Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008

William A. Rutala, Ph.D., M.P.H., David J. Weber, M.D., M.P.H., and the Healthcare Infection Control Practices Advisory Committee (HICPAC)

Frequently Asked Questions

Question: How should readers interpret the recommendation about contact time for disinfectants used on noncritical items? There seems to be a disconnect between the label instructions and what the studies show.

In order to get EPA clearance of the CDC Guideline it was necessary to insert the sentences "By law, all applicable label instructions on EPA-registered products must be followed. If the user selects exposure conditions that differ from those on the EPA-registered product label, the user assumes liability from any injuries resulting from off-label use and is potentially subject to enforcement action under FIFRA". There are several points that should be made about this apparent disconnect between label instructions and what studies show to include:

1. multiple scientific studies have demonstrated the efficacy of hospital disinfectants against pathogens causing healthcare-associated infections with a contact time of at least 1 minute;
2. the only way an institution can achieve a contact time of 10 minutes is to reapply the surface disinfectant 5-6 times to the surface as the typical dry time for a water-based disinfectant is 1.5-2 minutes and currently, healthcare facilities like UNC Health Care are achieving surface disinfection of non-critical patient care items and environmental surfaces by one application of a disinfectant and requiring a >1 minute dry time;
3. equally important as disinfectant contact time is the application of the disinfectant to the surface or equipment to ensure that all contaminated surfaces and non-critical patient care equipment are wiped as current studies demonstrate that only approximately 50% of high-risk objects are cleaned at terminal cleaning;
4. there are no data that demonstrate improved infection prevention by a 10 minute contact time versus a 1 minute contact time; and
5. we are not aware of an enforcement action against health care facilities for "off label" use of a surface disinfectant.