Abstract
Health care-associated infections inflict a huge clinical and economic burden on public health worldwide. Bacterial resistance to antibiotics continues to escalate, and antimicrobial stewardship initiatives have yet to make a major impact. Additionally, the ability of bacteria to evade environmental threats by living within a self-produced protective biofilm and/or producing resistant spores further challenges effective infection control. The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has also amplified the burden significantly. Amidst a particularly challenging infection era, the demand for meticulous infection control and prevention practices is paramount, a key component of which is the use of appropriate disinfectants that can combat a wide variety of microbial pathogens, including diverse forms of viruses and bacteria, particularly highly tolerant spore-forming and biofilm-forming microorganisms. This review addresses the advantages and disadvantages of commonly used disinfectants such as alcohols, hypochlorite, and quaternary ammonium compounds, together with oxidizing agents such as chlorine dioxide and peracetic acid, which are gaining increasing acceptance in routine infection control practices today. Given the increasing requirements for rapid-acting disinfectants that are effective against the toughest of microorganisms (e.g. spores and biofilm), are environmentally friendly, and remain active under diverse environmental conditions, emerging oxidizing agents warrant further consideration, particularly chlorine dioxide, which offers most requirements for an ideal disinfectant, including retention of activity over a broad pH range. Given the critical importance of infection control and antimicrobial stewardship in public health and health care facilities today, consideration of chlorine dioxide as a safe, selective, highly effective, and environmentally friendly disinfectant is warranted.
Highlights
Health care-associated infections inflict a huge clinical and economic burden on public health worldwide
While SARS-CoV-2 wreaks havoc across the globe, a longer-term, underlying, and escalating threat of bacterial resistance to antibiotics continues. Those most seriously affected by SARS-CoV-2 requiring intensive care become more susceptible to serious bacterial infections that antibiotics are increasingly less effective against
Bowler of biofilm – what it is, how it contributes to Health care-associated infections (HCAIs) and antibiotic resistance, and why biofilm should be acknowledged and targeted in infection control practices
Summary
Ethanol and isopropanol Chlorine, iodine, and fluorine Hydrogen peroxide, peracetic acid, and ozone Cetrimide and benzalkonium chloride prevalent of microorganisms in health care facilities. Despite its widespread use in hospital antisepsis and disinfection, alcohol has limited antimicrobial activity (i.e. not effective against bacterial spores) and exhibits other drawbacks including reduced activity in the presence of organic matter, absence of residual activity, limited activity against non-enveloped viruses, and being flammable Both ethanol and isopropyl alcohol have been shown to increase biofilm production in S. aureus and Staphylococcus epidemidis at concentrations ranging from 40 to 95% [19]. Peracetic acid and hydrogen peroxide are oxidizing agents with superior characteristics that include a broad spectrum of antimicrobial activity (including bacterial spores), environmentally friendliness (i.e. no hazardous by-products), absence of compromise by organic matter, and surface compatibility. Another oxidizing agent that has significant advantages over sodium hypochlorite is chlorine dioxide (ClO2). Both NaOCl and ClO2 exhibit broad spectrum antimicrobial activity (including bacterial spores, biofilm, and non-enveloped viruses), but
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