Efficacy of chlorine dioxide disinfection to non-fermentative Gram-negative bacilli and non-tuberculous mycobacteria in a hospital water system

A Titration Method for Standardization of Aqueous Sodium Chlorite Solutions Using Thiourea Dioxide

Accurate and cost-effective methods for the analysis of oxychlorine compounds in water are critical to modern chlorine-based water treatment. With alternatives to elemental chlorine and hypochlorite bleaches growing in popularity, simple quantification methods for the disinfectant chlorine dioxide (ClO2) in water, as well as chlorite (ClO2-) and chlorate (ClO3-), which are commonly used precursors in ClO2 generation, are required. However, currently, regulated standard methods require specialized equipment and do not effectively discriminate between molecular and ionic species. In this contribution, we present a simple titration-based method for chlorite determination in water using commercially available and easy-to-handle reagents. Specifically, chlorite is reduced with a slight excess of thioureadioxide (TUD). The remaining reductant is then back-titrated against a known amount of potassium permanganate, affording calculatable chlorite concentrations through measured consumption of a reductant and a clear visual endpoint upon accumulation of excess KMnO4. Straightforward methods for chlorite standardization with reasonable error and accuracy for field and/or lab application have the potential to greatly enhance quality assurance and therefore assist in resource deployment in water treatment.

Single-Center Experience of Control of Ventilator-Circuit-Transmitted Burkholderia cepacia Outbreak in an Intensive Care Unit

Burkholderia cepacia is an emerging nosocomial pathogen frequently associated with outbreaks, but the exact transmission route of this pathogen can at times be elusive in spite of extensive environmental investigative cultures. Active surveillance for sputum cultures was performed for all patients from September 2008 to September 2009 in an intensive care unit (ICU) with B. cepacia outbreak. With evidence of persistent positive conversion of sputum cultures (colonization) and infections among patients, discontinuing re-usable ventilator circuits was introduced. A total of 689 patients were admitted to this unit for a mean duration of 8.7 ± 7.5 days. There were 489 patients (71.0%) with a stay for one to ten days; 161 (23.4%) patients for 11 to 20 days; and 39 (5.7%) with over 20 days. In the first group, 13.5% of patients had cultures converting from negative to positive, in contrast to 66.7% in the last group (p < 0.01). With intervention of using disposable ventilator circuits since June 2009, the incidence of isolated B. cepacia decreased gradually. The estimated 30-day isolation-free probabilities of the groups before, during, one month (August 2009) after, and two months (September 2009) after this intervention were 38.5%, 47.3%, 66.5%, and 96.0%, respectively (p < 0.01). Furthermore, the effect of discontinuing reusable ventilator circuit persisted in the following 6 years; both total isolates of B. cepacia and the infection caused by it were much lower compared to the outbreak period. In summary, this six-year outbreak in a medical ICU persisted until reusable ventilator circuits were discontinued in 2009. The effect of disposable circuits on the decreased incidence of B. cepacia infection maintained in the following years.

The Bactericidal Effect of MA-T for Factitiously Contaminated and Used Masks

Matching transformation system (MA-T), an on-demand aqueous chlorine dioxide solution, is an excellent safety disinfectant, because chlorine dioxide is not detected during storage or before use. The production of chlorine dioxide in MA-T is induced by a catalytic reaction in the presence of target microorganisms. In this study, we investigated MA-T disinfection of masks as a reuse method to eliminate mask shortages. After spraying Escherichia coli on sterilized surgical mask, samples (factitiously contaminated masks) were treated with MA-T spraying or immersion, and the bactericidal efficacy was assessed by culturing. Used surgical masks were also sprayed with MA-T or were immersed in MA-T, and then were cultured to verify the bactericidal effect. The performance of N95 masks was assessed before and after application of MA-T. After spraying with MA-T, the numbers of bacteria of factitiously contaminated masks and used masks were drastically reduced compared with control samples (not applicable and p = 0.002, respectively). After MA-T immersion, the bacterial counts of both masks (factitiously contaminated masks and used masks) were significantly reduced (both p = 0.002). Taken together, the disinfection test on factitiously contaminated with E. coli and used surgical masks showed that masks can be disinfected by MA-T spray and sterilized by immersion, respectively. The N95 mask performance test after 30 min of immersion in MA-T showed that MA-T disinfected the mask without degrading the performance of the mask. In conclusion, MA-T is useful for the reuse of masks because of its decontamination effect and safety while maintaining the function of the mask.

Disinfectants In Interventional Practices

PURPOSE OF REVIEW

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.

RECENT FINDINGS

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.

Chlorine dioxide-loaded poly(acrylic acid) gels for prolonged antimicrobial effect

Chlorine dioxide, the so-called "ideal biocide", can be successfully applied as an antiseptic agent based on its rapid and safe antimicrobial property. One of the significant limitations of its topical or oral use is that the chlorine dioxide residence time in aqueous solution is very short due to the volatility of the gas. Therefore, the primary purpose of the present study was to increase the duration of chlorine dioxide effect by creating a system capable of loading the gas for a prolonged time and gradually releasing it at the site of action. Poly(acrylic acid) gels of various chlorine dioxide and polymer concentrations were formulated to achieve this goal. A two-factor, three-level face-centred central composite design was applied for the formulation. The microstructure of the gels was tracked by positron annihilation lifetime spectroscopy based on the ortho-positronium (o-Ps) lifetime distributions with the residual chlorine concentrations, determined by iodometric titration and their antibacterial effects. The results indicate that the polymer possesses two functions. On the one hand, as a diffusion barrier inhibits the fugacity of the gaseous chlorine dioxide but on the other side, the polymer chains form an arranged supramolecular structure with the hydrated forms of chlorine dioxide thus resulting in its sustained fugacity. The latter showed optimum as a function of the polymer concentration in the investigated range (0.1-0.3% w/w). The o-Ps lifetime distributions confirmed the microstructural changes of the formulations and were in good agreement with the analytical and microbiological evaluation. The application of chlorine dioxide-loaded bioadhesive gels could be a promising alternative for the effective and safe treatment of topical infections.

Infections and outbreaks of nontuberculous mycobacteria in hospital settings

Purpose of review

Non-tuberculous mycobacterial [NTM] infections in the hospital setting are a complex and often challenging entity. The goal of this review is to discuss diagnostic and treatment strategies for established as well as emerging nosocomial NTM infections.

Recent findings

NTM outbreaks have been documented in a variety of hospital settings. Contamination of medical devices or aqueous solutions is often implicated in the spread of infection. More recently, the slow grower M. chimaera has been reported in the setting of contaminated heater-cooler devices used for cardiopulmonary bypass and extracorporeal membrane oxygenation. In addition, increases in medical tourism for cosmetic surgery have led to outbreaks of rapidly growing mycobacteria.

Summary

Diagnosis and treatment of nosocomial NTM pose many challenges for the clinician. Surgical resection or debridement as well as combination antimycobacterial therapy are a mainstay in therapeutic management. Strict infection control and prevention practices are critical to the identification and cessation of outbreaks.

Efficacy and Safety Evaluation of a Chlorine Dioxide Solution

In this study, a chlorine dioxide solution (UC-1) composed of chlorine dioxide was produced using an electrolytic method and subsequently purified using a membrane. UC-1 was determined to contain 2000 ppm of gaseous chlorine dioxide in water. The efficacy and safety of UC-1 were evaluated. The antimicrobial activity was more than 98.2% reduction when UC-1 concentrations were 5 and 20 ppm for bacteria and fungi, respectively. The half maximal inhibitory concentrations (IC₅₀) of H1N1, influenza virus B/TW/71718/04, and EV71 were 84.65 ± 0.64, 95.91 ± 11.61, and 46.39 ± 1.97 ppm, respectively. A 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test revealed that the cell viability of mouse lung fibroblast L929 cells was 93.7% at a 200 ppm UC-1 concentration that is over that anticipated in routine use. Moreover, 50 ppm UC-1 showed no significant symptoms in a rabbit ocular irritation test. In an inhalation toxicity test, treatment with 20 ppm UC-1 for 24 h showed no abnormality and no mortality in clinical symptoms and normal functioning of the lung and other organs. A ClO₂ concentration of up to 40 ppm in drinking water did not show any toxicity in a subchronic oral toxicity test. Herein, UC-1 showed favorable disinfection activity and a higher safety profile tendency than in previous reports.

Antibacterial Metallic Touch Surfaces

Our aim is to present a comprehensive review of the development of modern antibacterial metallic materials as touch surfaces in healthcare settings. Initially we compare Japanese, European and US standards for the assessment of antimicrobial activity. The variations in methodologies defined in these standards are highlighted. Our review will also cover the most relevant factors that define the antimicrobial performance of metals, namely, the effect of humidity, material geometry, chemistry, physical properties and oxidation of the material. The state of the art in contact-killing materials will be described. Finally, the effect of cleaning products, including disinfectants, on the antimicrobial performance, either by direct contact or by altering the touch surface chemistry on which the microbes attach, will be discussed. We offer our outlook, identifying research areas that require further development and an overview of potential future directions of this exciting field.