The Effect of Chemical Disinfectants in Healthcare Facilities on Coated Fabrics

Coated fabric upholstery is used throughout healthcare facilities including waiting areas, examination rooms, and patient rooms. Coated fabric upholstery is often specified in healthcare facilities because it is strong, durable and cleanable.  There are three primary types of coated fabric constructions: polyvinyl chloride (PVC), Polyurethane (PU), and Silicone. PVC has fallen out of favor in healthcare settings because of health concerns regarding phthalates that are used as plasticizers and heavy metals used as stabilizers. PU-constructed upholstery is in demand. However, PU upholstery faces a significant challenge in the healthcare environment due to the use of harsh chemical cleaners and disinfectants.Silicone does not contain chemical additives, and stands up well to chemical cleaners.However, it is more expensive thatn either PVC or PU.

Healthcare facilities are waging an ongoing war against Hospital Acquired Infections (HAI)  with highly-trafficked and touched areas being implicated in harboring dangerous pathogens. HAIs are infections patients contract while they are receiving health care for another condition. HAIs can happen in any health care facility, including hospitals, ambulatory surgical centers, and long-term care facilities. HAIs can be caused by bacteria, fungi, viruses, or other, less common pathogens.

In 2014, a report published in the New England Journal of Medicine described the burden of HAIs in U.S. hospitals, and reported that, in 2011, there were an estimated 722,000 HAIs in U.S. acute care hospitals (an average of about 1 in 25 inpatients). Additionally, about 75,000 patients with HAIs died during their hospitalizations. More than half of all HAIs occurred outside of the intensive care unit. 

Contaminated hospital surfaces play a prominent role in the transmission of dangerous pathogens. Therefore, appropriate disinfection of those surfaces and equipment which patients and healthcare personnel touch is necessary to reduce exposure. However, the comparative effectiveness of disinfectants, application methods and contamination assessment techniques is unknown, and no consensus exists around benchmarks for what it means when something is said to be “clean.”

The primary method of combating HAIs in healthcare facilities is cleaning regimens using very strong chemical cleaners and disinfectants. These cleaners are designed to be used strictly on hard surfaces, but end up being used on almost all surfaces, including furniture upholstery. The result is that over time, repeated cleanings cause even the best urethane products to breakdown, usually by delamination of the surface layer.

Upholstery found in patient and waiting rooms is different from most items cleaned in a healthcare facility in that they cannot be described as having a “hard, nonporous surface.” The CDC recommends that disinfectants should be used throughout the hospital to disinfect surfaces.  This is especially important for frequently touched surfaces (e.g., bed rails, light switches, phone, TV remote, furniture, etc.). Microorganisms are invisible to the naked eye so you can never be sure which surfaces are contaminated and which are not. This is why disinfection is sometimes performed so broadly and indiscriminately. The CDC recommends using, “a one-step process and an Environmental Protection Agency (EPA)-registered hospital disinfectant designed for housekeeping purposes in patient care areas where: (1) uncertainty exists about the nature of the soil on the surfaces (e.g., blood or body fluid contamination versus routine dust or dirt); or (2) uncertainty exists about the presence of multidrug resistant organisms on such surfaces.”

The EPA breaks disinfectants into the following six categories:

• Bleach-Sodium Hypochlorite
• Phenols
• Quaternary Ammonium Compounds
• Accelerated Hydrogen Peroxide
• Botanicals
• Silver Dihydrogen Citrate
  
  

The Figure-1 below presents the attributes of the six categories of EPA registered hard-surface disinfectant chemical cleaners used in healthcare facilities.

Figure-1

The chemicals shown on this chart are used to disinfect patient care equipment and noncritical environmental surfaces in healthcare facilities. These disinfectants are not used in the sterilization of medical and surgical equipment which has its own categories of chemical sterilants.

Please note on the chart that the CDC acknowledges that some cleaners may damage floor, carpets and upholstery when used in high concentrations. It also states that thorough rinsing is required.

How a cleaning product is actually used is dependent on the cleaning protocols set up by the individual healthcare facility. Some of problems that exist with how these chemicals are used in healthcare facilities include:

1. The cleaning solution used is much more concentrated than stated in the directions.
2. The cleaning solution is allowed to remain on the surface for longer than the prescribed time.
3. The cleaning solution is not rinsed off with water.

The repeated use of chemical cleaners and disinfectants can cause a change in the surface texture of coated fabric furniture upholstery. This could include cracking, peeling, discoloration or loss of gloss.

In an attempt to better understand the effect chemical cleaners have on coated fabric upholstery, The Mitchell Group conducted a test of six EPA registered hard surface disinfectants used in healthcare facilities. Testing was done over a nine month period on eight of Mitchell’s healthcare products.

Each of six fabric samples was assigned to a specific cleaning agent. Cleaning agents in the form of a wipe were wiped across the sample for 10 strokes. Cleaning agents in the form of a spray were given one spray on the sample and then wiped with a clean cloth for 10 strokes. Samples were rinsed between cleanings. Each sample was cleaned three times a day Monday through Friday. During the testing period each fabric sample was cleaned with a disinfectant over 500 separate times.

Samples were reviewed and evaluated at the end of the test period. The evaluation consisted of both a visual inspection comparing each test specimen to the control sample, as well as a tactile inspection. The product samples were examined for change in surface texture, color, and loss of gloss. In addition, each sample was given an ink removal test to determine the efficiency of the stain resistant finish in the product.  All products tested showed no change in surface texture, color or gloss.

Samples were examined under a high power microscope. The examination showed that on some patterns, even after rinsing, there remained a residue of dried disinfectant in the grains of the pattern (see Figure-2 below).

Figure-2

It is still unclear what the long-term effect may be if the active ingredient of a disinfectant builds up on the fabric. Therefore, it is paramount to note that the upholstery should be rinsed with a damp towel or sponge after the application of a disinfectant.

The Mitchell Group continues to advance the understanding of product performance in extreme environments.