A study of the effects of Peracide on cleaning, health and safety, and turnaround time of incubators as compared to chlorine tablets.

Introduction

In the aftermath of the covid-19 pandemic, Trusts are facing tremendous infection control challenges due to the changes that occurred during the pandemic, both in medical care needs and provision, as well as changes in public behaviour. Chlorine based cleaners had been the go to disinfectant during the pandemic, but as everything ‘returns to normal’ it is becoming increasingly evident that continued use of high levels of chlorine-based cleaning products has significant health and environmental implications. Additionally, it is well known that chlorine-based cleaning products have a significant impact on the fixtures and fittings of any facility, often reducing the usable life of essential equipment such as mattresses and incubators.

Background

In an effort to provide an all-round high-level disinfectant system that can be used in a range of environments, from clinical to non-clinical, on hard surfaces and soft furnishings, and can easily be prepared and used by staff, a large NHS Trust was approached by Sky Chemicals with a view to trialling Peracide. The Trust recognised that daily cleaning with a sporicidal disinfectant and cleaner is the most cost-effective method of reducing Healthcare Acquired Infections (HCAI) costs, and agreed to a standard Peracide trial on selected wards.

An issue that staff specifically identified is that of the use of chlorine in their Trust, and specifically on their incubators. Many Trusts have used chlorine for a number of years, adhering to COSHH guidelines for safest possible use, however there are now viable alternatives to consider. Staff found that chlorine solution generated from chlorine tablets (NaDCC), their disinfectant of choice at the time, was leaving a strong and potentially harmful chlorine smell in incubators after disinfection. The smell was sufficient to raise concern with nurses, and in some cases, the residual chlorine smell was to the extent that nurses would rightly refuse to put pre-term and new-born babies into the incubators for fear of exposing them to chlorine gas.

Whilst we may discuss staff compliance as an issue, it was ultimately the infection control and neonatal nurses who decided to speak up about this. By their critical thinking skills, they were able to work with decision-makers and us, as manufacturers, to implement safer and more effective procedures. This will improve infection control practices and support the Trust in providing safer care to some of their most vulnerable patients.

Solution

During a ward trial of Peracide, the neo-natal unit enquired if they could use Peracide on incubators instead of chlorine. We said yes, and provided the information and training required to disinfect their incubators with Peracide.

As part of the discussion and training it came to light that incubator disinfection was an issue. The residual chlorine odour necessitated leaving the incubators to dry, and then air off before they could go back into use. However, without a sterile facility to store the incubators while drying, this allows the potential for contamination by other pathogens. Using Peracide to clean and disinfect results in no chlorine gas being generated, and as soon as the incubators are dry they are ready to use again, so no need to leave airing off waiting for the chlorine to dissipate.

In addition, the chlorine disinfectants were causing significant visible degradation to the incubators in a relatively short period of time. After only a few months the clear plastic on some incubators would begin to look frosted / cloudy, and this would then degrade further, eventually forming rough surfaces and cracks. This would inevitably require the replacement of incubators. Since the change to Peracide we have had no reports of serious degradation to the materials the incubators are made from.

Conclusion

Peracide does not contain any chlorine compounds, so chlorine gas and generation of further chlorine from residual disinfectant is not possible. Peracetic acid is very short lived in air and quickly degrades to non-harmful by-products. Once an incubator is dry there is no further generation of peracetic acid, hence no residual risk of exposure. Hence, they are now able to use their full capacity of incubators without excessive drying or airing times, and without the ongoing degradation that chlorine causes.

There will also be a cost benefit as Peracide does not destroy the polymer that incubators are made of, increasing the useful life of an incubator. Additionally, reducing the chance of cracks and rough surfaces means less places for pathogens to hide and potentially avoid contact with disinfectants.