Fast-acting, Alcohol-free Disinfectants: But What About Tuberculosis?
It seems that more and more companies are no longer using alcohol as an ingredient in their fast-acting disinfectants. They are instead using a combination of various quaternary ammonium compounds. The reason behind this change is an attempt to prevent the damaging alcohol vapors of spray and wipe disinfectants and thereby raise the durability of the surfaces and materials.
Although this might appear to be a great breakthrough, a closer look reveals the terrible implications of fast-acting, alcohol-free disinfectants. Most of these disinfectants suffer from three serious drawbacks:
- They are not effective against tuberculosis bacteria.
- They leave behind residue on the disinfected surfaces.
- They require long exposure times.
Tuberculocide – It is a Duty
Tuberculosis bacteria are highly resistant germs. They are easily able to withstand small concentrations of disinfectant. Although TB bacteria can be destroyed by alcohol, other agents such as quaternary ammonium compounds are not effective against these pathogens. Thus, it cannot be automatically assumed that a product is effective against TB bacteria, just because it can kill other bacteria. As a matter of fact, the European standards have declared that manufacturers must separately test a disinfectant's potency against TB bacteria. The manufacturer may then only label his product as a tuberculocide if the product was separately tested in this manner and found to be effective. Should the product label not mention its status as a tuberculocide, one can assume that the product is not effective against TB bacteria.
Residue on Disinfected Surfaces – No Thank You
Alcohol molecules vaporize in air. Hence, a spray and wipe disinfection can also be unhealthy, as it can lead to irritation of the airways, inflammation of the eyes, or skin rashes. On the other hand, alcohol disinfectants have the advantage of not “sticking” to surfaces and permits a residue-free drying. The situation is exactly the opposite for disinfectants with a high proportion of quaternary ammonium compounds. Although they do not produce an unpleasant odour, they remain on disinfected surfaces and create residue. This is a terrible disadvantage. Stripes and smears on the surfaces do not create the impression of a clean and hygienically flawless practice.
Long Exposure Times – Why Wait?
Alcohols are extremely fast-acting. For this reason they are the optimal ingredient for fast-acting disinfectants. Imagine that the treatment room needs to be prepared between patients – why squander time while idly waiting for a disinfectant to work? Quaternary ammonium compounds fundamentally require a longer exposure time than alcohols do. Alcohol-free disinfectants do not allow a quick and efficient preparation of the treatment room.
Conclusion
To have a risk-free disinfection of surfaces and guarantee protection against infections in your practice, you should always place your trust in an alcohol-based, fast-acting disinfectant. Negative side-effects such as airway irritation (nose and throat) can be minimized by setting the spray to its minimum level and by spraying it on disinfectant wipes. You can further dampen the cloth with a bottle of disinfectant with a clip lid. When choosing a disinfectant, it is important to consider the spectrum of its effectiveness as well as the respective exposure times. To destroy resistant TB bacteria, a somewhat longer exposure time is usually required. It is furthermore important to make sure that the manufacturer has made all the required information clearly available on the label.
Tuberculosis – Highly Contagious and Very Dangerous
The TB bacteria, Mycobacterium tuberculosis, is the agent responsible for the dangerous disease of the lungs, tuberculosis. Behind AIDS, tuberculosis is the most common and dangerous infectious disease in the world. Today, new cases of tuberculosis are being reported like never before: one third of the world's population has been infected with TB bacillus. Every year, 9 million people become infected and suffer from this disease. As the World Health Organization (WHO) wrote in their latest report in February 2008, multi-resistant strains of TB bacteria are showing up in larger numbers around the world. They are resistant against many antibiotics and thus the treatment of the infection is very limited. Even more aggressive are the ultra-resistant strains of the TB pathogen (also called the “extensively drug-resistant TB”), which have been appearing more and more in past years. A treatment with antibiotics is no longer possible for this strain; the mortality rate is at an appalling 42%.
Tuberculosis does not only affect people in developing countries. According to the WHO study, the two Western European countries with the highest rates of tuberculosis infection are Germany and Italy according to the WHO study. Even in Switzerland there are annually around 500 reported cases – over 50 of these patients die every year from tuberculosis.
Tuberculosis is extremely contagious. An infected patient can transmit the bacteria through coughing, sneezing, or simply through speaking. In the form of aerosol (e.g. through atomized spray), the germs can colonize on surfaces and survive there for many hours. Transmission occurs through small cuts or tears in the skin and only requires brief contact with contaminated surfaces. To stop this risk, it is legally mandatory to use fast-acting disinfectants with effectiveness against TB, commonly referred to as tuberculocide.
Tips & Tricks
The proper use of a surface disinfectant is decisive in guaranteeing the effectiveness of a product. Here are a few helpful disinfection tips.
- Place as few objects as possible around the patient area (2 meter radius from the dentist's chair), because these objects must be considered contaminated after the treatment. Glove boxes, instrument stands, gauze holders, and medication holders should not be placed in this area.
- The top surface of your devices and materials should be as flat and washable as possible. Dirt and germs could collect in joints or indentations, which would then become infection risks. When you acquire a new device, it is worth noting the potential contamination risks.
- Set up an obligatory order of operations for the disinfection process (e.g. start with the chair, then clean the unit, etc.) A constant and unchanging procedure ensures that no surfaces will be forgotten.
- Don't be greedy with the disinfectant. This is a safety concern for yourself and your patients! If the surfaces are not sufficiently moistened, then this may not be an effective disinfection. We suggest using 30 ml of disinfectant solution per square meter.'
- Visible contaminations should be first wiped away with a disposable cloth soaked in the disinfectant, before completely disinfecting the surface. Organic contamination could result in a failure of effectiveness for some disinfectant products.
- When possible, try to wipe and not to spray. You can thereby hinder the amount of aerosol and the resulting irritation to the airways.
