamination with organic material (blood, secretions, etc.), proceed as follows

• Before disinfection, the visible material should be wiped with a pre-soaked disinfectant wipe or a disposable tissue made of cellulose or similar that has been pre-soaked in disinfectant
• After use, the cloth is immediately disposed of and the surface is disinfected as usual

Fresh preparation of working solutions

Disinfectant solutions should normally be prepared freshly if they are not already available ready for use. The standards listed in the Association for Applied Hygiene e. V. (VAH list) and in the DVG list (disinfectants for use in veterinary practices and clinics and animal shelters) regarding the given concentration-time relationships must be strictly adhered to. Residual and and leftover working solutions must not be left open for a longer period of time. The maximum keep duration is one working day.

Precise dosing

Precise dosing is an absolute prerequisite for effective disinfection. Dosing aids should be used to measure concentrates or type-tested disinfectant dosing units should be used to avoid under- or overdosing.

Only use freshly prepared wipes

Only fresh wiping utensils (cloths, mops, etc.) may be used to remove disinfectant from the containers – protective gloves must be worn during handling. 

Cleaning utensils must be disinfected, prepared and dried after use. The possibility of bacterial growth on the cleaning utensils must be ruled out. If this is not possible, disposable wipes must be used.

The reference change procedure

When performing surface wipe disinfection, it is recommended to change the wiping cloth before each immersion in the disinfectant solution. The only way to prevent the spread of microorganisms is to use a fresh wiping cloth each time.

The so-called “single bucket method” – that is, the repeated immersion of a cloth or wiping utensil – must be avoided.

Rules for the reuse of disinfected areas

According to the RKI Hygiene Requirements for Cleaning and Disinfecting Surfaces recommendation, the disinfected surfaces can be used again as soon as they are visibly dry after routine disinfection measures.

In the following measures, the specified contact or dwell time must be waited out for before the area can be reused:

• All disinfection measures in the event of an epidemic and in the event of an officially ordered disinfection.
• Disinfection of contact surfaces close to the patient if there is a possibility that microorganisms might come directly from the surface, e.g., from wounds into the patient’s body (for example, open wounds in trauma patients).
• All disinfection measures in the area of feed preparation (e.g., animal ward) if it is necessary to rinse with drinking water after disinfection. This is the case for all food contact surfaces.
     

Rapid disinfection for small areas

Rapid disinfectants are particularly recommended in rooms that are often frequented by patients. There are a few rules that must be observed when using alcohol-based rapid disinfectants:

• Alcohol-based rapid disinfectants generally tolerate only a small amount of protein and soap contamination. The surfaces to be disinfected must therefore be largely free of organic contamination and must not be visibly contaminated.
• Visible contamination must be removed with a disposable cloth soaked in disinfectant before the actual disinfection begins.
• Safety rules for the application of alcohol-based solutions must be observed.
• The surface to be disinfected must be kept moist with disinfectant for the course of the given contact or dwell time.
• Do not wipe dry!
• Do not use on damp or wet surfaces!
• Electrical devices must be de-energized beforehand!
• Contact/exposure times must be adhered to.
     

Spray disinfection

As a result of nebulization of the disinfectant during spray disinfection, the active ingredients can enter the respiratory tract. This can lead to damage to the respiratory tract. Therefore, this type of disinfection should only be used in exceptional cases and in compliance with the recommended protective measures.

Recommendations and tips

Some of the most important recommendations on hygiene requirements for cleaning and disinfecting surfaces can be found on the Robert Koch Institute (RKI) website, the Association of Scientific Medical Associations (AWMF) website, and in the Industrial Association for Hygiene and Surface Protection (IHO) brochure.

Compatibility

The critical area

When using instrument and surface disinfectants, it is often underestimated in daily practice how important the selection of disinfectant agents is. Although the different suitability for certain materials and a different spectrum of action are decisive, the compatibility of the active ingredients of the products used in combination is equally important in order to prevent undesirable reactions.

Incompatibility of aldehyde- and amine-containing disinfectants

Use of aldehyde- and amine-containing disinfectants together is particularly critical. These two groups of active ingredients react with each other and lead to an irreversible brownish discoloration. This is especially important when disinfectants are changed. It is recommended to stay with a group of active ingredients or to ensure that all residues are safely rinsed off before using the new product.

Incompatibilities when using surface and instrument disinfectants

The problem of incompatibilities between two groups of active ingredients when using surface and instrument disinfectants based on different active ingredients is less well known. Discoloration can also occur here, e.g., if work surfaces have been disinfected with a surface disinfectant containing aldehyde and droplets of the amine-containing instrument disinfectant solution reach these surfaces when preparing instruments.

B. Braun compatibility list

When considering the use of B. Braun disinfectants, the compatibility list is an important tool. Find out at a glance, which products can be safely used in combination in your daily work and which preparations are not compatible with each other.