By Rick Mullen, Maintenance Sales News Associate Editor
David Bass, training & safety compliance manager, Crothall Healthcare, Environmental Services Department at Duke University Hospital, called the issue of sanitation versus disinfection “the great debate,” during his virtual presentation titled “Sanitation vs. Disinfection.” It was part of the recent ISSA Show North America Virtual Experience.
“The topic of sanitation versus disinfection is not a political issue,” Bass said. “It is, however, a subject worth discussing and thinking about.
“According to dictionary.com, to sanitize is to free from dirt, germs, etc., as by cleaning or sterilizing. To disinfect is to cleanse of infection or to destroy disease in rooms, wounds clothing, etc.
“We are certainly living in a very global setting. Time has demonstrated that populations are increasing and becoming more mobile. As a result, we have significant humanitarian needs that are being generated, specifically related to infections and their effects.
“Diseases and related infections can have a global impact. Tie that with the fact the populations are becoming more mobile, we can see why we are now dealing with epidemics that are, or have the potential to become, pandemics. Epidemics are regional in nature and pandemics are global in nature.”
AN HISTORICAL OVERVIEW
Bass gave the audience viewing his presentation an historical overview of epidemics and pandemics that have plagued mankind since prehistoric times. (Source: livescience.com)
Indeed, Bass said, what archaeologists and scientists call a prehistoric epidemic of unknown origin dates to 3000 B.C.
“Archaeological evidence indicates the population was concerned to the point of endeavoring to destroy anything that potentially caused the epidemic, including burning effected areas,” Bass said.
Some 2,000-plus years later, in 430 B.C., there was the “Plague of Athens,” which was likely related to typhoid fever, Bass said.
“As we move on through history to 531 A.D., the ‘Plague of Justinian,’ which was determined to be bubonic, affected basically the Roman Empire,” Bass said.
From 1346 to 1353, the bubonic plague, known as the “Black Death,” ravaged Europe and Asia.
“In more contemporary times, and oriented to North America, there was the Philadelphia Yellow Fever outbreak of 1793,” Bass said. “Then, about a 123 years later, the American polio outbreak of 1916, and just two years later, the Spanish Flu of 1918.”
According to historical records, the 1957 Asian flu pandemic was first reported in Singapore in February 1957, Hong Kong in April 1957, and in coastal cities in the United States in the summer of 1957. The estimated number of deaths was 1.1 million worldwide, including 116,000 in the United States.
“In the 2000s, we saw the effects of the swine flu epidemic, in 2009, and, in 2014, the West African Ebola virus outbreak,” Bass said. “What we are dealing with now is SARS-CoV-2 pandemic, also known as COVID-19. It began as a regional epidemic, and because of the global aspects of our worldwide society, it turned into a pandemic.
“COVID has forced us to think and talk about whether to sanitize or disinfect. So, the question of the day comes down to how do we combat pathogen enemies?”
CHEMICAL PRODUCTS USED
TO COMBAT DISEASE OUTBREAKS
The primary means historically used to sanitize and disinfect in the battle against epidemics and pandemics has been chemical products, Bass said. Bass also offered an historical perspective on the various types of chemicals used in the war against diseases. (Source: virox.com)
“Phenols came about in the 1800s,” Bass said. “We saw the development of chlorides in the 1920s, and alcohol in the 1950s. Aldehydes were developed in the 1960s and the 1970s saw the development of quats.
“Then, there was a bit of a lull in the development of any significant category of new disinfecting products. During that period of time — the 1980s and 1990s — there were increased incidents of ‘super germs,’ including MRSA (methicillin-resistant Staphylococcus aureus), VRE (vancomycin-resistant Enterococci) and CRE (Carbapenem-resistant Enterobacteriaceae).”
Moving into the 2000s, the development of ultraviolet light disinfection technology came into play, Bass said.
“While not chemical in nature, UVD processes are resources we have utilized. UVD goes back to 1903, and even before that (circa 1890s), when Niels Ryberg Finsen was credited with determining that UV energy could kill the tuberculosis bacterium,” Bass said. “Over time, we have experienced increased operability and decreased costs in employing that type of protocol in the disinfection fight. Last, but not least, we have the development of different peroxide disinfectants.”
Bass outlined some of the risks and hazards associated with the various categories of disinfectants:
■ Phenols are strong and harsh to surfaces as well as human tissue.
■ Chlorides are strong products. Prolonged use can be damaging to surfaces and human tissue.
■ Alcohol is effective against many, but not all pathogens. It is fast-acting but tends to be short-lived. Evaporation is a concern and areas must be sanitized before using alcohol.
■ Aldehydes are typically used in laboratory settings. Over time, Aldehydes develop some antibiotic microbial resistance. Occupational and personal health risks are also associated with aldehydes.
“One aldehyde product of note was used in hand hygiene and was related to hormonal issues. Consequently, that product was banned by the U.S. federal government in 2000,” Bass said.
■ Quats are not as harsh to surfaces or bio-tissue, but also are not as long-lasting. They require longer dwell times. Some issues have been raised about suspected negative environmental effects.
■ Peroxides are moderate in strength and efficacy and are less risk to bio-tissue. There have been some concerns and complaints in regard to scent.
“Accelerated hydrogen peroxide as well as vaporized hydrogen peroxide have recently come into use,” Bass said.
DECIDING BEST COURSE OF ACTION
“Step one is to examine your operation,” Bass said. “What type of facility do you have? Is it commercial? Is it health care related? Is it research related?
“Then, we need to look at the size and scope of the area we have. How much product will be needed to address the area? What are our customers’ expectations? What will be the end result? Is it simply to clean an area (sanitize), or is it to ensure the area is free from infectious pathogens (disinfect)?
“We also have to look at staffing. In particular, we want to know how many people are on a cleaning staff. Are they sufficiently trained to safely work with the types of products we have.
“Furthermore, there is the issue of budget. How much can I spend on products to gain the outcome we wish to achieve? Is the budget based on a corporate decision of our own organization, or is it based on a client’s contractual decision?”
Step two is product selection.
“We must look at what are the best results we can obtain with the various types of products we have available,” Bass said. “Hand-in-hand with that is determining what products do the least harm. We have to protect employees who are utilizing the chemicals.
“Then, there is the effectiveness and the efficacy of the products. Are they doing what we want them to do? What are the dwell times associated with the products we are using? Is what we are doing in concert with our client’s expectations and the environment the public will be utilizing?
“There are also sustainability considerations in product selection. Again, we are living in a time when climate aspects and issues are always in the news. Green and sustainable products that do the least harm to the environment come into play as we look at the types of products that help us accomplish what we intend to do.”
Step three is integrated approaches.
“Am I simply cleaning (sanitizing) or am I ensuring that a place, an area, a space is disinfected, as well,” Bass said.
Equipment selection is also important. Will hand-operated, electronic, or portable equipment be the best to do the job?
“Will we be utilizing items for misting or for UV disinfection?” Bass said. “It is very important that we use our resources. We need to know our facilities, spaces and surfaces. We need to know our product options.
“If working under a contract, we also need to know the wording of the contract, what budget constraints are in place and customers’ expectations.
“In addition, we need to continue to enhance and increase our knowledge to be able to properly educate customers as to the best approach, the best products, the best equipment, etc., for sanitizing and/or disinfecting.
“Finally, it is most important to know your staff — to know their capabilities and limitations. We must ensure employees are properly outfitted to achieve sanitizing and/or disinfecting goals.
“Remember, practice standard precautions. Practice hand hygiene at every opportunity. Use the proper PPE and follow isolation precautions as they pertain to the areas and environments in which we find ourselves.”
In addition to being the Training and Safety Compliance Manager for Crothall Healthcare at Duke University Hospital, Bass serves as the Family Medical Leave coordinator for the Environmental Services Department. He earned a Bachelor of Science degree in Industrial Relations and a Master of Public Administration degree from California State University, San Bernardino. He holds the certification as an Environmental Services Executive through IEHA/ISSA. He is a retired United States Marine Corps officer.