Training for Disinfectant for sales force

1. Sales Force Training Program
Fearless Pharma Pvt. Ltd.
Mumbai

2. Training Program Structure
• Brief about Fearless
• Module -1: Basics of Infection Control (Day-1)
– What is Infection?
– Infection Control
– Infection Control in Hospital
– Disinfectants
• Module -2: Product Portfolio (Day-2)
– Products
– Competitors Analysis
– Product Demonstration and uses
• Module -3: Sales, an Art (Day-3)
– Target Customers
– Criterion for selecting a hospital
– Sales Training
– Recap
– Q&A

3. Fearless Pharma
• Fearless Pharma conceived in 2011 with a sole vision to make world better without
fear.
• Promoted by Mr. Sajan Raj Kurup and Parent company Creativeland Asia.
• Headquarter based in Mumbai, India.
• Have offices in Delhi, Kochi, Singapore and
• Mission is to become India’s largest Infection Control Company by 20…

4. Organogram
Sajan Raj
Kurup
Founder & Chairman
Sajiv Kurup
Executive Director
Pramod
Mali
COO
ABC
Marketing Head
ABC
Sales Head
ABC
Product Manager/
Brand Manager

5. Sales Force Training Program
Module-1
Basics of Infection Control in Hospital

6. Infection
Definition and Types
• Injurious contamination of body or parts of the body by bacteria, viruses, fungi,
protozoa and rickettsia or by the toxin that they may produce.
• Local or generalized
• Infection symptoms and signs: pain, swelling, redness, pus, functional disorders,
rise in temperature and pulse rate etc.
• Community acquired infection.
• Nosocomial infection (NI) or Hospital Acquired Infections (HAIs)

7. Infection
Main Sources
• Person to person via hands of health-care providers, patients, and visitors
• Personal clothing and equipment (e.g. Stethoscopes, flashlights etc.)
• Environmental contamination
• Airborne transmission
• Hospital staff who are carriers
• Rare common-source outbreaks

8. Nosocomial Infections (NIs or HAIs)
Brief
• It includes infections
– not present nor incubating at admission,
– infections that appear more than 48 hours after admission,
– those acquired in the hospital but appear after discharge
– also occupational infections among staff.

9. Nosocomial Infections (NIs or HAIs)
Impact
• Functional disability & emotional stress.
• Disabling conditions.
• Leading causes of death.
• Increased economic
• An estimated 1 to 4 extra days for a urinary tract infection, 7 – 8 days for a SSI,
7 – 21 days for a blood stream infection, and 7 – 30 days for pneumonia.
• US$5 billion are added to US health costs every year as a result of NI.

10. Nosocomial Infections (NIs or HAIs)
Factors
• The Microbial Agents
• Patient Susceptibility
• Environmental Factors

11. Nosocomial Infections (NIs or HAIs)
Factors- The Microbial agents
• Bacteria are the most common pathogens.
• Commensal bacteria
• Pathogenic bacteria - e.g. Clostridium causing gangrene.
• Gram +ve bacteria: Staphylococcus aureus found on skin & nose. - Beta -hemolytic
Streptococcus
• Gram -ve bacteria as E.coli, Proteus, Klebsiella, Legionella species.

12. Nosocomial Infections (NIs or HAIs)
Factors- The Microbial agents Cont….
• Viruses: eg. HIV, HBV, HCV, Rota virus, Ebola, influenza, herpes simplex viruses.
• Parasites & Fungi: e.g. Giardia lamblia, Aspergillus sp.
• Microbial Survival times on hands:
– Acinetobacter spp 60 min
– E. coli 6 min (mean)
– Klebsiella spp 2 min (mean)
– VRE 60 min
– Pseudomonas spp 30 min; 180 in sputum
– Rotavirus 16% survive 20 min; 2% survive 60 min

13. Nosocomial Infections (NIs or HAIs)
Factors- Patient Susceptibility & Environmental Factors
• Patient Susceptibility
– Age
– Immune status
– Immunosuppressive drugs or irradiation
• Environmental Factors
– Healthcare settings
– Crowded conditions
– Microbial flora

14. Nosocomial Infections (NIs or HAIs)
Transmission
• Where do nosocomial infection come from?
• Endogenous infection
• Exogenous cross-infection

15. Nosocomial Infections (NIs or HAIs)
Incidences
• Lack of reliable data affects estimates on the burden- millions worldwide every
year
• No health-care facility, no country, no health-care system in the world is free of
this problem
• Developed world: 5–10% patients
• Developing countries: risk is at least 2 times higher and can exceed 25%
• ICU - 30% patients; attributable mortality as high as 44%

16. Nosocomial Infections (NIs or HAIs)
Leading Cause of Death

17. Infection Control
Brief
• Infection control - Preventing nosocomial or healthcare-associated infection.
• Infection control addresses factors related to the spread of infections within the
health-care setting.

18. Infection Control
1st Principle of Infection Prevention
At least 35-50% of all healthcare-associated infections are associated with only
5 patient care practices:
1. Hand hygiene and standard precautions
2. Surveillance of surgical procedures
3. Use and care of urinary catheters
4. Use and care of vascular access lines
5. Therapy and support of pulmonary functions

19. Infection Control
Four Ways to Prevent HAI
1. Maintain cleanliness of the hospital.
2. Personal attention to hand washing.
3. Personal protective equipment.
4. Use and dispose of sharps safely.
• Staff nurses play an important role in risk reduction by
1. Attention to hand hygiene,
2. Reduce the risks associated with patient care devices, and
3. Careful administration of prescribed antibiotics,

20. Infection Control in Hospitals
Chain of Infection
Why Isolation?..
because
transmission is
easier to control
than the source /
host!
Pathogen
Reservoir
Portal of
Exit
Mode of
transmissio
n
Portal of
Entry
Susceptible
Host

21. Infection Control in Hospitals
Basics
• Shared responsibility.
• Good practice
• Hospital policies & procedures.

22. Infection Control in Hospitals
Strategies To Decrease Transmission
• Proper hand hygiene
• Disinfection of surfaces and devices (Floor, hard surfaces, etc.)
• High Level Disinfection in OT
• Disinfection in ICU
• Device Management (Endoscope)

23. Hand Hygiene
Brief
• One of the best ways
• Hand hygiene reduces the incidence of infections
• Historical study: Semmelweiss
• More recent studies: rates lower when antiseptic hand washing was performed

24. Hand Hygiene
Definitions
• Hand washing
• Antiseptic hand wash
• Alcohol-based hand rub
• Surgical hand hygiene/antisepsis

25. Hand Hygiene
When to Use Hand Wash / Alcohol Hand Rubs

26. Hand Hygiene
How to Use Hand Wash
To effectively reduce the growth of germs on hands, hand washing must last 40–60
seconds and should be performed by following all of the illustrated steps

27. Hand Hygiene
How to Use Alcohol Hand Rubs
To effectively reduce
the growth of germs on
hands, hand rubbing
must be performed by
following all of the
illustrated steps. This
takes only 20–30
seconds!

28. Disinfection
Basics
• Cleaning some or all of the pathogenic organisms.
• Disinfectants are use to kill microorganisms on inanimate objects
• Not for use on skin or mucous membranes
• Qualities of perfect disinfectant

29. Disinfection
Terminologies
• Antisepsis
• Sanitization
• Biocide or germicide
• Fungicide / Virucide
• Bacteriostatic agent
• Sepsis
• Asepsis
• Aseptic
• Antiseptics
• Bactericidal, Virucidal, Fungicidal or Sporicidal
• Bacteriostatic
• Decontamination

30. Disinfectants
Types
• Disinfection does not destroy bacterial spores.
• Disinfectants vs antiseptics.
• Disinfection usually involves chemicals, heat or ultraviolet light.
The nature of chemical disinfection varies with the type of product:
1. Low level disinfectants
2. Intermediate level disinfectants
3. High level disinfection

31. Disinfectants
Factors for Effectiveness
• Type of contaminating
• Degree of contamination
• Amount of proteinaceous material present
• Presence of organic matter
• Chemical nature of disinfectant
• Concentration and quantity of disinfectant

32. Disinfectants
Factors for Effectiveness
• Contact time and temperature
• Residual activity
• Application temperature and pH
• Toxicity
• Cost

33. Disinfectants
Approach
• Noncritical Medical Devices
• Semi critical Medical Devices
• Critical Medical Devices

34. Disinfectants
Intermediate Level Disinfectants
• Phenols
• Alcohols
• Hypochlorites
• Iodine and Iodophors

35. Disinfectants
Phenols
• Good general purpose disinfectants
• Effective against bacteria and enveloped viruses.
• Not effective against non-enveloped viruses and spores.
• Maintains activity in the presence of organic material.
• Not recommended for semi critical items

36. Disinfectants
Alcohols
• Refers to two water-soluble chemicals: ethyl alcohol and isopropyl alcohol.
• Bactericidal rather than bacteriostatic (Gram +ve and Gram -ve)
• Also are Tuberculocidal, fungicidal, and Virucidal against enveloped viruses.
• Not effective against bacterial spores and have limited effectiveness against non-
enveloped viruses.
• Alcohols are commonly used topical antiseptics.

37. Disinfectants
Hypochlorites
• Most widely used form is known as “household bleach”.
• Broad spectrum of antimicrobial activity,
• Unaffected by water hardness, are inexpensive and fast acting,.
• Can eliminate viruses , effective against fungi, bacteria, and algae but spores.
• Recommended for use in both hospitals and the community
• Corrosiveness to metals
• Inactivation by organic matter
• discoloring or “bleaching” of fabrics, and
• Release of toxic chlorine gas when mixed with ammonia or acid.
• Most recommendation for decontamination of hepatitis and AIDS viruses

38. Disinfectants
Iodine and Iodophors
• Combination of iodine and a solubilizing agent or carrier; Eg. Povidone-iodine
• Non-staining, free of toxicity and irritancy.
• They are Bactericidal, Sporicidal, Virucidal and fungicidal but require a prolonged
contact time.
• Neutralized in the presence of organic material

39. Disinfectants
High Level Disinfectants
• Hydrogen Peroxide
• Formaldehyde
• Glutaraldehyde
• Ortho-phthaladehyde
• QAC
• Per-Acetic Acid
• ETO
• Gas Plasma

40. Disinfectants
Hydrogen Peroxide
• Stabilized hydrogen peroxides can be used to disinfect environmental surfaces.
• Can also be blended with Iodophors or quaternary ammonia.
• Hydrogen peroxide is also blended with Per-acetic acid in high concentrations for
use as a high-level disinfectant

41. Disinfectants
Formaldehyde
• Used as a disinfectant and sterilant both in the liquid and gaseous states.
• Aqueous solution is bactericidal, Tuberculocidal, fungicidal, Virucidal and
Sporicidal.
• Highly toxic.

42. Disinfectants
Glutaraldehyde
• These are bactericidal, Virucidal, fungicidal, Sporicidal and Tuberculocidal.
• Activity in the presence of organic matter (20% bovine serum); and noncorrosive
action to endoscopic equipment, thermometers, rubber, or plastic equipment.
• “Activated” solution
• Shelf-life of minimally 14 days
• Mostly as a high-level disinfectant

43. Disinfectants
Ortho-phthalaldehyde
• Similar to Gluteraldehydes with similar antimicrobial activity.
– Several potential advantages over Gluteraldehydes:
– Stability over a wide pH range (pH 3-9)
– Non-irritant
– Perceptible odor, and
– No activation
• A disadvantage is that it stains proteins gray

44. Disinfectants
Per-acetic Acid
• Characterized by a very rapid action against all microorganisms.
• No harmful and no residue.
• Effectiveness
• Sporicidal
• It is used in automated machines

45. Disinfectants
Quaternary Ammonium Compounds
• Good cleaning agents
• Not effective against non-enveloped viruses, fungi and bacterial spores.
• It carries strong positive charge
• Low in toxicity,
• Commonly used in ordinary environmental sanitation of noncritical surfaces such
as floors, furniture, and walls.

46. Disinfectants
Comparison of the characteristics of high-level disinfectants
HP (7.5%) PA (0.2%) Glut (>2.0%) OPA (0.55%)
HP/PA (7.35%
/ 0.23%)
HLD Claim 30 m @ 200
C NA
20-90 m @ 200
-
250
C
12 m @ 200
C,
15m @ 200
C
5 m @ 250
C in
AER
Sterilization
Claim
6 h @ 200
C
12m @ 50-
560
C
10 h @ 200
-250
C None 3 h @ 200
C
Activation No No
Yes (alkaline
glut)
No No
Reuse Life 21d Single use 14-30 d 14d 14d
Shelf Life
Stability
2 y 6 mo 2 y 2 y 2 y
Disposal
Restrictions
None None Local Local None
Cont…

47. Disinfectants
Comparison of the characteristics of high-level disinfectants
HP (7.5%) PA (0.2%) Glut (>2.0%) OPA (0.55%)
HP/PA (7.35%
/ 0.23%)
Materials
Compatibility
Good Good Excellent Excellent No data
Monitor MEC Yes (6%) No
Yes (1.5% or
higher)
Yes (0.3%
OPA)
No
Safety
Serious eye
damage
(safety
glasses)
Serious eye and
skin damage
(Conc. Soln.)
Respiratory
Eye irritant,
stains skin
Eye damage
Processing
Manual or
automated Automated
Manual or
automated
Manual or
automated Manual

48. Antiseptics
Biguanides
Chlorhexidine: (Savlon)
• Disrupts bacterial cell membrane & denaturation of bacterial proteins
• Non irritant, more active against gram +ve bacteria.
• Used in for surgical scrub, neonatal bath, mouth wash & general skin antiseptic.
• Most widely used antiseptic in dentistry 0.12-0.2% oral rinse or 0.5 -1 % tooth
paste

49. Antiseptics
Quaternary ammonium antiseptics
Cetrimide
• Detergents: Cidal to bacteria, fungi & viruses.
• Act by altering permeability of cell membrane
• Efficiently remove dirt and grease
• Widely used as antiseptics & disinfectants for surgical instruments, gloves etc.
• Combined with Chlorhexidine (Savlon)

50. Antiseptics
Soaps
• Anionic detergents
• Weak antiseptics with cleansing action
• Washing with soap and warm water one of the most effective methods of
preventing disease transmission
• Affect only Gm+ bacteria
• Can be medicated by adding other antiseptics

51. Antiseptics
Alcohols
Ethanol
• Antiseptic, cleansing agent at 40-90% conc.
• Act by precipitating bacterial proteins
• Irritant, should not be applied on mucous membrane, ulcers, open wounds.

52. Infection Control in Operation Theater
SSI
• 2nd most common cause of NIs.
• Can lead to mortality as high as 77%.
• Endogenous or exogenous
• Can be controlled by maintaining sterile environment in OT

53. Infection Control in Operation Theater
Fogging/ Fumigation
Fumigation usually involves the following phases:
• The area to be fumigated is usually covered to create a sealed environment
• The fumigant is released into the space to be fumigated
• The space is held for a set period while the fumigant gas percolates through the
space and acts on and kills any infestation in the product
• The space is ventilated so that the poisonous gases are allowed to escape from the
space, and render it safe for humans to enter.

54. Sterilization of Endoscopes
Endoscopes and Infection
• Incidence of infection is very low
• All heat-sensitive endoscopes (e.g. gastrointestinal endoscopes, bronchoscopes,
nasopharygoscopes) must be properly cleaned and, at a minimum, subjected to
high-level disinfection after each use.
• HLDs can be expected to destroy all microorganisms

55. Sterilization of Endoscopes
Chemical Method
• GTA, H2O2, OPA, and PAA with H2O2 are cleared by the FDA
• Decontamination of endoscopes should be undertaken
• Thorough manual cleaning with an enzymatic detergent

56. Sterilization of Endoscopes
By Glutaraldehyde and OPA
Glutaraldehyde should be in contact with all internal and external surfaces and
channels of the device for at least 20 minutes. For OPA, it should be submerged for at
least 10-15 minutes. Since GTA is an irritant, proper safety measures should be
considered to ensure safer working conditions, which includes:
• Superior ventilation
• Ducted exhaust hoods
• Ductless fume hoods with absorbents for the vapor,
• Tight fitting lids on immersion baths, and
• Automated endoscope processors

57. Sterilization of Endoscopes
Final removal of disinfectant after disinfection
• After high-level disinfection, rinse the endoscope and flush the channels with
sterile, filtered, or tap water to remove the disinfectant.
• Discard the rinse water after each use/cycle.
• Flush the channels with 70% to 90% isopropyl alcohol.

58. Q & A
Thank you