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[Model tests for effectiveness assay of disinfectants on surfaces. III. Dependence of test results on the type of substances and the test microbes (Staphylococcus aureus, Mycobacterium terrae)].

A new test method for surface disinfectants was applied to investigate the efficacy of the most important active components of disinfectants to Staphylococcus aureus and Mycobacterium terrae. The test germs were embedded in coagulated blood. Frosted glass served as test surface. The disinfection was performed by applying a fixed amount of the disinfectant and mixing it with the contamination by rubbing. The number of surviving germs was determined quantitatively. Generally, the two test germs showed a distinctly different behaviour towards the active substances applied. Mycobacteria proved to be clearly more resistant than staphylococci, except with formaldehyde and the cresol-soap solution. The formaldehyde, the mycobacteria were only a little more resistant, while to cresol-soap solution they were even a little more sensitive than were staphylococci. Compounds containing active chloride showed a sufficient effect on mycobacteria only if the consumption of the active component by blood was nearly excluded. The quaternary ammonium compound and glyoxal, even the high concentrations, showed a totally insufficient efficacy to mycobacteria. The results shall provide the basis for a new guideline to be established by the Federal Health Office concerning the efficacy testing of surface disinfectants effective against mycobacteria, especially tuberculosis bacteria.

Chlorine↗

[Increased growth of chemotherapy-resistant hospital organisms through disinfection (author's transl)].

In addition to determinants of resistance to chemtoherapy, a resistance plasmid of the hospital strain of Prtoeus rettgeri from the Munich Hospital area also carries information on resistance to mercury ions. At the same time strains with this R-factor are more insensitive to phenylmercuric borate, the active principle of the widely used disinfectant Merfer. This significance of the widely used disinfectant Merfer. This significance of this resistance to disinfectants for the appearance of the local hospital strain of Proteus rettgeri is discussed. Moreover, the far-reaching risks of the selection of chemotherapy-resistant bacterial strains by disinfectants with reduced activity against bacteria resistant to chemotherapy are pointed out. Therefore, it is recommended to abandon the use of mercury as an active principle of disinfectants.

Chlorides↗

[Evaluation of a micromethod for the bactericidal activity of five disinfectants on 108 hospital strains].

The authors studied 5 disinfectants containing aldehyde and quaternary ammonium against 108 hospital strains. The minimal bactericidal activities (MBC) were determined with a microdilution method and the dilution-neutralization method (AFNOR T 72-150). The microdilution method results were validated using the MBCs of four reference strains tested with the dilution-neutralization method (AFNOR T 72-150). 3 disinfectants proved to be valuable. 1 disinfectant was valuable but with a MBC toward all bacteria only a dilution away from the dilution of use. 1 disinfectant was determined as unsatisfactory as 9.5 p. cent of all strains proved resistant toward it. All disinfectants matched AFNOR standards; but those specifications did not match toward hospital strains. Such an evaluation using a simple and reliable method should be of use.

Acinetobacter↗

The antiseptic effect of a quick drying rubbing type povidone-iodine alcoholic disinfectant solution.

A quick drying rubbing type disinfectant of non-water non-towel type is an antiseptic method suitable for practical use in intensive care units where emergency situations are common. We determined the antiseptic efficacy and safety of a quick drying rubbing type povidone-iodine alcoholic disinfectant solution (HAD Hand Wash) in comparison with benzalkonium chloride alcoholic lotion. The bacterial reduction rate obtained by hand washing with a single 3 ml application was 93.8% for HAD Hand Wash and 94.1% for benzalkonium chloride alcoholic lotion. Thus, excellent antiseptic efficacy was obtained with both disinfectants. Roughening of hand skin which appeared in association with HAD Hand Wash solution was transient and mild in nature in all of the cases, indicating the high safety of this disinfectant. It is justified to say from these findings that HAD Hand Wash is useful as a hand and finger disinfectant.

Antisepsis↗

Efficacy of a variety of disinfectants against Actinobacillus pleuropneumoniae serotype 1.

The efficacy of 23 disinfectants (including the most commonly used chemical groups) and 6 quaternary ammonium compound based commercial formulations against Actinobacillus pleuropneumoniae serotype 1 (ATCC 4074) was studied. The organisms were tested in suspension and carrier tests with serum as the organic matter. Chloramine-T, hydrogen peroxide, glutaraldehyde, and mercurochrome alone, and a quaternary ammonium compound formulation containing 10% benzalkonium chloride, 2.5% glutaraldehyde, 6.8% glyoxal, and 6% formaldehyde were effective in all tests, regardless of the presence or absence of organic load. All but 2 of the nonformulated disinfectants (sodium hypochlorite and an iodophor) caused at least a 3-log10 reduction in colony-forming units in the suspension test. However, most of the disinfectants were not as effective in the carrier test as in the suspension test; this difference ranged from a 1- to 5-log10 reduction in colony-forming units. In addition, the presence of serum considerably reduced the disinfectant capacities of most of the compounds tested, particularly in the carrier test. These results indicate the importance of selecting suitable disinfectants for routine use on surfaces contaminated with this organism, especially in the presence of organic matter. Chloramine-T and the aforementioned commercial formulation were also tested directly under field conditions in pig nurseries, confirming their high effectiveness.

Actinobacillus pleuropneumoniae↗

[Bone bank management using a thermal disinfection system (Lobator SD-1). A critical analysis].

In the study presented on 380 allogenic bone donations from living and organ donors, we analyzed the safety of allograft handling bone-band documentation, logistics and costs. For transplant treatment we routinely used a thermal disinfection system (Lobator SD-1). From 380 allograft donors, 400 bone transplants were gained. The rejection rate was 12.2%. After thermal disinfection for 1 h at 80 degrees C, the grafts were cryopreserved at -80 degrees C and released from the bone bank for potential transplantation after 14-16 days. Five of 730 microbiological specimens showed bacterial contamination after thermal graft decontamination. The bacterial species found on the allografts normally have an inactivation temperature under 80 degrees C. Therefore, only secondary contamination can explain the positive bacteriological test results. With reform of the health care system the economical aspects of bone banking have triggered more interest. The cost for one bone transplant released from the bone bank was 424.75 DM: the overall cost for the bone bank in one year was 75,076 DM. Laboratory (58.2%) and material costs (22.5%) were the major factors. Personnel costs and apparatus costs were relatively low (< 20%). With introduction of the thermal disinfection system (Lobator SD-1) into the bone bank, the safety of allogenic bone transplants was greatly improved. Clinical and serological donor screening must be performed according to international bone bank directives. Considering the low rejection rate and the short turnover rate, the economical costs could be reduced. Using an appropriate disinfection system (thermal disinfection at 80 degrees C), laboratory tests covering venereal diseases, malaria and cytomegalia are no longer required. Also, secondary HIV testing of living donors can be omitted without reducing the safety of the transplant.

Bone Banks↗

[Bacterial biofilms and resistance to disinfectants].

When bacteria grow in close association with solid surface, they constitute a microbial community tight included in the exopolymer glycocalyx. Many laboratory studies have shown that these bacteria are 10 to 100 folds more resistant to disinfectants than the bacteria of the same strain in suspension. Several factors are responsible for this resistance: the glycocalyx which limits the diffusion and reacts with the disinfectant, the more or less dense repartition of the bacteria inside the biofilm, their physiologic state with reduced metabolism, and the surface on which is the biofilm. The activity assessment of disinfectant agents is achieved with standardized methods. They must take into account not only the conditions in which the disinfectants are employed, but also the micro-organism state. Experimental results showing the resistance of biofilm bacteria must lead to elaborate methods allowing the assessment of bactericide activity of disinfectants against biofilm bacteria.

Bacteria↗

The effect of cavity disinfectants on microleakage in dentin bonding systems.

The purpose of this study was to determine the effect on microleakage of two disinfectants, one a chlorhexidine based and the other alcohol based, used as cavity washes prior to the application of one step dentin bonding systems Syntac and Prime & Bond in Class V composite restorations. Children between 10-12 years old, with noncarious second primary molars about to exfoliate, were selected for this study. Cavity preparations were treated with either Syntac or Prime & Bond, combinations of one of the two disinfectants washes with Syntac or Prime & Bond or with one of the disinfectants only and filled with Tetric composite resin. All teeth were extracted one month later, stained and sectioned to evaluate dye penetration. As a result, focal dry disinfectant when used as a cavity wash prior to the use of Prime & Bond did not effect the ability of dentin bonding agents to prevent microleakage. Chlorhexidine solution had an adverse effect on Syntac and Prime & Bond and produced significantly higher microleakage when used with these bonding systems. The use of cavity disinfectants with composite resin restorations appears to be material specific regarding the interactions with various dentin bonding systems and the ability to seal dentin.

Analysis of Variance↗

The effects of cleaning and disinfection in reducing Salmonella contamination in a laboratory model kitchen.

AIMS: To establish a laboratory model to compare the effectiveness of detergent-based disinfection procedures for reducing cross-contamination risks during handling of contaminated chicken. METHODS AND RESULTS: During handling of chickens, artificially contaminated with Salmonella enteritidis PT4, the organism was widely spread to hands, cloths, and hand- and food-contact surfaces. Hygiene procedures were assessed on the basis of their ability to reduce the number of recoverable salmonellas to <1 CFU. Although detergent-based cleaning using a typical bowl-wash routine without rinsing produced some risk reduction (from 100 to 61.4% of contaminated surfaces), it was insufficient to consistently restore surfaces to a hygienic state. By combining detergent-based cleaning with a rinsing step or with hypochlorite at 500 ppm (of available chlorine) some further reduction in microbial risk was achieved, but was not considered satisfactory for food hygiene purposes. By contrast the risk reduction produced by hypochlorite at 5000 ppm was highly significant and was sufficient to reduce the number of contaminated surfaces to 2.9%. CONCLUSIONS: A key step in achieving a hygienic state through detergent-based cleaning is rinsing but even this will not produce a 'hygienic' result for difficult surfaces such as the chopping board or the dishcloth. Disinfectant compounds should be considered in order to reduce the potential for foodborne cross infection within the home environment. SIGNIFICANCE AND IMPACT OF THE STUDY: Although tests are available to determine the performance of disinfectants, there are no quantitative procedures available to compare the risk reduction achieved by disinfection with that produced by detergent-based procedures. This study describes a reproducible laboratory method which can be used to differentiate the effectiveness of different hygiene procedures for reducing cross-contamination risks during food handling.

Animals↗

[Optimizing surgical hand disinfection].

For more than 110 years hands of surgeons have been treated before a surgical procedure in order to reduce the bacterial density. The kind and duration of treatment, however, has changed significantly over time. Recent scientific evidence suggests a few changes with the aim to optimize both the efficacy and the dermal tolerance. Aim of this article is the presentation and discussion of new insights in surgical hand disinfection. A hand wash should be performed before the first disinfection of a day, ideally at least 10 min before the beginning of the disinfection as it has been shown that a 1 min hand wash significantly increases skin hydration for up to 10 min. The application time may be as short as 1.5 min depending on the type of hand rub. Hands and forearms should be kept wet with the hand rub for the recommended application time in any case. A specific rub-in procedure according to EN 12791 has been found to be suitable in order to avoid untreated skin areas. The alcohol-based hand rub should have a proven excellent dermal tolerance in order to ensure appropriate compliance. Considering these elements in clinical practice can have a significant impact to optimize the high quality of surgical hand disinfection for prevention of surgical site infections.

Disinfectants↗

Studies on disinfection of clinical thermometers. II. Oral thermometers from a tuberculosis sanatorium.

A study was made of the chemical disinfection of oral thermometers used by patients with active pulmonary tuberculosis. Only 10% of these thermometers were found to be contaminated with acid-fast bacilli. Because of this small number, the use of a phenol coefficient type test with Mycobacterium tuberculosis was suggested as an alternative method for evaluating tuberculocidal activity. These data, in conjunction with data from Part I of these studies dealing with disinfection of oral thermometers from a general hospital, were the criteria used to judge the efficacy of the disinfectants. It was concluded that 70% ethyl alcohol, 2% phenolic no. 1, and 3% phenolic no. 3 were reliable disinfectants for thermometers. Fifty per cent ethyl alcohol, 2% phenolic no. 2, 2% iodophor (300 ppm available iodine), and 0.1% benzalkonium chloride, aqueous or tincture, were unreliable.

Benzalkonium Compounds↗

[Skin and hand disinfection].

In modern medicine, hygiene has become an issue of ever increasing importance. Disinfection of hands is crucial, since hands are the main vector of bacteria. Successful disinfection depends not only on the appropriate choice of an active agent, but equally so on proper techniques and skin care. The spectre and the time profile of activity as well as the skin-protecting properties of the chosen disinfectant must be known. Basic knowledge of disinfection is necessary for a rational interpretation of the information given in the glossy printed material of advertisement.

Disinfectants↗

The effect of cleaning and disinfection of soft contact lenses on corneal infectivity in an animal model.

PURPOSE: Bacterial contamination of previously worn soft contact lenses, especially at sites of lens deposits, might play a role in the pathogenesis of lens-associated bacterial keratitis. We studied the effects of three commercial contact lens cleaners and disinfectants in a rabbit model to determine whether cleaning and disinfection reduced infectivity. METHODS: Duragel 75 soft contact lenses, designed to fit the eyes of rabbits, were worn by rabbits under tarsorrhaphies, then were removed and cleaned in one of three cleaner and disinfectant solutions according to the manufacturers' instructions. The lenses were contaminated by overnight incubation in a suspension of 10(8) Pseudomonas aeruginosa/ml and were placed under tarsorrhaphies on the eyes of fresh rabbits. The rabbits were observed for two weeks for signs of infection. Control rabbits wore new, uncleaned but contaminated lenses or worn, uncleaned but contaminated lenses. RESULTS: The rates of infection with the three commercial cleaner and disinfectant solutions ranged from 18% (two of 11) to 31% (four of 13); these incidences were not significantly different from one another or from the 19% (three of 16) incidence with new, contaminated but uncleaned lenses. By contrast, when worn, uncleaned but contaminated lenses were placed in rabbits' eyes, seven of eight were infected, a rate that is significantly higher than that of the other four groups (P = .0003). CONCLUSIONS: These data indicate that the three commercial lens cleaner and disinfectant solutions were of similar efficacy in reducing the infectivity of contaminated contact lenses to a level similar to that of new, unworn lenses.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

An alternative regimen for root canal disinfection.

OBJECTIVE: To compare the effect of a combination of 20% citric acid solution and photo-activated disinfection with the use of 20% citric acid and 2.25% sodium hypochlorite solutions on bacterial load on the dentine walls in prepared canals in vivo. SUBJECTS AND METHODS: Sixty-four randomly selected cases were evaluated and allocated to one of two groups. In Group 1, after gaining access to the root canal, bacterial load on the canal walls was sampled using endodontic files. A further sample was taken after apex location and initial widening of the canal had been completed and the photo-activated disinfection process carried out. A final sample was taken after completion of the canal preparation using citric acid and sodium hypochlorite solutions. In Group 2, the initial sample was taken as described previously. A second sample was taken after conventional preparation using 20% citric acid and sodium hypochlorite solutions as co-irrigants. A final sample was then taken after a subsequent PAD treatment. All samples were cultured for facultative anaerobic bacteria. RESULTS: Of the canals treated in Group 1 only two of the 23 canals infected showed culturable bacteria after the use of citric acid and photo-activated disinfection. Of these two canals, one was free of culturable bacteria on completion of conventional treatment but the other still contained culturable bacteria. In Group 2, four canals of the 23 infected initially, remained contaminated after conventional treatment. After subsequent photo-activated disinfection three of these four canals were free of culturable bacteria. CONCLUSION: Results indicate that the use of a chelating agent acting as a cleaner and disrupter of the biofilm and photo-activated disinfection to kill bacteria is an effective alternative to the use of hypochlorite as a root canal cleaning system.

Adolescent↗

Evaluation of donor skin disinfection methods.

BACKGROUND: Because most bacteria isolated from contaminated platelet concentrates are thought to originate from the donor's skin, the efficacy of four methods of skin disinfection was compared. STUDY DESIGN AND METHODS: Contact plates were used for antecubital skin cultures after they were demonstrated to be easier to use and at least as sensitive as a swab system. One antecubital fossa of each subject was disinfected by a standard method, the use of a povidone-iodine swabstick containing 0.75-percent available iodine followed by the use of a povidone-iodine swabstick containing 1-percent available iodine. The other arm was disinfected with either a 70-percent isopropyl alcohol scrub followed by an ampoule of 2-percent iodine tincture (Group 1; n = 126); a green-soap sponge followed by a 70-percent isopropyl alcohol swab, used for donors who are allergic to iodine (Group 2; n = 30); or a 0.5-percent chlorhexidine gluconate and 70-percent isopropyl alcohol sponge followed by an ampoule of 0.5-percent chlorhexidine gluconate and 70-percent isopropyl alcohol (Group 3; n = 40). Contact plate cultures were done before and after disinfection, and colonies counted after a 48-hour 37 degrees C incubation period. RESULTS: Similar numbers of bacteria grew from both antecubital fossae of the same subject before disinfection (p = 0.71). Compared to the standard povidoneiodine method, isopropyl alcohol and tincture of iodine resulted in significantly less bacterial growth (p < 0.001), the green soap and isopropyl alcohol method resulted in significantly more bacterial growth (p < 0.001), and the chlorhexidine gluconate and isopropyl alcohol method resulted in similar amounts of bacterial growth (p > 0.3). CONCLUSION: Isopropyl alcohol scrub followed by iodine tincture is more efficacious than povidone-iodine as measured by contact plate cultures. For donors who are allergic to iodine, chlorhexidine gluconate and isopropyl alcohol is more efficacious than green soap and isopropyl alcohol.

1-Propanol↗

Chlorination disinfection by-products in drinking water and the risk of adult leukemia in Canada.

The authors conducted a population-based case-control study of 1,068 incident leukemia cases and 5,039 controls aged 20-74 years during 1994-1997 to examine the association between exposure to drinking water chlorination disinfection by-products and adult leukemia risk in Canada. Residence and drinking water source histories and data from municipal water supplies were used to estimate individual chlorination disinfection by-product exposure according to water source, chlorination status, and chlorination disinfection by-product levels during the 40-year period before the interview. The analysis included 686 cases and 3,420 controls for whom water quality information was available for at least 30 of these years. Increased risk of chronic myeloid leukemia was associated with increasing years of exposure to different chlorination disinfection by-product indexes, with an adjusted odds ratio of 1.72 (95% confidence interval: 1.01, 3.08) for the highest exposure duration to total trihalomethanes of more than 40 microg/liter. In contrast, the risk of the other studied leukemia subtypes was found to decrease with increasing years of exposure to chlorination disinfection by-products. A protective effect was noted for chronic lymphoid leukemia (odds ratio = 0.60, 95 percent confidence interval: 0.41, 0.87) associated with the highest exposure duration to total trihalomethanes of more than 40 microg/liter. More studies with long-term exposure measures and large enough to evaluate leukemia subtypes are needed to further understanding of the issue.

Adult↗

The effect of a one-stage full-mouth disinfection on different intra-oral niches. Clinical and microbiological observations.

A treatment for periodontal infections often consists of consecutive rootplanings (per quadrant, at a 1- to 2-week interval), without a proper disinfection of the remaining intra-oral niches (untreated pockets, tongue, saliva, mucosa and tonsils). Such an approach, could theoretically lead to a reinfection of previously-treated pockets. The present study aims to examine the effect of a full-mouth disinfection on the microbiota in the above-mentioned niches. Moreover, the clinical benefit of such an approach was investigated. 16 patients with severe periodontitis were randomly allocated to a test and a control group. The patients from the control group were scaled and rootplaned, per quadrant, at 2-week intervals and obtained oral hygiene instructions. The patients from the test group received a full-mouth disinfection consisting of: scaling and rootplaning of all pockets in 2 visits within 24 h, in combination with tongue brushing with 1% chlorhexidine gel for 1 min, mouth rinsing with a 0.2% chlorhexidine solution for 2 min and subgingival irrigation of all pockets (3x in 10 min) with 1% chlorhexidine gel. Besides oral hygiene, the test group rinsed 2x daily with 0.2% chlorhexidine and sprayed the tonsils with a 0.2% chlorhexidine for 2 months. Plaque samples (pockets, tongue, mucosa and saliva) were taken at baseline and after 2 and 4 months, and changes in probing depth, attachment level and bleeding on probing were reported. The full-mouth disinfection resulted in a statistically significant additional reduction/elimination of periodontopathogens, especially in the subgingival pockets, but also in the other niches. These microbiological improvements were reflected in a statistically-significant higher probing depth reduction and attachment gain in the test patients. These findings suggest that a disinfection of all intra-oral niches within a short time span leads to significant clinical and microbiological improvements for up to 4 months.

Adult↗

Development of a standard test to assess the resistance of Staphylococcus aureus biofilm cells to disinfectants.

A standardized disinfectant test for Staphylococcus aureus cells in biofilms was developed. Two disinfectants, the membrane-active compound benzalkonium chloride (BAC) and the oxidizing agent sodium hypochlorite, were used to evaluate the biofilm test. S. aureus formed biofilms on glass, stainless steel, and polystyrene in a simple system with constant nutrient flow that mimicked as closely as possible the conditions used in the current standard European disinfectant test (EN 1040). The biofilm that was formed on glass contained cell clumps and extracellular polysaccharides. The average surface coverage was 60%, and most (92%) of the biofilm cells were viable. Biofilm formation and biofilm disinfection in different experiments were reproducible. For biofilms exposed to BAC and hypochlorite the concentrations needed to achieve 4-log killing were 50 and 600 times higher, respectively, than the concentrations needed to achieve this level of killing with the European phase 1 suspension test cells. Our results show that a standardized disinfectant test for biofilm cells is a useful addition to the current standard tests.

Anti-Infective Agents, Local↗