Application of disinfectants in Intensive Care Units (ICUs)

Hospital-Associated Infections (HAIs) are the leading cause of critical illness and death among patients in Intensive Care Units (ICUs), including Neonatal Intensive Care Units (NICUs) & Cardiac Intensive Care Units (CICUs). Research suggests that HAIs in NICUs vary between 8.7% to 74.3%. [1]. Similarly, HAIs are prevalent in ICUs of tertiary care hospitals due to multidrug resistance among the causative agents. [2]. CICUs also display sepsis during hospitalisation/admission along with non-cardiovascular comorbidities and multisystem organ dysfunction.

Pathogens spreading HAIs, such as MDR Gram-negative rods, Enterococcus, Acinetobacter, Fusobacterium and Clostridium difficile, are often found on surfaces around the patients. Some of the commonly-occurring HAIs are central line-associated bloodstream infections, methicillin-resistant Staphylococcus aureus (MRSA) infection, vancomycin-resistant Enterococci (VRE) bloodstream infections and Surgical Site Infections (SSIs). Additionally, ICUs demonstrate infections, including ESKAPE pathogens, which are a major challenge when it comes to infection control due to their multi-drug resistance property.

To inhibit infection transmission to patients and safeguard healthcare workers, it is vital to understand the concepts of disinfection, sterilization, cleaning and asepsis. Cleaning and disinfection depend on the degree of contamination and the equipment used. Asepsis, a process that maintains the sterility of already sterilized medical equipment, can also be utilized for reducing the risk of cross-contamination in healthcare. Here, we will focus on implementing safe and high-efficacy disinfection in intensive care units to combat infection risk.

Need For Disinfectants In ICUs

Patients admitted in ICUs are twice as likely to contact HAIs as compared to patients in general wards. On a global scale, infections acquired in ICUs prevail at a high rate of around 51.4%. [3]. Microbial contamination of ICUs can cause colonization and infection transfer. This is a major concern because pathogens can survive for days or months on unhygienic surfaces, thereby becoming infection reservoirs. Patients can acquire infections from a previous occupant if the room and objects are not disinfected regularly. Similarly, frontline workers- doctors, nurses and midwives can contact infections from patients or contaminated shared objects/equipment. In addition to contaminated equipment, nurses station and ill staff members can infect patients in ICUs and adversely impact their wellbeing. HAIs lead to slow recovery among patients and a longer stay in hospital, thereby increasing the healthcare costs. [4]. The average cost of a patient’s overnight stay in a hospital ICU in India is Rs. 15,000 in government hospitals which can go up to Rs. 30,000 in private hospitals. [5]. The risks of HAIs in ICUs, inclusive of tertiary care units, can be reduced by conducting surveillance and utilizing effective disinfectants. Healthcare organizations need to educate healthcare professionals about infection control procedures and ensure that they are implemented. Disinfection strategies may range from integrating supreme hand hygiene practices to sterilizing equipment and bedding.

Limitations Of Current Disinfectants For ICUs

Disinfection in ICUs is challenging because they are contaminated with several pathogens, include ESKAPE group of bacteria. Moreover, when one pathogen is controlled, the areas may get infected by other microbes, thereby becoming a vicious cycle. Hospital floors also get contaminated when airborne pathogens settle, by contact with trolley wheels or other objects and occasionally due to spilled blood or body fluids. Disinfection of ICU floors is essential for keeping harmful microbes at minimum. The continuous influx of pathogens makes ICUs susceptible to a pool of infections. That is why it is crucial to implement the use of effective disinfectants, and clean thoroughly following the discharge of a patient having known infection.

Among the most commonly used disinfectants in intensive care units are aldehyde-based, alcohol-based, per acetic acid based, or lower generation of QAC based. Such products are not applicable on all surfaces, which is why they cannot decontaminate the whole environment. However, these chemical disinfectants have a strong smell and induce irritation of eyes and skin and enhance allergic response in the body. Aldehyde disinfectants may seem effective at first, but they are toxic and can cause harm to human health. The age old chemistry of currently used disinfectants gives them a pungent odour and inherent toxicity. The concentration and dosage of chemical disinfectants can damage human health and environment. It is sometimes challenging to define a contact time for chemical disinfectants that supports efficient disinfection without harming surfaces or objects.

The adverse impacts of chemical disinfectants are not restricted to humans. They also damage equipment and furnishing by corrosion. If a chemical disinfectant is hazardous to health and environment, it cannot be used to decontaminate all areas, thereby increasing infection risk. For instance, glutaraldehyde and formaldehyde are banned in many countries due to their toxicity and potential carcinogenicity.

Choosing The Right Disinfectant For ICUs

When selecting a disinfectant for intensive care units, you need to watch for these traits-

• Short contact time: A disinfectant for ICUs would be considered effective if it has a short contact time during which it remains wet on the surface rather than evaporating.
• Powerful cleaning: Disinfectants in ICU must be able to decontaminate surfaces and objects, thereby reducing microbiota and infection risk.
• Safe to use: Some chemical disinfectants can cause skin irritation, respiratory irritation and lead occupational health and safety risks.
• Simple usage: If it’s not easy to use, it is less likely that the staff will utilize it, which can aggravate the risk of infection.
• Broad spectrum: The best disinfectant for ICUs must have high efficiency against various pathogens, such as bacteria, fungi, viruses and spores, mycobacteria & ESKAPE pathogens while having a short contact time.

Newer Generation of QACs

Quaternary ammonium compounds (QACs) are cationic salts consisting of organically substituted ammonium compounds. These are broad-spectrum disinfectants. QACs range from 1st to 7th generation. The newer generations are effective against various pathogens, including mycobacteria, bacterial spores and ESKAPE pathogens. The latest generation QACs have rapid disinfection action while being cost-effective.

Solution – Bioguard RTU, Concentrate, Wipes & Absorb Powder

Bioguard’s disinfectants contain the latest generation QACs with Biochem®, a unique patented compound that has dual action of cleaning and disinfection in high-risk environments like hospitals. Our products are economical and require minimum quantities without compromising on the disinfection efficacy.

• Disinfectant Concentrate and RTU (Ready to Use)

  These are alcohol-free, pH neutral solutions that exhibit a dual action of cleaning and disinfection on all surfaces. They have been proven effective as per the latest EN Standards and require only 30 seconds of contact time. Additionally these disinfectants are safe to use and effective against bacteria, viruses, fungi, spores, Mycobacteria and ESKAPE pathogens. Disinfectant concentrate is VOC tested, odourless, has dual action of cleaning and disinfection and does not cause any skin irritation. In addition to these properties of disinfectant concentrate, RTU disinfectant is alcohol-free.

• Absorb Powder

  Bioguard’s Absorb Powder is a user-friendly, safe and broad-spectrum disinfectant that as the name sounds, absorbs body fluid 300 times its weight. Additionally, it is effective against ESKAPE pathogens, spores incl. C. difficile & M. tuberculosis within just 30 seconds. This product can efficiently manage spills in less than 2 minutes.

Client Says

“ Bioguard products has given us much needed ease of use, the desired disinfection & hygiene. The products are effective and due to dual action, surfaces are visibly cleaner. It has increased our confidence level too. Now we are using single product & single dilution across the hospital. It has not only helped us save space & inventory. It has streamlined our disinfection processes related to surface (disinfection), fogging and deep cleaning. ”

Preethy David, ICN

MGM Hospital, Belapur

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“ Bioguard products has resolved issues of foul odor, irritation and restored the desired disinfection level in the ICU and reinforced the commitment of hygiene and disinfection among the nursing staff. ”

Dina Shah, Nursing Superintendent & Infection Control

SAL Hospital

Our Unique Benefits:

• Trusted – Used by healthcare professionals across the UK and Europe in high-risk environments. Bioguard products are protecting GCC countries and now India.
• Proven – Independently tested to the highest European and British standards against high-risk organisms.
• Alcohol-Free* – Ensuring our product is gentle when in contact with skin and meets certain users’ demand.
• pH Neutral – Neutral pH not only helps protecting the skin but also the surfaces where it is being used. It also ensures Health and Safety compliance and a safe working environment
• Safe – Products are non-hazardous and non-toxic and have been MEA & VOC tested to ensure they are safe and do not harm users.
• Reliable – The product will not be deactivated or ineffective in environments with high soiling levels.
• Fast – It is effective in under 30 seconds*.
• Eco-Friendly - Eco-friendly and non-damaging to the environment.
• Long-lasting – 3 years long shelf life.
• Easy – Using one product eliminates the risk of operatives using the wrong product, mixing products causing chemical reactions, or deactivating products.
• Multi-Surface – Usable on virtually all surfaces (including fabrics and furnishings), so can decontaminate whole environments without causing degradation to surfaces.
• Efficient – Combined cleaning and disinfection capability eliminates the need for multiple products.
• Robust – Broad Spectrum Microbiological efficacy means our products are effective against a wide variety of organisms such as ESKAPE pathogens & Clostridium difficile (spores & bacteria), Hepatitis, Tuberculosis, Norovirus, HIV, MRSA and Avian Flu.
• Manufacturing Excellence – Having full control over the entire research & development and manufacturing processes ensures we produce the highest quality products made to our exacting quality standards as well as the latest ISO & GMP registration standards.
• Patented Compound – All products are powered by Biochem, a unique compound for high performance cleaning & disinfection; effective against bacteria, viruses & spores including Covid-19.

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