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COVID-19 is caused by the 2019 Novel Coronavirus, or SARS CoV-2. Many hyperbaric facilities have been wondering which cleaning products are effective against SARS CoV-2 and are also approved for the hyperbaric chamber by chamber manufacturers. This blog post provides a list of products that meet both criteria. 

What disinfectants are effective against COVID-19?

The EPA "List N"

The U.S. Environmental Protection Agency (EPA) website lists registered disinfectants that can be used against SARS CoV- 2. This list is referred to as List N. List N includes products that meet EPA’s criteria for use against SARS-CoV-2, the cause of COVID-19. 

On March 13 2020, the U.S. EPA released an expanded list of EPA-registered disinfectant products that have qualified for use against SARS-CoV-2, the novel coronavirus that causes COVID-19. 

    The list contains nearly 200 additional products - including 40 new products that went through the agency’s expedited review process. The agency also made key enhancements to the web-based list to improve its usefulness.

    During this pandemic, it’s important that people can easily find the information they’re looking for when choosing and using a surface disinfectant,” said EPA Administrator Andrew Wheeler. With this expanded list, EPA is making sure Americans have greater access to as many effective and approved surface disinfectant products as possible and that they have the information at their fingertips to use them effectively.

    While disinfectant products on this list have not been tested specifically against SARS-CoV-2, the cause of COVID-19, they are expected to be effective against SARS-CoV-2 because they have been tested and proven effective on either a harder-to-kill virus or against another human coronavirus similar to SARS-CoV-2. The product list has also been updated to include the product’s active ingredient and the amount of time the surface should remain wet to be effective against the given pathogen.

    Disinfectant manufacturers follow the the EPA document “Guidance to Registrants: Process for making claims against emerging viral pathogens not on EPA-registered disinfectant labels” that provides general guidance to disinfectant manufacturers and addresses public concerns on a process that can be used to identify effective disinfectants for use against emerging viral pathogens.

    Tips for using the EPA "List N"

    • When purchasing a product, check if its EPA registration number is included on List N. If it is, you have a match and the product can be used against SARS-CoV- 2. You can find the EPA registration number on the product label - just look for the "EPA Reg. No."
    • Products may be marketed and sold under different brand names, but if they have the same EPA registration number, they are the same product.
    • List N includes products with emerging viral pathogen claims and those with human coronavirus claims. If a product with an emerging viral pathogen claim is not available, use a product with a coronavirus claim. If the product is listed as “N” under the Emerging Viral Pathogen Claim column, then it has a human coronavirus claim.

    What disinfectants are effective against COVID-19 AND can used on hyperbaric chambers?

    We compared products on the EPA List N to those cleaners and disinfectants that are approved for the hyperbaric chamber specifically the acrylic cylinder.  The products listed below can be used against SARS CoV- 2 and are manufacturer-approved for the hyperbaric chamber, specifically the acrylic cylinder.

    • Virasept  - Ecolab Professional Products Ecolab Inc. St. Paul, MN
    • Oxycide Daily Disinfectant - Ecolab Professional Products Ecolab Inc. St. Paul, MN
    • Neutral Disinfectant Cleaner - Ecolab Professional Products Ecolab Inc. St. Paul, MN
    • Clorox Healthcare Bleach Germicidal Cleaner - Clorox Professional Products (Oakland, CA)
    • Quaternary Disinfectant Cleaner - Ecolab Professional Products Ecolab Inc. St. Paul, MN
    • Coverage® Spray HB Plus - Steris Corporation Mentor, OH
    • Sani-Cloth® HB - PDI/ Nicepak Orangeburg, NY (discontinued, may continue to use items that are in stock)

    What other recommendations related to environmental infection control can hyperbaric facilities follow?

    The CDC has provided guidance on their website for the Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings.

    The following is an excerpt from the CDC regarding the implementation of Environmental Infection Control:

    • Dedicated medical equipment should be used when caring for patients with known or suspected COVID-19.
      • All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions and facility policies.
    • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
    • Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.
      • Refer to List N external icon on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.
    • Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine procedures.
    • Additional information about recommended practices for terminal cleaning of rooms and PPE to be worn by environmental services personnel is available in the Healthcare Infection Prevention and Control FAQs for COVID-19

    I would also refer you to the WoundReference topic "Cleaning and Disinfection of Hyperbaric Oxygen Monoplace Chamber". Please let me know if you have any additional thoughts or questions. As we are seeing the situation change daily, the same is true of the COVID 19 response policy at each institution or facility.  I am aware of one program that has recommended “holding” scheduled procedures for non-emergent cases. This would not include cases in which the patient is at risk for loss of life or limb. 

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