International Webinar Series : Knowledge to Conquer COVID-19

Talk-3/3: Effective and Safe Surface Disinfection

Speaker:
Dr. Md. Iqbal Hossain, SMAIChE
Associate Professor, Department of Chemical Engineering, BUET
&
Advisor, BUET AIChE Student Chapter

Email: iqbalhossain@che.buet.ac.bd & iqbal1982m@gmail.com

Website: www.iqbalbuet.com

Organized by: BUET AIChE Student Chapter

COVID-19: Transmission Routes for Corona Virus
SARS-CoV-2 Transmission Routes:
Through: Mouth, Nose, and Eye(Possibly)
 Direct Droplets (Short-range)
: 5+ to 10 µm size
: Direct Respiratory Transmission
 Direct Aerosol (Short-Long range)
: 5µm and lower in size
: Direct Respiratory Transmission

 Direct Contact (Short-Long range)

: Hands

 Fomite (contaminated surface)

: Touching Contaminated Surface
: Indirect Contact
Which Surfaces?
Any inanimate object: of
Steel, Aluminium, Metal, Wood,
Paper, Glass, Plastic, PVC, Silicon
and Rubber, etc. 2
Importance of Fomite (Inanimate Surface) Route

COVID-19 is thought to spread mainly

through close contact from person-to-
person.

The virus may be spread in other ways:

It may be possible that a person can get
COVID-19 by touching a surface or
object that has the virus on it and then
touching their own mouth, nose, or
possibly their eyes.

This is not thought to be the main way

the virus spreads, but we are still
learning more about how this virus
spreads.

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Persistence of Corona virus on Inanimate Surface(1)

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Persistence of Corona virus on Inanimate Surface(2)
Surface Persistence
Steel 4 hrs to ≥ 28 days

Aluminium 2 – 8 hrs

Metal 5 days

Wood 4 days

Paper <5 mins to 5 days

Glass 4 – 5 days

Plastic 8 hrs to 9 days

PVC 5 days

Silicon Rubber 5 days

Surgical Glove ≤ 8 hrs

(Latex)
Disposable Gown 1 hr to 2 days

Ceramic 5 days

Teflon 5 days

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Important Terminologies
Antisepsis: chemical destruction of vegetative pathogens on living tissue

Degerming: mechanical removal of microbes from limited area

Sanitization: lowering microbial counts on eating and drinking utensils to safe level

Biocide or Germicide: kills microorganisms

Fungicide: kills fungi

Virocide: inactivates viruses

Bacteriostatic agent: stops growths of bacteria

Sepsis: bacterial contamination

Asepsis: Absence of significant contamination

Aseptic Technique: minimize contamination

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 Effective and Safe Surface Disinfection
What is Disinfection?

Disinfection is the killing of many (pathogenic microorganisms), but not all

microorganisms. It is a process of reduction of number of contaminating organisms to a
level that cannot cause infection, i.e. pathogens must be killed. Some organisms and
bacterial spores may survive.

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 Comparison between Sterilization and Disinfection
SL. Sterilization Disinfection

Total destruction of all Cleaning of surfaces using chemicals that

microorganisms (whether or not kill bacteria and other very small living
1 pathogenic) and their spores things that cause disease (pathogen only)

Uses robust methods such as high Uses moderately effective methods

2 heat or chemicals

Uses chemicals, heat, high pressure, Uses detergents, hydrogen peroxide,

filtration, and irradiation alcohols, bleach, halogen like chlorine,
3 phenolic disinfectants, heavy metals,
heating and pasteurization

4 It gives extreme cleanliness It gives adequate cleanliness

5 Destroys living organisms and their Destroys only the living organisms, not
resistant structures the spores

Used in the decontamination of Mostly used to decontaminate the

6 food, medicine, and surgical surfaces and air
instruments

Cleaning??
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 Methods of Disinfection
Chemical Disinfectants
Types of Chemical Disinfectant
•Alcohol
•Chlorine and chlorine compounds Two Broad Groups:
•Formaldehyde
•Glutaraldehyde  Oxidizing Disinfectants:
•Hydrogen peroxide Includes Halogens : Chlorine,
•Iodophors Iodine, Bromine, and Chlorine
•Ortho-phthalaldehyde (OPA) Dixoxide
•Peracetic acid
•Peracetic acid and hydrogen peroxide and oxygen-releasing materials
•Phenolics such as peracetic acid and
•Quaternary ammonium compounds hydrogen peroxide.

Miscellaneous Inactivating Agents  Nonoxidizing Disinfectants:

•Other germicides Includes quaternary
•Metals as microbicides ammonium compounds,
•Ultraviolet radiation amphoterics, biguanides and
•Pasteurization acid anionics
•Flushing- and washer-disinfectors
more specific “Mode of Action”
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 ‘Mode of Action’ of Chemical Disinfectants
Chemical Disinfectant Mode of Action
Alcohol The most feasible explanation for the antimicrobial action of alcohol is
denaturation of proteins.

Chlorine and Chlorine Compounds
The exact mechanism by which free chlorine destroys microorganisms has not
been elucidated. Inactivation by chlorine can result from a number of factors:
oxidation of sulfhydryl enzymes and amino acids; ring chlorination of amino acids;
loss of intracellular contents; decreased uptake of nutrients; inhibition of protein
synthesis; decreased oxygen uptake; oxidation of respiratory components;
decreased adenosine triphosphate production; breaks in DNA; and depressed
DNA synthesis. The actual microbicidal mechanism of chlorine might involve a
combination of these factors or the effect of chlorine on critical sites .

Formaldehyde Formaldehyde inactivates microorganisms by alkylating the amino and sulfhydral

groups of proteins and ring nitrogen atoms of purine bases.

Hydrogen Peroxide Hydrogen peroxide works by producing destructive hydroxyl free radicals that can
attack membrane lipids, DNA, and other essential cell components. Catalase,
produced by aerobic organisms and facultative anaerobes that possess
cytochrome systems, can protect cells from metabolically produced hydrogen
peroxide by degrading hydrogen peroxide to water and oxygen. This defense is
overwhelmed by the concentrations used for disinfection .
Peracetic Acid Little is known about the mechanism of action of peracetic acid, but it is believed
to function similarly to other oxidizing agents—that is, it denatures proteins,
disrupts the cell wall permeability, and oxidizes sulfhydryl and sulfur bonds in
proteins, enzymes, and other metabolites.
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Ref.: https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html
Inactivation Properties of Chemical Disinfectants

Fig: Descending Order of Resistance

to Disinfectants

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Three-Levels of Chemical Disinfection
 Kills most vegetative bacteria and some fungi as well as enveloped
(lipid) viruses. It does not kill mycobacteria and bacterial spores.
 Typically used for cleaning environmental surfaces
 EPA-registered without a tuberculocidal claim (i.e., hepatitis B
virus and HIV label claims).

 Kills vegetative bacteria, most virus and most fungi, but not
resistant bacterial spores.
 Registered with the Environmental Protection Agency (EPA)
and have a tuberculocidal claim

 Destroys vegetative bacteria, mycobacteria, fungi, and

enveloped (lipid) and nonenveloped (non-lipid) viruses, but not
necessarily bacterial spores.
 Used as chemical sterilants and should never be used on
environmental surfaces
 Surface must be thoroughly cleaned prior to this disinfection

 Destroys all (pathogenic and non-pathogenic) and gives

absolute cleaness

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Overview of Sterilization and Disinfections

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 Environmental Surfaces : WHO
Environmental surfaces (divided into clinical contact and household contact) are-
 In health-care settings:
 Furniture and other fixed items inside and outside of patient rooms and
bathrooms, such as tables, chairs, walls, light switches and computer peripherals,
electronic equipment, sinks, toilets
 The surfaces of non-critical medical equipment, such as blood pressure cuffs,
stethoscopes, wheelchairs and incubators.

 In non-healthcare settings:
 Sinks and toilets, electronics (touch screens and controls), furniture and other
fixed items, such as counter tops, stairway rails, floors and walls.
Notes:
 Environmental surfaces are more likely to be contaminated with the COVID-19 virus in
health-care settings where certain medical procedures are performed. Therefore, these
surfaces, especially where patients with COVID-19 are being cared for, must be properly
cleaned and disinfected to prevent further transmission.

 Similarly, this advice applies to alternative settings for isolation of persons with
COVID-19 experiencing uncomplicated and mild illness, including households and non-
traditional facilities.
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General Effect of Concentration and Contact Time

Fig. Effect of disinfectant concentration and contact time on mortality of typical microorganisms.
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COVID-19: Reference for Concentration and Contact (1)

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COVID-19: Reference for Concentration and Contact (2)

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Technique: “Spray-Wipe-Spray” or “Wipe-Discard-Wipe”
Both techniques refer to the two-step procedure used to clean and disinfect
environmental surfaces.

Spray-Wipe-Spray:
 If using liquid disinfectant, the user would spray the surface with the disinfectant and
wipe it using a disposable towel to clean the surface (“spray-wipe”), followed by another
“spray” to disinfect the surface.

Wipe-Discard-Wipe:
When using disposable disinfectant wipes, the process is described as wipe-discard-wipe
because the user uses one wipe to clean the surface, discards the wipe, and uses a second
wipe to disinfect the surface.

Disinfectant products should not be used as cleaners unless the label indicates the
product is suitable for such use. The Centers for Disease Control and Prevention
recommends following manufacturer recommendations for use (e.g., amount, dilution,
contact time, safe use, disposal).

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CDC: Factors Affecting the Effectiveness of Disinfection
The activity of germicides against microorganisms depends on a number of factors, some
of which are intrinsic qualities of the organism, others of which are the chemical and
external physical environment.

2. Innate Resistance of
1. Number and Location
Microorganisms
of Microorganisms

3. Concentration and
7. Biofilms Disinfection Potency of Disinfectants

4. Physical and Chemical

6. Duration of Exposure Factors
5. Organic and Inorganic
Matter

Ref.: https://www.cdc.gov/infectioncontrol/guidelines/disinfection/efficacy.html 19
Safety: Evaluation of Hazardous Chemicals

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Safety: Hazardous Characteristics of Disinfectants

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Safety: Quantitative Safety Measures of Disinfectants
Disinfectant NIOSH REL Current OSHA PEL Original (SCP) IDLH
Chlorine dioxide 0.1 ppm (0.3 mg/m3) TWA 0.1 ppm (0.3 mg/m3) TWA 10 ppm
0.3 ppm (0.9 mg/m3) STEL

Chlorine 0.5 ppm (1.45 mglm3) 1 ppm (3 mglm3) CEILING 30 ppm

15-minute CEILING

Formaldehyde 0.016 ppm TWA, 0.75 ppm TWA, 2 ppm STEL 30 ppm
0.1 ppm 15-minute CEILING

Hydrogen peroxide 1 ppm (1.4 mglm3) TWA 1 ppm (1.4 mglm3) TWA 75 ppm

Isopropyl alcohol 400 ppm (980 mglm3) TWA 400 ppm (980 mglm3) TWA 12000 ppm
500 ppm (1,225 mglm3) STEL

REL: Recommended Exposure Limit; PEL: Permissible Exposure Limit ;

IDLH: immediately dangerous to life or health concentration value ;
NIOSH: National Institute for Occupational Safety and Health ;
OSHA: Occupational Safety and Health Administration ;
STEL: Short-term exposure limit ; TWA: Time-weighted average; ppm: Parts per million

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CDC Instruction for Effective and Safe Use of Disinfectants

Always read and follow the directions on the label to ensure safe and effective use.

 Wear skin protection and consider eye protection for potential splash hazards

 Ensure adequate ventilation

 Use no more than the amount recommended on the label

 Use water at room temperature for dilution (unless stated otherwise on the label)

 Avoid mixing chemical products

 Label diluted cleaning solutions

 Store and use chemicals out of the reach of children and pets
You should never eat, drink, breathe or inject these products into your body or apply
directly to your skin as they can cause serious harm. Do not wipe or bathe pets with these
products or any other products that are not approved for animal use.
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EPA 6 Steps for Effective and Safe Use of Disinfectants

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 Rational Approach for Healthcare Facilities

A Rational Approach to Disinfection

Guideline for Disinfection in Healthcare Facilities (2008)
Critical Items:
Critical items confer a high risk for infection if they are contaminated with any microorganism. This category
includes surgical instruments, cardiac and urinary catheters, implants, and ultrasound probes used in sterile body
cavities. Liquid chemical sterilants reliably produce sterility only if cleaning precedes treatment and if proper
guidelines are followed regarding concentration, contact time, temperature, and pH.

Semicritical Items:
Semicritical items contact mucous membranes or nonintact skin. This category includes respiratory therapy and
anesthesia equipment, some endoscopes, laryngoscope blades, esophageal manometry probes, cystoscopes,
anorectal manometry catheters, and diaphragm fitting rings. Semicritical items minimally require high-level
disinfection using chemical disinfectants.

Noncritical Items:
Noncritical items are those that come in contact with intact skin but not mucous membranes. Intact skin acts as an
effective barrier to most microorganisms; therefore, the sterility of items coming in contact with intact skin is “not
critical.” Noncritical items are divided into noncritical patient care items and noncritical environmental surfaces.

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Guidance for Public Spaces, Workplaces, Business…….

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 Checklist for Comprehensive Disinfection
This checklist presents the factors which must be considered and documented in planning,
implementing and evaluating any disinfection procedure.

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 Points to Remember: Causes of Disinfection Failure

Possible causes of disinfection failure include the following:

 Over-dilution of disinfectant during pre-mixing or application

 Incomplete or inadequate cleaning

 Poor disinfectant penetration or coverage

 Insufficient contact time on surfaces

 Inadequate temperature and humidity while the material is being applied.

*****Failure can also result from inactivation or neutralization of the disinfectant, due
to the presence of residual cleaning liquids which were not adequately flushed away
before the disinfectant was applied.

*****A common mistake is to select a product which is ineffective against the

contaminating organisms present (or suspected).

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