sodium-hypochlorite and Cross-Infection

A 1% potassium peroxymonosulphate-based environmental disinfectant (PPED) produces sodium hypochlorite when combined with sodium chloride, which functions as a disinfectant. However, little is known about the impact of hospital cleaning with PPED on hospital-onset Clostridioides difficile infection (HO-CDI).. To reduce HO-CDI, we promoted antimicrobial stewardship and hospital ward cleaning with PPED: this study was conducted to evaluate their impact.. We began a promotion of post-prescription review with feedback for broad-spectrum antimicrobials and hospital ward cleaning with PPED. We reviewed the ratio of HO-CDI, PPED consumption, and days of therapy (DOT) of broad-spectrum antimicrobials between July 2014 and March 2018, dividing this time into the pre-promotion (July 2014 to June 2015) and post-promotion periods (July 2015 to March 2018).. Using interrupted time series analysis, an immediate significant change in HO-CDI was observed after intervention (P=0.03), although a downward trend was not observed over this period (P=0.19). Trends in PPED consumption significantly changed over this period (P=0.02). DOT of carbapenems decreased immediately after the intervention began (P<0.01). A Poisson regression analysis showed that PPED consumption and DOT of carbapenems were independent factors affecting HO-CDI (P=0.039 and 0.016, respectively).. We revealed that DOT of carbapenems and use of PPED were associated with the HO-CDI ratio and that both interventions reduced the rate of HO-CDI. This is the first report on the impact of hospital ward cleaning with PPED on the reduction of HO-CDI.

Topics: Anti-Infective Agents; Antimicrobial Stewardship; Carbapenems; Clostridioides difficile; Clostridium Infections; Cross Infection; Disinfectants; Hospitals; Humans; Potassium; Sodium Chloride; Sodium Hypochlorite

This review aims to provide relevant, aggregate information about a variety of disinfectants and antiseptics, along with potential utility and limitations. While not exhaustive, this review's goal is to add to the body of literature available on this topic and give interventional providers and practitioners an additional resource to consider when performing procedures.. In the current SARS-CoV2 epidemiological environment, infection control and costs associated with healthcare-associated infections (HAIs) are of paramount importance. Even before the onset of SARS-CoV2, HAIs affected nearly 2million patients a year in the USA and resulted in nearly 90,000 deaths, all of which resulted in a cost to hospitals ranging from US$28 billion to 45 billion. The onset SARS-CoV2, though not spread by an airborne route, has heightened infection control protocols in hospitals and, as such, cast a renewed focus on disinfectants and their utility across different settings and organisms. The aim of this review is to provide a comprehensive overview of disinfectants used in the inpatient setting.

Topics: Chlorine Compounds; Cross Infection; Disinfectants; Ethanol; Formaldehyde; Glutaral; Humans; Hydrogen Peroxide; Iodophors; Oxides; Peracetic Acid; Phenol; Povidone-Iodine; Quaternary Ammonium Compounds; Sodium Hypochlorite; Triazines

To search for evidence of the efficiency of sodium hypochlorite on environmental surfaces in reducing contamination and prevention of healthcare-associated infection HAIs.. Systematic review in accordance with the Cochrane Collaboration.. We analyzed 14 studies, all controlled trials, published between 1989-2013. Most studies resulted in inhibition of microorganism growth. Some decreased infection, microorganism resistance and colonization, loss of efficiency in the presence of dirty and surface-dried viruses.. The hypochlorite is an effective disinfectant, however, the issue of the direct relation with the reduction of HAIs remains. The absence of control for confounding variables in the analyzed studies made the meta-analysis performance inadequate. The evaluation of internal validity using CONSORT and TREND was not possible because its contents were not appropriate to laboratory and microbiological studies. As a result, there is an urgent need for developing specific protocol for evaluating such studies.

Topics: Cross Infection; Disinfectants; Disinfection; Equipment Contamination; Hospitals; Humans; Sodium Hypochlorite

Hypochlorite has been used as a disinfectant for more than 100 years. It has many of the properties of an ideal disinfectant, including a broad antimicrobial activity, rapid bactericidal action, reasonable persistence in treated potable water, ease of use, solubility in water, relative stability, relative nontoxicity at use concentrations, no poisonous residuals, no color, no staining, and low cost. The active species is undissociated hypochlorous acid (HOCl). Hypochlorites are lethal to most microbes, although viruses and vegetative bacteria are more susceptible than endospore-forming bacteria, fungi, and protozoa. Activity is reduced by the presence of heavy metal ions, a biofilm, organic material, low temperature, low pH, or UV radiation. Clinical uses in health-care facilities include hyperchlorination of potable water to prevent Legionella colonization, chlorination of water distribution systems used in hemodialysis centers, cleaning of environmental surfaces, disinfection of laundry, local use to decontaminate blood spills, disinfection of equipment, decontamination of medical waste prior to disposal, and dental therapy. Despite the increasing availability of other disinfectants, hypochlorites continue to find wide use in hospitals.

Topics: Chlorine; Chlorine Compounds; Communicable Disease Control; Cross Infection; Dental Disinfectants; Disease Transmission, Infectious; Disinfection; Environmental Microbiology; Equipment and Supplies; Health Facilities; Health Facility Environment; Humans; Laundry Service, Hospital; Renal Dialysis; Sodium Hypochlorite; Water Microbiology

Topics: Autopsy; Blood Donors; Blood Transfusion; Carrier State; Chronic Disease; Cross Infection; Ethylene Oxide; Formaldehyde; gamma-Globulins; Glutaral; Hepatitis A; Hepatitis B; Hepatitis B Antigens; Humans; Laboratory Infection; Lactones; Preventive Health Services; Propionates; Renal Dialysis; Sodium Hypochlorite; Sterilization

In a randomized trial, adjunctive ultraviolet-C light treatment with a room decontamination device and sodium hypochlorite delivered via an electrostatic sprayer were similarly effective in significantly reducing residual healthcare-associated pathogen contamination on floors and high-touch surfaces after manual cleaning and disinfection. Less time until the room was ready to be occupied by another patient was required for electrostatic spraying.

Topics: Cross Infection; Decontamination; Disinfection; Hospitals; Humans; Patients' Rooms; Sodium Hypochlorite; Static Electricity; Ultraviolet Rays

New technologies for automated disinfection have been developed, including the use of hydrogen peroxide atomized by specific equipment, with associated silver compounds.. To compare the effectiveness of an automated disinfection system with hydrogen peroxide <8% and silver ion versus a manual method with 0.5% sodium hypochlorite solution when evaluating the reduction of microbial mesophilic contamination and Clostridium difficile presence; and to evaluate the time required for both of these processes.. This was a randomized multicentre trial performed in different hospital wards that had been occupied previously by patients with Clostridium difficile infection. When patients were discharged their rooms were randomized to one of two decontamination arms. The surfaces where sampled using swabs, before and after disinfection. Swab samples were cultured for quantitative detection of microbial mesophilic contamination and qualitative detection of C. difficile.. Before disinfection, 13% of surfaces decontaminated with hydrogen peroxide and silver ions and 20% of surfaces decontaminated with sodium hypochlorite showed presence of C. difficile spores. After disinfection, the samples containing C. difficile were 0% (P < 0.001) in the group decontaminated with hydrogen peroxide and silver ions, and were 3% (P < 0.001) in the group decontaminated with sodium hypochlorite. This difference was not statistically significant; nor was the difference in the reduction of the microbial mesophilic contamination.. The differences between the groups were not statistically significant; however, the disinfection with hydrogen peroxide and silver ions is preferable due to less dependence on operators.

Topics: Aged; Aged, 80 and over; Automation; Clostridioides difficile; Clostridium Infections; Cross Infection; Disinfection; Equipment Contamination; Female; Hospitals; Humans; Hydrogen Peroxide; Infection Control; Italy; Male; Middle Aged; Patients' Rooms; Silver; Sodium Hypochlorite

Patients admitted to hospital can acquire multidrug-resistant organisms and Clostridium difficile from inadequately disinfected environmental surfaces. We determined the effect of three enhanced strategies for terminal room disinfection (disinfection of a room between occupying patients) on acquisition and infection due to meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, C difficile, and multidrug-resistant Acinetobacter.. We did a pragmatic, cluster-randomised, crossover trial at nine hospitals in the southeastern USA. Rooms from which a patient with infection or colonisation with a target organism was discharged were terminally disinfected with one of four strategies: reference (quaternary ammonium disinfectant except for C difficile, for which bleach was used); UV (quaternary ammonium disinfectant and disinfecting ultraviolet [UV-C] light except for C difficile, for which bleach and UV-C were used); bleach; and bleach and UV-C. The next patient admitted to the targeted room was considered exposed. Every strategy was used at each hospital in four consecutive 7-month periods. We randomly assigned the sequence of strategies for each hospital (1:1:1:1). The primary outcomes were the incidence of infection or colonisation with all target organisms among exposed patients and the incidence of C difficile infection among exposed patients in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT01579370.. 31 226 patients were exposed; 21 395 (69%) met all inclusion criteria, including 4916 in the reference group, 5178 in the UV group, 5438 in the bleach group, and 5863 in the bleach and UV group. 115 patients had the primary outcome during 22 426 exposure days in the reference group (51·3 per 10 000 exposure days). The incidence of target organisms among exposed patients was significantly lower after adding UV to standard cleaning strategies (n=76; 33·9 cases per 10 000 exposure days; relative risk [RR] 0·70, 95% CI 0·50-0·98; p=0·036). The primary outcome was not statistically lower with bleach (n=101; 41·6 cases per 10 000 exposure days; RR 0·85, 95% CI 0·69-1·04; p=0·116), or bleach and UV (n=131; 45·6 cases per 10 000 exposure days; RR 0·91, 95% CI 0·76-1·09; p=0·303) among exposed patients. Similarly, the incidence of C difficile infection among exposed patients was not changed after adding UV to cleaning with bleach (n=38 vs 36; 30·4 cases vs 31·6 cases per 10 000 exposure days; RR 1·0, 95% CI 0·57-1·75; p=0·997).. A contaminated health-care environment is an important source for acquisition of pathogens; enhanced terminal room disinfection decreases this risk.. US Centers for Disease Control and Prevention.

Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Cross-Over Studies; Disinfectants; Disinfection; Drug Resistance, Multiple, Bacterial; Female; Humans; Male; Middle Aged; Patients' Rooms; Quaternary Ammonium Compounds; Sodium Hypochlorite; Ultraviolet Rays; United States

We tested infection prevention strategies to limit exposure of long-term care facility residents to drug-resistant pathogens in a prospective, cluster randomized 2-year trial involving 3 long-term care facilities (LTCFs) using methicillin-resistant Staphylococcus aureus (MRSA) as a model. We hypothesized that nasal MRSA surveillance using rapid quantitative polymerase chain reaction and decolonization of carriers would successfully lower overall MRSA colonization. In year 1, randomly assigned intervention units received decolonization with nasal mupirocin and chlorhexidine bathing and enhanced environmental cleaning with bleach every 4 months. Newly admitted MRSA nares-positive residents were decolonized on admission. Control units were screened but not decolonized. All units received periodic bleach environmental cleaning and instruction on hand hygiene. In year 2, all units followed intervention protocol caused by failure of the cluster randomized approach to sufficiently segregate patients. MRSA colonization was monitored using point prevalence testing every 4-6 months. Colonization status at admission and discharge was performed 1 quarter per year to determine acquisition. Fisher exact test was used for statistical analysis. Baseline MRSA colonization rate was 16.64%. In year 1, the colonization rate of intervention units was 11.61% (P = .028) and 17.85% in control units (P = .613) compared with baseline. Intervention unit rate difference compared with the controls was significant (P = .001). In year 2, the colonization rate was 10.55% (P < .001) compared with baseline. The transmission rates were 1.66% and 3.52% in years 1 and 2, respectively (P = .034). The planned interventions of screening and decolonization were successful at lowering MRSA colonization.

Topics: Anti-Bacterial Agents; Carrier State; Chlorhexidine; Cross Infection; Disinfectants; Infection Control; Long-Term Care; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nose; Nursing Homes; Prospective Studies; Sodium Hypochlorite; Staphylococcal Infections

To compare a hydrogen peroxide dry-mist system and a 0.5% hypochlorite solution with respect to their ability to disinfect Clostridium difficile-contaminated surfaces in vitro and in situ.. Prospective, randomized, before-after trial.. Two French hospitals affected by C. difficile.. In situ efficacy of disinfectants was assessed in rooms that had housed patients with C. difficile infection. A prospective study was performed at 2 hospitals that involved randomization of disinfection processes. When a patient with C. difficile infection was discharged, environmental contamination in the patient's room was evaluated before and after disinfection. Environmental surfaces were sampled for C. difficile by use of moistened swabs; swab samples were cultured on selective plates and in broth. Both disinfectants were tested in vitro with a spore-carrier test; in this test, 2 types of material, vinyl polychloride (representative of the room's floor) and laminate (representative of the room's furniture), were experimentally contaminated with spores from 3 C. difficile strains, including the epidemic clone ribotype 027-North American pulsed-field gel electrophoresis type 1.. There were 748 surface samples collected (360 from rooms treated with hydrogen peroxide and 388 from rooms treated with hypochlorite). Before disinfection, 46 (24%) of 194 samples obtained in the rooms randomized to hypochlorite treatment and 34 (19%) of 180 samples obtained in the rooms randomized to hydrogen peroxide treatment showed environmental contamination. After disinfection, 23 (12%) of 194 samples from hypochlorite-treated rooms and 4 (2%) of 180 samples from hydrogen peroxide treated rooms showed environmental contamination, a decrease in contamination of 50% after hypochlorite decontamination and 91% after hydrogen peroxide decontamination (P < .005). The in vitro activity of 0.5% hypochlorite was time dependent. The mean (+/-SD) reduction in initial log(10) bacterial count was 4.32 +/- 0.35 log(10) colony-forming units after 10 minutes of exposure to hypochlorite and 4.18 +/- 0.8 log(10) colony-forming units after 1 cycle of hydrogen peroxide decontamination.. In situ experiments indicate that the hydrogen peroxide dry-mist disinfection system is significantly more effective than 0.5% sodium hypochlorite solution at eradicating C. difficile spores and might represent a new alternative for disinfecting the rooms of patients with C. difficile infection.

Topics: Clostridioides difficile; Cross Infection; Disinfectants; Disinfection; Enterocolitis, Pseudomembranous; Environmental Microbiology; France; Hospitals, University; Humans; Hydrogen Peroxide; Infection Control; Patients' Rooms; Sodium Hypochlorite; Spores, Bacterial; Treatment Outcome; Volatilization

Clostridioides difficile is a spore forming bacterial species and the major causative agent of nosocomial gastrointestinal infections. C. difficile spores are highly resilient to disinfection methods and to prevent infection, common cleaning protocols use sodium hypochlorite solutions to decontaminate hospital surfaces and equipment. However, there is a balance between minimising the use of harmful chemicals to the environment and patients as well as the need to eliminate spores, which can have varying resistance properties between strains. In this work, we employ TEM imaging and Raman spectroscopy to analyse changes in spore physiology in response to sodium hypochlorite. We characterize different C. difficile clinical isolates and assess the chemical's impact on spores' biochemical composition. Changes in the biochemical composition can, in turn, change spores' vibrational spectroscopic fingerprints, which can impact the possibility of detecting spores in a hospital using Raman based methods.. We found that the isolates show significantly different susceptibility to hypochlorite, with the R20291 strain, in particular, showing less than 1 log reduction in viability for a 0.5% hypochlorite treatment, far below typically reported values for C. difficile. While TEM and Raman spectra analysis of hypochlorite-treated spores revealed that some hypochlorite-exposed spores remained intact and not distinguishable from controls, most spores showed structural changes. These changes were prominent in B. thuringiensis spores than C. difficile spores.. This study highlights the ability of certain C. difficile spores to survive practical disinfection exposure and the related changes in spore Raman spectra that can be seen after exposure. These findings are important to consider when designing practical disinfection protocols and vibrational-based detection methods to avoid a false-positive response when screening decontaminated areas.

Topics: Clostridioides difficile; Cross Infection; Disinfection; Humans; Hypochlorous Acid; Sodium Hypochlorite; Spores, Bacterial

The overuse of biocides in healthcare-facilities poses risk for emergence and spread of antibiotic resistance among nosocomial pathogens. Hospital-acquired infections due to S. maltophilia have been increased in the recent years and with its various resistance mechanisms contribute to patient morbidity and mortality in hospitals. The current study aimed to evaluate the susceptibility of biofilm-producing and non-producing S. maltophilia clinical isolates to five commonly used hospital biocides, alone and in combination with EDTA to examine the synergistic effect of combining EDTA on the bactericidal activity of them by microbroth dilution method. As well as the frequency of efflux genes encoding resistance to biocides among isolates. This study also intended to assess the effect of exposure of S. maltophilia isolates to sub-inhibitory concentrations of sodium hypochlorite upon the antimicrobial susceptibility patterns.. Based on minimum inhibitory and bactericidal concentrations of biocides sodium hypochlorite 5% (w/v) and ethyl alcohol 70% (v/v) were the strongest and weakest biocides against S. maltophilia isolates, respectively. The combination of EDTA with biocides significantly increased the effectiveness of the studied biocides. Exposure to sub-inhibitory concentration of sodium hypochlorite showed a significant change in the susceptibility of isolates towards ceftazidime (p = 0.019), ticarcillin/clavulanate (p = 0.009), and chloramphenicol (p = 0.028). As well as among the isolates examined, 94 (95%) were able to produce biofilm. The frequency of sugE1 resistance genes was found in 90.7% of our clinical S. maltophilia isolates. None of the isolates carried qacE and qacEΔ1 gene.. The current study recommended that using the mixture of biocides with EDTA can be effective in reducing nosocomial infections. Also, this study demonstrated that exposure to sub-inhibitory concentrations of sodium hypochlorite leads to reduced antibiotic susceptibility and development of multidrug-resistant S. maltophilia strains.

Topics: Anti-Bacterial Agents; Biofilms; Ceftazidime; Chloramphenicol; Clavulanic Acid; Cross Infection; Disinfectants; Edetic Acid; Ethanol; Gram-Negative Bacterial Infections; Humans; Iran; Microbial Sensitivity Tests; Sodium Hypochlorite; Stenotrophomonas maltophilia; Ticarcillin

Nosocomial pathogens are transmitted by contamination of surfaces causing healthcare-associated infections (HAI). The impact of locally produced disinfectant with operational training as a means to improve hygiene in resource-limited healthcare facilities and prevent HAI was evaluated.. In Burkina Faso, 4 types of electro-chlorinator devices that convert salt and water into sodium hypochlorite through electrolysis were installed in 26 healthcare facilities distributed across 3 sanitary districts. The program was evaluated at 4 months and 11 months and performance compared with a control group.. After 11 months, over 90% of the facilities applied 8 of the 11 essential hygiene practices defined by the Ministry of Health, compared to 20% in the control group. 61.5% of the healthcare facilities improved the chlorine concentration of their sodium hypochlorite solutions, reaching an average concentration of 5.1 g/L compared to an average of 2.1 g/L in the control group. Additionally, a cost-benefit analysis demonstrated that locally produced sodium hypochlorite led to daily savings ranging between 2.7 and 53 euros depending on the device compared with the purchase of chlorine tablets.. Results, therefore, suggest that electro-chlorinator devices in addition to hygiene sensitization can be a simple, cost-effective and tailored intervention to reduce the prevalence of HAI in low-resource settings.

Topics: Burkina Faso; Cross Infection; Disinfectants; Electrolysis; Halogenation; Health Facilities; Humans; Hygiene; Sodium Hypochlorite

Pathogens in drain biofilms pose a significant risk for hospital-acquired infection. However, the evidence of product effectiveness in controlling drain biofilm and pathogen dissemination are scarce. A novel in-vitro biofilm model was developed to address the need for a robust, reproduceable and simple testing methodology for disinfection efficacy against a complex drain biofilm.. Identical complex drain biofilms were established simultaneously over 8 days, mimicking a sink trap. Reproducibility of their composition was confirmed by next-generation sequencing. The efficacy of sodium hypochlorite 1000 ppm (NaOCl), sodium dichloroisocyanurate 1000 ppm (NaDCC), non-ionic surfactant (NIS) and peracetic acid 4000 ppm (PAA) was explored, simulating normal sink usage conditions. Bacterial viability and recovery following a series of 15-min treatments were measured in three distinct parts of the drain.. The drain biofilm consisted of 119 mixed species of Gram-positive and -negative bacteria. NaOCl produced a >4 log. Drains are one source of microbial pathogens in healthcare settings. Microbial biofilms are notoriously difficult to eradicate with conventional chemical biocidal products. The development of this reproducible in-vitro drain biofilm model enabled understanding of the impact of biocidal products on biofilm spatial composition and viability in different parts of the drain.

Topics: Biofilms; Cross Infection; Disinfectants; Disinfection; Hospitals; Peracetic Acid; Reproducibility of Results; Sodium Hypochlorite; Surface-Active Agents; Triazines; Water Supply

Topics: Bacterial Load; Cross Infection; Disinfectants; Disinfection; Environmental Microbiology; Humans; Hydrogen Peroxide; Intensive Care Units; Linear Models; Patients' Rooms; Sodium Hypochlorite; Water Supply

The quality of daily cleaning was assessed comparing a standard bleach product with the bleach product containing a novel colorant additive in an inpatient setting. Effectiveness was assessed using fluorescent markings and microbiological analysis of environmental and experimental specimens. Our findings showed no significant difference in cleaning between these groups.

Topics: Anti-Infective Agents; Cross Infection; Disinfectants; Fluorescent Dyes; Housekeeping, Hospital; Humans; Infection Control; Patients' Rooms; Sodium Hypochlorite; Stem Cells

Nosocomial infections cause significant morbidity and mortality worldwide, and the pathogenic organisms responsible for such infections can develop resistance to antimicrobial agents. Understanding the activity of disinfectants against clinical and environmental bacterial isolates is therefore crucial. We analysed the in vitro activity of five antimicrobial products (phenolic compounds, didecyldimethylammonium chloride (DDAC), sodium hypochlorite, isopropanol + ammonium compounds (IACs), hydrogen peroxide) against 187 bacterial strains comprising clinical isolates, as well as 30 environmental isolates of

Topics: 2-Propanol; Ammonium Compounds; Bacteria; Cross Infection; Disinfectants; Hospitals; Hydrogen Peroxide; Phenols; Sodium Hypochlorite; Water Microbiology; Water Supply

Environmental disinfection with sodium hypochlorite and hydrogen peroxide vapor was performed after a hospital-associated outbreak of Middle East respiratory syndrome. Although only 11% of total beds were disinfected, the isolation and vancomycin-resistance rates of Enterococcus spp significantly decreased for 2 months, whereas other multidrug-resistant organisms did not.

Topics: Coronavirus Infections; Cross Infection; Disease Outbreaks; Disinfectants; Disinfection; Environmental Microbiology; Hospitals; Humans; Hydrogen Peroxide; Retrospective Studies; Sodium Hypochlorite; Vancomycin-Resistant Enterococci

Transmission of healthcare-associated infections caused by antibiotic- and multi-drug resistant (MDR) pathogens (e.g. Methicillin-resistant. Accelerated hydrogen peroxide (AHP), quaternary ammonium compounds (Quat), and sodium hypochlorite were tested at label and reduced contact times and concentrations against four MDR. Both off-label disinfectant concentrations and contact times significantly affected efficacy of all disinfectants tested. Bactericidal efficacy varied among MRSA and. The quantitative disinfectant efficacy method used highlights the inter-strain variability that exists within a bacterial species. It also underscores the need for a disinfectant validation method that takes these variances into account.

Topics: Anti-Bacterial Agents; Cross Infection; Disinfectants; Drug Resistance, Multiple, Bacterial; Humans; Hydrogen Peroxide; Infection Control; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Quaternary Ammonium Compounds; Sodium Hypochlorite; Staphylococcus aureus; Time Factors

The hospital environment is a source of pathogen transmission. The effect of enhanced disinfection strategies on the hospital-wide incidence of infection has not been investigated in a multicentre, randomised controlled trial. We aimed to assess the effectiveness of four disinfection strategies on hospital-wide incidence of multidrug-resistant organisms and Clostridium difficile in the Benefits of Enhanced Terminal Room (BETR) Disinfection study.. We did a prespecified secondary analysis of the results from the BETR Disinfection study, a pragmatic, multicentre, crossover cluster-randomised trial that assessed four different strategies for terminal room disinfection in nine hospitals in the southeastern USA. Rooms from which a patient with a specific infection or colonisation (due to the target organisms C difficile, meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci (VRE), or multidrug-resistant Acinetobacter spp) was discharged were terminally disinfected with one of four strategies: standard disinfection (quaternary ammonium disinfectant, except for C difficile, for which 10% hypochlorite [bleach] was used; reference); standard disinfection and disinfecting ultraviolet light (UV-C), except for C difficile, for which bleach and UV-C was used (UV strategy); 10% hypochlorite (bleach strategy); and bleach and UV-C (bleach and UV strategy). We randomly assigned the sequence of strategies for each hospital (1:1:1:1), and each strategy was used for 7 months, including a 1-month wash-in period and 6 months of data collection. The prespecified secondary outcomes were hospital-wide, hospital-acquired incidence of all target organisms (calculated as number of patients with hospital-acquired infection with a target organism per 10 000 patient days), and hospital-wide, hospital-acquired incidence of each target organism separately. BETR Disinfection is registered with ClinicalTrials.gov, number NCT01579370.. Between April, 2012, and July, 2014, there were 271 740 unique patients with 375 918 admissions. 314 610 admissions met all inclusion criteria (n=73 071 in the reference study period, n=81 621 in the UV study period, n=78 760 in the bleach study period, and n=81 158 in the bleach and UV study period). 2681 incidenct cases of hospital-acquired infection or colonisation occurred during the study. There was no significant difference in the hospital-wide risk of target organism acquisition between standard disinfection and the three enhanced terminal disinfection strategies for all target multidrug-resistant organisms (UV study period relative risk [RR] 0·89, 95% CI 0·79-1·00; p=0·052; bleach study period 0·92, 0·79-1·08; p=0·32; bleach and UV study period 0·99, 0·89-1·11; p=0·89). The decrease in risk in the UV study period was driven by decreases in risk of acquisition of C difficile (RR 0·89, 95% CI 0·80-0·99; p=0·031) and VRE (0·56, 0·31-0·996; p=0·048).. Enhanced terminal room disinfection with UV in a targeted subset of high-risk rooms led to a decrease in hospital-wide incidence of C difficile and VRE. Enhanced disinfection overcomes limitations of standard disinfection strategies and is a potential strategy to reduce the risk of acquisition of multidrug-resistant organisms and C difficile.. US Centers for Disease Control and Prevention.

Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Cross-Over Studies; Disinfectants; Disinfection; Drug Resistance, Multiple, Bacterial; Hospitals; Humans; Quaternary Ammonium Compounds; Randomized Controlled Trials as Topic; Sodium Hypochlorite; Southeastern United States; Ultraviolet Rays

To quantify the survival of Clostridium difficile spores on hospital bed sheets through the United Kingdom National Health System (UK NHS) healthcare laundry process (Health Technical Memorandum (HTM) 01-04) in vitro and on bed sheets from patients with C. difficile through the commercial laundry.. Clostridium difficile spores were inoculated onto cotton sheets and laundered through a simulated washer extractor cycle using an industrial bleach detergent with sodium hypochlorite 15% and peracetic acid sour 14% (acetic acid and hydrogen peroxide; pH, 2-4). Spore survival on hospital sheets naturally contaminated with C. difficile was also assessed using a washer extractor plus drying and finishing cycles at a commercial laundry.PatientsNaturally contaminated C. difficile bed sheets were taken from beds of patients that had previously been diagnosed with C. difficile infection (CDI) and had received care on an isolated C. difficile ward.. The simulated washer extractor cycle, with an industrial detergent, demonstrated survival of 2 strains of C. difficile NCTC 11209 (0-4 colony-forming units [cfu] per 25 cm2) and ribotype 001/072 (0-9 cfu per 25 cm2). Before laundering, naturally contaminated bed sheets had an average spore load of 51 cfu per 25 cm2, and after washing, drying, and finishing, the spore load was 33 cfu per 25 cm2. Before and after washing, the C. difficile strain was identified as ribotype 001/072. Both the simulated and in-situ laundering processes failed the microbiological standards of no pathogenic bacteria remaining.. Clostridium difficile spores are able to survive laundering through a commercial washer extractor and may be contributing to sporadic outbreaks of CDI. Further research to establish exposure of laundry workers, patients, and the hospital environment to C. difficile spores from bed sheets is needed.

Topics: Clostridioides difficile; Cross Infection; Disinfectants; Disinfection; Hospital Units; Housekeeping, Hospital; Humans; Hydrogen Peroxide; Laundering; Sodium Hypochlorite; Spores, Bacterial; United Kingdom

Antimicrobial disinfectants are used as primary treatment options against pathogens on surfaces in healthcare facilities to help prevent healthcare associated infections (HAIs). On many surfaces, pathogenic microorganisms exist as biofilms and form an extracellular matrix that protects them from the antimicrobial effects of disinfectants. Disinfectants are used as all-purpose antimicrobials though very few specifically make biofilm efficacy claims. The objective of this study was to evaluate the efficacy of eight registered disinfectants (six registered by the Environmental Protection Agency and two products registered in by the European Chemical Agency) with general bactericidal claims, but currently no biofilm efficacy claims, against. This study tested the bactericidal efficacy of eight registered disinfectant products against. Overall, sodium hypochlorite and hydrogen peroxide disinfectants had significantly higher bactericidal efficacies than quaternary ammonium chloride disinfectants. We also found that all tested disinfectants except for quaternary ammonium chloride disinfectants met and exceeded the EPA standard for bactericidal efficacy against biofilms.. In general, bactericidal efficacy against biofilms differed by active ingredient. The efficacies of sodium hypochlorite and hydrogen peroxide disinfectants did not vary between strains, but there were significant differences between strains treated with quaternary ammonium chloride disinfectants.

Topics: Anti-Bacterial Agents; Biofilms; Cross Infection; Disinfectants; Drug Combinations; Drug Synergism; Hydrogen Peroxide; Pseudomonas aeruginosa; Quaternary Ammonium Compounds; Sodium Hypochlorite; Staphylococcus aureus; Surface Properties

This study investigated the influence of contact time and concentration on bactericidal efficacy of 3 types of disinfectants (accelerated hydrogen peroxide [AHP], quaternary ammonium compounds [Quats], and sodium hypochlorite) on stainless steel surfaces using Environmental Protection Agency procedure MB-25-02. We found that bactericidal efficacy was not reduced at contact times or concentrations immediate lower than label use values, but all 3 disinfectants were significantly less bactericidal at significantly lower than label use contact times and concentrations. Overall, the bactericidal efficacy of the sodium hypochlorite disinfectant was most tolerant to the decreases of contact times and concentrations, followed closely by AHP disinfectant, and Quat disinfectant was most affected by contact time and concentration.

Topics: Ammonium Compounds; Bacteria; Cross Infection; Disinfectants; Disinfection; Dose-Response Relationship, Drug; Humans; Hydrogen Peroxide; Sodium Hypochlorite; Surface Properties; Time Factors

Topics: Blood-Borne Pathogens; Cross Infection; Decontamination; Dermatologic Surgical Procedures; Humans; Mohs Surgery; Sodium Hypochlorite

Topical antimicrobials are often employed for decolonization and infection prevention and may alter the endogenous microbiota of the skin. The objective of this study was to compare the microbial communities and levels of richness and diversity in community-dwelling subjects and intensive care unit (ICU) patients before and after the use of topical decolonization protocols. We enrolled 15 adults at risk for Staphylococcus aureus infection. Community subjects (n = 8) underwent a 5-day decolonization protocol (twice daily intranasal mupirocin and daily dilute bleach-water baths), and ICU patients (n = 7) received daily chlorhexidine baths. Swab samples were collected from 5 anatomic sites immediately before and again after decolonization. A variety of culture media and incubation environments were used to recover bacteria and fungi; isolates were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry. Overall, 174 unique organisms were recovered. Unique communities of organisms were recovered from the community-dwelling and hospitalized cohorts. In the community-dwelling cohort, microbial richness and diversity did not differ significantly between collections across time points, although the number of body sites colonized with S. aureus decreased significantly over time (P = 0.004). Within the hospitalized cohort, richness and diversity decreased over time compared to those for the enrollment sampling (from enrollment to final sampling, P = 0.01 for both richness and diversity). Topical antimicrobials reduced the burden of S. aureus while preserving other components of the skin and nasal microbiota.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Cross Infection; Female; Humans; Intensive Care Units; Male; Microbiota; Middle Aged; Mupirocin; Nose; Skin; Sodium Hypochlorite; Staphylococcal Infections; Staphylococcus aureus

The development of portable steam generators has made disinfection of the environment more practical. This study assessed the "in vitro" ability of an overheated dry-saturated steam vapour system to kill multidrug and extensively-drug resistant nosocomial pathogens, defining the antimicrobial spectrum and the contact times compared with the activity of sodium hypochlorite.. The antibacterial efficacy of the overheated dry-saturated steam vapour system and of sodium hypochlorite against nosocomial pathogen isolates: extensively drug-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, carbapenemase-producing Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, high-level aminoglycoside-resistant Enterococcus faecalis, Candida parapsilosis and Aspergillus fumigatus were assessed using a surface time-kill test carried out on glass surfaces, with or without bovine serum albumin (BSA).. The bactericidal activity of the overheated dry-saturated steam vapour system was observed at 180 °C after 5 min contact with or without BSA, using an initial inoculum of 10(9) CFU/mL. To reduce C. parapsilosis and A. fumigatus counts (from 10(7) CFU/mL), a longer contact time was necessary (7 min). In vitro tests with sodium hypochlorite at 5 % in the absence of an organic substance also resulted in an overall reduction in bacterial counts (from 10(9) CFU/mL) after 5 min of treatment. For mycotic challenge (10(7) CFU/mL), a longer contact time was necessary (7 min). In the presence of an organic substance, after 5 min, the hypochlorite reduced the viable count from 10(9) to 10(5) CFU/mL for all bacterial strains except E. faecalis that showed a reduction of 2 log units (10(9) to 10(7) CFU/mL). For C. parapsilosis and A. fumigatus, a 2 log unit reduction was observed after 7 min.. Steam disinfection of environmental surfaces using a portable steam generator is a practical and effective method that is not affected by the presence of organic matter.

Topics: Bacteria; Cross Infection; Desiccation; Disinfection; Drug Resistance, Multiple, Bacterial; Microbial Sensitivity Tests; Sodium Hypochlorite; Steam

An organic load of 5%-10% fetal calf serum significantly reduced hypochlorite and UV radiation killing of Clostridium difficile spores, but organic material collected from hospital surfaces did not affect hypochlorite and only modestly affected UV killing of spores. Hypochlorite reduced aerobic microorganisms on unclean surfaces with no wiping.

Topics: Animals; Cattle; Clostridioides difficile; Cross Infection; Disinfectants; Disinfection; Enterocolitis, Pseudomembranous; Equipment Contamination; Humans; Patients' Rooms; Serum; Sodium Hypochlorite; Spores, Bacterial; Ultraviolet Rays

Implementation of a hospital-wide program of terminal cleaning of patient rooms revolving around hydrogen peroxide vapor (HPV) technology and evaluation of its impact on endemic nosocomial Clostridium difficile-associated diarrhea (CDAD) have not been previously reported.. This was a retrospective quasiexperimental study involving a 900-bed community hospital. During the preintervention period (January 2007-November 2008), rooms vacated by patients with CDAD or on contact precautions for other targeted pathogens underwent 1 or more rounds of cleaning with bleach. During the intervention period (January-December 2009), targeted newly evacuated rooms underwent "enhanced cleaning" consisting of use of bleach followed by HPV decontamination utilizing a priority scale based on the pathogen and room location. Rooms vacated by patients with CDAD but for which HPV decontamination was not possible the same day underwent 4 rounds of cleaning with bleach instead.. During the intervention period, 1,123 HPV decontamination rounds were performed involving 96.7% of hospital rooms. Of 334 rooms vacated by patients with CDAD (May-December 2009), 180 (54%) underwent HPV decontamination. The rate of nosocomial CDAD rate dropped significantly from 0.88 cases/1,000 patient-days to 0.55 cases/1,000 patient-days (rate ratio, 0.63; 95% confidence interval: 0.50-0.79, P < .0001).. A hospital-wide program of enhanced terminal cleaning of targeted patient rooms revolving around HPV technology was practical and was associated with a significant reduction in CDAD rates.

Topics: Adult; Clostridium Infections; Cross Infection; Diarrhea; Disinfectants; Disinfection; Endemic Diseases; Hospitals, Community; Housekeeping, Hospital; Humans; Hydrogen Peroxide; Infection Control; Patients' Rooms; Retrospective Studies; Sodium Hypochlorite; Volatilization

Pathogens in healthcare settings can be transmitted via skin contact and environmental media. This study investigates bacterial contamination rate on surfaces of mechanical ventilator systems and bedside equipment. An experimental study evaluates the effectiveness of 75% alcohol in killing bacteria on surfaces.. Surface swab sampling was conducted on ventilator systems and patient bedside equipment for detection of bacterial contamination. Surfaces of ventilator systems, such as faceplates, Y-pieces, and water traps, were swab sampled at 0.5, 8, and 24 hours after initial disinfection using a solution containing 0.5% sodium hypochlorite and pasteurization. The 75% alcohol aerosol was sprayed on the surfaces of faceplates, Y-pieces, and water traps on ventilator systems at 24 hours after initial disinfection, and then bacterial levels on the surfaces were evaluated.. Detection rates of Staphylococcus aureus were measured on the handrails of mechanical ventilators (64.7%), Y-pieces of breathing circuits (86.7%), and resuscitators (60.0%). Pseudomonas aeruginosa was identified on the surfaces of Y-pieces (6.7%) and water traps (13.3%) of breathing circuits, and also on suction systems (6.7%) and resuscitators (13.3%). The positive rate for total bacterial count was clearly increased on the surfaces of faceplates, Y-pieces, and water traps at 8 hour following disinfection by 0.5% sodium hypochlorite solution and pasteurization. Concentrations of S. aureus on surfaces decreased following treatment with 75% alcohol. However, considerable P. aeruginosa growth on water trap surfaces was observed after treatment with 75% alcohol.. The surfaces of ventilator systems, including faceplates, Y-pieces, and water traps, must be disinfected frequently (at least every 8 h) to control bacterial growth. Disinfection using 75% alcohol spray with air drying effectively decreased S. aureus on ventilator system surfaces.

Topics: Alcohols; Colony Count, Microbial; Cross Infection; Disinfectants; Disinfection; Equipment Contamination; Humans; Infection Control; Outcome and Process Assessment, Health Care; Pasteurization; Pseudomonas aeruginosa; Respiratory Care Units; Sodium Hypochlorite; Staphylococcus aureus; Surface-Active Agents; Ventilators, Mechanical

Vancomycin-resistant enterococcus (VRE) colonization and infection have increased at our hospital, despite adherence to standard VRE control guidelines.. We implemented a multi-modal, hospital-wide improvement programme including a bleach-based cleaning-disinfection programme ('Bleach-Clean'). VRE colonization, infection and environmental contamination were compared pre and post implementation.. The programme included a new product (sodium hypochlorite 1000 ppm + detergent), standardized cleaning-disinfection practices, employment of cleaning supervisors, and modified protocols to rely on alcohol-based hand hygiene and sleeveless aprons instead of long-sleeved gowns and gloves. VRE was isolated using chromogenic agar and/or routine laboratory methods. Outcomes were assessed during the 6 months pre and 12 months post implementation, including proportions (per 100 patients screened) of VRE colonization in high-risk wards (HRWs: intensive care, liver transplant, renal, haematology/oncology); proportions of environmental contamination; and episodes of VRE bacteraemia throughout the entire hospital.. Significant reductions in newly recognized VRE colonizations (208/1948 patients screened vs 324/4035, a 24.8% reduction, P = 0.001) and environmental contamination (66.4% reduction, P = 0.012) were observed, but the proportion of patients colonized on admission was stable. The total burden of inpatients with VRE in the HRWs also declined (median percentage of colonized inpatients per week, 19.4% vs 17.3%, P = 0.016). Hospital-wide VRE bacteraemia declined from 14/2935 patients investigated to 5/6194 (83.1% reduction; P < 0.001), but there was no change in vancomycin-susceptible enterococcal bacteraemia (P = 0.54).. The Bleach-Clean programme was associated with marked reductions in new VRE colonizations in high-risk patients, and VRE bacteraemia across the entire hospital. These findings have important implications for VRE control in endemic healthcare settings.

Topics: Bleaching Agents; Carrier State; Cross Infection; Disinfectants; Disinfection; Enterococcus; Gram-Positive Bacterial Infections; Humans; Incidence; Sodium Hypochlorite; Vancomycin Resistance

In a study of 40 methicillin-resistant Staphylococcus aureus (MRSA) carriers, hand contamination was equally likely after contact with commonly examined skin sites and commonly touched environmental surfaces in patient rooms (40% vs 45%). These findings suggest that contaminated surfaces may be an important source of MRSA transmission.

Topics: Carrier State; Cross Infection; Disinfectants; Environmental Microbiology; Equipment Contamination; Female; Gloves, Protective; Hand; Hospitals, Veterans; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Sodium Hypochlorite; Staphylococcal Infections

This study evaluated daily cleaning with germicidal bleach wipes on wards with a high incidence of hospital-acquired Clostridium difficile infection (CDI). The intervention reduced hospital-acquired CDI incidence by 85%, from 24.2 to 3.6 cases per 10,000 patient-days, and prolonged the median time between hospital-acquired CDI cases from 8 to 80 days.

Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Disinfectants; Disinfection; Hospitals, Urban; Humans; Incidence; Minnesota; Sodium Hypochlorite

Between June 1, 2004, and March 14, 2005, 16 patients in the surgical/medical intensive care unit (ICU) were infected and another 2 were colonized with multidrug-resistant (MDR) Acinetobacter baumannii. We describe the systematic investigation initiated to discover an environmental reservoir and a novel measure taken to terminate the outbreak.. Cultures were taken from moist areas in the ICU, including sink traps, sink and counter surfaces, drains, and faucets. Strains were characterized using restriction endonuclease analysis. A weekly full drainpipe chase cleansing protocol with sodium hypochlorite (bleach) solution for all 24 ICU and waiting room area sinks connected by common plumbing was initiated in March 2005.. Eleven of 16 infected patients (69%) had a clonal MDR strain, 1 patient (6%) was infected with an unrelated strain, and in 4 patients (25%) strains were not available for typing. The reservoir for the A baumannii clone was detected in a sink trap within one of the ICU patient rooms that likely represented contamination of the entire horizontal drainage system. The bleaching protocol initiated in March 2005 successfully decontaminated the reservoir and eliminated the MDR A baumannii infections.. A systematic search for an environmental reservoir followed by decontamination significantly reduced (P < .01) the incidence of MDR A baumannii infection.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Aged; Aged, 80 and over; Bacterial Typing Techniques; Chicago; Cross Infection; Disease Outbreaks; Disinfectants; Disinfection; DNA Fingerprinting; Drug Resistance, Multiple, Bacterial; Environmental Microbiology; Female; Humans; Intensive Care Units; Male; Middle Aged; Polymorphism, Restriction Fragment Length; Sodium Hypochlorite

We were alerted to increased rates of Clostridium difficile-positive tests at all 3 hospitals in our health care system by MedMined Data Mining Surveillance Service, CareFusion (San Diego, CA). In response, an intervention of terminal room cleaning with dilute bleach was instituted to decrease the amount of C difficile environmental spore contamination from patients with C difficile infection (CDI).. The intervention consisted of replacing quaternary ammonium compound as a room cleaning agent with dilute bleach to disinfect rooms of patients with CDI upon discharge. All surfaces, floor to ceiling were wiped with dilute bleach applied with towels to thoroughly wet the surfaces. Daily room cleaning remained unchanged. Patients remained on C difficile contact isolation precautions until discharge. To determine the effectiveness of this program, rates of nosocomial CDI for all 3 hospitals were determined using the MedMined Virtual Surveillance Interface for 10 months prior to and 2 years after the cleaning intervention. Statistical significance was determined using Poisson regression analysis.. There was a 48% reduction in the prevalence density of C difficile after the bleaching intervention (95% confidence interval: 36%-58%, P < .0001).. The implementation of a thorough, all-surface terminal bleach cleaning program in the rooms of patients with CDI has made a sustained, significant impact on reducing the rate of nosocomial CDI in our health care system.

Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Disinfectants; Disinfection; Housekeeping, Hospital; Humans; Sodium Hypochlorite

Topics: Clostridioides difficile; Cross Infection; Decontamination; Disinfectants; Enterocolitis, Pseudomembranous; Humans; Hydrogen Peroxide; Patients' Rooms; Sodium Hypochlorite; Spores, Bacterial

Chlorhexidine gluconate (CHG) and povidone iodine (PI) are rarely used concurrently despite a lack of evidence regarding functional incompatibility of these agents.. CHG and PI, alone and combined, were evaluated against Staphylococcus aureus (methicillin-susceptible S aureus [MSSA] and methicillin-resistant S aureus [MRSA]), Staphylococcus epidermidis (MRSE), Acinetobacter baumannii, Pseudomonas aeruginosa, and Escherichia coli using checkerboard microbroth dilution techniques. Minimum bactericidal concentration (MBC) was the concentration (percent wt/vol) that reduced bacterial burden ≥ 5-log(10) colony-forming units/mL at 2 hours when compared with bacterial densities in growth controls. Fractional bactericidal concentration indexes (FBCIs) were calculated to determine CHG and PI compatibility. Additionally, tissue plugs from freshly excised porcine vaginal mucosa were infected with S aureus (MSSA), treated for 2 hours with CHG 3%, PI 5%, or CHG 3% and PI 5% combined and then viable bacteria on the tissue plugs enumerated.. In broth, CHG demonstrated dose-dependent bactericidal activity, whereas PI activity was all-or-none. All isolates studied were similarly susceptible to CHG (MBCs: 0.0078% ± 0.0019%, 0.0069% ± 0.0026%, 0.0024% ± 0.0005%, 0.0024% ± 0.0005%, 0.0059% ± 0.0%, and 0.0029% ± 0.0%, respectively). The MBCs of PI were identical (0.625%) for all isolates. Overall, FBCI calculations showed indifference. Treatment of MSSA-infected porcine tissue for 2 hours demonstrated that the CHG-PI combination was superior to either antiseptic alone.. FBCIs, determined in broth culture, indicate that combining CHG and PI had no negative impact on antisepsis. Moreover, data from an ex vivo porcine mucosal infection model suggest a potential benefit when combining the 2 antiseptic agents.

Topics: Administration, Topical; Animals; Anti-Infective Agents, Local; Bacteria; Cross Infection; Disease Models, Animal; Drug Therapy, Combination; Female; In Vitro Techniques; Microbial Sensitivity Tests; Microbial Viability; Mucous Membrane; Povidone-Iodine; Sodium Hypochlorite; Swine; Treatment Outcome

Prosthetic restorations that have been tried in the patient's mouth are potential sources of infection. In order to avoid cross-infection, protocols for infection control should be established in dental office and laboratory. This study evaluated the antimicrobial efficacy of disinfectants on full metal crowns contaminated with microorganisms. Full crowns cast in a Ni-Cr alloy were assigned to one control group (n=6) and 5 experimental groups (n=18). The crowns were placed in flat-bottom glass balloons and were autoclaved. A microbial suspension of each type of strain - S. aureus, P. aeruginosa, S. mutans, E. faecalis and C. albicans- was aseptically added to each experimental group, the crowns being allowed for contamination during 30 min. The contaminated specimens were placed into recipients with the chemical disinfectants (1% and 2% sodium hypochlorite and 2% glutaraldehyde) for 5, 10 and 15 min. Thereafter, the crowns were placed into tubes containing different broths and incubated at 35ºC. The control specimens were contaminated, immersed in distilled water for 20 min and cultured in Thioglycollate broth at 35ºC. Microbial growth assay was performed by qualitative visual examination after 48 h, 7 and 12 days. Microbial growth was noticed only in the control group. In the experimental groups, turbidity of the broths was not observed, regardless of the strains and immersion intervals, thus indicating absence of microbial growth. In conclusion, all chemical disinfectants were effective in preventing microbial growth onto full metal crowns.

Topics: Anti-Infective Agents; Cross Infection; Crowns; Decontamination; Dental Alloys; Dental Disinfectants; Equipment Contamination; Glutaral; Humans; Sodium Hypochlorite

Topics: Aerosols; Bacillus; Clostridioides difficile; Colony Count, Microbial; Cross Infection; Decontamination; Disinfectants; Enterocolitis, Pseudomembranous; Hospitals, University; Humans; Hydrogen Peroxide; Patients' Rooms; Sodium Hypochlorite; Spores, Bacterial; Volatilization

Vascular access in hemodialysis is a major point of concern in the management of chronic patients. Although arteriovenous fistula remains as the access of first choice, tunneled central venous catheters are still commonly used. Infection remains the principal cause of catheter dysfunction or loss. Many protocols have been used in order to prevent exit site infections and bacteremia. We describe our experience with the use of sodium hypochlorite, an electrolytic chloroxidizer used as a topical disinfectant. It has been shown to be active against a broad spectrum of potential pathogens and has other specific advantages compared to other cleansing agents, including its non-toxic, non-irritating nature and its low cost. We conclude that sodium hypochlorite solution in different concentrations (10 and 50%) is effective in preventing exit site infections and bacteremia associated with tunneled central venous catheters in chronic hemodialysis patients.

Topics: Bacteremia; Candidiasis; Catheterization, Central Venous; Catheters, Indwelling; Cross Infection; Disinfectants; Dose-Response Relationship, Drug; Equipment Contamination; Humans; Incidence; Infection Control; Kidney Failure, Chronic; Renal Dialysis; Sodium Hypochlorite

Peritoneal catheter exit-site and tunnel infections remain critical problems in patients undergoing peritoneal dialysis. Catheter-related peritonitis occurs in about 20% of patients and exit-site infections are responsible for catheter removal in more than one-fifth of the cases. For the last 2 years in the Department of Nephrology, San Bortolo Hospital, Vicenza, Italy, we have been treating exit-site infections caused by Pseudomonas with sodium hypochlorite packs as well as systemic and local antibiotic therapy. Considering the encouraging results obtained on Pseudomonas infection, we decided to utilize the same schedule for the treatment of exit-site infections caused by other germs which are generally difficult to eradicate to prevent peritonitis and catheter removal. Between 2003 and 2004, 10 patients contracted infection of the exit-site. All patients underwent a swab test because of the reddening and the purulent secretion of the exit-site. The swab resulted positive for Pseudomonas in 7 patients, Corynebacterium sp. in 2 patients, and Candida albicans in 1 patient. All patients were treated with systemic antibiotic therapy or antifungal therapy, local sodium hypochlorite 50% packs. After 15 days all patients were submitted to a swab test of the exit site. In all patients, the swab test resulted negative after 15 days and 1 month, and they could continue peritoneal dialysis. This procedure avoided peritoneal catheter removal and temporary switch to hemodialysis in all patients with exit site infection. The mechanism of action is related to the wide antimicrobial spectrum and the rapid action of sodium hypochlorite possibly creating a protective barrier on the exit-site.

Topics: Anti-Bacterial Agents; Catheters, Indwelling; Cilastatin; Cross Infection; Disinfectants; Drug Therapy, Combination; Humans; Imipenem; Infection Control; Kidney Failure, Chronic; Peritoneal Dialysis; Peritonitis; Pseudomonas Infections; Sodium Hypochlorite

An increased rate of Clostridium difficile-associated diarrhea (CDAD) was noted in 2 intensive care units of a university-affiliated tertiary care facility. One unit instituted enhanced environmental cleaning with a hypochlorite solution in all rooms, whereas the other unit used hypochlorite solution only in rooms of patients with CDAD. The CDAD rates decreased in both units.

Topics: Clostridioides difficile; Cross Infection; Diarrhea; Disinfectants; Enterocolitis, Pseudomembranous; Humans; Intensive Care Units; Sodium Hypochlorite

Topics: Bacillus cereus; Bedding and Linens; Cross Infection; Disinfection; Gram-Positive Bacterial Infections; Humans; Sodium Hypochlorite

Clostridium difficile is a health care-associated pathogen that is difficult to eradicate in the health care environment through the use of common hospital disinfectants. Many of these disinfectants fail to inactivate C difficile spores, which can result in patient-to-patient transmission. This study demonstrates that the use of 10% hypochlorite solution, along with interventions, reduced the incidence of health care-associated C. difficile infection.. A case-only study was conducted over a 24-month period. Interventions used to reduce the incidence of health care-associated C difficile included 10% hypochlorite disinfection, soap and water hand hygiene, contact isolation for suspected and confirmed cases, educational tool for patients and visitors, daily isolation rounds, automated report functions, and standardized nursing unit isolation processes. The microbiology method that was used to isolate the C difficile organism for DNA typing included a minimum of 1 mL of stool placed in a conical screw top tube, and then an equal volume of 95% ethyl alcohol was added to the tube. Prereduced blood agar plates were inoculated with the treated and untreated specimen. Plates were incubated anaerobically for 48 hours at 37 degrees C. Plates were examined for gray, flat colonies and gram stains performed; further testing was performed only on gram-positive rods.. A 66% reduction in the number of health care-associated C difficile cases was achieved during the study. A total of 25 isolates was DNA typed per pulse-field gel electrophoresis. Two distinct genetic patterns were identified. Results yielded that the Florida isolates also had the epidemic strain of the organisms that was noted in Quebec, Canada and other parts of the United States.. A combination of automated daily isolation reports, use of a standardized methodology for isolation rounds, as well as development of a 10% hypochlorite disinfection protocol resulted in a dramatic decrease in health care-associated C difficile cases. Weekly nursing director reports and daily rounds by nursing leadership keep the direct line supervisors abreast of infection control issues on their respective nursing units. The addition of the dual-chamber bleach container ensured that the proper dilution was achieved when disinfecting reusable equipment.

Topics: Clostridioides difficile; Clostridium Infections; Cohort Studies; Cross Infection; Data Collection; Disinfectants; Dysentery; Florida; Humans; Infection Control; Nursing Care; Patient Isolation; Sodium Hypochlorite; Universal Precautions

Contaminated environmental surfaces may play an important role in transmission of some healthcare-associated pathogens. In this study, we assessed the adequacy of cleaning practices in rooms of patients with Clostridium difficile-associated diarrhea (CDAD) and vancomycin-resistant Enterococcus (VRE) colonization or infection and examined whether an intervention would result in improved decontamination of surfaces.. During a 6-week period, we cultured commonly touched surfaces (i.e. bedrails, telephones, call buttons, door knobs, toilet seats, and bedside tables) in rooms of patients with CDAD and VRE colonization or infection before and after housekeeping cleaning, and again after disinfection with 10% bleach performed by the research staff. After the housekeeping staff received education and feedback, additional cultures were collected before and after housekeeping cleaning during a 10-week follow-up period.. Of the 17 rooms of patients with VRE colonization or infection, 16 (94%) had one or more positive environmental cultures before cleaning versus 12 (71%) after housekeeping cleaning (p = 0.125), whereas none had positive cultures after bleach disinfection by the research staff (p < 0.001). Of the 9 rooms of patients with CDAD, 100% had positive cultures prior to cleaning versus 7 (78%) after housekeeping cleaning (p = 0.50), whereas only 1 (11%) had positive cultures after bleach disinfection by research staff (p = 0.031). After an educational intervention, rates of environmental contamination after housekeeping cleaning were significantly reduced.. Our findings provide additional evidence that simple educational interventions directed at housekeeping staff can result in improved decontamination of environmental surfaces. Such interventions should include efforts to monitor cleaning and disinfection practices and provide feedback to the housekeeping staff.

Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Disinfection; Education; Enterococcus; Equipment Contamination; Fomites; Gram-Positive Bacterial Infections; Hospitals, Veterans; Housekeeping, Hospital; Humans; Infection Control; Patients' Rooms; Sodium Hypochlorite; Vancomycin Resistance

It is believed that surface-dried viruses can remain infectious and may therefore pose a threat to public health. To help address this issue, we studied 0.1 N NaOH and 0.1% hypochlorite for their capacity to inactivate surface-dried lipid-enveloped (LE) [human immunodeficiency virus (HIV), bovine viral diarrhoea virus (BVDV) and pseudorabies virus (PRV)] and non-lipid-enveloped [NLE; canine parvovirus (CPV) and hepatitis A virus (HAV)] viruses in a background of either plasma or culture medium. In addition, 80% ethanol was tested on surface-dried LE viruses. Without treatment, surface-dried LE viruses remained infectious for at least one week and NLE viruses for more than one month. Irrespective of the disinfectant, inactivation decreased for viruses dried in plasma, which is more representative of viral contaminated blood than virus in culture medium. Inactivation by all disinfectants improved when preceded by rehydration, although the infectivity of CPV actually increased after rehydration and disinfection may thus be overestimated in the absence of rehydration. This is the first comprehensive study of five important (model) viruses in a surface-dried state showing persistence of infectivity, resistance to three commonly used disinfectants and restoration of susceptibility after rehydration. Our results may have implications for hygiene measurements in the prevention of virus transmission.

Topics: Cross Infection; Disinfectants; Disinfection; DNA Viruses; Humans; RNA Viruses; Sodium Hydroxide; Sodium Hypochlorite; Virus Inactivation

To compare the effects of hospital cleaning agents and germicides on the survival of epidemic Clostridium difficile strains.. We compared the activity of and effects of exposure to 5 cleaning agents and/or germicides (3 containing chlorine, 1 containing only detergent, and 1 containing hydrogen peroxide) on vegetative and spore forms of epidemic and non-epidemic C. difficile strains (3 of each). We carried out in vitro exposure experiments using a human fecal emulsion to mimic conditions found in situ.. Cleaning agent and germicide exposure experiments yielded very different results for C. difficile vegetative cells, compared with those for spores. Working-strength concentrations of all of the agents inhibited the growth of C. difficile in culture. However, when used at recommended working concentrations, only chlorine-based germicides were able to inactivate C. difficile spores. C. difficile epidemic strains had a greater sporulation rate than nonepidemic strains. The mean sporulation rate, expressed as the proportion of a cell population that is in spore form, was 13% for all strains not exposed to any cleaning agent or germicide, and it was significantly increased by exposure to cleaning agents or germicides containing detergent alone (34%), a combination of detergent and hypochlorite (24%), or hydrogen peroxide (33%). By contrast, the mean sporulation rate did not change substantially after exposure to germicides containing either a combination of detergent and dichloroisocyanurate (9%) or dichloroisocyanurate alone (15%).. These results highlight differences in the activity of cleaning agents and germicides against C. difficile spores and the potential for some of these products to promote sporulation.

Topics: Anti-Bacterial Agents; Clostridioides difficile; Cross Infection; Detergents; Humans; Hydrogen Peroxide; Microbial Sensitivity Tests; Sodium Hypochlorite; Spores, Bacterial

To assess the response to the action of different antiseptics and disinfectants usually used in Argentinian hospitals of hospital staphylococci sensitive and resistant to methicillin. To test the effectiveness of the biocides by measuring their effective bactericidal concentrations, and to determine whether there is any correlation between biocide resistance and methicillin resistance in this bacterial population.. The action of seven biocides was tested against 25 strains of nosocomial Staphylococcus spp. sensitive and resistant to methicillin, and in Staphylococcus aureus ATCC 6538. Hospital strains were obtained from April, 2000 to May, 2002, from clinical samples (blood culture, urine culture, catheter tip or abscess) from male and female inpatients and outpatients at two tertiary hospitals. After isolation, antibiotic sensitivity was tested with the agar diffusion method of Kirby and Bauer. The action of hospital biocides on the strains was studied with the Kelsey-Sykes test, which establishes the effective bactericide concentrations of these compounds.. The results showed that the response of strains sensitive and resistant to methicillin varied in comparison to the collection strain. Chlorhexidine digluconate, povidone iodine, weak tincture of iodine and alkaline glutaraldehyde were effective against most strains, regardless of whether they were sensitive or resistant to methicillin.. We found no indication of a relationship between resistance to methicillin and resistance to biocides. Our study shows that further research is needed to evaluate the efficacy of chemical agents against microorganisms that have been exposed to antibiotic therapies.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Argentina; Benzalkonium Compounds; Child; Chlorhexidine; Cross Infection; Disinfectants; Female; Glutaral; Humans; Iodine Compounds; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Povidone-Iodine; Sodium Hypochlorite; Staphylococcal Infections; Staphylococcus; Xylenes

The effect of widely used antiseptics and disinfectants on some hospital isolates of gram-negative bacteria was assessed by the quantitative suspension test Chlorhexidine gluconate (4%), savlon (1:100), and 5.25% sodium hypochlorite were tested. Savlon and chlorhexidine gluconate were effective at in-use concentrations and sodium hypochlorite was effective at 1:50 dilution.

Topics: Anti-Infective Agents, Local; Cetrimonium Compounds; Chlorhexidine; Cross Infection; Disinfectants; Drug Combinations; Gram-Negative Bacteria; Hand Disinfection; Humans; Microbial Sensitivity Tests; Sodium Hypochlorite

Topics: Bedding and Linens; Cross Infection; Decontamination; Disinfectants; Equipment Contamination; Humans; Hydrogen Peroxide; Laundry Service, Hospital; Sodium Hypochlorite; Temperature; United States

Despite the fact that the ADA had set the goal of less than 200 colony-forming units per milliliter of unfiltered output water from dental unit waterlines to be achieved voluntarily by the year 2000, there is much confusion and resistance within the profession with regard to waterlines. Many in the profession are still wondering what the most effective means are to predictably achieve the goal. It is a well-established fact that bacterial biofilm can readily form within dental unit waterlines and degrade the microbial quality of the water in dental units regardless of the water source. These biofilms are primarily formed by various microcolonies of bacteria that attach to surfaces over time within the waterlines. An increasing number of medically compromised and immunocompromised patients being treated in dental offices and increased public awareness have brought about renewed interest in this issue. There are generally four categories of products that are available to address this issue: independent water systems, sterile water delivery systems, filtration, and chemical treatment protocols. A recent study at the University of California at Los Angeles demonstrates that the Ultra chemical treatment protocol can be an effective means of controlling biofilm in dental unit waterlines.

Topics: Alkalies; Bacterial Adhesion; Biofilms; Cross Infection; Dental Equipment; Disinfectants; Disinfection; Equipment Contamination; Equipment Design; Filtration; Humans; Immunocompromised Host; Infection Control, Dental; Oxidants; Peroxides; Sodium Hypochlorite; Water Microbiology

Transmission of microbial pathogens to patients from biofilm within dental unit waterlines, or DUWLs, is a concern. To reduce the risk of toxicity to dental patients when water coolants are used, numerous chemical agents have been tested. In a series of trials, the authors investigated the recurrence of microbial growth after treating DUWLs with sodium hypochlorite (bleach), or B; glutaraldehyde, or G; or isopropanol 15.3 percent, or I.. The authors excised tubing sections from dental units in a general clinic. The tubing sections were evaluated at baseline and after overnight treatment. Effluent water samples and biofilm samples from tubing sections also were evaluated, by culture, at baseline and after treatment with the chemical agents. Biofilm within the tubing was examined by scanning electron microscopy, or SEM, and the authors identified bacterial isolates using standard techniques. The authors performed minimum inhibitory concentration tests on identified isolates pre- and posttreatment and compared the results to determine possible differences in resistance.. In baseline evaluations, the authors determined that the effluent and biofilm matrix harbored an average of 1 x 10(5) colony-forming units, or CFU, per square centimeter and 1 x 10(4) CFU/cm2 recoverable microorganisms, respectively. A single overnight treatment of the DUWLs with B, G or I rendered effluent and biofilm samples that were free of recoverable bacteria. The number of viable bacteria in the effluent and the biofilm of B- or I-treated DUWLs returned to pretreatment levels by day six and day 15, respectively. DUWLs treated with G showed evidence of bacterial recurrence in the effluent and the biofilm to pretreatment levels by day three. The authors compared recurrence of biofilm and effluent posttreatment with untreated control tubing. The lower recurrence of viable bacteria in both biofilm and effluent samples for tubing treated with B and I was significant (P < or = .05). No evidence of resistance to the agents was noted during the study. Multiple treatments held the bacterial population to below recoverable levels but failed to remove the biofilm matrix, as evidenced by SEM.. B, G and I eliminated recoverable bacteria after treatment and inhibited their recurrence in DUWL. Recolonization rates varied by agent.. The residual effect of these agents raises concerns about the slow release of potentially toxic substances from the residual biofilm matrix. These agents reduce microorganisms in effluent water but do little to destroy the biofilm matrix in the DUWL, even with periodic treatments. Bacterial populations in the dental unit water rapidly recolonize the DUWL. Chemical agents or agents that potentially could be trapped in the matrix can represent an additional risk to the patient.

Topics: 2-Propanol; Anti-Bacterial Agents; Bacteria; Biofilms; Colony Count, Microbial; Cross Infection; Dental Equipment; Disinfectants; Disinfection; Drug Resistance, Microbial; Equipment Contamination; Glutaral; Humans; Intubation; Microscopy, Electron, Scanning; Risk Factors; Sodium Hypochlorite; Surface Properties; Water Microbiology

Effect of sodium hypochlorite disinfection of impressions on the size and quality of plaster models is studied. Twenty-minute submerging of silicone impressions in 0.5% sodium hypochlorite solution did not change their size and did not deteriorate the quality of surface and hardness of plaster models. Stomalgin impressions cannot be disinfected by sodium hypochlorite solution because of expressed destructive effect of this disinfectant on the impressions.

Topics: Alginates; Cross Infection; Dental Disinfectants; Dental Impression Materials; Disinfection; Drug Interactions; Hardness; Humans; Silicone Elastomers; Sodium Hypochlorite

Opportunistic infections caused by gram-negative rods (GNR), conventionally regarded as organisms with low or no pathogenicity, and intractable infections caused by various resistant organisms pose a great problem now. In view of this, we determined the bactericidal effects of 5 commonly used disinfectants using as the test strains Xanthomonas maltophilia and Serratia marcescens, chosen among other GNR since they often cause nosocomial infections. Regarding the bactericidal activities against X. maltophilia and S. marcescens, both sensitive strains and resistant strains were killed within 20 s of exposure to povidone-iodine and sodium hypochlorite. With chlorhexidine, 1 strain each of both species was not killed within 10 min of exposure at a concentration of 0.2%. Both sensitive strains and resistant strains of X. maltophilia were killed within 20 s of exposure to benzalkonium at 0.02%, while a concentration of 0.1% was required for benzalkonium to kill S. marcescens within 20 s. With Tego-51, both sensitive strains and resistant strains of X. maltophilia were killed within 20 s at 0.02%, while 1 strain of S. marcescens was not killed within 20 s at a concentration of 0.1%. In the use of disinfectants, comparative bactericidal effects of various disinfectants against clinical isolates should be taken into consideration.

Topics: Anti-Infective Agents, Local; Benzalkonium Compounds; Chlorhexidine; Cross Infection; Disinfectants; Drug Resistance, Microbial; Glycine; Gram-Negative Bacterial Infections; Humans; Iodophors; Opportunistic Infections; Povidone-Iodine; Serratia Infections; Serratia marcescens; Sodium Hypochlorite; Time Factors; Xanthomonas

Six strains each of Enterococcus faecium and E. faecalis were investigated with respect to their resistance to heat and sodium hypochlorite. All enterococci survived the temperatures and holding times specified by the Department of Health (DoH) for the disinfection of 'foul and used' or 'infected' linen (65 degrees C for 10 min or 71 degrees C for 3 min). In addition, three strains (one E. faecium and two E. faecalis) could withstand 150 ppm available chlorine for 5 min, the treatment suggested by the DoH for the disinfection of heat labile materials. Further, our results showed that four strains of E. faecium were able to survive the British Standard for heat disinfection of bedpans (80 degrees C for 1 min). The significance of these findings with particular reference to the potential for enterococci to survive and disseminate in the hospital environment is discussed.

Topics: Cross Infection; Disinfectants; Disinfection; Enterococcus faecalis; Enterococcus faecium; Gram-Positive Bacterial Infections; Hot Temperature; Humans; Sodium Hypochlorite; Species Specificity

Topics: Antiviral Agents; Body Fluids; Cross Infection; Disinfectants; Disinfection; Humans; Infection Control; Sodium Hypochlorite

The standard procedures of decontamination between two patients were studied. As standards were chosen the OSHA's standards (Organization for Safety and Health Administration). The study was conducted by means of a "time and motion" analysis. The most important conclusions reached were: 1) it's impossible to complete the whole sequence in less than 10-15 minutes; 2) within this period one assistant didn't have any time to help the doctor at the chair; 3) consequently the doctor has to work alone for 10-15 minutes, unless a second assistant had been employed; 4) consequently, when we try to improve the decontamination, we need another assistant to make the work smoother, with a rise of the costs; 5) the systematic usage of the so called "barriers" is extremely time-wasting; 6) the only way to reduce the decontamination-time is the use of automatic devices, as the "Autosteril".

Topics: Cross Infection; Decontamination; Dental Equipment; Dental Offices; Disinfection; Equipment Contamination; Sodium Hypochlorite; Sterilization; Time and Motion Studies; United States; United States Occupational Safety and Health Administration

Topics: Attitude of Health Personnel; Bacteria; Bacteriological Techniques; Bedding and Linens; Borates; Burns; Consumer Behavior; Cross Infection; Fires; Gossypium; Humans; Hydrogen Peroxide; Hydrogen-Ion Concentration; Laundering; Nylons; Polymers; Skin Diseases; Skin Tests; Sodium; Sodium Hypochlorite; Textiles