The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

PRECIPITATE FORMATION SIGNIFICANTLY INCREASED COST OF HIGH-LEVEL DISINFECTION.

Pam Leisenring, Tom Leisenring, Gary R. Lowe; Respiratory Care Services, Arkansas Children’s Hospital, Little Rock, AR

Introduction: High-level disinfection solutions (SOLN) are commonly used in hospitals for cleaning medical equipment. We changed from 2.4% gluteraldehyde (GLU) to ortho-phthalaldehyde (OPA) due to a shorter soak time (GLU–45 minutes/OPA–12 minutes). Both SOLN are supposed to remain viable for 14 days of use. The change would save therapist time and produce faster equipment readiness. Unexpectedly, we experienced adverse issues with the OPA product. Methods: With the first use of OPA, Pulmonary Lab staff noted white specks in the solution at ~5 days and a copious precipitate (PREC) two days later. The OPA was deactivated and disposed of. The second use of OPA formed the same PREC at 5 days. The manufacturer advised it could be a reaction to residual organic material, ammonia, or hard water and recommended disposal of any PREC solution as a precautionary measure. Over the next 50 days, PREC formed at an average of every 5.56 days (~40% of the expected 14-day use). With unsuccessful resolution over 50 days, we stopped using OPA. We followed up with three 14-day trials using 3 different basins containing OPA: one new stainless steel bowl (Basin 1), one clean used stainless steel bowl (Basin 2), and one clean used plastic cleaning bin (Basin 3). All bins were covered with acrylic lids and kept under a ventilation hood. No cleaning occurred in these basins which were observed for PREC formation. Results: Trial 1-PREC in Basin 1-Day 9 & Basin 2-Day 10; Basin 3-none. Trial 2-PREC in Basin 1-Day 6 & Basin 2-Day 12; Basin 3-none. Trial 3-No PREC in Basin 1 or 2, appeared in Basin 3-Day 9. All passed effectiveness testing throughout the trials. Conclusion: The change from GLU to OPA was projected to increase annual costs ~ $1335. This was justified in time saved for disinfection and quicker equipment readiness. However, we found used OPA formed a PREC at an average of every 5.56 days. Five of nine unused solutions formed PREC before Day 14 for no discernible reason. We followed the manufacturer’s recommendation to dispose of OPA with PREC more than doubling our cleaning expense. Projected cost to neutralize and replenish used OPA every 5.56 days vs. 14 days would be ~$5,796 more per year with OPA. A second cleaning room in our department had comparable PREC formation. Projected annual cost for both areas would be ~$11,592 more than GLU. Unable to identify a specific cause for the PREC formation or to find a correctible solution, we discontinued use of the OPA. Sponsored Research - None