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OBJECTIVE: Pathogenic microbes may be transmitted directly from the orthodontist to the patient or from the patient to the doctor, and indirectly from patient to patient. The latter may occur via contaminated instruments or surfaces, and is referred to as cross-contamination. The objective of this study was to evaluate the extent of bacterial contamination of orthodontic pliers and the efficacy of the disinfection techniques applied after clinical use. We also sought to examine under standardized conditions the virucidal, bactericidal and fungicidal effects of disinfection techniques used in practice. MATERIALS AND METHODS: The efficacy of various disinfection methods was determined after clinical use in-vivo on 10 test subjects and in-vitro with deliberate contamination. The following disinfection methods were tested: 1. Iso-Septol spray 2. Incidur spray 3. Trough disinfection in combination with 5% Sekusept Plus solution 4. Ultrasound bath in combination with 5% Sekusept Plus solution 5. Thermal disinfection For in-vitro contamination we used the test organisms Staphylococcus aureus, Escherichia coli, Candida albicans, Coxsackie virus B4, HSV 1, and Adenovirus type 5. The tests were carried out six to eight times for each organism. The Weingart pliers and distalend cutters were tested. The criteria for effective disinfection were a reduction in infectiosity of five log steps (for bacteria and fungi) or four log steps (viruses). Statistical analysis was carried out using the Wilcoxon and Whitney U-test. RESULTS: The presence of contamination following clinical use was not adequately eliminated with all disinfection methods. The spray methods exhibited shortcomings in disinfection. For the type of contamination defined, trough disinfection with 5% Sekusept Plus and the Incidur and Iso-Septol spray disinfection methods provided insufficient disinfection. Conversely, the ultrasound bath with 5% Sekusept Plus solution and steam disinfection met the criteria for effective disinfection for all microbes. No statistically significant difference was found between the oiled and unoiled states. In some cases, there were slightly higher rates of contamination with the Weingart pliers as with the distalend cutters. However, these were not statistically significant. CONCLUSIONS: It should be possible to disinfect lipophilic viruses and the usual bacterial infections adequately with all methods, provided that the use of sprays and trough disinfection is preceded by cleaning with brush and water, followed by drying. With hydrophilic viruses, however, the spray and trough disinfection methods are limited in their efficacy and cannot be considered adequate. Exclusively chemical methods are therefore less effective than thermal or physical-chemical methods. Thermal disinfection and the ultrasound bath in combination with 5% Sekusept Plus are clearly superior to spray disinfection and trough disinfection alone. The ultrasound bath and thermal disinfection can therefore be recommended for the disinfection of orthodontic pliers. We recommend that the pliers be cleaned beforehand due to their uneven surfaces.
BACKGROUND: Contaminated surfaces can act as a reservoir for pathogenic microorganisms and potentially exacerbate the risk of infection. Surface disinfection and decontamination provide temporary amelioration against bacterial colonization. Disinfected surfaces eventually become contaminated, thus, mitigating the benefit of the initial disinfection. It is hypothesized that to improve on the current state of the art, a disinfectant should not only immediately disinfect a surface but also provide persistent antimicrobial action after the product has been applied. We describe here a silver-based disinfectant technology designed to provide long-lasting sanitization and disinfection to treated surfaces as evaluated on hard surfaces after repeated environmental insults. METHODS: A comparative evaluation of 6 disinfectant formulations for residual antimicrobial activity after water rinsing was performed. Log reduction of bacterial populations on disinfectant-treated substrates were measured after 30 minutes to 8 hours of exposure and compared with an untreated control. In a similar study, the residual antimicrobial activity of a silver disinfectant was evaluated against antibiotic- and biocide-resistant bacteria also after water rinsing. Further, residual antimicrobial activity of the silver disinfectant was measured after 5 cycles of rinsing, abrasion, and contamination against representative household and nosocomial pathogens (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Enterobacter aerogenes, Enterococcus faecium, or Salmonella choleraesuis) after 10-minute exposure times. RESULTS: In the comparative assay, only the silver disinfectant and a persistent quaternary ammonium compound disinfectant demonstrated significant residual activity (> or =3.0 log(10) reduction to control) against S aureus whereas only the silver disinfectant demonstrated activity against Pseudomonas. No residual activity (< or = 0.5 log reduction to untreated control) was observed for the other disinfectant products. The silver-based disinfectant also showed significant and equivalent efficacy against antibiotic- and silver-resistant bacteria. In addition, the silver disinfectant was able to achieve significant residual activity in 10 minutes against all organisms tested after 1, 3, and 5 cycles of water rinse, abrasion, and microbial contamination. CONCLUSIONS: The findings show the ability of a new silver-based disinfectant to reduce bacterial populations that contact treated surfaces within minutes, highlight the potential to interrupt cross-contamination from environmental surfaces, and reduce the risk of infection within the home and health care settings.
The present investigations are divided into two parts. First it is tested which commercial disinfectants are efficient in aerosol disinfection of bacterial spores. This part is carried out in an aerosol chamber with airborne spores (laboratory experiments). The best results are obtained with peracetic acid, hydrogen peroxide and formaldehyde are effective with some restrictions. With these disinfectants it is tested in the second part if the aerosol disinfecting-method is capable for disinfecting rooms with electronic equipment. This part is carried out in a vessel under open air conditions (field experiments). Bacterial spores dried on germ carriers of limewood, aluminium and rusty iron are exposed to disinfectant aerosols under those temperature and relative humidity conditions which are representative for the four seasons in Germany. In these investigations there are also included germ carriers with spores, that have been lyophilized without any protective substances respectively with Bentonite, Mixtura desiccans and Silicagel + Serum as protective substances. To check the corrosive effect of disinfectant aerosols electronic pocket calculators and pocket transistor receivers have been exposed to the aerosols. The best results are obtained with formaldehyde at temperatures above 10 degrees C and relative humidities within 65% to 95%. At temperatures and relative humidity conditions outside of this optimal range the effectiveness of formaldehyde tends to zero. Hydrogen peroxide is capable for disinfecting spores on germ carriers of limewood and aluminium at all temperature and relative humidity conditions; on germ carriers of rusty iron the effectiveness is reduced strongly. Same results could be obtained with peracetic acid respectively a mixture of peracetic acid and hydrogen peroxide. With these disinfectants a decontamination of rusty iron surfaces is impossible too except the germ concentration on the surface is below 10(4) CFU/cm2. As to the protective substances used in the lyophilization process Bentonite and Mixtura desiccans cause hardly any change in the disinfectant resistance of bacterial spores. Silicagel + Serum in comparison to that protects the imbedded spores that far, that no disinfection of these germ carriers was achieved with the oxidizing agents. As about 15 disinfection runs with each disinfectant did not cause permanent damages to the pocket calculators and transistor receivers it can be emphasized as result of these investigations that aerosol disinfection is an effective method in disinfecting rooms with electronic equipment under middle European climate conditions.(ABSTRACT TRUNCATED AT 400 WORDS)
The effects of chlorine and chlorine dioxide disinfections on quality and toxicity of wastewater were compared. The experiment results showed that chlorine disinfection had no obvious effect on wastewater color, while chlorine dioxide disinfection decreased wastewater color observably. The DOC of wastewater did not change much after chlorine and chlorine dioxide disinfections. Chlorine disinfection significantly increased UV230 of wastewater and chlorine dioxide disinfection slightly decreased UV230 of wastewater. When the disinfectants dosage was 30 mg/L, UV230 increased about 0.7 cm(-1) after chlorine disinfection and decreased about 0.05 cm(-1) after chlorine dioxide disinfection. The acute toxicity of wastewater increased with increasing disinfectants dosage for both chlorine and chlorine dioxide disinfections and the acute toxicity after chlorine disinfection is much stronger than that after chlorine dioxide disinfection. The genotoxicity of wastewater increased slightly after chlorine disinfection and decreased slightly after chlorine dioxide disinfection.
Vaccinia viruses embedded in rabbit dermal scabs were subjected to physical and chemical disinfection procedures. Scabs were suspended in vitro without saline or in physiological saline, and left for 1 hour at 70 to 90 degrees C. A complete inactivation was achived only in those scab samples which had been incubated at 90 degrees C for 1 hour and suspended in physiological saline. Scabs which had been placed in a disinfecting apparatus (Vacudes 4000) filled with mattrasses consistently proved to be free of infectious vaccinia viruses in each of the chosen programs. In addition scabs were subjected to disinfection by means of chemical disinfecting agents. The scabs had been placed in a chemical disinfecting suspension and left there for 90 minutes. Complete disinfection was obtained with glutaraldehyde 2%, formaldehyde 2%, Lysoformin 2% or 3%, phenol 5% and chloramine T 2%. Complete disinfection was likewise achieved after 3 hours treatment with some alchohols (ethylalcohol 80%, isopropylalcohol 7%, n-propylalcohol 60%), Amocid 5% and formaldehyde 1%.0.5% formaldehyde caused complete disinfection when applied for 6 hours. The only exception was a Quat which did not disinfect fully even after 18 hours application. Concerning the tests to disinfect the hands complete disinfection occurs when using chloramine T (1.5%) or isopropylalcohol (70%) in 2 to 5 minutes. Further tests were performed with scabs which were placed in sick rooms that were terminally disinfected with formaline vapor. It could be confirmed that the usual terminal disinfection with formaldehyde vapor was unable to completely disinfect the scabs. It is necessary to double the amount of formaldehyde (10 g formaldehyde per cubic metre of space) and prolong the period of treatment to 24 hours to achieve a greater degree of disinfection rate.
BACKGROUND/AIMS: There is some confusion as to the effectiveness of the available disinfectants for achieving "high level" disinfection, and the microbiologic method to assess the efficacy of the selected disinfectant regime. The "in use" method is adequate for control and for establishing comparisons between different disinfectants. METHODOLOGY: This study compares the efficacy of the different disinfectants and disinfection regimes available, including automatic systems to the 20-minute immersion in 20 degrees C 2%-alkaline-glutaraldehyde (AG). After cleaning and disinfection the effluent obtained from each channel was collected under sterile conditions. A total of 0.1 mL of the effluent was introduced in liquid thioglycolate, an additional 0.1 mL was seeded in solid blood agar and in MacConkey agar medium, and maintained for 48 hours at 37 degrees C. Thioglycolate media turbidity after a 48-hour culture indicates bacterial growth. RESULTS: The disinfectants used were 2% AG, 0.125% and 0.27% glutaraldehyde, glutaraldehydephenol-phenate, peracetic acid, N-duopropenida, 13%-H2O2-27%-lactic acid and ortho-phtalaldehyde using manual and automated methods. Most of the disinfectants available obtain similar or better results compared with 20' 2% AG. The best results (bacterial reduction greater than 3 log10), were those obtained using 20-minute 1/4 or 1/2 glutaraldehydephenol-phenate, 10-minute peracetic acid, or hydrogen-peroxide compounds, 5-minute 0.125% and 0.27% AG at high temperature and 5-minute 0.5% ortho-phtalaldehyde. CONCLUSIONS: A sensitive microbiologic method described may be useful in the control of disinfection and allowed: 1) knowledge of the limits of the efficacy of the disinfection methods usually used, 2) effective comparison of the different disinfectants and disinfection regimes and 3) awareness of the need for microbiologic regulations in assessing "high level" disinfection.
Skin disinfection at the site of venipuncture is a critical point in every blood transfusion collection procedure, as it contributes to ensure the bacterial safety of transfusion. Quantitative and qualitative analysis of bacteria present in the antecubital fossae before and after skin disinfection may be one method of assessing the anti-bacterial efficiency of disinfection. Swab culture systems and contact plates are the two techniques usually employed for this purpose. A washing and swabbing technique was used to quantify bacteria before and skin disinfection of the antecubital fossae in blood donors. This contra-placebo study was carried out on 32 donors, each of whom served as his own control, with a random choice of test arm and opposing control arm. Bacterial counts were determined in the antecubital fossae without skin disinfection (control, n = 32) and after a 3 step skin preparation procedure (cleaning, wiping, disinfection) using placebo (distilled water, n = 16) or an antiseptic product (mixture of chlorexidine, benzalkonium chloride and benzylic alcohol, n = 16). The absence of a statistical difference in bacterial counts between the right and left antecubital fossae without disinfection was controlled in a preliminary study of 20 subjects. Mean bacterial counts were 25,000/cm2 and 27,400/cm2 respectively for aerobic and anaerobic bacteria before disinfection, with a wide variation in results between individuals. When using placebo, preparation of the venipuncture site by the 3 step method (cleaning, wiping, disinfection) resulted in a non significant mean reduction of 0.56 log in aerobic and anaerobic bacteria. Using the antiseptic product, the same method resulted in a significant mean reduction of 1.8 and 1.7 log respectively in aerobic (p = 0.015) and anaerobic flora (p = 0.005). On an average, 2,750 aerobic bacteria/cm2 and 2,910 anaerobic bacteria/cm2 remained after disinfection, while qualitative analysis showed that disinfection suppressed the transitory flora in all cases but left part of the resident flora in 12/16 cases. These findings are comparable to those of other studies carried out to evaluate this kind of technique for the disinfection of operation sites. In comparison with other techniques classically employed for this type of evaluation (swab systems or contact plates), the method used in this study was the advantage of allowing the quantification of the reduction in bacteria. Hence this method could be employed for comparative assessment of skin disinfection techniques with the aim of improving their anti-bacterial efficiency and could also make possible the definition of a minimum bacterial count (resident flora) to be obtained in all cases after disinfection.
In recent years an increase of the incidence of Candida infections caused mainly by C. albicans strains especially in high risk inpatients with neoplasms, decreased immunity, burns and after treatment with multiple antibiotics has been observed. Candida organisms are particularly dangerous for newborns being responsible for about 30% of septicaemia cases in newborns in intensive care units. Fungal infections can be endogenous in origin but exogenous infection sources occur in hospitals. The cause of the latter are errors in aseptic management and insufficiently disinfected medical instruments and equipment. The purpose of the study was a comparison of the sensitivity to disinfectants of C. albicans belonging to two laboratory strains C. albicans PZH and C. albicans ATCC 10231 used for the determination of concentrations of two disinfectants used. Besides that, this sensitivity was determined in 14 strains isolated from the patients and one from the circuit of dialysis solution supply to artificial kidney. The study was carried out by the qualitative suspension method, in which the cells in the fluid were subjected to the action of disinfectants, and by the carrier method in which the cells of the microorganisms were present on the surface of metal cylinders. By the suspension method the sensitivity was determined to chloramine T in concentrations from 5.0% to 0.001%, formalin from 10.0% to 0.25%, glutaraldehyde from 2.0% to 0.1%, Septyl from 3.5% to 0.25%. The exposure time was 5, 10, 15, 30 and 60 minutes. The tested strains differed in their sensitivity to the disinfectants used. The greatest interstrain differences were observed in the sensitivity to the disinfectants used. The greatest interstrain differences were observed in the sensitivity to chloramine T. The highest concentrations were tolerated by the strains isolated from the patients and from the artificial kidney circuit as well as by the standard strain ATCC 10231. In the 10-minute exposure time accepted by us as comparison standard these strains were 200-time less susceptible to chloramine than the standard C. albicans PZH strain. Two strain isolated from the patients were tenfold as sensitivive. The sensitivity to the remaining tested disinfectants showed less evident differences. The sensitivity of the strains from the patients to formalin was similar to that of the standard PZH strain. A similar sensitivity was found to Septyl, with the exception of the strain from the artificial kidney circuit which was sevenfold less sensitive than the PZH strain. In the case of glutaraldehyde 9 strains from the patients and the ATCC 10231 strain were two or four times less sensitive than the PZH strain. No cross-sensitivity or tolerance to the disinfectants were noted in the study. Both standard strains were similarly sensitive to formalin, but the ATCC 10231 strain was less sensitive to Septyl, glutaraldehyde and chloramine T. In the experiment by the carrier method the effect was evidenced of the surface on the action of disinfectants. This was particularly evident in the case of chloramine T. Even in sensitive strains the disinfection parameters (concentration and exposure time) were significantly higher than in the suspension method. The least sensitive strains survived the effect of 5% chloramine during 2 hours of exposure. Septyl in the working concentration 2.5% at 10-minute exposure time disinfected all carriers with the exception of that carrying the strain isolated from the artificial kidney circuit, which survived 15% Septyl exposure during 10 minutes. The disinfectant Aldesan (2% glutaraldehyde) and formalin 8% killed all fungi during 10 minutes. The study shows that the sensitivity of C. albicans strains to disinfectants varies. For the assessment of the fungicidal action of disinfectants the standard test ATCC 10231 should be used since its sensitivity was similar to that of most strains from the patients and medical equipment. (ABSTRACT TRUNCATED)
BACKGROUND: Skin disinfection before neuroaxial blockade procedures is usually obtained with sterile swabs impregnated in disinfectant. Spray disinfection is also an option which is frequently used in minor invasive procedures. The purpose of our study was to compare the efficacy of conventional swab disinfection with spray disinfection prior to epidural catheterization. METHODS: Seventy patients who requested epidural analgesia were randomly selected. The first group (n=35) received disinfection with swabs (SW) containing 2-propanol and benzalkonium chloride. The other 35 patients received spray (SP) disinfection with the same solution. Three microbiological cultures were obtained: one culture prior to skin disinfection, a second immediately after disinfection and a third from the tip of the epidural catheter upon removal. RESULTS: One patient in the SW group had a positive skin culture immediately after the disinfection with a very low number of colony forming units. The other skin culture specimens were all sterile in both groups. The colonization rate of catheters was not statistically different between the groups at removal. CONCLUSION: In this study, spray disinfection was equally efficacious compared with the conventional skin disinfectant technique. Our results support the routine use of this simple and cheap alternative method of skin disinfection before epidural anaesthesia.
One of the most common pathogens in infection of hydrogel contact lens wearers is Pseudomonas aeruginosa, which can gain access to the eye via contamination of the lens, lens case, and lens care solutions. Only one strain per species is used in current regulatory testing for the marketing of chemical contact lens disinfectants. The aim of this study was to determine whether P. aeruginosa strains vary in their susceptibility to hydrogel contact lens disinfectants. A method for rapidly screening bacterial susceptibility to contact lens disinfectants was developed, based on measurement of the MIC. The susceptibility of 35 P. aeruginosa isolates to two chemical disinfectants was found to vary among strains. MICs ranged from 6.25 to 100% for both disinfectants at 37 degrees C, and a number of strains were not inhibited by a 100% disinfectant concentration in the lens case environment at room temperature (22 degrees C). Resistance to disinfection appeared to be an inherent rather than acquired trait, since some resistant strains had been isolated prior to the introduction of the disinfectants and some susceptible P. aeruginosa strains could not be made more resistant by repeated disinfectant exposure. A number of P. aeruginosa strains which were comparatively more resistant to short-term disinfectant exposure also demonstrated the ability to grow to levels above the initial inoculum in one chemical disinfectant after long-term (24 to 48 h) disinfectant exposure. Resistance was correlated with acute cytotoxic activity toward corneal epithelial cells and with exsA, which encodes a protein that regulates cytotoxicity via a complex type III secretion system. These results suggest that chemical disinfection solutions may select for contamination with cytotoxic strains. Further investigation of the mechanisms and factors responsible for resistance may also lead to strategies for reducing adverse responses to contact lens wear.
In order to examine whether thorough surgical hand disinfection (handwashing plus hand disinfection) between consecutive operations is necessary, tests were carried out simulating normal clinical conditions. The tests were performed according to the guidelines for the evaluation of disinfection procedures of the German Society for Hygiene and Microbiology. Surgical hand disinfection was as follows: handwashing with soap without antimicrobial additives and subsequent 5-min disinfection with 60% n-propanol. This was followed by simulated operations of 30 or 120 min duration with a 30-min break between operations, during which half of the test group kept on the surgical gloves, while the other half removed them. The second surgical hand disinfection was done without prior handwashing by 50% of the test group. The disinfection time was reduced from 5 to 1 min by 50% of the test group. The results were evaluated by means of explorative data analysis and inductive statistical methods. Removing the surgical gloves during the interoperative break did not result in significantly higher numbers of colony forming units (cfu) compared with retaining the gloves. This was also the case after a subsequent handwashing. At the second surgical hand disinfection, after a simulated operation of 60 min duration (including break), there was no significant difference in the numbers of cfus between the test group who had washed their hands and those who had not. Reducing the disinfection time from 5 min to 1 min was not associated with a significant increase in the number of cfus. However, after a simulated operating time of 150 min (including the break), the second surgical hand disinfection with handwashing resulted in a significantly lower number of microorganisms than disinfection alone. In half the tests, the numbers of cfu were significantly lower when the test group disinfected their hands for 5 min rather than 1 min.
STATEMENT OF THE PROBLEM: In selecting a disinfectant for dental prostheses, compatibility between the disinfectant and the type of denture base material must be considered to avoid adverse effects on the hardness of the acrylic resin. PURPOSE: This study investigated the hardness of 2 denture base resins after disinfection and long-term water immersion. MATERIAL AND METHODS: Thirty-two disk-shaped specimens (13 mm in diameter and 8 mm thick) were fabricated from each resin (Lucitone 550 and QC-20), polished, stored in water at 37 degrees C for 48 hours, and submitted to hardness tests (Vickers hardness number [VHN]) before disinfection. Disinfection methods included scrubbing with 4% chlorhexidine gluconate for 1 minute, immersion for 10 minutes in 1 of the tested disinfectant solutions (n=8) (3.78% sodium perborate, 4% chlorhexidine gluconate, or 1% sodium hypochorite), and immersion in water for 3 minutes. The disinfection procedures were repeated 4 times, and 12 hardness measurements were made on each specimen. Control specimens (not disinfected) were stored in water for 56 minutes. Hardness tests (VHN) were also performed after 15, 30, 60, 90, and 120 days of storage in water. Statistical analyses of data were conducted with a repeated measures 3-way analysis of variance (ANOVA) and Tukey post-hoc test (alpha=.05). RESULTS: Mean values +/- SD for Lucitone 550 (16.52 +/- 0.94 VHN) and QC-20 (9.61 +/- 0.62 VHN) demonstrated a significant (P <.05) decrease in hardness after disinfection, regardless of material and disinfectant solutions used (Lucitone 550: 15.25 +/- 0.74; QC-20: 8.09 +/- 0.39). However, this effect was reversed after 15 days of storage in water. Both materials exhibited a continuous increase (P <.05) in hardness values for up to 60 days of water storage, after which no significant change was observed. CONCLUSION: Within the limitations of this in vitro study, QC-20 and Lucitone 550 specimens exhibited significantly lower hardness values after disinfection regardless of the disinfectant solution used.