Course Access
Hi all,
I also value the questions and comments from our ID colleagues on this
matter. The need for rigorous and critical consideration of newer
technologies is so important and the right questions so clearly need to
be asked!
On another matter which is largely unrelated but I would value any
comments that either Lindsay, Matthias or any other ASID member might be
willing to make relates to a sporicidal wipe system for disinfection of
non-lumened scopes, which uses a patented chlorine dioxide agents
(Tristel). These wipes are currently being promoted by a company in
Australia and adopted by some centres. I harbour grave concerns in
relation to this product and its use. Would it be possible to have this
request cross-posted to the asid-ozbug members as I wonder what view is
held in this community in relation to this product? Specifically, I
wonder if there is comment that any ID person might make on the use of a
sporicidal agent applied by a “wipe” rather than through an automated
system and the apparent absence or any validation for a
clean/disinfection process?
I look forward to some possible replies/responses
Kind regards
Rachel
Rachel Thomson
Nurse Unit Manager
Infection Prevention & Control Unit
Royal Hobart Hospital
E: rachel.thomson@dhhs.tas.gov.au
________________________________
Behalf Of Gerald Chan
Thanks Matthias for further identifying the many gaps in the eWater
system and their “research”.
It is alarming to note that Austin Health’s approval was not sought
(from its clinical departments) as the company often quotes its use
there in marketing its product.
I have declined their request to allow my organisation’s letterhead to
be used by them for the informal random swabs they’d conducted in our
catering department.
As mentioned to the rep then, there will obviously be a microbial count
reduction noted in the swab results (post-eWater) as we are not dealing
with plain water but either hypochlorous acid/hydrochloric acid or
caustic soda (depending on which tap the “water” is from).
That plus vigorous scrubbing of the surfaces to be swabbed when eWater
was applied.
I think with the discussion points raised, there is an obvious lack of
supporting evidence to pursue a trial at this stage.
Thanks Matthias and Lindsay for your feedback.
Kind regards,
Gerald
Gerald Chan
Coordinator Infection Control
St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150
P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4685
W: http://www.sjog.org.au/murdoch
Murdoch
facebook facebook.com/stjohnofgodmurdoch
twitter twitter.com/sjgh_murdoch
>>> “GRAYSON, Lindsay” 26/06/2012 12:44
PM >>>
Dear All,
Further to Matthias’ email… His point #16 is correct – namely that
neither Infection Control nor Infectious Diseases know anything about
eWater and have never been asked to assess it, let alone approve it!!
Until this email I had never heard of eWater.
Needless to say, we are currently investigating how Austin Health
“approved eWater”, but it was not via any clinical department. I will
report back since it may be a lesson for others.
Thanks Matthias
Kind regards
Lindsay
Prof. M. Lindsay Grayson
Infectious Diseases Department,
Austin Health
Department of Medicine, University of Melbourne
Studley Rd., Heidelberg, VIC 3084
Australia
________________________________
Dear Colleagues,
The topic of the eWater System appeared on both the ACIPC and OzBug
e-mail lists (I overlooked the ACIPC one initially) and I thought it
would be worth writing a somewhat more detailed joint reply to both
lists.
I have previously posted (to ACIPC) on what seemed a similar technology,
the ActiveIon device.
I have looked at some of the available information concerning the eWater
System, and even though I cannot make any final conclusions, I have a
number of questions and issues of concern that I would like to share. If
I were to look at purchasing the device, these would be some of the
points that I would look at more closely.
(1) The description is that the system performs electrolysis of an NaCl
solution and creates two solutions, one a (probably weak) bleach (NaOCl)
and/or hypochlorous acid (HOCl) solution (not sure which one
predominates), the other a sodium hydroxide (NaOH) solution. The bleach
solution — according to the description — is microbicidal and can be
used for disinfection, including disinfection in the food industry, in
hospitals, even hand antisepsis. The NaOH solution — according to the
description — is for cleaning.
(2) The question comes: What would be the difference between using the
eWater system and just buying bleach and/or hypochlorous acid itself,
which are cheap standard chemicals that are easily available?
(3) Has the system been tested by a manufacturer-independent (!)
disinfectant testing laboratory with relevant expertise? Experience
tells us that one cannot solely rely on manufacturer-provided test
reports or manufacturer claims when it comes to disinfectants —
preferable would be at least two independent test reports from
experienced reputable labs.
(4) Has the system been tested by any of the available standardised
testing protocols for surface disinfection (or other types of
application, depending on the intended use)? There are, for example, US
ASTM standards and European EN standards. The EN standard for surface
disinfection is EN 13697, and such tests are typically done in
variations (a) with or without organic load (“dirty conditions”) and (b)
with or without mechanical action (simulating the wiping).
(5) If, for example, antimicrobial activity would fail in the presence
of organic load, then a prior cleaning step would become highly
critical. Organic load is, of course, an issue in the food industry,
where one of the advertising targets lies.
(6) FYI, disinfectant testing and assessment is usually done in two
steps, step 1 is testing in suspension — like the MBC (minimum
bactericidal concentration) for antibiotics – and step 2 is testing
under simulated practice conditions, e.g. surface disinfection on a
carrier.
(7) Has any testing employed experimental controls that — in terms of
biological plausibility — leave no other conclusions than what the
machine produced killed the microorganisms and not (!) some other part
of the application? (In the ActiveIon example, the microbial reduction
achieved by one testing lab was similar to what one would expect from
applying plain inactive water and wiping, but such a control was
omitted).
(8) Is there a way to make sure that the disinfectant concentrations
coming out of the machine are kept consistent and in an antimicrobially
active range to fulfill their purpose? Meaning how are concentrations
monitored and ensured that there is active disinfectant? Is there a
testing method provided to measure the concentrations in daily use (in
analogy to checking fridge temperatures in labs on a daily basis as part
of quality control)? Apparently, electrodes age over time and may
deliver electrolysis less consistently. Is there experience with
stability of not only disinfectant concentration but also microbicidal
activity over the intended period of machine usage (I presume years)?
Also, how long are the prepared solutions stable after electrolysis and
before application?
(9) The company address given on the website is an Australian one, but
it is unclear to me if they are a distributor or the manufacturer. Some
of the documentation appears to be from Japan; this may indicate that
the Australian address may be a distributor.
(10) I saw two “research” publications on the website, both looked like
research papers, but none had proper bibliographic information (journal
name, year, volume, etc.). (I found one of these subsequently, with
journal information, by putting the title into PubMed).
(11) A table on the website showing microbial test results (citing an
article published in Japanese) misspelled quite a number of bacterial
names. If someone claiming to have microbiological expertise is unable
to spell some of the most common bacterial names, this should ring alarm
bells.
(12) On the eWater website, there are three linked documents from RMIT
University (origin: School of Civil Engineering). One is a brief
Executive Summary, another a more comprehensive multi-page document,
another what appears to be a conference poster. The Executive Summary
appears to focus on cost, environmental and social factors, the bigger
document has “report final” in its file name but has oblique “draft”
written over the pages and no authors specified. The microbiology part
is dubious. All three are written in a very positive tone, raising the
question whether they might be industry-sponsored.
(13) The claim that the system can “sterilise” medical instruments
appears unsubstantiated. From a solution like the one described, one
would expect at best (!) high-level disinfection, but not sterilisation.
Even claims for high-level disinfection would have to be substantiated
by standardised testing, and it should be specified what types of
instruments can be treated and under which conditions.
(14) It is proposed to use the electrolysed water for hand hygiene, but
it is unclear to me how it should be useful for that purpose. NaOCl
(bleach) is genuinely unsuitable (!) for hand hygiene, because in higher
concentrations it would be damaging to hands and in lower concentrations
it would take too long to kill microorganisms (alcohol hand rubs produce
several log reduction in about 30 sec). Again, results from standardised
tests would be needed.
(15) The main target is apparently the food industry, but it is also
promoted for hospitals. Even if the product were “only” intended for the
food industry, one would still expect that the system should fulfill
basic claims concerning antimicrobial efficacy. Both industries are
critical in terms of preventing infections.
(16) The company advertises with an endorsement from Austin Health. That
would raise the question whether Austin’s Infection Control Department
and/or Lindsay Grayson’s group has seen and/or endorsed this, or whether
the company only liaised with scientifically untrained personnel, such
as the housekeeping or kitchen department. The latter would be quite
inappropriate. (We had an occasion here where a manufacturer tried to
market a new product by circumventing the Infection Control Committee
and went straight to Housekeeping).
I think that this system should be properly investigated by an
institution or authority with the competency and clout to do this before
it is used in the healthcare and food industry.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387
kkh
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