Understanding the Future of Fogging in the OR

bottom view of multicultural surgeons operating patient in operating room

Disinfection in a healthcare setting, and particularly within an operating room (OR), is both fundamental and uncompromisingly critical. When it comes to maximizing the impact of cleaning and disinfection, methodology matters.


Though manual cleaning regimens are often the frontline defense against pathogens, they’re less effective than many realize, improving aesthetics without actually preventing the spread of infectious diseases. Fortunately, manual cleaning techniques aren’t the only way healthcare providers are fighting infections. 


Newer developments in automated disinfection include tech-driven solutions for fast-paced healthcare environments, including fogging technology that can distribute EPA-registered disinfectant solutions like hypochlorous acid (HOCl).


However, guidelines from the Centers for Disease Control and Prevention (CDC) and the Association for Operative Registered Nurses (AORN) have been slow to address these new technologies, hindering their adoption and slowing the implementation of more efficient, effective disinfection protocols. 

Outdated Guidelines Based on Unsafe Chemicals

Over a decade ago, the CDC and other professional organizations advised against the use of less advanced fogging solutions, citing efficacy and health concerns as the primary reasons for rejecting fogging as an effective disinfection protocol. 


In the CDC’s 2003 and 2008 recommendations, the agency reports that it “does not support disinfectant fogging.” Specifically, these guidelines say: 

  • 2003: “Do not perform disinfectant fogging for routine purposes in patient-care areas. Category IB”
  • 2008: “Do not perform disinfectant fogging in patient-care areas. Category II”

These outdated recommendations are based on studies from the 1970s that found a lack of microbicidal efficacy and adverse effects on healthcare workers exposed to formaldehyde, phenol-based agents, or quaternary ammonium compounds that remain present in the air after fogging. 


However, more recently, the CDC noted, “These recommendations do not apply to newer technologies involving fogging for room decontamination that have become available since the 2003 and 2008 recommendations were made.” 


Citing the CDC’s outdated guidance, AORN has also advised against using spray bottles in surgery rooms, noting a concern about the potential for small, contaminated aerosol droplets, spray bottles, or distribution systems. 

The Latest Advances in Fogging Technology 

Modern HOCl-based products address many of the concerns posed by the CDC, AORN, and others, including using safe, EPA-certified cleaning products and implementing ready-to-use (RTU) solutions. The emergence of hand-held devices that make cleaning easier and more precise also address many historic concerns. 


#1 Chemical Composition 


How clinical and EVS staff apply products is only part of the equation. The products themselves are critically important. Modern foggers use a more effective disinfectant that’s also safer than the legacy fogging chemicals flagged by the CDC, namely formaldehyde, phenol-based agents, and quaternary ammonium compounds.


In modern automated systems, hypochlorous acid (HOCl) stands out as one of the top disinfectants due to its powerful efficacy and exceptional safety profile. Not only is it a potent disinfectant, but it’s also safe for humans and gentle on the environment. 


Nevoa’s automated, no-touch fogging solutions deliver 100 percent HOCl surface contact, eliminating the unpredictability of manual cleaning without compromising efficacy or environmental impact. 


#2 Product Readiness


Hand mixing cleaners can render solutions ineffective or excessively potent, an especially problematic concern when using fogging technology as it disperses the cleaner into the air and even excessive volume of a healthy solution can undermine cleaning initiatives. 


Similarly, studies have found that contaminated disinfectants can spread rather than eradicate infectious diseases, prompting healthcare decision-makers and regulators to balk at these solutions.  


Fortunately, today’s RTU products solve this problem, making the likelihood of product contamination negligible and making disinfectant easier to use and apply. 


#3 Disinfection Delivery 


Especially in a surgical setting, disinfection technologies have historically been impractical to apply between scheduled procedures, requiring too much time, introducing too much complexity, or demonstrating too little efficacy. Today’s disinfection technologies solve these challenges, making the process more efficient and effective than manual cleaning alone. 


Nevoa’s Stratus handheld fogger is groundbreaking in this regard, providing EVS teams with a flexible disinfection solution that elevates terminal cleaning between procedures. The fogger kills 99.9999 percent of pathogens in just one minute, including Staph, MRSA and Pseudomonas — the leading causes of surgery site infections (SSIs).


Advances in Fogging Warrant Another Look

With the right disinfection solution, product readiness, and delivery capacity, it’s clear that healthcare providers should reevaluate their disinfection protocols and solutions ahead of forthcoming guidance from professional organizations and regulatory bodies. 


Every patient deserves advanced disinfection, and Nevoa is here to help you deliver. 


Our whole-room fogging technology is the only patented, hospital-grade surface disinfecting system approved for fogging with EPA-registered hypochlorous acid (HOCl). Contact Nevoa today and let us help you rethink disinfection in your OR or healthcare setting.

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