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Emerging Pathogens in Healthcare Settings

The 21st century world is being impacted by emerging pathogens on an unprecedented scale. Not only are we experiencing diagnostic and treatment challenges that come with emerging pathogens, but there can also be implications for cleaning and disinfecting against a novel pathogen.

Where to start?

It is imperative to select appropriate disinfecting products when dealing with emerging pathogens. But when a pathogen is novel, it is not likely that a disinfectant on the market will have claims against it — at least not right away — and adding new claims to an existing product does not happen overnight. It takes about a year to get new claims approved by the US Environmental Protection Agency (EPA).

So, how do you identify an effective product? The first step is to see if any specific policies, requirements, or resources have been issued in relation to the novel pathogen(s) in question. For example, the EPA’s Emerging Viral Pathogen Policy. It is important to note that the EPA’s Emerging Viral Pathogen policy only applies to viruses. It does not apply to emerging bacteria, fungi, or other pathogens.

Understanding EPA’s List Q

List Q is unique from the other EPA Lists because it does not target a specific pathogen. With this List, the user searches for eligible products for use against an emerging pathogen by selecting the appropriate tier based on virus type.

To navigate List Q, there are a few things you need to know about the emerging pathogen including if it is:

  • An enveloped virus (tier 1- the easiest of the 3 types to kill),
  • A large non-enveloped virus (tier 2), or a
  • A small non-enveloped virus (tier 3 – the hardest of the virus types to kill).

Lastly, it is important to understand that because a given product from List Q meets the criteria for use against one emerging virus (e.g., Mpox), it does not mean this product will be effective against any future emerging viruses. It is designed to be used on a pathogen-by-pathogen basis.2

In situations when guidance like the EPAs Emerging Viral Pathogen policy is not activated, I recommend using a sporicidal, like bleach, because it is broad-spectrum against hard-to-kill pathogens. Please note — some disinfecting chemistries may be more effective than others against a given pathogen. For example, disinfectants with quaternary ammonium compounds (e.g., “quats”) as the only active ingredient have not been found to be effective against Candida auris.3

Control and contain

Beyond identifying the correct product to use, it is also imperative to identify a process for managing an emerging pathogen. For example, protocols should include the personal protective equipment (PPE) to be worn to enter the room, cleaning frequency, and the appropriate disinfectant to be used. Cleaning and disinfecting protocols may differ by pathogen, so it is also important that staff are educated and trained to safely and effectively clean and disinfect against novel pathogens.

Additional Resources

In addition to the EPA’s Emerging Viral Pathogen Policy and the EPA Disinfectant Lists, other organizations have published helpful resources you can use to help you identify the appropriate disinfecting products to use and implement a process for managing an emerging pathogen. The Centers for Disease Control and Prevention (CDC) guidance, the National Emerging Special Pathogens Training and Education Center is another great resource for guidelines.