Healthcare

The CDC, APIC and OSHA guidelines recommend using bleach as a broad spectrum germicide to disinfect surfaces contaminated by blood spills and hard-to-kill pathogens such as C. difficile spores and norovirus, both of which are quite resistant to disinfection by quaternary ammonium compounds (QACs). For resistant organisms and surfaces that are highly soiled, the CDC recommends a 1:10 dilution of 5.25% – 6.15% bleach (5250 ppm – 6150 ppm sodium hypochlorite solution).

Clorox^® ready-to-use bleach products meet these guidelines for surface disinfection and are formulated at or above the recommended 1:10 concentration. To adhere to our high standards and yours, our proprietary purification processes maximize product shelf life, so you can trust Clorox^® products to be effective.

Bleach is not only an effective disinfectant but it is also widely used. 8 out of 10 hospitals use bleach to kill pathogens of most concern in their facilities. Clorox^® bleach products are used by five of U.S. News and World Report's Top 10 Most Influential Hospitals.

The following Clorox^® bleach disinfecting products are EPA-registered to be fast and effective against the following organisms, including C.difficile. You can count on these Clorox^® bleach disinfecting products to deliver the results you need.

	Contact Time
Effective against:	Clorox® Germicidal Wipes	Dispatch® Hospital Cleaner Disinfectant with Bleach	Dispatch® Hospital Cleaner Disinfectant Towels with Bleach
C.difficile spores	5 min	5 min	5 min
Bacteria	30 sec	1 min	1 min
Viruses	1 min	1 min	1 min

Sodium hypochlorite’s mode of action differs from that of QACs and, in general, it is effective against a broader range of microorganisms and has lower contact times than many QACs. While bleach tears apart the microbe’s cell walls and deactivates proteins required for bacterial growth (by destroying the molecular structure), QACs act on cellular membranes and exhibit more variability in effectiveness by organism type.

A strong oxidizer, bleach reacts with nucleic acids (DNA/RNA), lipids and fatty acids associated with the cell membrane and destroys the cellular activity of structural and functional proteins. There is no evidence of bacteria or viruses developing resistance to the powerful oxidizing action of bleach when used at recommended dilutions.

By contrast, quaternary ammonium compounds must cross the microbe’s cell membrane to render it inactive. The components of the cell membrane vary by organism type and can inhibit the effects of QACs. QACs take longer to affect the cell than bleach. In the laboratory, some bacteria have developed resistance mechanisms to QACs over time.

CONCERN: My staff does not like using bleach due to concerns about the odor.

FACT: Clorox understands that bleach's odor and the risk of respiratory irritation are concerns to those who use bleach. There are several reasons your team can use bleach with confidence:

1. Multiple leading hospital studies noted that when patient and Environmental Services' personnel were exposed to bleach, little or no concern about the odor of bleach was expressed.:
   • A Mayo Clinic (Rochester) study (abstract presented at APIC 2010) indicated only 8.8% of patients noticed the smell of bleach when it was used in their room; of this number, none found the odor bothersome.¹
   • At Barnes-Jewish Hospital (St. Louis), an 18-month study was conducted demonstrating 1:10 bleach's efficacy against C. difficile spores. The authors noted that "During the study, patients, family and staff did not complain about the odor of bleach."²
   • At Cleveland Veterans Affairs Medical Centers, during a five-and-a-half month study involving routine use of 1:10 bleach with documented decreases in C.difficile incidence, authors reported that "EVS reported no surface damage or complaints due to use of bleach."³
2. Bleach's odor is caused by the chemical reaction that occurs when bleach begins to break down proteins, such as those that make up HAI-causing pathogens.
3. When bleach is used as directed, the hypochloric acid emitted by are lower than recognized levels that cause respiratory irritation and below the EPA's occupation exposure limits for chlorine. In fact, when bleach disinfectants are used as directed, the perceivable sensory irritation occurs at 1.0ppm in the air, which is 500 times the odor threshold during regular use.⁴

CONCERN: Using bleach will damage equipment and surfaces.

FACT: Bleach's effect on surfaces is caused by two factors:

• The oxidizing action of hypochlorite on these surfaces.
• The salt that is left behind after using bleach. Over time, the salt buildup can scratch and damage surfaces.

To minimize hypochlorite's impact on surfaces, Clorox^® bleach products are specially formulated with anticorrosion agents. To ensure that salt buildup does not cause surface damage over time, wipe down these surfaces after disinfecting with a fresh, clean, damp cloth.

When used as directed, Clorox^® bleach products are safe to use on a variety of hard, nonporous surfaces, including stainless steel, plastics, glazed ceramics, glass, porcelain and other materials. Use bleach with confidence to clean and disinfect many surfaces such as bedrails, tables, equipment surfaces, countertops, floors, toilets, sinks, trash cans, desktop keyboards, telephone receivers, light switches, desks and mobile devices such as IV stands, carts and glucometers.

CONCERN: All bleach is the same.

FACT: Compare your current bleach to the Clorox^® portfolio of bleach-based products.

	Clorox® Germicidal Bleach 6.15% NaOCI	Clorox® Germicidal Wipes 0.55% NaOCI	Dispatch® Spray 0.65% NaOCI	Dispatch® Towels 0.65% NaOCI
EPA-registered hospital disinfectant
Ready-to-use, one-step cleaner disinfectant
Approved for instrument pre-cleaning and disinfection of noncritical instruments
EPA-registered to kill C. Difficile spores (at a 1:10 dilution)
Ready-to-use formulation with similar 1:10 dilution recommended by CDC for use against C. Difficile spores and other emerging pathogens
Short contact times required to achieve broad-spectrum disinfection
Mercury-free manufacturing process
Proprietary formulation process to maximize shelf life

CONCERN: Bleach contaminates our groundwater.

FACT: The bleach cycle – from production to use to degradation – is simple and sustainable. It begins and ends with sodium chloride (common table salt), which is converted to bleach through electrolysis and combination with water, chlorine and sodium hydroxide. Clorox does not purchase sodium hydroxide or chlorine that is manufactured with the mercury cell process. This eliminates a source of mercury contaminants found in some bleach products.

During use and disposal, 95% to 98% of bleach rapidly breaks down back into salt and water. The remaining byproducts are effectively treated by municipal wastewater and septic systems. Bleach does not contaminate groundwater because it does not survive sewage treatment, either in municipal sewage treatment plants or in septic systems. No dioxins are formed.

¹ Kimberly Aronhalt, BSN, RN, Infection Preventionist, Mayo Clinic, Rochester, Minn. Patient and Environmental Service employee satisfaction and tolerance of using germicidal bleach wipes for patient room cleaning to reduce transmission of Clostridium difficile infection
² Mayfield JL et al. Clinical Infectious Diseases 2000;31:995-1000
³ Eckstein BD et al. BMC Infectious Diseases 2007,7:61
⁴ EPA 1999. “Toxicology Profile for Chlorine”, ASTDR, USDHHS, September 2007