A quick search of this website using the term “cleaning” revealed several articles discussing healthcare-associated infections, a big problem in all types of facilities, including senior care locations. And although the information provided along with ways to help prevent HAIs is excellent, one topic related to HAIs appears to be absent. That is the issue known as quat binding.
Quat binding refers to an efficacy problem that can develop when using disinfectants. When it occurs, the disinfectant being used to clean surfaces may not be producing the germ- and bacteria-killing effectiveness necessary to prevent the spread of diseases, or in this case, prevent HAIs. But more about these serious issues later.
First we need to address the use of disinfectants in general. This is not only good, practical information that can help protect the health of those living, working, or using senior care locations; it is cost-saving information as well.
Disinfectants can be expensive. Unlike other types of cleaning solutions, such as an all-purpose cleaner or even a window cleaner, disinfectants are very complicated chemicals that often took considerable time and resources to develop. They must be tested and evaluated and then registered with the EPA. (The U.S. Environmental Protection Agency registers antimicrobial products that can be used against common pathogens found in all types of facilities. Registration means that the product has been tested and evaluated; the efficacy claims of the product are valid, and if used per instructions, it should be effective at killing the pathogens listed on the product’s label.) Those costs all must be recouped when the products are marketed.
Because of their costs, and of course because we are working to protect human health, one of the things executive directors and administrators must ensure that their cleaning professionals (whether in-house or contracted) are aware of is that in most cases, disinfecting is a two-step process. The following example may clarify what we are saying.
Let’s say a desktop has been used by several people. Because studies tell us that desktops can harbor as much as 400 times more bacteria than a toilet seat, to ensure any germs and bacteria on that desktop are not passed from one person to another, the surface must be cleaned first and then disinfected (based on studies conducted and reported by Charles Gerba, Ph.D., of the University of Arizona).
Cleaning first with an all-purpose cleaner or similar product removes soils. Following this by using a disinfectant kills up to 100% of any germs and bacteria on the surface.
There are two more things to remember about disinfectants. Not all disinfectants are designed to kill the same pathogens. The label will provide “kill claim” information as to what types of pathogens the disinfectant is designed to eliminate. If this is not known, then a janitorial distributor may suggest a “broad-range” disinfectant to address the disinfecting needs of a senior care location.
Next, administrators and cleaning professionals should know that once a disinfectant has been applied to a surface, it must dwell on the surface for a few minutes. The amount of time can vary from five to 10 minutes, but it is very important. This dwell time is necessary for the disinfectant to kill designated pathogens effectively.
Quat binding is a bit complicated — just the term sounds complicated — but I will make it as easy as possible to understand.
“Quats” refers to quaternary ammonium chloride, the active ingredient in most disinfectants. Quat binding occurs when the quats are absorbed into the wipes, cleaning cloths or mop heads used for cleaning.
And that’s not the only thing happening. Quats have positively charged ions, and cleaning cloths typically have negatively charged ions. This means the killing power of quats not only is being absorbed but pulled into the cleaning cloth.
In one test, a cleaning cloth was soaked in a disinfectant solution for about 10 minutes. Quat levels, which were measured before and after the test, found that the quat level had been cut in half after just 10 minutes. When this happens, not only has the disinfecting power of the disinfectant been reduced, the product will likely not be able to meet the “kill claims” listed on the product’s label.
Dealing with the quat binding challenge
If you have never heard of quat binding, join the club. Even some hospital directors are admitting that the phenomenon is new to them. Fortunately, we are learning that there are at least three ways to slow if not prevent quat binding, and they should be used together as part of a system:
- Use higher concentrations of disinfectant than are called for, especially if several surfaces and fixtures are to be cleaned.
- If using cleaning cloths and spray bottles, do not spray the disinfectant on the cleaning cloth. Instead, spray the disinfectant directly on the surface to be cleaned, allow adequate dwell time for the product as mentioned earlier, then wipe.
- Change wipes (or other cleaning applicators) frequently. Assume that some amount of quat binding is beginning as soon as the disinfectant is applied.
Because of the cost issues related to the use of disinfectants, if a cleaning contractor has been hired to maintain your community, check to see whether he or she is a member of a group purchasing organization. These organizations negotiate agreements with manufacturers for their members to purchase cleaning products at reduced rates.
Although the contractor may be able to help lessen some of the costs associated with disinfectants, ultimately what is most important is that everyone works together to ensure that your community is clean and healthy for all that work or live there or visit.
Tobi Colbert is business development manager for the National Service Alliance, a group purchasing organization for the professional cleaning and related service industries.
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