• Sarah Chute

Review of Cs20 and HLD5 for high level disinfection from PREempt

Updated: Feb 9, 2020

So why would I be interested in doing a review of high level disinfectants? Well I'll tell you why. I love cupping therapy and if you follow me on Instagram you'll see my many posts on it. what I don't love about cupping is the lack of consistency when it comes to cleaning and disinfecting the cups. It seems everyone from manufacturers to distributors to educators all have their own ideas when it comes to this topic. I've seen people recommend boiling cups, using lysol wipes, using thyme based products and even dishwashers to clean and disinfect their cups. I find this incredibly frustrating and I would hope that you do too. With cupping therapy being so hot and trendy right now you would think that there would be a set of guidelines to follow. Well there is, but I feel like many people are unaware of these guidelines which brings me to why I am writing this review.

If you are a Canadian RMT working in a province that is regulated (Ontario, British Columbia, Newfoundland, New Brunswick, and PEI) then you must follow the guidelines set out by your regulatory college. Since I work in Ontario, I will speak specifically about the guidelines set forth by the CMTO (College of Massage Therapists of Ontario). As the college does not maintain classification lists for equipment used in a massage therapy practice, we are advised to follow the guidelines set out by both the CDC and Public Health. So what if you live in a province that isn't regulated? Well this is part of the problem as they do not have a regulatory body to advise them what to do in this case. But that is no excuse, as they still need to follow the guidelines set out by their public health division. They can also look to Colleges of acupuncture within their province as they are required to perform high level disinfection. And if I wanted to be really picky I would say that they would hopefully inform themselves of what regulated provinces (which suggest to follow the guidelines of the CDC) and follow suit. This would then allow them to perform to the highest standards.

So lets start with the CDC and their classification for cupping equipment. According to Spaulding's classification of medical equipment/devices, the CDC considered cupping equipment to fall under "Semi critical Equipment/Devices". This is defined as equipment/devices that comes into contact with NON-INTACT skin or mucous membranes, but does not penetrate them. Now you might think this is not an appropriate classification for cupping equipment because generally we only work with intact skin. And normally I would agree with you, but this leaves room for the potential possibility that the cups come into contact with non intact skin (such as a mosquito bite, a nick from shaving, a pimple breaks). Lets compare this classification to that of non critical equipment which is defined as equipment/devices that touch ONLY INTACT skin and not mucous membranes, or DOES NOT DIRECTLY touch the client/patient/resident. As cups always touch the client, this classification is not applicable. But again I must reiterate that we are to follow the CDC, therefore there really is no wiggle room around this.

Public Health Ontario states that all healthcare providers are to follow the guidelines set out in "Best Practices for Cleaning, Disinfection and Sterilization of Medical Equipment/Devices put out by the Provincial Infectious Disease Advisory Committee on Infection Prevention and control. This document is found throughout Canada (modified by various provinces and Colleges/associations) and should be followed by all healthcare practitioners. The goal of these standards are to minimize the risk of exposure or injury, prevent transmission of microorganisms, contain contaminated materials, and minimize damage to medical devices from foreign material or inappropriate handling. Here you will find cleaning and disinfection options for semi-critical equipment. Semi-critical equipment (cupping vessels) requires high level disinfection. This includes glutaraldehyde greater then 2%, hydrogen peroxide greater then 6% and hydrogen peroxide Enhanced action formulation 2%.

These are our options: boiling, ultraviolet light, glass bead sterilization, microwave ovens and chemical sterilization are not acceptable for achieving disinfection/sterilization (page 67).

Sprout master 35% food grade hydrogen peroxide is often used diluted to achieve a 7 or 7.5% hydrogen peroxide solution, but it does not have a DIN therefore is not a viable option to use as a high level disinfectant. (All disinfectant need to have a Drug Identification Number (DIN) (page 62). Another common product being used to disinfect cups is Decon 30 by Benefect. We are ONLY allowed to use the recommended process options found within Best Practices for Cleaning, Disinfection and Sterilization of Medical Equipment/Devices. I have personally talked to several agents at Public health Ontario, including a regional IPAC (Infection Prevention and Control) specialist, concerning using other products for disinfection and was told very clearly to follow what is in the guidelines. This doesn't mean that that there aren't other products out there that could be viable options, but it is up to IPAC to make recommendations. Their recommendations are developed through reviews of literature and consultations with experts in infectious disease, surveillance, communicable disease and immunization.

Cleaning and disinfecting cups is not something you often learn from a course (though I will say that more and more companies are starting to do this), so if you find yourself taking suggestions on anything other than what is outlined by these two bodies (CDC and Public Health) then I urge you to practice to the highest standards and perform high level disinfection. Having said this I can only talk about Canada and the U.S, but I hear more and more countries are regulating cupping therapy. Hopefully it won't be long before all countries are unified in the classification and disinfection of cupping equipment.

In comes PREempt products. Manufactured in 1998 by Virox technologies, they quickly became a game changer for how the healthcare system approached disinfection. Their products are clean, fast, responsible and sustainable and best of all their products are recognized by the Best Practices for Cleaning, Disinfection and sterilization in All Health Care Settings. These products are already well known within high end spas and salons (because disinfection is expensive), but are less known in the massage industry. Their products are ready to use, saving you time and money. They do not require special ventilation and have zero VOC's (volatile organic compounds) compared to harmful chemicals. Hydrogen peroxide, which is the active ingredient, breaks down into water and oxygen which reduces its impact on the environment. Cs20 and HLD5 are made using the patented Accelerated Hydrogen peroxide (AHP) technology. This is a synergistic blend of commonly used and safe ingredients that when combined with hydrogen peroxide increases its germicidal efficacy and cleaning performance. You can rest assured that by using these products you are not impacting your own personal health, nor the health of your clients all while respecting the health of the environment. Their products are available in over 70 countries and have 9 patents.


PREempt Cs20

Active ingredient and concentration: 7% hydrogen peroxide

Specifications: high level disinfectant and 20 minute sterilant

Sporicidal: (Bacillus subtilis and clostridium sporogenes) 20 minutes

Tuberculocidal: Mycobaterium terrae) 20 minutes

Fungicidal: trichophyton mentagrophytes 20 minutes

License #: 103055

Self life : 12 months

Ready to use: Yes (no mixing needed)

Ventilation required: No

Reusable solution: solution is good for 14 days

Test strips available: AHP7

Size: 1L bottle and 4 L bottle


Canadian link: https://www.viroxprobeauty.ca/

US Link: https://www.viroxprobeauty.com/

CS2o is a sterilant and a high level disinfectant for reprocessing heat sensitive semi-critical and critical devices when heat sterilization is not an option.If your cups come into visible contact with blood, then sterilization is mandatory and this is the product of choice. This product is like a 2-in-1 and is all you need to practice cupping therapy to the highest standards. The test strips are so easy to use. If the colour on the stick doesn't match the colour on the strips container ,then you now your product is no longer usable. This solution is contraindicated for use on copper, brass, carbon tipped devices and aluminum. If spas and salons are using this for their manicure and pedicure tools that rarely come into contact with blood why wouldn't we as therapists follow suit with our tools that rarely come into contact with blood, but help keep our clients safe. This product really gets your cups cleaned as it is not only hydrogen peroxide, but rather a combination of other ingredients with the hydrogen peroxide to provide a remarkable and clean product. It has a slight yellow colour and smell, but nothing that is over powering nor needing ventilation. The test strips make monitoring this product easy and they even provide you with a chart to record its usage.


Active ingredient and concentration: 2% hydrogen peroxide (AHP)

Specifications: 5 minutes high level disinfectant and 6 hour sterilant

Virucidal : poliovirus, sabin strain type 1 (most enveloped and non enveloped viruses) 5 minutes

Bactericidal: pseudomonas aeruginosa, staphyloccoccus aureus, salmonella enterica 5 min

Fugicidal: trichophyton mentagrophytes 5 minutes

Tuberculocidal: Mycobaterium terrae) 5 minutes

Sporicidal: (Bacillus subtilis and clostridium sporogenes) 5 minutes

License #: 103056

Self life : 12 months

Ready to use: Yes (no mixing needed)

Ventilation required: No

Reusable solution: solution is good for 14 days

Size: 4 litre bottle

Test strips: AHP2

Canadian link: https://www.viroxprobeauty.ca/

US Link: https://www.viroxprobeauty.com/

This is a great product that fits into anyone's practice. I reach for this one if I've run out of cups or gua sha tools and I need them right away for my next client. I also go for this one with some of my more expensive cups and tools that I feel would do better in a solution that has less time to soak in, but still follows the standards. I also like to use this with tools that are potentially more porous then other materials so that they still get disinfected but will remain intact and will not be compromised. The test strips are so easy to use. This solution is contraindicated for use on copper, brass, and carbon tipped devices and aluminum. When you're done with your batch you can just put it down the sink. Super easy. (the U.S version of this is the HLD8 with a soak time of 8 minutes )

It is my hope that in writing this review therapists and educators alike will decide to practice to the highest standards. Its easy when we have products like these and thus there really is no excuse to cut corners when it comes to the health and safety of our clients. Preempt products truly achieve the balance between safety and efficacy. I feel good about using these products and I hope you will too.



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