CLEANING AND DISINFECTION ADVISORY NOTE

REF NO: 035

VIRUSOLVE®+
Guidelines for Fogging
INTRODUCTION:
This document has been developed in accordance with current applicable infection control
and regulatory guidelines. It is intended for use as a guideline only. At no time should this
document replace existing documents established by the facility unless written permission
has been obtained from the responsible facility manager.

The overall goal of infection prevention practices is to eliminate the risk of the transmission of
pathogens between individuals including health care workers..

This advisory note sets out information and guidance on the correct protocol for the application of
VIRUSOLVE+ disinfectant cleaning solution using fogging equipment.

CLEANING PRODUCTS:

Virusolve+
Use dilution: 5% solution of Virusolve+ concentrate in clean water.
Note: A ready-to-use solution at 5% strength is also available from Amity

Dilution of Virusolve+

1. Preparation of working solution: Pre-mix and label from a controlled location Virusolve+ at a
dilution of 5% (1 part chemical to 19 parts water), (equivalent to 1:20 or 1part in 20). Use
potable tap water at between 18 and 30 °C for this purpose.
2. Place mixed solution in either a labelled, flip-top 1 Litre bottle or a small hand bucket.

Application:
Virusolve+ diluted to 5% is suitable for the disinfection and cleaning of heavily soiled surfaces
including surface contaminated with body fluids including blood.

Hand cleaner

Infection
Controlled
Certificate No. GB06/69741 Certificate No. GB06/69740 Certificate No. GB06/69739
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Hand Hygiene Products
Liquid soap and/or alcohol-based hand rubs or gels should be used for all routine hand
decontamination.
Liquid soap should be in a wall-mounted dispenser, and preferably elbow operated. The
dispenser should be regularly maintained, and should be cartridge filled, using individual
cartridges that can be discarded when empty, to avoid cross contamination of the soap.
Bacteria can grow in bar soap, which can then become a reservoir and source of infection. Bar
soap may be used by individual residents for their own use but not by healthcare staff.
The choice and sitting of alcohol based hand products (Virusan and Virusan AS) in the facility
should be subject to risk assessment that is, it should be user friendly and of no risk to vulnerable
individuals

Antiseptic hand wash using active materials such as chlorhexidine 4% (e.g. Virusan and
Virusan AS), can provide a residual activity on the hands following hand-washing and is useful
when an increased level of hand decontamination is necessary.
Virusan and Virusan AS both contain components that help replenish the natural skin oils.

RULES OF CLEANING AND DISINFECTING

Appropriate personal protection must be used for those responsible for the decontamination of a
room or area when using fogging equipment.

Protective Barriers:

1. Disposable gloves – nitrile, latex, vinyl, neoprene

2. Protective apron
3. Wet suit
4. Full face mask or Visor
5. Respiratory protection – breathing mask, liquid aerosol protection type (particle filters marked
SL)

Disposable Gloves
Since June 1998, examination gloves have been classified as a medical device. This means that
they must comply with European law, regardless of the material from which they are made, and
carry a ‘CE’ mark, which demonstrates that safety and product performance have been
monitored.
They should conform to BS EN 455 Parts 1, (freedom from holes), 2, (requirements and testing
for physical properties, and 3, (requirements and testing for biological evaluation).
• A risk assessment should be carried out prior to glove use, in order to determine the best
size and type of glove. Gloves must be worn for any contact with blood or body fluids,
secretions, excretions, non-intact skin, and mucous membranes.
• Gloves must be assessed for the nature of the task to be undertaken, such as sterile or
unsterile use.
• Staff should be instructed in the use of gloves, in terms of putting on, taking off, and
appropriateness of use.
• Gloves should be single use, well fitting, and powder free. The glove material of choice
must be carefully considered:

Natural rubber latex (NRL) is biodegradable, combustible, has good sensitivity, and due to its
non-permeability, is an excellent barrier against blood borne viruses.
However, it is also listed under COSHH as being a hazard to health, as it can cause an allergic
response ranging from mild dermatitis, to severe anaphylactic shock.
There are many components such as vulcanising agents, accelerators, preservatives, colorants,
and a host of other processing aids, used in the manufacture of NRL gloves. When these are
exposed to the naturally occurring proteins found in NRL, allergy and sensitisation can occur.
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Latex allergy is both a serious condition in latex allergic patients and clients, and a significant
occupational health problem.
However, if latex gloves are used the following applies:
1. A risk assessment, regularly reviewed and documented, assessing the potential/actual
latex sensitivity status and skin condition of the worker, must be carried out.
2. Similarly, residents should be assessed on admission for potential latex sensitivity
(previous history, specific IgE testing, etc).
3. Latex gloves must not be powdered, and must be low protein (less than 50mcg of protein
per gram of rubber).
4. There should be a latex allergy policy within each care home, with clear monitoring and
reporting systems, information about latex allergy, product lists, and alternative
protection.

Neoprene and Nitrile gloves are often used as an alternative to NRL, where there is a high risk
of exposure to blood and body fluids (e.g. dentistry, surgery), or as an alternative for latex allergic
workers/residents.

Vinyl gloves are generally recommended for low risk areas, where contact with blood and blood
stained body fluids is unlikely. However, this may change in the near future, as vinyl production
improves, and stronger components are added.

Plastic/co-polymer gloves whilst often of use in the catering and food industries must NOT be
used as protective equipment in a healthcare setting. They have welded seams which often split,
are porous, and poor fitting, compromising dexterity and safety.

Plastic Aprons

1. The purpose of wearing a plastic apron is to protect the clothing from contamination by
micro-organisms, blood or body fluids.
2. Plastic aprons are recommended for use as a barrier when performing tasks that carry a
risk of contaminating the uniform of the worker, such as handling body fluids, changing
dressings, bed bathing, or handling equipment from any contaminated source.
3. Plastic aprons are single use and must be discarded after completion of the intended
task. As already stated for gloves, aprons should be easily accessible to staff, and stored
in convenient, clean dry areas, but away from sources of contamination.

FOGGING EQUIPMENT:

Fogging equipment is available in several forms and possessing differing characteristics.

a) cold foggers
b) thermal foggers
c) electrostatic foggers

Cold Foggers

Cold fogging process as it has been around for a long time. It’s only since the introduction of
safer chemical biocides such as Virusolve+ that it has been able to be used more safely and
causes less damage to all surfaces and fabrics.

There are now 3 kinds of cold fogging process in use.

- The traditional cold fogging equipment,
- Ultrasonic fogging equipment,
- Plasma fogging equipment developed by Bioquell.

The principals of cold fogging are simple; the equipment produces particles at around 6-10
microns. These are light enough to linger in the air long enough to kill airborne viruses. The
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particles will also settle on horizontal surfaces and areas which would not normally be cleaned
through routine cleaning practices. The equipment can be directed towards vertical surfaces at
the risk of over wetting.
A 5% solution of Virusolve+ works well in these types cold fogging equipment without any
problems. We recommend counter rotating atomization equipment.

The newer equipment such as the remote plasma fog generator equipment Bioquell use is very
expensive and they hold the patent and rites to this equipment. It uses hydrogen peroxide as the
chosen chemical disinfectant. We have no data on the suitability of using Virusolve+ with this
equipment, but have included the information for completeness.

The main down site to cold (wet) fogging is that it is not recommended to be used where
electrical/electronic equipment such as computers are present.

Thermal Foggers

Thermal fogging is much more impressive visually as the equipment produces a visible smoke
effect. The basis for this system is that like all smoke particles, they attach themselves to
surfaces horizontal and vertical plus fabrics and furnishings.

Equipment is available from a number of commercial sources and works well with Virusolve+.

The benefits to this system are that it produces a dry fog and it is safe to use around electrical
equipment.

Electrostatic Foggers

An improvement to both of the above systems can be achieved by the use of electrostatic
charging nozzles. This produces charged fog particles that are attracted to surfaces and give
much improved coverage to inverted surfaces (ceilings, underside surfaces) and to vertical
surfaces (walls, etc).

A further benefit is that electrostatically charged fogs clear much faster thus giving reduced turn
around time.

General Observations:

Fogging was demonstrated to be most effective with particle sizes in the range 10-20 micron with
an air velocity at the nozzle of 100 m s-1. Larger particle sizes can be used if the air velocity is
increased or fans are used to assist with the distribution of the droplets.

Compressed air driven fogging nozzles are recommended, either plumbed-in systems or portable
units.
Portable electric fogging machines may not operate at sufficient volume flow rate for all
applications and their use should be carefully considered.

The minimum number of fogging nozzles required for effective treatment will need to have been
established. When possible, nozzles should not be placed near to the floor or be pointed at
surfaces within the range of the plume generated by the nozzle.

PROCEDURES:
• Wash hands – refer CADAN 033 for information on hand cleansing.
• Put on disposable gloves and personal protective equipment (PPE) appropriate to the exposure
risk – see below.
• Assemble equipment and supplies (cleaning/disinfecting solutions, etc.)
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Warning signs/beacons should always be deployed to warn personnel and casual visitors of the
process and to prohibit entry into treatment areas.

Cold Fogging

The procedure used is quite simple and requires 2 men to carry the procedure out (for health &
safety reasons).
Basic PPE is used respirator, & gloves.
Application of the fog should be for about 15 to 30 minutes to allow full dispersal of the fog and to
give sufficient contact time for the disinfection process. However, the time taken to treat an area
will be dependant upon the equipment used and its operating characteristics (refer to
manufacturer’s instructions for details).

The process generates particles that are so small they are not visible to the eye.
Allow 45 to 60 minutes to elapse for fog to dissipate before the area is re-entered.

Thermal Fogging

The equipment is normally remote operated or on a timer to reduce the exposure risk to the
operator.
The typical application time is about 15 to 30 minutes and again this will be dependant on the
specifics of the equipment used (see manufacturer’s recommendations).
The process generates particles that are quite visible to the eye, so the progress of the
application can be easily observed.

Allow 45 to 60 minutes to elapse for the smoke to dissipate and the smoke droplets to settle and
hence reduce the risk to operators, before re-entry.

Clean up:

Following use of fogging equipment, operators should wash all exposed skin areas and also
hands after removal of protective gloves.

REFERENCES:
1. HSE Information Sheet No 29 – Controlling exposure to disinfectants used in food and
drink industries
2. The selection, use and maintenance of respiratory protective equipment. A practical guide
(Second edition) HSG53 HSE Books 1998 ISBN 0 7176 1537 5
3. Evaluation of an Automatic Fogging Disinfection Unit, Nakata et al, Environmental Health
and Preventive medicine 6, 160-164, Oct 2001
4. Terminal Disinfection in Hospitals with Quaternary Ammonium Compounds by Use of a
Spray-Fog Technique, Friedman et al, Applied Microbiology, p223-227, Feb 1968

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CONTACT DETAILS:

For UK and Rest of the World: For North America:

Amity International, Amity International,

Libra House, West Street PO Box 5254,
Worsbrough Dale, 1704 Denver Road,
BARNSLEY ANDERSON,
S YORKS, S72 7FD, SOUTH CAROLINA,
ENGLAND SC29623, USA.

Tel: +44 (0) 1226 770787 Tel: 864 622 2233

Fax: +44 (0) 1226 770757 Fax: 864 622 2234

E-mail: [email protected]
Web site: www.amityinternational.com

For any further information, please contact your distributor or Amity.

In the event of any technical queries, please contact:

Mr. Ram Singh at the UK/ROW address, above, or by e-mail to:

[email protected]

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