Quaternary Ammonium Compound Disinfectants Research Articles

Analysis of disinfectant use by medical organizations of the Republic of Tatarstan in the context of changes in the epidemiological situation 2019–2022

BACKGROUND: Disinfection is an important aspect of ensuring epidemiological safety in medical organizations, particularly during the COVID-19 pandemic.
 AIM: To analyze the disinfectant use in state medical organizations of the Republic of Tatarstan from 2019 to 2022, considering changes in the epidemiological situation related to COVID-19, and provide recommendations based on the analysis.
 MATERIALS AND METHODS: Electronic auction data from zakupki.gov.ru were used to analyze disinfectant purchases by state medical organizations in the Republic of Tatarstan from 2019 to 2022. Data analysis involved the application of descriptive statistical methods.
 RESULTS: A total of 118 electronic auctions were analyzed. A relationship between the nature of the epidemiological situation and the selection of disinfectants for purchase based on their chemical composition and intended use was identified. Before the pandemic, medical organizations preferred quaternary ammonium compound disinfectants and antibacterial soaps for hand hygiene. During the COVID-19 pandemic, their use of chlorine-based disinfectants, hydrogen peroxide, and alcohol-based hand sanitizers containing 60–69% ethanol increased. As the epidemiological situation stabilized, a discernible shift in preferences toward compound disinfectants was noted. Antiseptics with an alcohol content 70% are increasingly sought after.
 CONCLUSIONS: Medical organizations in the Republic of Tatarstan promptly respond to changes in the epidemiological situation by implementing necessary modifications to antiepidemic measures. When developing procurement strategies, not only the requirements of sanitary legislation but also the latest scientific findings in the field of disinfectology must be considered.

Deriving Novel Quaternary Ammonium Compound Disinfectant Scaffolds from a Natural Product: Mechanistic Insights of the Quaternization of Ianthelliformisamine C.

In the search for novel quaternary ammonium compound (QAC) disinfectants that can evade bacterial resistance, we turned to natural products as a source of inspiration. Herein we used natural product ianthelliformisamine C as a scaffold to design a small library of QACs. We first synthesized ianthelliformisamine C via an amide coupling that allowed for facile purification without the need for protecting groups. We then alkylated and quaternized the internal amines to yield four novel QACs, but all but one demonstrated no antibacterial activity against the tested strains. Using a combination of membrane depolarization and permeabilization assays, we were able to demonstrate that ianthelliformisamine C and the active QAC analog enact cell death via membrane permeabilization, contrary to prior reports on ianthelliformisamine C's mechanism of action.

Tomato Brown Rugose Fruit Virus: Survival and Disinfection Efficacy on Common Glasshouse Surfaces.

Tomato brown rugose fruit virus (ToBRFV) is a contact-transmitted tobamovirus affecting many tomato growing regions of the world. This study investigated the effects of different glasshouse surfaces on the survival of the virus; the efficacy of different disinfectants; and heat treatment against ToBRFV (surfaces included steel, aluminium, hard plastic, polythene, glass and concrete). A bioassay followed by ELISA was used to check virus viability. ToBRFV survived for at least 7 days on all surfaces tested and on some for at least 6 months. The virus survived for over two hours on hands and gloves. Hand washing was shown to be unreliable for the removal of the virus. Glutaraldehyde and quaternary ammonium compound disinfectants were effective at one hour on all surfaces. Some other disinfectants were effective at one hour of contact time, on all surfaces except concrete. Sodium hypochlorite was partially effective against ToBRFV, even on concrete. A 5 min soak of plastic trays in water at 90 °C was effective at denaturing ToBRFV; however, 5 min at 70 °C was not. Heating infected sap showed the thermal inactivation point to be 90 °C, confirming the hot water treatment results and showing that deactivation was due to the heat treatment and not a washing effect of the water.

Evaluation of the efficacy of combination of glutaraldehyde and quaternary ammonium compound disinfectant against different isolated C. perfringens strains recovered from broilers

Evaluation of the efficacy of combination of glutaraldehyde and quaternary ammonium compound disinfectant against different isolated C. perfringens strains recovered from broilers

Ecological risk under the dual threat of heavy metals and antibiotic resistant Escherichia coli in swine-farming wastewater in Shandong Province, China

Mineral elements and antibiotic-resistant bacterial pollutants in livestock and poultry farms’ wastewater are often sources of ecological and public health problems. To understand the heavy-metal pollution status and the characteristics of drug-resistant Escherichia coli (E. coli) in swine-farm wastewater in Shandong Province and to provide guidance for the rational use of mineral-element additives, common antibiotics, and quaternary ammonium compound disinfectants on swine farms, 10 mineral elements were measured and E. coli isolated from wastewater and its resistance to 29 commonly used antibiotics and resistance genes was determined. Finally, phylogenetic and multi-locus sequence typing (MLST) analyses was performed on E. coli. The results showed serious pollution from iron and zinc, with a comprehensive pollution index of 708.94 and 3.13, respectively. It is worth noting that average iron levels in 75% (12/16) of the districts exceed allowable limits. Multidrug-resistant E. coli were found in every city of the province. The E. coli isolated from swine-farm wastewater were mainly resistant to tetracyclines (95.3%), chloramphenicol (77.8%), and sulfonamides (62.2%), while antibiotic resistance genes for quinolones, tetracyclines, sulfonamides, aminoglycosides, and β-lactams were all more than 60%. The clonal complex 10 (CC10) was prevalent, and ST10 and ST48 were dominant in E. coli isolates. Multidrug-resistant E. coli were widely distributed, with mainly A genotypes. However, the mechanism of the effect of iron on antibiotic resistance needs more study in this area. Thus, further strengthening the prevention and control of iron and zinc pollution and standardizing the use of antibiotics and mineral element additives in the swine industry are necessary.

Investigation into the Metabolism of Quaternary Ammonium Compound Disinfectants by Bacteria.

Since the start of the COVID-19 pandemic, our reliance on disinfectants and sanitizers and the use thereof has grown. While this may protect human health, it may be selecting for antimicrobial-resistant microorganisms, including those that are not only capable of growth in the presence of disinfectants but also thrive using this as an energy source. Furthermore, there is a growing concern in emerging nosocomial pathogens, which have shown resistance to antibiotics and disinfectants. This rise in resistance has led to the investigation of various mechanisms behind resistance, such as biofilms, efflux pumps, and mobile genetic elements. Although many resistance mechanisms have been identified, it was discovered that some potentially pathogenic microbes could metabolize these compounds, which remains an avenue for further investigation. Investigating alternative metabolic pathways in microorganisms capable of growth using disinfectants as their sole carbon and energy source may provide insight into the metabolism of quaternary ammonium compound (QAC)-based antimicrobials. Many of the metabolic reactions proposed include hydroxylation, N-dealkylation, N-demethylation, and β-oxidation of QACs. If clear metabolic pathways and reactions are elucidated, possible alternative approaches to QACs may be advised. Alternatively, this may provide opportunities for biodegradation of the compounds that adversely affect the environment.

Efficacy of disinfectants to inactivate H1N1 influenza A virus isolated from pigs

ABSTRACT: The aim of this study was to access the efficacy of four disinfectants to inactivate influenza A [H1N1] 0 hour and 72 hours after disinfectant dilution. A pandemic H1N1 influenza virus isolated from a pig with respiratory disease was used to obtain inoculums containing 6.4log10 EID50/mL; 5.4log10 EID50/mL; 4.4log10 EID50/mL and 3.4log10 EID50/mL. Suspension test was composed of 400μL of viral inoculum, 100μL of organic load and 500μL of each individually diluted disinfectant and incubated for ten minutes of contact time. After a neutralizing step, each mixture was filtered on a 0.22μm membrane and 0.2mL was inoculated in six 9-day-old embryo chicken egg through allantoic route. The allantoic fluid from eggs was harvest for RT-PCR and hemagglutination test. The experiment was repeated 72 hours after disinfectant dilution. On the first assessment with fresh disinfectant, influenza virus was inactivated by oxidizing compost disinfectant and phenolic disinfectant in all virus concentrations, the quaternary ammonium compound (QAC) and glutaraldehyde association inactivated the virus up to a concentration of 5.4log10 EID50/mL. QAC disinfectant did not eliminate virus viability. Seventy-two hours after disinfectants were diluted, oxidizing compost disinfectant and QAC and glutaraldehyde association disinfectant demonstrated the same result as the evaluation with fresh disinfectant solution. Phenolic disinfectant inactivated viral inoculum up to a concentration of 5.4log10 EID50/mL. QAC had no effect on inactivating 3.4log10 EID50/mL of influenza virus. In conclusion, three of the four disinfectants tested were effective to inactivate pandemic H1N1 influenza virus in the presence of organic load. Test result performed 72hours after disinfectant dilution suggest a decrease in the effectiveness of one disinfectant.

Quaternary Ammonium Compound Disinfectants Reduce Lupus-Associated Splenomegaly by Targeting Neutrophil Migration and T-Cell Fate

Abstract Hypersensitivity reactions and immune dysregulation have been reported with the use of quaternary ammonium compound disinfectants (QACs). We hypothesized that QAC exposure would exacerbate autoimmunity associated with systemic lupus erythematosus (lupus). Surprisingly, however, we found that compared to QAC-free mice, ambient exposure of lupus-prone mice to QACs led to smaller spleens with no change in circulating autoantibodies or the severity of glomerulonephritis. This suggests that QACs may have immunosuppressive effects on lupus. Using a microfluidic device, we showed that ambient exposure to QACs reduced directional migration of bone marrow-derived neutrophils toward an inflammatory chemoattractant ex vivo. Consistent with this, we found decreased infiltration of neutrophils into the spleen. While bone marrow-derived neutrophils appeared to exhibit a pro-inflammatory profile, upregulated expression of PD-L1 was observed on neutrophils that infiltrated the spleen, which in turn interacted with PD-1 on T cells and modulated their fate. Specifically, QAC exposure hindered activation of splenic T cells and increased apoptosis of effector T-cell populations. Collectively, these results suggest that ambient QAC exposure decreases lupus-associated splenomegaly likely through neutrophil-mediated toning of T-cell activation and/or apoptosis. However, our findings also indicate that even ambient exposure could alter immune cell phenotypes, functions, and their fate. Further investigations on how QACs affect immunity under steady-state conditions are warranted.

Quaternary Ammonium Compound Disinfectants Reduce Lupus-Associated Splenomegaly by Targeting Neutrophil Migration and T-Cell Fate.

Hypersensitivity reactions and immune dysregulation have been reported with the use of quaternary ammonium compound disinfectants (QACs). We hypothesized that QAC exposure would exacerbate autoimmunity associated with systemic lupus erythematosus (lupus). Surprisingly, however, we found that compared to QAC-free mice, ambient exposure of lupus-prone mice to QACs led to smaller spleens with no change in circulating autoantibodies or the severity of glomerulonephritis. This suggests that QACs may have immunosuppressive effects on lupus. Using a microfluidic device, we showed that ambient exposure to QACs reduced directional migration of bone marrow-derived neutrophils toward an inflammatory chemoattractant ex vivo. Consistent with this, we found decreased infiltration of neutrophils into the spleen. While bone marrow-derived neutrophils appeared to exhibit a pro-inflammatory profile, upregulated expression of PD-L1 was observed on neutrophils that infiltrated the spleen, which in turn interacted with PD-1 on T cells and modulated their fate. Specifically, QAC exposure hindered activation of splenic T cells and increased apoptosis of effector T-cell populations. Collectively, these results suggest that ambient QAC exposure decreases lupus-associated splenomegaly likely through neutrophil-mediated toning of T-cell activation and/or apoptosis. However, our findings also indicate that even ambient exposure could alter immune cell phenotypes, functions, and their fate. Further investigations on how QACs affect immunity under steady-state conditions are warranted.

Mupirocin and Chlorhexidine Genotypic Resistance Found in Staphylococcus aureus Isolated From Young Infants Below 90 Days Old: A Genetic Basis for Eradication Failure.

To investigate the genetic characteristics associated with eradication failure of Staphylococcus aureus in infants below 90 days old. S. aureus isolated from clinical specimen cultures (blood, surgical tissue, or drainage, pus, etc.) and routine screening cultures in the neonatal intensive care unit (nasal and axillary skin swab) from patients below 90 days old were collected prospectively for 1 year, from August 2017 to July 2018. The isolates underwent typing and screening for genes associated with chlorhexidine (qacA/B), quaternary ammonium (smr), and mupirocin resistance (iles mutation, mupA, mupB), as well as Panton-Valentine leukocidin (PVL) toxin. During the study period, 40 nonduplicate isolates were included for analyses, of which 70.0% were methicillin-resistant S. aureus (MRSA). Mupirocin resistance was found in 25% of the total isolates; 17.4% of the colonizers; and 35.3% of the pathogens (P = 0.196). Chlorhexidine resistance gene was found in 3 MRSA isolates colonized in the nares of preterm infants. All isolates harbored the disinfectant quaternary ammonium compound (QAC) resistance gene. PVL toxin gene was found in 57.5%, and the presence of PVL gene among colonizers and pathogens was similar (69.6% vs. 41.2%, P = 0.072). Mupirocin, chlorhexidine, and QAC-resistant MRSAs harboring the PVL toxin gene were found in the nasal carriages of preterm infants. In this highly vulnerable patient population, one-fourth of the isolates harbored mupirocin-resistant genes, and all were resistant to QAC disinfectants. These strains are associated with persistence in both carriage and environmental reservoirs within the hospitals.

Comparative evaluation of anticandidal activity of pre-incorporated quaternary ammonium compound disinfectant alginate with 5.25% sodium hypochlorite spray disinfectant on the conventional alginate: An In Vivo study

ContextA lot of research and literature exists regarding the methods of disinfecting alginates; however, there is still need for a infallible, quick, and standardized method, which can be used as chair side disinfectant for alginate impressions in patients with candida related denture stomatitis. AimAn In Vivo study was undertaken to evaluate the anticandidal activity of pre-incorporated quaternary ammonium compound disinfectant in the alginate with conventional alginate impression material disinfected with 5.25% sodium hypochlorite spray (1min) in primary impressions of completely edentulous patients with denture stomatitis. Methods and materialGroup 1 consisted of 10 conventional alginate (Imprint) impressions disinfected by 5.25% sodium hypochlorite spray for 1min. Group 2 consisted of 10 pre-incorporated quaternary ammonium compound alginates (Jeltrate Plus). Totally, 20 swabs (10 per group) were collected from palatal concavities of primary impressions and inoculated on Sabouraud GC Agar media at 37°C for 24–96h. Digital colony counter was used for counting colony-forming units (CFU). Statistical analysis usedThe data analysis was done using descriptive statistics and independent t-test. ResultsAccording to p value (p<0.01), there was a statistical significant difference in mean values of the two groups. Group 1 showed significant anticandidal activity in comparison to Group 2. ConclusionsAccording to limitations of this In Vivo study, sodium hypochlorite (5.25% for 1min) spray disinfectant is more clinically effective as compared to the pre-incorporated quaternary ammonium compound alginate for patients with denture stomatitis.

A cluster of KPC-2 and VIM-2-producing Klebsiella pneumoniae ST833 isolates from the pediatric service of a Venezuelan Hospital.

Background Klebsiella pneumoniae is a bacterial pathogen that has developed resistance to multiple antibiotics and is a major cause of nosocomial infections worldwide. Carbapenemase-producing Klebsiella pneumoniae have been isolated in many hospitals in Venezuela, but they have not been well-studied. The aim of this study was to characterize carbapenem-resistant Klebsiella pneumoniae isolates from the pediatric service of a hospital located in Anzoategui State, in the eastern part of Venezuela.MethodsNineteen Klebsiella pneumoniae strains isolated in the hospital from April to July 2014 were evaluated phenotypically and molecularly for the presence of carbapenemases blaKPC, blaIMP and blaVIM. Molecular epidemiology was performed with Repetitive Extragenic Palindromic-PCR (REP-PCR) and Multilocus Sequence Typing (MLST). They were also studied for phenotypic and molecular resistance to a quaternary ammonium compound (QAC) disinfectant.ResultsAll 19 isolates contained both bla VIM-2 and bla KPC-2 genes, and the bla KPC-2 gene was associated with Tn4401b. All isolates were phenotypically sensitive to QACs and contained qacΔE and addA2 genes typical of class 1 integrons. Analysis by REP-PCR and MLST showed that all isolates had identical profiles characteristic of sequence type ST833.ConclusionAll 19 strains are bla VIM-2 and bla KPC-2−producing ST833 K. pneumoniae sensitive to QACs. This analysis may help to understand the routes of dissemination and confirms that QAC disinfectants can be used to help control their spread.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1927-y) contains supplementary material, which is available to authorized users.

Tolerance to quaternary ammonium compound disinfectants may enhance growth of Listeria monocytogenes in the food industry

The antibacterial effect of disinfectants is crucial for the control of Listeria monocytogenes in food processing environments. Tolerance of L. monocytogenes to sublethal levels of disinfectants based on quaternary ammonium compounds (QAC) is conferred by the resistance determinants qacH and bcrABC. The presence and distribution of these genes have been anticipated to have a role in the survival and growth of L. monocytogenes in food processing environments where QAC based disinfectants are in common use. In this study, a panel of 680 L. monocytogenes from nine Norwegian meat- and salmon processing plants were grouped into 36 MLVA profiles. The presence of qacH and bcrABC was determined in 101 isolates from the 26 most common MLVA profiles. Five MLVA profiles contained qacH and two contained bcrABC. Isolates with qacH and bcrABC showed increased tolerance to the QAC Benzalkonium chloride (BC), with minimal inhibitory concentrations (MICs) of 5–12, 10–13 and <5ppm for strains with qacH (two allele variants observed), bcrABC, and neither gene, respectively. Isolates with qacH or bcrABC were not more tolerant to BC in bactericidal tests in suspension or in biofilms compared with isolates lacking the genes. Water residue samples collected from surfaces in meat processing plants after QAC disinfection had bactericidal effect against L. monocytogenes when the sample BC levels were high (>100ppm). A sample with lower BC concentrations (14ppm of chain length C-12 and 2.7ppm of chain length C-14) inhibited growth of L. monocytogenes not containing bcrABC or qacH, compared to strains with these genes.The study has shown that L. monocytogenes harbouring the QAC resistance genes qacH and bcrABC are prevalent in the food industry and that residuals of QAC may be present in concentrations after sanitation in the industry that result in a growth advantage for bacteria with such resistance genes.

Use of green fluorescent protein labeled non-tuberculous mycobacteria to evaluate the activity quaternary ammonium compound disinfectants and antibiotics.

Although infections with NonTuberculous Mycobacteria have become less common in AIDS patients, they are important opportunistic infections after surgical procedures, likely because they are ubiquitous and not efficiently killed by many commonly used disinfectants. In Venezuela there have recently been many non-tuberculous mycobacteria soft tissue infections after minor surgical procedures, some apparently related to the use of a commercial disinfectant based on a Quaternary Ammonium Compound. We studied the activity of this and other quaternary ammonium compounds on different non-tuberculous mycobacteria by transforming the mycobacteria with a dnaA-gfp fusion and then monitoring fluorescence to gauge the capacity of different quaternary ammonium compounds to inhibit bacterial growth. The minimum inhibitory concentration varied for the different quaternary ammonium compounds, but M. chelonae and M. abscessus were consistently more resistant than M. smegmatis, and M. terrae more resistant than M. bovis BCG.

Evaluation of quaternary ammonium compound disinfectants against mycobacteria in dental practices

This paper discusses the use in dental practices of quaternary ammonium compounds (QAC) and alcohol-based disinfectants in relation to bactericidal efficacy against mycobacteria. QAC disinfectants are commonly used in dental practices, although there are concerns about their efficacy against tuberculosis-causing bacteria. The paper discusses a recent study where two QAC products (ready-to-use and saturated wipe liquor presentations) were tested, using a recognized suspension test, at the manufacturer's recommended concentration, under simulated ‘clean’ and ‘dirty’ conditions. The test data indicated that, after a 10-minute contact time, suitable kill of the test organism was not obtained. These findings raise questions about the suitability of QAC disinfectants for dental practices. CPD/Clinical Relevance: Tuberculosis, a disease caused by Mycobacterium tuberculosis, is increasingly becoming a communicable disease of concern. It is important that dental practices ensure that a suitable level of decontamination takes place between patients. QAC disinfectants may not be suitable for this purpose and alternative biocides, like alcohol, may need to be considered.

Antimicrobial resistances and virulence markers in Methicillin-resistant Staphylococcus aureus from broiler and turkey: A molecular view from farm to fork

Little is known about the characteristics of MRSA occurring along the broiler and turkey production chains. The aim of this study was to characterise and compare MRSA of turkey and broiler origin sampled on different production levels using a DNA microarray and antimicrobial susceptibility testing. Main differences could be observed in the prevalence of the resistance genes erm(C), aacA-aphD and tet(K) and the number of non-wild type strains with minimum inhibitory concentration values (MICs) above the epidemiological cut-off values (ECOFFs) for gentamicin and kanamycin. Overall, MRSA with non-wild type phenotype for the macrolide-lincosamide-streptogramin group, tetracycline, and trimethoprim were found in more than 70% of poultry isolates. Non-wild type isolates carrying the qacC gene conferring resistance to quaternary ammonium compound disinfectants were found at all production stages in similar frequencies. Regarding the presence of enterotoxin genes in poultry-derived MRSA the enterotoxin gene cluster (egc) was only found in Non-CC (clonal complex) 398 strains. Three CC398 strains harboured the genes sed (from turkey at slaughter and broiler meat) and sea-N315 (from a chicken carcass). One Non-CC398 strain isolated from turkey meat was found positive for the seb gene and also enterotoxin production. Similarity analysis based on selected resistance and virulence markers revealed a high clonality among Non-CC398 isolates. Isolates of the same clonal complex clustered together according to their common virulence and resistance profiles. Strains of CC9 were grouped in two subclusters due to different resistance genes. Our results underline, that there are other poultry associated clones of MRSA (mainly CC9 and CC5) besides the predominant CC398 which are similar in both poultry species.

Activity of iodophor and quaternary ammonium compound disinfectants on Candida standard and clinical isolates of bovine mastitis

Activity of iodophor and quaternary ammonium compound disinfectants on Candida standard and clinical isolates of bovine mastitis

Virucidal activity of a quaternary ammonium compound disinfectant against feline calicivirus: A surrogate for norovirus

Norovirus, formerly known as Norwalk virus, is an important cause of gastroenteritis outbreaks in hospitals, food services, schools, and cruise ships. Infection control practices by using disinfectants to eliminate noroviruses from surfaces and environmental samples reduce the morbidity and spread of virus outbreaks. There are not many commercial disinfectants effective against norovirus. Noroviruses cannot be cultivated in vitro. However, feline calicivirus can be used as a surrogate to determine disinfectant efficacy against noroviruses. Feline calicivirus was used in a virucidal effectiveness test protocol as a surrogate for norovirus to determine the virucidal efficacy of R-82, a quaternary ammonium compound disinfectant cleaner. Feline calicivirus suspensions containing at least 5% fetal bovine serum were dried on carriers and treated with 1:256 dilutions of R-82 disinfectant in water, with a hardness of 400 ppm as calcium carbonate, for 10 minutes. Hypochlorite concentrations of 100 +/- 10 and 1,000 +/- 10 ppm, respectively, were also analyzed as internal control standards. After contact period, the test agents were neutralized with 2 mL of appropriate neutralizer, and mixtures were scraped from carrier surfaces with a cell scraper. Selected dilutions of the neutralized inoculum/test agent mixtures were added to cultured cell monolayers of appropriate host cells. Postincubation, the infectious feline calicivirus was scored microscopically by observing virus-specific cytopathic effects produced by replicating infectious virus. The performance criterion was a minimum of 4-log(10) reduction in cytopathic effects of feline calicivirus. After a 10-minute contact time, formulation R-82 diluted 1:256 showed a 6.6- and 6.4-log(10) reductions in cytopathic effects of feline calicivirus during initial and confirmatory testing, respectively, demonstrating complete inactivation of the virus. A hypochlorite solution of 1,000 ppm exhibited similar log(10) reductions to the quaternary ammonium disinfectant, demonstrating the reproducibility of the protocol. Formulation R-82, a quaternary ammonium compound, is a 1-step disinfectant cleaner, which exhibited virucidal activity against feline calicivirus suspensions dried on hard surface carriers. Surfaces are vectors for virus transmission during outbreaks by transferring the virus to people or other environmental surfaces. Therefore, treatment of contaminated surfaces with formulation R-82 will optimize disinfection of noncritical and critical surfaces in health care institutions, reducing the possibility of virus transmission during outbreaks.

Efficacy of disinfectants and detergents for cleaning hospital environmental surfaces as part of documented cleaning protocols

BACKGROUND: Concern over increasing nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection rates in the United Kingdom has led to discussion of routine environmental surface cleaning in hospitals. Documented cleaning protocols ensure better compliance and describe in detail the steps needed to clean specific surfaces and may specify the use of a detergent or disinfectant. Although disinfectants have antimicrobial activity, concerns have been expressed about antibiotic resistance, risks to human health from prolonged exposure, and wider environmental issues. Detergents are better at detaching soil from surfaces. However, if the detached soil is not removed, reattachment and recolonization can occur. The aim of the investigation was to assess the ability of cleaning protocols, with and without disinfectants, to reduce microbial counts on hospital environmental surfaces. METHODS: A general surgical ward of a 500-bed hospital was selected. After existing cleaning practices had been completed, surface counts were taken from eight designated environmental surfaces, using direct contact methods. This was repeated every day for 14 days to obtain baseline contamination levels. Existing cleaning protocols were evaluated and modified in accordance with best practice. The 14-day sampling cycle was repeated using modified protocols with existing non-ionic detergent. This was followed by another 14-day cycle, using a quaternary ammonium compound (QAC) disinfectant in place of the existing detergent. Surface counts for each site were compared using ANOVA with Tukey comparisons (p = 0.05). RESULTS: Compared to the existing protocol, the modified cleaning significantly reduced contamination on 7/8 surfaces using the existing detergent and 8/8 using QAC. No significant difference was seen between modified protocols using detergent and QAC disinfectant on any surface. The most contaminated site was the patient's toilet sink handle (mean 9.3 cfu/cm 2 , range 1.8–25 cfu/cm 2 using existing protocols), but both modified protocols reduced this figure to >0.5 cfu/cm 2 . The least contaminated site with existing cleaning protocols was the ward sink handles (0.9 cfu/cm 2 , range 0.1–6.5 cfu/cm 2 ). Both modified protocols reduced this figure to >0.5 cfu/cm 2 . CONCLUSIONS: Optimizing cleaning methods can significantly reduce surface counts and may be more important in microbial removal than the requirement to use a disinfectant.

Persistent silver disinfectant for the environmental control of pathogenic bacteria

Background: Contaminated surfaces can act as a reservoir for pathogenic microorganisms and potentially exacerbate the risk of infection. Surface disinfection and decontamination provide temporary amelioration against bacterial colonization. Disinfected surfaces eventually become contaminated, thus, mitigating the benefit of the initial disinfection. It is hypothesized that to improve on the current state of the art, a disinfectant should not only immediately disinfect a surface but also provide persistent antimicrobial action after the product has been applied. We describe here a silver-based disinfectant technology designed to provide long-lasting sanitization and disinfection to treated surfaces as evaluated on hard surfaces after repeated environmental insults. Methods: A comparative evaluation of 6 disinfectant formulations for residual antimicrobial activity after water rinsing was performed. Log reduction of bacterial populations on disinfectant-treated substrates were measured after 30 minutes to 8 hours of exposure and compared with an untreated control. In a similar study, the residual antimicrobial activity of a silver disinfectant was evaluated against antibiotic- and biocide-resistant bacteria also after water rinsing. Further, residual antimicrobial activity of the silver disinfectant was measured after 5 cycles of rinsing, abrasion, and contamination against representative household and nosocomial pathogens (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Enterobacter aerogenes, Enterococcus faecium, or Salmonella choleraesuis ) after 10-minute exposure times. Results: In the comparative assay, only the silver disinfectant and a persistent quaternary ammonium compound disinfectant demonstrated significant residual activity (≥3.0 log10 reduction to control) against S aureus whereas only the silver disinfectant demonstrated activity against Pseudomonas. No residual activity (≤ 0.5 log reduction to untreated control) was observed for the other disinfectant products. The silver-based disinfectant also showed significant and equivalent efficacy against antibiotic- and silver-resistant bacteria. In addition, the silver disinfectant was able to achieve significant residual activity in 10 minutes against all organisms tested after 1, 3, and 5 cycles of water rinse, abrasion, and microbial contamination. Conclusions: The findings show the ability of a new silver-based disinfectant to reduce bacterial populations that contact treated surfaces within minutes, highlight the potential to interrupt cross-contamination from environmental surfaces, and reduce the risk of infection within the home and health care settings. (Am J Infect Control 2002;31:208-14.)