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Molecular approaches to validate disinfectants against human hepatitis B virus.

Disinfection is an important measure to prevent hepatitis B virus (HBV) transmission by instruments. However, virucidal testing of disinfectants against HBV is difficult, because no simple quantitative infectivity assay exists. Since molecular changes of viral epitopes and the genome may indicate virus inactivation, we measured the alteration of these constituents with 0.065% peracetic acid (PAA) for exposure times up to 1 h. Plasma of a chronic HBV carrier with 10(9) HBV genomes/ml served as viral source in the form of a 10% dilution or of a purified HB-antigen preparation. Alterations of HBV epitopes were analyzed with four monoclonal antibodies in an enzyme-linked immunosorbent assay. Changes of the HBV genomes were determined by the inability to amplify the target sequence with a quantitative real-time polymerase chain reaction, either of a short fragment (189 bp) or of the full-length (3,200 bp). The determination of the epitope and genome alteration was quantified as log10 reduction factor (RF) with the parallel line bioassay. Under a high protein load of 10% human plasma, PAA induced a HBV genome alteration of RF = 1.5 after an exposure time of 60 min. Similar RFs were seen with the four HB epitopes. Without protein load, the alteration of these epitopes amounted to a RF of more than 3.5 within 30 min. Such inhibition of PAA activity by protein load was also seen in the virucidal tests with parvovirus. Although the RF were higher in the virucidal tests, the time-dependent dose-response curves for the epitope and genome alteration and for the infectivity inactivation followed the same inactivation kinetics. The molecular alteration and disintegration epitope and genome test may therefore be suitable to measure antiviral activity of disinfectants against HBV.

Animals↗

Inactivation of thymidylate synthase by chlorine disinfectants.

The effects of two chlorine disinfectants, calcium hypochlorite (HTH) and 3-chloro-4,4-dimethyl-2-oxazolidinone (Agent I), on the activity of thymidylate synthase have been investigated. Although both disinfectants inactivated the enzyme, the following differences were observed: When the two disinfectants were used at the same total chlorine concentration, the rate and extent of inactivation were greater with Agent I than HTH. The substrate dUMP partially protected thymidylate synthase from inactivation by Agent I, but it did not appreciably protect against inactivation by HTH. Large changes in the ultraviolet spectrum of the enzyme occurred when it was treated with HTH, which suggests reactions with aromatic amino acid side chains; no spectral changes occurred when thymidylate synthase was treated with Agent I. Blocking the sulfhydryl groups of thymidylate synthase with sulfhydryl reagents prevented the irreversible inactivation of the enzyme by Agent I, but not by HTH.

Calcium↗

Bactericidal effect of a disinfectant dental stone on irreversible hydrocolloid impressions and stone casts.

Infection control in dentistry focuses on the prevention of cross-contamination among patients, dentists, and dental auxilary personnel. This study evaluated the bactericidal effect of a dental gypsum material containing 0.25% chloramine-T on oral irreversible hydrocolloid impressions and dental casts. Eighty irreversible hydrocolloid impressions from 40 human volunteers were prepared. Forty impressions were poured with the disinfectant dental stone and a similar number were poured with a comparable, nondisinfectant stone. After setting for 60 minutes, the impressions and separated casts were sampled for bacterial contamination. The disinfectant stone inhibited bacterial growth in 39 of 40 impressions and casts, whereas all casts and impressions poured with the nondisinfectant stone were contaminated. The disinfectant dental stone containing chloramine-T was effective in eliminating bacterial contamination of both the irreversible hydrocolloid impression and stone cast.

Alginates↗

The effect of immersion disinfection of elastomeric impressions on the surface detail reproduction of improved gypsum casts.

This investigation examined improved gypsum casts for surface roughness and line-detail reproduction after the immersion disinfection of elastomeric impression materials in an acid glutaraldehyde, an alkaline glutaraldehyde, and a phenol. Impressions were made of a surface roughness standard (Ra = 3.08 microns) that was custom made to include engraved grooves following American Dental Association specification No. 19. Mean surface roughness (Ra) values for all casts of all combinations of disinfectant treatments, impression materials, and improved gypsum stones were obtained with a surface analyzer. Untreated impressions served as controls. Data examined by an analysis of variance indicated that the addition silicone and polyether impression materials provided a surface roughness similar to the precision displacement specimen standard. The acid glutaraldehyde disinfectant demonstrated enhanced line-detail reproduction compared with the standard. Addition silicone and polyether impression materials combined with the acid glutaraldehyde provided the model system closest to the mean surface roughness of the reference standard. These combinations revealed differences in the surface roughness reproduction among the represented improved dental stones.

Calcium Sulfate↗

Effects of disinfectants on dimensional accuracy of impression materials.

There is a continuing concern over the potential for cross-contamination of viral infections such as AIDS by means of dental impressions. This investigation compared the effects of various viricidal agents on the accuracy of irreversible hydrocolloid and silicone impressions made of single-unit and full mandibular arch models. Measurements on casts made from the treated impressions were compared with the corresponding measurements on casts made from untreated impressions. The results of this study led to the conclusions that there was no preferred disinfectant with respect to dimensional stability for the irreversible hydrocolloid, condensation silicone, or vinyl polysiloxane impression materials tested, and there was no difference in the accuracy of the casts obtained either by spraying with or immersion in any of the disinfectants tested. Therefore using the disinfectants described with either the immersion or spray techniques will not significantly affect the dimensional accuracy of cats made from treated impressions.

Aerosols↗

The effect of a surface disinfectant on a dental cast.

This study determined the effect of a disinfectant solution on dental casts. Stone samples were immersed in a disinfectant solution and in control solutions. The results indicate that a saturated calcium sulfate (clear slurry) solution with 0.525% sodium hypochlorite was an effective disinfectant and acted without damage to the dental cast.

Calcium Sulfate↗

Effects of disinfecting irreversible hydrocolloid impressions on the resultant gypsum casts: Part III--Dimensional changes.

This study evaluated the effect of disinfection time (10, 30 and 60 minutes) on the dimensional changes of stone casts poured against an irreversible hydrocolloid impression material (Jeltrate). Impressions were made of a stainless steel analog of a maxillary arch. The impressions were sprayed with bleach, iodophor, phenol, and water and were stored for designated times before poured in a type IV stone (Vel-mix). The arch width, length, and depth of the vault of the resultant casts were measured by use of a contact measuring device (MicroVal) capable of measuring to 0.0001 mm. Data were analyzed with two-way analysis of variance at the 95% confidence level. Results indicated that disinfection treatment of alginate impressions with surface disinfectants did not cause significant dimensional changes in the resultant stone casts from statistical and clinical points of view.

Analysis of Variance↗

Practical denture disinfection.

Dental laboratory personel are at risk of contracting infections from dental prostheses that have not been properly disinfected. A 4% chlorhexidine scrub for 15 seconds followed by a 3-minute contact time with a chlorine dioxide solution was effective in disinfecting contaminated dentures. Chair-side disinfection of dental prostheses before laboratory procedures is the key to keeping microbial contamination out of the dental laboratory.

Chlorhexidine↗

Efficacy of various surface disinfectants on an irregular surface.

Representative samples of hard surface disinfectants were tested against Pseudomonas aeruginosa (ATCC 27853) on frosted glass rods. The same protocol was followed by two investigators on 100 rods for each product tested. Results showed Sporicidin surface disinfectant (Ash Dentsply, York, Pa.) and household bleach 1:10 to be most effective against P. aeruginosa. Lysol disinfectant spray (Lehn & Fink Products, Montvale, N.J.), performed similarly whereas Biocide (Biotrol International, Woods Cross, Utah) failed to inhibit growth on more than half of the rods treated. Failure of the iodophor may be attributed to the use of cotton-filled gauze, because cellulose is believed to react with nascent iodine.

Cresols↗

Chemical inactivation of hepatitis B virus: the effect of disinfectants on virus-associated DNA polymerase activity, morphology and infectivity.

The inactivation of hepatitis B virus (HBV) using two commercially available disinfectants was analysed. Indirect evidence of virus inactivation was obtained by examining the decrease in HBV-associated DNA polymerase and HBcAg activities after treatment with increasing concentrations of disinfectant. Inactivation was accompanied by the irreversible loss of all morphological forms typically found in hepatitis B-positive sera and in particular 42-nm HBV particles were absent. Physiochemical analysis confirmed that the exposure of HBV to either product resulted in the degradation of virus particle structure. Direct evidence of HBV inactivation was obtained by treatment of virus pellets prior to inoculation into susceptible chimpanzees. No evidence of hepatitis B was found in animals receiving treated HBV thereby confirming the suitability of certain disinfectants for the inactivation of potentially infectious material.

1-Propanol↗

Evaluation of surface disinfection procedures for enumerating fungi in foods: a collaborative study.

An effective technique for assessing fungal infections of particulate foods such as cereals, nuts, fruits and vegetables is surface disinfection with a sodium hypochlorite solution before plating directly onto agar media. The surface disinfection procedure is used to inactivate the surface mycoflora then permitting assessment of the percentage of particles invaded by specific fungi. A previously recommended procedure treating samples with 0.4% chlorine for 2 min has been shown to be ineffective for barley highly contaminated with conidia of either A. flavus or A. parasiticus. An international collaborative study has demonstrated that modifying the procedure by increasing the chlorine concentration to 0.8%, or increasing the contact time to 8 min, or increasing the volume of chlorine solution is not the answer, especially with surface contamination loads of approximately 10(6) conidia/g. The inclusion of a 70% ethanol pre-rinse prior to a 0.8% chlorine treatment for 2 min made a significant improvement to the inactivation of surface conidia of A. flavus on barley. However, pretreatment with ethanol inactivated some of the internal Alternaria infections especially when the ethanol was not rinsed off. Further studies including an ethanol pre-rinse are recommended to optimise the surface disinfection procedure for seeds and nuts which have a high concentration of fungal surface contaminants.

Aspergillus↗

The effectiveness of ethanol gauze for hand disinfection in surgical wards.

The effectiveness of ethanol gauze in removing transient bacteria on the hands was investigated in a surgical ward during clinical nursing rounds. Two nurses with similar duties were selected as subjects for each round; one disinfected her hands with ethanol gauze when moving between patients while the other immersed her hands in 0.05% aqueous chlorhexidine gluconate when aware of contaminating her hands. Hand samples were taken after preliminary disinfection before the round, and again after the round on 37 occasions. Pseudomonas aeruginosa and Staphylococcus aureus were not detected in nurses using ethanol gauze, except in one nurse where S. aureus was isolated from both the pre- and postround hand culture. Both organisms were detected on four occasions from the postround hand cultures in the chlorhexidine group. Acinetobacter anitratus was not removed by pre-round disinfection, and was found on five and 11 occasions from the postround hand cultures in the ethanol gauze and chlorhexidine groups, respectively.

Bacteria↗

Evaluation of three disinfectants after in-use stress.

Solutions of 2.0% and 3.4% glutaraldehyde, and of 0.5% phenate with 0.18% glutaraldehyde were stressed with a microbial and organic soil load for the periods advocated by the respective manufacturers. The disinfecting efficacy of the stressed solutions was challenged with Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus subtilis, Mycobacterium bovis (BCG), a water Mycobacterium sp. and Candida albicans. The three disinfectants were active against the fast-growing bacteria in appropriate dilutions; lesser dilutions of the glutaraldehyde solutions killed the mycobacteria and the yeast, while stressed phenate with glutaraldehyde did not. One hour exposure of the stressed disinfectants failed to kill the spore preparations while reducing the number of survivors.

Aldehydes↗

A multi-centre evaluation of two chlorhexidine-containing formulations for surgical hand disinfection.

Many experimental methods have been used to assess the efficacy of products intended for surgical hand disinfection. In this study, a modification of the Peterson glove juice method was used to compare two chlorhexidine-based surgical hand disinfectants, 'Hibiscrub' and an experimental formulation, F.6115. The study was performed by four independent laboratories and data merged for analysis. There was found to be no significant difference between the two formulations. The results illustrate that this modified Peterson glove juice method has the potential to form the basis of a standard method for testing surgical hand disinfectants which is both relevant to the practical situation and reproducible in different laboratories.

Chlorhexidine↗

What standards should we use for the disinfection of large equipment?

There are no universal guidelines for cleaning and disinfecting large items of medical equipment. Washer/disinfectors provide one method of making medical equipment safe for staff and patients. Methods of evaluating the performance of such machines are discussed in an attempt to stimulate a much needed review of existing advice and guidelines on cleaning and disinfection. A plea is made for interested parties to agree practical standards for the cleaning and disinfection of medical equipment using washer/disinfectors.

Disinfection↗

Hygienic hand disinfection for the removal of epidemic vancomycin-resistant Enterococcus faecium and gentamicin-resistant Enterobacter cloacae.

An outbreak strain of Enterococcus faecium, bearing plasmid-mediated vancomycin resistance, and an epidemic gentamicin-resistant, multiply-resistant strain of Enterobacter cloacae, both survived well on fingertips of three volunteers for up to 30 minutes after inoculation. Hand disinfection of inoculated fingers with 60% isopropyl alcohol, or with alcoholic chlorhexidine, reliably gave a 4 log10 reduction of both test organisms. Enterobacter cloacae could not be detected in any finger washings, even by enrichment culture. Chlorhexidine digluconate and povidone-iodine were also effective against E. faecium and Ent. cloacae, giving 4 log10 reductions, but finger washings taken after disinfection yielded low counts of the test strains, e.g. less than 45 recoverable colony forming units (cfu) per finger. Handwashing with soap and water was the least reliable method. The epidemicity, serious antimicrobial multiple resistance and survival on finger-tips of these two strains justifies the use of handwashing agents which have maximum effect. The rapid bactericidal (and residual) activity of alcoholic chlorhexidine suggests that, on the basis of present evidence, it is the preferred agent for hygienic hand disinfection against such strains.

Adult↗

Efficacy of selected disinfectants against mycobacteria and cryptosporidia.

We have tested the in-vitro efficacy of various disinfectants against clinical isolates of Mycobacterium tuberculosis, Mycobacterium avium-intracellulare, and against the protozoon Cryptosporidium parvum. The disinfectants were tested both with and without an organic load. 'Sactimed sinald' (a quaternary ammonium compound), 'Steris 20' (a peracetic acid compound) and 'Pentapon DC1' (a beta-ene compound) were all equally as effective as 'Cidex' (glutaraldehyde) against all the mycobacteria tested, as well as C. parvum. 'Virkon' (a per-oxygen compound) and 'Phoraid' (an iodine compound) were less effective than glutaraldehyde. 'Pentapon DHY' (a beta-ene compound) was ineffective against any of the organisms tested. We have also assessed a method of determining disinfectant efficacy using [35S]-methionine labelling of proteins, which appears promising, although it requires further evaluation.

Animals↗

Disinfectant testing on surfaces.

During the last decade a consensus view has evolved in Europe on the quantitative testing of disinfectant efficacy in suspension tests, as well as in surface tests. Harmonization of the different national test methods is being pursued within the framework of the European Committee for Standardisation (CEN/TC216). An expert subgroup of the Committee has drafted a test method to measure the microbicidal activity of disinfectants on bacteria attached to surfaces. The outcome of an initial collaborative study from seven laboratories is that this test system yields reproducible results in different laboratories; thus fulfilling the requirements for a basic surface disinfectant test.

Disinfectants↗