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Bolten A, Schmidt V, Steinhauer K. Use of the European standardization framework established by CEN/TC 216 for effective disinfection strategies in human medicine, veterinary medicine, food hygiene, industry, and domestic and institutional use - a review. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc14. [PMID: 36157383 PMCID: PMC9487781 DOI: 10.3205/dgkh000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The SARS-CoV-2 pandemic illustrates the necessity of effective preventive measures for existing and newly emerging pathogens. When confronted with pathogens or spoilage agents, especially if they are not yet well studied, effective hygiene protocols are needed immediately. In the medical field, effective preventive measures are key to prevent vulnerable patients from infections. In production areas, effective hygiene measures are needed to protect goods from spoilage or microbial contamination. The European standardization framework established by the European Committee for Standardization (CEN) ensures that effective hygiene measures are available and can be immediately implemented when needed. Based on a broad portfolio of standards/laboratory tests, activity claims specifically addressing the special features of applications of antimicrobial formulations are substantiated. In this review, the concept of using standardized surrogate test organisms is explained, and the European standardized test approach to claim microbicidal and virucidal efficacy, the specificity of claims and their relevance for infection prevention measures is illustrated. Furthermore, relevance of the European Norm test methods is elucidated in the light of legal requirements. Finally, the review explains the systematics of the standardized methodological portfolio of CEN, Technical Committee 216, which is very useful when effective strategies for fighting or preventing microbial and viral induced infections, contaminations or spoilage are needed on an immediate basis.
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Affiliation(s)
| | - Verona Schmidt
- Chemische Fabrik Dr. Weigert GmbH & Co. KG, Hamburg, Germany
| | - Katrin Steinhauer
- bactologicum GmbH, Itzehoe, Germany,Faculty of Mechanical Engineering, University of Applied Sciences, Kiel, Germany,*To whom correspondence should be addressed: Katrin Steinhauer, bactologicum GmbH, 25524 Itzehoe, Germany, Phone: +49 4821 13636 36, E-mail:
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Kramer A, Arvand M, Christiansen B, Dancer S, Eggers M, Exner M, Müller D, Mutters NT, Schwebke I, Pittet D. Ethanol is indispensable for virucidal hand antisepsis: memorandum from the alcohol-based hand rub (ABHR) Task Force, WHO Collaborating Centre on Patient Safety, and the Commission for Hospital Hygiene and Infection Prevention (KRINKO), Robert Koch Institute, Berlin, Germany. Antimicrob Resist Infect Control 2022; 11:93. [PMID: 35794648 PMCID: PMC9257567 DOI: 10.1186/s13756-022-01134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The approval of ethanol by the Biocidal Products Regulation has been under evaluation since 2007. This follows concern over alcohol uptake from ethanol-based hand rubs (EBHR). If ethanol is classified as carcinogenic, mutagenic, or reprotoxic by the European Chemicals Agency (ECHA), then this would affect infection prevention and control practices. AIM A review was performed to prove that ethanol is toxicological uncritical and indispensable for hand antisepsis because of its unique activity against non-enveloped viruses and thus the resulting lack of alternatives. Therefore, the following main points are analyzed: The effectiveness of ethanol in hand hygiene, the evidence of ethanol at blood/tissue levels through hand hygiene in healthcare, and the evidence of toxicity of different blood/tissue ethanol levels and the non-comparability with alcoholic consumption and industrial exposure. RESULTS EBHR are essential for preventing infections caused by non-enveloped viruses, especially in healthcare, nursing homes, food industry and other areas. Propanols are effective against enveloped viruses as opposed to non-enveloped viruses but there are no other alternatives for virucidal hand antisepsis. Long-term ingestion of ethanol in the form of alcoholic beverages can cause tumours. However, lifetime exposure to ethanol from occupational exposure < 500 ppm does not significantly contribute to the cancer risk. Mutagenic effects were observed only at doses within the toxic range in animal studies. While reprotoxicity is linked with abuse of alcoholic beverages, there is no epidemiological evidence for this from EBHR use in healthcare facilities or from products containing ethanol in non-healthcare settings. CONCLUSION The body of evidence shows EBHRs have strong efficacy in killing non-enveloped viruses, whereas 1-propanol and 2-propanol do not kill non-enveloped viruses, that pose significant risk of infection. Ethanol absorbed through the skin during hand hygiene is similar to consumption of beverages with hidden ethanol content (< 0.5% v/v), such as apple juice or kefir. There is no risk of carcinogenicity, mutagenicity or reprotoxicity from repeated use of EBHR. Hence, the WHO Task Force strongly recommend retaining ethanol as an essential constituent in hand rubs for healthcare.
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Affiliation(s)
- Axel Kramer
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany. .,WHO Task Force Alcohol-Based Hand Rub, Zürich, Switzerland. .,Institute of Hygiene and Environmental Medicine University Medicine Greifswald, Walther-Rathenau-Straße 38, 17475, Greifswald, Germany.
| | - Mardjan Arvand
- Division Hospital Hygiene, Infection Prevention and Control, Robert-Koch Institute, Berlin, Germany
| | - Bärbel Christiansen
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany.,Department of Hospital Hygiene, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Stephanie Dancer
- Department of Microbiology, University Hospital Hairmyres, Glasgow, UK.,School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Maren Eggers
- Labor Prof. Dr. G. Enders MVZ GbR, Stuttgart, Germany
| | - Martin Exner
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany.,Institute of Hygiene and Public Health, University Hospital, Bonn, Germany
| | - Dieter Müller
- Department of Occupational Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Nico T Mutters
- German Commission for Hospital Hygiene and Infection Prevention at the Robert-Koch Institute, Berlin, Germany.,Institute of Hygiene and Public Health, University Hospital, Bonn, Germany
| | - Ingeborg Schwebke
- German Association for the Control of Virus Diseases (DVV e. V.), Berlin, Germany
| | - Didier Pittet
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva, Hospitals and Faculty of Medicine, Geneva, Switzerland
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Tarka P, Nitsch-Osuch A. Evaluating the Virucidal Activity of Disinfectants According to European Union Standards. Viruses 2021; 13:534. [PMID: 33804814 PMCID: PMC8063834 DOI: 10.3390/v13040534] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/20/2022] Open
Abstract
The disinfection of surfaces in medical facilities is an important element of infection control, including the control of viral infections such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Preparations used for surface disinfection are typically characterized via their activity against test organisms (i.e., viruses, bacteria and fungi) in the laboratory. Typically, these methods use a suspension of the test organism to assess the bactericidal, fungicidal or virucidal activity of a given preparation. However, such suspension methods do not fully imitate real-life conditions. To address this issue, carrier methods have been developed, in which microorganisms are applied to the surface of a carrier (e.g., stainless steel, glass and polyvinyl chloride (PVC)) and then dried. Such methods more accurately reflect the applications in real-life clinical practice. This article summarizes the available methods for assessing the virucidal activity of chemical disinfectants for use in medical facilities based on the current European standards, including the activity against coronaviruses.
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Affiliation(s)
- Patryk Tarka
- Department of Social Medicine and Public Health, Medical University of Warsaw, Oczki Street 3, 02-007 Warsaw, Poland;
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Eggers M, Schwebke I, Suchomel M, Fotheringham V, Gebel J, Meyer B, Morace G, Roedger HJ, Roques C, Visa P, Steinhauer K. The European tiered approach for virucidal efficacy testing - rationale for rapidly selecting disinfectants against emerging and re-emerging viral diseases. ACTA ACUST UNITED AC 2021; 26. [PMID: 33478622 PMCID: PMC7848678 DOI: 10.2807/1560-7917.es.2021.26.3.2000708] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When facing an emerging virus outbreak such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a quick reaction time is key to control the spread. It takes time to develop antivirals and vaccines, and implement vaccination campaigns. Therefore, preventive measures such as rapid isolation of cases and identification and early quarantine of cases' close contacts-as well as masks, physical distancing, hand hygiene, surface disinfection and air control-are crucial to reduce the risk of transmission. In this context, disinfectants and antiseptics with proven efficacy against the outbreak virus should be used. However, biocidal formulations are quite complex and may include auxiliary substances such as surfactants or emollients in addition to active substances. In order to evaluate disinfectants' efficacy objectively, meaningful efficacy data are needed. Therefore, the European Committee for Standardisation technical committee 216 'Chemical disinfectants and antiseptics' Working Group 1 (medical area) has developed standards for efficacy testing. The European tiered approach grades the virucidal efficacy in three levels, with corresponding marker test viruses. In the case of SARS-CoV-2, disinfectants with proven activity against vaccinia virus, the marker virus for the European claim 'active against enveloped viruses', should be used to ensure effective hygiene procedures to control the pandemic.
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Affiliation(s)
- Maren Eggers
- Labor Prof Gisela Enders MVZ GbR, Stuttgart, Germany
| | | | - Miranda Suchomel
- Institute of Hygiene and Applied Immunology, Medical University, Vienna, Austria
| | | | - Jürgen Gebel
- Institute for Hygiene and Public Health, University of Bonn, Germany
| | | | | | | | - Christine Roques
- Faculté des sciences pharmaceutiques, Paul Sabatier University, Toulouse, France
| | - Pilar Visa
- Eurofins BioPharma Product Testing Spain S.L.U, Barcelona, Spain
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