The fire station is a hazardous place to live and work. News reports often have stories of firefighters dying from illnesses contracted on the job and last year the Centers for Disease Control reported that deaths from MRSA now exceed those caused by the human immunodeficiency virus in the United States.
The International Association of Fire Fighters has stated that it considers MRSA to be a serious threat to emergency healthcare responders.
Here’s an overview of the types of products you’ll need to clean and disinfect your facilities and equipment to reduce the level of risk to your people and their families from the bugs that are out there.
Fire and EMS organizations should use products approved by the Environmental Protection Agency and the Food and Drug Administration unless no such products are available for use against certain microorganisms or sites.
Keep in mind that there is no one product that does it all. For example, no antimicrobial products are registered for use specifically against certain emerging pathogens (like Norwalk virus), potential terrorism agents (like variola major or Yersinia pestis) or Creutzfeldt-Jakob disease agents.
The agencies
The CDC is not a regulatory agency and does not test, evaluate, or otherwise recommend specific brand-name products of chemical germicides. Instead, their publications focus on provide overall guidance for providers to select general classifications of products based on certain infection-control principles.
EPA and FDA classify disinfectants in slightly different ways. While FDA has adopted the same basic terminology and classification scheme as CDC to categorize medical devices — like critical, semi-critical, and non-critical — FDA classifies disinfectant agents by their antimicrobial potency for processing surfaces, like sterilization, along with high-, intermediate- and low-level disinfection.
EPA, on the other hand, registers environmental surface disinfectants based on the manufacturer’s microbiological activity claims when registering its disinfectant. This difference has confused users because EPA does not use the terms intermediate- and low-level disinfectants as used in CDC guidelines. Fire and EMS agencies should look for and use EPA registered disinfectants.
EPA’s list of registered antimicrobial products are effective against certain blood-borne and body-fluid pathogens, mycobacteria tuberculosis (tubercle bacteria), human HIV-1 virus, hepatitis B, hepatitis C viruses. The use of EPA-registered products effective against human blood borne pathogens listed are in compliance with OSHA’s Occupational Exposure to blood borne Pathogens (29 CFR 1910).
EPA registered products are effective against Methicillin Resistant Staphylococcus aureus (MRSA), Vancomycin Resistant Enterococcus faecalis or faecium (VRE), human Norovirus (Norwalk like virus), as well as products used for medical waste. The lists are organized alphabetically by product names and by numerical order of their EPA registration numbers.
On the label
The information about listed products is current based upon the dates on the lists. If you would like to review the product label information for any of these products, go to the EPA’s product label system. Inclusion on this list does not constitute an endorsement by EPA.
The CDC designates any EPA-registered hospital disinfectant without a tuberculocidal claim (effective against the bacteria that causes tuberculosis) as a low-level disinfectant and any EPA-registered hospital disinfectant with a tuberculocidal claim as an intermediate-level disinfectant.
Substantiated label claims of effectiveness of a disinfectant against specific microorganisms other than the test microorganisms are permitted, but not required, provided that the test microorganisms are likely to be present in or on the recommended use areas and surfaces.
Disinfectant manufacturers might also test specifically against organisms of known concern in health-care practices — HIV, HBV, hepatitis C virus [HCV], and herpes, although it is considered likely that any product satisfying AOAC tests for hospital disinfectant designation will also be effective against these relatively fragile organisms when the product is used as directed by the manufacturer.
The benchmark
Potency against Mycobacterium tuberculosis has been recognized as a substantial benchmark. Keep in mind, however, that tuberculosis is not transmitted via environmental surfaces, but rather by the airborne route. So the use of such products on environmental surfaces plays no role in preventing the spread of tuberculosis.
However, because mycobacteria, like the TB bacteria, are the top dog in the hierarchy of germs, any germicide with a tuberculocidal claim on the label is considered capable of inactivating a broad spectrum of pathogens. It is this broad-spectrum capability — against less-resistant organisms as blood-borne pathogens like the hepatitis virus (B and C) and HIV — rather than the product’s ability to knock out the TB bacteria, that is the basis for protocols and regulations dictating use of tuberculocidal chemicals for most surface disinfection.
The choice of specific cleaning or disinfecting agents is largely a matter of judgment, guided by product label claims and instructions and government regulations. A single liquid chemical germicide might not satisfy all disinfection requirements in a given facility.
The right solution
Realistic use of liquid chemical germicides depends on consideration of multiple factors, including the degree of microbial killing required; the nature and composition of the surface, item, or device to be treated; and the cost, safety, and ease of use of the available agents. Selecting one appropriate product with a higher degree of potency to cover all situations might be more convenient.
The website, Infection Control Source, operated by Kestrel Health Information, Inc., is a very good resource for finding practically anything you need to meet your disinfecting needs. One feature allows you to select several different products and see a side-by-side comparison.
The following is a summary of the three levels of disinfection along with examples of the pathogens that they are effective against. After each category are some examples of commercially available disinfectant agents.
1. FDA sterilant/high-level disinfection (CDC sterilant/high-level disinfection) kills bacterial spores. Example products: Revital-Ox Resert XL HLD, Cidex OPA, Metrex Compliance High Level Disinfectant/Sterilant, Sporox, and Sterilox Liquid.
2. FDA hospital disinfectant with tuberculocidal claim (CDC intermediate-level disinfectant) kills mycobacterium, nonlipid or small viruses and fungi. Example Products: EnviroSystems EcoTru, Bleach-sodium Hypochlorite 5.25 percent (bleach concentrate); Thymol, Weiman Germicidal Solution, and ProSpray.
3. FDA Hospital Disinfectant (CDC low-level disinfectant) kills vegatetive bacteria, and lipid or medium-sized viruses. Example Products: Pure Green 24; Accelerated, Hydrogen Peroxide, and Clorox Broad Spectrum Quaternary Disinfectant Cleaner.
