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Biasi A, Gionta M, Pisa F, Pizzuti M, Sortino A, Immesi A, Alt JR, Zampaglione I. Enhancement of microbicidal efficacy of chemical disinfectants when combined with ultrasound technology. J Appl Microbiol 2024; 135:lxae043. [PMID: 38373840 DOI: 10.1093/jambio/lxae043] [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: 11/21/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
AIMS This study investigated the antimicrobial efficacy of ultrasound technology (US) in combination with two different disinfectants (Disinfectant A and Disinfectant B), containing peracetic acid (PAA) and quaternary ammonium compounds (QACs), respectively, against two sporigenic pathogens, Aspergillus brasiliensis and Bacillus subtilis. METHODS AND RESULTS The microbicidal activity of the coupled treatment was compared with the use of the disinfectants alone, and the efficacy of the disinfection strategies was evaluated by the log reduction of the population of the microorganism inoculated onto stainless-steel surface. The combination treatment resulted in a log reduction of 5.40 and 3.88 (Disinfectant A + US) against A. brasiliensis and B. subtilis, at 850 and 500 ppm PAA, compared to 265 and 122 (Disinfectant A only). For Disinfectant B, in combination with US, showed a logarithmic reduction of 5.04 and 4.79 against A. brasiliensis and B. subtilis at 078% v v-1 and 392% v v-1 QACs, respectively, vs. 1.58 and 1.64 (Disinfectant B only). Moreover, no colonies or not statistically significant growth was observed within the US bath containing the disinfectant. CONCLUSIONS The antimicrobial efficacy of the two disinfectants was greatly enhanced when used in combination with US, and this also makes it possible to avoid the overuse of chemicals for disinfection.
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Affiliation(s)
- Antonio Biasi
- Cantel Medical Italy, a STERIS Company, Via Laurentina, 169, 00071 Pomezia, Italy
| | - Mirella Gionta
- Cantel Medical Italy, a STERIS Company, Via Laurentina, 169, 00071 Pomezia, Italy
| | - Federica Pisa
- Cantel Medical Italy, a STERIS Company, Via Laurentina, 169, 00071 Pomezia, Italy
| | - Maura Pizzuti
- Cantel Medical Italy, a STERIS Company, Via Laurentina, 169, 00071 Pomezia, Italy
| | - Andrea Sortino
- Cantel Medical Italy, a STERIS Company, Via Laurentina, 169, 00071 Pomezia, Italy
| | - Alessio Immesi
- Cantel Medical Italy, a STERIS Company, Via Laurentina, 169, 00071 Pomezia, Italy
| | - Jodi R Alt
- STERIS Corporation, 5960 Heisley Rd, Mentor, OH 44060, USA
| | - Imma Zampaglione
- Cantel Medical Italy, a STERIS Company, Via Laurentina, 169, 00071 Pomezia, Italy
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Geraldes C, Tavares L, Gil S, Oliveira M. Biocides in the Hospital Environment: Application and Tolerance Development. Microb Drug Resist 2023; 29:456-476. [PMID: 37643289 DOI: 10.1089/mdr.2023.0074] [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] [Indexed: 08/31/2023] Open
Abstract
Hospital-acquired infections are a rising problem with consequences for patients, hospitals, and health care workers. Biocides can be employed to prevent these infections, contributing to eliminate or reduce microorganisms' concentrations at the hospital environment. These antimicrobials belong to several groups, each with distinct characteristics that need to be taken into account in their selection for specific applications. Moreover, their activity is influenced by many factors, such as compound concentration and the presence of organic matter. This article aims to review some of the chemical biocides available for hospital infection control, as well as the main factors that influence their efficacy and promote susceptibility decreases, with the purpose to contribute for reducing misusage and consequently for preventing the development of resistance to these antimicrobials.
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Affiliation(s)
- Catarina Geraldes
- Department of Animal Health, Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), Lisbon, Portugal
| | - Luís Tavares
- Department of Animal Health, Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), Lisbon, Portugal
| | - Solange Gil
- Department of Animal Health, Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), Lisbon, Portugal
- Department of Animal Health, Biological Isolation and Containment Unit (BICU), Veterinary Hospital, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
| | - Manuela Oliveira
- Department of Animal Health, Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), Lisbon, Portugal
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Seo J, Song R. [Effect of 2% Chlorhexidine Bathing on the Incidence of Hospital-Acquired Infection and Multidrug-Resistant Organisms in Adult Intensive Care Unit Patients: Systematic Review and Meta-Analysis]. J Korean Acad Nurs 2021; 51:414-429. [PMID: 34497251 DOI: 10.4040/jkan.21046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/21/2021] [Accepted: 06/15/2021] [Indexed: 01/30/2023]
Abstract
PURPOSE This systematic review and meta-analysis analyzed the effects of 2% chlorhexidine bathing on the incidence of hospital-acquired infection (HAI) and multidrug-resistant organisms (MDRO) in adult intensive care units. METHODS PubMed, CINAHL, Cochrane library, and RISS database were systematically searched, and 12 randomized studies were included in the analysis. Comprehensive Meta-Analysis version 3.0 was used to calculate the effect size using the odds ratio (OR) and a 95% confidence interval (CI). Subgroup analysis was performed according to the specific infection and intervention types. RESULTS In general, 2% chlorhexidine bathing has a significant effect on the incidence of HAI (OR, 0.59; 95% CI, 0.40~0.86) and MDRO (OR, 0.52; 95% CI, 0.34~0.79). Subgroup analyses show 2% chlorhexidine bathing is effective in bloodstream infections (OR, 0.51; 95% CI, 0.39~0.66) but not for urinary tract infections, ventilator-associated pneumonia infections, and Clostridium difficile infections. Moreover, 2% chlorhexidine bathing alone or its combination with other interventions has a significant effect on the incidence of HAI and MDRO (OR, 0.59; 95% CI, 0.38~0.92). CONCLUSION This meta-analysis reveals that 2% chlorhexidine bathing significantly reduces the incidence of HAI and MDRO in intensive care units. The effect of 2% chlorhexidine bathing on pediatric patients or patients at general wards should be further assessed as a cost-effective intervention for infection control.
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Affiliation(s)
- Jisu Seo
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Rhayun Song
- College of Nursing, Chungnam National University, Daejeon, Korea.
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What's new and notable in bacterial spore killing! World J Microbiol Biotechnol 2021; 37:144. [PMID: 34351499 PMCID: PMC8342367 DOI: 10.1007/s11274-021-03108-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023]
Abstract
Spores of many species of the orders Bacillales and Clostridiales can be vectors for food spoilage, human diseases and intoxications, and biological warfare. Many agents are used for spore killing, including moist heat in an autoclave, dry heat at elevated temperatures, UV radiation at 254 and more recently 222 and 400 nm, ionizing radiation of various types, high hydrostatic pressures and a host of chemical decontaminants. An alternative strategy is to trigger spore germination, as germinated spores are much easier to kill than the highly resistant dormant spores—the so called “germinate to eradicate” strategy. Factors important to consider in choosing methods for spore killing include the: (1) cost; (2) killing efficacy and kinetics; (3) ability to decontaminate large areas in buildings or outside; and (4) compatibility of killing regimens with the: (i) presence of people; (ii) food quality; (iii) presence of significant amounts of organic matter; and (iv) minimal damage to equipment in the decontamination zone. This review will summarize research on spore killing and point out some common flaws which can make results from spore killing research questionable.
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Chlorhexidine Gluconate Bathing Reduces the Incidence of Bloodstream Infections in Adults Undergoing Inpatient Hematopoietic Cell Transplantation. Transplant Cell Ther 2021; 27:262.e1-262.e11. [PMID: 33781532 DOI: 10.1016/j.jtct.2021.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/09/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022]
Abstract
Bloodstream infections (BSIs) occur in 20% to 45% of inpatient autologous and allogeneic hematopoietic cell transplant (HCT) patients. Daily bathing with the antiseptic chlorhexidine gluconate (CHG) has been shown to reduce the incidence of BSIs in critically ill patients, although very few studies include HCT patients or have evaluated the impact of compliance on effectiveness. We conducted a prospective cohort study with historical controls to assess the impact of CHG bathing on the rate of BSIs and gut microbiota composition among adults undergoing inpatient HCT at the Duke University Medical Center. We present 1 year of data without CHG bathing (2016) and 2 years of data when CHG was used on the HCT unit (2017 and 2018). Because not all patients adhered to CHG, patients were grouped into four categories by rate of daily CHG usage: high (>75%), medium (50% to 75%), low (1% to 49%), and none (0%). Among 192 patients, univariate trend analysis demonstrated that increased CHG usage was associated with decreased incidence of clinically significant BSI, defined as any BSI requiring treatment by the medical team (high, 8% BSI; medium, 15.2%; low, 15.6%; no CHG, 30.3%; P = .003), laboratory-confirmed BSI (LCBI; P = .03), central line-associated BSI (P = .04), and mucosal barrier injury LCBI (MBI-LCBI; P = .002). Multivariate analysis confirmed a significant effect of CHG bathing on clinically significant BSI (P = .023) and MBI-LCBI (P = .007), without consistently impacting gut microbial diversity. Benefits of CHG bathing were most pronounced with >75% daily usage, and there were no adverse effects attributable to CHG. Adherence to daily CHG bathing significantly decreases the rate of bloodstream infection following HCT.
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Javitt MJ, Grossman A, Grajewski A, Javitt JC. Association Between Eliminating Water From Surgical Hand Antisepsis at a Large Ophthalmic Surgical Hospital and Cost. JAMA Ophthalmol 2020; 138:382-386. [PMID: 32105297 DOI: 10.1001/jamaophthalmol.2020.0048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Alcohol-based surgical scrub is recommended for presurgical antisepsis by leading health organizations. Despite this recommendation, water-based scrub techniques remain common practice at many institutions. Objective To calculate the potential financial savings that a large, subspecialty ophthalmic surgical center can achieve with a conversion to waterless surgical hand preparation. Design, Setting, and Participants A review of accounting records associated with the purchase of scrubbing materials and water company invoices was conducted to assess direct costs attributable to water consumption and scrub materials for brushless, alcohol-based surgical scrub and water-based presurgical scrub. The flow rate of scrub sinks to estimate water consumption per year was tested. Savings associated with operating room (OR) and personnel time were calculated based on the prescribed scrub times for waterless techniques vs traditional running-water techniques. The study was conducted from January 5 to March 1, 2019. Main Outcomes and Measures The primary outcomes for this study were the quantity of water consumed by aqueous scrubbing procedures as well as the cost differences between alcohol-based surgical scrub and water-based scrub procedures per OR per year. Results Scrub sinks consumed 15.9 L of water in a 2-minute period, projecting a savings of 61 631 L and $277 in water and sewer cost per operating room per year. Alcohol-based surgical scrub cost $1083 less than aqueous soap applied from wall-mounted soap dispensers and $271 less than preimpregnated scrub brushes per OR per year in supply costs. The decrease in scrub time from adopting waterless scrub technique could save between approximately $280 000 and $348 000 per OR per year. Conclusions and Relevance Adopting waterless scrub techniques has the potential for economic savings attributable to water. Savings may be larger for surgical facilities performing more personnel-intensive procedures.
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Affiliation(s)
- Matthew J Javitt
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Adriana Grossman
- Medical Student, University of Miami Miller School of Medicine, Miami, Florida
| | - Alana Grajewski
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jonathan C Javitt
- Dana Center for Preventive Ophthalmology, Wilmer Ophthalmological Institute, Baltimore, Maryland
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CLOSTRIDIUM PERFRINGENS PANOPHTHALMITIS AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTION. Retin Cases Brief Rep 2017; 14:192-194. [PMID: 29155693 DOI: 10.1097/icb.0000000000000655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This report describes a fulminant infection with Clostridium perfringens after an intravitreal anti-vascular endothelial growth factor injection. METHODS This is a retrospective case review. RESULTS Our patient's rapid infection eventually led to enucleation, despite broad-spectrum antibiotic therapy. CONCLUSION Reporting rare causes and common clinical findings of C. perfringens ocular infection may lead to earlier detection and intervention.
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Prospective, randomised, controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine. J Glob Antimicrob Resist 2017; 8:159-163. [PMID: 28216018 DOI: 10.1016/j.jgar.2016.12.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/19/2016] [Accepted: 12/02/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Chlorhexidine (CHX) is the most commonly used oral hygiene product for the prevention of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation (MV). The change in dental plaque (DP) microbiota following CHX use in patients under MV has not been described previously. The aim of this study was to evaluate the incidence of pathogenic bacteria associated with VAP and the coverage of DP within the oral cavity in patients administered CHX. METHODS This was a prospective, randomised, controlled, double-blind study in patients (n=16) under MV who were mouth-rinsed with either CHX or placebo. Microbiology samples were collected from the oral mucosa (OM) and DP after admission to the ICU and on Days 3, 5, 7 and 10. Minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of CHX were determined. RESULTS Upon admission, the occurrence of multidrug-resistant (MDR) bacteria, including carbapenem-resistant Klebsiella pneumoniae, was reported. The CHX group had a lower incidence of methicillin-resistant Staphylococcus aureus (MRSA) compared with the placebo group for the OM (RR=0.51, 95% CI 0.27-0.98; P=0.011). There was high agreement between the culture results of OM and DP (κ=0.825). VAP developed in six patients. The species identified following tracheal aspiration of VAP patients were similar to those found in the OM for four cases. The strains showed low MICs and MBCs for CHX (<0.039mg/mL). CONCLUSIONS Although DP is rapidly colonised by MDR bacteria, use of 2% CHX reduced the incidence of S. aureus colonisation.
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Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: A review of the literature. Am J Infect Control 2016; 44:e17-21. [PMID: 27131130 DOI: 10.1016/j.ajic.2016.02.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/25/2016] [Indexed: 12/17/2022]
Abstract
Chlorhexidine bathing is effective in reducing levels of pathogens on skin. In this review, we examine the evidence that chlorhexidine bathing can prevent colonization and infection with health care-associated pathogens and reduce dissemination to the environment and the hands of personnel. The importance of education and monitoring of compliance with bathing procedures is emphasized in order to optimize chlorhexidine bathing in clinical practice.
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Leggett M, Setlow P, Sattar S, Maillard JY. Assessing the activity of microbicides against bacterial spores: knowledge and pitfalls. J Appl Microbiol 2016; 120:1174-80. [DOI: 10.1111/jam.13061] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/25/2015] [Accepted: 10/14/2015] [Indexed: 11/27/2022]
Affiliation(s)
- M.J. Leggett
- Cardiff School of Pharmacy and Pharmaceutical Sciences; Cardiff University; Cardiff UK
| | | | - S.A. Sattar
- Faculty of Medicine; University of Ottawa; Ottawa ON Canada
| | - J.-Y. Maillard
- Cardiff School of Pharmacy and Pharmaceutical Sciences; Cardiff University; Cardiff UK
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Nerandzic MM, Sankar C T, Setlow P, Donskey CJ. A Cumulative Spore Killing Approach: Synergistic Sporicidal Activity of Dilute Peracetic Acid and Ethanol at Low pH Against Clostridium difficile and Bacillus subtilis Spores. Open Forum Infect Dis 2015; 3:ofv206. [PMID: 26885539 PMCID: PMC4751341 DOI: 10.1093/ofid/ofv206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/29/2015] [Indexed: 01/05/2023] Open
Abstract
The synergistic combination of dilute peracetic acid and ethanol at low pH provides a novel approach for development of a rapid and effective method for reducing C. difficile spores on skin. Background. Alcohol-based hand sanitizers are the primary method of hand hygiene in healthcare settings, but they lack activity against bacterial spores produced by pathogens such as Clostridium difficile and Bacillus anthracis. We previously demonstrated that acidification of ethanol induced rapid sporicidal activity, resulting in ethanol formulations with pH 1.5–2 that were as effective as soap and water washing in reducing levels of C difficile spores on hands. We hypothesized that the addition of dilute peracetic acid (PAA) to acidified ethanol would enhance sporicidal activity while allowing elevation of the pH to a level likely to be well tolerated on skin (ie, >3). Methods. We tested the efficacy of acidified ethanol solutions alone or in combination with PAA against C difficile and Bacillus subtilis spores in vitro and against nontoxigenic C difficile spores on hands of volunteers. Results. Acidification of ethanol induced rapid sporicidal activity against C difficile and to a lesser extent B subtilis. The addition of dilute PAA to acidified ethanol resulted in synergistic enhancement of sporicidal activity in a dose-dependent fashion in vitro. On hands, the addition of 1200–2000 ppm PAA enhanced the effectiveness of acidified ethanol formulations, resulting in formulations with pH >3 that were as effective as soap and water washing. Conclusions. Acidification and the addition of dilute PAA induced rapid sporicidal activity in ethanol. Our findings suggest that it may be feasible to develop effective sporicidal ethanol formulations that are safe and tolerable on skin.
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Affiliation(s)
| | - Thriveen Sankar C
- Case Western Reserve University School of Medicine , Cleveland, Ohio
| | - Peter Setlow
- Department of Molecular, Microbial and Structural Biology , University of Connecticut Health Center , Farmington
| | - Curtis J Donskey
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Geriatric Research, Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Ohio
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Nerandzic MM, Sunkesula VCK, C. TS, Setlow P, Donskey CJ. Unlocking the Sporicidal Potential of Ethanol: Induced Sporicidal Activity of Ethanol against Clostridium difficile and Bacillus Spores under Altered Physical and Chemical Conditions. PLoS One 2015; 10:e0132805. [PMID: 26177038 PMCID: PMC4503543 DOI: 10.1371/journal.pone.0132805] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/19/2015] [Indexed: 01/05/2023] Open
Abstract
Background Due to their efficacy and convenience, alcohol-based hand sanitizers have been widely adopted as the primary method of hand hygiene in healthcare settings. However, alcohols lack activity against bacterial spores produced by pathogens such as Clostridium difficile and Bacillus anthracis. We hypothesized that sporicidal activity could be induced in alcohols through alteration of physical or chemical conditions that have been shown to degrade or allow penetration of spore coats. Principal Findings Acidification, alkalinization, and heating of ethanol induced rapid sporicidal activity against C. difficile, and to a lesser extent Bacillus thuringiensis and Bacillus subtilis. The sporicidal activity of acidified ethanol was enhanced by increasing ionic strength and mild elevations in temperature. On skin, sporicidal ethanol formulations were as effective as soap and water hand washing in reducing levels of C. difficile spores. Conclusions These findings demonstrate that novel ethanol-based sporicidal hand hygiene formulations can be developed through alteration of physical and chemical conditions.
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Affiliation(s)
- Michelle M. Nerandzic
- Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
- * E-mail:
| | - Venkata C. K. Sunkesula
- Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Thriveen Sankar C.
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Peter Setlow
- Department of Molecular Biology and Biophysics, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Curtis J. Donskey
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Geriatric Research, Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
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