By Heather F. Collins, M.S. and Barbara A. Christianson
On February 12, 2020, the U.S. Environmental Protection Agency (EPA) announced the availability of 11 products that have been approved for use to disinfect surfaces against the emerging multidrug-resistant fungus Candida auris (C. auris). C. auris can cause severe infections and spreads easily among hospitalized patients and nursing home residents. The 11 products are approved for use against C. auris to disinfect surfaces in hospitals, nursing homes, and other healthcare facilities, to help reduce patient infections. There were no antimicrobial pesticide products registered specifically for use against C. auris prior these new use registrations.
EPA worked in collaboration with the Centers for Disease Control and Prevention (CDC) and other federal partners to ensure that the products would be effective against C. auris. Previously, on October 16, 2019, EPA had granted public health exemptions under the provisions of section 18 of the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) as amended, to the CDC, for uses of antimicrobial products, on hard, nonporous surfaces in healthcare settings for disinfection from C. auris.
The 11 products that are now registered for use against C. auris are:
- Avert Sporicidal Disinfectant Cleaner (EPA Reg. No. 70627-72);
- Blondie (EPA Reg. No. 67619-24);
- Dagwood (EPA Reg. No. 67619-25);
- Micro-Kill Bleach Germicidal Bleach Wipes (EPA Reg. No. 37549-1);
- Oxivir 1 (EPA Reg. No. 70627-74);
- Oxivir 1 Wipes (EPA Reg. No. 70627-77);
- Oxivir Wipes (EPA Reg. No. 70627-60);
- Oxycide™ Daily Disinfectant Cleaner (EPA Reg. No. 1677-237);
- Virasept (EPA Reg. No. 1677-226);
- Wonder Woman Formula B Germicidal Wipes (EPA Reg. No. 9480-12); and
- Wonder Woman Formula B Spray (EPA Reg. No. 9480-10).
Because there are few products with C. auris claims at this time, CDC and EPA have identified additional products that are effective against C. auris. Although these products do not yet have formal EPA-registered claims for C. auris, testing at CDC has confirmed they are effective against C. auris. The label on the product will not include instructions for C. auris. CDC guidance states to “follow the instructions provided for C. albicans, if included, or else follow those for fungicidal activity.” These products include:
- Oxivir TB Spray (EPA Reg. No. 70627-56); and
- PDI Super Sani-Cloth (EPA Reg. No. 9480-4).
The CDC Guidance further states that, if none of the above-listed products are available, or any of the EPA-registered products that are newly approved for the specific claims against C. auris, CDC recommends use of an EPA-registered hospital-grade disinfectant effective against Clostridioides difficile spores, because CDC believes these products have been used effectively against C. auris (List K).
Additional information on C. auris is available on EPA’s website and CDC’s website.
By Heather F. Collins, M.S. and Barbara A. Christianson
On October 2, 2019, the U.S. Environmental Protection Agency (EPA) published a notice in the Federal Register announcing the availability of, and soliciting public comment on, the draft document entitled “Antimicrobial Performance Evaluation Program (APEP) A (Draft) Risk Based Strategy to Ensure the Effectiveness of Hospital-Level Disinfectants” (draft Strategy). EPA states that “The draft Strategy provides a framework to ensure that registered hospital-level disinfectants and tuberculocide products continue to meet Agency efficacy standards once they are in the marketplace.”
The draft Strategy was developed in response to EPA’s Office of Inspector General’s (OIG) report “EPA Needs a Risk-Based Strategy to Assure Continued Effectiveness of Hospital-Level Disinfectants,” which recommends EPA’s Office of Pesticide Programs (OPP) to develop a risk-based strategy to assure the effectiveness of public health pesticides used in hospital settings once products are in the marketplace. EPA developed the draft Strategy based on OIG’s recommendations.
EPA states that the draft Strategy uses a risk-based approach “to inform the Agency on the prioritization and selection of hospital-level disinfectants and associated label claims for testing,” and states that its order of priority is as follows:
- Product label claims for specific microbes and disease prevalence data;
- Evaluation of uncommon label claims and unique product application processes; and
- Evaluation of products tested using new and/or recently revised methods.
Additional refinement factors may also be considered such as:
- Issues identified during post-registration, product reregistration, and registration review;
- Trends observed under the previous testing program (Antimicrobial Testing Program (ATP)); and
- Products with high production volumes.
EPA states that it will be considering two options individually or in combination for obtaining samples for testing: (1) EPA purchase of products in the marketplace; and (2) product samples provided by the registrant. Several options for allocating efficacy and chemistry testing resources may be utilized individually or in combination; these options include: (1) Office of Pesticide Programs Microbiology Laboratory and the Analytical Chemistry Laboratory; (2) interagency agreements and contracts; (3) third-party verification testing; and (4) registrant testing; and/or Data Call-Ins.
In the Federal Register notice, EPA lists six focus questions on which it is specifically requesting public comment:
- Please comment on the proposed risk factors and refinements, their proposed prioritization, their strengths and limitations, and recommendations for other risk factors not considered.
- Are the options provided for sample collection suitable for the purpose of the testing program, and if not, what approaches would you suggest to optimize sample collection. Please provide advantages and disadvantages to your recommendations as appropriate.
- Should the Agency and/or stakeholders conduct the laboratory evaluation (formulation chemistry and product efficacy) of disinfectant products? Provide examples to support your opinions and itemize situations where one approach would be more favorable versus the other.
- Please comment on the flexibility and feasibility of the example workplan approach (See Appendix A, draft Strategy).
- Please comment on the proposed communication strategy to convey test results to registrants and the general public including the preferred frequency of updates.
- Please provide suggested routes for resolution of efficacy failures. Previously, these were addressed by “regulatory fixes” to include retesting, label amendments, etc.
EPA states that the draft Strategy may be of interest to health care/hospital professionals and all entities who have EPA registered antimicrobial products that are available in the marketplace, particularly those with products that make hospital disinfectant claims (e.g., claims against Staphylococcus aureus and Pseudomonas aeruginosa) and other claims for notable public health pests (e.g., Clostridium difficile, methicillin resistant Staphylococcus aureus, Mycobacterium spp.).
All comments on the draft Strategy document must be received by EPA on or before December 2, 2019. EPA expects to publish the APEP final strategy in 2020 and schedule implementation to begin in 2022.
Documents referenced in the draft Strategy are available at www.regulations.gov in Docket Number EPA-HQ-OPP-2018-0265. More information on the APEP is available on our blog.
By Heather F. Collins, M.S., and Sheryl Lindros Dolan
On June 21, 2018, during the U.S. Environmental Protection Agency’s (EPA) Office of Pesticide Programs (OPP) webinar, EPA discussed the new draft risk-based strategy for ensuring the performance of public health antimicrobial products and announced the intended replacement of the former Antimicrobial Testing Program (ATP) with the new Antimicrobial Product Evaluation Program (APEP). Comments on the draft risk-based strategy may be submitted to EPA until July 16, 2018.
Public health antimicrobial products are those products that bear a claim to control microorganisms that pose a threat to human health, and whose presence cannot readily be observed by the user, including microorganisms infectious to people in any area of the inanimate environment. The Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) requires product performance (i.e., efficacy) data to support registration of antimicrobial products bearing a public health claim.
EPA began the webinar with an overview of the Office of Inspector General (OIG) Report entitled “EPA Needs a Risk-Based Strategy to Assure Continued Effectiveness of Hospital-Level Disinfectants.” Report #16-P-0316 (Sept. 19, 2016). OIG conducted a review of EPA’s ATP to “determine whether the program ensures the efficacy of EPA-registered hospital sterilants, disinfectants, and tuberculocides (“hospital-level disinfectants”); and to evaluate options for improving the ATP.” See Bergeson & Campbell, P.C.’s article dated September 21, 2016, “Results of EPA OIG’s Review of EPA’s Antimicrobial Testing Program” for a full summary of the OIG report. In the 2016 report, OIG recommends OPP suspend administering the current ATP and develop a risk-based strategy to assure the effectiveness of public health pesticides used in hospital settings once products are in the marketplace. EPA agreed with OIG’s recommendations.
EPA provided that “[t]he intent of the [APEP] is to ensure continued effectiveness of antimicrobial products with public health claims (hospital disinfectants, tuberculocides, and other health care claims) in the marketplace. The maintenance and development of technically-sound test methods, quality improvement tools (e.g., peer review of new protocols), and outreach and stewardship activities will further support the program.”
The risk-based testing strategy will ensure the effectiveness of public health pesticides used in hospital settings by:
- Establishing a framework for periodic testing after registration;
- Defining a program that is responsive to current public health risks;
- Identifying risk factors for selecting products to test;
- Establishing a process to be used for obtaining samples for testing; and
- Setting a date to begin risk-based post-registration testing.
Risk-based factors under consideration by EPA include:
- Use of healthcare-associated infection data reports;
- Claims against microorganisms of greatest concern to healthcare-associated infections (e.g., Clostridium difficile, MRSA,VRE);
- Emerging pathogens and homeland security considerations;
- Trends in previous ATP compliance history (e.g., claims against Mycobacterium bovis BCG);
- Atypical label claims (e.g., very short contact times, use sites and surfaces, new product delivery and application procedures);
- Claims not evaluated under the previous ATP;
- New and unusual active ingredients;
- Formulation chemistry-related issues (e.g., shelf-life/stability once prepared, lack of expiration dates);
- Use of new or procedurally-revised test methods;
- Tips and complaints;
- Issues identified during reregistration (e.g., frequency of repeat testing, acceptance criteria not met); and
- Link to other federal initiatives.
OIG recommends a functional program begin after registration review is completed in 2022. According to OIG, the development of a solid, acceptable testing strategy is key -- the strategy must be finalized and communicated to regulated and public health communities. OIG specified other EPA outreach activities for the testing program that must be considered, e.g., setting and clearly communicating goals and establishing the baseline reporting mechanisms.
EPA expects to release this final strategy in November 2018 and seeks public input prior to implementation. Please submit your comments on this topic by July 16, 2018, to the Office of Pesticide Programs Docket, EPA-HQ-OPP-2018-0265 at https://www.regulations.gov.
For additional information, please visit https://www.epa.gov/pesticide-registration/antimicrobial-testing-program or https://www.epa.gov/pesticide-registration/webinar-risk-based-strategy-ensure-continued-effectiveness-hospital.
By Susan M. Kirsch
On October 17, 2017, the U.S. Environmental Protection Agency (EPA) issued a “Quick Guide for Disinfectant Products for Drinking Water Use by Public Water Systems” (Quick Guide) which it states was developed “in response to requests to help prospective pesticide registrants gain a basic understanding of the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) product registration process and how it relates to the Safe Drinking Water Act (SDWA) requirements.” Further, “applicants seeking to register pesticide products for treatment of drinking water in public water systems [(PWS)] should refer to this [Quick Guide] for a broad overview of the applicability of FIFRA and SDWA and for references to additional relevant resources.” EPA states the Quick Guide can be used to:
- Compare the jurisdictional authority of FIFRA and SDWA;
- Determine whether a product is required to obtain FIFRA registration; and
- Identify SDWA standards that are applicable to pesticide products used in drinking water disinfection.
EPA states that “it does not register or approve disinfection products under the SDWA, but instead imposes requirements on each regulated PWS to deliver water that meets specific standards to persons served by the system,” and that each PWS “must determine what product or combination of products to use to meet the federal and any applicable state, tribal or territorial drinking water requirements.”
A review of the Quick Guide reveals it is a high level decision support and reference tool which lists the basic steps necessary to obtain product approval for drinking water disinfection use by PWSs under both FIFRA and SDWA; and includes a corresponding flow chart that highlights the intersection between the jurisdictional authorities of the two statutes and illustrates more generally the steps for obtaining product approval. The flow chart also ties these steps to relevant EPA guidance/manuals and applicable Code of Federal Regulations citations, and provides online links to these resources. The Quick Guide does not supply details on any applicable state, tribal, or territorial laws. As EPA notes, some states, tribes, and territories have requirements for the regulatory approval, registration, and licensing of disinfectant products that may be used in their PWSs. Similarly, “FIFRA registration does not mean that the product meets state, tribal or territorial laws regarding drinking water products for use by PWSs.”
More information is available on EPA’s website.
By Lynn L. Bergeson, Sheryl Lindros Dolan, and Margaret R. Graham
On February 17, 2017, the U.S. Environmental Protection Agency (EPA) announced that the Centers for Disease Control and Prevention (CDC) issued guidance revising its recommendation regarding controlling Candida auris (C. auris) infections in U.S. healthcare facilities. The CDC guidance now recommends a “thorough daily and terminal cleaning and disinfection” of patient rooms in which C. auris infection or colonization was present … with the use of an [EPA]-registered hospital-grade disinfectant effective against Clostridium difficile [(C. difficile)] spores.” The new guidance updates the CDC’s clinical alert on C. auris issued in June 2016 after receiving reports from international healthcare facilities that C. auris, “an emerging multidrug-resistant (MDR) yeast, [was] causing invasive healthcare-associated infections with high mortality.” Previously, CDC recommended use of an EPA-registered disinfectant with a fungal efficacy claim.
As EPA is responsible for regulating hospital disinfectants and other antimicrobial pesticides used in healthcare facilities, this updated guidance has particular interest and significance for registrants of hospital disinfectant products. EPA maintains a list of registered antimicrobial products effective against C. difficile (List K) and states that “Guidance to the companies that register antimicrobial products and seek label claims against C. auris is under development.”