Alcohol-based Disinfectants Research Articles

Evaluation of skin surface hydration state and barrier function of stratum corneum of dorsa of hands and heels treated with PROTECT X2 skin protective cream

Skin roughness is a term commonly used in Japan to describe a poor skin condition related to a rough and dry skin surface that develops as a result of various damaging effects from the environment or skin inflammation. Recovery from skin roughness requires skin care for a long period, thus it is important to prevent development of such skin changes. PROTECT X2 contains agents used for a protective covering of the skin from frequent hand washing or use of alcohol-based disinfectants. These unique components are also thought to be effective to treat skin roughness of the dorsa of the hands and heels. In the present study, we evaluated the effectiveness of PROTECT X2 to increase skin surface hydration state, as well as enhance the barrier function of the stratum corneum of the dorsa of the hands and heels in elderly individuals. A total of 8 elderly subjects and their caretakers without any skin diseases participated in the study. They applied PROTECT X2 by themselves to the dorsum area of 1 hand and heel 3 to 5 times daily for 1 month, while the opposite sides were left untreated. We measured stratum corneum (SC) hydration and transepidermal water loss (TEWL) before beginning treatment, then 1 week and 1 month after the start of treatment to compare between the treated and untreated skin. SC hydration state after applications of PROTECT X2 was 1.5- to 3.0-fold higher than that of the untreated skin in the dorsa of both hands and heels, indicating that the moisturizing ingredients accompanied by water were replenished in those areas where the cream was applied. Also, TEWL in the dorsum of the hands was 17.0-27.9% lower on the treated side, indicating improvement in SC barrier function. On the basis of these findings, we concluded that PROTECT X2 enhances water-holding in the SC and aids the barrier function of the skin in the dorsum of the hands. In addition, we consider that this formulation is useful for not only protecting the hands from the effects of such agents as detergents and alcohol-based disinfectants, but also for protecting heel skin covered by a thick SC from dry and cold conditions such as those encountered in winter. However, since the SC in that area is much thicker than that of the hands, the barrier function was not significantly improved within 1 month of daily treatments.

Effect of Disinfectants on Glucose Monitors

Monitoring blood glucose levels is an integral part of routine diabetes management. To minimize the risk of transmission of bloodborne pathogens during monitoring, the Centers for Disease Control and Prevention (CDC) recommends that glucose meters be disinfected after each use whenever they are used to test multiple patients. The objective of this study is to assess the compatibility of some common disinfectants with certain blood glucose meter systems. We tested six disinfectants for adverse impact on meter performance or the exterior meter surfaces. The disinfectants tested were 0.525% sodium hypochlorite, 20% 2-propanol and 10% ethanol, 17.2% isopropanol, 55% isopropanol, 70% isopropanol, and hydrogen peroxide. To assess meter performance, we tested OneTouch® Ultra® blood glucose monitoring systems with control solution before and after application of either water or disinfectant. To assess the effect on exterior meter surfaces, we performed a soaking test to simulate long-term exposure to disinfectant. Paired t-test results showed that the control solution data associated with disinfectant and with water application were not significantly different for each meter type. However, most of the meter types were adversely affected by hydrogen peroxide and/or by the higher concentrations of alcohol-based disinfectants. Although none of the six disinfectants affected meter performance, hydrogen peroxide and isopropanol >20% adversely affected the exterior surfaces of the tested meters. When complying with CDC instructions for meter disinfection, users should use caution and choose disinfectants that have been validated by the meter manufacturer.

Serratia marcescens Infections and Outbreaks in Neonatal Intensive Care Units

Serratia marcescensis an important cause of hospital-acquired infections, especially in neonatal intensive care units (NICUs). this review analyzes clinical signs, risk factors, biotyping and sources of infection in newborns exhibited by this bacteria as well as the therapy which is commonly used and management. This review examines the reported cases of outbreaks of S. marcescensin NiCUs published in pubmed over the last 10 years. This report highlights the different prevention and control strategies employed in order to eradicate Serratia out breaks in NICUs, including all healthcare procedures such as hand washing, introduction of alcohol-based antiseptic gel, enhanced cleaning and disinfection of medical equipment and wards, use of single-patient medical instruments, cohorting of colonized and infected infants, periodic screening cultures, earliest discharge of the infants.

Microbiological Efficacy and Tolerability of a New, Non-Alcohol-Based Hand Disinfectant

Alcohol-based hand disinfectants are widely used in hospitals. Occasionally, there is a need for non-alcohol-based products, but alternatives have been scarce. We studied the microbiological efficacy and tolerability of a water-based hand disinfectant for healthcare workers. A water-based hand disinfectant was introduced as the only hand disinfectant in 5 wards in Turku University Hospital, Finland. Ninety-nine healthcare workers participated in fingerprint sampling during the 7-week study period. In another ward, 26 healthcare workers who were using alcohol-based hand disinfectant acted as control subjects for the skin reaction studies. The water-based product was tested in the laboratory according to the European standard EN 12791. We obtained 292 fingerprint samples before disinfection and 302 after disinfection. The opinions of healthcare workers were collected by use of a questionnaire, and skin reactions were assessed subjectively by use of questionnaires and objectively by measuring moisture and transepidermal water loss. When tested in accordance with the European standard, the product met the requirements for short-term and long-term efficacy. The results of the fingerprint test showed that there was a statistically significant decrease in colonization of the fingertips before and after disinfection (P<.001). The users of the water-based hand disinfectant reported dry skin more often than did control subjects, but visual inspection and the results of the moisture measurement showed no difference between the users of the water-based hand disinfectant and the control subjects. Transepidermal water loss measurement also showed no deterioration of skin condition. The water-based hand disinfectant was shown to be an effective hand disinfectant that caused relatively little skin irritation and can serve as a hand hygiene alternative in situations in which alcohol-based disinfectant cannot be used.

Bacterial contamination of cystic fibrosis clinics

Background Respiratory pathogens from CF patients can contaminate inpatient settings, which may be associated with increased risk of patient-to-patient transmission. Few data are available that assess the rate of bacterial contamination of outpatient settings. We determined the frequency of contamination of CF clinics and the effectiveness of alcohol-based disinfectants in reducing hand carriage of bacterial pathogens. Methods We conducted a point prevalence survey and before–after trial in outpatient clinics at 7 CF centers. The study examined CF patients with positive respiratory cultures for Pseudomonas, Staphylococcus, Stenotrophomonas or Burkholderia species. Hand carriage and environmental contamination with respiratory pathogens were assessed during clinic visits (Part I) and the effectiveness of hand hygiene performed by CF patients (Part II) was determined using molecular typing of recovered isolates. Results In Part I ( n = 97), the contamination rate was 13.6%. Pseudomonas and S. aureus, including methicillin-resistant strains, were cultured from patients' hands (7%), the exam room air (8%), and less commonly, environmental surfaces (1%). In Part II ( n = 100), the hand carriage rate of pathogens was 13.5% and 4 participants without initial detection of pathogens had hand contamination when recultured at the end of the clinic visit. Conclusions Respiratory pathogens from CF patients can contaminate their hands and the clinic environment, but the actual risk of patient-to-patient transmission in the outpatient setting remains difficult to quantify. These findings support several recommendations CF infection control recommendations including hand hygiene for staff and patients, contact precautions for certain pathogens, and disinfecting equipment and surfaces touched by patients and staff.

A Comparison of the Antimicrobial Property of Lidocaine/Prilocaine Cream (EMLA®) and an Alcohol-Based Disinfectant on Intact Human Skin Flora

The application of EMLA cream is indicated for topical anesthesia of the skin in connection with IV cannulation. Recently, we described that EMLA cream has an antibacterial effect in vitro. The impact of the local anesthetic lidocaine/prilocaine cream (EMLA) on intact human skin flora was compared to that of an alcohol-based skin disinfectant (Skinsept Pur). Samples were taken from 0 to 12 h after treatment. The number of colony forming units (cfu) on the skin decreased significantly after both EMLA and Skinsept Pur treatment from 44.9 +/- 1.3 (42.4 +/- 7.0) to 0.9 +/- 0.17 (1.61 +/- 0.47) cfu/cm(2), respectively (mean +/- sem), at the first sampling time (1 h) and remained significantly below 0 h values for the study period. The cfu count was significantly lower with EMLA cream at 4, 6, and 12 h compared to Skinsept Pur. EMLA cream has a longer bacteriostatic effect after early bactericidal impact compared to skin disinfection with Skinsept Pur.

Alcohol‐based hand‐disinfection reduced children's absence from Swedish day care centers

To determine if the use of alcohol-based hand-disinfection as a complement to regular hand washing at daycare centers (DCCs) can reduce the childhood rate of absenteeism. Children aged 0-6 years attending DCC were studied in a cluster randomized controlled trial during 30 weeks. Thirty matched pairs of DCCs were included in the study, where one of the DCCs was randomized to intervention and the other to control within each pair. The intervention consisted in children and staff using alcohol-based oily disinfectant gel containing 70% ethanol after regular hand washing. The main outcome was the rate of episodes of absence from DCC due to infection. A regression model was fitted at the individual level and controlling several possible confounders for illness. Absences were reported by the parents. Differences in missing absence reports between the two groups led to only evaluating those 29 DCCs (1431 children) that were able to provide complete reports. In the multivariate regression, the intervention significantly reduced the rate of absenteeism of a child by 12% compared to a child in a control DCC (IRR 95% CI: 0.799-0.965). Hand-disinfection used by children and staff significantly decreased childrens absences due to infections in Swedish DCCs.

Improving adherence to surgical hand preparation

At present, no universal agreement on detailed practice for surgical hand preparation exists. In order to fill this gap, in 2002 a Franco-German recommendation for surgical hand preparation was published as a first step towards a generally accepted European recommendation. Based on an assessment of the actual literature, a protocol for surgical hand preparation is discussed with the aim to recommend evidence-based standard procedures including prerequisites, washing and disinfection phase, and its practical implementation. In contrast to hygienic hand disinfection, for surgical hand preparation compliance is not an issue, since it mostly is regarded as a ceremony which is carried out without exception. Nevertheless, the following factors influence acceptance and efficacy: skin tolerance, ease of use, duration of procedure, and recommended time), potential for impaired efficacy due to incorrect performance of the procedure, possibility of systemic risks and irritating potential by applied preparations, religious restrictions, ecological aspects, costs and safety. Here, we report our experience with the introduction of a new hand preparation regime in all surgical disciplines in our university hospital based on the above factors. The following statements were evaluated: 1) The immediate efficacy of an alcohol-based hand disinfectant is impaired by a preceding hand wash for up to 10 minutes. Therefore hands should not be routinely washed before the disinfection period unless there is a good reason for it such as visible soiling. 2) A shortened application time (1.5 minutes) is equal to 3 min in terms of efficacy. 3) Hands should be air dried before gloves are put on, otherwise the perforation rate of gloves will increase. 4) The efficacy of alcohol-based disinfectants is significantly higher when hands are allowed to dry for 1 minute after the washing phase and before the disinfection phase. To clarify the above questions before the establishment of the modified technique, the surgical team was invited to a meeting. As a result, the heads of surgical departments supported the new technique and decided to change their practice.

Benzyl alcohol and ethanol can enhance the pathogenic potential of clinical Staphylococcus epidermidis strains

Staphylococcus epidermidis is the most frequent cause of health care-associated infections, particularly in neonates and patients with indwelling catheters. The pathogenesis of infections caused by this organism is associated with its ability to form biofilms. We hypothesized that alcohol used in skin disinfectants, as well as preservative in solutions administered through catheters, can enhance biofilm formation by S epidermidis. We performed polymerase chain reaction (PCR) analysis to investigate the prevalence of ica locus in a collection of 169 commensal and clinical S epidermidis strains. Using a microtiter plate assay, we examined the effect of ethanol and benzyl alcohol on biofilm production. Quantitative real-time reverse transcriptase PCR analysis evaluated quantitative changes in gene expression. We found that ica-positive but biofilm-negative or low-grade biofilm-positive S epidermidis strains displayed induction or increase in biofilm production after incubation in media supplemented with both ethanol and benzyl alcohol. The expression of the icaADBC operon was up-regulated in the presence of alcohol. Our results suggest that biofilm production and, therefore, the pathogen potential of S epidermidis can be induced by alcohol. Considering the routine use of alcohol-based skin disinfectants and benzyl alcohol-containing solutions in hospitals, the alcohol-inducible biofilm phenotype of S epidermidis has potentially profound clinical ramifications.

Effects of disinfectants and detergents on skin irritation

We investigated the biological response of regular human skin to alcohol-based disinfectants and detergents in a repetitive test design. Using non-invasive diagnostic tools such as transepidermal water loss, laser-Doppler flowmetry and corneometry, we quantified the irritative effects of a propanol-based hand disinfectant (Sterillium), its propanol mixture (2-propanol 45% w/w and 1-propanol 30% w/w), sodium lauryl sulfate (SLS) 0.5% and distilled water. The substances were applied in a 2-D patch test in a repetitive occlusive test design to the back. Additionally, we performed a wash test on the forearms that was supposed to mimic the skin affection in the normal daily routine of health care workers. In this controlled half-side test design, we included the single application of the hand rub, SLS 0.5% and water as well as a tandem application of the same substances. Patch test and wash test showed similar results. The alcohol-based test preparations showed minimal irritation rather comparable to the application of water. However, the detergent SLS produced stronger barrier disruption, erythema and dryness than the alcohol-based preparations. There was no additional irritation at the combined use of SLS and disinfectants. By contrary, there was even a decrease in barrier disruption and erythema induced by the tandem application of SLS followed by alcohol-based disinfection compared with the use of SLS alone. These findings show a less irritant effect of alcohol-based disinfectants on the skin than detergents. Our study shows that there is no summation of irritating effects of a common detergent and propanol and that the combination of washing and disinfection has a rather protective aspect compared with washing alone.

Hygienic safety of reusable tap water filters (Germlyser®) with an operating time of 4 or 8 weeks in a haematological oncology transplantation unit

BackgroundMicrobial safe tap water is crucial for the safety of immunosuppressed patients.MethodsTo evaluate the suitability of new, reusable point-of-use filters (Germlyser®, Aquafree GmbH, Hamburg, Germany), three variations of a reusable filter with the same filter principle but with different outlets (with and without silver) and inner surface coating of the filter encasements (with and without nano-crystalline silver) were tested. The filter efficacy was monitored over 1, 4 and 8 weeks operating time in a haematological oncology transplantation unit equipped with 18 water outlets (12 taps, 6 showers).ResultsThe filtered water fulfilled the requirements of absence of pathogens over time. From 348 samples, 8 samples (2.3%) exceeded 100 cfu/ml (no sample ≥ 500 cfu/ml). As no reprocessed filter exhibited 100% filter efficacy in the final quality control after each reprocessing, these contaminations could be explained by retrograde contamination during use.ConclusionAs a consequence of the study, the manufacturer recommends changing filters after 4 weeks in high risk areas and after 8 weeks in moderate infectious risk areas, together with routine weekly alcohol-based surface disinfection and additionally in case of visible contamination. The filter efficacy of the 3 filters types did not differ significantly regarding total bacterial counts. Manual reprocessing proved to be insufficient. Using a validated reprocessing in a washer/disinfector with alkaline, acid treatment and thermic disinfection, the filters were effectively reprocessable and now provide tap water meeting the German drinking water regulations as well as the WHO guidelines, including absence of pathogens.

Fires and Burn Caused by Alcohol-based Disinfectants and Electrocautery - A case report -

Operating room fires, though rare, can involve substantial morbidity and mortality. Surgical fires require an ignition source, oxidizer, and fuel. Ignition sources generally include lasers and electrocautery, oxidizer are usually oxygen, nitrous oxide, and ambient air, whereas fuels are classically surgical drapes, materials, and prepping agents. We experienced a patient who, during skin incision, sustained burns resulting from a fire in the operating room. Shortly after application of disinfectants and placement of the surgical drapes, the surgeon used the electrosurgical un it on the incision. In this case, the use of an alcohol-based disinfectant was the major contributing factor to the surgical fire. To avoid recurrence, if alcohol is used for skin prepping, it should be allowed to dry completely before draping. (Korean J Anesthesiol 2007; 53: 676∼9)

Impact of the reinforcement of a Methicillin-Resistant Staphylococcus aureus Control Programme: A 3-year evaluation by several indicators in a French University Hospital

Our objective was to evaluate the impact of the reinforcement of a methicillin-resistant Staphylococcus aureus (MRSA) control programme and to assess the impact of risk adjustment on the interpretation of data. A stepwise, retrospective analysis of 3-year prospectively collected data was performed in a 600-bed French teaching hospital in the Parisian area. A reinforcement of a pre-existing programme for limiting the spread of MRSA was implemented in 2002 and 2003 by increasing the frequency of the feedback of surveillance data, by using alcohol-based disinfectants, and by increasing patient screening. Different indicators were used to follow the change over time of MRSA transmission: the proportion of MRSA acquired in our hospital, the incidence of newly acquired MRSA/1,000 patient-days (PD) (incidence of newly acquired MRSA), the incidence of newly acquired MRSA isolated in at least one clinical specimen/1,000 PD (incidence of newly acquired clinical MRSA), and a risk-adjusted indicator, the incidence of newly acquired-MRSA isolated in at least one clinical specimen/1,000 PD of carriers identified at admission (incidence related to the risk of acquisition). The change over time of these indicators was studied with the chi-square test for trend. During the study, all indicators decreased significantly, with a mean drop of 0.07/1,000 PD for the incidence of newly acquired clinical MRSA, and a mean drop of 3.0/1,000 PD for the incidence related to the risk of acquisition. The proportion of MRSA acquired in our hospital decreased from 49.3% in 2002 to 24.1% in 2004. Concurrently, between 2002 and 2004, the number of patients screened on admission to hospital or at the time of intra-hospital transfer increased by 31% and the consumption of waterless alcohol-based hand disinfectants increased by 244%. The decreasing trend of all indicators emphasizes the effectiveness of the reinforcement of our MRSA control programme. From 2002 to 2004, the trend of the indicator related to the risk of acquisition over time is similar to those of other indicators. Further studies should be useful to assess if risk-adjustment is absolutely necessary when tracking rates within a single institution.

Disinfectant Efficacy on Foodborne Spoilage Yeast Strains

Yeast strains are usually known for their beneficial role in the production of bread and fermented foods. Abundant growth of unwanted yeast strains during production can, however, lead to defects in the final products and problems with process hygiene when failures occur in the decontamination procedure. A low pH or a high sugar or salt content favours the growth of yeast strains. In many cases the risk caused by a growth of spoilage yeast strains in products has been underestimated because many of these yeast strains are not known to be opportunistic pathogens. The yeast strains also readily form biofilms on process surfaces at both low and elevated temperatures. The aim of this study was to assess the efficacy of various types of commonly used disinfectants against yeast strains isolated from dairy and bakery, fermented functional food, praline, confiture and sugar processes by means of both suspension and carrier tests. According to both suspension and biofilm tests, alcohol-based disinfectants are most effective in decontaminating the yeast strains isolated. Furthermore, the results showed that the tenside-based and peroxide-based disinfectants were efficient against suspended yeast cells. In the biofilm-carrier test the chlorine-based foam cleaner was also effective. The disinfectants containing chlorine and persulphate were ineffective in destroying yeast cells both in suspensions and in biofilm formations.

Less skin irritation from alcohol-based disinfectant than from detergent used for hand disinfection

The benefit of alcohol-based disinfectant used on normal skin has been debated. The objective of the present study was to compare the effects of repeated exposure to an alcohol-based disinfectant, a detergent and an alcohol-based disinfectant/detergent alternately for 10 days, including noninvasive measurements in the evaluation. Skin reactivity in irritated skin after a 4-week interval was also evaluated. Detergent, disinfectant and alternate disinfectant and detergent were applied twice daily every 10 min for 1 h to the ventral upper arms and forearms of 17 healthy volunteers. A control area was included. After 4 weeks an SLS patch was applied to each area. Irritant reactions were quantified with a visual score recording and measurements of transepidermal water loss (TEWL) and skin colour were performed on days 1, 5, 11, 38 and 40. On day 5 the detergent caused a higher visual score than either disinfectant applied alone or alternate disinfectant and detergent, P < 0.05. On day 11 detergent and alternate disinfectant and detergent caused a higher score than disinfectant, P < 0.05. An increased irritant response for detergent compared with disinfectant alone and alternate disinfectant and detergent was confirmed by TEWL evaluations on days 5 and 11, P < 0.001, while no significant difference was found by colour measurement. After 4 weeks, when evaluated by colour measurement, significantly less response to the SLS patch was found on the disinfectant-treated area compared with the control area and detergent area, and a similar trend was found for TEWL, although it was not statistically significant. Alcohol-based disinfectant caused less visible skin irritation and less skin barrier disruption than the use of detergent. The alternate use of detergent and disinfectant caused less irritation than the use of detergent, and a possible interaction between the two irritants was not indicated. After 4 weeks there was a tendency for decreased skin reactivity in the skin areas which had 4 weeks previously been exposed to disinfectant.

Short‐term effects of alcohol‐based disinfectant and detergent on skin irritation

The most important risk factor for occupational contact dermatitis in hospital personnel is the exposure to irritants such as water, detergents and alcohol-based solutions. This study was undertaken to evaluate the short-term effects of repeated exposure to an alcohol-based disinfectant, to a detergent and to an alcohol-based disinfectant/detergent alternately. The hardening effect in preirritated skin after a 4-week interval was also evaluated. Detergent, disinfectant and disinfectant/detergent alternately were applied daily every 15 min for 6 h for 2 days to the flexor upper arms and forearms of 15 volunteers. A control area was included. After 4 weeks, a sodium lauryl sulfate patch was applied to each area. Irritant reactions were quantified by visual score, transepidermal water loss (TEWL) and skin colour at baseline, D3, D8, D35 and D37. As evaluated by clinical assessment, detergent caused more redness of the skin than both disinfectant applied alone and disinfectant/detergent alternately at D3 and D8, P < 0.001 and P < 0.001, respectively. An increased irritant response for detergent as compared to disinfectant alone and disinfectant/detergent was confirmed by TEWL and colour evaluations, P = 0.001 and P = 0.001 and P = 0.006 and P = 0.009, respectively. No hardening effect in preirritated skin was found after a 4-week interval. In conclusion, hand disinfection with alcohol-based disinfectant or alternate use of disinfectant/detergent causes less skin irritation than hand disinfection with a detergent. This study evaluated the short-term effects of disinfectant and detergent exposure only, and more long-term studies are necessary before recommendations can be made.

Use of 2% 2-phenoxyethanol and 0.1% octenidine as antiseptic in premature newborn infants of 23–26 weeks gestation

In preterm newborn infants, topical iodine-containing antiseptics disturb thyroid hormone regulation while alcohol-based disinfectants may cause local burns. We therefore investigated the use of an aqueous solution containing 0.1% octenidine and 2% 2-phenoxyethanol for skin disinfection during the first seven days of life in premature newborns with a gestational age <27 weeks who were consecutively admitted to our level III neonatal intensive care unit between November 1, 2000 and December 31, 2001 (N=24). In boys. (N=13) the renal excretion of absorbed 2-phenoxyethanol and its metabolite 2-phenoxyacetic acid was quantitated by high-pressure liquid chromatography. In the most immature newborn (gestational age 23 6/7 weeks), a transient erythematous reaction was observed following application of the octenidine/phenoxyethanol solution prior to umbilical vessel catheterization. No other local reactions were observed. The urinary concentration of 2-phenoxyethanol was <2ppm in all samples, while urinary 2-phenoxyacetic acid concentrations reached 5–95ppm (median 24ppm). One infant had a culture-proven septicaemia (Bacillus species) during the first seven days of life. We conclude that, in contrast to alcohol-based antiseptics, an aqueous solution of 0.1% octenidine and 2-phenoxyethanol does not cause major skin damage in premature newborn infants <27 weeks' gestation. 2-Phenoxyethanol is readily absorbed by the newborn's skin but apparently undergoes extensive oxidative metabolization to 2-phenoxyacetic acid.

Health and safety issues pertaining to dental photographic mirrors and cheek and lip retractors.

This paper investigates the health and safety implications of using photographic dental mirrors and cheek retractors for photography of the intra-oral cavity. Medical photographers have moral and ethical responsibilities, and therefore should be aware of the diseases they are likely to encounter, and the possibility of cross infection when using these instruments. Although autoclaving is the safest way to remove infectious micro-organisms from contaminated instruments, that this may not be a practical method for small departments who only occasionally use these instruments. The alternative approach is to cold-sterilize the instruments using a chlorine- or alcohol-based disinfectant. The author provides information and guidelines for those who photograph the intra-oral cavity occasionally.

Inhibition of human peripheral blood neutrophil respiratory burst by alcohol-based venipuncture site disinfection.

Ethanol inhibits the respiratory burst of neutrophils. Therefore, the effects of alcohol-based skin disinfection on oxygen metabolism in neutrophils were tested using 70% ethanol or an ethanol-isopropanol-n-propanol mixture. Neutrophil respiratory burst activity as assessed fluorometrically by oxidation of 2', 7'-dichlorofluorescein diacetate increased at 10 min after disinfection with 70% ethanol compared to the activity at 30 s. The increase was significant for triggering oxidative burst with formyl-peptide but not with phorbol myristate acetate.

Mycobacterium avium and multidrug-resistant Mycobacterium tuberculosis disseminated mixed infection in a patient with the acquired immunodeficiency syndrome

case has been reported (8). The patient was a 52-yr-old woman who had been on CAPD for 10 months. In that case, investigation of the source of infection revealed that Aeromonus spp. came from the inner tube of a spray that was used to disinfect the catheter connector site. The bottle previously contained an alcohol-based disinfectant but had subsequently been used as a container to spray a houseplant with water. In our patient, the source of infection was not determined. An intestinal route of infection was possible because healthy carriers (from 0.2 to 27%) of Aeromonas spp. have been reported. Cultures of the patient’s stools did not yield the organism but they were submitted after a week of antibiotic treatment. An exogenous route through the catheter is another possibility as in the previously described case, although the catheter was handled aseptically by hospital personnel.