Arxada introduces a new technology development in hospital disinfection, with Quanticare™ disinfectant wipes and liquid: fast-acting sporicidal daily disinfectants. Along with a fast, 4-minute sporicidal claim against Clostridium difficile, Quanticare™ disinfectant wipes and liquid provide industry-leading 15-second disinfection against bacteria and viruses, and a 1-minute claim against Candida auris, an emerging pathogen across healthcare facilities. Quanticare™ has rapid disinfection, enabling ease of use for daily cleaning. Quanticare™ has been rigorously tested for material compatibility, with improvements on most surfaces, including stainless steel, as compared to commonly used products, including bleach-based, quat-alcohol-based, and other hydrogen peroxide-based wipe products.
Introduction
Healthcare acquired infections (HAIs) represent a significant health and safety concern for patients admitted to healthcare facilities.[1] HAIs lead to increased morbidity and mortality rates of patients, resulting in a significant financial burden on healthcare systems. For example, it is estimated that the direct annual cost of treating HAIs in the United States alone is greater than $30 billion.[2] Such HAIs are not anomalies but represent a significant challenge that infection preventionists and environmental service staff face each day. In fact, the Centers for Disease Control (CDC) estimates that 1 in 31 hospital patients and 1 in 43 long term health residents has an HAI on any given day.[3]
Beyond the associated healthcare cost, there are significant human health implications from HAIs. More than 1 in 17 patients with HAIs dies due to these infections.[4] Hence, effective disinfection is crucial in healthcare settings in order to prevent the spread of infections and ensure patient safety.
Three key factors that significantly impact the effectiveness and utility of a disinfectant include: 1) disinfection speed of kill, 2) disinfectant wipe mileage and minimizing excess dwell time, and 3) material compatibility. Innovating to optimize these factors can lead to improved disinfectants and enhance prevention protocols to help reduce HAIs.
This critical need led to Arxada’s development of Quanticare™, seeking to achieve the fastest disinfection possible, while improving compatibility with materials in equipment to allow simplification in healthcare settings, ease of use for disinfection procedures, and powerful, broad spectrum of kill. With Quanticare™, finally, there is a sporicidal disinfectant product that can be used everywhere across the facility for everyday cleaning. This innovation can fundamentally enhance cleaning and disinfection programs for reducing the risk of HAIs.
Speed of kill
The speed of kill, or contact time, of a disinfectant refers to the time it takes for a disinfectant to effectively kill pathogens. A fast speed of kill is essential in healthcare environments where high-touch surfaces are frequently contaminated. Rapid disinfection reduces the window of opportunity for pathogens to spread, thereby lowering the risk of HAIs. For instance, a disinfectant with a quick kill time can be particularly beneficial in busy areas such as emergency rooms and intensive care units, where surfaces are constantly being touched and contaminated.[5],[6]
Quanticare™ provides fast speed of kill across all levels of disinfection, including sporicidal, fungicidal, and tuberculocidal performance, and the fastest bactericidal and virus speed of kill versus comparable products in those disinfection spaces (Table 1). Short contact times allow for reductions in the overall disinfection and cleaning times, potentially improving labor productivity via faster turnover in high-traffic and busy environments.
Table 1. Disinfection speed of kill of Quanticare™ vs critical pathogens and comparable market products
Surface coverage and dwell time
Surface coverage, also known as mileage, is the amount of surface area that a single disinfectant wipe can effectively cover. Maximizing wipe mileage ensures that more surfaces can be disinfected with fewer wipes, making the disinfection process more efficient and cost-effective. High-quality wipes that maintain their efficacy over larger areas help ensure thorough disinfection without the need for frequent replacements. This is particularly important in large healthcare facilities where extensive surface areas need to be disinfected regularly.
Quanticare™ disinfectant wipes have been formulated to provide excellent mileage per wipe to allow for efficient, rapid disinfection (Figure 1). Rapid disinfection helps to provide up to twice the mileage, enabling an improved experience for environmental services and infection prevention staff when following disinfection protocols
Figure 1. Quanticare™ wipes provide up to 2x the amount of surface coverage per similar wipe size than other products
Dwell time is the period a disinfectant must remain wet on a surface to achieve effective disinfection. Minimizing excess dwell time, which is the time beyond the required disinfection period, is crucial for both maintaining operational efficiency, allowing for efficient area turnover, as well as minimizing damage due to material incompatibility. Excess dwell time can delay the availability of critical equipment and surfaces, impacting patient care. By using disinfectants with optimal dwell times, healthcare facilities can ensure that surfaces are disinfected quickly and are ready for use sooner, thereby improving workflow and reducing the risk of contamination.
As shown in Table 2 below, Quanticare™ disinfectant wipes are effective in matching dwell times with disinfection needs, exemplified by the sporicidal disinfection speed of kill, whereas other market products exhibit excess dwell times up to 2 – 4 times longer than their sporicidal disinfection times. This potentially results in delayed area turnover after disinfection and cleaning due to residual wetness.
Table 2. % area remaining wet from a wipe after time t following application
Material compatibility
Since surface disinfection is a key aspect of effective infection prevention, material compatibility of the disinfectant is critical when using in healthcare settings. Some disinfectants can cause surface damage to various materials, leading to cracks, pits, or fissures in the material. These damaged surfaces can be sources of pathogens, harboring microbes and making it difficult to disinfect effectively, and increasing the risk of pathogen transmission.[7] Further, incompatible disinfectants can lead to premature failure of medical equipment, resulting in increased costs for repairs and replacements.
The chemical resistance of a material will impact its compatibility with disinfectants, although some harsh chemicals can negatively impact even more resistant materials. For example, while stainless steels are more corrosion resistant alloys than carbon steel, some oxidizer disinfectant chemistries can be quite harsh and even corrosive to stainless steels. Aluminum surfaces can pose an even greater risk, particularly to more acidic or more basic solutions. A key innovation with the Quanticare™ technology has been reducing this corrosivity without sacrificing the performance properties. Figure 2 shows how the Quanticare™ liquid exhibits a corrosion rate less than 0.1 millinches per year (mpy), whereas other commercial products are much more corrosive to aluminum, with far higher compatibility targets of less than 1 mpy.
Figure 2. Quanticare™ liquid corrosivity towards aluminum surfaces is far below that of existing market products
Plastic and polymer surfaces are also equally important. Often, equipment and device manufacturers will choose the materials primarily based upon a combination of physical properties desired, such as strength, flexibility, or thermal resistance, commercial availability, and cost (Figure 3). A further consideration needs to be given to the impact of disinfectants on the materials. However, this may not always be feasible when considering the other aspects the polymers must deliver to the equipment or device. Thus, disinfectant formulations used for routine disinfection and cleaning may cause damage to such surfaces.
Figure 3. Relative chemical resistance of polymers
Environmental stress cracking refers to the premature cracking and embrittlement failure of polymers due to contact with environmental factors, such as disinfectant solutions and stress. In instances where materials fail, the formulation additives found in disinfectants cause structural changes in the material, resulting in damage. Quanticare™ wipes and liquid have been innovatively formulated to reduce the issues and damage risks associated with less chemically resistant plastics. In materials testing under constant tension over time, the application of Quanticare™ wipes showed improved compatibility versus other market products on multiple types of plastics, with either no signs or reduced damage (Table 3).
Table 3. Comparison of plastic compatibility of Quanticare™ wipes versus other market products after 14 days of exposure and constant tension
Conclusion
The need for continued improvement in the prevention of HAIs has led to the development of the Quanticare™ product line. The versatility in speed of kill for multiple levels of disinfection, enhanced mileage, and improved material compatibility allows the possibility for one product to provide each level of disinfection, differentiated only by the time needed for disinfection, across multiple areas in a healthcare facility. By achieving the fastest disinfection yet on the market Quanticare™ disinfectant wipes and liquid have the potential to reduce disinfection product complexity, simplify both training and implementation of disinfection protocols, and allow faster turnover of rooms and areas. This unique combination of product simplification, faster speed and broader spectrum of kill enables use of a high level, sporicidal disinfectant for both critical areas and everyday cleaning, provides economies of scale and fundamentally enhanced cleaning and disinfection programs for reducing the risk of HAIs.
Experimental
Disinfection testing was performed according to standard EPA test methods: AOAC Method 961.02, ASTM E1053, AOAC 965.12, OECD Quantitative Method for Testing Antimicrobial products against spores of Clostridium difficile and for evaluating efficacy against Candida auris. The impact of formulation on materials was evaluated both via visual observations, as well as quantitative methods for resistance to cracking and corrosion rates. Cracking resistance was performed according to a modified ASTM D1693 and ISO 22088 bent strip method, comparing both wipe soaking and immersion soaking of the material in the disinfectant solutions. Corrosion testing was performed using a Gamry Reference 600 potentiostat for electrochemical corrosion studies.
Abbreviations
HAIs, healthcare-acquired infections; CDC, Centers for Disease Control; mpy – millinches per year
References
[1] Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. “Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis” Lancet 2011, 377(9761), 228 – 241.
[2] Stone PW. “Economic burden of healthcare-associated infections: an American perspective. Expert review of pharmacoeconomics & outcomes research.” 2009, 9(5), 417 – 422.
[3] HAI and Antimicrobial Use Prevalence Surveys | HAIs | CDC
[4] Klevens RM, Edwards JR, Richards CL. “Estimating health care associated infections and deaths in U.S. hospitals, 2002.” Public Health Rep 2007, 122(2), 160–166.
[5] Factors Affecting the Efficacy of Disinfection and Sterilization | Infection Control | CDC
[6] Assadian O, Harbath S, Vos M, Knobloch JK, Asensio A, Widmer AF “Practical Recommendations for Routine Cleaning and Disinfection Procedures in Heatlhcare Institutions: a Narrative Review” J Hosp Infect 2021, 113(3), 104–114.
[7] “Surface disinfection incompatibility with medical devices creates potential patient risks: a case study”, online publication by Healthcare Surfaces Institute and the Associationof Healthcare Value Analysis Professionals (AHVAP).
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