Prevention of Infection: Selecting and Using Disinfectants

Disinfection Insights You Can Use Today

Part 2 of 3: Selecting and Using Disinfectants

According to a recent study reported by APIC, the significant presence of multidrug-resistant gram-negative bacteria (MDR-GNB), such as E. coli, among nursing home residents demonstrates the need for heightened infection control prevention and control measures in nursing homes. In the release, APIC President Linda Greene says, "This study underscores the importance of having strong infection prevention programs in all nursing homes and long-term care facilities."

A holistic industry-wide approach to infection prevention and control is paramount if healthcare-associated infections (HAIs) are to be eliminated. Bedrock measures are necessary to be effective.

Kelly M. Pyrek writes, "Education and training is the cornerstone of HAI prevention, and the WHO guideline recommends that IPC education should be in place for all healthcare workers by utilizing team- and task-based strategies that are participatory and include bedside and simulation training to reduce the risk of HAI and antimicrobial resistance."

The following brief by J. Darrel Hicks focuses on the selection and use of disinfectants.

Cleaning executives have trusted in the efficacy that an EPA registration implies for the disinfectants used by staff. But now users are being informed by the EPA Office of Inspector General — in the 2016 report — that, “Once the EPA tests a product and it passes, it is listed as Agency Confirmed Efficacy on the agency’s website and is typically not tested again; the long-term efficacy of the product cannot be assured.”

The IG also revealed that the EPA relies on manufacturers to voluntarily submit product samples for testing. And in the last three years, out of the approximately 300 registered disinfectant products yet to be tested, manufacturers submitted only 12 samples to the EPA for ATP efficacy evaluation.

However, this isn’t a new problem. In August 1990, the U.S. Government Accountability Office (GAO) released “Disinfectants: EPA Lacks Assurance They Work.” The report reads, “…historical enforcement and other data estimated that 20 percent of disinfectants on the market did not work as claimed, posing health risks to users.”

It was this report that launched the initial Antimicrobial Testing Report in 1991, and successes have been slow coming ever since. According to an IG report in 2010, “after nearly 19 years, over 40 percent of registered products have not been tested . . . [and] those that have been tested have experienced a consistently high failure rate.”

What does all this mean for environmental services managers today? Continue reading the full article here.

Selecting And Using Disinfectants. Reproduced and used with permission from CleanLinkFacility Cleaning Decisions. Copyright 2017 by CleanLink.

EMist is dedicated to infection prevention and control. The patented EM360™ Electrostatic Spray System coupled with the Health-E™ Certified Healthy Process make disinfecting better, easier and more cost effective. We help break the chain of infection. Visit our website for more information: EMist.com

Ensuring The Efficacy Of Disinfectants

Disinfection Insights You Can Use Today

Part 1 of 3: Ensuring The Efficacy Of Disinfectants

According to a recent Time Article, "The world is not ready for the next pandemic ... From Ebola in West Africa to Zika in South America to MERS in the Middle East, dangerous outbreaks are on the rise around the world. The number of new diseases per decade has increased nearly fourfold over the past 60 years, and since 1980, the number of outbreaks per year has more than tripled."

Waging war against deadly germs, a recent article from Facility Cleaning Decisions reported the following.

A recent announcement from the U.S. Environmental Protection Agency (EPA) might make the job of cleaning and disinfecting much more difficult for those in the business of providing clean and sanitary public spaces. Managers in the know may have already read the report, but not all realize how it relates to a hospital, medical facility, ambulatory, or long-term care center."

It is common knowledge that antimicrobial pesticides are designed to destroy or suppress harmful bacteria, viruses, and other microorganisms on inanimate objects and surfaces in healthcare settings.

Most managers also know that the EPA has a testing program — the Antimicrobial Testing Program (ATP) — which has a purpose to ensure that EPA-approved hospital disinfectants and tuberculocides in the marketplace continue to meet stringent efficacy standards. Products found to be effective are reported to the public on the EPA website, and those that do not meet the ATP efficacy standards need to be brought into compliance.

"But according to the Office of Inspector General for the EPA, there are flaws in the process of ensuring the efficacy of hospital-grade, hard-surface disinfectants. The findings were revealed in a report titled “EPA Needs A Risk-Based Strategy To Assure Continued Effectiveness Of Hospital-Level Disinfectants” on September 19, 2016.

The Inspector General (IG) report concluded that the EPA’s Antimicrobial Testing Program, “does not assure that hospital disinfectant products continue to be effective after they are registered,” and that some products listed as effective on the EPA’s website, “could now be ineffective” due to inconsistencies in the manufacturing, product degradation or improper quality assurance.

Read the full article here.

Ensuring The Efficacy of Disinfectants. Reproduced and used with permission from CleanLink - Facility Cleaning Decisions. Copyright 2017 by CleanLink.

E-Mist is dedicated to infection prevention and control. The patented EM360™ Electrostatic Spray System coupled with the SanoTech 360™ Certified Healthy Process make disinfecting better, easier and more cost effective. We help break the chain of infection. Visit our website for more information: Emist.com

Schools and Businesses Should Take Mold Remediation Seriously

Molds are part of the natural environment, and can be found everywhere, indoors and outdoors. Molds are various types of fungi (singular = fungus) that grow in filaments and reproduce by forming spores. The term mildew is sometimes used to refer to some kinds of mold, particularly mold in the home with a white or grayish color or mold growing in shower stalls and bathrooms. Mold may grow indoors or outdoors and thrives in damp, warm, and humid environments. Mold can be found in essentially any environment or season.

E-Mist's patented electrostatic technology can be used in the mold remediation process. The EM360 makes disinfecting better, easier and more cost effective.

You can also read the U.S. Environmental Protection Agency (EPA) guidelines, Mold Remediation in Schools and Commercial Buildings.

Mold can spread quickly through a property if left untreated. Concern about indoor exposure to mold has been increasing as the public becomes aware that exposure to mold can cause a variety of health effects and symptoms, including allergic reactions.

"Molds can be found almost anywhere; they can grow on virtually any organic substance, as long as moisture and oxygen are present. There are molds that can grow on wood, paper, carpet, foods, and insulation. When excessive moisture accumulates in buildings or on building materials, mold growth will often occur, particularly if the moisture problem remains undiscovered or unaddressed. It is impossible to eliminate all mold and mold spores in the indoor environment. However, mold growth can be controlled indoors by controlling moisture indoors.


Molds reproduce by making spores that usually cannot be seen without magnification. Mold spores waft through the indoor and outdoor air continually. When mold spores land on a damp spot indoors, they may begin growing and digesting whatever they are growing on in order to survive. Molds gradually destroy the things they grow on.


Many types of molds exist. All molds have the potential to cause health effects. Molds can produce allergens that can trigger allergic reactions or even asthma attacks in people allergic to mold. Others are known to produce potent toxins and/or irritants. Potential health concerns are an important reason to prevent mold growth and to remediate/clean up any existing indoor mold growth.


Since mold requires water to grow, it is important to prevent moisture problems in buildings. Moisture problems can have many causes, including uncontrolled humidity. Some moisture problems in buildings have been linked to changes in building construction practices during the 1970s, ’80s, and ’90s. Some of these changes have resulted in buildings that are tightly sealed, but may lack adequate ventilation, potentially leading to moisture buildup. Building materials, such as drywall, may not allow moisture to escape easily. Moisture problems may include roof leaks, landscaping or gutters that direct water into or under the building, and unvented combustion appliances. Delayed maintenance or insufficient maintenance are also associated with moisture problems in schools and large buildings. Moisture problems in portable classrooms and other temporary structures have frequently been associated with mold problems.”1

Mold Remediation/Cleanup and Biocides

According to the EPA, "The purpose of mold remediation is to remove the mold to prevent human exposure and damage to building materials and furnishings. It is necessary to clean up mold contamination, not just to kill the mold. Dead mold is still allergenic, and some dead molds are potentially toxic. The use of a biocide, such as chlorine bleach, is not recommended as a routine practice during mold remediation, although there may be instances where professional judgment may indicate its use (for example, when immune-compromised individuals are present). In most cases, it is not possible or desirable to sterilize an area; a background level of mold spores will remain in the air (roughly equivalent to or lower than the level in outside air). These spores will not grow if the moisture problem in the building has been resolved.

If you choose to use disinfectants or biocides, always ventilate the area. Outdoor air may need to be brought in with fans. When using fans, take care not to distribute mold spores throughout an unaffected area. Biocides are toxic to humans, as well as to mold. You should also use appropriate PPE and read and follow label precautions. Never mix chlorine bleach solution with cleaning solutions or detergents that contain ammonia; toxic fumes could be produced.

Some biocides are considered pesticides, and some states require that only registered pesticide applicators apply these products in schools. Make sure anyone applying a biocide is properly licensed, if necessary. Fungicides are commonly applied to outdoor plants, soil, and grains as a dust or spray—examples include hexachlorobenzene, organomercurials, pentachlorophenol, phthalimides, and dithiocarbamates. Do not use fungicides developed for use outdoors for mold remediation or for any other indoor situation.1

Antimicrobials are also used to maintain quality of life by mitigating microorganism growth that causes odors, visual contamination resulting from mold and mildew growth, and other microbiologically induced contamination.3

Types of antimicrobial pesticides Disinfectants and biocides can kill mold spores and take away their ability to reproduce. However, these products should not be used alone in addressing a mold-growth problem.

Antimicrobial pesticides are used to destroy or stop the growth of microorganisms such as bacteria, viruses, and fungi. They are designed to be used on inanimate objects only and can be found as sprays, liquids, concentrated powders, wipes, and gases (mostly for hospital use).

There are several different types of anti-microbial products and it is important to know their intended use. The US EPA has very specific definitions for each one:

  • Cleaner: A product that physically removes debris from the surface.
  • Sanitizer: A product that kills 99.9% of the germs identified on its label.
  • Disinfectant: A product that kills nearly 100% of the germs identified on its label. Destroys most pathogens but not bacterial spores.
  • Sterilizer: A product that destroys all microorganisms, including bacterial spores.

The Centers for Disease Control (CDC) further classifies disinfectants as high, intermediate, and low level disinfectants, which has to do with which particular microorganisms it inactivates and the concentration at which it is active.

The antimicrobial activity of the product is affected by the concentration of the active ingredients and the dwell time.

  • Dwell time: The amount of time that the product must remain on the surface for optimum antimicrobial activity. Typically included on the label.
  • Concentration of active ingredients: The concentration of an active ingredient varies from product to product, so read the label to determine if a product can be used as a disinfectant or only as a sanitizer. The percent of the active ingredient and the inert ingredients in a product may also change the hazards associated with a particular product.

The US EPA registers antimicrobial products and ensures that labels may not make claims about their effectiveness that are not supported by data. They have also compiled a list of registered products that are effective against specific pathogens, including tuberculosis bacteria, HIV-1 virus, and hepatitis C. For the lists of these products and others, see their website on Selected EPA-Registered Disinfectants.

Mold Remediation in Schools and Commercial Buildings

This document is widely used for mold remediation in schools and commercial buildings. Click here to access/download.

FAQ: Mold

The following FAQ by the CDC, provides information about mold.

What are molds? Molds are fungi that can be found both indoors and outdoors. No one knows how many species of fungi exist but estimates range from tens of thousands to perhaps three hundred thousand or more. Molds grow best in warm, damp, and humid conditions, and spread and reproduce by making spores. Mold spores can survive harsh environmental conditions, such as dry conditions, that do not support normal mold growth.

What are some of the common indoor molds?

  • Cladosporium
  • Penicillium
  • Alternaria
  • Aspergillus

How do molds affect people? Some people are sensitive to molds. For these people, exposure to molds can cause symptoms such as nasal stuffiness, eye irritation, wheezing, or skin irritation. Some people, such as those with serious allergies to molds, may have more severe reactions. Severe reactions may occur among workers exposed to large amounts of molds in occupational settings, such as farmers working around moldy hay. Severe reactions may include fever and shortness of breath. Some people with chronic lung illnesses, such as obstructive lung disease, may develop mold infections in their lungs.

In 2004 the Institute of Medicine (IOM) found there was sufficient evidence to link indoor exposure to mold with upper respiratory tract symptoms, cough, and wheeze in otherwise healthy people; with asthma symptoms in people with asthma; and with hypersensitivity pneumonitis in individuals susceptible to that immune-mediated condition. The IOM also found limited or suggestive evidence linking indoor mold exposure and respiratory illness in otherwise healthy children. In 2009, the World Health Organization issued additional guidance, the WHO Guidelines for Indoor Air Quality: Dampness and Mould [Click Here To Download PDF - 2.52 MB]. Other recent studies have suggested a potential link of early mold exposure to development of asthma in some children, particularly among children who may be genetically susceptible to asthma development, and that selected interventions that improve housing conditions can reduce morbidity from asthma and respiratory allergies, but more research is needed in this regard.

Where are molds found? Molds are found in virtually every environment and can be detected, both indoors and outdoors, year round. Mold growth is encouraged by warm and humid conditions. Outdoors they can be found in shady, damp areas or places where leaves or other vegetation is decomposing. Indoors they can be found where humidity levels are high, such as basements or showers.

How can people decrease mold exposure? Sensitive individuals should avoid areas that are likely to have mold, such as compost piles, cut grass, and wooded areas. Inside homes, mold growth can be slowed by controlling humidity levels and ventilating showers and cooking areas. If there is mold growth in your home, you should clean up the mold and fix the water problem. Mold growth can be removed from hard surfaces with commercial products, soap and water, or a bleach solution of no more than 1 cup of household laundry bleach in 1 gallon of water.

If you choose to use bleach to clean up mold:

  • Never mix bleach with ammonia or other household cleaners. Mixing bleach with ammonia or other cleaning products will produce dangerous, toxic fumes.
  • Open windows and doors to provide fresh air.
  • Wear non-porous gloves and protective eye wear.
  • If the area to be cleaned is more than 10 square feet, consult the U.S. Environmental Protection Agency (EPA) guide titled Mold Remediation in Schools and Commercial Buildings. Although focused on schools and commercial buildings, this document also applies to other building types.
  • Always follow the manufacturer’s instructions when using bleach or any other cleaning product.

Specific Recommendations:

  • Keep humidity levels as low as you can—no higher than 50%--all day long. An air conditioner or dehumidifier will help you keep the level low. Bear in mind that humidity levels change over the course of a day with changes in the moisture in the air and the air temperature, so you will need to check the humidity levels more than once a day.
  • Use an air conditioner or a dehumidifier during humid months.
  • Be sure the home has adequate ventilation, including exhaust fans.
  • Add mold inhibitors to paints before application.
  • Clean bathrooms with mold killing products.
  • Do not carpet bathrooms and basements.
  • Remove or replace previously soaked carpets and upholstery.

What areas have high mold exposures?

  • Antique shops
  • Greenhouses
  • Saunas
  • Farms
  • Mills
  • Construction areas
  • Flower shops
  • Summer cottages

I found mold growing in my home, how do I test the mold?

Generally, it is not necessary to identify the species of mold growing in a residence, and CDC does not recommend routine sampling for molds. Current evidence indicates that allergies are the type of diseases most often associated with molds. Since the susceptibility of individuals can vary greatly either because of the amount or type of mold, sampling and culturing are not reliable in determining your health risk. If you are susceptible to mold and mold is seen or smelled, there is a potential health risk; therefore, no matter what type of mold is present, you should arrange for its removal. Furthermore, reliable sampling for mold can be expensive, and standards for judging what is and what is not an acceptable or tolerable quantity of mold have not been established.

A qualified environmental lab took samples of the mold in my home and gave me the results. Can CDC interpret these results?

Standards for judging what is an acceptable, tolerable, or normal quantity of mold have not been established. If you do decide to pay for environmental sampling for molds, before the work starts, you should ask the consultants who will do the work to establish criteria for interpreting the test results. They should tell you in advance what they will do or what recommendations they will make based on the sampling results. The results of samples taken in your unique situation cannot be interpreted without physical inspection of the contaminated area or without considering the building’s characteristics and the factors that led to the present condition.

What type of doctor should I see concerning mold exposure? You should first consult a family or general health care provider who will decide whether you need referral to a specialist. Such specialists might include an allergist who treats patients with mold allergies or an infectious disease physician who treats mold infections. If an infection is in the lungs, a pulmonary physician might be recommended. Patients who have been exposed to molds in their workplace may be referred to an occupational physician. CDC is not a clinical facility. CDC does not see patients, diagnose illness, provide treatment, prescribe medication, or provide referrals to health care providers.

My landlord or builder will not take any responsibility for cleaning up the mold in my home. Where can I go for help?

If you feel your property owner, landlord, or builder has not been responsive to concerns you’ve expressed regarding mold exposure, you can contact your local board of health or housing authority. Applicable codes, insurance, inspection, legal, and similar issues about mold generally fall under state and local (not federal) jurisdiction. You could also review your lease or building contract and contact local or state government authorities, your insurance company, or an attorney to learn more about local codes and regulations and your legal rights. CDC does not have enforcement power in such matters, nor can we provide you with advice. You can contact your county or state health department about mold issues in your area to learn about what mold assessment and remediation services they may offer. You can find information on your state's Indoor Air Quality program here.

I'm sure that mold in my workplace is making me sick. If you believe you are ill because of exposure to mold in the building where you work, you should first consult your health care provider to determine the appropriate action to take to protect your health. Notify your employer and, if applicable, your union representative about your concern so that your employer can take action to clean up and prevent mold growth. To find out more about mold, remediation of mold, or workplace safety and health guidelines and regulations, you may also want to contact your local (city, county, or state) health department.

You should also read the U.S. Environmental Protection Agency (EPA) Guidelines, Mold Remediation in Schools and Commercial Buildings, at http://www.epa.gov/mold/mold_remediation.html.

I am very concerned about mold in my children’s school and how it affects their health. If you believe your children are ill because of exposure to mold in their school, first consult their health care provider to determine the appropriate medical action to take. Contact the school’s administration to express your concern and to ask that they remove the mold and prevent future mold growth. If needed, you could also contact the local school board.

CDC is not a regulatory agency and does not have enforcement authority in local matters. Your local health department may also have information on mold, and you may want to get in touch with your state Indoor Air Quality office.

Also, see these Web sites for more indoor air quality tools for schools:


1 Mold Remediation in Schools and Commercial BuildingsBenefits of Antimicrobial Pesticides in Public-Health and Industrial Uses

Disinfecting vs. Cleaning: What's the Difference?

By Darrel Hicks Abstract: When educating the public, we often use words like clean, disinfect, and processed interchangeably. What is often overlooked is that to infection control practitioners, the differences are quite large.

Knowing the difference between these terms can mean the difference between life and death.

Main Article: In our world today, but especially in healthcare, there are few if any, tenets as impervious to overstatement as the importance of cleanliness. A facility might appear to be ‘clean’ and not be safe and disinfected. However, IF the facility is safe and disinfected, it is clean, too.

Improving sanitation (safe, clean and disinfected) and infection prevention can seem to be an expensive proposition, but for hospitals there’s nothing as unaffordable as ‘bad medicine.’ We’re not talking about dollars only. The cost of pain, suffering and death from healthcare acquired conditions has to be considered along with a damaged reputation in the community.

Gus Iverson writes, “Our ancestors in Mesopotamia were washing wounds with alcohol 4,000 years ago, but the real gravity of sanitation didn’t start to resonate until about 150 years ago, when the work of Louis Pasteur led surgeons towards new concepts like wearing gloves and disinfecting their instruments. Today, the mission is clear: to practice medicine in the cleanest environment possible.” Or, as Hippocrates quipped, “FIRST, DO NO HARM.”

Webster defines CLEAN (as an adjective)- free of soil, pollution and other undesirable materials. As a verb- make clean, remove dirt, marks or stains.

In recent years, there has been much discussion and debate surrounding the terms “environmental cleaning” and “environmental disinfection”; to many epidemiologists and microbiologists the terms seem to be interchangeable. “Clean hands” seem to have one definition while “clean environmental surfaces” seem to have different criteria.

Hands can be made clean and safe with potable water, soap, time, proper friction, rinsing with potable water and thorough drying. But, environmental surfaces are rendered “disinfected” by merely wiping the “proper” disinfectant on the hard non-porous surface and allowing the proper contact time (which may take re-wetting the surface six times to attain a 10-minute contact time).

I believe the goal of cleaning hands and environmental surfaces ought to be to break the chain of infection from hosts, to persons or commonly touched surfaces (fomites) and to other humans. Or, as I like to say, returning the commonly touched surface to its “fit for purpose” condition.

In order to make an environmental surface (especially, a frequently touched surface) fit for purpose, I believe the term “processing” should be adopted. Whether addressing the epidemiologist, microbiologist or the front-line Housekeeper, we all understand that environmental surfaces must be processed.

Processing Definition of “PROCESSING” –includes cleaning and disinfecting an item or area using a clean micro-denier cloth or flat mop, and an appropriate and facility-approved, EPA-registered disinfectant. We don’t clean operating rooms, we process them. We don’t clean a patient’s room, the Housekeeper processes the room.

This isn’t a matter of semantics but a realization that a new, more descriptive term must be adopted, understood and communicated to the person who must deliver a safe, clean and disinfected item or area (i.e., the Housekeeper or Cleaning Professional). The Housekeeper’s role must be a part of a multi-modal approach to infection prevention whether she works in a hospital, ambulatory surgery center, long-term care facility, office building, fitness center or an elementary school.

Cleaning Cleaning is not the same as disinfecting or sanitizing. Cleaning may and should occur before disinfecting or sanitizing surfaces. Cleaning is the removal of all foreign material from objects by using water and detergents, soaps, enzymes and the mechanical action of washing or scrubbing the object.

Disinfection/sterilization cannot be accomplished if soil removal is inadequate.

Witness the recent news about “dirty” duodenoscopes causing the death of 100 patients in the U.S.

If 98% of the micro-soil can be removed from an environmental surface with a clean micro-denier cloth and clean potable water, then it doesn’t matter what disinfectant you choose. If microbial pathogens are collected from a hard, non-porous surface, held in the micro-denier cloth and NOT released until laundered, then we change the conversation.

We need to stop looking at the wiping material, be it cotton or man-made fiber, as a cleaning cloth. Instead, it is merely a delivery system for the disinfectant. If the wiping material is binding the active ingredients in the disinfectant, does it matter whether or not the contact time (or dwell time) is observed? If the soil load on a surface is greater than the 5% mandated by EPA’s disinfectant registering protocols, is the efficacy of the disinfectant diminished?

Instead, we should be choosing the best, micro-denier wiper available to do a superior job of soil removal. The guiding principle is always to remove germs if possible rather than kill them, and then, when necessary use the least amount of the mildest chemical or disinfectant that will do the job; because stronger often means more toxic to humans.

In closing, simple cleaning of the environmental surfaces may be one of our key defenses in the future battle against infectious disease. With antibiotic-resistant organisms proliferating on surfaces for up to 56 or more days, the study of cleaning and measuring cleanliness is becoming all important.

Copyright © 2016 InfectionControl.Tips. All rights reserved. Used with permission. For more information, visit InfectionControl.tips

About E-Mist E-Mist helps healthcare organizations prevent and reduce HAIs. Founded on a legacy of electrostatic science and technology, the E-Mist Infection Control System and Process eliminates traditional disinfectant methods. The EM360 System is mobile, touchless, safer, cordless, and more cost-effective approach to environmental surface disinfection. E-Mist makes disinfection better, easier and more cost effective.