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Effect of daily vaginal disinfection on duration of gestation after premature rupture of the membranes and on infant outcome.

OBJECTIVES: We examined the effects of daily vaginal disinfection on the interval between premature rupture of the membranes (PROM) and delivery and on infant outcome. METHODS: Daily vaginal disinfection with povidone iodine was performed on 43 women with PROM. The control group consisted of 59 women with PROM who did not undergo vaginal disinfection. In both groups, the infants born to these women were followed until 1 year of corrected age. RESULTS: The degree of cervical dilatation, the leukocyte count, and the serum C-reactive protein level on admission did not differ between the 2 groups. Although there was no difference in the gestational week at delivery between the groups, the interval between PROM and delivery was significantly longer in the disinfectant group than among the control subjects (9.5 +/- 14.9 days vs. 3.9 +/- 5.1 days, p < 0.01). There was no difference in infant outcome between the 2 groups. CONCLUSIONS: These findings suggest that daily vaginal disinfection with povidone iodine prolongs the duration of gestation in women with PROM and dose not have an adverse effect on the fetus.

Adolescent↗

Accuracy of irreversible hydrocolloid impression material mixed with disinfectant solutions.

PURPOSE: Irreversible hydrocolloid is capable of resisting contamination by viruses and saliva when the disinfectant iodine or the disinfectant chlorhexidine is added to the water being used to mix the material. This study investigates the accuracy of alginate impressions made with water to which either of the two disinfectants has been added. MATERIALS AND METHODS: A total of 30 casts were made from an impression of a master cast. Ten impressions were made using water according to the manufacturer's instructions, ten were made using water to which iodine had been added, and ten were made using water to which chlorhexidine had been added. A measuring microscope was used to measure three different dimensions on each cast. Each measurement was repeated three times, and the average was used to compute the mean and standard deviation for each measured dimension. The data were statistically evaluated using a one-way analysis of variance. RESULTS: There was no statistical difference in the accuracy of irreversible hydrocolloid impressions mixed with water or with either of two disinfectant solutions. CONCLUSION: Accurate casts can be obtained when either of the two disinfectants are incorporated into the alginate impression material.

Alginates↗

Effect of immersion disinfection on properties of impression materials.

PURPOSE: Dimensional change and wettability were determined for three addition silicones and a polyether impression material after disinfection by immersion for two 30-minute cycles in 2% acid-potentiated glutaraldehyde. MATERIALS AND METHODS: Contact angles of water on disks were measured on a goniometer. Dimensional change was determined by change in distance between two reference lines. Contact angle (degree) and dimensional change (percent) of five samples were measured after 0-, 30-, 60-, and 1,440-minute intervals of storage in air and disinfectant. RESULTS: The contact angle in air increased for two addition silicones and remained constant for the remaining materials. In disinfectant, the contact angle increased for all four materials, with the contact angle of the polyether increasing the least. In air, dimensional change decreased significantly for an addition silicone and a polyether. In disinfectant, the dimensional changes of the addition silicones were not significant, but the polyether increased in dimension after 1,440 minutes. CONCLUSIONS: Two 30-minute cycles of disinfection in 2% acid-potentiated glutaraldehyde reduced wettability, but had little effect on the dimensional change of the addition silicones and polyethers tested.

Analysis of Variance↗

Gypsum compatibility of antimicrobial alginates after spray disinfection.

PURPOSE: This investigation examined the gypsum compatibility of two antimicrobial alginates after spray disinfection. Subjective compatibility evaluations were compared with objective quantitative profilometer readings of gypsum cast surface roughness. MATERIALS AND METHODS: COE Hydrophilic Gel Alginate, Jeltrate Plus, Antimicrobial Alginate, and their nonantimicrobial counterparts, Coe Alginate and Jeltrate Plus, were used in this study. After spray disinfection with water (control), Alcide LD, Biocide, OMC II, and 0.5% NaOCI, impressions of the American National Standards Institute/American Dental Association (ANSI/ADA) specification no. 18 detail reproduction die and impressions made simultaneously of a smooth glass die were cast in Microstone, Silky-Rock, and Die-Keen. Five specimens were made for each alginate/disinfectant/gypsum combination for a total of 300 samples each for both the subjective and objective analyses. For the subjective analysis of gypsum compatibility, the specimens made from the ANSI/ADA specification no. 18 test die were evaluated by using a 1-to-4 visual rating system at magnification x12. For the objective analysis, the arithmetic average surface roughness of each specimen made from the smooth glass die was recorded three times with a 200-mg skidless stylus instruments. RESULTS: The results of the ANSI/ADA specification no. 18 testing for gypsum compatibility showed that 11 of 60 possible combinations did not pass the test. All impressions made with nonantimicrobial COE Alginate passed the test regardless of the disinfectant/gypsum combination. The results of the three-factor analysis of variance for the subjective and objective analyses showed significant interactions between alginates, disinfectants, and stones at the P < .05 level. To further delineate these differences, unpaired t tests (P < .05) within brands for each disinfectant/gypsum combination were performed. CONCLUSIONS: The addition of 1% chlorhexidine diacetate to COE Hydrophilic Gel Alginate has decreased its compatibility with the dental stones and disinfectants tested when compared with its nonantimicrobial counterpart. In terms of gypsum compatibility, the nonantimicrobial COE Alginate was compatible with all disinfectant and gypsum combinations tested. The addition of 1.70% didecyldimethyl ammonium chloride to Jeltrate Plus Antimicrobial Alginate has increased its compatibility with all the dental stones tested. A strong positive correlation (r = 0.7398) was found between visual gypsum compatibility evaluation scores and surface roughness of gypsum casts.

Alginates↗

Water treatment and monitor disinfection.

Water treatment system and dialysis monitors are susceptible to microbial contaminations and periodical disinfection procedures are mandatory to obtain results requested from international standards and guidelines. Several chemical germicides or some physical treatments are on the market validated by device manufacturer according to medical device directives. With time, interfering substances from dialysis device or water are able to modify disinfection efficiency. Simulating-use testing is not a common procedure to validate disinfectants and recent data document as biofilm represents the most important cause of disinfection inefficacy. Some international standards include tests in the presence of various interfering substances but their use is not widespread. When using a disinfectant, residue toxicity, material compatibility and potential risks for the staff also have to be considered. A quality assurance program has to be implemented to obtain adequate performances and to improve results on patients.

Disinfection↗

[Preventive effect of postoperative disinfection of endoscope on bacterial adhesion to endoscope].

We took culture of throat swab from 77 subjects who were negative for infection of HBV, HCV, HIV and syphilis infection before and after endoscopy. Moreover, the existence of bacterium including Helicobacter pylori at overcoat of endoscopic instrument was investigated right after examination and after disinfection of endoscope. Povidoneiodine, 70% alcohol and 1% benzalkonium chloride was used as a disinfectant for endoscope, and it took less than 10 minutes to wash by hand to disinfection. alpha-haemolytic streptococci, Staphylococcus epidermids, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Candida, Pseudomonas aeruginosa and MRSA were cultured in throat swab. The rate of adhesion of bacterium especially such as Candida, K. pneumoniae and S. epidermids to endoscope was considerably high. 23 of 77 subjects had H. pylori infection, and the adhesion of H. pylori to endoscope was found to be 65.2% of the subjects. On the contrast, no bacterium was detected from the endoscopic instrument after careful disinfection. These findings stress the importance of postoperative disinfection of the endoscope to prevent the chance to acquire bacterial infection.

2-Propanol↗

Effect of resin disinfectants-I3 and -I5 on Giardia muris and Giardia lamblia.

The resin-I5 column developed in our laboratories rendered aqueous suspensions containing up to 5 X 10(4) cysts of Giardia muris or Giardia lamblia per ml incapable of excystation. The inhibition of excystation was effective at both 4 and 25 degrees C. The addition of Na2S2O3 to column eluates containing cysts appeared to partially reverse the disinfectant action, and the reversal was more pronounced at 4 degrees C than at 25 degrees C. In contrast, the rapid removal of cysts from the column eluates by centrifugation and filtration or the use of other reductants, notably cysteine and glutathione, did not similarly reverse the disinfectant properties of the column. Based on these data, we suggest that the disinfecting agent is acquired by the cyst in its passage through the resin column and that either the disinfecting agent or its reaction can be partially and specifically neutralized by Na2S2O3. We hypothesize that the time between disinfectant acquisition and activity is a function of the thickness of the Giardia cyst wall and consequently takes longer at the lower temperature. Nevertheless, resin-I5 appears to inactivate a larger number of cysts in a shorter period of time with lower residual halogen levels than do agents of other published methods.

Animals↗

A suspension method to determine reuse life of chemical disinfectants during clinical use.

In-use testing of disinfectants is necessary to ensure efficacy over time. The current official procedure for testing disinfectants, the Association of Official Analytical Chemists (AOAC) use-dilution method, cannot be adapted to repeated sampling techniques of use-life testing. It is therefore necessary to use an alternative method when evaluating the activity of a disinfectant under actual use. The Clinical Research Associates (CRA) suspension method was developed to fill this need. It consists of adding 0.5 ml of a standard culture to 5.0 ml of test disinfectant and sampling the mixture after 10 min for surviving bacteria. When this test was compared with the AOAC use-dilution method under a simulated use situation, the two methods were generally equivalent in identifying disinfectant inactivation. In addition, the CRA method was less time consuming, easier to perform, and less variable than the AOAC method. Use of the CRA method in a clinical study demonstrated the need for reuse claims to be based on clinical use studies rather than on laboratory testing only.

Disinfectants↗

Disinfection of human enteric viruses in water by copper and silver in combination with low levels of chlorine.

The efficacy of copper and silver ions, in combination with low levels of free chlorine (FC), was evaluated for the disinfection of hepatitis A virus (HAV), human rotavirus (HRV), human adenovirus, and poliovirus (PV) in water. HAV and HRV showed little inactivation in all conditions. PV showed more than a 4 log10 titer reduction in the presence of copper and silver combined with 0.5 mg of FC per liter or in the presence of 1 mg of FC per liter alone. Human adenovirus persisted longer than PV with the same treatments, although it persisted significantly less than HRV or HAV. The addition of 700 micrograms of copper and 70 micrograms of silver per liter did not enhance the inactivation rates after the exposure to 0.5 or 0.2 mg of FC per liter, although on some occasions it produced a level of inactivation similar to that induced by a higher dose of FC alone. Virus aggregates were observed in the presence of copper and silver ions, although not in the presence of FC alone. Our data indicate that the use of copper and silver ions in water systems may not provide a reliable alternative to high levels of FC for the disinfection of viral pathogens. Gene probe-based procedures were not adequate to monitor the presence of infectious HAV after disinfection. PV does not appear to be an adequate model viral strain to be used in disinfection studies. Bacteroides fragilis bacteriophages were consistently more resistant to disinfection than PV, suggesting that they would be more suitable indicators, although they survived significantly less than HAV or HRV.

Adenoviruses, Human↗

Efficacy of common laboratory disinfectants on the infectivity of Cryptosporidium parvum oocysts in cell culture.

Nine liquid disinfectants were tested for their ability to reduce infectivity of Cryptosporidium parvum oocysts in cell culture. A 4-min exposure to 6% hydrogen peroxide and a 13-min exposure to ammonium hydroxide-amended windshield washer fluid reduced infectivity 1,000-fold. Other disinfectants tested (70% ethanol, 37% methanol, 6% sodium hypochlorite, 70% isopropanol, and three commercial disinfectants) did not reduce the infectivity after a 33-min exposure. The results indicate that hydrogen peroxide and windshield washer fluid or ammonium hydroxide disinfectant may be suitable laboratory disinfectants against C. parvum oocysts.

Ammonium Hydroxide↗

Single-cell protein profiling of wastewater enterobacterial communities predicts disinfection efficiency.

The efficiency of enterobacterial disinfection is dependent largely on enterobacterial community physiology. However, the relationship between enterobacterial community physiology and wastewater processing is unclear. The purpose of this study was to investigate this relationship. The influence of wastewater treatment processes on enterobacterial community physiology was examined at the single-cell level by using culture-independent methods. Intracellular concentrations of two conserved proteins, the growth-related protein Fis and the stationary-phase protein Dps, were analyzed by epifluoresence microscopy of uncultivated cells by using enterobacterial group-specific polyclonal fluorochrome-coupled antibodies. Enterobacterial single-cell community protein profiles were distinct for different types of biological treatment. The differences were not apparent when bulk methods of protein analysis were used. Trickling filter wastewater yielded Fis-enriched communities compared to the communities in submerged aeration basin wastewater. Community differences in Fis and Dps contents were used to predict disinfection efficiency. Disinfection of community samples by heat exposure combined with cultivation in selective media confirmed that enterobacterial communities exhibited significant differences in sensitivity to disinfection. These findings provide strategies that can be used to increase treatment plant performance, reduce the enterobacterial content in municipal wastewater, and minimize the release of disinfection by-products into receiving water.

Bacterial Proteins↗

Disinfection of contaminated water by using solar irradiation.

Contaminated water causes an estimated 6 to 60 billion cases of gastrointestinal illness annually. The majority of these cases occur in rural areas of developing nations where the water supply remains polluted and adequate sanitation is unavailable. A portable, low-cost, and low-maintenance solar unit to disinfect unpotable water has been designed and tested. The solar disinfection unit was tested with both river water and partially processed water from two wastewater treatment plants. In less than 30 min in midday sunlight, the unit eradicated more than 4 log10 U (99.99%) of bacteria contained in highly contaminated water samples. The solar disinfection unit has been field tested by Centro Panamericano de Ingenieria Sanitaria y Ciencias del Ambiente in Lima, Peru. At moderate light intensity, the solar disinfection unit was capable of reducing the bacterial load in a controlled contaminated water sample by 4 log10 U and disinfected approximately 1 liter of water in 30 min.

Colony Count, Microbial↗

New formaldehyde base disinfectants.

Preparations of formaldehyde in various organic liquids-ethylene glycol, glycerol, and propylene glycol-serve as effective disinfectants towards microbial vegetative cells and spores. This disinfection is a temperature-dependent process and is manifest when these formaldehyde base disinfectants are dissolved in water. The irritating vapors associated with formaldehyde disinfection are not present in either of these new formaldehyde base disinfectants or in aqueous solutions of them.

Bacillus↗

A practical approach to evaluation of the germicidal efficiency of a general purpose military disinfectant.

The bactericidal activity of a general purpose disinfectant consisting of 25% sodium-o-phenylphenolate and 75% sodium-4- and 6-chloro-2-phenylphenolate was evaluated by a simulated in-use, surface-square dilution method. Common floor (asphalt, rubber, and unglazed tiles) and wall (stainless steel tile, ceramic tile, and painted wood) surfaces of various porosities and compositions were selected to simulate actual-use conditions. The method used consisted of inoculating the surfaces of 1-in. square sections of floor and wall covering with a test organism, air-drying the inoculated surface, applying the disinfectant, allowing it to act for 10 min, and recovering the survivors by plating. Confirmatory results of the standard phenol coefficient and use-dilution tests indicated 700 ppm of the disinfectant to be a safe use concentration. The in-use surface-square dilution studies have shown that this is a more than adequate safe concentration for stainless steel, both glazed and unglazed ceramic tile, and nonwaxed surface of asphalt tile. However, concentrations ranging between 2,500 and 6,000 ppm for plastic-fortified rubber tile, 1,500 and 2,000 ppm for waxed asphalt tile, and 2,000 ppm for painted wood were required to achieve 99.9% reduction of either Salmonella choleraesuis or Salmonella schottmuelleri. These results indicate that a disinfectant concentration derived from the Association of Official Agricultural Chemists use-dilution test cannot always be relied upon to provide a dependable index to actual safe use-dilution when a disinfectant is supplied to certain wall or floor surfaces.

Anti-Infective Agents, Local↗

Skin disinfection in preterm infants.

Greater care and a more thorough approach to intravenous catheter site disinfection may be important for the prevention of catheter related sepsis, especially with coagulase negative staphylocci in preterm infants. The efficacy of skin disinfection was evaluated in preterm infants using a skin swabbing technique after disinfectant exposure. In the first part of the study, 25 peripheral intravascular catheter sites were quantitatively sampled immediately after routine cannula insertion. Bacterial counts greater than 100 colony forming units/cm2 were observed from 10 (40%) sites. In the second part, sampling for bacterial colony counts was done after skin cleansing with various durations of exposure of chlorhexidine/alcohol swabs or povidone iodine. The overall mean reduction in bacterial colony counts after skin cleansing ranged from 90-99%. Skin sterilisation was achieved in 33-92% of cases. The use of two consecutive 10 second exposures resulted in a significantly improved reduction in colony counts compared with a single 10 second wipe. A longer 30 second exposure also resulted in a greater reduction of bacterial numbers compared with a shorter duration of 5 or 10 seconds. Repopulation of disinfected sites occurred within 48 hours. This effect was delayed by occluding the cleansed site with a semipermeable dressing. There were no significant differences between povidone iodine and the chlorhexidine swabs in reducing bacterial numbers. This study has demonstrated that a brief exposure with a premoistened disinfectant swab is not sufficient for complete elimination of resident skin flora of newborn infants. The use of two consecutive cleanings, or a longer duration of cleansing is recommended for more effective skin sterilisation.

Catheterization↗

A membrane filter technique for testing disinfectants.

A membrane filter was used for assessing the surface disinfecting activity of phenolic disinfectants and a chloroxylenol disinfectant. The influence of the type of organism, inoculum size, and hardness of water was investigated. Pseudomonas aeruginosa was chosen for the standardized test. Disinfectant solutions were prepared in water of 300 ppm hardness and applied for two and a half minutes and eight minutes to the bacteria deposited from filtration of 1 ml of a suspension containing 10-6 bacteria. The membrane filter test has certain advantages over many tests, eg, all organisms surviving after treatment can be counted and residual disinfectant is easily removed.

Cell Count↗

Use of biological assay systems to assess the relative carcinogenic hazards of disinfection by-products.

Other workers have clearly shown that most, if not all, drinking water in the U.S. contains chemicals that possess mutagenic and/or carcinogenic activity by using bacterial and in vitro methods. In the present work, increased numbers of tumors were observed with samples of organic material isolated from 5 U.S. cities administered as tumor initiators in mouse skin initiation/promotion studies. Only in one case was the result significantly different from control. In studies designed to test whether disinfection practice contributes significantly to the tumor initiating activity found in drinking water mixed results have been obtained. In one experiment, water disinfected by chlorination, ozonation or combined chlorine resulted in a significantly greater number of papillomas when compared to nondisinfected water. In two subsequent experiments, where water was obtained from the Ohio River at different times of the year, no evidence of increased initiating activity was observed with any disinfectant. Analysis of water obtained at the comparable times of the year for total organic halogen, and trihalomethane formation revealed a substantial variation in the formation of these products. Considering the problems such variability poses for estimating risks associated with disinfection by-products, a model system which makes use of commercially obtained humic acid as a substrate for chlorination was investigated using the Ames test. Humic and fulvic acids obtained from two surface waters as well as the commercially obtained humic acid were without activity in TA 1535, TA 1537, TA 1538, TA 98 or TA 100 strains of S. typhimurium. Following treatment with a 0.8 molar ratio of chlorine (based on carbon) significant mutagenic activity was observed with all humic and fulvic acid samples. Comparisons of the specific mutagenic activity of the chlorinated products suggests that the commercial material might provide a useful model for studying health hazards associated with disinfection reactions by-products.

Animals↗

Waterborne outbreak control: which disinfectant?

Drinking water disinfection was shown to be an important public health measure around the turn of the century. In the United States, it was perhaps the single most important factor in controlling typhoid fever, a waterborne disease that was rampant throughout the world during the last century. It may also be assumed that disinfection was important in limiting the number of cases of other diseases known to be capable of waterborne transmission, i.e., cholera, amebiasis, shigellosis, salmonellosis, and hepatitis A. Even though modern treatment has eliminated water as a major vehicle of infectious disease transmission, outbreaks still occur. In fact, the annual number has been increasing since 1966. Interruption in chlorination or failure to achieve adequate levels of chlorine residual is the most often identified deficiency of the involved water supplies. This finding indicates that waterborne microbial pathogens remain as a potential health threat and underscores the importance of disinfection. From the outset, chlorination has been the drinking water disinfectant of choice in the country. Numerous studies have demonstrated its ability to inactivate bacterial, viral, and protozoal pathogens when applied under proper conditions. However, the finding that chlorinated organics that are potentially carcinogenic are formed has prompted an evaluation of alternative disinfectants. The viable alternatives to chlorine currently under consideration for widespread use are ozone, chlorine dioxide, and chloramines. In terms of biocidal efficiency, ozone is the most potent of the three. Chlorine dioxide is about the equivalent of free chlorine in the hypochlorous acid form but much more efficient than the hypochlorite form of free chlorine. The chloramines are weaker biocides than hypochlorite. Although this general order of ranking of efficiency holds for diverse types of microorganisms, quantitative comparisons vary with different microorganisms and experimental conditions.

Communicable Disease Control↗