Disinfection and the prevention of infectious disease

Viable Escherichia coli enumeration on a polydimethylsiloxane (PDMS) chip with vertical channel-well configuration

The culture-based methods for viable Escherichia coli (E. coli) detection suffer from long detection time and laborious procedures, whereas the molecule tests and immune recognition technologies lack live/dead E. coli differentiation. Rapid, easy-to-use, and accessible viable E. coli detection is of benefit to bacterial infection diagnosis and risk warning of E. coli contamination of water and food, safeguarding human health. Herein, we propose a microwell chip-based solution to realize simple and rapid determination of viable E. coli. The vertical channel-well configuration is applied to develop the microwell array chip for increasing the microwell density (6200 wells/cm2), yielding a broad dynamic range from 103 to 107 CFU/mL. We incorporate an inducible enzyme assay with the developed chip and achieve the differentiation of live/dead E. coli within 4 h, significantly shortening the detection time from over 24 h in the standard method. By encapsulating single E. coli into microwells, the concentration of viable cells can be determined simultaneously through counting positive microwells. In addition, the air soluble PDMS that can store negative pressure for independent sample digitalization endows the developed chip with simple operation and less reliance on external equipment. With further developments for increasing the number of microwell and integrating more sample panels, the developed chip can become a useful tool for rapid viable E. coli enumeration with user-friendly operation, simple procedures, and accessibility in decentralized settings, thereby deploying this device for water and food safety monitoring, as well as clinical bacterial infection diagnosis.

Correlating the physico-chemical properties of two conventional glazed porcelain stoneware tiles in relation to cleanability and sanitization

Keeping surfaces clean can reduce the spread of infections. In particular, to decrease the potential for SARS CoV-2 contamination, performing disinfection of high-touching surfaces. Several ceramic tiles and porcelain stoneware tiles with antimicrobial properties are already available on the market. However, the widespread use of antimicrobial glazed stoneware tiles may require to replace the ceramic surfaces already present in many buildings. The unfeasibility of such replacement can be due to both product durability (lifetime of a tile is usually long) and/or monetary restrictions. Furthermore, as porcelain stoneware per se does not have antimicrobial activity, these materials are fabricated by adding chemical agents able to provide antimicrobial properties. This approach requires a compatibility between the antimicrobial agents and the glaze formulation, as well as a careful control of the firing cycle and the final properties of the ceramic products. It follows that the final cost of antimicrobial tiles is not competitive with that of conventional tiles. In the latter, the persistence of potential pathogens on the surfaces is a crucial problem to face: the longer a pathogen survives on a surface, the longer it may be a source of transmission and thus endanger susceptible subjects. In this work, bacteria's capacity to adhere and to be effectively removed from two conventional glazed porcelain stoneware tiles (under dirty and clean conditions) was investigated. Two different glazes were tested, one mainly glassy (glossy) and the other mainly crystalline (matt). The sanitization procedures were carried out by chemical and chemo-mechanical procedures. The results showed that chemo-mechanical sanitization was the most effective, and the best results could be obtained on the stoneware tiles coated with the mainly glassy glaze, with the lowest porosity and the lower roughness values and water contact angles, especially under clean conditions.

Development of benchmark datasets for text mining and sentiment analysis to accelerate regulatory literature review

In the field of regulatory science, reviewing literature is an essential and important step, which most of the time is conducted by manually reading hundreds of articles. Although this process is highly time-consuming and labor-intensive, most output of this process is not well transformed into machine-readable format. The limited availability of data has largely constrained the artificial intelligence (AI) system development to facilitate this literature reviewing in the regulatory process. In the past decade, AI has revolutionized the area of text mining as many deep learning approaches have been developed to search, annotate, and classify relevant documents. After the great advancement of AI algorithms, a lack of high-quality data instead of the algorithms has recently become the bottleneck of AI system development. Herein, we constructed two large benchmark datasets, Chlorine Efficacy dataset (CHE) and Chlorine Safety dataset (CHS), under a regulatory scenario that sought to assess the antiseptic efficacy and toxicity of chlorine. For each dataset, ∼10,000 scientific articles were initially collected, manually reviewed, and their relevance to the review task were labeled. To ensure high data quality, each paper was labeled by a consensus among multiple experienced reviewers. The overall relevance rate was 27.21% (2,663 of 9,788) for CHE and 7.50% (761 of 10,153) for CHS, respectively. Furthermore, the relevant articles were categorized into five subgroups based on the focus of their content. Next, we developed an attention-based classification language model using these two datasets. The proposed classification model yielded 0.857 and 0.908 of Area Under the Curve (AUC) for CHE and CHS dataset, respectively. This performance was significantly better than permutation test (p < 10E-9), demonstrating that the labeling processes were valid. To conclude, our datasets can be used as benchmark to develop AI systems, which can further facilitate the literature review process in regulatory science.

Nanoparticle Engineered Photocatalytic Paints: A Roadmap to Self-Sterilizing against the Spread of Communicable Diseases

Applications of visible-light photocatalytic engineered nanomaterials in the preparation of smart paints are of recent origin. The authors have revealed a great potential of these new paints for self-sterilizing of the surfaces in hospitals and public places simply with visible light exposure and this is reported for the first time in this review. A recent example of a communicable disease such as COVID-19 is considered. With all precautions and preventions taken as suggested by the World Health Organization (WHO), COVID-19 has remained present for a longer time compared to other diseases. It has affected millions of people worldwide and the significant challenge remains of preventing infections due to SARS-CoV-2. The present review is focused on revealing the cause of this widespread disease and suggests a roadmap to control the spread of disease. It is understood that the transmission of SARS-CoV-2 virus takes place through contact surfaces such as doorknobs, packaging and handrails, which may be responsible for many preventable and nosocomial infections. In addition, due to the potent transmissibility of SARS-CoV-2, its ability to survive for longer periods on common touch surfaces is also an important reason for the spread of COVID-19. The existing antimicrobial cleaning technologies used in hospitals are not suitable, viable or economical to keep public places free from such infections. Hence, in this review, an innovative approach of coating surfaces in public places with visible-light photocatalytic nanocomposite paints has been suggested as a roadmap to self-sterilizing against the spread of communicable diseases. The formulations of different nanoparticle engineered photocatalytic paints with their ability to destroy pathogens using visible light, alongwith the field trials are also summarized and reported in this review. The potential suggestions for controlling the spread of communicable diseases are also listed at the end of the review.

Polymeric approach to combat drug-resistant methicillin-resistant Staphylococcus aureus

ABSTRACT

The current global death rate has threatened humans due to increase in deadly unknown infections caused by pathogenic microorganisms. On the contrary, the emergence of multidrug-resistant bacteria is also increasing which is leading to elevated lethality rate worldwide. Development of drug-resistant bacteria has become one of the daunting global challenges due to failure in approaching to combat against them. Methicillin-resistant Staphylococcus aureus (MRSA) is one of those drug-resistant bacteria which has led to increase in global mortality rate causing various lethal infections. Polymer synthesis can be one of the significant approaches to combat MRSA by fabricating polymeric coatings to prevent the spread of infections. This review provides last decade information in the development of various polymers against MRSA.

GRAPHICAL ABSTRACT

The effectiveness of a nonalcoholic disinfectant containing metal ions, with broad antimicrobial activity

Disinfectants have different efficacies depending on their use and the target microorganism. This study aimed to evaluate the efficacy and safety of our new nonalcoholic disinfectant, which consists mainly of metal ions. According to the 17th revised Japanese Pharmacopoeia and ASTM international E1052 method, the bactericidal and virucidal efficacy of this new disinfectant against 13 microorganisms was evaluated by the in vitro quantitative suspension test. Additionally, the disinfectant cytotoxicity against multiple cell lines was examined. Then, a safety test using a human open patch test was performed with 26 healthy volunteers. This disinfectant showed strong bactericidal and virucidal activities: all microorganisms except enterovirus were inactivated very quickly. The infectivity of 12 microbial strains was eliminated within 5 min of disinfectant exposure. Additionally, this disinfectant showed little acute cytotoxicity in vitro. All volunteers were negative in the human open patch test. Our new disinfectant has a broad spectrum of microbial targets, is safe for human skin, and demonstrates no cytotoxicity. This disinfectant could prevent common microbial infections.

Prevalence of SARS-CoV-2 RNA on inanimate surfaces: a systematic review and meta-analysis

Coronavirus disease (COVID-19) is a respiratory disease affecting many people and able to be transmitted through direct and perhaps indirect contact. Direct contact transmission, mediated by aerosols or droplets, is widely demonstrated, whereas indirect transmission is only supported by collateral evidence such as virus persistence on inanimate surfaces and data from other similar viruses. The present systematic review aims to estimate SARS-CoV-2 prevalence on inanimate surfaces, identifying risk levels according to surface characteristics. Data were obtained from studies in published papers collected from two databases (PubMed and Embase) with the last search on 1 September 2020. Included studies had to be papers in English, had to deal with coronavirus and had to consider inanimate surfaces in real settings. Studies were coded according to our assessment of the risk that the investigated surfaces could be contaminated by SARS-CoV-2. A meta-analysis and a metaregression were carried out to quantify virus RNA prevalence and to identify important factors driving differences among studies. Thirty-nine out of forty retrieved paper reported studies carried out in healthcare settings on the prevalence of virus RNA, five studies carry out also analyses through cell culture and six tested the viability of isolated viruses. Overall prevalences of SARS-CoV-2 RNA on high-, medium- and low-risk surfaces were 0.22 (CI₉₅ [0.152-0.296]), 0.04 (CI₉₅ [0.007-0.090]), and 0.00 (CI₉₅ [0.00-0.019]), respectively. The duration surfaces were exposed to virus sources (patients) was the main factor explaining differences in prevalence.

A 3D-printed, touch-activated, sanitizer dispensing device for reducing healthcare-acquired infections

Aim: We present a touch-activated, sanitizer dispensing (TSD) device, intended to be mounted on high-touch surfaces, that aims to reduce nosocomial infections. It disinfects the person’s hand touching its surface while being self-sterilizing. Materials & methods: The TSD device consists of an array of 3D-printed, passive, miniaturized, mechanical valves that dispense a small amount of liquid sanitizer when touched. Its mechanical performance and disinfecting efficiency were quantified using simulations and experimental tests. Results & conclusion: The TSD device has a disinfecting efficiency comparable to the standard hand sanitizing approach, reducing the microbiological load by approximately 30-times. It can be easily mounted on high-touch surfaces in a healthcare setting and it is expected to greatly reduce the spread of nosocomial infections.

THE COMPUTATION OF REPRODUCTION NUMBERS FOR THE ENVIRONMENT-HOST-ENVIRONMENT CHOLERA TRANSMISSION DYNAMICS

This study presents a new model for the environment-host-environment transmission dynamics of V. cholerae in a community with an interconnected aquatic pond–river water network. For the case when the human host is the sole target of anti-cholera control and the volume of water in the pond is maximum, the disease-free equilibrium of the model is shown to be globally asymptotically stable whenever a certain epidemiological threshold, known as the basic reproduction number [Formula: see text], is less than unity. The epidemiological implication of this result is that cholera can be eliminated from the community if the control strategies implemented can bring (and maintain) [Formula: see text] to a value less than unity. Four scenarios, that represent different interpretations of the role of the V. cholerea pathogen within the environment, were studied. The corresponding basic reproduction numbers were shown to exhibit the same threshold property with respect to the value unity (i.e., if one is less (equal, greater) than unity, then the three others are also less (equal, greater) than unity. Further, it was shown that for the case where anti-cholera control is focused on the human host population, the associated type reproduction number of the model (corresponding to each of the four transmission scenarios considered) is unique. The implication of this result is that the estimate of the effort needed for disease elimination (i.e., the required herd immunity threshold) is unique, regardless of which of the four transmission scenarios is considered. However, when any of the other two bacterial population types in the aquatic environment (i.e., bacterial in the pond or river) is the focus of the control efforts, this study shows that the associated type reproduction number is not unique. Extensive numerical simulations of the model, using a realistic set of parameters from the published literature, show that the community-wide implementation of a strategy that focus on improved water quality, sanitation, and hygiene (known as WASH-only strategy), using the current estimated coverage of 50% and efficacy of 60%, is unable to lead to the elimination of the disease. Such elimination is attainable if the coverage and efficacy are increased (e.g., to 80% and 90%, respectively). Further, elimination can be achieved using a strategy that focuses on oral rehydration therapy and the use of antibiotics to treat the infected humans (i.e., treatment-only strategy) for moderate effectiveness and coverage levels. The combined hybrid WASH-treatment strategy provides far better population-level impact vis a vis disease elimination. This study ranks the three interventions in the following order of population-level effectiveness: combined WASH-treatment, followed by treatment-only and then WASH-only strategy.

The Transcriptional Repressor SmvR Is Important for Decreased Chlorhexidine Susceptibility in Enterobacter cloacae Complex

Major facilitator superfamily (MFS) efflux pumps have been shown to be important for bacterial cells to cope with biocides such as chlorhexidine (CHX), a widely used molecule in hospital settings. In this work, we evaluated the role of two genes, smvA and smvR, in CHX resistance in Enterobacter cloacae complex (ECC). smvA encodes an MFS pump whereas smvR, located upstream of smvA, codes for a TetR-type transcriptional repressor. To this aim, we constructed corresponding deletion mutants from the ATCC 13047 strain (CHX MIC, 2 mg/liter) as well as strains overexpressing smvA or smvR in both ATCC 13047 and three clinical isolates exhibiting elevated CHX MICs (16 to 32 mg/liter). Determination of MICs revealed that smvA played a modest role in CHX resistance, in contrast to smvR that modulated the ability of ECC to survive in the presence of CHX. In clinical isolates, the overexpression of smvR significantly reduced MICs of CHX (2 to 8 mg/liter). Sequence analyses of smvR and promoter regions pointed out substitutions in conserved regions. Moreover, transcriptional studies revealed that SmvR acted as a repressor of smvA expression even if no quantitative correlation between the level of smvA mRNA and MICs of CHX could be observed. On the other hand, overproduction of smvA was able to complement the lack of the major resistance-nodulation-cell division (RND) superfamily efflux pump AcrB and restored resistance to ethidium bromide and acriflavine. Although SmvA could expel biocides such as CHX, other actors, whose expression is under SmvR control, should play a critical role in ECC.

Stethoscope disinfection is rarely done in Ethiopia: What are the associated factors?

Introduction

The stethoscope, which is non-critical medical devices and a symbol of healthcare, is likely to be contaminated by pathogenic microorganisms and can play a contributory role in the transmission of hospital-acquired infection. And regular cleaning of the diaphragm of the stethoscope with a suitable disinfectant is decisive. However, in the resource-constrained setting like many healthcare facilities in Ethiopia healthcare provider’s stethoscope disinfection practice and its associated factors have not been well studied so far. Therefore, this study sought to determine stethoscope disinfection practice and associated factors among the healthcare providers in Addis Ababa, Ethiopia.

Methods

A facility-based cross-sectional study was carried out between April and May 2016. For this study, 576 healthcare providers (physicians, health officers, nurses, midwives, and anesthesiologist) were included from 21 healthcare facilities in Addis Ababa. A pre-tested structured questionnaire was used for data collection. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were used to identify factors that were significantly associated with stethoscope disinfection after every use.

Results

A total of 546 healthcare providers participated in this study, for a response rate of 94.7%. Two-fifths, 39.7% (95%CI: 35.9, 44.0%) of healthcare providers disinfecting their stethoscope after every use. And a significant number of participants 34.6% (95%CI: 30.8, 38.5%) never disinfect their stethoscope. Three out of four (76.0%) healthcare providers believe that stethoscope contamination can contribute to the transmission of infections. Safe infection prevention practice (AOR = 3.79, 95%CI: 2.45–5.84), awareness on infection prevention guideline (AOR = 1.93; 95%CI: 1.31, 2.82), and favorable attitude towards infection prevention (AOR = 1.73, 95%CI: 1.02, 2.93) were significantly associated with stethoscope disinfection after every use. The study also found that the odds of stethoscope disinfection were likely to be reduced by 79% among physicians than nurses (AOR = 0.21; 95%CI: 0.09, 0.49).

Conclusions

Only a small proportion of healthcare providers disinfect their stethoscopes after every use. Factors such as safe infection prevention practice, awareness on infection prevention guidelines, and favorable attitude towards infection prevention were the independent predictors of stethoscopes disinfection after every use. Hence, promotion of stethoscope hygiene along with an educational program to enhance disinfection compliance in healthcare facilities may have a positive effect.

The Effects of Dry, Humid and Wear Conditions on the Antimicrobial Efficiency of Triclosan-Containing Surfaces

This study evaluated the effects of triclosan-containing polyester surfaces under various conditions at concentrations of between 400 ppm and 850 ppm. Staphylococcus aureus was chosen for the tests because it rapidly develops resistance to many antimicrobial agents. The results show that dry and humid conditions have bacteriostatic activity that inhibits the growth of S. aureus, with a greater effect under dryness (p < 0.05). Further, concentrations as low as 400 ppm showed activities of 0.99 log10 and 0.19 log10 for dry and humid conditions, respectively. The study of the association between triclosan concentrations and bacterial inhibition showed a high correlation for dry (R2 = 0.968) and humid conditions (R2 = 0.986). Under wear conditions, triclosan showed a gradual reduction in its bacteriostatic activity due to successive washing/drying treatments (p < 0.05). Thus, the use of triclosan in low concentrations is suggested as achieving bacteriostatic activity. Moreover, its use can be considered as complementary to the cleaning and disinfection procedures carried out in the food industry. However, it must not replace them. Manufacturing processes must be improved to preserve the triclosan properties in the antimicrobial materials to control microorganisms involved in cross-contamination between surfaces and food.

An assay for determining the susceptibility of Salmonella isolates to commercial and household biocides

Poultry and meat products contaminated with Salmonella enterica are a major cause of foodborne illness in the United States. The food industries use a wide variety of antimicrobial interventions to reduce bacterial contamination. However, little is known about Salmonella susceptibility to these compounds and some studies have shown a concerning link between biocide resistance and antibiotic resistance. To investigate this, a 96 well panel of 17 common household and commercially used biocides was designed to determine the minimum inhibitory concentrations (MIC) of these compounds for Salmonella. The panel contained two-fold serial dilutions of chemicals including Dodecyltrimethylammonium chloride (DC), Benzalkonium chloride (BKC), Cetylpyridinium chloride (CPC), Hexadecyltrimethylammonium bromide (HB), Hexadecyltrimethylammonium chloride (HC), Acetic acid (AA), Lactic acid (LA), Citric acid (CA), Peroxyacetic acid (PXA), Acidified sodium chlorite (ASC), Sodium hypochlorite (SHB), 1,3 dibromo, 5,5 dimethylhydantoin (DBH), Chlorhexidine (CHX), Sodium metasilicate (SM), Trisodium phosphate (TSP), Arsenite (ARI), and Arsenate (ARA). The assay was used to test the susceptibility of 88 multidrug resistant (MDR) Salmonella isolates from animal sources. Bacteria are defined as multidrug resistant (MDR) if it exhibited non-susceptibility to at least one agent in three or more antimicrobial categories. The concentration of biocide at which ≥50% of the isolates could not grow was designated as the minimum inhibitory concentration or MIC50 and was used as the breakpoint in this study. The MIC50 (μg ml-1) for the tested MDR Salmonella was 256 for DC, 40 for BKC, 80 for CPC. HB and HC, 1,640 for AA, 5664 for LA, 3,156 for CA, 880 for PXA, 320 for ASC, 3.0 for CHX, 1,248 for DBH, 3,152 (6%) for SHB, 60,320 for SM, 37,712 for TSP, 56 for ARI and 832 for ARA. A few isolates were not susceptible at the MIC50 breakpoint to some chemicals indicating possible resistance. Isolates with MICs of two 2-fold dilutions above the MIC50 were considered resistant. Biocides for which resistant isolates were detected included CPC (n = 1 isolate), HB (1), CA (18), ASC (7), CHX (22), ARA (16), and ARI (4). There was no correlation detected between the biocide susceptibility of Salmonella isolates and antibiotic resistance. This assay can determine the MICs of bacteria to 17 biocides in a single test and will be useful in evaluating the efficacy of biocides and to detect the development of resistance to them.

Bactericidal efficacy of a quaternary ammonium compound with food additive grade calcium hydroxide toward Salmonella Infantis and Escherichia coli on abiotic carriers

The bactericidal efficacies of 0.2% food additive grade calcium hydroxide (FdCa(OH)2) solution, a quaternary ammonium compound (QAC) diluted at 1:500 (QACx500) and their mixture-Mix500 (FdCa(OH)2 powder added at final concentration 0.2% to QACx500)-were investigated at two different temperatures (room temperature (RT) (25 ± 2°C) and 2°C), using varying contact time, with or without presence of organic materials (5% fetal bovine serum: FBS), either in suspension or on abiotic carrier (steel, rubber and plastic). In the suspension test, QACx500 could inactivate Salmonella Infantis at effective level (≥3 log reductions), within 30 sec and 5 sec, respectively, with or without 5% FBS at RT; however, at 2°C it required 30 min and 1 min, respectively. Mix500 revealed the same efficacy as QACx500 at RT, but, at 2°C it required 1 min and 30 sec, respectively with or without FBS. Whereas, 0.2% FdCa(OH)2 solution alone could inactivate S. Infantis within 1 min and 3 min, respectively at RT and 2°C, even with 5% FBS. In the carrier test, single disinfectant required bit more (3 or 5 min) contact time to reduce bacterial load (S. Infantis or Escherichia coli) down to the effective level on rubber surface than that on steel and plastic surface. However, Mix500 could inactivate both bacteria on carrier surfaces within 1 min, even at 2°C. Thus, synergistic effects were observed in the suspension test and the carrier test at both temperatures toward both bacteria.

Novel N-chloramine precursors for antimicrobial application: synthesis and facile covalent immobilization on polyurethane surface based on perfluorophenyl azide (PFPA) chemistry

To control the pathogen cross contaminations on medical material surface, there is a pressing need to develop antimicrobial materials with highly efficacious surface biocidal activity. In this work, N-chloramine precursors containing a quaternary ammonium unit and perfluorophenyl azide unit were synthesized and covalently immobilized on inert polyurethane (PU) film upon UV light irradiation. The surface modification was confirmed by contact angle, Fourier transform infrared (ATR FTIR) spectroscopy, X-ray photoelectron spectroscopy (XPS), and atomic force microscopy (AFM) analyses. After bleaching treatment, satisfactory biocidal activity was achieved for the surface-modified PU films. It was found that the introduced surface QA center contributed an even faster surface contact killing behavior and that precursors with a longer structural linker caused higher surface chlorine content and higher antimicrobial efficacy. This approach provides a novel and facile method that enables the covalent immobilization of N-chloramine precursors on inert polymeric surface to produce durable antimicrobial materials.

Synergism between high hydrostatic pressure and glutaraldehyde for the inactivation of Staphylococcus aureus at moderate temperature

The sterilization of transplant and medical devices should be effective but not detrimental to the structural properties of the materials used. In this study, we examined the effectiveness of chemical and physical agents for inactivating Staphylococcus aureus, a gram-positive bacterium and important cause of infections and biofilm production. The treatment conditions in this work were chosen to facilitate their subsequent use with sensitive materials. The effects of temperature, high hydrostatic pressure, and glutaraldehyde disinfectant on the growth of two strains of S. aureus (ATCC 25923 and BEC 9393) were investigated individually and/or in combinations. A low concentration of glutaraldehyde (0.5 mM), high hydrostatic pressure (300 MPa for 10 min), and moderate temperature (50 °C), when used in combination, significantly potentiated the inactivation of both bacterial strains by > 8 orders of magnitude. Transmission electron microscopy revealed structural damage and changes in area that correlated with the use of pressure in the presence of glutaraldehyde at room temperature in both strains. Biofilm from strain ATCC 25923 was particularly susceptible to inactivation. The conditions used here provided effective sterilization that can be applied to sensitive surgical devices and biomaterials, with negligible damage. The use of this experimental approach to investigate other pathogens could lead to the adoption of this procedure for sterilizing sensitive materials.

Cleaning and disinfection programs against Campylobacter jejuni for broiler chickens: productive performance, microbiological assessment and characterization

Detailed cleaning and disinfection programs aims to reduce infection pressure from microorganisms from one flock to the next. However, studies evaluating the benefits to poultry performance, the sanitary status of the facilities, and the sanitary quality of the meat are rarely found. Thus, this study was designed to evaluate 2 cleaning and disinfecting programs regarding their influence on productive performance, elimination of Campylobacter, and characterization of Campylobacter jejuni strains when applied to broiler chickens’ facilities. Two subsequent flocks with 960 birds each were distributed into 32 pens containing 30 birds each. In the first, the whole flock was inoculated with a known strain of Campylobacter jejuni in order to contaminate the environment. In the second flock, performance and microbiological evaluations were done, characterizing an observational study between 2 cleaning and disinfection programs, regular and proposed. The regular program consisted of sweeping facilities, washing equipment and environment with water and neutral detergent. The proposed cleaning program consisted of dry and wet cleaning, application of 2 detergents (one acid and one basic) and 2 disinfectants (250 g/L glutaraldehyde and 185 g/L formaldehyde at 0.5% and 210 g/L para-chloro-meta-cresol at 4%). Total microorganism count in the environment and Campylobacter spp. identification were done for the microbiological assessment of the environment and carcasses. The positive samples were submitted to molecular identification of Campylobacter spp. and posterior genetic sequencing of the species identified as Campylobacter jejuni. The birds housed in the facilities and submitted to the proposed treatment had better performance when compared to the ones in the regular treatment, most likely because there was a smaller total microorganism count on the floor, walls, feeders and drinkers. The proposed program also resulted in a reduction of Campylobacter spp. on floors, drinkers and birds. Moreover, it was possible to identify 6 different Campylobacter jejuni strains in the facilities. The proposed treatment resulted in a positive influence on the birds’ performance and reduction of environment contamination for broiler chickens.

Evaluation of subchronic exposure to triclosan on hepatorenal and reproductive toxicities in prepubertal male rats

Triclosan (TCS), a common antimicrobial ingredient, is present in many consumer products, including soaps, shampoos, and toothpaste. Owing to its widespread use, potential adverse effects on animals and humans may arise from lifetime exposure, but data on chronic prepubertal exposure of TCS are still lacking. The aim of the present study was to investigate the influence of subchronic TCS exposure (0.25, 25, 250, or 750 mg/kg) on target organ toxicity in prepubertal male rats. After daily administration of TCS to rats by oral gavage for 60 d, a significant reduction in body weight and relative weights of liver, kidneys, testes, and adrenal glands was observed in the 750-mg/kg (high dose) group. Serum alanine aminotransferase and aspartate aminotransferase activities as well as levels of blood urea nitrogen, and creatinine were significantly increased at 750 mg/kg TCS. Further, TCS (750 mg/kg) elevated the protein expressions of hepatic CYP2B1, RXR/PPAR, and levels of malondialdehyde. High-dose TCS exposure induced histological changes as evidenced by reduction of Bowman's space, occlusion of the tubular lumen, and degeneration of tubular epithelial cells in the kidney. Tubular necrosis was confirmed as evidenced by a rise in expression of high mobility group box 1 renal protein. Daily sperm production was significantly diminished by high doses of TCS with marked inhibition of androgen receptor protein expression. Our results indicated that subchronic exposure to excessively high concentrations of 750 mg/kg TCS induced hepatorenal and reproductive toxicities in prepubertal male rats; however, the biological relevance of these findings is questionable as these drug levels are not encountered in the environment.

Persistence analysis of poliovirus on three different types of fomites

AIMS

The goal of this study was to explore various models for describing viral persistence (infectivity) on fomites and identify the best fit models.

METHODS AND RESULTS

The persistence of poliovirus over time was studied on three different fomite materials: steel, cotton and plastic. Known concentrations of poliovirus type 1 were applied to the surface coupons in an indoor environment for various lengths of time. Viruses were recovered from the surfaces by vortexing in phosphate buffer. Seven different mathematical models of relative persistence over time were fit to the data, and the preferred model for each surface was selected based on the Bayesian information criterion.

CONCLUSIONS

While the preferred model varied by fomite type, the virus showed a rapid initial decay on all of the fomite types, followed by a transition to a more gradual decay after about 4-8 days. Estimates of the time for 99% reduction ranged from 81 h for plastic to 143 h for cotton. A 6 log reduction of recoverable infectivity of poliovirus did not occur during the 3-week duration of the experiment for any of the fomites.

SIGNIFICANCE AND IMPACT OF THE STUDY

In protected indoor environments poliovirus can remain infective for weeks. The models identified by this study can be used in risk assessments to identify appropriate strategies for managing this risk.

Effectiveness of UV-C light irradiation on disinfection of an eSOS(®) smart toilet evaluated in a temporary settlement in the Philippines

Ultraviolet germicidal (short wavelength UV-C) light was studied as surface disinfectant in an Emergency Sanitation Operation System(®) smart toilet to aid to the work of manual cleaning. The UV-C light was installed and regulated as a self-cleaning feature of the toilet, which automatically irradiate after each toilet use. Two experimental phases were conducted i.e. preparatory phase consists of tests under laboratory conditions and field testing phase. The laboratory UV test indicated that irradiation for 10 min with medium-low intensity of 0.15-0.4 W/m(2) could achieve 6.5 log removal of Escherichia coli. Field testing of the toilet under real usage found that UV-C irradiation was capable to inactivate total coliform at toilet surfaces within 167-cm distance from the UV-C lamp (UV-C dose between 1.88 and 2.74 mW). UV-C irradiation is most effective with the support of effective manual cleaning. Application of UV-C for surface disinfection in emergency toilets could potentially reduce public health risks.

Evaluation of Commonly Used Products for Disinfecting Clipper Blades in Veterinary Practices: A Pilot Study

Nosocomial infections are a concern of growing interest in veterinary medicine. Clipper blades have been confirmed as fomites for numerous potential pathogens and, as such, may be associated with wound and surgical site infections. The goal of this study was to evaluate the disinfectant capabilities of several commonly used clipper blade cleaning products. Seventy sterile clipper blades were inoculated with strains of Pseudomonas aeruginosa , Escherichia coli , and Staphylococcus aureus . Blades were then subjected to one of seven treatment groups for disinfecting. Quantitative cultures of remaining bacteria were performed. All blades in the control group showed large amounts of bacterial recovery. Culture results showed no recovery in blades soaked in alcohol or chlorhexidine or those sprayed with an ethanol/o-phenylphenol product, while moderate recovery was seen with all other treatments. These results show that persistent contamination of clipper blades can occur with the use of several commonly used disinfectant products. Further research is necessary to evaluate fungicidal capabilities as well as the effect of disinfection on clipper blade maintenance.

Contamination of environmental surfaces by methicillin-resistant Staphylococcus aureus (MRSA) in rooms of inpatients with MRSA-positive body sites

Methicillin-resistant Staphylococcus aureus (MRSA) can contaminate environmental surfaces that are frequently touched by the hands of patients with MRSA colonization/infection. There have been many studies in which the presence or absence of MRSA contamination was determined but no studies in which MRSA contamination levels were also evaluated in detail. We evaluated MRSA contamination of environmental surfaces (overbed tables, bed side rails, and curtains) in the rooms of inpatients from whom MRSA was isolated via clinical specimens. We examined the curtains within 7–14 days after they had been newly hung. The environmental surfaces were wiped using gauze (molded gauze for wiping of surface bacteria; 100% cotton, 4 cm × 8 cm) moistened with sterile physiological saline. The MRSA contamination rate and mean counts (range) were 25.0% (6/24 samples) and 30.6 (0–255) colony-forming units (cfu)/100 cm², respectively, for the overbed tables and 31.6% (6/19 samples) and 159.5 (0–1620) cfu/100 cm², respectively, for the bed side rails. No MRSA was detected in 24 curtain samples. The rate of MRSA contamination of environmental surfaces was high for the overbed tables and bed side rails but low for the curtains. Therefore, at least until the 14th day of use, frequent disinfection of curtains may be not necessary.

Sterilization Efficiency of a Novel Electrochemical Disinfectant against Staphylococcus aureus

Disinfection of hazardous microorganisms that may challenge environmental safety is a crucial issue for economic and public health. Here, we explore the potential of a novel electrochemical disinfectant named plasma activated water (PAW), which was generated by nonthermal plasma, for inactivating Staphylococcus aureus (S. aureus). Meanwhile, the influence of bovine serum albumin (BSA) on the PAW disinfection efficacy was investigated. In the presence of BSA, PAW treatments achieved a reduction of S. aureus ranging from 2.1 to 5.5 Log, when without BSA it reached 7 Log. The sterilization efficacy depended on the PAW treatment time of S. aureus and plasma activation time for PAW generation. The results of electron spin resonance spectra showed the concentrations of hydroxyl radical (OH•) and nitric oxide radical (NO•) in water activated by plasma for 10 min (10-PAW) were higher than those in water activated by plasma for 5 min (5-PAW). Additionally, the physiological analysis of S. aureus demonstrated that the integrity of cell membrane, membrane potential, and intracellular pH homeostasis as well as DNA structure were damaged by PAW, and the molecule structure and chemical bonds of S. aureus were also altered due to PAW. Thus, PAW can be a promising chemical-free and environmentally friendly electrochemical disinfectant for application in the medical and food industries.

Evaluation of Bacterial Contamination of Clipper Blades in Small Animal Private Practice

Nosocomial infections are a growing concern in veterinary hospitals, and identifying fomites is imperative to reducing the risk of pathogen transmission. In veterinary medicine, shaving of hair is necessary prior to many procedures. Contaminated clipper blades have been cited as potential fomites involved in the transmission of pathogens in veterinary and human medicine. The primary goal of this study was to evaluate bacterial contamination of clipper blades in veterinary practices. A secondary goal was to assess whether there was an association between bacterial contamination of clipper blades and clipper blade cleaning solutions, clipper blade cleaning protocols, clipper blade storage, and type of practice. Sixty clipper blades from 60 different practices were cultured. Information regarding blade cleaning solutions, protocols, and storage was collected from each practice. Fifty-one percent (31/60) of clipper blades sampled were contaminated with bacteria. Category of cleaning solutions had a significant association with bacterial contamination (P < 0.02). Cleaning frequency (P = 0.55), storage location (P = 0.26), and practice type (P = 0.06) had no significant association with bacterial contamination. This study documented bacterial contamination of clipper blades in veterinary practices, and clipper blades should be considered potential fomites.

APSIC Guidelines for environmental cleaning and decontamination

This document is an executive summary of APSIC Guidelines for Environmental Cleaning and Decontamination. It describes best practices in routine cleaning and decontamination in healthcare facilities as well as in specific settings e.g. management of patients with isolation precautions, food preparation areas, construction and renovation, and following a flood. It recommends the implementation of environmental hygiene program to keep the environment safe for patients, staff and visitors visiting a healthcare facility. Objective assessment of cleanliness and quality is an essential component of this program as a method for identifying quality improvement opportunities. Recommendations for safe handling of linen and bedding; as well as occupational health and safety issues are included in the guidelines. A training program is vital to ensure consistent adherence to best practices.

In vitro evaluation of six chemical agents on smooth Brucella melitensis strain

Brucellosis is a zoonosis that disseminated by a variety of ways between animals and humans. The effective disinfection of contaminated environments, soil, feces, and animal bodies plays an irreplaceable role in the prevention and control of brucellosis. To kill Brucella effectively, the bactericidal effects of frequently used disinfectants (including aldehydes, halogens, quaternary ammonium compound, phenolics, and alkalines) and the potential factors that influence disinfection effects were determined in the present study. The results revealed that the minimum bactericidal concentrations (MBCs) of the six disinfectants were all significantly lower than the routinely used concentrations, and all the tested disinfectants were effective against B. melitensis NI. The results of quantitative determination showed that the bactericidal effects of the disinfectants were influenced by their concentration, exposure time, dirty condition and the temperature. Under dirty conditions and a low temperatures, sodium hypochlorite and sodium hydroxide showed better bactericidal effect, while benzalkonium chloride was almost without bactericidal ability. In addition, increasing the disinfectant concentration at low temperatures can improve the bactericidal effect. The present study suggested that Brucella is sensitive to commonly used disinfectants. However, the bactericidal effect is vulnerable to dirty conditions and low temperatures. Thus, it is necessary to test the in vitro sensitivity of disinfectants that are commonly used on farms or the new disinfectant formulations periodically, with the aim of improving the efficacy of animal and human brucellosis prevention programs.

N-Halamine-modified antimicrobial polypropylene nonwoven fabrics for use against airborne bacteria

Disinfecting, nonbleaching compound 1-chloro-2,2,5,5-tetramethyl-4-imidazolidinone (MC) was uniformly coated onto polypropylene melt-blown nonwoven fabrics having basis-weights of 22 and 50 g/m(2) in order to impart antimicrobial properties via a pad-dry technique. The antimicrobial efficacies of the tested fabrics loaded with MC compound were evaluated against bioaerosols of Staphylococcus aureus and Escherichia coli O157:H7 utilizing a colony counting method. It was determined that both types of coated fabrics exhibited superior antimicrobial efficacy upon exposure to aerosol generation for 3 h. The effect of the coating on air permeability was found to be minimal. Samples were stable for a 6 month time period when they were stored in darkness. However, when the fabrics were exposed to fluorescent light, partial chlorine loss was observed. The MC-coated fabrics exhibited great potential for use in protective face masks and air filters to combat airborne pathogens.

Implementing AORN recommended practices for environmental cleaning

In recent years, researchers have developed an increasing awareness of the role of the environment in the development of health care-associated infections. AORN's "Recommended practices for environmental cleaning" is an evidence-based document that provides specific guidance for cleaning processes, for the selection of appropriate cleaning equipment and supplies, and for ongoing education and quality improvement. This updated recommended practices document has an expanded focus on the need for health care personnel to work collaboratively to accomplish adequately thorough cleanliness in a culture of safety and mutual support. Perioperative nurses, as the primary advocates for patients while they are being cared for in the perioperative setting, should help ensure that a safe, clean environment is reestablished after each surgical procedure.

Comparative proteomic analysis of a Candida albicans DSE1 mutant under filamentous and non-filamentous conditions

Candida albicans is a common opportunistic pathogen that causes a variety of diseases in immunocompromised hosts. In a pathogen, cell wall proteins are important virulence factors. We previously characterized Dse1 as a cell wall protein necessary for virulence and resistance to cell surface-disrupting agents, such as Calcofluor white, chitin deposition, proper adhesion and biofilm formation. In the absence of decomplexation, our objectives were to investigate differential proteomic expression of a DSE1 mutant strain compared to the wild-type strain. The strains were grown under filamentous and non-filamentous conditions. The extracted cell proteome was subjected to tryptic digest, followed by generation of peptide profiles using MALDI-TOF MS. Generated peptide profiles were analysed and unique peaks for each strain and growth condition mined against a Candida database, allowing protein identification. The DSE1 mutant was shown to lack the chitin biosynthesis protein Chs5, explaining the previously observed decrease in chitin biosynthesis. The wild-type strain expressed Pra1, involved in pH response and zinc acquisition, Atg15, a lipase involved in virulence, and Sod1, required for oxidative stress tolerance, in addition to proteins involved in protein biosynthesis, explaining the increase in total protein content observed compared to the mutants strain. The mutant, on the other hand, expressed glucoamylase 1, a cell wall glycoprotein involved in carbohydrate metabolism cell wall degradation and biofilm formation. As such, MALDI-TOF MS is a reliable technique in identifying mutant-specific protein expression in C. albicans.

Use of 70% alcohol for the routine removal of microbial hard surface bioburden in life science cleanrooms

ABSTRACT 

Alcohol-based disinfectants are used for the removal of microbial hard surface bioburden in Life science Cleanrooms. Evidence for using formulations containing 70% alcohol has been lost over time but probably originates from historical observations of the activity of 60–70% alcohol. Tradition is no longer adequate to inform contemporary cleaning practice. We evaluated the efficacy of ethanol, isopropanol and trade-specific denatured alcohol 7 against vegetative Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli and Enterococcus hirae using standardized European Suspension and Hard Surface tests. All three alcohols were effective at lower concentrations than the 70% standard. This constitutes the first evaluation of disinfectant formulations containing ≤70% alcohol using standard methodology. The utility of trade-specific denatured alcohol #7 and evidence-based cleanroom practice warrant further validation.

Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination

There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.

Hydrogen peroxide as an effective disinfectant for Pasteurella multocida

Pasteurella multocida (P. multocida) infections vary widely, from local infections resulting from animal bites and scratches to general infections. As of yet, no vaccine against P. multocida has been developed, and the most effective way to prevent pathogenic transmission is to clean the host environment using disinfectants. In this study, we identified which disinfectants most effectively inhibited environmental isolates of P. multocida. Three readily available disinfectants were compared: 3% hydrogen peroxide (HP), 70% isopropyl alcohol, and synthetic phenol. In suspension tests and zone inhibition tests, 3% HP was the most promising disinfectant against P. multocida.

Insusceptibility to disinfectants in bacteria from animals, food and humans-is there a link to antimicrobial resistance?

Enterococcus faecalis (n = 834) and Enterococcus faecium (n = 135) from blood and feces of hospitalized humans, from feces of outpatients and livestock and from food were screened for their susceptibility to a quaternary ammonium compound (didecyldimethylammoniumchloride, DDAC) and to 28 antibiotics by micro-/macrodilution. The maximum DDAC-MIC in our field study was 3.5 mg/l, but after adaptation in the laboratory, MIC values of 21.9 mg/l were observed. Strains for which DDAC had MICs > 1.4 mg/l ("non-wildtype," in total: 46 of 969 isolates/4.7%) were most often found in milk and dairy products (14.6%), while their prevalence in livestock was generally low (0-4%). Of human isolates, 2.9-6.8% had a "non-wildtype" phenotype. An association between reduced susceptibility to DDAC, high-level-aminoglycoside resistance and aminopenicillin resistance was seen in E. faecium (p < 0.05). No indications for a common source of non-wildtype strains were found by RAPD-PCR; however, several non-wildtype E. faecalis shared the same variant of the emeA-gene. In addition, bacteria (n = 42) of different genera were isolated from formic acid based boot bath disinfectant (20 ml of 55% formic acid/l). The MICs of this disinfectant exceeded the wildtype MICs up to 20-fold (staphylococci), but were still one to three orders of magnitude below the used concentration of the disinfectant (i. e., 1.1% formic acid). In conclusion, the bacterial susceptibility to disinfectants still seems to be high. Thus, the proper use of disinfectants in livestock surroundings along with a good hygiene praxis should still be highly encouraged. Hints to a link between antibiotic resistance and reduced susceptibility for disinfectants-as seen for E. faecium-should be substantiated in further studies and might be an additional reason to confine the use of antibiotics.

Personal and household hygiene, environmental contamination, and health in undergraduate residence halls in New York City, 2011

BACKGROUND

While several studies have documented the importance of hand washing in the university setting, the added role of environmental hygiene remains poorly understood. The purpose of this study was to characterize the personal and environmental hygiene habits of college students, define the determinants of hygiene in this population, and assess the relationship between reported hygiene behaviors, environmental contamination, and health status.

METHODS

501 undergraduate students completed a previously validated survey assessing baseline demographics, hygiene habits, determinants of hygiene, and health status. Sixty survey respondents had microbiological samples taken from eight standardized surfaces in their dormitory environment. Bacterial contamination was assessed using standard quantitative bacterial culture techniques. Additional culturing for coagulase-positive Staphylococcus and coliforms was performed using selective agar.

RESULTS

While the vast majority of study participants (n = 461, 92%) believed that hand washing was important for infection prevention, there was a large amount of variation in reported personal hygiene practices. More women than men reported consistent hand washing before preparing food (p = .002) and after using the toilet (p = .001). Environmental hygiene showed similar variability although 73.3% (n = 367) of subjects reported dormitory cleaning at least once per month. Contamination of certain surfaces was common, with at least one third of all bookshelves, desks, refrigerator handles, toilet handles, and bathroom door handles positive for >10 CFU of bacteria per 4 cm(2) area. Coagulase-positive Staphylococcus was detected in three participants' rooms (5%) and coliforms were present in six students' rooms (10%). Surface contamination with any bacteria did not vary by frequency of cleaning or frequency of illness (p>.05).

CONCLUSIONS

Our results suggest that surface contamination, while prevalent, is unrelated to reported hygiene or health in the university setting. Further research into environmental reservoirs of infectious diseases may delineate whether surface decontamination is an effective target of hygiene interventions in this population.

Current and emergent strategies for disinfection of hospital environments

A significant number of hospital-acquired infections occur due to inefficient disinfection of hospital surfaces, instruments and rooms. The emergence and wide spread of multiresistant forms of several microorganisms has led to a situation where few compounds are able to inhibit or kill the infectious agents. Several strategies to disinfect both clinical equipment and the environment are available, often involving the use of antimicrobial chemicals. More recently, investigations into gas plasma, antimicrobial surfaces and vapour systems have gained interest as promising alternatives to conventional disinfectants. This review provides updated information on the current and emergent disinfection strategies for clinical environments.

Does hygiene intervention at day care centres reduce infectious illnesses in children? An intervention cohort study

BACKGROUND

Day care attendance is a major risk factor for respiratory and gastrointestinal illnesses in preschool children. In this study, we describe the results of a hygiene intervention cohort trial at day care centres (DCCs) on the rates of febrile, respiratory, and gastrointestinal illnesses in preschool children.

METHODS

Thirty DCCs in 2 communities were included. The number of illness episodes was registered for each child every 6 months, as well as potential risk factors. The hygiene intervention was introduced in half of the DCCs and the results analysed using a multivariate mixed effects hierarchical Poisson regression model.

RESULTS

The study lasted 2.5 y, of which the hygiene intervention lasted 1.5 y. Two thousand three hundred and forty-nine children participated, delivering 2832 person-y. Adjusted incidence rate ratios of the illnesses at the intervention and non-intervention DCCs were not significantly different for any of the illnesses. The intervention was not more effective in children less than 3 y of age than in older children and no significant effects were seen with time. Compliance with the hygiene protocol was good as measured by the use of hygiene products and by a survey among the staff at the DCCs.

CONCLUSIONS

The most likely explanation for the lack of effects of the intervention is that the baseline standard of hygiene at the DCCs was probably too high for the intervention to demonstrate significant results, but recall bias cannot be excluded. Even though hygiene is important for minimizing the spread of microbes at DCCs, other risk factors need to be studied.

Fighting nosocomial infections with biocidal non-intrusive hard and soft surfaces

Approximately 7 million people worldwide acquire a healthcare associated infection each year. Despite aggressive monitoring, hand washing campaigns and other infection control measures, nosocomial infections (NI) rates, especially those caused by antibiotic resistant pathogens, are unacceptably high worldwide. Additional ways to fight these infections need to be developed. A potential overlooked and neglected source of nosocomial pathogens are those found in non-intrusive soft and hard surfaces located in clinical settings. Soft surfaces, such as patient pyjamas and beddings, can be an excellent substrate for bacterial and fungal growth under appropriate temperature and humidity conditions as those present between patients and the bed. Bed making in hospitals releases large quantities of microorganisms into the air, which contaminate the immediate and non-immediate surroundings. Microbes can survive on hard surfaces, such as metal trays, bed rails and door knobs, for very prolonged periods of time. Thus soft and hard surfaces that are in direct or indirect contact with the patients can serve as a source of nosocomial pathogens. Recently it has been demonstrated that copper surfaces and copper oxide containing textiles have potent intrinsic biocidal properties. This manuscript reviews the recent laboratory and clinical studies, which demonstrate that biocidal surfaces made of copper or containing copper can reduce the microbiological burden and the NI rates.

Biocide resistance of Candida and Escherichia coli biofilms is associated with higher antioxidative capacities

BACKGROUND

Most clinical guidelines for the use of biocides have been developed for planktonic micro-organisms, but in nature, most micro-organisms live as surface-adherent communities or biofilms.

AIM

To evaluate the effectiveness of commonly used biocides against Escherichia coli and Candida spp. in three distinct growth phases: planktonic, adhesion and biofilm.

METHODS

Ultrastructural, architectural and cellular viability changes following a 5 min exposure to biocide were monitored by scanning electron microscopy and confocal laser scanning microscopy using fluorescent dyes. Comparative transcript expression of the antioxidants SOD1 and CAT1 in the planktonic and biofilm phases was evaluated using quantitative real-time polymerase chain reaction.

FINDINGS

E. coli and Candida spp. in the planktonic phase were susceptible to all the tested biocides at the recommended concentrations. However, early adhesion and late biofilm phases of both were less susceptible to the biocides, and exceeded the recommended concentrations on several occasions. A short period of biocide exposure failed to fully eradicate the adherent microbial cells, and they recovered from the biocide challenge, forming biofilm on the biocide-treated surfaces. The biofilm phase showed higher expression of SOD1 and CAT1.

CONCLUSION

The recommended concentrations of biocides for clinical disinfection in the hospital setting may not fully eradicate the adhesion or biofilm phases of E. coli and Candida spp. Higher antioxidative capacities in microbial biofilms may be responsible for the resistance of biofilms against clinical biocides.

Reproduction numbers for infections with free-living pathogens growing in the environment

The basic reproduction number ℛ(0) for a compartmental disease model is often calculated by the next generation matrix (NGM) approach. When the interactions within and between disease compartments are interpreted differently, the NGM approach may lead to different ℛ(0) expressions. This is demonstrated by considering a susceptible-infectious-recovered-susceptible model with free-living pathogen (FLP) growing in the environment. Although the environment could play different roles in the disease transmission process, leading to different ℛ(0) expressions, there is a unique type reproduction number when control strategies are applied to the host population. All ℛ(0) expressions agree on the threshold value 1 and preserve their order of magnitude. However, using data for salmonellosis and cholera, it is shown that the estimated ℛ(0) values are substantially different. This study highlights the utility and limitations of reproduction numbers to accurately quantify the effects of control strategies for infections with FLPs growing in the environment.

Effect of low-concentration chlorine dioxide gas against bacteria and viruses on a glass surface in wet environments

Aims:  To evaluate the efficacy of low‐concentration chlorine dioxide (ClO₂) gas against model microbes in the wet state on a glass surface.

Methods and Results:  We set up a test room (39 m³) and the ClO₂ gas was produced by a ClO₂ gas generator that continuously releases a constant low‐concentration ClO₂ gas. Influenza A virus (Flu‐A), feline calicivirus (FCV), Staphylococcus aureus and Escherichia coli were chosen as the model microbes. The low‐concentration ClO₂ gas (mean 0·05 ppmv, 0·14 mg m⁻³) inactivated Flu‐A and E. coli (>5 log₁₀ reductions) and FCV and S. aureus (>2 log₁₀ reductions) in the wet state on glass dishes within 5 h.

Conclusions:  The treatment of wet environments in the presence of human activity such as kitchens and bathrooms with the low‐concentration ClO₂ gas would be useful for reducing the risk of infection by bacteria and viruses residing on the environmental hard surfaces without adverse effects.

Significance and Impact of the Study:  This study demonstrates that the low‐concentration ClO₂ gas (mean 0·05 ppmv) inactivates various kinds of microbes such as Gram‐positive and Gram‐negative bacteria, enveloped and nonenveloped viruses in the wet state.

Triclosan: environmental exposure, toxicity and mechanisms of action

Triclosan [5-chloro-2-(2,4-dichlorophenoxy)phenol; TCS] is a broad spectrum antibacterial agent used in personal care, veterinary, industrial and household products. TCS is commonly detected in aquatic ecosystems, as it is only partially removed during the wastewater treatment process. Sorption, biodegradation and photolytic degradation mitigate the availability of TCS to aquatic biota; however the by-products such as methyltriclosan and other chlorinated phenols may be more resistant to degradation and have higher toxicity than the parent compound. The continuous exposure of aquatic organisms to TCS, coupled with its bioaccumulation potential, have led to detectable levels of the antimicrobial in a number of aquatic species. TCS has been also detected in breast milk, urine and plasma, with levels of TCS in the blood correlating with consumer use patterns of the antimicrobial. Mammalian systemic toxicity studies indicate that TCS is neither acutely toxic, mutagenic, carcinogenic, nor a developmental toxicant. Recently, however, concern has been raised over TCS's potential for endocrine disruption, as the antimicrobial has been shown to disrupt thyroid hormone homeostasis and possibly the reproductive axis. Moreover, there is strong evidence that aquatic species such as algae, invertebrates and certain types of fish are much more sensitive to TCS than mammals. TCS is highly toxic to algae and exerts reproductive and developmental effects in some fish. The potential for endocrine disruption and antibiotic cross-resistance highlights the importance of the judicious use of TCS, whereby the use of TCS should be limited to applications where it has been shown to be effective.

N-halamine copolymers for use in antimicrobial paints

A series of copolymers containing units of a novel hydantoinylacrylamide and the sodium salt of 2-(acrylamido)-2-methylpropanesulfonic acid have been synthesized. The homopolymer of the hydantoinylacrylamide compound was insoluble in water, while the copolymers with the sulfonic acid sodium salt were water-dispersible/soluble, with the solution becoming completely transparent when the feed ratio for the copolymer contained 7 parts of the hydantoin moiety to 3 parts of the sodium sulfonate moiety. The polymers were added into a commercial water-based latex paint, and upon drying, the painted surfaces treated with the water-miscible copolymers were rendered antimicrobial following chlorination with dilute household bleach. The chlorinated homopolymer failed to provide an antimicrobial property for the paint because of its tendency to isolate into aggregates in the paint, while the completely miscible copolymers were capable of 6-log inactivation of Staphylococcus aureus and Escherichia coli O157:H7 within 5 min of contact time.

Inactivation of surrogate coronaviruses on hard surfaces by health care germicides

Background

In the 2003 severe acute respiratory syndrome outbreak, finding viral nucleic acids on hospital surfaces suggested surfaces could play a role in spread in health care environments. Surface disinfection may interrupt transmission, but few data exist on the effectiveness of health care germicides against coronaviruses on surfaces.

Methods

The efficacy of health care germicides against 2 surrogate coronaviruses, mouse hepatitis virus (MHV) and transmissible gastroenteritis virus (TGEV), was tested using the quantitative carrier method on stainless steel surfaces. Germicides were o-phenylphenol/p-tertiary amylphenol) (a phenolic), 70% ethanol, 1:100 sodium hypochlorite, ortho-phthalaldehyde (OPA), instant hand sanitizer (62% ethanol), and hand sanitizing spray (71% ethanol).

Results

After 1-minute contact time, for TGEV, there was a log₁₀ reduction factor of 3.2 for 70% ethanol, 2.0 for phenolic, 2.3 for OPA, 0.35 for 1:100 hypochlorite, 4.0 for 62% ethanol, and 3.5 for 71% ethanol. For MHV, log₁₀ reduction factors were 3.9 for 70% ethanol, 1.3 for phenolic, 1.7 for OPA, 0.62 for 1:100 hypochlorite, 2.7 for 62% ethanol, and 2.0 for 71% ethanol.

Conclusion

Only ethanol reduced infectivity of the 2 coronaviruses by >3-log₁₀ after 1 minute. Germicides must be chosen carefully to ensure they are effective against viruses such as severe acute respiratory syndrome coronavirus.

Hygiene: new hopes, new horizons

Although promotion of safe hygiene is the single most cost-effective means of preventing infectious disease, investment in hygiene is low both in the health and in the water and sanitation sectors. Evidence shows the benefit of improved hygiene, especially for improved handwashing and safe stool disposal. A growing understanding of what drives hygiene behaviour and creative partnerships are providing fresh approaches to change behaviour. However, some important gaps in our knowledge exist. For example, almost no trials of the effectiveness of interventions to improve food hygiene in developing countries are available. We also need to figure out how best to make safe hygiene practices matters of daily routine that are sustained by social norms on a mass scale. Full and active involvement of the health sector in getting safe hygiene to all homes, schools, and institutions will bring major gains to public health.

Effectiveness of environmental decontamination as an infection control measure

The effectiveness of environmental decontamination (ED) as a measure in the control of infectious diseases is controversial. This work quantifies the effectiveness of ED by analysing the transmission of pathogens from the environment to susceptible hosts in a Susceptible–Infected–Susceptible model. Analysis of the model shows that ED can render a population disease-free only when the duration of infection (D) is within a certain range. As host-to-host transmission rate is increased,Dfalls outside this range and the higher levels of ED have a diminishing return in reducing the number of infected hosts at endemic equilibrium. To avoid this, ED can be combined with other control measures, such as treating infected individuals to push the duration of infection into the specified range. We propose decision criteria and minimum ED efforts required for control policies to be effective.