Mitch: Greetings Pat! Hope things are well. From your perspective what is the current state of Healthcare and Environmental Services?
Pat: Disinfection in healthcare continues to grow as an area of focus. Specifically, the prevention of Clostridium Difficile (C. diff) remains a hot topic for healthcare decision makers. The industry is also experiencing a trend for hospitals or hospital groups to assemble value analysis teams (or “VAT’s”) which comprise representatives from many disciplines such as Environmental Services, Infection Prevention, Supply Chain and Material Management, Safety and Transportation. These groups meet regularly to discuss relevant topics and make decisions about products, processes, and more. Chemistry, safety, efficacy, contact time, versatility, compatibility, GPO compliance, and cost are all factors that must be taken into consideration when making decisions regarding C. diff. Manufacturers and distributors provide valuable roles through the education of these variables to lead the decision makers towards the most optimal decision for their facilities, patients, and employees.
Mitch: What options do acute or long-term healthcare facilities have for C. diff disinfection?
Pat: There are three main chemistries when it comes to C. diff disinfection options in today’s market: Sodium Hypochlorite (Bleach), Hydrogen Peroxide/Peracetic Acid, and Sodium Dichloroisocyanurate (NaDCC). There are numerous manufacturers that provide C. diff disinfection options utilizing these chemistries. Each products’ technical data sheet, US EPA approved label, and safety data sheet (SDS) are valuable pieces of information when it comes to reviewing the product and deciding which option is best suited for the facility. For example, each product has both a concentrated and ready to use (RTU) shelf life that can be found in the technical literature for that specific product (such as the Tech Data Sheet or SDS). Customers should always consider the concentrate and RTU shelf life to avoid expiration of product or any associated costs for expired chemical disposal. It is very important for facilities to clearly understand how to properly dispose of cleaning chemicals and disinfectant products used in their facilities. Specific disposal requirements vary based on local county, state, or federal regulations. Improper disposal of regulated chemicals can result in significant fines and other consequences in addition to causing harm to the environment.
Mitch: How about safety? Any concerns there?
Pat: When it comes to safety, certain C. diff disinfectants strongly recommend personal protection equipment (PPE), occupational exposure limits, and engineering controls, which can be found in section 8 of the respective SDS. The safety requirements and protocols clearly explain the required employee training, chemical storage, and chemical handling within the facility. Each hospital group or facility should also ask their local manufacturer or distributor about the training programs that are available for all levels of environmental services (managers, supervisors, housekeepers, etc.) to ensure proper usage and processes are in place through training.
Another aspect of safety pertains to storage of the concentrate and RTU C. diff disinfectant. Healthcare facilities should ensure storage requirements are adhered to and products are housed and used safely. HMIS (Hazardous Materials Identification System) and NFPA (National Fire Protection Agency) hazard rating systems and placards are efficient resources to quickly determine the potential hazards associated with chemical products. These regulatory tools help to provide ranking for human health, flammability, PPE, reactivity, and physical hazards. These are universal codes in the United States that are well accepted and known within the industry and can be used as quick and helpful aids when reviewing, selecting, and handling potentially hazardous chemical products.
Mitch: When you talk about bleach and other chemicals, there is a general understanding as to what those products can and cannot do. Are there any compatibility issues our shared customers should be aware of?
Pat: The disinfectants’ versatility and compatibility play strong roles in the decision-making process as well. Driven by budgets and other factors, healthcare facilities want to streamline purchases and use fewer products to achieve a wider variety of goals. C. diff disinfectants typically carry a versatile list of “kill” claims. Facilities are beginning to use C. diff disinfectants for most disinfectant needs. These decisions can be made at the hospital group, hospital, or hospital department level. Aside from pathogen efficacy versatility, surface compatibility is important. Healthcare decision makers and VATs should perform a preliminary surface compatibility risk assessment prior to purchasing a C. diff disinfectant. The usage of the various C. diff disinfectant chemistries can cause undesirable surface damage to furniture, varied hard non-porous surface substrates, and fabrics or textiles which could require high replacement costs Additionally, the decision makers or VAT’s should request compatibility testing for hard and soft surface claims from the prospective C. diff disinfectant manufacturers. They should also consult manufacturers of the common healthcare devices and furniture such as carts, patient beds, mattresses, etc.
As for floor disinfection, there is a growing trend around floor disinfection within healthcare facilities. A recent study by Donskey et al. demonstrated that a nonpathogenic virus inoculated onto floors in hospital rooms disseminated rapidly to the footwear and hands of patients and to high-touch surfaces in the room. Additionally, a study by Deshpande et al. found that floors in patient rooms were often contaminated with Methicillin-resistant Staphylococcus aureus (MRSA), VRE, and C. difficile, with C. difficile being the most frequently recovered pathogen found in both CDI isolation rooms and non-CDI rooms. Hospitals and hospital groups should facilitate risk assessments to identify when floors should or should not be disinfected, thus the pH of the prospective C. diff disinfectant should be highly considered. RTU C. diff disinfectants can range from pH levels of 3 to 12. Chemicals with pH levels closer to neutral (7) tend to provide less floor finish and protector damage over time. Chemicals with pH levels farther away from neutral tend to damage floor finishes and protectors. Damaged floor coatings can result in unsightly floors, creating improved breeding grounds for pathogens, higher replacement costs, and undesirable downtime in the affected areas.
Mitch: Pat, what are your comments regarding pricing?
Pat: Last but certainly not least, these factors all funnel into the total cost of ownership of the C. diff disinfectant. The case costs should always be analyzed as a function of the RTU gallon or quart prices for pricing parity. Additionally, there are GPO compliant manufacturers that offer C. diff disinfectants. The hospital group or facility should take into consideration the GPO contracts when making the purchasing decisions.
Mitch: Thank you Pat for your insight and we look forward to your presentation on C. diff at the SMA Healthrite Expo coming up in Arizona. Any final thoughts?
Pat: As the healthcare market continues to be a source of growth for manufacturers and distributors, we can collectively help our shared customers achieve their disinfection needs. 3M has the ability to educate the market regarding all variables that require close consideration when reviewing, selecting, and handling C. diff disinfectants or any other products. We are able to help strengthen our collective value proposition for our customers and bridge the gap from being just another sales person to becoming a valued supplier!
 Evaluation of Hospital Floors as a Potential Source of Pathogen Dissemination Using a Nonpathogenic Virus as a Surrogate Marker. Infection Control & Hospital Epidemiology, 37(11), 1374-1377. doi:10.1017/ice.2016.181
 Abhishek Deshpande; Jennifer L. Cadnum; Dennis Fertelli; Brett Sitzlar; Priyaleela Thota; Thriveen Sankar C.; Annette Jencso; Heba Alhmidi; Sreelatha Koganti; and Curtis J. Donskey appears in the American Journal of Infection Control, Volume 45, Issue 3 (March 2017).
Patrick Kehoe is the Cleaning Chemicals Marketer for 3M’s Commercial Solution Division. He has held a variety of roles in the JanSan industry; managing both the Dallas/Fort Worth territory and then the Chicago territory as a 3M Sales Rep, followed with being the Sales Trainer for 3M. Aside from his product marketing responsibilities, Patrick works with the SMA Marketing team on various shared initiatives. Additionally, Patrick recently completed his MBA at the University of Minnesota- Carlson School of Management, and residues in St. Paul, MN with his wife and two children.
Mitch Rosenfield , Director of Healthcare for Strategic Market Alliance (SMA), has 37 years of experience in the Sanitary Supply and Wholesale Distribution Industry. He is responsible for managing all SMA Healthcare initiatives, including GPO (Group Purchasing Organization) partnerships, and is a recognized industry expert in products, practices, and regulatory requirements specific to healthcare and facility wellness. He began his career as a Territory Manager for Johnson Wax Professional for 5 years, followed by 28 years with Brady Industries, attaining the dual role of Corporate Healthcare Specialist and Corporate Trainer. In 2014 he became an ISSA Certification Expert for CIMS and CIMS-GB. In 2016, Mr. Rosenfield earned a Certificate of Mastery in Infection Prevention from the Association for the Healthcare Environment (AHE), a division of the American Hospital Association.