Multiple Disinfectants Lessons Chance of Resistance
Background
There is a growing concern with the noscomial infection rates within hospitals. Nosocomial infections occur in a health care setting, and the patient did not have it prior to arriving to the health care facility. Nosocomial infections are a major source of morbidity and mortality, affecting more than two million patients annually in the United States.” (2) Not only are nosocomial infections a burden on the patient, but they can also financially hurt the hospital as stated in a Clinical Microbiology Review, “The extra days, extra charges, and deaths attributed to nosocomial infections vary by infections site, but together, the adverse consequences of nosocomial infections and their associated costs are substantial.” (2) This increases the risk to which hospitals should be concerned about the cleaning techniques that are used along with the disinfectants. To reduce the risk of the bacteria becoming resistant to a disinfectant, hospitals should implement alternating types of disinfectants. Similar to tests done on antibiotic resistance, by combining two antibiotics, or in this case disinfectants, the probability of bacteria being resistant to both is far lower than them becoming resistant to one. (5, 89) While the new procedure would not combine the two disinfectants, the use of both would kill any bacteria that survived the first disinfectant. The most common disinfectant used by health care facilities is a ten percent bleach and water solution. (3) A new disinfectant out on the market is Difficil-S. This disinfectant, “does not give off toxic gases, nor cause long-term corrosion to surfaces. It is one of the most powerful broad spectrum disinfectants ever developed.” (1)
Policy
As head of Mercy hospital, we would like to propose that an alternative disinfectant be used every other week, in addition to all other standard cleaning policies. The first week we will use a ten percent bleach and water solution to disinfect all minimal risk items. A minimal risk item is any item not in direct contact with the patient, but is still part of the environment. (4) The following week the disinfectants will be switched from the bleach solution to Difficil- S. This system will be used continuously from now on with all disinfectant cleaning procedures. To enforce this policy, the unit manager in each department must sign off on watching the correct solution be made for that week. The person making the solution must also sign off on which disinfectant they will be using before each cleaning. If there is failure to adhere to any of these new policies, the first offense will result in a one week suspension without pay. After a second offense, the employee will be terminated. This new policy should not alter the budget dramatically, due to the new product being low in cost. (1) If however, there is a serious issue with the cost of the new disinfectant, the procedure can be altered to using it one week a month to counteract the difference if there should be one. The principle of the procedure would still be intact because the new disinfectant would still lessen the survival rate of the bacteria.
Conclusion
It may be argued that switching disinfectants is a waste of time when bleach is known to be highly effective in killing bacteria. The truth of the matter is bacteria are still fully capable of becoming resistant to bleach. (5) Therefore using a second disinfectant is a fairly efficient way of reducing this risk. Along with this point, in the same amount of time it takes to make a bleach solution each week, the same time is used to make the alternative disinfectant. It may also be argued that the addition of Difficil-S will cause an increase in funding. This is not a worry because Difficil-S is simply replacing bleach, it is not a fund on top of bleach. As stated before, if there is a serious funding problem, the procedure can be altered slightly to help with the difference. Implementing this policy will not show dramatic changes, but will help reduce the risk of bacteria becoming resistant to the common, every-day, disinfectant. By helping to reduce the risk of infections in hospital stays, this in turn will help doctors to not have to prescribe more antibiotics for infected patients. With all these components combined, this will help to reduce the never-ending battle of antibiotic resistance.
Bibliography
1.) British Journal of Heathcare Management (2009). Products News and Services. 15(7): 358-61
2.) Emorie, Grace T., Gaynes, Robert P. (1993) An Overview of Nosocomial Infections, Including the Role of Microbiology Laboratory.
3.) Hensley DM. Clinical Laboratory Science. (2008). Evaluation of disinfectants on military NATO and DECON litters. 21(2): 102-6
4.) Parker LJ. British Journal of Nursing. (1999). Managing and maintain a safe environment in the hospital setting. 8(16): 1053-4, 1056, 1058.
5.) Saylers, Abigail A., Whitt, Dixie D. (2005). Revenge of the Microbes. ASM Press.
