The evolution of hospital cleaning

Finding the most effective cleaning products and methods has long been the NHS’s ‘holy grail’. There have been many options tried and tested over the decades – each with its own strengths and weaknesses. We look at the developments in hospital cleaning over recent years:

Sodium Hypochlorite

Generally classed as an intermediate level disinfectant, sodium hypochlorite is used extensively as a disinfection agent as CRAs (chlorine release agents) are highly effective for disinfection purposes. Unfortunately, the breakdown products from chlorine disinfection are toxic to aquatic life and the potential by-products from chlorine disinfection can be harmful.

Its primary uses are in stain removal so it is particularly effective on cotton fabrics such as bed sheets and towels. These items at the front line of healthcare operations tend to mark and stain easily, but do bleach out well. These properties also make it ideal for dental stains often caused by fluorosis. Over bleaching of textiles can degrade the fibre structure, shortening the lifespan of the textile. Furthermore, most coloured fabrics are not stable to sodium hypochlorite bleaching.

More importantly, in the form of CRAs it is used extensively to disinfect hard surfaces from blood spillage and has been proven to be effective in the removal of HIV and Hepatitis B virus.

These CRAs act so effectively by destroying the cellular activity of proteins and are highly active oxidising agents.

When used in high concentration, sodium hypochlorite has shown impressive levels of sporicidal and virucidal eradication and has previously been labelled as the best defence against the infection of the digestive system, clostridium difficile (C Diff).

All of these applications have made it a staple part of hospital and healthcare cleaning routines for decades. In addition, it is an inexpensive product in an industry where cost is a key factor whilst being relatively safe with a low-toxicity value and is still an essential part of the process today.

However, it does have its downsides, surfaces that have been treated with bleach must be rinsed to its corrosive nature. As such, whilst it is effective at killing microorganisms, the long term sterile nature of the surface depends entirely on how the surface is treated after rinsing.

Bleach also contains products that are not compatible with certain types of materials and can have adverse reactions. Unlike other disinfectant agents, the breakdown products from chlorine bleach can be harmful by-products and can be harmful to aquatic animals.

Due to the nature of the application, persons handling bleach contain products must wear appropriate PPE to avoid exposure to the liquid or its vapours, which can cause harm to the user.

Peracetic acid

In recent years, peracetic acid has emerged as the disinfectant of choice over a number of more traditional methods of disinfection.

Like hydrogen peroxide it is a broad spectrum disinfectant agent and an effective bactericide, fungicide and sporicide although it is generally considered a more potent alternative to hydrogen peroxide. It breaks down the permeability of cell walls and oxidises enzymes, metabolites and proteins.

It is effective at low temperatures killing many micro-organisms and rinses away completely leaving no residue. PAA is used as a destainer in laundry applications and is highly effective at low temperatures.

PAA is a low corrosion risk – In contrast to some disinfectants which can affect metal surfaces, PAA has a much lower rate of corrosion. This means it is suitable for cleaning use on many medical and dental instruments without fear of damage.

Peracetic acid is now generally accepted as an alternative to traditional disinfectants for the sterilisation of medical devices including endoscopy equipment due to it being such a strong disinfectant but leaving behind no toxic deposit.  

With a long shelf life and low unit cost it is increasingly becoming the product health authorities are using to keep within budget.

Unlike bleach, it does not linger, or on surfaces. PAA components are completely biodegradable to its base elements of hydrogen and water. In comparison to bleach, which requires rinsing after use, PAA does not need to be rinsed off surfaces. When used correctly, it can be used to sanitise surfaces, vessels, closed systems and equipment safely, ensuring surfaces remain sanitised until required.

PAA’s highly effective nature means very low concentrations are required to achieve the desired disinfection effect. When compared to bleach and hydrogen peroxide, which are typically overdosed during cleaning, PAA is a cost effective, efficient & safer alternative for hospitals and the end user.

Ultra violet light

UV light is usually administered in sealed cabinets that are capable of emitting high energy UV light.

UV is mutagenic to bacteria, viruses and other microorganisms. It acts by disrupting the DNA in the microorganisms, breaking bonds and inhibiting cellular functions. The UV acts to either kill or disable the microorganism. As microorganisms have little in the way of UV protection, UV is highly effective.

Ultra violet light has become a popular process for hospital cleaning due to the absence of chemicals and all the complications these can bring. It has been found to be effective against pathogens which are resistant to drugs and in particular to antibiotics.

However, the capital cost of UV disinfection remains high and potentially prohibitive, and the safety of the user of UV disinfection equipment remains a continual concern. Compared with liquid options, UV units tend to be bench based and are used for small items. For this reason, whilst highly effective, UV has a limited scope of disinfection within the hospital environment.

Traditional trigger spray cleaners

Disinfectant trigger spray cleaning products are used widely in the healthcare sector due to their ease of application.

They are often found in the forms of chlorine releasing agents such as chlorides, isothiaolinones, alkonium and dimethylammonium.

However, in order to achieve sufficient bacteria-killing levels, the contact time for the product may need to be up to five minutes. Therefore, it would not be difficult for these products to be used incorrectly which would pose a risk in a healthcare environment. Furthermore, products of this nature usually leave a residue behind which would be undesirable in a hospital situation as it could affect food preparation and medication handling areas.

Hydrogen Peroxide

Hydrogen Peroxide is a popular option for high-level disinfection and sterilisation in healthcare settings as it is effective against a broad range of bactericidal, virucidal, fungical and sporicidal organisms. As it is particularly effective on hard surfaces it is often applied to some hospital and healthcare equipment as a disinfectant. Hydrogen peroxide can also be used in a vapour form to clean rooms (HPV).

It can make a good alternative to some toxic sterilisers which are unsuitable for use on devices such as endoscopy tools.

The future of hospital cleaning

There is likely to be a place for most of these methods and chemicals in the healthcare sector in the coming years. However, as pressure mounts to spend less and do more it seems that peracetic acid is the future of hospital cleaning and is predicted to be a strong growth product in the sector. 

For more information on any of our products suitable for use in medical care please visit our website or call on 01535 637876


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