This week, we have special content from the SimGeeks podcast. SimGeeks is a podcast about medical simulation from William Belk and David Shablak. Episode 10 is about cleaning and disinfecting simulation equipment in the age of coronavirus. Will and David welcome special guest Nick Brauer. The following is a summary of the podcast. For the complete recording, listen here.
David and Will did a lot of research about CDC terminology, so let’s start with the basics. “Several points really jump out at me” from the CDC guidelines, says David. “One of the things, according to the CDC, is the difference between cleaning and disinfecting.”
Cleaning is the act of removing dirt, germs, and impurities from the surface of something. Cleaning does not kill germs – simply removes them. However, removing germs lowers the risk of spreading infection, which in turn should lower rates of infection.
Disinfection after cleaning refers to the use of chemicals that are registered by the Environmental Protection Agency (EPA) to kill germs and viruses on the surface of materials. “The difference is that cleaning is taking off surface debris, mud, dirt, dust, and trying to remove viruses and bacteria…. Disinfection afterwards is the killing of [viruses, germs, and bacteria].”
Will adds an important note to these observations. “What we are dealing with [in the COVID-19 pandemic] is a virus.” To review, viruses are smaller, and are genetic material, not independently living organisms, the way bacteria are.
Neither antibiotics nor antibacterials work on viruses. Although antivirals exist, they are specific to certain viruses, not broadly applicable the way antibiotics are. Will says, “When we are talking about disinfecting and cleaning, the difference between bacteria and viruses is important as well.”
EPA-Registered Cleaning Chemicals
The EPA created a list, called the List N, regarding what is effective for disinfecting and killing many types of germs and viruses; it’s about 31 pages long. However, David filtered List N down to disinfectants specifically for COVID-19, also called SARS-CoV-2.
Be sure to search for what surface the disinfectants are effective on. “There is a huge difference between a hard, non-porous surface and a fabric or porous surface,” says David. “Out of the 140 products on that list that will kill and disinfect [COVID-19], there were only about five that will work on a non-porous surface, and most of those are a laundry pre-soak.”
The top three main chemicals in the cleaners David noted on this list are:
- Quaternary ammonium, which is NOT the same as ammonia
- Sodium hypochlorite, the main component of bleach. The CDC suggests 1000 PPM in solution, which is 1/3 cup bleach to one gallon of water
- Hydrogen peroxide
“When you’re looking for a disinfectant coming back into your sim centers, when you’re looking for a deep clean product," says David, "the key is to start with soap and water and then go with something on this list that has a good disinfectant.”
Another common disinfectant is isopropyl alcohol, and an effective base for that is about 70 percent alcohol and 30 percent water. “The water content keeps the alcohol from evaporating off the surface too fast,” says David. “With all of these chemicals, you want to look at contact time, or dwell time.”
Dwell time is the amount of time needed to leave the chemicals on the surface in order to kill the virus. In order for a disinfectant to be effective, it needs to spend time on the surface. David points out, “You can’t just spray it, wipe it off, and go.” List N will have dwell time guidelines; usually it’s about one minute.
Manikins and Task Trainers
Nick Brauer offers a blog post at the SimGHOST site about cleaning and disinfecting manikins, task trainers, and other equipment found in well-equipped simulation labs and sim centers. The list includes a number of the most popular vendors in simulation equipment.
“I encourage everyone to dig and read the [user] manuals” that come with manikins, says Nick, “or contact the vendors directly.” General guidelines:
- Use soap and water to clean the exterior of manikins
- Do not submerge manikins or equipment
- Most of the manikin companies recommend starting with soap and water to clean and 70% isopropyl alcohol to disinfect
Because of the way the virus is constructed, soap and water will dissolve the lipid layer surrounding it. “It doesn’t disinfect or kill it,” Nick says, “but it does help dissolve it and wash it away.”
Will says that it’s clear by staying home, people will not be spreading the virus. When it’s time to go back to work and go back into sim centers, while it’s unlikely the virus will be lingering on any surfaces, it’s best practice to completely clean and disinfect the areas.
“Before we start scheduling labs, before we start scheduling classes, we need to plan a day or two that’s just going to be cleaning,” Will says. “Sweep, mop, vacuum; use household cleaners and bleach solutions to wipe your counters and mop your floors. Make sure you get the doorknobs. Promote hand washing.”
Will also encourages people to be careful while cleaning. Use gloves and masks, if possible, and make sure the space is well-ventilated. Quaternary ammonium, especially, can be harmful to skin and lungs if precautions aren’t taken.
Effective hand washing, proper donning and doffing of PPE, and proper use of soaps and disinfecting chemicals will not be going away any time soon, Will points out. The demand will remain high.
Go to the podcast for more tips, tricks, cleaning electronics, and some important notes about UV light. Thanks to SimGeeks Podcast for giving SimTalk Blog permission to repurpose their content. Don’t forget to tune in, subscribe, and rate their podcasts. They are doing great work.
About SimGeeks: The goal of SimGeeks Podcast is to address all things simulation in a relaxed and entertaining format. Belk and Shablak want to create a place for listeners to discover new simulation topics and make new friends. Belk is an education manager who specializes in simulation for EMS and air medical providers. Shablak, NRP, CHSOS has been a "Sim Tech" for over eight years in an EM residency, and recently moved to Orbis Education to an ABSN Nursing program in Cincinnati.
Nick Brauer, a special guest in this episode, is the Vice President of SimGHOSTS and a Simulation Specialist at the University of Tennessee Health Science Center.
SimGeeks Podcast is available on iTunes and Spotify, as well as many other podcast platforms. Give them a listen, share with others, and rate them! The Gathering of Healthcare Simulation Technology Specialists (SimGHOSTS) is an international organization based in the United States dedicated to supporting individuals and institutions operating medical simulation technology. Brauer authored a blog post on this topic, “Medical Simulation Equipment Cleaning Protocols.”