Abstract
Background
Automated dispensers that dilute concentrated disinfectants with water are commonly used in healthcare facilities. However, most facilities do not perform routine monitoring to ensure that the dispensers are functioning correctly and being used as recommended by the manufacturer.
Table 1.
Concentrations of disinfectant measured in samples obtained from automated dispensers and from in-use buckets on environmental services carts in 6 hospitals
QA, quaternary ammonium disinfectant; PA, peracetic acid-based disinfectant.
a. Expected concentrations, ∼1,300 parts per million (PPM) for PA and ∼800 PPM for QA; higher-than-expected concentration of peracetic acid, >1,800 ppm; b. Lower than expected concentration, 300-900 PPM for PA and 200-400 PPM for QA; cNo disinfectant detected, limit of detection (∼300 PPM for PA and ∼150 PPM for QA); d. Wrong product, the in-use product that was supposed to be PA or QA was a detergent intended for floors.
Methods
In 6 acute care hospitals in Northeast Ohio, we tested disinfectant concentrations and pH of products obtained from automated dispensers and in-use containers from environmental services (EVS) personnel carts. The disinfectants included quaternary ammonium (800 parts per million [ppm]; pH 8) and peracetic acid-based products (∼1300 ppm; pH 3).
Results
All 6 hospitals had 1 or more malfunctioning dispensers (Table 1). Of 57 systems assessed, 14 (25%) dispensed products with lower-than-expected concentrations, including 8 (14%) with no detectable disinfectant (i.e., water). Nine of 62 (15%) in-use products had no detectable disinfectant, and 4 (7%) were the wrong product (i.e., a detergent for floors used for high-touch surfaces). Reasons for dispenser malfunction included incorrect connection of the concentrate container, dysfunction of a low-product indicator, and failure to change the concentrate container when indicated. pH measurements identified disinfectants with lower-than-expected concentrations, and an intervention that included monitoring was effective in ensuring that the dispensers were operating correctly.
Conclusion
Improved monitoring of automated disinfectant dispenser systems in healthcare facilities is needed to ensure patient safety. pH measurements could provide a simple means to ensure that dispensers are functioning correctly.
Disclosures
Elie Saade, MD, MPH, FIDSA, Janssen Global Services: Advisor/Consultant|Janssen Global Services: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant|Janssen Research and Development: Advisor/Consultant Curtis Donskey, MD, Clorox: Grant/Research Support|Pfizer: Grant/Research Support