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Kaiser Permanente Rejects Antimicrobials for Infection Control

With no proof that antimicrobial-treated furniture and fabrics improve infection prevention, health care system bans 15 chemicals from use in interior products

December 11, 2015



Nurses station at the San Marcos Medical Offices. A bright open area with windows to outside and beautiful wall art of nature Nurses station at the San Marcos Medical Offices

OAKLAND, Calif. — Concerned about mounting exposure to toxic chemicals in everyday life and the threat of drug-resistant bacteria, Kaiser Permanente has banned paint and other interior building products treated with “germ-fighting” antimicrobial agents for use in its hospitals and other buildings.

Manufacturers routinely add antimicrobial chemicals to products for added infection control, although the Centers for Disease Control and Prevention (CDC) has found no evidence to suggest the products offer any enhanced protection from the spread of bacteria and germs, and that proper cleaning and hand washing are the best ways to prevent infection.

The Guidelines for Environmental Infection Control in Health-Care Facilities, published in 2003 by the CDC and its Healthcare Infection Control Practice Advisory Committee, say no evidence is available to suggest that use of products treated with antimicrobial chemicals will make patients healthier or prevent disease.

Kaiser Permanente, the nation’s largest integrated health care provider and not-for-profit health plan, has been steering builders and architects it works with away from these antimicrobial products since 2006. Recently, the organization formalized its opposition to finishes and fabrics containing antimicrobial chemicals and identified 15 specific antimicrobial chemicals to ban from its hospitals and other buildings because they can be toxic to both people and the environment.

A bright and sunny cafe with people at tables chatting

Cafe in the Oakland Medical Center, Calif.

“Health care interiors can be beautiful spaces designed to inspire health and healing,” said John Kouletsis, vice president of facilities planning and design. “But lurking beneath the surface can be a surprising number of pollutants that are anything but benevolent.”

Kaiser Permanente has a long history of working with manufacturers to remove harmful chemicals from the products it purchases and to develop greener and safer products that are now widely available to consumers.

“Our thought is that if there’s a nonchemical way to solve a problem or there are greener products available that offer the same performance, we should pursue those as safer alternatives,” Kouletsis said.

Kaiser Permanente consulted with infectious-disease experts before notifying furniture and fabric suppliers it would no longer buy products with the antimicrobial agents. The infection prevention community agreed with the CDC’s 2003 findings that properly cleaning and disinfecting surfaces will kill pathogens effectively and prevent the risk of spreading hospital-associated infections. The risk is further reduced with appropriate hand washing by staff and patients.

The antimicrobial ban is effective immediately and applies only to new construction projects and renovations not yet in the purchasing phase. With thousands of projects underway at any given time ─ from minor remodels to major hospital construction ─ the decision to ban these products will have significant influence. Kaiser Permanente has 38 hospitals and more than 600 medical offices in the U.S.

The lobby/waiting room of the Pearlridge Clinic, Hawaii

Pearlridge Clinic lobby, Hawaii

Kaiser Permanente prohibited the use of furniture treated with toxic flame retardant chemicals in 2014, and four additional hospital systems quickly followed suit. Together their combined purchasing power amounted to roughly $50 million a year, a substantial enough sum to encourage manufacturers to make healthier products available to consumers.

Antimicrobials have found their way into every corner of the health care setting. They are now routinely added to paint and grout, ceramic tile, fabrics, glass, and even refrigerators and toilet seats. The products are marketed to health care consumers, as well as to gyms, daycare centers, senior-citizen residences and general consumers.

“Several years ago we stopped purchasing hand soaps that contain the antibacterial triclosan because it was found to be no more effective than washing with plain soap and water, and may cause hormone related health problems,” said Kathy Gerwig, vice president of employee safety, health, and wellness, and Kaiser Permanente’s environmental stewardship officer. “Removing antimicrobials from interior products is an extension of our longstanding efforts to create healthier environments for everyone.”

Banned Antimicrobials Commonly Found In
Benzisothiazolin 3-one (BIT) Adhesives, ceilings, composite wood, engineered wood flooring, floor sealants and coatings, flooring finishes, high-performance coatings, natural oil wood finishes, OSB, paints, resilient flooring, toilet seats, wall protection, wood flooring,
4,4-dimethyloxazolidine Tile-Installation products, admixes
Diiodomethyl p-tolyl sulfone Adhesives, ceilings, composite wood, engineered wood flooring, floor sealants and coatings, flooring finishes, high-performance coatings, natural oil wood finishes, OSB, paints, resilient flooring, toilet seats, wall protection, wood flooring, grout, tile-installation products
Kathon 886 (CIT/MIT mixture) Adhesives, ceilings, composite wood, engineered wood flooring, floor sealants and coatings, flooring finishes, high performance coatings, natural oil wood finishes, OSB, paints, resilient flooring, toilet seats, wall protection, wood flooring, grout, tile-installation products, carpet, acoustical ceiling components, carpet backing
Methylchloroisothiazolinone (CIT, CMIT) Paint, high-performance coatings, flooring, wood flooring
Methylisothiazolinone (MIT) Ceilings, composite wood, engineered wood flooring, floor sealants and coatings, flooring finishes, high-performance coatings, OSB, paints, resilient flooring, toilet seats, wall protection, wood flooring, carpet, acoustical-ceiling components, carpet backing
N-octadecyldimethyl (3-(trimethoxysilyl) propyl) ammonium chloride ceilings, acoustical-ceiling components
Quaternary ammonium compounds, benzyl-C8-16-alkyldimethyl,chlorides paint shield
Silver sodium hydrogen zirconium phosphate carpet backing
Triclosan ceilings, ceramic tile, composite wood, engineered wood flooring, floor sealants and coatings, flooring finishes, high-performance coatings, OSB, paints, resilient flooring, toilet seats, wall protection, wood flooring, grout, tile-installation products, carpet, acoustical-ceiling components, carpet backing
Zinc Pyrithione adhesives, paints, flooring, acoustical-ceiling components, ceilings, carpet backing, wood flooring, high-performance coatings, composite wood, carpet- tile and sheet, resilient flooring, wood flooring, carpet backing, engineered wood flooring, wall-protection adhesive, OSB, textiles, toilet seats
Silver (nano) adhesives, textiles, ceramic tiles, hospital beds and furniture, paints, air conditioning, epoxy resin floor, PVC-wall cladding, flooring, grout, hygienic-laminated surfaces, wall paper, carpet, hospital doors, toilet seats
Silver zinc zeolites resin, adhesives, grouts, ceramic tile, toilet seats
Didecyl dimethyl ammonium chloride (DDAC) wood flooring
Hexamethylenetetramine adhesives and sealants, agricultural chemicals (non pesticidal), CBI, finishing agents, paints

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 10 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.