Abstract
BackgroundC. difficle spores in the environment of patients with C. difficile associated disease (CDAD) are difficult to eliminate. Bleach (5000 ppm) has been advocated as an effective disinfectant for the environmental surfaces of patients with CDAD. Few alternatives to bleach for non-outbreak conditions have been evaluated in controlled healthcare studies.MethodsThis study was a prospective clinical comparison during non-outbreak conditions of the efficacy of an accelerated hydrogen peroxide cleaner (0.5% AHP) to the currently used stabilized hydrogen peroxide cleaner (0.05% SHP at manufacturer recommended use-dilution) with respect to spore removal from toilets in a tertiary care facility. The toilets used by patients who had diarrhea with and without C. difficile associated disease (CDAD) were cultured for C. difficile and were monitored using an ultraviolet mark (UVM) to assess cleaning compliance on a daily basis 5 days per week. A total of 243 patients and 714 samples were analysed. The culture results were included in the analysis only if the UVM audit from the same day confirmed that the toilet had been cleaned.ResultsOur data demonstrated that the efficacy of spore killing is formulation specific and cannot be generalized. The OxivirTB® AHP formulation resulted in statistically significantly (p = 0.0023) lower levels of toxigenic C. difficile spores in toilets of patients with CDAD compared to the SHP formulation that was routinely being used (28% vs 45% culture positive). The background level of toxigenic C. difficile spores was 10% in toilets of patients with diarrhea not due to CDAD. The UVM audit indicated that despite the enhanced twice-daily cleaning protocol for CDAD patients cleaning was not achieved on approximately 30 - 40% of the days tested.ConclusionOur data indicate that the AHP formulation evaluated that has some sporicidal activity was significantly better than the currently used SHP formulation. This AHP formulation provides a one-step process that significantly lowers the C. difficile spore level in toilets during non-outbreak conditions without the workplace safety concerns associated with 5000 ppm bleach.
Highlights
C. difficle spores in the environment of patients with C. difficile associated disease (CDAD) are difficult to eliminate
The objective of this research was to determine if the presence of C. difficile spores in toilets of patients with CDAD could be reduced in non-outbreak conditions when a non-bleach based disinfecting agent that had some sporicidal activity was used for cleaning toilets
Preliminary in vitro testing (Figure 2) of various disinfectant formulations using simulated-use suspension testing in the absence of an organic challenge indicated that the OxivirTB® formulation provided a 2-3 Log10 kill of C. difficile spores after only 1 minute exposure
Summary
C. difficle spores in the environment of patients with C. difficile associated disease (CDAD) are difficult to eliminate. Few alternatives to bleach for non-outbreak conditions have been evaluated in controlled healthcare studies. Reducing C. difficile spores from environmental sources is challenging as few surface disinfectant and/or cleaning agents have sporocidal activity in a short enough time-frame (e.g. 3 minutes) to be effective [13]. Neither Wilcox’s original study [16] nor Eckstein’s recent study [9] were able to demonstrate complete eradication of spores when 5,000 ppm bleach was used for cleaning/disinfecting toilet facilities of patients with CDAD. There are no published studies that have audited cleaning compliance in conjunction with evaluating bleach alternatives (that have some sporicidal activity) that could be used for environmental cleaning of CDAD patient toilets during non-outbreak conditions
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