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Rutala WA, Donskey CJ, Weber DJ. Disinfection and sterilization: New technologies. Am J Infect Control 2023; 51:A13-A21. [PMID: 37890943 DOI: 10.1016/j.ajic.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Adherence to professional guidelines and/or manufacturer's instructions for use regarding proper disinfection and sterilization of medical devices is crucial to preventing cross transmission of pathogens between patients. Emerging pathogens (e.g., Candida auris) and complex medical devices provide new challenges. METHODS A search for published English articles on new disinfection and sterilization technologies was conducted by Google, Google scholar and PubMed. RESULTS Several new disinfection methods or products (e.g., electrostatic spraying, new sporicides, colorized disinfectants, "no touch" room decontamination, continuous room decontamination) and sterilization technologies (e.g., new sterilization technology for endoscopes) were identified. CONCLUSIONS These technologies should reduce patient risk.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - Curtis J Donskey
- Geriatric Research, Education and Clinical Care, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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2
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Weber DJ, Rutala WA, Anderson DJ, Sickbert-Bennett EE. ..úNo touch..Ñ methods for health care room disinfection: Focus on clinical trials. Am J Infect Control 2023; 51:A134-A143. [PMID: 37890944 DOI: 10.1016/j.ajic.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Hospital patient room surfaces are frequently contaminated with multidrug-resistant organisms. Since studies have demonstrated that inadequate terminal room disinfection commonly occurs, ..úno touch..Ñ methods of terminal room disinfection have been developed such as ultraviolet light (UV) devices and hydrogen peroxide (HP) systems. METHODS This paper reviews published clinical trials of ..úno touch..Ñ methods and ..úself-disinfecting..Ñ surfaces. RESULTS Multiple papers were identified including clinical trials of UV room disinfection devices (N.ß=.ß20), HP room disinfection systems (N.ß=.ß8), handheld UV devices (N.ß=.ß1), and copper-impregnated or coated surfaces (N.ß=.ß5). Most but not all clinical trials of UV devices and HP systems for terminal disinfection demonstrated a reduction of colonization/infection in patients subsequently housed in the room. Copper-coated surfaces were the only ..úself-disinfecting..Ñ technology evaluated by clinical trials. Results of these clinical trials were mixed. DISCUSSION Almost all clinical trials reviewed used a ..úweak..Ñ design (eg, before-after) and failed to assess potential confounders (eg, compliance with hand hygiene and environmental cleaning). CONCLUSIONS The evidence is strong enough to recommend the use of a ..úno-touch..Ñ method as an adjunct for outbreak control, mitigation strategy for high-consequence pathogens (eg, Candida auris or Ebola), or when there are an excessive endemic rates of multidrug-resistant organisms.
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Affiliation(s)
- David J Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC.
| | - William A Rutala
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC
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Knobling B, Ulatowski A, Franke G, Belmar Campos C, Büttner H, Klupp EM, Maurer PM, Brill FHH, Knobloch JK. Superiority of manual disinfection using pre-soaked wipes over automatic UV-C radiation without prior cleaning. J Hosp Infect 2023; 140:72-78. [PMID: 37543180 DOI: 10.1016/j.jhin.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND The efficacy of ultraviolet C (UV-C) radiation against a broad spectrum of micro-organisms has been demonstrated in several studies, but differences in the specific doses and the extent of microbial reduction were found. Furthermore, the conditions of laboratory tests differ greatly from reality, such that efficacy achieved in tests may not necessarily be assumed in reality. Consequently, it is important to investigate the effectiveness of UV-C in representative field trials. The aim was therefore to develop and establish a field test to evaluate automatic UV-C in comparison to manual disinfection. METHODS Before and after disinfection, samples were repeatedly collected from naturally highly contaminated surfaces using the swab technique to obtain representative data sets for disinfected and non-disinfected surfaces. Subsequently, the log reduction values (LRV) and the disinfection success were evaluated for UV-C radiation and full compliant manual disinfection using alcohol-based wipes. RESULTS Surfaces that are naturally contaminated with bacteria on a regular and nearly uniform basis have been identified as particularly suitable for field testing. Mean contamination was reduced from 23.3 to 1.98 cfu/cm2 (LRV 0.9) and 29.7 to 0.26 cfu/cm2 (LRV 1.2) for UV-C and manual disinfection, respectively. UV-C disinfection achieved 75.5% successful disinfected surfaces, whereas manual disinfection showed 98.1%. CONCLUSIONS Full compliant manual disinfection showed slightly higher LRVs and disinfection success than automatic UV-C disinfection. Successful, operator-independent UV-C disinfection still has the potential to improve disinfection performance in addition to manual disinfection.
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Affiliation(s)
- B Knobling
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Ulatowski
- Dr. Brill + Partner GmbH Institute for Hygiene and Microbiology, Hamburg, Germany
| | - G Franke
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Belmar Campos
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Büttner
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E M Klupp
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P M Maurer
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F H H Brill
- Dr. Brill + Partner GmbH Institute for Hygiene and Microbiology, Hamburg, Germany
| | - J K Knobloch
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Knobling B, Franke G, Belmar Campos C, Büttner H, Christner M, Klupp EM, Maurer PM, Knobloch JK. Tolerance of clinical vancomycin-resistant Enterococcus faecium isolates against UV-C light from a mobile source. Antimicrob Resist Infect Control 2023; 12:63. [PMID: 37403134 PMCID: PMC10320914 DOI: 10.1186/s13756-023-01259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/29/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Admission to a room previously occupied by patients carrying environmentally robust pathogens implies an increased risk of acquiring those pathogens. Therefore, 'No-touch' automated room disinfection systems, including devices based on UV-C irradiation, are discussed to improve terminal cleaning. It is still unclear if clinical isolates of relevant pathogens behave differently under UV-C irradiation compared to laboratory strains used in the approval process of disinfection procedures. In this study we analysed the susceptibility of well characterized clonally divergent vancomycin-resistant enterococci (VRE) strains, including a linezolid-resistant isolate, against UV-C radiation. METHODS Susceptibility against UV-C of ten clonally divergent clinical isolates of VRE was determined in comparison to the commonly used test organism Enterococcus hirae ATCC 10541. Ceramic tiles contaminated with 105 to 106 colony forming units/25 cm² of the different enterococci were positioned at a distance of 1.0 and 1.5 m and irradiated for 20 s, resulting in a UV-C dose of 50 and 22 mJ/cm², respectively. Reduction factors were calculated after quantitative culture of the bacteria recovered from treated and untreated surfaces. RESULTS Susceptibility to UV-C varied considerably among the strains studied, with the mean value of the most robust strain being up to a power of ten lower compared to the most sensitive strain at both UV-C doses. The two most tolerant strains belonged to MLST sequence types ST80 and ST1283. The susceptibility of the laboratory strain E. hirae ATCC 10541 ranged between the most sensitive and most tolerant isolates for both irradiation doses. However, for UV-C dose of 22 mJ/cm², the reduction of the most tolerant isolate of ST1283 was statistically significantly lower compared to E. hirae ATCC 10541. The most susceptible strains belonged to the MLST sequence types ST117 and ST203. CONCLUSIONS These results indicate that UV-C doses reported in the literature are sufficient for the reduction of commonly used reference strains of enterococci but could be insufficient for the reduction of tolerant patient VRE-isolates in a hospital setting. Therefore, for future studies, the most tolerant clinical isolates should be used to validate automated UV-C devices or longer exposure times should be expected to ensure efficacy in the real world.
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Affiliation(s)
- B Knobling
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Franke
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Belmar Campos
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Büttner
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Christner
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E M Klupp
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P M Maurer
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J K Knobloch
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Knobling B, Franke G, Carlsen L, Belmar Campos C, Büttner H, Klupp EM, Maurer PM, Knobloch JK. Phenotypic Variation in Clinical S. aureus Isolates Did Not Affect Disinfection Efficacy Using Short-Term UV-C Radiation. Microorganisms 2023; 11:1332. [PMID: 37317306 DOI: 10.3390/microorganisms11051332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/16/2023] Open
Abstract
Pigmentation, catalase activity and biofilm formation are virulence factors that cause resistance of Staphylococcus aureus to environmental stress factors including disinfectants. In recent years, automatic UV-C room disinfection gained greater importance in enhanced disinfection procedures to improve disinfection success in hospitals. In this study, we evaluated the effect of naturally occurring variations in the expression of virulence factors in clinical S. aureus isolates on tolerance against UV-C radiation. Quantification of staphyloxanthin expression, catalase activity and biofilm formation for nine genetically different clinical S. aureus isolates as well as reference strain S. aureus ATCC 6538 were performed using methanol extraction, a visual approach assay and a biofilm assay, respectively. Log10 reduction values (LRV) were determined after irradiation of artificially contaminated ceramic tiles with 50 and 22 mJ/cm2 UV-C using a commercial UV-C disinfection robot. A wide variety of virulence factor expression was observed, indicating differential regulation of global regulatory networks. However, no direct correlation with the strength of expression with UV-C tolerance was observed for either staphyloxanthin expression, catalase activity or biofilm formation. All isolates were effectively reduced with LRVs of 4.75 to 5.94. UV-C disinfection seems therefore effective against a wide spectrum of S. aureus strains independent of occurring variations in the expression of the investigated virulence factors. Due to only minor differences, the results of frequently used reference strains seem to be representative also for clinical isolates in S. aureus.
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Affiliation(s)
- Birte Knobling
- Department Infection Prevention and Control, Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Gefion Franke
- Department Infection Prevention and Control, Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Laura Carlsen
- Department Infection Prevention and Control, Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Cristina Belmar Campos
- Department Infection Prevention and Control, Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Henning Büttner
- Department Infection Prevention and Control, Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Eva M Klupp
- Department Infection Prevention and Control, Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Philipp Maximilian Maurer
- Department Infection Prevention and Control, Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Johannes K Knobloch
- Department Infection Prevention and Control, Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Khandelwal A, Lapolla B, Bair T, Grinstead F, Hislop M, Greene C, Bigham MT. Enhanced disinfection with hybrid hydrogen peroxide fogging in a critical care setting. BMC Infect Dis 2022; 22:758. [PMID: 36175863 PMCID: PMC9520114 DOI: 10.1186/s12879-022-07704-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022] Open
Abstract
Background Environmental contamination contributes to hospital associated infections, particularly those caused by multi-drug resistant organisms (MDRO). This study investigated bioburden presence on surfaces in a critical care center’s patient rooms following typical environmental services (EVS) practices and following intervention with hybrid hydrogen peroxide™ (HHP™) fogging. Methods Upon patient discharge, following standard cleaning or cleaning with ultraviolet (UV) light use, patient rooms were sampled by swabbing for adenosine triphosphate (ATP) and aerobic colony counts (ACC) from five preset locations. Rooms were then fogged via HHP technology using chemical indicators and Geobacillus stearothermophilus biological indicators for sporicidal validation monitoring. Following fogging, rooms were sampled again, and results were compared. Results A 98% reduction in ACC was observed after fogging as compared to post EVS practices both with and without UV light use. No statistical difference was seen when comparing cleaning to cleaning with UV light use. Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa were identified following EVS practices and not detected following HHP fogging. ATP samples were reduced 88% by fogging application. Chemical and biological indicators confirmed correct application of HHP fogging, as seen through its achievement of a 6-log reduction of bacterial spores. Conclusion HHP fogging is a thorough and efficacious technology which, when applied to critical care patient rooms, significantly reduces bioburden on surfaces, indicating potential benefits for implementation as part of infection prevention measures.
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Affiliation(s)
- Anjay Khandelwal
- Department of Surgery, Division of Burn Surgery, Paul and Carol David Foundation Burn Institute, Akron Children's Hospital, Akron, OH, USA.,Department of Surgery and Pediatrics, NEOMED, Rootstown, OH, USA
| | - Brian Lapolla
- Department of Construction, Facilities and Public Safety, Akron Children's Hospital, Akron, OH, USA
| | - Tina Bair
- Department of Infection Prevention and Control, Akron Children's Hospital, Akron, OH, USA
| | - Frances Grinstead
- Department of Executive Management, CURIS System, 610 Kane Court, Oviedo, FL, 32765, USA
| | - Meaghan Hislop
- Department of Scientific Research, CURIS System, 610 Kane Court, Oviedo, FL, 32765, USA.
| | - Christine Greene
- Ramboll Group, Ramboll USA, Inc., 4245 North Fairfax Drive, Suite 700, Arlington, VA, 22203, USA
| | - Michael T Bigham
- Department of Quality Services and Division of Pediatric Critical Care, Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA.,Department of Pediatrics, NEOMED, Rootstown, OH, USA
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Changaris DG, Carenbauer AL. Potassium Linoleate (Isomerized) Satisfies the United States Environmental Protection Agency MB-05-16 for Hospital Disinfectant on Hard, Non-porous Surfaces. Cureus 2022; 14:e22851. [PMID: 35273892 PMCID: PMC8901164 DOI: 10.7759/cureus.22851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/08/2022] Open
Abstract
Potassium conjugated linoleic acid or potassium linoleate (isomerized), 86 mM, satisfies the United States Environmental Protection Agency protocol hospital disinfectant for non-porous surfaces MB-05-16 with one-minute treatment. This stringent protocol requires separate preparations of Staphylococcus aureus (American Type Culture Collection 6538) and Pseudomonas aeruginosa (American Type Culture Collection 15442) unstirred for 48 hours, submerging 10 mm polished cylinders in the culture, and placing for 45 minutes in a 37°C humidified chamber before treating. Since potassium linoleate (isomerized) also satisfies the United States Environmental Protection Agency protocol MB-35-00 for Candida auris, this study establishes potassium linoleate (isomerized) as an effective cross-kingdom antimicrobial plant salt, soap, or cleanser. We affirm the need for formal post-treatment plating on agar to establish efficacy and not rely on OD600 when testing for antimicrobial capacity. Aqueous dilution of the soap causes variable opalescence making optical density an unreliable marker for antimicrobial efficacy.
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