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The dimensional stability of elastomeric impression materials following disinfection.

Public awareness of infectious diseases has focused attention on the prevention of nosocomial disease. Difficulties in sterilizing impressions have led to chemical disinfection as an alternative. Recent literature indicated a lack of consensus between researchers about distortion caused by disinfection. A polysulfide, polyether, and vinyl polysiloxane were disinfected by immersion in iodophor, sodium hypochlorite, and glutaraldehyde. Distortion was evaluated by use of a stainless steel die (ADA specification No. 19). Linear dimension variations after disinfection were clinically insignificant.

Aldehydes↗

Effects of disinfecting irreversible hydrocolloid impressions on the resultant gypsum casts: Part I--Surface quality.

This study evaluated the effects of disinfection time (10, 30, and 60 minutes) on the surface quality of stone casts poured against an alginate impression material (Jeltrate). Five antimicrobial agents were tested: Sporicidin spray, sodium hypochlorite, and iodophor for spray; and Sporicidin cold sterilization solution and Cidexplus glutaraldehyde solution for immersion. Impressions, flushed with water and stored for 0, 10, 30, and 60 minutes before pouring, served as untreated controls. On completion of the disinfection treatments, the impressions were rinsed and poured in Velmix stone. The effects on cast surface were evaluated under a stereomicroscope by three experienced raters. A 1-to-4 scoring system was developed to rate the surface quality in terms of smoothness and detail reproduction. Both immersion disinfectants proved to be unacceptable for treating alginate impressions. The mean scores of other disinfectant-time combinations were compared with the use of the Tukey-Kramer method with a 95% confidence interval. The results indicated that treatment time had statistically significant effects on the quality of cast surface in Sporicidin spray, sodium hypochlorite, and untreated control groups but not in the iodophor spray group.

Analysis of Variance↗

Disinfection studies with two strains of mouse-passaged scrapie agent. Guidelines for Creutzfeldt-Jakob and related agents.

A variety of disinfection procedures were tested on two strains of scrapie agent, treated either as brain macerates (autoclaving) or as 10% homogenates (chemical treatments). It is suggested that a given treatment should produce a titre loss, of both strains of scrapie, of at least 10(4) units before it be regarded as useful for the disinfection of the agents of scrapie and Creutzfeldt-Jakob disease (CJD). By this criterion, treatment at room temperature with about 4% Hycolin (0.6% chlorinated phenols), 0.2% permanganate, 5% Tego (dodecyl-di(aminoethyl)-glycine) or 5% sodium dodecyl sulphate (SDS) are unsuitable. However, data indicate that SDS might be used to reduce the heat stability of scrapie agent. Hypochlorite (Sterilex) was the only satisfactory chemical reagent tested. At least 10(4)-10(5) units of infectivity were lost by treatment with hypochlorite containing 1,000 ppm available chlorine after a 4-16 h exposure, or containing 10,000 ppm available chlorine after a half-hour exposure. The latter result points to the use of concentrated hypochlorite (about 2% available chlorine; approximately 20% Sterilex) to decontaminate surfaces. We suggest that the cleaning action of SDS, or other strong detergents, might also help to decontaminate surfaces, but studies on this are needed. Autoclaving at 126 degrees C for 1-2 h reduced titres by 10(3)-10(7) units, depending on the strain of agent. However, total disinfection of brain containing high titres of infectivity was approached only at 136 degrees C when titre losses of about 10(6) units were obtained by autoclaving for 4-32 min. Further studies are needed before we can make simple, general recommendations for the disinfection of CJD agents in hospital practice.

Animals↗

The mechanics of endoscope disinfection.

The decontamination of flexible fibreoptic endoscopes has considerably improved in recent years. This is mainly due to the introduction of instruments with more accessible channels, the use of automated washer disinfectors and a greater awareness of the problems associated with disinfection. Unfortunately the most widely used and effective disinfectant is 2% glutaraldehyde and this is toxic, irritant and sensitizing. With the implementation of Control of Substances Hazardous to Health legislation, strict environmental controls are required to reduce skin contact and vapour inhalation. Alcohol is probably the most suitable alternative disinfectant at present but it is flammable and cannot be used in automated systems. Other agents are either insufficiently effective or corrosive. Autoclavable or heat tolerant rigid endoscopes are now available but flexible endoscopes will not tolerate heat disinfection temperatures.

Disinfection↗

Mycobactericidal testing of disinfectants: an update.

Tuberculosis, a major killer in developing countries, is on the rise again in industrialized nations. AIDS, increased use of immunosuppression and the emergence of multiple drug-resistant Mycobacterium tuberculosis (MDR-TB) have further enhanced its significance. TB is projected to cause 3.5 million deaths per year by 2000. Also, other types of mycobacteria are being incriminated in human infections with increasing frequency. Thus, the enhanced risk of nosocomial and iatrogenic spread of mycobacteria is forcing a review of infection control in general and claims of mycobactericidal activity of disinfectants in particular. Mycobacteria are more resistant to disinfection than enveloped viruses and other types of vegetative bacteria, but a proper comparison with non-enveloped viruses requires more data. Flaws in currently used protocols for mycobacterial activity are: (i) a lack of proper quantitation; (ii) unrealistically long contact times at higher than ambient temperatures; (iii) absence of a suitable organic load; (iv) ineffective neutralizers; (v) unsuitable surrogates for M. tuberculosis; (vi) improper recovery media; and (vii) inappropriate types of carriers. Furthermore, we have recently found a product meant for 14 day reuse to become non-mycobactericidal after only a week under actual use in an endoscopy unit. These considerations make the available data on product efficacy unreliable, especially in view of the increasing threat from MDR-TB. Recent findings suggest that the use of Mycobacterium terrae as a surrogate, better recovery media, flat surfaces as carriers, elimination of neutralizers, proper removal of cell clumps and a required > or = 4 log10 reduction in the number of colony forming units of the test bacterium after disinfectant treatment should make mycobacteridal tests more precise and reliable, thus making product registration and selection easier. There is also an urgent need to develop standardized protocols to determine the mycobactericidal activity of disinfectants under conditions of reuse.

Disease Reservoirs↗

Methodology for HIV disinfectant testing.

Due to the variation in protocols from studies by different workers for the inactivation of HIV by chemical disinfectants, only limited comparisons of the results can be made. These variations include those which apply to disinfectant testing in general, such as the level of organic load and the form of neutralization of the disinfectant, and those which apply particularly to HIV inactivation, such as the method used to detect infectious virus. Our suspension and carrier tests to assess the efficacy of chemical disinfectants against HIV are described and problems with the interpretation and applicability of the results are discussed.

Antiviral Agents↗

Effects of cold disinfectants on the mechanical properties and the surface topography of nickel-titanium arch wires.

The effects of disinfectants on the mechanical properties and surface topographies were determined for 0.017 x 0.025-inch Nitinol and Titanal wires. Three disinfectants approved by the American Dental Association were tested at maximum antimicrobial concentrations: 2% acidic glutaraldehyde, chlorine dioxide, and iodophor. Bending and tensile tests were evaluated to determine whether the stiffness, strength, or range of the wires changed after disinfectant treatment. Laser spectroscopy was used to detect surface changes from corrosion or tarnish after treatment. No detrimental changes were detected in the mechanical properties or surface topography of either wire product after disinfectant treatment. Nitinol was found to be stronger and stiffer than Titanal. On average, Titanal exhibited five times more specular reflectivity than Nitinol.

Chlorine↗

New methods in the evaluation of chemical disinfectants used in health care services.

BACKGROUND: A considerable number of tests are recommended in the literature to evaluate in vitro commercial chemical solutions. The variety of tests reflects their limitations and the need to enhance disinfection process. METHODS: In this study the efficacy of 4 chemical disinfectants selected by their practical use in Health Care Services and by literature recommendation in aerobic and in strict anaerobic bacteria were evaluated by their practical use in Health Care Services and by literature recommendation in aerobic and in strict anaerobic bacteria. Viability was tested in biofilms grown on glass and rubber tip carriers. RESULTS: The results showed microbial growth in chemical solutions at concentrations recommended by the literature or at very close concentrations to them. Viable cells were recovered from biofilms after 30 minutes (Bacteroides fragilis) and 60 minutes (Streptococcus mutans and Salmonella tiphymurium) contact with 2.4% glutaraldehyde and after 60 minutes (S tiphymurium) in 2.0% glutaraldehyde. In 70% ethyl alcohol, S tiphymurium was viable up to 10 minutes, Escherichia coli up to 30 minutes, and S mutans up to 60 minutes. In 1% sodium hypochlorite, S mutans was viable up to 30 minutes and S tiphymurium up to 45 minutes. Detection of cell viability could be related to methodologic differences, including biofilm formation, as demonstrated by scanning electron microscopy. It should be emphasized that B fragilis, the most clinically relevant obligate anaerobe, remained viable in one routinely used solution. CONCLUSION: These findings pointed out the need of periodic surveillance of disinfectants' activity used in Health Care Services and the need of reviewing routines of disinfection protocols.

Bacteria↗

Water disinfection by electrochemical treatment.

The electrochemical disinfection of germinated brown rice (GBR) circulating water and cooling tower water containing Legionella bacteria was investigated. Results showed the total aerobic plate counts (APC) in the treated GBR circulating water decreased significantly and the turbidity was largely improved at a pulse voltage of 1.0 kV; Legionella bacteria were also disinfected effectively at 1.0 kV. The disinfection was attributed to the synergistic effects of the oxide anode, the electric field, and the radicals formed during the electrochemical treatment. This suggests that electrochemical treatment could be applicable to the disinfection of water from other sources.

Disinfection↗

Hepatic antioxidant enzymes and total glutathione of Cyprinus carpio exposed to three disinfectants, chlorine dioxide, sodium hypochlorite and peracetic acid, for superficial water potabilization.

This study was carried out in order to assess the effects of disinfectant-treatment on antioxidant response of Cyprinus carpio L. Therefore, enzymatic activities of glutathione S-transferases, glyoxalase I, glyoxalase II, glutathione peroxidases, glutathione reductase, catalase and total glutathione content of carp liver, exposed to surface water treated with three disinfectants for potabilization, sodium hypochlorite, chlorine dioxide and peracetic acid were investigated. Specimens of carp were exposed in four experimental tanks supplied with a continuous water flow from Lake Trasimeno (Italy), three of them treated with constant concentration of sodium hypochlorite, chlorine dioxide and peracetic acid, for 10 and 20 days, while the control tank was supplied with untreated lake water. Differences in biochemical parameters were observed in specimens following exposure to these disinfectants and mainly, chlorine compounds induced marked biochemical variations of carp liver, compared to those induced by peracetic acid treatment. Our results showed that antioxidant parameters of Cyprinus carpio could be used as biomarkers of oxidative stress when this species is exposed to disinfectants for water potabilization.

Animals↗

Nine episodes of anaphylaxis following cystoscopy caused by Cidex OPA (ortho-phthalaldehyde) high-level disinfectant in 4 patients after cytoscopy.

BACKGROUND: Ortho-phthalaldehyde (OPA) is a high-level disinfectant commonly used for processing heat-sensitive medical devices. OBJECTIVE: We report 4 patients who experienced 9 episodes of anaphylaxis following cystoscopy after a urology practice switched from using Cidex (glutaraldehyde [GTA]) to OPA for disinfecting their cystoscopes. METHODS: Allergic evaluations consisted of: skin testing to saline, histamine, glycerin, lidocaine, latex, GTA, and OPA and blood tests for total immunoglobulin E (IgE) and latex specific IgE. FINDINGS: The 4 patients were evaluated after 3 of them had experienced 2 episodes of anaphylaxis and one of them 3 episodes following outpatient cystoscopy for ongoing evaluation of bladder cancer. Skin testing of subjects and controls to lidocaine, latex, latex specific IgE, and GTA was negative. Skin testing to OPA resulted in immediate wheal and flare reactions in all 4 patients within 20 minutes and late reactions at 24 hours but negative reactions in controls. Subsequent to the testing, 3 of the patients returned for repeat cystoscopy in which GTA but not OPA was used to disinfect the cystoscopes and tolerated the procedure. CONCLUSIONS: OPA solution should be considered a cause of anaphylactic/allergic reactions following cystoscopy and possibly following instrumentation with other medical devices disinfected by this material.

Aged↗

Efficacy of three surface disinfectants for dental radiographic films and gloves.

Contaminated radiographic films and gloves may transmit infectious diseases. Objective. To determine whether Pre Sept (NaDC), a sodium dichloroisocyanurate based disinfectant; Bronocide SP (AIP) an alcohol-phenol-iodine disinfectant and polyvinyl pyrrolidine iodine (PVPI) can be used to disinfect radiographic films and gloves. Study design. Radiographic films were contaminated with Candida albicans, Streptococcus mutans, Lactobacilli or saliva and placed in either 0.1, 0.25 or 0.5 NaDC for 1, 2 or 5 min; PVPI for 5 min or sprayed with AIP. Gloves contaminated with C. albicans, S. mutans or Lactobacilli were sprayed with AIP. After treatment the films and gloves were tested for viable microorganisms. Results. A 0.5% solution of NaDC killed all microorganisms after one-minute exposure. PVPI killed 99.8% and AIP spray between 95.8 and 99% of microorganisms. Conclusions. NaDC was the most successful disinfectant in the laboratory and clinical setting followed by PVPI and AIP.

Benzyl Alcohols↗

Efficacy of alcohol-based gels compared with simple hand wash and hygienic hand disinfection.

A recent research letter on the limited efficacy of alcohol-based hand gels has alerted the global infection control community and raised the question of the true significance of data obtained according to EN 1500. It has been described that a 1 min simple hand wash reduces artificial contamination of hands by a log(10) reduction factor of 2.8 and a 1 min reference hand disinfection with 2-propanol (60%, v/v) by a factor of 4.6 steps. The EN 1500 gel data show that the 30 s efficacy of most gels is closer to a simple hand wash than to the reference hand disinfection. The 30 s efficacy of most alcohol-based liquid products and one gel, however, is almost identical to the reference hand disinfection. In many European countries alcohol-based liquid products have been established as a standard practice in hygienic hand disinfection for decades. Replacement of these products with most available gels would be a step backward in terms of efficacy and has still to be seen critically from the efficacy point of view.

Anti-Infective Agents, Local↗

Alcohol-based hand disinfection: a more robust hand-hygiene method in an intensive care unit.

This study involved observation of hand-hygiene behaviour and evaluation of the effect of alcohol-based hand disinfection and handwashing with plain liquid soap on microbial flora. The study was performed in a combined medical and surgical intensive care unit. We demonstrated a crude compliance of hand hygiene of 50.4%, which was only performed adequately in 20.8% of cases. Of this group, handwashing and hand-disinfection procedures were performed properly 34.0% and 71.6% of the time, respectively. Hand samples for bacteriological examinations with the glove juice method demonstrated that whilst handwashing was sensitive to the way in which hand hygiene was performed, alcohol-based hand disinfection was less sensitive to such performance. Our study demonstrated that alcohol-based hand disinfection is a robust hand-hygiene method with many advantages in a practical setting. It is very feasible for use in hospital wards.

Adult↗

Evaluation of a 2% chlorhexidine gluconate in 70% isopropyl alcohol skin disinfectant.

The efficacy of a new skin disinfectant, 2% (w/v) chlorhexidine gluconate (CHG) in 70% (v/v) isopropyl alcohol (IPA) (ChloraPrep), was compared with five commonly used skin disinfectants against Staphylococcus epidermidis RP62A in the presence or absence of protein, utilizing quantitative time-kill suspension and carrier tests. All six disinfectants [70% (v/v) IPA, 0.5% (w/v) aqueous CHG, 2% (w/v) aqueous CHG, 0.5% (w/v) CHG in 70% (v/v) IPA and 10% (w/v) aqueous povidone iodine (PI)] achieved a log(10) reduction factor of 5, in colony-forming units/mL, in a suspension test (exposure time 30s) in the presence and absence of 10% human serum. Subsequent challenges of S. epidermidis RP62A in a biofilm (with and without human serum) demonstrated reduced bactericidal activity. Overall, the most effective skin disinfectants tested against S. epidermidis RP62A were 2% (w/v) CHG in 70% IPA and 10% (w/v) PI. These results suggest that enhanced skin antisepsis may be achieved with 2% (w/v) CHG in 70% (v/v) IPA compared with the three commonly used CHG preparations [0.5% (w/v) aqueous CHG, 2% (w/v) aqueous CHG and 0.5% (w/v) CHG in 70% (v/v) IPA].

2-Propanol↗

Evaluation of a new disinfection procedure for ultrasound probes using ultraviolet light.

Following 183 ultrasound examinations, a randomized trial was conducted to compare three procedures for disinfection of probes under routine conditions: dry wiping with a soft, dry, non-sterile paper towel, antiseptic wiping with a towel impregnated with disinfectant spray and dry wiping followed by a 10 min ultraviolet C (UVC) cycle in a disinfection chamber. After ultrasonography, swabs were taken from transducer heads before and after cleaning and streaked onto plates that were then cultured. The number of colonies per plate was counted and organisms identified. The median microbial reduction was 100% for UVC, 98.4% for antiseptic wiping and 87.5% for dry wiping (P<0.001). The percentage of negative specimens was 88% for UVC, 16% for antiseptic wiping and 4% for dry wiping (P<0.0001). Microbial flora was isolated from 12 probes (6.6%) before cleaning, whereas specimens obtained after cleaning contained no pathogens except in one case after antiseptic wiping. UVC disinfection of ultrasound probe may provide a useful method for reducing the bacterial load under routine conditions.

Adult↗

The impact of electrochemical disinfection on Escherichia coli and Legionella pneumophila in tap water.

In order to reduce the risks of Legionnaires' disease, caused by the bacterium Legionella pneumophila, disinfection of tap water systems contaminated with this bacterium is a necessity. This study investigates if electrochemical disinfection is able to eliminate such contamination. Hereto, water spiked with bacteria (10(4)CFU Escherichia coli or L. pneumophila/ml) was passed through an electrolysis cell (direct effect) or bacteria were added to tap water after passage through such disinfection unit (residual effect). The spiked tap water was completely disinfected, during passage through the electrolysis cell, even when only a residual free oxidant concentration of 0.07 mg/l is left (L. pneumophila). The residual effect leads to a complete eradication of cultivable E. coli, if after reaction time at least a free oxidant concentration of 0.08 mg/l is still present. Similar conditions reduce substantially L. pneumophila, but a complete killing is not realised.

Chlorine↗

In vitro potential genotoxic effects of surface drinking water treated with chlorine and alternative disinfectants.

A battery of in vitro short-term tests revealing different genetic end-points was set up in order to study surface-water genotoxicity after disinfection with different biocides: sodium hypochlorite (NaClO), chlorine dioxide (ClO(2)) and peracetic acid (PAA). The surface water both before and after disinfection was concentrated by adsorption on C(18) silica cartridges and the concentrates containing non-volatile organics were divided into different portions for chemical analyses and biological assays. The following in vitro tests were conducted on the water concentrates dissolved in DMSO: the Salmonella mutagenicity assay with S. typhimurium strains TA98 and TA100; the SOS Chromotest with Escherichia coli, the Microtox and Mutatox assays with Vibrio fischeri; and gene conversion, point mutation and mitochondrial DNA mutability assays with D7 diploid Saccharomices cerevisiae strain. The results show that the SOS Chromotest and the yeast assays are highly sensitive in detecting genotoxicity. The surface-water extracts were very often toxic to most of the test organisms considered, partially masking their potential mutagenic activity. Therefore, the assays with E. coli and with S. cerevisiae are more likely to show a mutagenic effect because these organisms are generally less sensitive to most toxic compounds. Among the tested disinfectants, NaClO and ClO(2) increased water genotoxicity, whereas PAA was able to slightly reduce raw water activity. However, because the organic compounds in the lake water varied with the season of the year, the disinfection processes, at times, both increased and decreased the raw water activity.

Chlorine Compounds↗