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Preventing Transmission of Bloodborne Pathogens via Environmental Surfaces

Compared to HIV and HCV, the titer of HBV in blood and other body fluids is extremely high, which is why it is the most efficiently transmitted. Of the three bloodborne pathogens, only HBV has been implicated in transmission of the disease indirectly from environmental surfaces to patients by staff members. The incident was reported at a dialysis center. The possibility that transmission occurred by this route has resulted in the implementation of specific infection control strategies which include testing patients for HBsAg and dialyzing positive patients in separate areas on dedicated machines.^a,b Dialysis centers that practice these strategies have been shown to have significantly lower HBV infection rates among patients.^c

Compared to HBV, both HIV and the hepatitis C virus (HCV) are not present in the blood of infected humans in extremely high concentrations. For this reason, transmission via environment surfaces is thought to be unlikely with HIV and HCV. HBV, however remains viable up to 7 days in dried blood and is relatively stable on environmental surfaces. HIV and HCV are much less stable.

Sources

a. CDC: Control measures for hepatitis B in dialysis centers. In Viral hepatitis Investigation and Control Series. Atlanta, Center for Disease Control, November 1977.

b. Favero MS, Alter MJ, Bland LA: Dialysis-associated infections. In Bennett JV, Brachmann PS, Sanford JP (eds). Hospital Infections. Boston. Little, Brown & Co. 1992, pp 375-403.

c. Alter MJ, Favero MS, Maynard JE: Impact of infection control strategies on the incidence of dialysis-associated hepatitis in the United States. J Infect Dis 153:1149-1151, 1986.

Disinfection of Surfaces

The choice of which sterilization or disinfection procedure or which specific chemical germicide should be used for sterilization, disinfection, antisepsis, or environmental sanitization depends on a number of factors. No single chemical germicide is adequate for all purposes. Products intended for use on specific medical devices are regulated by the FDA. The EPA regulates chemical germicides formulated as sanitizers, disinfectants, hospital disinfectants, or sterilant/disinfectants (sporicides) intended for use on environmental or housekeeping surfaces.

High-level disinfectants, by Spaulding's definition, are sterilants. Used with the correct concentration and contact time, they kill all microorganisms, including a high number of bacterial spores.

Intermediate-level disinfection is recommended for use on blood and other potentially infectious materials. Intermediate-level chemical germicides usually correspond to EPA-approved "hospital disinfectants" that are also "tuberculocidal." These include many phenolics, iodophors and chlorine compounds. Intermediate-level disinfection is appropriate for between-patient processing of certain noncritical instruments or devices or for environmental surfaces, particularly after significant spills of blood in any area or spills of microbial cultures in the laboratory.

Although not officially registered, a solution of 5.25% sodium hypochlorite (Clorox or other household bleach) diluted between 1:10 and 1:100 with water can be used for intermediate-level disinfection. The standard recommendation is to use at least a quarter cup of bleach per one gallon of water. Bleach, however, is corrosive to metals (especially aluminum) and should not be used to routinely decontaminate medical instruments with metallic parts. Lysol or some other EPA-registered tuberculocidal disinfectant is also appropriate. The label of disinfectants must be checked to ensure that they meet this requirement.

Low-level disinfectants kill vegetative bacteria except M. tuberculosis, some fungi, and some viruses. These disinfectants, called "hospital disinfectants" or "sanitizers", are appropriate for between-patient processing of certain noncritical instruments or devices or for routine cleaning and housekeeping. Manufacturer's label information should be closely examined and followed for EPA recommended use.

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