Influenza guidelines ignore TGA system

Dateline: 08.06.2009
Author: Greg Whiteley*

Panic, panic, it’s a Pandemic. Yes, we have a pandemic underway. But why panic? It is only Influenza virus after all?

So what are the recommendations (reference 1) from the authorities for preventing the spread? Well that’s where it all gets a bit confused. But first a related story on the last great influenza pandemic to strike our shores, and it involved the horse industry.

The official report by Justice Callinan (reference 2), into the Equine Influenza Virus outbreak indicates the Equine Influenza (EI) virus is not that different from the human influenza viruses (when you look at morphology and infectious pattern of spread).

Secondly the EI virus was flown into Australia with an infected horse that was held in quarantine under isolation. But the EI virus got out of quarantine not through a horse, but through one of the staff caring for the horse (possibly a veterinarian or some other visitor). Importantly the visitor took out the EI virus (unknowingly) probably on clothing or tools, and then went to another horse or stables outside of quarantine and that second horse “caught” the EI virus from the clothing or tools.

Influenza viruses do survive on surfaces. Only after the EI virus had “escaped” via a person who had not adequately decontaminated after visiting the “sick” horse, did other horses get infected (somewhere between 60,000 and 80,000 by some estimates).

We know that human Influenza viruses survive on surfaces as well. In fact the national guidelines (2006) go so far as talk in terms of survival for 24 to 48 hours in ideal conditions (page11). The same document states that:

“Any cleaners that enter the room of an infectious patient…should be advised to keep a distance of at least one metre from the patient if possible.” (page 17)

There are also recommendations for barrier precautions including gowns, gloves and a surgical mask. Which is all fine, but what if there are lots of people who have coughed and spluttered and sneezed all over surfaces before being sent home with the illness? How do we decontaminate the surfaces?

Well that’s where it all gets so very interesting, because the official documents then turn back the clock, ignore the TGA Legislative system that controls disinfectants, ignore the latest 2008 CDC Guidelines, and recommend a neutral detergent cleaner and only 1000ppm of Chlorine for disinfection.

The official Australian Guidelines do not even mention the TGA, or Hospital Grade Disinfectants which are the appropriate product category under Therapeutic Goods Order Number 54, 1996. The official recommendations instead border on the illegal.

Hospital Grade Disinfectants are tested under a peer reviewed series of protocols, TGA licensed and then sold for disinfecting healthcare environmental surfaces. There are existing products licensed by the TGA, which are entered onto the Australian Government register of therapeutic goods (the ARTG), that already have registered claims against Influenza Virus. The products work, they are correctly labeled, and they are relatively safe to use (particularly when compared to chlorine at >1000ppm). These Hospital Grade Disinfectants are easier to use and efficacious so they are more likely to be used in sufficient quantities to actually work and kill the Influenza Virus as intended.

Anyone who has had to work with a strong chlorine solution will know that it smells, it is highly irritating if used as a spray (it hurts like hell if it gets into your eyes), it is corrosive, it stains all fabrics and destroys leather chairs, and when concentrated the liquid is a class 8 Dangerous Good and the powders are dual class 8 and class 5 Dangerous Goods (Class 5 is organic oxidisers). Chlorine is as nasty as it is cheap, and the damage is usually irreversible and must be balanced against the initial low cost. Staff will normally use less because chlorine is so unpleasant to use, thus compromising its intended disinfecting purpose.

It seems that the cleaning industry is again being subjected to a top down, impractical approach from a well meaning committee of well qualified people, who have never had to enact the recommendations that they have made.

A public review of the Pandemic Infection Control Guidelines may be a timely and appropriate response.

References

1. ‘Interim Infection Control Guidelines for Pandemic Influenza in Healthcare and Community Settings’, Australian Government Department of Health and Ageing, June 2006, ISBN 0 642 82934 9

2. ‘Equine Influenza, The August 2007 outbreak in Australia, Report of the Influenza Inquiry’, Equine Influenza Inquiry, The Hon Ian Callinan, 2008

* Greg Whiteley is Whiteley Corporation’s chief executive officer

Influenza guidelines ignore TGA system