Antiseptic Stewardship for Surface Disinfectants

Abstract

Surface disinfectants can be based on different types of biocidal agents such as benzalkonium chloride, DDAC, glutaraldehyde, alcohols, hydrogen peroxide, silver (mostly in combination with hydrogen peroxide), peracetic acid and sodium hypochlorite. A health benefit was described in outbreak situations or on special care units for products based on different types of biocidal agents. A low adaptive response in combination with mostly an inhibition of biofilm formation and removal of existing biofilm can be attributed to none of the biocidal agents. Overall, on surfaces where biofilm formation should be inhibited the use or peracetic acid seems to be the most appropriate option (low selection pressure, mainly inhibition of biofilm formation, mainly moderate removal of biofilm). Hydrogen peroxide and sodium hypochlorite have also a low selection pressure and can moderately remove biofilm but they increased biofilm formation in more species. They seem to be appropriate on surfaces where enhancement of biofilm formation is of minor relevance. Benzalkonium chloride seems to be the least suitable biocidal agent taking into account the frequently observed strong and stable adaptive response, cross-tolerance to some other biocidal agents and selected antibiotics and the inconclusive effect on biofilm formation and removal.