Promises and pitfalls of recent advances in chemical means of preventing the spread of nosocomial infections by environmental surfaces
Section snippets
Currently used disinfectant chemicals
As shown in Fig 1, we continue to use a wide array of chemicals as disinfectants, many to disinfect hard, nonporous environmental surfaces in industrial and institutional settings.15 Such use is largely based on history and tradition and much less on proven effectiveness of those chemicals in the field. Also, it is worth reiterating here that, all things considered equal, the microbicidal activity of any disinfectant is inversely proportional to the degree of soiling of the target surface and
“Green” products
‘Green’ products made from household chemicals such as vinegar and baking soda or the “all-natural” ones containing plant extracts may indeed be safer as “cleaners” but without the speed and broad-spectrum microbicidal activity essential for routine disinfection of environmental surfaces.30 Although certain of these products may also be government registered, that on its own does not make them suitable for use, especially in health care settings where fast and broad-spectrum microbicidal
Wiping of surfaces
Although most environmental surface disinfectants are meant for wiping surfaces, their label claims are almost always based on testing devoid of any wiping action. For an effective product applied in sufficient quantity and for an adequate contact time, the mechanical action of wiping can substantially enhance the process of decontamination. On the other hand, because decontamination cannot take place without contact for a sufficient length of time, use of too small a quantity of product and/or
Self-sanitizing surfaces
For claims of self-sanitization, a disinfectant can be chemically bound50, 51 to an environmental surface or it can be made from material doped with a disinfectant.52 Also, titanium dioxide-containing coatings can release microbicidal ions upon exposure to ultraviolet light53 or natural sunlight50; this is essentially an oxidizing process. More recently, the US Environmental Protection Agency has granted copper and several of its alloys the first ever registration as inherently antimicrobial
Government registration of disinfectants
Not unlike other regulations, the testing requirements for government registration of disinfectants often lag behind the changing profile of nosocomial pathogens and advances in disinfectant test methodologies. For instance, dozens of government-registered environmental surface disinfectants in North America claimed activity against Clostridium difficile using the vegetative form of this anaerobic spore former. Only recently has corrective action been taken through a voluntary recall of such
Concluding remarks
Many traditionally used products and practices for decontaminating environmental surfaces in health care settings are now under scrutiny for their effectiveness and relevance with the changing profile of nosocomial pathogens on the one hand and human64 and environmental safety on the other. For instance, there is now irrefutable evidence showing that the routine cleaning and disinfection of environmental surfaces in many hospitals are quite frequently totally inadequate, with much contamination
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Plasma-activated liquid as a potential decontaminant in healthcare: assessment of antibacterial activity and use with cleaning cloths
2024, Journal of Hospital InfectionA systematic review and meta-analysis of decontamination methods to prevent hospital environmental contamination and transmission of Clostridioides difficile
2022, AnaerobeCitation Excerpt :Most UV room decontamination devices have a wavelength of 200–320 nm, which lies in the germicidal active portion of the electromagnetic spectrum [38], whereas the protocol of UV devices has not yet been standardized. Consequently, several different protocols to demonstrate efficacy have been tried [39]. Thus, there is a need to develop a standardized protocol for UV treatment.
A review of wipes used to disinfect hard surfaces in health care facilities
2021, American Journal of Infection ControlFour steps to clean hospitals: LOOK, PLAN, CLEAN and DRY
2019, Journal of Hospital InfectionCitation Excerpt :This is because repeated exposure of environmental flora to microbiocidal products encourages tolerance and even cross-resistance to antimicrobial agents [54]. Daily use of powerful disinfectants might even consolidate endemic problems with environmental organisms such as vancomycin-resistant enterococci and Acinetobacter spp. [40]. However, detergent cleaning should be temporarily replaced with disinfectant if the patient is known to harbour a transmissible pathogen, or if the patient is involved, or might be involved, in an outbreak [54,55].
Self-disinfecting surfaces and infection control
2019, Colloids and Surfaces B: BiointerfacesCitation Excerpt :In many situations the lack of adequate training of the environmental cleaning services or of the medical staff ultimately promotes the use of inappropriate detergents or germicides promoting the survival of microorganisms on the surfaces, even after cleaning [43]. Among the most used disinfectants are substances based on hypochlorite, alcohols, aldehydes, phenols and quaternary ammonium compounds [44]. However, not all of these substances are efficient against some specific types of microorganisms, namely spore forming pathogens like C. difficile [45].
STATEMENT OF CONFLICT OF INTEREST: The author reports no conflicts of interest.
Publication of this article was made possible by unrestricted educational grants from The Clorox Company, the American Society for Healthcare Engineering, and the Facility Guidelines Institute.