Ability of cleaning-disinfecting wipes to remove bacteria from medical device surfaces

Surface Cleaning with a Microfiber Cloth and Water followed by Ultraviolet-C Light Exposure Achieves Non-Inferior Disinfection of a Pathogenic Staphylococcus aureus Strain versus Use of Germicidal Wipes

BACKGROUND

We hypothesized that ultraviolet-C (UV-C) irradiation (Surfacide, Waukesha, WI) following use of microfiber cloths (Sanny Shop LLC, Longmont, CO) soaked in water would be noninferior to surface disinfection wipes containing a quaternary ammonium compound and alcohol (PDI Healthcare, Woodcliff Lake, NJ) for the pathogenic Staphylococcus aureus (S. aureus) sequence type 5 (ST5).

METHODS

This was a randomized laboratory study of disinfection approaches for S. aureus ST5. A total of 270 polycarbonate slides loaded with ST5 were prepared for the standard surface disinfection group (N=18) and water-soaked microfiber cloths and UV-C treatment group (N=144), along with positive and negative microbiological controls.

RESULTS

All 18 samples of S. aureus ST5 bacteria treated with standard chemical wipes showed complete disinfection (colony forming units (CFU) = 0). All 144 treatments with water-soaked microfiber wipes followed by UV-C exposure showed complete disinfection (CFU =0) regardless of soiling, height from the floor, or orientation to the emitters. The upper 95% exact one-sided confidence limit for any CFU >0 was 2.1%.

DISCUSSION

These data affirm our hypothesis that surface wiping with a damp cloth followed by triangular UV-C irradiation delivery is noninferior to surface disinfection for S. aureus ST5 using germicidal wipes, even when UV-C is compromised by height from the floor and orientation to the emitters and surface disinfection is targeted.

CONCLUSION

Removing bioburden with chemical-free microfiber cloths followed by triangular UV-C delivery is a noninferior strategy to targeted surface disinfection with chemical disinfecting wipes for the pathogenic S. aureus ST5 strain in the laboratory setting.

Disinfection, sterilization and antisepsis: An overview

BACKGROUND

Each year in the United States there are approximately 100,000,000 outpatient/inpatient surgical procedures. Each of these procedures involves contact by a medical device or surgical instrument with a patient's sterile tissue and/or mucous membrane. A major risk of all such procedures is the introduction of infection.

METHODS

We searched published literature for articles on the use and effectiveness of disinfectants, sterilization methods and antiseptics.

RESULTS

The level of disinfection is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Antiseptics are essential to infection prevention as part of a hand hygiene program as well as other uses such as surgical hand antisepsis and pre-operative patient skin preparation.

CONCLUSIONS

When properly used, disinfection and sterilization can ensure the safe use of invasive and non-invasive medical devices. Cleaning should always precede high-level disinfection and sterilization. Strict adherence to current disinfection and sterilization guidelines is essential to prevent patient infections and exposures to infectious agents.

A review of wipes used to disinfect hard surfaces in health care facilities

BACKGROUND

Despite a plethora of wipes available for use in health care facilities, there is a paucity of articles describing wipe composition, potential interactions between wipes and disinfectants, the manner in which wipes are used, and their relative efficacy. The purpose of this article is to provide an in-depth review of wipes used for disinfection of hard surfaces in health care settings.

METHODS

Comprehensive searches of the Pubmed database and Internet were conducted, and articles published from 1953 through September 2019 and pertinent on-line documents were reviewed. Bibliographies of relevant articles were reviewed.

RESULTS

Wipes vary considerably in their composition, and the disinfectants with which they are used. With reusable dry wipes, the ratio of wipe material to disinfectant and the amount of disinfectant absorbed by the wipe and delivered to surfaces is difficult to standardize, which may affect their efficacy. The manner in which wipes are used by health care personnel is highly variable, due in part to insufficient instructions for use and inadequate education of relevant personnel.

CONCLUSIONS

Additional research is needed regarding the best practices for using different types of wipes, improved methods for educating staff, and establishing the relative efficacy of wipes in reducing environmental contamination and health care-associated infections.

Disinfectant wipes transfer Clostridioides difficile spores from contaminated surfaces to uncontaminated surfaces during the disinfection process

BACKGROUND

Pre-wetted disinfectant wipes are increasingly being used in healthcare facilities to help address the risk of healthcare associated infections (HAIs). However, HAIs are still a major problem in the US with Clostridioides difficile being the most common cause, leading to approximately 12,800 deaths annually in the US. An underexplored risk when using disinfectant wipes is that they may cross-contaminate uncontaminated surfaces during the wiping process. The objective of this study was to determine the cross-contamination risk that pre-wetted disinfectant towelettes may pose when challenged with C. difficile spores. We hypothesized that although the tested disinfectant wipes had no sporicidal claims, they will reduce spore loads. We also hypothesized that hydrogen peroxide disinfectant towelettes would present a lower cross-contamination risk than quaternary ammonium products.

METHODS

We evaluated the risk of cross-contamination when disinfectant wipes are challenged with C. difficile ATCC 43598 spores on Formica surfaces. A disinfectant wipe was used to wipe a Formica sheet inoculated with C. difficile. After the wiping process, we determined log10 CFU on previously uncontaminated pre-determined distances from the inoculation point and on the used wipes.

RESULTS

We found that the disinfectant wipes transferred C. difficile spores from inoculated surfaces to previously uncontaminated surfaces. We also found that wipes physically removed C. difficile spores and that hydrogen peroxide disinfectants were more sporicidal than the quaternary ammonium disinfectants.

CONCLUSION

Regardless of the product type, all disinfectant wipes had some sporicidal effect but transferred C. difficile spores from contaminated to otherwise previously uncontaminated surfaces. Disinfectant wipes retain C. difficile spores during and after the wiping process.

From one species to another: A review on the interaction between chemistry and microbiology in relation to cleaning in the built environment

Since the advent of soap, personal hygiene practices have revolved around removal, sterilization, and disinfection-both of visible soil and microscopic organisms-for a myriad of cultural, aesthetic, or health-related reasons. Cleaning methods and products vary widely in their recommended use, effectiveness, risk to users or building occupants, environmental sustainability, and ecological impact. Advancements in science and technology have facilitated in-depth analyses of the indoor microbiome, and studies in this field suggest that the traditional "scorched-earth cleaning" mentality-that surfaces must be completely sterilized and prevent microbial establishment-may contribute to long-term human health consequences. Moreover, the materials, products, activities, and microbial communities indoors all contribute to, or remove, chemical species to the indoor environment. This review examines the effects of cleaning with respect to the interaction of chemistry, indoor microbiology, and human health.

Chemical, Thermo-Mechanical and Antimicrobial Properties of DBD Plasma Treated Disinfectant-Impregnated Wipes during Storage

Disinfectant-impregnated wipes are broadly used in hospitals, as an important approach for infection prevention and control. But their ageing performance has rarely been studied. Untreated and Dielectric Barrier Discharge (DBD) plasma pre-treated wiping materials made of nonwoven 100% polyester (W1), nonwoven 55% cellulose/45% polyester (W2) and woven cotton (W3) were impregnated with a quaternary ammonium compound solution (ADBAC) for 30 min, 3, 7, 15, and 30 days of storage time and characterized in term of chemical, thermo-mechanical and antimicrobial efficacy. X-ray photoelectron spectroscopy analysis on the plasma-treated polyester wipes demonstrates the incorporation of reactive oxygen species on the fiber surface. Laser scanning microscopy demonstrates the plasma etching effect in smoothing the surface of the cotton wipe reducing the adsorption of ADBAC. The result showed no significant changes in breaking force and elongation during storage for W1 and W2. However, plasma treatment affects W3 in weft direction reducing the force at break in water and ADBAC treated wipes. Dynamic mechanical analysis results show that ADBAC and plasma treatment have a significant influence in W1 and W3 viscoelastic properties improving the elastic response limiting the polymeric chains mobility and the non-elastic response due to the etching effect, respectively. Overall, the plasma pre-treatment of ADBAC-impregnated wipes is able to enhance the antimicrobial performance and the storage time of polyester-containing wipes.

Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: A bundle approach

Over the past decade, there is excellent evidence in the scientific literature that contaminated environmental surfaces and noncritical patient care items play an important role in the transmission of several key health care-associated pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter, norovirus, and Clostridium difficile. Thus, surface disinfection of noncritical environmental surfaces and medical devices is one of the infection prevention strategies to prevent pathogen transmission. This article will discuss a bundle approach to facilitate effective surface cleaning and disinfection in health care facilities. A bundle is a set of evidence-based practices, generally 3-5, that when performed collectively and reliably have been proven to improve patient outcomes. This bundle has 5 components and the science associated with each component will be addressed. These components are: creating evidence-based policies and procedures; selection of appropriate cleaning and disinfecting products; educating staff to include environmental services, patient equipment, and nursing; monitoring compliance (eg, thoroughness of cleaning, product use) with feedback (ie, just in time coaching); and implementing a "no touch" room decontamination technology and to ensure compliance for patients on contact and enteric precautions. This article will also discuss new technologies (eg, continuous room decontamination technology) that may enhance our infection prevention strategies in the future.

Chemical disinfectants: Controversies regarding their use in low risk healthcare environments (part 1)

In recent years, the number of disinfectants designed to decontaminate healthcare environments and reusable, non-invasive care equipment (NICE) has increased markedly, making the selection of the most appropriate disinfectant a somewhat daunting prospect. In addition to the microbial challenge, there are numerous factors to consider including: efficacy; range and speed of activity; stability of the ingredients; compatibility of the disinfectant with surfaces; inactivation of the disinfectant by organic matter; method of application; convenience; health and safety concerns; and cost. While the microbial challenge continues to evolve, and novel disinfectants continue to emerge, guidance updates have been notably absent. Most healthcare surfaces belong to a UK-defined category of 'low risk' for which guidance dictates 'cleaning and drying is usually sufficient'. This paper assesses the evidence and arguments regarding the use of disinfectants for low-risk healthcare surfaces. A novel subcategorisation of 'low risk' is presented to provide a more specific up-to-date disinfectant needs assessment.

Do we know how best to disinfect child care sites in the United States? A review of available disinfectant efficacy data and health risks of the major disinfectant classes

BACKGROUND

Children in child care settings have a high infectious burden. They are frequently exposed to sanitizing and disinfecting agents, whose toxicities have not been studied in these settings. Current guidance on the preferred disinfection agents for child care is vague.

METHODS

This article combines 2 different sources of information: the Environmental Protection Agency registration data on the efficacy of hospital-grade disinfectants and a review of the research on the toxicities of the most common of these disinfectants to summarize information that could be used for more evidence-based early care and education disinfection regulations and guidelines.

RESULTS

Coverage of these organisms varied both between disinfectant classes (defined by active ingredient), as well as within classes. The 3 most common active ingredients in the database-quaternary ammonias, bleaches, and hydrogen peroxides-had 251, 63, and 31 products, respectively. Quaternary ammonias and bleaches are both known asthmagens, with the potential for toxic gas release when mixed. Quaternary ammonias may also cause reproductive toxicity. Disinfectant-grade peroxides have relatively low inhalational toxicity.

CONCLUSIONS

A clear rationale is needed to establish policies for determining preferable disinfection products for use in child care settings, based on efficacy against relevant pathogens, toxicity, ease of use, and cost. When other factors are equal, the use of peroxide-based disinfectant products is recommended to minimize inhalational toxicity.

Surface area wiped, product type, and target strain impact bactericidal efficacy of ready-to-use disinfectant Towelettes

Background

Disinfectant products are often used on environmental surfaces (e.g. countertops, patient beds) and patient care equipment in healthcare facilities to help prevent the transmission of healthcare-associated infections. Ready-to-use (RTU) disinfectants in the form of pre-wetted towelettes are increasingly popular among healthcare facilities. Currently, the EPA does not require disinfectant manufacturers to include a recommended maximum surface area per towelette on their product labels. The objective of this study was to investigate the efficacy of disinfectant towelette products on a hard non-porous surface across different coverage areas using a quantitative EPA method. We hypothesized that there would be significant differences in the efficacy of disinfectant towelette products, and that the greater surface area(s) wiped would result in reduced bactericidal efficacy.

Methods

This study tested ten disinfectant towelette products against Staphylococcus aureus strain ATCC CRM-6538 and Pseudomonas aeruginosa strain ATCC 15442 on Formica surfaces. Defined surface areas were wiped and the towelette weighed before and after wiping to determine the amount of liquid released. Bactericidal efficacy testing was also performed after wiping following standard EPA protocols.

Results

We found that disinfectant product, area of surface wiped, and strain impacted the bactericidal efficacy achieved. Disinfectant product type and area of surface wiped significantly impacted the percent of liquid released per ft²from the towelette.

Conclusion

Overall, bactericidal efficacy varied by towelette product, surface area wiped, and strain. This study also found that wiping larger surface areas may lead to decreased bactericidal efficacy. Further research is needed to test its implication.

New Biocide Foam Containing Hydrogen Peroxide for the Decontamination of Vertical Surface Contaminated With Bacillus thuringiensis Spores

Despite scientific advances, bacterial spores remain a major preoccupation in many different fields, such as the hospital, food, and CBRN-E Defense sector. Although many disinfectant technologies exist, there is a lack for the decontamination of difficult to access areas, outdoor sites, or large interior volumes. This study evaluates the decontamination efficiency of an aqueous foam containing hydrogen peroxide, with the efficiency of disinfectant in the liquid form on vertical surfaces contaminated by Bacillus thurengiensis spores. The decontamination efficiency impact of the surfactant and stabilizer agents in the foam and liquid forms was evaluated. No interferences were observed with these two chemical additives. Our results indicate that the decontamination kinetics of both foam and liquid forms are similar. In addition, while the foam form was as efficient as the liquid solution at 4°C, it was even more so at 30°C. The foam decontamination reaction follows the Arrhenius law, which enables the decontamination kinetic to be predicted with the temperature. Moreover, the foam process used via spraying or filling is more attractive due to the generation of lower quantity of liquid effluents. Our findings highlight the greater suitability of foam to decontaminate difficult to access and high volume facilities compared to liquid solutions.

An effective intervention to improve the cleanliness of medical lead clothes in an orthopedic specialized hospital

Dirty medical lead clothes, contaminated with blood or other infected material, may carry ongoing bioburden, which increase the risk of hospital-acquired infection. In this study, we investigated medical lead clothes contamination levels and assessed the effectiveness of the intervention that was constructed to improve the cleanliness of lead clothes.