While it may have been 107°F in Dallas, the hottest topic at the 2023 Exchange Conference was emerging and high-consequence pathogens. The conference hosted each year by the Association for the Healthcare Environment (AHE), allows for the exchange of evidence-based best practices and solutions. With emerging pathogens continuing to be a top concern for healthcare facilities, staying up to date is critical for Environmental Services (EVS) leaders and Infection Preventionists (IPs) to effectively eliminate the environment as a source of infection. I was fortunate to have the opportunity to present on the implications of cleaning and disinfecting against emerging pathogens in a session titled “Know the Enemy: Deepening Your Understanding of Environmentally Spread Emerging Pathogens.” In this post, I will share some of the key takeaways from this practical session.
6 Challenges with Emerging Pathogens
Emerging pathogens come with their own set of unique challenges. Global changes in recent decades have resulted in increased spill-over from animal to human hosts, often catching us under-prepared. Because of the diagnostic and treatment challenges inherent with a novel pathogen, transmission can go unchecked resulting in outbreaks. Finally, there can be implications for cleaning and disinfecting against a novel pathogen.
Cleaning & Disinfection Implications
Some general considerations as they relate to cleaning and disinfecting against emerging pathogens include:
- Product: For emerging pathogens, it’s imperative to select appropriate disinfecting products. However, because the pathogen is novel, it is not likely that any disinfectant on the market will have claims against it — at least not right away. Adding new claims to an existing product does not happen overnight. It takes about a year to get these claims approved by the US Environmental Protection Agency (EPA). Additionally, some disinfecting chemistries may be more effective than others against a given pathogen. For example, disinfectants with quaternary ammonium compounds (e.g., “quats”) as the only active ingredient have not been found to be effective against Candida auris.1
- Training: Staff will need to be educated, trained, and competent to safely and effectively clean and disinfect against a new pathogen. Consider having a dedicated cleaning team to respond to these pathogens. In addition to Centers for Disease Control and Prevention (CDC) guidance, the National Emerging Special Pathogens Training and Education Center (NETEC) is another great resource.
- Process: There is the need to identify a process for managing the pathogen. For example, protocols should include the personal protective equipment (PPE) to be worn to enter the room, the appropriate disinfectant to be used, and the cleaning frequency. Again, see CDC and/or NETEC guidelines and resources.
- EPA: As the regulatory body over disinfectants, it is essential to be aware of any specific policies, requirements, or resources as they relate to novel pathogens. Some examples include the EPAs Emerging Viral Pathogen Policy and the EPA Disinfectant Lists that should be leveraged to find appropriate products.
Leveraging the Hierarchy of Pathogen Kill by Disinfectants
As guidance from the CDC and EPA may not be immediately forthcoming in the early weeks of the emergence of a new pathogen, it is imperative to have a plan. In the interim before the EPAs Emerging Viral Pathogen policy is activated, I recommend using a sporicidal, like bleach, because it is broad-spectrum against hard-to-kill pathogens. I also recommend creating job action sheets specific to the emerging pathogens of concern. These should describe the roles and responsibilities for each discipline. For example, an EVS Job Action Sheet for Candida auris could include the precautions to be taken and which disinfecting product to use (e.g., EPA List P).
Understanding the EPAs Emerging Viral Pathogen Policy and List Q
It is important to note that the EPA’s Emerging Viral Pathogen policy only applies to viruses. It does not apply to emerging bacteria, fungi, or other pathogens. This policy is activated once the CDC declares an outbreak of the emerging virus. This means that products meeting EPA’s List Q criteria can be used – unless there is a more targeted list – for example, EPA’s List L for Ebola. Many disinfectant manufacturers already have the EPAs Emerging Viral Pathogen claim on some or all of their products, so it is ready to go in the event of a novel virus.2,3
List Q is unique from the other EPA Lists because it does not target a specific pathogen. With this List, the user searches for eligible products for use against an emerging pathogen by selecting the appropriate tier based on virus type. To navigate List Q, the user will need to know whether the emerging pathogen is:
- An enveloped virus (tier 1- the easiest of the 3 types to kill),
- A large non-enveloped virus (tier 2), or a
- A small non-enveloped virus (tier 3 – the hardest of the virus types to kill).
Lastly, it is important to understand that because a given product from List Q meets the criteria for use against one emerging virus (e.g., Mpox), it does not mean this product will be effective against any future emerging viruses. It is designed to be used on a pathogen-by-pathogen basis.4
The 21st century world is being impacted by emerging infectious diseases on an unprecedented scale.5 Preparedness is key to control and containment. Attendance at conferences such as AHE Exchange is one way for EVS leaders and IPs to stay one step ahead of the next new pathogen. We need to be better prepared than we were for COVID-19. Robust and adaptable protocols for cleaning and disinfection are a great place to start.
References
1. Centers for Disease Control and Prevention. Infection Prevention and Control for Candida auris [Internet]. [cited 2023 Aug 14]. Available from https://www.cdc.gov/fungal/candida-auris/c-auris-infection-control.html
2. US Environmental Protection Agency. What is an Emerging Viral Pathogen Claim [Internet]. [cited 2023 Aug 14]. Available from https://www.epa.gov/coronavirus/what-emerging-viral-pathogen-claim
3. US Environmental Protection Agency. Guidance to Registrants: Process for Making Claims Against Emerging Viral Pathogens Not On EPA-Registered Disinfectant Labels [Internet]. [cited 2023 Aug 14]. Available from https://www.epa.gov/pesticide-registration/emerging-viral-pathogen-guidance-and-status-antimicrobial-pesticides
4. US Environmental Protection Agency. Disinfectants for Emerging Viral Pathogens (EVPs): List Q [Internet]. [cited 2023 Aug 14]. Available from https://www.epa.gov/pesticide-registration/disinfectants-emerging-viral-pathogens-evps-list-q
5. Ambat A, Vyas N. Assessment and preparedness against emerging infectious disease among private hospitals in a district of South India. Open Access: Med J Armed Forces India [internet]. 2022;78(1):42-46.