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Survival and disinfection of parainfluenza viruses on environmental surfaces.

Three dilutions of each of three parainfluenza strains were placed on nonabsorptive (stainless steel, laminated plastic, skin) and absorptive (hospital gown, facial tissue, laboratory coat) surfaces to assess persistence of virus recovery at 0, 0.5, 1, 2, 4, 6, 8, and 10 hours. Virus persisted longest on stainless steel. Additionally, the ability to recover virus was enhanced by increasing the initial concentration of virus in the initial inoculum. Drying of the inoculum on surfaces reduced but did not immediately eliminate the ability to recover virus. Cleaning the contaminated surface with a number of commonly available disinfectant or antiseptic agents reduced or eliminated virus with only short exposure times. It is likely that removal of contaminated material by vigorous cleaning was as important as the actual disinfecting substance. In general, all three strains of parainfluenza virus responded similarly. Persistence of all three strains of parainfluenza virus for up to 10 hours on nonabsorptive surfaces and up to 4 hours on absorptive surfaces suggests a need to consider fomites a possible source of transmission of the parainfluenza viruses inside and outside the hospital.

Clothing↗

Disinfection procedures and infection control in the outpatient oral surgery practice.

The infection control and disinfection procedures employed by 434 oral surgeons were surveyed. Gloving practices varied substantially, with 55% of respondents wearing gloves during less than or equal to 10% of patient contacts and only 24% wearing gloves routinely. Gloving practices correlated strongly with having been taught in dental school or during residency training to wear gloves. While 100% of participants had received instruction in the use of intravenous fluids in dental school or residency training, usage patterns differed substantially from those currently recommended in hospitals and in outpatient, nondental surgical settings. Of the respondents who used intravenous fluids in an office setting, 68% used a single bag or bottle for more than one patient. The median number of patients receiving intravenous fluid from a single bag or bottle was 12, and the median duration of use of a single unit was three days. It was noted that infection control and disinfection procedures varied significantly by type of practice (private vs. other nonmilitary vs. military practices).

Adult↗

Environmental disinfection to control equine infectious diseases.

Cleaning and disinfection are essential to the environmental control of infectious diseases of all animals. By understanding the types of pathogens, environment, and disinfection process, success can be attained in effectively stopping disease outbreaks.

Animal Husbandry↗

Adsorption of a biosurfactant on surfaces to enhance the disinfection of surfaces contaminated with Listeria monocytogenes.

The effects of sodium hypochlorite (NaOCl) and peracetic acid/hydrogen peroxide (PAH) on the inactivation of adherent Listeria monocytogenes LO28 cells were examined. The surfaces tested were stainless steel and polytetrafluoroethylene (PTFE) conditioned or not with an anionic biosurfactant produced by Pseudomonas fluorescens. Dilution-neutralization methods were used to assess the effectiveness of sanitizer solutions on planktonic and adherent cells. Tests were performed on L. monocytogenes cultivated at 37 degrees Celsius (body temperature) or 20 degrees Celsius (ambient temperature). The results demonstrated that i) a total deficiency in nutrients induced by the incubation of cells in 0.15 M NaCl favored the action of NaOCl and PAH on planktonic cells; ii) by reducing the number of cells adhering to stainless steel, pre-conditioning of the surface with the biosurfactant reduced the level of contamination of the surface and thus favored the bactericidal activities of the disinfectants; and iii) the weak binding energies involved in the adsorption of the biosurfactant on PTFE surfaces resulted in there being no reduction by the polymer of the surface contamination. Furthermore, this study confirmed that adherent cells exhibited increased resistance to the actions of the disinfectants when compared to the resistance of planktonic cells.

Adsorption↗

The formation and control of disinfection by-products using chlorine dioxide.

In this study, chlorine dioxide (ClO2) was used as an alternative disinfectant with vanillic acid, p-hydroxybenzoic acid, and humic acid as the organic precursors in a natural aquatic environment. The primary disinfection by-products (DBPs) formed were trihalomethanes (THMs) and haloacetic acids (HAAs). Under neutral conditions (pH = 7) for vanillic acid, more total haloacetic acids (THAAs) than total trihalomethanes (TTHMs) were found, with a substantial increase during the later stages of the reaction. In the case of p-hydroxybenzoic acid, the amount of THAAs produced was minimal. Raising the concentration of ClO2 was not favorable for the control of THAAs in low concentrations of vanillic acid. ClO2 could reduce the total amount of TTHMs and THAAs for higher concentration of vanillic acid. It was found that the humic acid treatment dosage was not significant. Under alkaline conditions (pH = 9), the control of TTHMs and THAAs for the treatment of vanillic acid was better and more economical, however, an appreciable amount of inorganic by-products were observed. Under the same alkaline condition, the control of THAA for the treatment of p-hydroxybenzoic acid was not beneficial and for the treatment of humic acid was not significant.

Chlorine Compounds↗

Manual cleaning and disinfection of flexible endoscopes--an approach to evaluating a combined procedure.

Compliance in endoscope reprocessing is unsatisfactory worldwide. The success of the reprocessing procedure relies upon both disinfection and cleaning. Products for instrument disinfection have to be tested accordingly. However, there is still no accepted standard against which to test the result of the cleaning procedure. Different strategies for endoscope reprocessing are possible: one- or two-step procedures. The decision for the method chosen strongly depends on the possibilities in individual hospitals. Products based on glutaraldehyde should not be used if it is not absolutely certain that instruments are already clean. There has to be an awareness that instruments are not designed for easy cleaning. A one-step procedure with products based on aliphatic amines could be an alternative. Methods of assessing such a procedure are suggested.

Bacillus subtilis↗

Disinfection of bronchoscopes, contaminated in vitro with Mycobacterium tuberculosis, Mycobacterium avium-intracellulare and Mycobacterium chelonae in sputum, using stabilized, buffered peracetic acid solution ('Nu-Cidex').

The efficacy of 0.35% stabilized buffered peracetic acid solution ('Nu-Cidex') against clinical isolates of Mycobacterium tuberculosis, Mycobacterium avium-intracellulare and Mycobacterium chelonae in homogenized sputum was tested. An in-use method, using an automated bronchoscope washing machine, showed that over 10 cycles, at a disinfectant contact time of 5 min, M. tuberculosis and M. chelonae were effectively eradicated from the bronchoscope, even in the absence of detergent and pre-cleaning. M. avium-intracellulare was not eradicated in only one of 10 cycles with contact times of 5 and 10 min, but numbers were reduced by > 7 log10 and > 5 log10, respectively. With detergent present, M. avium-intracellulare was successfully eradicated in all cycles at a contact time of 5 min or greater. The results demonstrate that peracetic acid is an effective mycobactericidal agent for use in the disinfection of bronchoscopes.

Bronchoscopes↗

Limited effectiveness of chlorhexidine based hand disinfectants against methicillin-resistant Staphylococcus aureus (MRSA).

Hand disinfectants containing chlorhexidine are thought to be less bactericidal against methicillin-resistant Staphylococcus aureus (MRSA) than methicillin-susceptible Staphylococcus aureus (MSSA). We report an in vitro comparison between three distinct MRSA strains and three MSSA strains. The bactericidal efficacy of chlorhexidine digluconate, 'Hibiscrub' and 'Hibisol' against Staphylococcus aureus was determined in a quantitative suspension test. Logarithmic reduction factors (RF) were calculated for each of six parallel experiments. Chlorhexidine digluconate and 'Hibisol' showed RF > 5 at most concentrations and reaction times but 'Hibiscrub' did not. MRSA was found to be significantly less susceptible than MSSA to chlorhexidine digluconate, 'Hibiscrub' and 'Hibisol' (P < 0.05; two-tailed t-test for independent samples). 'Hibisol' was significantly more effective against MRSA than 'Hibiscrub' (P < 0.05). Hand disinfectants containing both alcohol and chlorhexidine (e.g., 'Hibisol') are more effective against MRSA than scrubs based only on chlorhexidine ('Hibiscrub') and should be used in clinical practice.

Chlorhexidine↗

A new alcohol solution (N-duopropenide) for hygienic (or routine) hand disinfection is more useful than classic handwashing: in vitro and in vivo studies in burn and other intensive care units.

INTRODUCTION: Standard handwashing is a key measure for the prevention of crossed nosocomial infection, but this measure is not always observed. We study whether fast disinfection with an alcohol solution is better than handwashing and whether it can enhance observance. MATERIALS AND METHODS: The effects of several alcohol solutions on native and acquired microbiota are compared with classic handwashing in 'in vitro' and 'in vivo' (health volunteers) quantitative tests. A field assay was subsequently performed in severely ill patient intensive care units (ICUs) (Burn and other ICUs), using a semiquantitative method to compare the effects of disinfection with standard handwashing (n=102) with N-duopropenide alcohol application (n=264). RESULTS AND DISCUSSION: In both designs--health volunteers and hospital ward teams--we found significant differences between handwashing and N-duopropenide application. Handwashing barely modified the native or acquired microbiota (only 0.1 to <2 log10 reduction) and did not eliminate Staphylococcus aureus and Gram-negative bacteria (from 34 to 23%: P>0.05). However, N-duopropenide reduced the acquired microbiota by 5 log (10) and the native hand microbiota by more than 2 log10, as well as significantly reducing S. aureus and Gram-negative bacteria (33-1.3%; P<0.01).

Aldehydes↗

[Evaluation of 7 endoscope washer-disinfectors: bactericidal activity of the disinfectants, antibacterial efficacity of paired washer-disinfector products].

The authors studied seven automatic washer disinfectors for flexible endoscopes with two methods. The first method, a microdilution method, studied the bactericidal activity of the seven disinfectants against 21 strains: four reference strains, 14 hospital strains reported in the literature as nosocomial strains responsible for infections transmitted by flexible endoscopes and three vancomycin-resistant Enterococci. The ability of the seven automatic washer disinfectors to decontaminate flexible endoscopes following inoculation with four reference strains was studied with the second method. There were three kinds of results: the results of three automatic washer disinfectors in conformity with both methods; the results of three automatic washer disinfectors conformity with 1 method only; the results of one automatic washer disinfector without conformity with any methods. Both methods should be used for evaluation of automatic washer disinfector. Then, these results emphasize the necessity to modify the use of disinfectants and/or the systems of some automatic washer disinfectors.

Anti-Bacterial Agents↗

Effect of cleaning-in-place disinfectants on wild bacterial strains isolated from a milking line.

Two cleaning-in-place disinfectant systems (alkaline-acid, alkaline-Cl2) were tested on wild bacteria isolated from a milking line. Most of the isolated strains were Gram-negative and capsule-positive. The effect of milk and cream on the resistance of the wild strains to the cleaning systems was tested. Suspension tests did not show the resistance of bacteria whereas the surface test showed high resistance towards all cleaning-agents. Milk had a protective effect only on the surfaces whereas cream showed mild protection in suspension and complete protection on the surfaces. It was concluded that the growth pattern of contaminants on surfaces needs further attention and the laboratory suspension tests do not correlate with the practical situation. Disinfectant tests based on bacterial growth on the surface are of importance.

Animals↗

Chemical and biological characterization of newly discovered iodoacid drinking water disinfection byproducts.

Iodoacid drinking water disinfection byproducts (DBPs) were recently uncovered in drinking water samples from source water with a high bromide/iodide concentration that was disinfected with chloramines. The purpose of this paper is to report the analytical chemical identification of iodoacetic acid (IA) and other iodoacids in drinking water samples, to address the cytotoxicity and genotoxicity of IA in Salmonella typhimurium and mammalian cells, and to report a structure-function analysis of IA with its chlorinated and brominated monohalogenated analogues. The iodoacid DBPs were identified as iodoacetic acid, bromoiodoacetic acid, (Z)- and (E)-3-bromo-3-iodopropenoic acid, and (E)-2-iodo-3-methylbutenedioic acid. IA represents a new class (iodoacid DBPs) of highly toxic drinking water contaminants. The cytotoxicity of IA in S. typhimurium was 2.9x and 53.5x higher than bromoacetic acid (BA) and chloroacetic acid (CA), respectively. A similar trend was found with cytotoxicity in Chinese hamster ovary (CHO) cells; IA was 3.2x and 287.5x more potent than BA and CA, respectively. This rank order was also expressed in its genotoxicity with IA being 2.6x and 523.3x more mutagenic in S. typhimurium strain TA100 than BA and CA, respectively. IA was 2.0x more genotoxic than BA and 47.2x more genotoxic than CA in CHO cells. The rank order of the toxicity of these monohalogenated acetic acids is correlated with the electrophilic reactivity of the DBPs. IA is the most toxic and genotoxic DBP in mammalian cells reported in the literature. These data suggest that chloraminated drinking waters that have high bromide and iodide source waters may contain these iodoacids and most likely other iodo-DBPs. Ultimately, it will be important to know the levels at which these iodoacids occur in drinking water in order to assess the potential for adverse environmental and human health risks.

Acetates↗

Microbiological evaluation of photo-activated disinfection in endodontics (an in vivo study).

OBJECTIVE: To determine the microbiological effect of photoactivated disinfection (PAD) as an adjunct to normal root canal disinfection in vivo. DESIGN: A randomised trial carried out in general dental practice. SUBJECTS AND METHODS: Patients presenting with symptoms of irreversible pulpitis or periradicular periodontitis requiring endodontic therapy were selected at random. A microbiological sample of the canal was taken on accessing the canal, after conventional endodontic therapy, and finally after the PAD process (photosensitiser and light) had been carried out on the prepared canal. All three samples from each canal were plated within 30 minutes of sampling and cultured anaerobically for five days. Growth of viable bacteria was recorded for each sample to determine bacterial load. RESULTS: Thirty of the 32 canals were included in the results. Cultures from the remaining two did not reach the laboratory within the target time during which viability was sustained. Of the remaining 30, 10 canals were negative to culture. These were either one of the canals in multi rooted teeth where the others were infected or where a pre-treatment with a poly-antibiotic paste had been applied to hyperaemic vital tissue. Sixteen of the remainder were negative to culture after conventional endodontic therapy. Three of the four which had remained infected cultured negative after the PAD process. In the one canal where culturable bacteria were still present, a review of the light delivery system showed a fracture in the fibre reducing the effective light output by 90%. CONCLUSIONS: The PAD system offers a means of destroying bacteria remaining after using conventional irrigants in endodontic therapy.

Adolescent↗

Assessment of bismuth thiols and conventional disinfectants on drinking water biofilms.

AIMS: Biofilms in water distribution systems represent a far more significant reservoir of micro-organisms than the water phase. Biofilms are (i) resistant to disinfectants, (ii) nuclei for microbial regrowth, (iii) a refuge for pathogens, (iv) accompanied by taste and odour problems, and (v) corrode surfaces. The effects of the current strategies for disinfection of drinking water systems in large buildings (chlorination, copper and silver ionization, and hyper-heating) were compared with a new generation of bismuth thiol (BT) biocides. METHODS AND RESULTS: Multispecies biofilms were treated with 0.8 mg l(-1) of free chlorine, 400 and 40 microg l(-1) of copper and silver ions, respectively, at 55 and 70 degrees C, and bismuth-2,3-dimercaptopropanol (BisBAL). Furthermore, the effect of combined heat and BisBAL on planktonic cell viability was examined in monoculture using Escherichia coli suspensions. Inactivation rates for BisBAL were similar to copper-silver ions, where the effects were slower than for free chlorine or temperature. The BisBAL effect on E. coli monocultures was augmented greatly by increasing temperatures. CONCLUSIONS: Like copper-silver ions, BTs show more persistent residual effects than chlorine and hyper-heating in water systems. BT efficiency increased with temperature. Like copper-silver ions, BT action is relatively slow. SIGNIFICANCE AND IMPACT OF THE STUDY: BT presents a new approach to containing water biofilms. BT action is not as rapid, but is more thorough than chlorine, and less caustic. BTs may also be more efficacious in hot water systems. At sub-minimum inhibition concentration levels, BTs uniquely inhibit bacterial exopolysaccharide, thereby retarding biofilm formation. Thus, the combination of bactericidal and residual effects may prevent slime build-up in hot water systems.

Biofilms↗

Comparison of microbial contamination of enteral feeding solution between repeated use of administration sets after washing with water and after washing followed by disinfection.

We compared microbial contamination of in-use enteral feeding solution from repeatedly used administration sets (a delivery bag and an infusion tube) after washing with water or washing followed by disinfection. In eight hospitals where administration sets were re-used after washing with water, residual solution was collected from both the delivery bag and the distal end of the infusion tube immediately after use and the microbial contamination level and microbial species found examined. The residual enteral feeding solution (28 samples) in the delivery bag grew 10(2)-10(8) colony forming units (cfu)/mL and 36 samples from the distal end of the infusion tube grew 10(2)-10(9) cfu/mL. Re-processing was changed to washing with water followed by disinfection with 0.1% (100 ppm) sodium hypochlorite, and similar examinations were performed. The residual solutions in the bag (22 samples) and in the distal end of the infusion tube (24 samples) were contaminated with < 10(1)-10(4) cfu/mL each, a significant decrease (P < 0.01, Wilcoxon U-test) compared with washing with water alone.

Disinfectants↗

Endoscope disinfection using acidic electrolytic water.

BACKGROUND AND STUDY AIMS: The aim of the present study was to evaluate a new endoscope disinfector (WM-1) that uses acidic electrolytic water (AEW). MATERIALS AND METHODS: AEW was produced by electrolysis of a 0.05% NaCl-water mixture, with a redox potential greater than 1000 mV and a pH lower than 2.7. In the first study, an endoscope artificially contaminated with 15 species of bacteria and four strains of viruses was treated using the WM-1. In the second study, endoscopic contamination after clinical use was examined by culture for Helicobacter pylori and other bacteria, and by polymerase chain reaction for the H. pylori urease gene and hepatitis C virus. The extent of contamination was then examined after exposing the WM-1 to AEW. The safety of AEW was examined using both in vivo and in vitro studies. RESULTS: All of the bacteria and viruses were destroyed or inactivated after the instrument had been exposed to AEW. Clinical contamination was detected from the instrument in 19 of 30 endoscopic procedures, whereas no bacteria or viruses were detected after five minutes' exposure to AEW. AEW was found to be nonirritant, nontoxic to cells, and nonmutagenic. CONCLUSION: The WM-1 successfully and safely disinfected the endoscopes. With running costs of yen 24 per day ($0.21 per day), the WM-1 provides an effective and inexpensive alternative to conventional disinfection equipment.

Acids↗

Experimental evaluation of an automated endoscope reprocessor with in situ generation of peracetic acid for disinfection of semicritical devices.

OBJECTIVE: To evaluate the effectiveness of a high-level disinfection solution generated inside an endoscope processing system for decontaminating external and internal surfaces of experimentally contaminated heat-sensitive medical devices. METHODS: The American Society for Testing and Materials Simulated-Use Test protocol (E1837-02), which incorporates a soil load in each inoculum, was used to evaluate the efficacy of the system when processing 4 common types of endoscopes contaminated separately with 5 types of nosocomial pathogens: Pseudomonas aeruginosa (ATCC 15442), spores of Clostridium difficile (ATCC 9689), a glutaraldehyde-resistant strain of Mycobacterium chelonae, a vancomycin-resistant strain of Enterococcus faecalis, and a methicillin-resistant strain of Staphylococcus aureus. Rinse solution samples from channels and from surfaces of the processed endoscopes were tested for any microbicidal residues. RESULTS: For all organisms tested, the baseline level of contamination of the endoscopes ranged from 5 log(10) to greater than 7 log(10) at each external surface site and internal channel. All tests showed reductions in viability of the test organisms to undetectable levels. All rinse solution samples from external and internal sites of the endoscopes proved to be free of any residual microbicidal activity. CONCLUSIONS: The endoscope reprocessor, with its processor-generated high-level disinfection solution, successfully reduced the numbers of selected, clinically relevant pathogens to undetectable levels both in the channels and on the outside surfaces of the 4 representative endoscopes tested in this study.

Cross Infection↗

Activity of disinfectants against vancomycin-resistant Enterococcus faecium.

Vancomycin-resistant enterococci (VRE) often contaminate the hospital environment. We examined the activity of commonly used disinfectants against eight strains of VRE, using a quantitative suspension test method. Isopropyl alcohol and sodium hypochlorite were highly effective. Hydrogen peroxide was ineffective for all strains. After 10 minutes of incubation (the manufactures' recommended time of exposure), three phenolic and three quaternary ammonium compounds also were highly effective. After 3 minutes of exposure, however, occasional failures did occur. With the exception of 3% hydrogen peroxide, most disinfectants appear to be active against VRE.

Anti-Bacterial Agents↗