THE MOST CLINICALLY PROVEN DISINFECTANT WIPE IN THE WORLD

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1 THE MOST CLINICALLY PROVEN DISINFECTANT WIPE IN THE WORLD Patented formula Clinell Sporicidal Wipes come in a stable form that delivers peracetic acid on demand. Peracetic acid is a safe alternative to chlorine and is proven to provide similar or better performance against spores than chlorine 1. Simple and easy to use Just wet with water to activate the dry wipes. No more dilution errors. They do not generate toxic fumes and can be safely used next to patients. The most powerful wipe in the world Clinell Sporicidal Wipes kill most known pathogenic microorganisms with a non-selective action. It has a proven 6 log spore kill, in 1 minute under dirty conditions 2. Proven to outperform other leading Sporicidal wipes 3, based on kill rates and contact times. info@clinell.com Contains detergent Clinell Sporicidal Wipes clean and disinfect. The peracetic acid remains effective in highly soiled conditions unlike chlorine based products which are inhibited by dirt and organic matter. Safe to use on most surfaces Clinell Sporicidal Wipes are CE certified class IIa medical devices. They can be used on most non-invasive medical devices and equipment without corrosion, unlike chlorine solutions. Cost efficient Proven to save costs of 660,000 per annum 4. Proven to be faster Proven to be faster and more effective at reducing spore counts than chlorine solutions 5. CLINELL SPORICIDAL WIPES

2 PROBLEMS WITH EXISTING SOLUTIONS Irregular spray patterns lead to areas of low biocide concentration. Wet wipes always deliver the correct dose. Wet wipes are significantly better at removing microbial bioburden than spray and dry wipe 7. Sprays and wipes When using sprays and dry wipes, it is common to end up with variable concentrations of biocides 6. It has been shown that impregnated wet wipes are significantly better at removing microbial bioburden than when using a spray and dry wipe 7. Studies have shown that low concentrations of biocides can cause microorganisms to develop cross-resistance to antibiotics 8,9. A wet wipe has the advantage of always having a pre-measured dose of biocides at the correct concentration, thereby avoiding the risk of low doses that than can lead to resistance 8,9. Provided there is proper use of efficacious surface disinfectants, avoiding low concentrations of biocides, the present scientific data does not suggest that resistance problems will emerge 10,11. Sprays do not provide even coverage. Inconsistent biocide coverage is ineffective Low biocide concentration may select for resistance. Uniform concentration of biocide with a wet wipe. CLINELL SPORICIDAL WIPES info@clinell.com

3 Two part solution sprays inconsistently mix the biocide delivering variable concentrations of disinfectant. Two chamber sprays and wipes Due to the instability of the active biocide or to prevent degradation over time, dual chamber sprays function by mixing two solutions within the spray head. It is common to use such sprays at an angle to deliver the active biocide. The angle of delivery will affect the amount of solution that is adequately mixed, potentially resulting in the application of a suboptimal (low) concentration of biocide. Spray does not mix effectively More solution from one chamber enters the spray head It is common to use sprays at an angle, to shoot down onto the surface. When using two part sprays at an angle more solution will enter the head from one chamber than the other. This creates an uneven mix which can lead to a suboptimal concentration of biocides. In a laboratory setting the biocide may not be tested from a dual chamber spray bottle, hence the test data may not reflect practical, in-use, conditions. Wasted solution In addition to affecting the efficacy of the biocide, inconsistent mixing increases wastage, reducing the number of uses resulting in increased cost. The final mixed solution of some two part sprays is gel based or produces a precipitate. This gel/precipitate can build up over time clogging the nozzle and inhibiting the spray. Blocked nozzles lead to even greater inconsistency of coverage than usual, resulting in low concentrations of biocides, which can cause microorganisms to develop cross-resistance 12. When used at an angle different quantities of solutions mix. Producing an ineffective disinfectant. Inconsistent mixing wastes solution, reducing the number of uses and increasing costs. 3. Blocked nozzle 4. Wasted solution Inconsistent biocide coverage Some sprays create a gel/precipitate within the spray head, this residue will often block the nozzle. Blocked nozzles reduce the biocidal coverage of the spray. CLINELL SPORICIDAL WIPES

4 PROBLEMS WITH EXISTING SOLUTIONS The molecular structure of the dry wipe can alter the formulation of the disinfectant - by binding certain components and rendering them inactive. Do dry wipes affect your disinfectant? DRY WIPE Active biocide Dry wipe material retains elements of biocide Inactive biocide comes off the dry wipe. Ineffective against microorganisms. WET WIPE Active biocide impregnated into wet wipe Active biocide comes off the wet wipe. Effective against microorganisms. Efficacy testing on disinfectant sprays and solutions has been performed on the liquid. Dry wipes are made of either synthetic or natural materials which can bind to the biocide, changing the concentration of the active disinfectant which is released. This means that the liquid coming off the dry wipe may not be the same concentration as the liquid that went into the dry wipe. For example, it has been shown that the combination of quaternary ammonium compounds (QACs) with an inappropriate type of fabric will effectively abolish its antimicrobial activity 13,14. The efficacy testing of wet wipes is performed on the solution released by the wipe and by measuring the performance of the wet wipe itself. So you know what you are using exactly conforms to the efficacy testing data. Sporicidal wet wipes deliver a consistent, measured dose that is always effective Dry wipes can interfere with the action of common hospital disinfectants 13. CLINELL SPORICIDAL WIPES info@clinell.com

5 CHLORINE SOLUTIONS If a used wipe is plunged back into a bucket of chlorine, organic matter is introduced into the chlorine solution. This increases the breakdown of the active disinfectant. Double dipping When a used wipe is dipped back into the bucket, organic matter (dirt) is introduced into the chlorine solution and this increases the breakdown of the active disinfectant. In addition the incompatibility of cloths and chlorine-based products has been clearly demonstrated 15,16. Chlorine solution is tested in the laboratory for its effectiveness but the testing is not done on the solution in conjunction with the cloth, but only on the solution by itself. Correct dilution level Over diluted solutions are weak and ineffective. Microorganisms survive Correct dilution level Surface Damage damage Under diluted solutions are toxic and can cause damage to materials. The cloth can bind the chlorine and lead to a significant variation in the concentration of effective sporicide released from the cloth. In contrast, with a sporicidal wipe you get a standard consistent dose that is always effective no matter how and when it is used. 3. Organic matter 4. Organic matter Microorganisms survive Organic matter makes chlorine ineffective. Organic matter binds to chlorine, reducing efficacy.

6 WHY CHOOSE CLINELL SPORICIDAL? Improved cleaning and disinfection of room surfaces decreases the risk of healthcare associated infections 28. Effective sporicidal agents Enhanced environmental cleaning with sporicidal agents of rooms housing Clostridium difficile infected patients is warranted 17. Key measures to prevent C. difficile transmission include correct cleaning and disinfection of the surfaces in hospital rooms daily and at discharge using a sporicidal disinfectant. For effective disinfection of C. difficile, a sporicidal product plus correct practices are essential 18. QACs ARE NOT SPORICIDAL The number of chemical agents that possess sporicidal activity is limited to alkylating agents and oxidizing agents, such as peracetic acid, hydrogen peroxide and chlorine, the latter groups display more rapid sporicidal activity 19. Quaternary Ammonium Compounds (QACs) are not sporicidal and are termed sporistatic 20,21,22,23 which means they only inhibit spore germination and/or outgrowth. QACs do not kill spores. HEALTH RISKS CHLORINE TABLETS ARE INEFFICIENT Chlorine solutions, made from powders or tablets break down over time. It is common practice to leave the prepared solution for many hours before using it, therefore at the time of use the solution can be ineffective. Dilution errors can easily occur when preparing chlorine solutions. An error of using too much water when mixing up a solution can result in a disinfectant that is too weak and ineffective. Conversely, using too little water results in a solution that is too strong, toxic and harmful to materials as well as to the user. TOXICOLOGICAL HAZARDS All disinfecting procedures must include a risk assessment of potential toxicological hazards 24. Chlorine solutions, made from tablets and powders, are very toxic to both the user and the patients, emitting toxic, carcinogenic fumes and byproducts. Excessive chlorine use has been shown to cause obstructive lung disease 25, shortness of breath, eye irritation, nasal complaints, cough and skin complaints Toxic fumes from chlorine based solutions can cause the following: Lung damage, including cancer. Eye irritation, nose and throat damagecausing coughs and shortness of breath. Chronic inhalation of chlorine can increase the risk of lung cancer 27 CLINELL SPORICIDAL WIPES info@clinell.com

7 CLINELL SPORICIDAL WIPES Proven to reduce Clostridium 72% 4 difficile associated disease by Peracetic acid generating wipes activated by water, for surface disinfection and cleaning of non-invasive medical devices. SPORICIDAL WIPES Clinell Sporicidal Wipes are a high level disinfectant wipe used specifically to target Clostridium difficile spores. It cleans and disinfects, providing a direct replacement and safe alternative to chlorine products 1,5. Containing patented technology, Clinell Sporicidal Wipes are designed for use on all surfaces of non-invasive medical devices. They are inactive when dry and with the addition of water they generate peracetic acid levels that are proven to kill most known microorganisms. Kills at least % of spores in one minute, in dirty conditions 2 ANTIMICROBIAL ACTIVITY Powerful disinfecting composition using a ph optimised peracetic acid and hydrogen peroxide combination, generated from sodium percarbonate and tetra acetyl ethylene diamine. High power oxidative kill against all microorganisms including non-enveloped viruses and bacterial endospores. Greater than 6 log kill (> %) of spores in 1 minute in dirty conditions 2. Conforms to EN1275, EN1276, EN13704, EN14348, EN14476, EN14561, EN14562 and EN Class IIa Medical Device BACTERIA Acinetobacter baumannii Escherichia coli Pseudomonas aeruginosa Staphylococcus aureus Enterococcus hirae Klebsiella pneumoniae (ESBL) Enterococcus faecalis Enterococcus faecium (VRE) SPORES Clostridium difficile Bacillus subtilis MYCOBACTERIA Mycobacterium terrae FUNGI Candida albicans Aspergillus niger VIRUSES Adenovirus Poliovirus Canine Parvovirus MERS CoV TEST EN14561 EN14561 EN14561 ASTM E EN13704 Bab et al EN14563 EN14348 EN14562 EN14562 EN1275 EN14476 EN14476 EN14476 EN14476 Dry before activation, each wipe consists of 2 non-woven fabrics bonded together with a unique powder combination in the middle layer. Water activates the powder to generate high levels of hydrogen peroxide and peracetic acid. This unique method of application ensures consistent efficacy, with no dilution errors. PRODUCT INFORMATION UNIT OF ISSUE ORDER CODE NHSSC Sporicidal Wipes Pack of 25 CS25 VJT113 Sporicidal Wall Mounted Dispenser for CS25 CS25D - USE DISINFECTANTS SAFELY. ALWAYS READ THE LABEL AND PRODUCT INFORMATION BEFORE USE. ALWAYS FOLLOW MEDICAL EQUIPMENT MANUFACTURERS CLEANING PROCEDURES AND GUIDELINES. info@clinell.com CLINELL SPORICIDAL WIPES

8 Clinell s industry leading aftercare and training services Including a revolutionary training kit, specialised nurse trainers, educational materials, customised posters and dispenser installation. Contact us on: or info@clinell.com. REFERENCES Humphreys P, A systematic evaluation of a peraceticacid-based high performance disinfectant. Journal of Infection Prevention. February, 2013, doi: / Sporicidal efficacy test, Hospital Infection Research Laboratory. May files/data/clinell Sporicidal - Efficacy Test.pdf. 3. Siani H, et al. Efficacy of sporicidal wipes against Clostridium difficile. Am J Infect Control Apr;39(3): doi: /j.ajic Carter Y, Barry D. Tackling C difficile with environmental cleaning. Nurs Times Sep 13-19;107(36): Doan et al. Clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with Clostridium difficile 027. J Hosp Infect Aug Sattar, S.A. and J.-Y. Maillard, The crucial role of wiping in decontamination of high-touch environmental surfaces: Review of current status and directions for the future. Am J Infect Control, (5, Supplement): p. S97-S Panousi M et al. Evaluation of alcohol wipes used during aseptic manufacturing. Lett Appl Microbiol May;48(5):648-5 doi: /j X x. Epub 2009 Feb Maillard JY et al Emerging bacterial resistance following biocide exposure: should we be concerned? Chemica Oggi. 2009;27(3): Karatzas KA, et al. Phenotypic and proteomic characterization of multiply antibiotic-resistant variants of Salmonella enterica serovar Typhimurium selected following exposure to disinfectants. Appl Environ Microbiol Mar;74(5): DOI: /AEM Gebel J et al. The role of surface disinfection in infection prevention. GMS Hyg Infect Control, Vol. 8(1), ISSN Meyer B, Cookson B. Does microbial resistance or adaptation to biocides create a hazard in infection prevention and control? J Hosp Infect Nov;76(3): DOI: /j.jhin Maillard JY et al Emerging bacterial resistance following biocide exposure: should we be concerned? Chemica Oggi. 2009;27(3): Bloss R et al. Adsorption of active ingredients of surface disinfectants depends on the type of fabric used for surface treatment. J Hosp Infect. 75 (2010) Engelbrecht, K., et al., Decreased activity of commercially available disinfectants containing quaternary ammonium compounds when exposed to cotton towels. Am J Infect Control, 2013, Epub ahead of print(0). 15. Goldsmith MT, Latlief MA, Friedl JL, Stuart LS. Adsorption of available chlorine and quaternary by cotton and wool Fabrics from disinfecting solutions. Appl Microbiol 1954;2: Wren MW, Rollins MS, Jeanes A, Hall TJ, Coe n PG, Gant VA. Removing bacteria from hospital surfaces: a laboratory comparison of ultramicrofibre and standard cloths. J Hosp Infect 2008;70:265e7 17. Weber et al. Role of the environment in the transmission of Clostridium difficile in health care facilities. Am J Infect Control May;41(5 Suppl):S doi: /j. ajic Cadnum et al. Transfer of Clostridium difficile Spores by Nonsporicidal Wipes and Improperly Used Hypochlorite Wipes: Practice + Product = Perfection. Infect Control Hosp Epidemiol Apr;34(4):441- doi: / Maillard, J.Y., Innate resistance to sporicides and potential failure to decontaminate. Journal of Hospital Infection, (3): p McDonnell, G., Antisepsis, disinfection, sterilization - types, action and resistance. 2007, Washington, D.C.: ASM Press. 2 Russell, A.D., Assesssment of sporicidal efficacy. International Biodeterioration & Biodegradation, (3 4): p Russell, A., Bacterial spores and chemical sporicidal agents. Clinical Microbiology Reviews, (2): p Siani, H., C. Cooper, and J.-Y. Maillard, Efficacy of sporicidal wipes against Clostridium difficile. American Journal of Infection Control, (3): p Gebel J et al. The role of surface disinfection in infection prevention. GMS Hyg Infect Control. 2013, Vol. 8(1), ISSN Sastre J et al. Airway response to chlorine inhalation (bleach) among cleaning workers with and without bronchial hyperresponsiveness. Am J Ind Med Apr;54(4): doi: /ajim.2091 Epub 2010 Oct LoVecchio F et al. Outcomes of chlorine exposure: a 5-year poison center experience in 598 patients. Eur J Emerg Med: June Volume 12 - Issue 3 - pp Jappinen P et al. Cancer incidence among pulp and paper workers exposed to organic chlorinated compounds formed during chlorine pulp bleaching. Scand J Work Environ Health Oct;17(5): Weber et al. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis Aug;26(4): doi: / QCO.0b013e f04. GAMA Healthcare Ltd., 2 Regal Way, Watford, Hertfordshire, WD24 4YJ. T: +44 (0) E: info@gamahealthcare.com JBN