A California blood banker would like to know if anyone has experience using an alternative to 10% bleach to disinfect equipment and countertops. One of the staff members of her hospital transfusion service is very sensitive to bleach and requests that an alternative disinfecting method be made available. The inquiring blood banker is hoping that an e-network colleague will provide some non-bleach options.

The following replies were submitted in response to the above question.

1. Editor's note:  When considering a switch to any of the following non-bleach disinfection methods for transfusion service equipment and/or countertops, etc., it would seem prudent to validate the non-bleach disinfecting method to ensure it meets federal, state and local regulations and is appropriate for the intended use.

2. A Canadian reports that there are many good alternative disinfectants available for use in a laboratory, and that at her blood center (in a major Canadian city) they also have concerns regarding bleach, including its interactions with some of their sensitive test methods, as well as the fact that bleach is corrosive to stainless steel. They have adopted a hydrogen peroxide based disinfectant. The formulation (by Virox Technologies) is based on a stabilized, pH-controlled version of hydrogen peroxide. According to the Canadian, in working concentrations the disinfectant is effective against vegetative bacteria, enveloped and non-enveloped viruses, and fungi, and is suitable for level 2 lab applications such as a clinical blood bank. She lists the following advantages of this type of disinfection method:

• stable for 30 days at working concentrations (no need to make up daily)
• non-toxic, non-corrosive, very low odor (slightly sour)
• environmentally friendly, breaks down to water and oxygen
• non-corrosive to stainless steel
• reasonably priced

The only disadvantage of this disinfectant that the Canadian mentioned is that it lacks stain-removing ability. For example, a blood spill on a bench would be completely removed by bleach, but not necessarily by the hydrogen peroxide-based disinfectant. It depends on the kind of counter materials used; their counters are rather porous. Finally, the Canadian reports that this disinfectant has been approved for the foregoing intended use by Health Canada, but she is unaware of its status in the US.

3. A blood banker from Chula Vista, California, reports that at her hospital they have been using an antimicrobial wipe for several years now. The wipe that they use is called "Super Sani-Cloth" germicidal disposable wipes made by Nice-Pak Products (Orangeburg, New York 10962-1376; phone # 800-999-6423; catalog # Q55172). The active ingredients include isopropyl alcohol and n-alkyl dimethyl ethylbenzyl ammonium chloride. The disinfectant comes in a container that looks much like those used for baby wipes.

4. A blood banker from Kelowna, BC, Canada reports that she works with two co-workers who have asthma, and as a result, they have looked for alternative disinfectants to bleach. They have settled on a disinfectant called ENDBAC 256 DISINFECTANT CLEANER (pdf MSDS). According to the Canadian, this disinfectant is stable in a diluted form for one year, provided it is in a closed container. The Canadian reports that the chemical has a very mild mint smell, leaves no film residue, is inexpensive, and dries quickly. Because her hospital has a no scent rule and is very conscious of allergens, it is her hospital's approved disinfectant.

5. Some additional links to consider (list not intended to be fully comprehensive) are displayed below:

• http://www.clareys.com/safetyline/wipesandointments.html
• http://www.firstrespondersupplies.com/wipes.htm
• http://www.hmark.com/ems/disinfectants.html
• http://www.wexfordlabs.com/downloads.htm

The e-Network Forum is encouraged to submit additional links for the above list.

ADDENDA Dec. 8, 2002

6. A medical technologist in Ohio, (whose institution's football team will try to beat the Miami Hurricanes in the Fiesta Bowl on January 3, 2003), warns that laboratories should not be using bleach in equipment that is used for serological testings, because some blood group antigens are sensitive to clorox, even clorox vapors (i.e., the S antigen; see the abstract by Rygiel SA, Issitt CH, Fruitstone MJ. Destruction of the S antigen by Clorox, that appeared in Transfusion 1983;23410). The Ohio technologist adds that even with extensive rinsing with distilled water, residual clorox remains in the equipment. Secondly, the technologist is concerned that more and more equipment is being made with plastic parts and rubber gromets, and that these plastic parts and rubber gromets are very sensisitive to clorox, become brittle and can subsequently break during operation. This not only is a potential operator safety issue, but leads to increased preventative maintenance and repair costs. The Ohio technologist has added another contact to the list of bleach alternatives - Wexford Laboratories , which makes two products, Wexcide and Thymocide (on their list of products, as PDF files).

Editor's NOTE: As suggested before, each laboratory must do its own due diligence before implementing any new system in the clinical laboratory, including new systems for maintaining the cleanliness of equipment, table tops, etc.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator