DISINFECTION 239
PRACTICAL USES
This final section brings together some of the data presented
in the preceding sections, and also provides information in
certain specific instances. Disinfectants will be considered
from two points of view, first their medical, and second their
nonmedical uses. Some brief information on antiseptic and
preservative use will also be supplied.
Medical Uses
The use and choice of disinfectants in hospitals have been
extensively considered in the last decade in Britain by a spe-
cial committee (Report, 1965) set up for this purpose. Our
comments here are thus based on the recommendations of this
report and on the findings presented by Kelsey and Maurer
(1967). The Report (1965) recommended that two classes
of disinfecting agents were needed, (a) for general disinfec-
tion and (b) for surface disinfection of clean objects. Agents
for general disinfection should have a wide spectrum, and at
appropriate dilutions should remain active in the presence of
organic matter; the main purpose of such disinfectants, e.g.,
phenolic disinfectants based on coal-tar acids, is not neces-
sarily to kill all bacteria but to ensure that an object is free
of significant numbers of organisms. Chemicals for surface
disinfection must be quick-acting, have a wide spectrum, be
non-harmful to materials and leave no objectionable odours.
Such disinfectants, e.g., hypochlorites, should be used for
the rapid disinfection of clean surfaces such as trolley tops,
kitchen tables and clinical thermometers.
Kelsey and Maurer (1967, 1972) have presented a list
of the steps to be taken in drawing up a policy for the use
of general purpose disinfectants in hospitals, and among the
points they make is the non-usage of disinfectants in cer-
tain cases, especially where sterilization is the objective or
where other more reliable means are available. For further
information, see Lynn (1980), Ayliffe and Collins (1982)
and Lowbury (1982). Preoperative disinfection of the skin
(including surgeon’s hands), disinfection of operation sites
and topical prophylaxis, i.e., antisepsis in burns, are dis-
cussed by Lowbury (1982). Ayliffe and Collins (1982) pro-
vide a rational approach to hospital disinfection.
Nonmedical Uses
The main nonmedical uses of disinfectants occur in the
food, dairy, brewing and fermentation industries (Foster
et al. , 1958; Frazier, 1967). The maintenance of equipment
for use in these industries in a proper sanitary condition
cannot be overemphasized. This therefore means that the
cleaning of such equipment is of considerable importance,
since the presence of organic matter can reduce or virtually
eliminate the effect of many disinfectants (page 164). In the
dairy industry, milk stone—resulting from milk drying on
equipment, and thus consisting of fat, protein and minerals—
and milk film are a well-known problem in disinfection
(Clegg, 1967). Chemicals which are of use against micro-
organisms in liquid suspension in laboratory tests may be of
little use against such organisms on a soiled surface if they
are poor detergents (Cousins, Hoy and Clegg, 1960).
To counteract the unwanted effects of organic matter,
one of the following two methods may be employed (see
also Davis, 1972a,b and BSI 1977):
1) detergent first, followed by a disinfectant;
2) combination of detergent and disinfectant (this
corresponds to a sanitizer, or to the detergent-
sterilant of Davis (1968), as described in the
Introduction).
Harris (1969) stresses the need for using two operations,
i.e., the use of cleaning before disinfection. Cleaning is the
first essential in the sanitary care of food equipment, and
approximate sterility the last (Foster et al. , 1958). Steam
under pressure is an obvious method of sanitization, but
this is limited only to closed systems which can withstand
pressure (Frazier, 1967). Theoretically, separate procedures
would be expected to give a better result (Clegg, 1970),
because of the inactivating effect of organic matter on disin-
fectants; however, a finding made several years ago (Neave
and Hoy, 1947) suggests that a detergent-disinfectant com-
bination would be of greater use, because “the effect of the
detergent on milk solids more than outweighs the effect of
milk residues inactivating the disinfectant” (Clegg, 1970).
An effective detergent should dissociate organic and inor-
ganic solids, emulsify, saponify or suspend grease, fats and
oils, have good wetting ability, be easily rinsed and be non-
corrosive (Olivant and Shapton, 1970). Detergents are thus
of considerable importance in this field, because they can
also be responsible for the mechanical removal of bacteria
(Gilbert, 1969). The most commonly used detergents are
strong and mild alkalis, alkali salts, strong acids, anionic
alkyl sulphates and aryl sulphonates and non-ionic conden-
sates (Davis, 1968). An excellent descaling agent is nitric
acid which can be used hot at concentrations of 0.25–0.5%
or cold at 0.5–1%, and which is, in addition, a powerful
disinfectant. It is, however, less effective than alkali in the
removal of hardened protein films, and is normally employed
with a corrosion inhibitor. In actual fact, many detergents are
good disinfectants and vice versa, e.g., a detergent such as
sodium hydroxide possesses considerable germicidal power
(Whitehouse and Clegg, 1963), whereas hypochlorites have
a useful detergent effect by disintegrating protein matter
(Davis, 1968). Cleaning is an essential first part in high-
speed food and beverage processing plant, and considerable
economic benefit is achieved as a result of the production of
stable liquid detergents and disinfectants which can be deliv-
ered by tanker and then distributed to the cleaning areas by
pipeline (Hill, 1969). However, even with good precleaning,
traces of inactivating protein material may remain on equip-
ment, and it is thus important to choose a disinfectant which
has a high protein tolerance (Harris, 1969). The design of
equipment to facilitate cleaning must also be stressed, and
stainless steel is an obvious example, with glass pipelines to
give a high degree of visual cleanliness (Harris, 1969).
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