Cleaning and disinfection (the removal or killing of disease-causing germs) are critically important to maintain healthy conditions in homes, schools, healthcare facilities and other indoor areas. At the same time, the U.S. Environmental Protection Agency and others have noted that some cleaning products can present health and environmental concerns. This has led a number of state and local governments to enact programs designed to reduce potential health and environmental impacts from cleaning products used in public buildings. Several of these “environmentally preferable” or “green” cleaning initiatives include guidelines for the selection and use of disinfectants. Because disinfectants play an essential role in preventing the spread of disease-causing germs, particularly in schools, daycare centers and healthcare facilities, it is critically important that green cleaning efforts promote effective and safe uses of these products. The Water Quality & Health Council offers the following guiding principles for addressing disinfectants under green cleaning programs. These principles are intended to help governments and other organizations designprograms to guide the responsible selection and use of chemical products, while reinforcing public health protection against microbial threats.
1. Preventing the spread of illnesses in schools, daycare centers and healthcare facilities is a public health priority. All policies and guidance related to green cleaning should highlight the critical importance of controlling the spread of disease-causing germs in schools, daycare centers and healthcare facilities and other public buildings. These facilities serve the populations at highest risk for infections, including children under five, the elderly, pregnant women and patients with compromised immune systems.Contaminated surfaces can be the source of a wide variety of bacteria and viruses – posing significant health risks to students, patients, workers and others.
- Cold and flu viruses can survive on surfaces for up to three days. According to U.S. Centers for Disease Control and Prevention (CDC), nearly 22 million school days are lost annually due to the common cold alone.
- Contaminated surfaces are a source of norovirus infections. Norovirus outbreaks, which may cause severe gastroenteritis(diarrhea), have increased dramatically in recent years, shutting down schools and business.
- Athletic equipment in schools can harbor viruses, including herpes gladiatorum, which can produce lesions on the face, head and neck.
- According to the latest figures from CDC, healthcare-associated infections (HAIs) account for at least 2 million infections, 90,000 deaths and $4.5 billion in excess health care costs annually. Contaminated surfaces contribute to the spread of HAIs, acquired by patients and residents within healthcare settings.
- Shigella bacteria are a particular concern in bathrooms and diaper changing stations. According to CDC, children, especially toddlers aged 2 to 4, are the most likely to get shigellosis, and many cases are related to the spread of illness in child-care settings.
- Risks of infection are increasing due to emerging antibiotic resistant microbes (e.g., Methicillin-resistant Staphylococcus aureus (MRSA)) and the growth of sensitive populations such as dialysis patients and residents of long term care facilities.
- Disinfection of household and workplace surfaces may be critical to control the spread of viruses in the event of a pandemic influenza outbreak.
2. Appropriate disinfection techniques should be urged for high-touch surfaces where germs can easily be spread. Green cleaning guidelines should highlight areas within public buildings where the use of disinfectants is appropriate to help prevent the spread of disease-causing germs from person to surfaces to person.Disinfection is critically important for areas where people are likely to come into contact with contaminated surfaces, including bathroom fixtures, doorknobs, handrails, athletic equipment, desk tops, computer key boards and other high-touch surfaces. After cleaning, disinfection provides an additional safeguard against the transmission of illnesses. While disinfectants are not typically required for many general purpose cleaning tasks (e.g., walls and floors), they may be appropriate in facilities such as daycare centers, where contact with these surfaces is more frequent and poses a greater risk of contamination. Surfaces should be cleaned thoroughly, whether or not disinfectants are used.
3. Illness prevention requires a continuous and proactive process.Appropriate disinfection protocols should be followed in response to specific contamination incidents (e.g., spilled blood or vomiting). Disinfection should also be considered as part of routine cleaning and maintenance programs to help control pathogens that may be commonly present in indoor environments. Green cleaning program guidelines should recommend cleaning and disinfection schedules for high touch surfaces.
4. Promoting safe chemical practices helps protect workers, students, patients and other building occupants. A key to reducing potential risks for workers and building occupants is to ensure that disinfectants are stored, handled and used safely. Cleaning programs can include guidelines, employee training, safety information, and other materials to effectively teach safe chemical practices. Notable precautions to consider include:
- Always follow product instructions;
- Prevent improper mixing of disinfectants and other products;
- Store products away from food, and in areas not accessible to children; · Empty and thoroughly rinse out buckets after each use;
- Wear gloves and other appropriate protective clothing according to product instructions;
- Store products in their original containers and never remove product labels.
5. Disinfectants must be proven effective for their intended use. To maintain critical public health protection, all products used to kill germs should be registered with EPA, and have demonstrated efficacy that achieves health protection goals for their intended use. EPA requires registration for any product sold or distributed in the United States that claims to kill germs. The registration process includes rigorous efficacy tests to verify the manufacturer’s claims. The manufacturer must also submit the product label and extensive data on chemistry and toxicology.
6. Criteria for “environmentally preferred” products should be based on evidence of reduced health and environmental risks. Any criteria developed for “environmentally preferable” products should be based on scientific evidence of reduced health and environmental risks, considering both the characteristics of the specific product ingredients and the potential for exposure. Measuring the overall environmental performance of products and services is complex. Each product has multiple attributes related to its ingredients, packaging, manufacturing processes and uses. Cleaning and disinfection guidelines and product criteria should be periodically reviewed as knowledge, products, and circumstances change.
7. Disinfectants should be considered separately from other cleaning products.In “green” cleaning programs, disinfectants should be considered as a separate category from other products. There are currently no widely-accepted definitions or criteria for “environmentally preferred” disinfectant products. It should be recognized that criteria for cleaners may not be appropriate for disinfectants. For example, “non-toxic” is an unrealistic criterion for disinfectants since, by definition, they must be effective at killing microorganisms.
8. Additional research is needed to improve disinfection practices and illness prevention. Government programs should support targeted research and evaluation of disinfection practices, to encourage continuous improvement in illness prevention measures.Not all infectious disease agents on surfaces in the indoor environment are of equal risk to people. For a particular microbe, risk is dependent on factors such as its infectivity, ability to cause severe disease and survival capability. The susceptibility of the person who contacts the microbe is also a factor. Therefore, it is necessary to develop a framework for addressing high-risk infectious agents, as well as an inventory of critical microbes. Disinfection efficacy should be evaluated and addressed in terms of orders of magnitude reductions (e.g., capable of reducing norovirus by 99.9999%). Inactivation of organisms is time, microbe, surface and disinfectant dependent. Efficacy studies show a tailing effect, meaning that some proportion of the microbial population is robust and survives longer than others. The risks of this residual contamination and risk reduction through enhanced disinfection need to be addressed.