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PubMed2004

Practical limitations of disinfection of body fluid spills with 10,000 ppm sodium hypochlorite (NaOCl).

The purpose of this study was to monitor disinfection with 10,000 ppm sodium hypochlorite for decontamination of common hospital spills. Simulated spills deliberately contaminated with 10(8) bacterial challenges were used for the study. Results showed greater than 5 log reduction in the challenge bacteria for all spills (serum, pus, sputum, csf, ascitic fluid, urine, and stool) except blood. Disinfection was satisfactory for blood contaminated with gram-negative bacteria, but not for staphylococci. As a practical procedure, surfaces contaminated from gross spillage of human body fluids should first be contained with absorbent materials, then disinfected with hypochlorite.

Body Fluids↗

PubMed2004

Prevention of catheter-related bloodstream infection in critically ill patients using a disinfectable, needle-free connector: a randomized controlled trial.

OBJECTIVE: The aim of this study was to assess the efficacy of a disinfectable, needle-free connector in the prophylaxis of catheter-related bloodstream infection. METHODS: A randomized controlled trial was performed in a polyvalent intensive care unit. Patients who needed multilumen central venous catheters were randomly assigned to a study or a control group. All catheters were inserted and manipulated according to the Centers for Disease Control and Prevention (CDC) recommendations. Study group patients were equipped with catheters with disinfectable, needle-free connectors whereas control group patients were equipped with catheters with 3-way stopcocks. Two peripheral blood cultures and a semiquantitative culture of the catheter tip were performed on removal of the catheter. RESULTS: The study included 243 patients, with a total of 278 central venous catheters. The catheters' mean insertion duration was 9.9 days. Both groups were comparable regarding patient and catheter characteristics. Incidence rate of catheter-related bloodstream infection was 0.7 per 1000 days of catheter use in the study group, compared with 5.0 per 1000 days of catheter use in the control group (P=.03). CONCLUSIONS: To add a disinfectable, needle-free connector to the CDC recommendations reduces the incidence of catheter-related bloodstream infection in critically ill patients with central venous catheters.

Catheterization, Central Venous↗

PubMed2005

Computer equipment used in patient care within a multihospital system: recommendations for cleaning and disinfection.

Computer hardware has been implicated as a potential reservoir for infectious agents. Leaders of a 22-hospital system, which spans North America and serves pediatric patients with orthopedic or severe burns, sought to develop recommendations for the cleaning and disinfection of computer hardware within its myriad patient care venues. A task force comprising representatives from infection control, medical affairs, information services, and outcomes management departments was formed. Following a review of the literature and of procedures within the 22 hospitals, criteria for cleaning and disinfection were established and recommendations made. The recommendations are consistent with general environmental infection control cleaning and disinfection guidelines, yet flexible enough to be applicable to the different locales, different computer and cleaning products available, and different patient populations served within this large hospital system.

Computers↗

PubMed2006

Redesign of portable suction equipment cases: an engineering approach to a disinfection problem.

BACKGROUND: Patients with tracheostomies carry a case for suctioning supplies. A returned case cultured positive for Staphylococcus aureus even after it had been cleaned with a disinfectant. The purposes of this study were to determine (1) the source of the S aureus and (2) how to provide a microbiologically safe case for the next patient. METHODS: Reviews of patient and environmental cultures plus pulsed-field gel electrophoresis (PFGE) were used to determine the source of the S aureus. Repeated wiping with various detergents/disinfectants did not remove the S aureus from the case, which could not be immersed for cleaning because of a chipboard component. We designed a case made of denim with a washable synthetic fiber to provide shape. The new cases were purposefully contaminated and laundered and then cultured. RESULTS: PFGE indicated that the S aureus was from the patient who had most recently used the case. Contamination of the denim case with the original S aureus, followed by laundering, resulted in a case that was free of the S aureus. These results were repeated for other pathogens. CONCLUSION: Commercially available cases for suction equipment can become contaminated with pathogens from the user and may be difficult to disinfect. By making the case out of washable materials, less expensive cases, which could be readily disinfected, resulted.

Disinfection↗

PubMed2006

A new peroxide-based flexible endoscope-compatible high-level disinfectant.

Semicritical medical devices such as flexible endoscopes require high-level disinfection between each use, and glutaraldehyde is often used for this purpose because of its favorable materials compatibility. However, workplace safety and the relatively slow microbicidal activity of such formulations remain a concern. Although recently introduced substitutes based on 0.55% ortho-phthaldehyde (OPA), 7% to 14% hydrogen peroxide, and 0.1% to 0.3% peracids are considered less toxic than glutaraldehyde, OPA can be a potential respiratory sensitizer, and the materials compatibility profile of peroxide/peracids at effective concentrations remains an issue. This study describes a high-level disinfectant/sterilant based on 2% accelerated hydrogen peroxide (AHP). It is a blend of stabilized hydrogen peroxide with safe inerts, which act in synergy, and has a 14-day reuse, 5-minute high-level disinfection, and 6-hour sterilization claim at room temperature. Extensive testing of this formulation using nationally and internationally accepted protocols has found it to be a fast-acting and broad-spectrum microbicide in addition to being biodegradable, virtually nontoxic, and free from volatile organic compounds and alkyl phenol ethoxylates. In addition, materials compatibility testing has proven it to be compatible with flexible endoscopes. Therefore, this new chemistry represents a significant advancement in the design of safer and faster acting, high-level disinfectants.

Anti-Infective Agents↗

PubMed2004

Control of bacterial growth in water using synthesized inorganic disinfectant.

Chlorine is a popular method for controlling bacterial growth in cooling towers. However, there are several drawbacks such as the difficulties in maintaining the disinfection efficacy particularly at high temperature and pH. In order to overcome these difficulties, an inorganic disinfectant based on silver and copper, which is called EEKO-BALL (commercial name), was recently developed. EEKO-BALL is made from specific ceramics and coating materials. This study was performed to evaluate the efficacy of EEKO-BALL and compare it with that of silver (Ag+) and copper (Cu2+) ions. In addition, a field study was undertaken to investigate the control of bacterial growth in several cooling tower systems. The results showed that the contact time required for inactivating 99% of E. coli was 15 min in the EEKO-BALL stock solution at 25 degrees C, pH 7.3, with 0.05 mgl(-1) Ag and 0.05 mgl(-1) Cu. EEKO-BALL was approximately four times more effective than silver and copper ions in inactivating E. coli at 25 degrees C, pH 7.3. The control of bacterial growth in the cooling towers was found to be effective, lasting more than two months after a one-time installation of the EEKO-BALL. Overall, this study suggests that EEKO-BALL can effectively work as an inorganic disinfectant for bacterial growth control.

Ceramics↗

PubMed2004

Toxicological effects of disinfections using sodium hypochlorite on aquatic organisms and its contribution to AOX formation in hospital wastewater.

Sodium hypochlorite (NaOCl) is often used for disinfecting hospital wastewater in order to prevent the spread of pathogenic microorganisms, causal agents of nosocomial infectious diseases. Chlorine disinfectants in wastewater react with organic matters, giving rise to organic chlorine compounds such as AOX (halogenated organic compounds adsorbable on activated carbon), which are toxic for aquatic organisms and are persistent environmental contaminants. The aim of this study was to evaluate the toxicity on aquatic organisms of hospital wastewater from services using NaOCl in pre-chlorination. Wastewater samples from the infectious and tropical diseases department of a hospital of a large city in southeast of France were collected. Three samples per day were collected in the connecting well department at 9 a.m., 1 p.m. and 5 p.m. during 8 days from 13 March to 22 March 2001, and a mixture was made at 6 p.m. with the three samples in order to obtain a representative sample for the day. The toxicity test comprised the 24-h EC50 on Daphnia magna and a bioluminescence assay using Vibrio fischeri photobacteria. Fecal coliforms and physicochemical analyses such as total organic carbon (TOC), chloride, AOX, total suspended solids (TSS) and chemical oxygen demand (COD) were carried out. Wastewater samples highlighted considerable acute toxicity on D. magna and V. fischeri photobacteria. However, low most probable numbers (MPN), ranging from <3 to 2400 for 100 ml, were detected for fecal coliforms. Statistical analysis, with a confidence interval of 95%, gave a strong linear regression assessed with r=0.98 between AOX concentrations and EC50 (TU) on daphnia. The identification of an ideal concentration of NaOCl in disinfecting hospital wastewater, i.e. its non-observed effect concentration (NOEC) on algae and D. magna, seems to be a research issue that could facilitate the control of AOX toxicity effects on aquatic organisms. Therefore, it would be necessary to monitor the biocide properties of NaOCl on fecal coliforms at various doses and its toxicity effects on aquatic organisms.

Animals↗

PubMed2004

Fuzzy synthetic evaluation of disinfection by-products--a risk-based indexing system.

Disinfection by-products (DBPs) are formed when disinfectants such as chlorine, chloramine, and ozone react with organic matter in water. Chlorine being the most common disinfectant used in the drinking water industry worldwide, significant attention has been focused on chlorinated DBPs. A new indexing method using fuzzy synthetic evaluation is proposed to determine the health risk associated with the two major groups of chlorinated DBPs--trihalomethanes (THMs) and haloacetic acids (HAAs). Initially, membership functions for cancer and non-cancer risks associated with THMs and HAAs are used to establish the fuzzy evaluation matrices. Subsequently, weighted evaluation matrices for both types of risks are established by performing cross products on the weighted vectors (founded on the analytic hierarchy process) and the fuzzy evaluation matrices. In the final stage, the weighted evaluation matrices of cancer and non-cancer risks are aggregated to determine the final risk rating. Two case studies are provided to demonstrate the application of this method.

Carcinogens↗

PubMed2004

Effect of peracetic acid and aldehyde disinfectants on biofilm.

The effects of two aldehyde (Cidex, Endosporine) and four peracetic acid (PAA) (Nu Cidex, Anioxyde 1000, Hydraseptic, Peralkan) disinfectants on an Escherichia coli biofilm model were studied. The biofilm was prepared in glass tubes, and evaluated indirectly using a colourimetric method. The ability of the disinfectants to fix or remove the biofilm from tubes was determined by their detergent activity (DA). The two aldehyde derivatives and two of the PAA (Nu Cidex, Anioxyde 1000) agents fixed the biofilm. However, the effects of Hydraseptic and Peralkan were equivalent to the control (sterile water). Regardless of their disinfectant activity, PAA agents display different DAs that could be used to select the weakest biofilm-fixing agents. Users should be concerned about the efficiency of the cleaning stage of medical devices, and when choosing a PAA product, non-fixing ability should be considered in addition to antimicrobial activity.

Biofilms↗

PubMed2005

Water disinfection with ozone, copper and silver ions, and temperature increase to control Legionella: seven years of experience in a university teaching hospital.

The efficacy of ozonation, copper-silver ionization and increased temperature in controlling Legionella spp. in the hot water distribution networks of a university hospital was evaluated. Two separate water distribution networks were studied; network 1 which supplies the surgical intensive care units, and network 2 which supplies the medical intensive care units and the emergency room. Network 1 has been disinfected by ozonation since 1995, and network 2 has been disinfected by ionisation since 1999. The hot water temperature was increased from 50 to 65 degrees C in 1998 and 2000 in networks 1 and 2, respectively. Water samples and swabs of the water outlets were cultured for Legionella spp. between four and six times each year, providing data before and after implementation of the disinfection procedures. There was no significant difference in the proportion of samples positive for Legionella spp. after ozonation in network 1 or after ionization in network 2. In both networks, there was a significant reduction in legionella isolates after increasing the hot water temperature to 65 degrees C. Maintaining the hot water temperature above 50 degrees C throughout both networks proved to be the most effective control measure in our hospital.

Copper↗

PubMed2005

For debate: is disinfection of specimens, which may contain unknown or bio-terrorist organisms, essential before electron microscopic examination?

Severe and unexpected infections may be due to bioterrorism (BT), or the natural emergence of novel micro-organisms. Whatever the cause, there will be an urgent need to identify it for several reasons: defusing public anxiety, providing logical management and countermeasures, etc. For viruses and some bacteria, electron microscopy provides the fastest answers and identifying the cause quickly may eliminate BT. In the interests of safety, many would recommend that the specimen be disinfected at some stage before examination, but with unknown agents, however, reliable disinfection cannot be guaranteed and attempting to do so may also impair structure sufficiently to make recognition difficult or even impossible. As a basis for debate, this paper discusses the pros and cons of disinfecting such specimens.

Bioterrorism↗

PubMed2006

A membrane-based quantitative carrier test to assess the virucidal activity of disinfectants and persistence of viruses on porous fomites.

A membrane-based quantitative carrier test method to assess the virucidal activity of disinfectants and the persistence of viruses on fomites under different environmental conditions is described. The method is based on the inactivation of the virus adsorbed to cellulose ester membranes followed by the direct enumeration of the viruses surviving the treatment without the need of an elution step. The method was suitable for four different human enteroviruses tested. Experiments comparing the infectivity loss of human enteroviruses in suspension or adsorbed to the filters after treatment with chlorine and glutaraldehyde showed that the human enteroviruses tested suffered significantly greater log10 reductions when suspended than when adsorbed. Significant differences in the effect of the disinfectants on the various human enteroviruses tested were also observed. Moreover, the procedure allowed determining the inactivation of viruses on fomites under different environmental conditions. Low temperatures and high relative humidities favored the survival of human enteroviruses. Also, viruses adsorbed to the membranes retained their infectivity frozen at -70 degrees C for more than 1 year, thus providing the possibility of preparing very simple reference materials for testing virucidal activities of antiseptics and disinfectants.

Adsorption↗

PubMed2005

Evaluation of two commercial disinfectants on the viability and infectivity of Cryptosporidium parvum oocysts.

Cryptosporidiosis is mainly a problem in neonatal ruminants. Not only do Cryptosporidium spp. spread ubiquitously in our environment, but the protozoa are highly resistant to harsh environmental conditions and disinfectants, and a control measure is urgently required. This study investigated the potential biocidal activity on Cryptosporidium parvum oocysts of two commercial disinfectants developed originally to be used in farms and food-processing industries. The products, containing formaldehyde and hydrogen peroxide respectively, both had some anticryptosporidial effects. The viability and infectivity of purified C. parvum oocysts exposed to both disinfectants at different concentrations and exposure times were evaluated by inclusion or exclusion of vital dye (propidium iodide), use of an excystation technique and infection of suckling mice. Viability assays showed a decrease in oocyst viability associated with an increase in exposure time for each of the concentrations used. The intensity of infection in neonatal mice was significantly lower (P<0.05) than in the control litters.

Animals↗

PubMed2006

Assessment of cleaning and disinfection in Salmonella-contaminated poultry layer houses using qualitative and semi-quantitative culture techniques.

Salmonella infection of laying flocks in the UK is predominantly a problem of the persistent contamination of layer houses and associated wildlife vectors by Salmonella Enteritidis. Methods for its control and elimination include effective cleaning and disinfection of layer houses between flocks, and it is important to be able to measure the success of such decontamination. A method for the environmental detection and semi-quantitative enumeration of salmonellae was used and compared with a standard qualitative method, in 12 Salmonella-contaminated caged layer houses before and after cleaning and disinfection. The quantitative technique proved to have comparable sensitivity to the standard method, and additionally provided insights into the numerical Salmonella challenge that replacement flocks would encounter. Elimination of S. Enteritidis was not achieved in any of the premises examined although substantial reductions in the prevalence and numbers of salmonellae were demonstrated, whilst in others an increase in contamination was observed after cleaning and disinfection. Particular problems with feeders and wildlife vectors were highlighted. The use of a quantitative method assisted the identification of problem areas, such as those with a high initial bacterial load or those experiencing only a modest reduction in bacterial count following decontamination.

Animals↗

PubMed2005

Disinfectant efficacy of chlorite and chlorine dioxide in drinking water biofilms.

The drinking water industry is closely examining options to maintain disinfection in distribution systems. In particular this research compared the relative efficiency of the chlorite ion (ClO2-) to chlorine dioxide (ClO2) for biofilm control. Chlorite levels were selected for monitoring since they are typically observed in the distribution system as a by-product whenever chlorine dioxide is applied for primary or secondary disinfection. Previous research has reported the chlorite ion to be effective in mitigating nitrification in distribution systems. Annular reactors (ARs) containing polycarbonate and cast iron coupons were used to simulate water quality conditions in a distribution system. Following a 4 week acclimation period, individual ARs operated in parallel were dosed with high (0.25mg/l) and low (0.1mg/l) chlorite concentrations and with high (0.5 mg/l) and low (0.25mg/l) chlorine dioxide concentrations, as measured in the effluent of the AR. Another set of ARs that contained cast iron and polycarbonate coupons served as controls and did not receive any disinfection. The data presented herein show that the presence of chlorite at low concentration levels was not effective at reducing heterotrophic bacteria. Log reductions of attached heterotrophic bacteria for low and high chlorite ranged between 0.20 and 0.34. Chlorine dioxide had greater log reductions for attached heterotrophic bacteria ranging from 0.52 to 1.36 at the higher dose. The greatest log reduction in suspended heterotrophic bacteria was for high dose of ClO2 on either cast iron or polycarbonate coupons (1.77 and 1.55). These data indicate that it would be necessary to maintain a chlorine dioxide residual concentration in distribution systems for control of microbiological regrowth.

Bacteria↗

PubMed2007

The application of bioluminescence assay with culturing for evaluating quantitative disinfection performance.

Various methods, including bioluminescence assay, were investigated regarding their suitability for quantitatively evaluating the disinfection performance. Although bioluminescence assay itself has been widely reported as a rapid, easy and suitable method for analyzing live microorganisms, the limited sensitivity of its measurement (approximately 10(3)-10(4)cells/assay vial), which is insufficient for disinfection study, requires further study. Among three methods (amplifying by enzymatic method, membrane filtration, and amplification by culturing) examined for increasing the detection sensitivity, amplification by culturing showed the best performance as Escherichia coli was employed as an indicating microorganism. Even with a short culturing time of 4h, the detection limit of E. coli measurement was successfully improved 200-fold, and the analytical results were not dependent upon the state of E. coli growth (stationary state with E. coli stock suspension vs. growth state with E. coli). In addition, the analytical integrity of bioluminescence assay with culturing was further demonstrated in comparison with spread plate method as free chlorine and UV irradiation were employed in the disinfection study.

Disinfection↗

PubMed2006

Updated weight of evidence for an association between adverse reproductive and developmental effects and exposure to disinfection by-products.

Disinfection by-products (DBP) are produced when water is treated with chemical disinfectants. Some toxicological and epidemiological studies suggest an association between DBP exposure and adverse reproductive and developmental effects. In a previous critical review, [Graves, C.G., Matanoski, G.M., Tardiff, R.G., 2001. Weight of evidence for an association between adverse reproductive and developmental effects and exposure to disinfection by-products: a critical review. Regul. Toxicol. Pharmacol. 34, (2) 103-124] evaluated the weight of evidence for this exposure and these effects. This investigation updates the previous evaluation and considers all toxicological and epidemiological evidence since the earlier review and reassesses the weight-of-evidence for all of the data on the various effects, outcome by outcome. The updated toxicity weight of evidence found little indication of previously unreported reproductive or developmental toxicity. In particular, the recently published findings of an exceptionally well conducted cohort study of broad scope found no impact of chlorination by-products on the highly controversial outcome of spontaneous abortion, unlike predecessor studies of more limited methodology, leading the authors to recommend no further epidemiologic pursuit for this hypothesis since the cohort was scrutinized very closely and dispelled any concern of such an association. The updated epidemiologic weight of evidence demonstrated that no association with DBP exposure exists for over a dozen outcomes including low and very low birth weight, preterm delivery, some specific congenital anomalies, and neonatal death. The analysis found inconsistent or very weak results for all congenital anomalies/birth defects, all central nervous system anomalies, neural tube defects, and spontaneous abortion. As in the previous article, the updated weight of evidence suggested a positive association with DBP exposure and some measure of growth retardation such as intrauterine growth retardation, small for gestational age, term low birth weight, and small body length or head circumference. Exposure assessment in most epidemiological studies remains inadequate to definitively demonstrate any association of small magnitude.

Animals↗

PubMed2003

Structural integrity of the polyurethane female condom after multiple cycles of disinfection, washing, drying and relubrication.

The female condom provides an important alternative means of protection against HIV and other sexually transmitted infections for women, particularly in situations where partners are reluctant or refuse to use male condoms. The relatively high cost of the device, however, is a barrier to its use in resource-poor environments. This has led to some reuse of the product and two studies have demonstrated that female condoms can withstand a limited level of reuse without an excessive loss of structural integrity when washed with soap and water. A consultation on female condom reuse convened by the World Health Organization and the Joint United Nations Programme on AIDS in June 2000 recommended that all used female condoms should be disinfected immediately after use, before washing. The effect of such treatments on the female condom was not known. This study was undertaken to assess the effect of the disinfection, washing, drying and relubrication on the properties of the condom. Samples from three batches of female condoms were subjected to seven treatment cycles before being tested for structural integrity. In all cases the batches of condoms complied with the manufacturer's release specification for the product after treatment. Some minor changes in properties were seen but these were not considered important. There was evidence of a small increase in the number of condoms with holes following repeated disinfection and washing cycles, suggesting that excessive or rough handling can damage the condom. Condoms should therefore be handled carefully and inspected thoroughly for signs of damage after washing and drying before being stored with the intention of subsequently reusing the device.

Single-Use Internal Condom↗