Using best management practices for disinfecting will help ensure that you are cleaning appropriately to kill the bugs—the microbes—you need to kill. A side benefit is that you use only the amount of disinfectant necessary to do the job. Ultimately, best management practices protect patients, employees and the environment.

1. Pre-clean
Conduct general surface cleaning to remove dirt and debris. This can remove many microorganisms and increase the effectiveness of the disinfectant.

2. Evaluate the Need to Disinfect
Because disinfectants are designed to kill, they are toxic. Determine if a lesser level of clean is sufficient. Does an item truly need to be disinfected or is cleaning sufficient? If the item touches intact skin, then cleaning by itself is sufficient. General surface cleaning can be accomplished by washing with a detergent, rinsing and thorough drying.

3. Assess the Level of Disinfection
Know the target microbes you need to kill. Make a list of the specific targets like Mycobacterium or Parvo virus, and more general target like spores, bacilli or viruses. Items used in a semi-sterile area require different levels of disinfecting than hard surfaces such as patient furniture or instruments in contact with unbroken skin.

4. Select an Ideal Disinfectant
Chose a disinfectant that has high efficacy and is less toxic to employees and the environment. Disinfectants that act by oxidizing such as hydrogen peroxide or peracetic acid create fewer by-products than quaternary "quat" compounds or chlorine. This means less toxics ultimately reach the sewer.

Hydrogen peroxide and peracetic acid are also generally more effective against all types of microbes and are not as easily inactivated by organic matter.

5. Dispensing
To protect workers from concentrated solutions, determine what equipment is necessary to ensure proper dilutions and easy use. Do not mix different disinfectants together or mix bleach with disinfectant. Together they may create toxic gases, such as chlorine.

Use personal protective equipment—like goggles and gloves—for employee protection. To reduce waste, use washable towels or applicators.

Calibrate carefully. Calibrate dispensing equipment carefully and often—at least every time a new container of disinfectant is opened. When calibrating, check the equipment for leaks and malfunctions. Equipment can be calibrated with water instead of the chemical to prevent waste.

Measure accurately. Concentrates need to be measured before being put in the dilution tank. All disinfectants have a concentration at which they achieve their maximum ability to disinfect. Adding extra does not help. In fact, it increases the likelihood of injury, damage to equipment, and contaminating groundwater, as well as increases material cost. Follow manufacturer directions for the lowest concentration of disinfectant to achieve the highest level of antimicrobial activity. Mix only the amount needed, do not mix a gallon if you only need a quart.

Label containers. Make sure diluted disinfectant is labeled with the name, date and initials of whoever is diluting the solution to better track the expiration date of the dilution (outdates). Check manufacturer’s instructions for an outdate and how to protect from inappropriate uses.

6. Use Proper Dilution and Allow Time for Disinfectant to React
More concentrated disinfectants do not necessarily react more quickly or effectively. Follow label directions carefully. They provide information on proper dilution rate, timing and application.

Reduce volume. Use the smallest possible amount of solution—lowest possible dose—to obtain the desired level of microbial control. This practice also reduces the potential for a microorganism to build resistance to a specific chemical as well as reduces waste to the environment.

7. Staff Training
Train staff and clearly post the procedure at the disinfectant dispensing station.

8. Storage
Keep containers closed when not in use. Store in original container, on lower shelves. Check containers regularly for leaks, breaks, rust or other corrosion. If a leak or break occurs, transfer product into another container with the same labeling or to an empty container that originally held the same disinfectant and has the same label.

In one year, the hospital received 23,342 cases and performed 4,587 surgeries. The number of cases they treat increases every year. This increase in cases results in more disinfectant use and waste. The hospital wanted to see if they could reduce their use of disinfectants while maintaining strict disease control.

A MnTAP intern reviewed the hospital’s procedures and evaluated their disinfection by sampling microorganisms. She worked with the hospital staff and identified the following improvement opportunities:

• More training. Proper disinfection procedures were not well understood because staff were not adequately trained.
• Post instructions. No written instructions were posted for proper procedures. Staff used their own judgment.
• Proper disinfectant use. Staff sometimes used the wrong dilution and selected less than ideal disinfectants.
• Understanding disinfection. Staff mistakenly believed that using a higher concentration results in more effective cleaning.

The lack of procedures led to excess disinfectant use, costing over $5,000 a year. The clinic was not achieving its desired level of disinfection and had increased chemical loss to the wastewater. As a result of the intern’s research, the veterinary hospital developed and posted a written procedure, and trained its staff how to follow it. The hospital also instituted pre-cleaning and using the appropriate dilution. No increase in infections has been noticed.

Inventory tips. Maintain appropriate inventory. Only order and stock what is needed to avoid unnecessary disposal of excess or outdated disinfectant.