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PubMed2003

Disinfection and the prevention of infectious disease.

This article reviews published literature to determine the role environmental disinfection plays in the prevention of infectious disease. Health benefits from disinfection have been established through studies of applications such as critical instrument sterilization, water treatment, and food production. Guidelines by the Centers for Disease Control and Prevention, the Food and Drug Administration, the Environmental Protection Agency, and the International Scientific Forum on Home Hygiene acknowledge the incidence of disease due to insufficient disinfection and that one of the means for prevention of disease is through proper disinfection. Studies conducted in day care centers, long-term care facilities, and laboratories show that disinfectants containing a variety of active ingredients demonstrated efficacy against a broad spectrum of pathogens and interrupted microbial transmission and that the use of disinfectants results in public health benefits.

Cross Infection↗
PubMed2006

Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap.

BACKGROUND: Needleless valve connectors for vascular catheters are widely used throughout the United States because they reduce the risk of biohazardous injuries from needlesticks and exposure to bloodborne pathogens, such as human immunodeficiency virus and hepatitis C virus. Patients with long-term central venous catheters are at significant risk of acquiring catheter-related bloodstream infections caused by microbes that gain access through the connection between the administration set and the catheter or an injection port. Most healthcare practitioners wipe the membranous septum of the needleless connector or the injection port with 70% alcohol before accessing it. We report a simulation study of the efficacy of conventional alcohol disinfection before access, compared with that of a novel antiseptic-barrier cap that, when threaded onto a needleless luer-activated valved connector, allows a chlorhexidine-impregnated sponge to come into continuous contact with the membranous surface; after removal of the cap, there is no need to disinfect the surface with alcohol before accessing it. METHODS: One hundred five commercial, needleless luer-activated valved connectors, each accessible by a blunt male-connector luer-lock attachment, were purchased from 3 manufacturers and were tested. The membranous septum of each test device was first heavily contaminated with approximately 10(5) colony-forming units of Enterococcus faecalis and then was allowed to dry for 24 hours. Fifteen of the contaminated devices were not disinfected (positive controls), 30 were conventionally disinfected with a commercial 70% alcohol pledget, and 60 had the antiseptic cap threaded onto the connector and then removed after 10 minutes. The test connectors were then accessed with a sterile syringe containing nutrient broth media, which was injected, captured on the downstream side of the intraluminal fluid pathway, and cultured quantitatively. RESULTS: All 15 control connectors (100%) showed massive transmission of microorganisms across the membranous septum (4,500-10,000 colony-forming units). Of the 30 connectors accessed after conventional disinfection with 70% alcohol, 20 (67%) showed transmission of microorganisms (442-25,000 colony-forming units). In contrast, of the 60 connectors cultured after application of the novel antiseptic cap, only 1 (1.6%) showed any transmission of microorganisms (P < .001). CONCLUSIONS: The findings of this study show that, if the membranous septum of a needleless luer-activated connector is heavily contaminated, conventional disinfection with 70% alcohol does not reliably prevent entry of microorganisms. In contrast, the antiseptic-barrier cap provided a high level of protection, even in the presence of very heavy contamination. This novel technology deserves to be studied in a clinical trial.

Bacteriological Techniques↗
PubMedDate not supplied

Endoscope disinfection by ortho-phthalaldehyde in a clinical setting: an evaluation of reprocessing time and costs compared with glutaraldehyde.

Ortho-phthalaldehyde provides high-level disinfection in 12 minutes at room temperature (20 degrees C). To determine whether the endoscopy unit at Massachusetts General Hospital could cost-effectively increase endoscope throughput and decrease delayed procedures while maintaining biocidal efficacy with heavy use, ortho-phthalaldehyde solution (0.55% w/v) was used for high-level disinfection in place of glutaraldehyde in the unit's five automatic endoscope reprocessors. During this 38-day study, 1,839 endoscopes were processed in 1,201 cycles. Each machine ran an average of 80 disinfection cycles in each of three consecutive periods. The shorter disinfection time of ortho-phthalaldehyde (12 minutes) resulted in an average savings of 53 hours in disinfection time per study period for the five processors when compared with glutaraldehyde's 20-minute disinfection time.Ortho-phthalaldehyde costs more per gallon than glutaraldehyde ($31.03 versus $13.20). This higher cost would be offset, however, by additional time savings resulting from the fact that compared with glutaraldehyde, ortho-phthalaldehyde is faster-acting and a mixing and activation step is not required. In addition, testing prior to each cycle verified that despite heavy use, ortho-phthalaldehyde solution remained efficacious, lasting through an average of 80 cycles, whereas glutaraldehyde only lasts for an average of 40 cycles. Test strips showed the concentration of ortho-phthalaldehyde in the reprocessors remained above the minimum effective concentration for the entire 14-day maximal reuse period. Additional microbiological efficacy testing of spent solution diluted to its minimum effective concentration demonstrated the solution remained tuberculocidal in tests with Mycobacterium bovis.

Disinfectants↗
PubMed1997

Structural damage to Schiotz tonometers after disinfection with solutions.

Although Schiotz tonometry has been long ago replaced by Goldmann applanation tonometry measurement of intraocular pressure, it remains a viable clinical technique in nursing homes and other "out of office" settings. Because Schiotz tonometers come into contact with the cornea and tear film, they must be properly disinfected to prevent cross-infection with HIV and other infectious pathogens. The Centers for Disease Control and Prevention (CDC) recommends that all eye contact devices be disinfected by a 5- to 10-min soak in one of following disinfectants: 3% hydrogen peroxide, 1:10 sodium hypochlorite (household bleach), or 70% isopropyl alcohol. The effects of these disinfectants on Schiotz tonometers have not been previously investigated. This study investigated the effects of CDC-recommended disinfectants on the structural integrity of Schiotz tonometers. The results of the study indicated that soaking in 1:10 sodium hypochlorite and 3% hydrogen peroxide damaged Schiotz tonometers and rendered them inoperable. Alcohol caused minor damage to the tonometer and was the safest of the CDC disinfectants. This study showed there is limited application of CDC infection control criteria to Schiotz tonometers due to the extensive corrosion and damage caused by hydrogen peroxide and bleach.

1-Propanol↗
PubMed1980

A technique for disinfection of the MDO oxygen electrode.

A method for disinfection and aseptic assembly of the MDO (Mehrdraht Dortmund Oberfläche) oxygen electrode has been evaluated. The method is based on treating each electrode component separately and then assembling the different parts under aseptic surgical conditions. The performance of the disinfected electrode was studied and found to be unchanged as compared with a non-disinfected electrode. Bacteriological studies on the effectiveness of the disinfection technique described and on the permeability of the electrode membranes to bacteria and bacterial spores were performed. The electrode membranes were penetrated by bacteria in experiments simulating in-use conditions in about 11% of membranes tested, after contamination of the inner electrode surface with heavy inocula. When studies were performed with the disinfected MDO oxygen electrode on humans, routine cultures from the wound were positive in about 10% of the cases. No clinical wound infection was seen. The majority of the positive cultures were probably caused by the surgical technique rather than the handling of the electrode. The disinfection method for the MDO oxygen electrode described in this paper makes it possible to use the electrode clinically, except in cases of hepatitis.

Bacterial Infections↗
PubMed1992

[Relationship between hand-washing activity of disinfectants and in vitro bactericidal activity in the presence of peptone].

A study was made on the relation between in vitro bactericidal activity against Staphylococcus epidermidis which is the main bacterial flora of skin and the disinfecting activity of hand-washing with povidone-iodine, sodium hydrochloride, chloramin-T, chlorhexidine gluconate and benzalkonium-chloride. Although the bactericidal activity of povidone-iodine and sodium hydrochloride was significantly high as compared with those of the other three disinfectants, both povidone-iodine and sodium hydrochloride showed no or a little hand-washing effects. In vitro the bactericidal activity of both povidone-iodine and sodium chloride were significantly retarded by the addition of peptone in the reaction mixture. On the other hand, chloramin-T, chlorhexidine gluconate and benzalkonium chloride showed a high disinfecting activity in hand washing in spite of low in vitro bactericidal activity. Moreover, the bactericidal activity of these three disinfectants were not suppressed by the addition of peptone in the reaction mixture. These results strongly suggested that hand washing effect of disinfectant is affected by the protein on the hand and that hand-washing activity of disinfectant should be determined by in vitro bactericidal activity in the presence of peptone.

Chlorhexidine↗
PubMed2005

Efficacy of two peroxygen-based disinfectants for inactivation of Cryptosporidium parvum oocysts.

Two commercial peroxygen-based disinfectants containing hydrogen peroxide plus either peracetic acid (Ox-Virin) or silver nitrate (Ox-Agua) were tested for their ability to inactivate Cryptosporidium parvum oocysts. Oocysts were obtained from naturally infected goat kids and exposed to concentrations of 2, 5, and 10% Ox-Virin or 1, 3, and 5% Ox-Agua for 30, 60, and 120 min. In vitro excystation, vital dyes (4',6'-diamidino-2-phenylindole and propidium iodide), and infectivity in neonatal BALB/c mice were used to assess the viability and infectivity of control and disinfectant-treated oocysts. Both disinfectants had a deleterious effect on the survival of C. parvum oocysts, since disinfection significantly reduced and in some cases eliminated their viability and infectivity. When in vitro assays were compared with an infectivity assay as indicators of oocyst inactivation, the excystation assay showed 98.6% inactivation after treatment with 10% Ox-Virin for 60 min, while the vital-dye assay showed 95.2% inactivation and the infectivity assay revealed 100% inactivation. Treatment with 3% Ox-Agua for 30 min completely eliminated oocyst infectivity for mice, although we were able to observe only 74.7% inactivation as measured by excystation assays and 24.3% with vital dyes (which proved to be the least reliable method for predicting C. parvum oocyst viability). These findings indicate the potential efficacy of both disinfectants for C. parvum oocysts in agricultural settings where soil, housing, or tools might be contaminated and support the argument that in comparison to the animal infectivity assay, vital-dye and excystation methods overestimate the viability of oocysts following chemical disinfection.

Animals↗
PubMed2006

Does a preceding hand wash and drying time after surgical hand disinfection influence the efficacy of a propanol-based hand rub?

BACKGROUND: Recently, a propanol-based hand rub has been described to exceed the efficacy requirements of the European standard EN 12791 in only 1.5 min significantly. But the effect of a 1 min preceding hand wash and the effect of one additional minute for evaporation of the alcohol after its application on the efficacy after a 1.5 min application time has never been studied. METHODS: We have investigated a propanol-based hand rub (Sterillium, based on 45% propan-2-ol, 30% propan-1-ol and 0.2% mecetronium etilsulfate) in three variations: with (A) and without (B) a 1 min hand wash before the disinfection of 1.5 min with immediate sampling after the disinfection; and (C) without a hand wash before the disinfection but with sampling 1 min after the disinfection. The efficacy of the three variations was compared to the reference treatment of EN 12791. All experiments were performed in a Latin-square design with 20 volunteers. Pre- and post-values (immediate and after 3 hr) were obtained according to EN 12791. RESULTS: The 3 min reference disinfection reduced resident hand bacteria on average by 1.8 log10 steps (immediate effect) and 1.4 log10-steps (sustained effect) respectively. Method A was equally effective as the reference (immediate efficacy: 1.5 log10-steps; sustained efficacy: 1.6 log10-steps). Method B seemed to be more effective (immediate efficacy: 2.3 log10-steps; sustained efficacy: 1.7 log10-steps). Method C revealed the best efficacy (immediate efficacy: 2.3 log10-steps; sustained efficacy: 2.0 log10-steps). A comparison of all three treatment variations and the reference treatment revealed a significant difference for the immediate efficacy (p = 0.026; Friedman test), but not for the sustained efficacy (p = 0.430). A post-hoc-test for the immediate efficacy indicated a significant difference between methods A and C (p < 0.05; Wilcoxon-Wilcox test). Hence, none of the treatment variations was significantly less effective than the reference treatment. CONCLUSION: An application of the propanol-based hand rub for 1.5 min after 1 min hand wash fulfills the efficacy requirements of EN 12791. The efficacy can be improved to some extent by omitting the preceding hand wash and by awaiting the evaporation of the alcohol which is clinical practice anyway. The preceding hand wash has the most negative effect on the immediate effect. Based on our data hands should not be routinely washed before the disinfection period unless there is a good reason for it such as visible soiling.

Anti-Infective Agents, Local↗
PubMed1986

Stability and effectiveness of chlorine disinfectants in water distribution systems.

A test system for water distribution was used to evaluate the stability and effectiveness of three residual disinfectants--free chlorine, combined chlorine, and chlorine dioxide--when challenged with a sewage contaminant. The test distribution system consisted of the street main and internal plumbing for two barracks at Fort George G. Meade, MD. To the existing pipe network, 152 m (500 ft) of 13-mm (0.5 in.) copper pipe were added for sampling, and 60 m (200 ft) of 2.54-cm (1.0 in.) plastic pipe were added for circulation. The levels of residual disinfectants tested were 0.2 mg/L and 1.0 mg/L as available chlorine. In the absence of a disinfectant residual, microorganisms in the sewage contaminant were consistently recovered at high levels. The presence of any disinfectant residual reduced the microorganism level and frequency of occurrence at the consumer's tap. Free chlorine was the most effective residual disinfectant and may serve as a marker or flag in the distribution network. Free chlorine and chlorine dioxide were the least stable in the pipe network. The loss of disinfectant in the pipe network followed first-order kinetics. The half-life determined in static tests for free chlorine, chlorine dioxide, and combined chlorine was 140, 93, and 1680 min.

Bacteriophages↗
PubMed2004

Nontraditional method of evaluating disinfectants: with isolated microorganisms from the food factory.

Cleaning and disinfection in the food industry are critical in the production process, and the efficacy of the disinfectants used is frequently debated. Several factors are involved in the effectiveness of a disinfectant agent. It is important to consider the number and type of microorganism present as well as the physical and chemical characteristics of the water; these factors vary from industry to industry and they determine efficacious disinfection. In the laboratory it is possible to evaluate disinfectants to be used in a particular factory, even though these are different from those reported by international organizations. Some useful practices are: 1. To use cultures of microorganisms isolated in one's own lab instead of reference cultures. 2. To use as a diluter the water that is used daily in the factory under question. 3. To compare different disinfectant products under identical conditions of time and temperature.

Disinfectants↗
PubMed1995

Special needs for disinfectants in food-handling establishments.

Freedom from microbial and foreign body contamination is essential in food production, and the principal means for controlling the surface route of contamination is sanitation (cleaning and disinfection). After the cleaning phase, disinfection plays a crucial role in further reducing microbial numbers and viability. However, disinfectants for use in the food industry may contaminate the product. Therefore, as well as being effective and suitable for factory use, such disinfectants must also be non-toxic and non-tainting. The author describes the usage criteria and operator safety requirements of disinfectants, together with methods to determine taint potential, toxicity and efficacy. Using these parameters, a limited number of disinfectants are judged suitable for general food industry use and these are compared.

Animals↗
PubMed2005

Efficacy of directed misting application of a peroxygen disinfectant for environmental decontamination of a veterinary hospital.

OBJECTIVE: To evaluate effectiveness of 4% peroxymonosulfate disinfectant applied as a mist to surfaces in a large animal hospital as measured by recovery of Staphylococcus aureus and Salmonella enterica serovar Typhimurium. DESIGN: Field trial. SAMPLE POPULATION: Polyester transparencies inoculated with bacteria. PROCEDURE: Polyester transparencies were inoculated with S aureus or S Typhimurium and placed in various locations in the hospital. After mist application of the peroxygen disinfectant, viable bacterial numbers were quantified and compared with growth from control transparencies to assess reduction in bacterial count. RESULTS: When applied as a mist directed at environmental surfaces contaminated with a geometric mean of 4.03 x 10(7) CFUs of S aureus (95% confidence interval [CI], 3.95 x 10(7) to 4.11 x 10(7)) or 6.17 x 10(6) CFUs of S Typhimurium (95% Cl, 5.55 x 10(6) to 6.86 x 10(6)), 4% peroxymonosulfate reduced the geometric mean number of viable S aureus by 3.04 x 10(7) CFUs (95% Cl, 8.6 x 10(5) to 1.7 x 10(6)) and S Typhimurium by 3.97 x 10(6) CFUs (95% Cl, 8.6 x 10(5) to 3.5 x 10(6)). CONCLUSIONS AND CLINICAL RELEVANCE: Environmental disinfection with directed mist application of a 4% peroxymonosulfate solution was successful in reducing counts of bacterial CFUs by > 99.9999%. Directed mist application with this peroxygen disinfectant as evaluated in this study appeared to be an effective and efficient means of environmental disinfection in a large animal veterinary hospital and would be less disruptive than more traditional approaches to intensive environmental cleaning and disinfection.

Aerosols↗
PubMed2000

[Residual bacterial contamination of rhinoscopes used in ENT consultation after cleaning with a pad impregnated with a disinfectant].

INTRODUCTION: The duration of the official disinfection procedure of a Hopkins rhinoscope agreed by the hospital hygiene authorities may be a handicap in a busy ENT consultation. A shortened procedure is sometimes used, but without risk assessment. OBJECTIVE: To determine the risk of contamination of the endoscope used for rhinoscopy after simple manual cleaning with a pad impregnated with a disinfectant solution (Neosabenyl). PATIENTS AND METHOD: In 60 patients undergoing rhinoscopy at our ENT policlinic, a nasal swab as well as the endoscope were examined bacteriologically. The nasal physiological flora and specifically Staphylococcus aureus were semiquantitatively analysed on each specimen. In 50 patients, the rhinoscopes were simply cleaned with an impregnated pad, whereas in 10 patients the official disinfection procedure with glutaraldehyde was applied. RESULTS: 25 out of the 50 endoscopes (50%) which were manually cleaned with the impregnated pad, were still contaminated with bacteria. Among the 12 (20%) identified healthy carriers of S. aureus, 7 (58%) showed a rhinoscope still contaminated with S. aureus after cleaning with the pad. The overall risk of contaminating the following patient with S. aureus is 14%. None of the 10 endoscopes cleaned and disinfected with glutaraldehyde were contaminated. CONCLUSIONS: Simple manual cleaning and disinfection with an impregnated pad is insufficient and carries the risk of contaminating the following patient. This emphasises the need to follow the recommended cleaning and disinfection procedures even in a small or busy practice.

Carrier State↗
PubMed2003

[The use of disinfectants in veterinary practice].

The use of chemical disinfectants within the veterinary practice is only permitted when the disinfectants are legally registered. A distinction has to be made between disinfectants to be used on the skin of men or animals and disinfectants to be used on surfaces like floors, walls, cages, stables and for veterinary instruments. For the first group, to be considered as (veterinary) medicines, the Act on (Veterinary) Medicines applies. For the second group, to be considered as veterinary biocides, the Pesticide Act applies. A small survey carried out by the Keuringsdienst van Waren shows that in veterinary practice disinfectants are applied in an inappropriate way. A lack of knowledge and the lack of hygienic protocols could be reasons for these misuses. In this article the Keuringsdienst van Waren gives information about the legal aspects of disinfectants that fall within the scope of the Pesticide Act.

Animals↗
PubMed2002

[Chemical disinfection. An alternative to sterilization in the treatment of cure instruments].

UNLABELLED: Sterilization is the reference method recommended to ensure the asepsia of an instrument used to perform cures. Chemical disinfection has shown itself to be highly effective in this process for endoscope equipment without there being definitive references about its efficiency on instruments used for cures. OBJECTIVE: Evaluate the efficiency of chemical disinfection on instruments used for cures, with the reference method being sterilization. METHODS: Prospective study in which the efficiency of glutaraldehyde-phenolate is compared to sterilization on 9 sets of instruments used for cures, each one having a dissection clamp and a Kocher clamp, used in 122 cures carried out in different wards at the León Hospital. Their efficiency was evaluated by means of microbiological studies after cures were performed and after disinfection or sterilization occurred. RESULTS: There were no positive cultures after either the disinfection or the sterilization. The existence of positive cultures after cures was related to the type of wound treated, clean wounds were always negative while dirty wounds were frequently positive (p < 0.05). CONCLUSION: Chemical disinfection with glutaraldehyde-phenolate is as efficient as sterilization in assuring the asepsia of instruments, while offering some clear advantages compared to sterilization since this chemical disinfection has a low cost, its use avoids the need to have duplicate instrument sets, it provides a longer life for these instruments and does not require moving instruments from their work site, thus preventing their loss.

Disinfectants↗
PubMed1992

A critical evaluation of the Multi-item Microbial Challenge Test in ophthalmic disinfectant testing.

The Multi-item Microbial Challenge Test (MIMCT) is a stringent, carrier assay of the disinfecting efficacy of a contact lens care regimen. The test involves four steps: 1) in vitro contamination of contact lenses in the presence of organic load; 2) cleansing the contact lens by mechanical rubbing and subsequent rinsing; 3) disinfection of the cleansed lens; and 4) assaying the contact lens and the disinfecting solution for viable microorganisms. The variability of the individual steps was evaluated in this study by the Contributions of Elements protocol. The efficacy of the cleansing step, while reputed to be highly variable, was found to be reproducible and dependent upon the formulation under test. A contact lens disinfecting regimen must reduce the level of contaminants to approximately 10(-4) CFU/lens to enjoy a 95% chance of passing the MIMCT. This reflects a 10-log unit reduction from the initial inoculum of approximately 10(6) CFU/lens. The stringency of the MIMCT depends on the ability of the recovery system to allow the growth of low numbers of residual challenge microorganisms in the presence of the disinfecting solution. Neutralizers included in the recovery system to inhibit the disinfectant are therefore critically important to the stringency of the assay. The design of experiments to evaluate neutralizers specifically for the MIMCT is discussed with suggestions for an improved procedure.

Candida albicans↗
PubMedDate not supplied

A survey of disinfection of irreversible hydrocolloid and silicone impressions in European Union dental schools: epidemiologic study.

PURPOSE: The objective of this cross-sectional study was to describe corresponding procedures for irreversible hydrocolloid and silicone impressions taught and used in European Union dental schools. MATERIALS AND METHODS: A self-administered questionnaire requesting information about rinsing and disinfection methods was sent to each of the 373 heads of prosthodontic, pedodontic, and orthodontic departments in the 131 European Union dental schools. Response rate was 94%. Statistical analysis included chi-square or Fisher exact tests, and ANOVA or Kruskall-Wallis tests. RESULTS: Of the responding departments, 92% systematically rinsed their impressions. Fifteen percent of the departments, mostly orthodontics, never disinfected irreversible hydrocolloid impressions, and 11% never disinfected silicone impressions. The immersion method was used by 65% for irreversible hydrocolloid impressions (73% for silicone), with a disinfection time of 10.3 +/- 6.3 minutes (11.8 +/- 7.4 for silicone). The disinfected impressions were not rinsed by 16% for irreversible hydrocolloid and 14% for silicone. Most departments used brand-name products. CONCLUSION: The same disinfection procedure for both irreversible hydrocolloid and silicone impressions was used by 78% of departments. There was great diversity, however, between departments in the procedure used for each impression material.

Alginates↗
PubMed1992

[Newer information about several aspects of animal epidemic disinfection].

The amendment of the German Veterinary Legislation concerning the eradication of notifiable diseases demanded also an updating of the relevant disinfection measures and technologies. Some hints are given, based on own experimental results, for the choice of chemical disinfectants, on some special problems of disinfection in livestock buildings and of disinfection of animal slurry and farm-yard manure as well as on biotechnological disinfection methods and environment-friendly disinfectants.

Animals↗