A review of wipes used to disinfect hard surfaces in health care facilities

Compositional factors driving antibacterial efficacy in healthcare wet wipe products

Healthcare-associated infections represent a persistent global pathogenic challenge, with surface contamination serving as a critical transmission vector. Antibacterial wet wipes are widely used in public health service settings, but their effectiveness varies depending on their composition and design. Evaluating existing products based on objective criteria provides a valuable foundation for enhancing future functional wet wipe formulations. In this study, four compositionally distinct proprietary antimicrobial wet wipes were assessed using objective criteria to provide a foundation for designing functional and biodegradable wet wipe formulations with enhanced properties. The mechanical properties, chemical composition, surface tension, disinfectant release, and morphological structure of four widely used wet wipe products in UK and European healthcare settings were evaluated. These products are anonymised as HP (containing oxidizing agents), BDB, DPA, and ADM (based on quaternary ammonium compounds). Antibacterial performance was tested according to EN 16615, EN 13727, and ASTM E2967 standards (suspension and wiperator-based methods) using contact times of 30 and 60 s, against E. coli, S. aureus, MRSA, and A. baumannii. The BDB product underperformed in the analysis based on the EN 16615 standard, particularly at the short contact time, where it was ineffective against E. coli and S. aureus. In contrast, HPE, DPA, and ADM products demonstrated high efficiency, achieving >5 Log bacterial reduction within 60 s for all tested strains. The ADM product demonstrated superior antibacterial performance, eliminating A. baumannii in the shortest contact time and avoiding spread of bacteria to clean surfaces. Our findings demonstrate a correlation between the liquid release rate of the wipe and the biocidal agents used, with effectiveness in reducing bacterial viability on surfaces. This research establishes a framework for optimizing disinfectant wipe design by emphasizing the importance of material properties and disinfectant formulation in determining overall effectiveness.

Effect of surfactants on inactivation of Bacillus subtilis spores by chlorine

Bacterial spores pose significant risks to human health, yet the inactivation of spores is challenging due to their unique structures and chemical compositions. This study investigated the synergistic effect between surfactants and chlorine on the inactivation kinetics of Bacillus subtilis spores. Two surfactants, cocamidopropyl betaine (CAPB) and cetyltrimethylammonium chloride (CTMA) were selected to investigate chlorine disinfection in absence and presence of surfactants. The concurrent presence of both chlorine and surfactant resulted in a moderate reduction in the lag-phases for spore inactivation and negligible increase in the second-order inactivation rate constants. In contrast, when the spores were pre-exposed to surfactants, the lag-phases decreased by about 50 % for both CAPB and CTMA, and the second-order inactivation rate constants during post-chlorination remained constant for CAPB but increased by a factor of 2.3 for CTMA, compared to the control group with phosphate buffer. This synergistic effect became more pronounced with longer surfactant pre-exposure times, reaching its maximum at 3-6 h. The observed synergistic effect suggests that surfactants can potentially enhance the permeability of the coat which is the outmost layer of B. subtilis spores and a primary barrier for chemical disinfectants. Tracing a group of B. subtilis spores sequentially treated with surfactant and chlorine by atomic force microscopy, a significant decrease in compressive stiffness of the spores was observed due to exposure to surfactants, indicating alterations in the coat by surfactants. The trend in reducing compressive stiffness aligned well with the decrease of lag-phases in inactivation kinetics. Furthermore, CTMA was found to inactivate B. subtilis spores through mechanisms different from chlorine. Chlorine primarily inactivated B. subtilis spores before damaging the inner membrane of the spores which plays a crucial role in protecting the genetic material stored in the core of the spores. In comparison, CTMA damaged 22 % of the inner membrane for an inactivation efficiency of 99 %. A synergistic effect in damaging the inner membrane was observed when applying CTMA and chlorine simultaneously instead of sequentially.

The impact of a novel color additive for disinfectant wipes on room cleanliness and turnover time

BACKGROUND

Contaminated environmental surfaces in the health care setting put patients at risk of acquiring health care-associated infections. Highlight (Kinnos) is a novel color-additive technology for disinfectant wipes that helps users visualize surfaces that have been cleaned by producing a transient color on wiped surfaces that fades off after effective cleaning.

METHODS

To quantify the impact of real-time visual feedback on room cleanliness and efficiency, a pre-post quasi-experimental study was conducted by comparing Replicate Organism Detection and Counting (RODAC) plate counts and room turnaround times with and without the use of the color additive.

RESULTS

Compared with the control group of disinfectant alone, disinfection with the color additive resulted in a 69.2% improvement in room cleanliness accompanied by a 5.9% faster room turnover time.

DISCUSSION

As far as we know, this study is the first to publish on the impact of a novel color additive on the environment of care as measured by microbial culturing and room turnaround times, finding advantages in both metrics relative to the status quo.

CONCLUSIONS

The use of real-time visual feedback can improve the thoroughness of disinfection cleaning while maintaining operational efficiency.

New commercial wipes inhibit the dispersion and adhesion of Staphylococcus aureus and Pseudomonas aeruginosa biofilms

AIM

Bacterial biofilms can form on surfaces in hospitals, clinics, farms, and food processing plants, representing a possible source of infections and cross-contamination. This study investigates the effectiveness of new commercial wipes against Staphylococcus aureus and Pseudomonas aeruginosa biofilms (early attachment and formed biofilms), assessing LH SALVIETTE wipes (Lombarda H S.r.l.) potential for controlling biofilm formation.

METHODS AND RESULTS

The wipes efficacy was studied against the early attachment phase and formed biofilm of S. aureus ATCC 6538 and P. aeruginosa ATCC 15442 on a polyvinyl chloride (PVC) surface, following a modified standard test EN 16615:2015, measuring Log10 reduction and cell viability using live/dead staining. It was also evaluated the wipes anti-adhesive activity over time (3 h, 2 4h), calculating CFU.mL-1 reduction. Data were analyzed using t-student test. The wipes significantly reduced both early phase and formed S. aureus biofilm, preventing dispersion on PVC surfaces. Live/dead imaging showed bacterial cluster disaggregation and killing action. The bacterial adhesive capability decreased after short-time treatment (3 h) with the wipes compared to 24 h.

CONCLUSIONS

Results demonstrated decreased bacterial count on PVC surface both for early attachment phase and formed biofilms, also preventing the bacterial biofilm dispersion.

Impact of benzalkonium chloride on anaerobic granules and its long-term effects on reactor performance

This study assessed the inhibitory and performance-degrading effects induced by the cationic surfactant benzalkonium chloride (BAC) on anaerobic granules during the long-term operation of a laboratory-scale expanded granular sludge bed (EGSB) reactor. To address the critical scientific problem of how BAC affects the efficiency of EGSB reactors, this research uniquely evaluated the long-term stress response to BAC by systematically comparing continuous and discontinuous inhibitor exposure scenarios. The novel comparison demonstrated that inhibitor concentration is of minor relevance compared to the biomass-specific cumulative inhibitor load in the reactor. After exceeding a critical biomass-specific cumulative inhibitor load of 6.1-6.5 mg BAC/g VS, continuous and discontinuous exposure to BAC caused comparable significant deterioration in reactor performance, including accumulation of volatile fatty acids (VFA), decreased removal efficiency, reduced methane production, as well as the wash-out, flotation, and disintegration of anaerobic granules. BAC exposures had a more detrimental effect on methanogenesis than on acidogenesis. Moreover, long-term stress by BAC led to an inhibition of protein production, resulting in a decreased protein-to-polysaccharide ratio of extracellular polymeric substances (EPS) that promoted destabilizing effects on the granules. Finally, hydrogenotrophic methanogenesis was triggered. Reactor performance could not be restored due to the severe loss of granular sludge.

Disinfection, sterilization and antisepsis: An overview

BACKGROUND

Each year in the United States there are approximately 100,000,000 outpatient/inpatient surgical procedures. Each of these procedures involves contact by a medical device or surgical instrument with a patient's sterile tissue and/or mucous membrane. A major risk of all such procedures is the introduction of infection.

METHODS

We searched published literature for articles on the use and effectiveness of disinfectants, sterilization methods and antiseptics.

RESULTS

The level of disinfection is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Antiseptics are essential to infection prevention as part of a hand hygiene program as well as other uses such as surgical hand antisepsis and pre-operative patient skin preparation.

CONCLUSIONS

When properly used, disinfection and sterilization can ensure the safe use of invasive and non-invasive medical devices. Cleaning should always precede high-level disinfection and sterilization. Strict adherence to current disinfection and sterilization guidelines is essential to prevent patient infections and exposures to infectious agents.

Does repeated exposure to hydrogen peroxide induce Candida auris resistance?

BACKGROUND

To minimize environmental colonization by microorganisms that may persist and thrive in healthcare settings, thus reducing healthcare-associated infections (HAIs), new insights over already known biocides are certainly of relevance. Although the efficacy of hydrogen peroxide (H2O2) against the emergent yeast Candida auris is moderately documented, concerns over the potential induction of resistance after repeated exposure do persist. The main objective of the present study was to evaluate the hypothetical induction of Candida auris resistance following 30 days of consecutive exposure to lethal and sublethal concentrations of H2O2. Furthermore, the authors aimed to elucidate about the rank of efficacy of H2O2 against C. auris comparing to other Candida species and whether different strains of C. auris may display different susceptibilities to H2O2.

METHODS

During the induction of resistance assays, both type strains and clinical isolates of Candida auris, Candida albicans and Candida parapsilosis were exposed repeatedly to defined concentrations of H2O2, for 30 days.

RESULTS

After that period, no significant differences were found when comparing the minimal inhibitory concentration values of H2O2 in case of the induced strains versus each respective positive control. Moreover, H2O2 displayed similar effectiveness against all the tested Candida species and no differences were demonstrated among the distinct strains of C. auris.

CONCLUSIONS

The adoption of H2O2 solutions in routine protocols in order to promote disinfection standards against Candida auris, improving patient safety and reducing healthcare costs, is certainly welcomed.

Contact time has limited impact on the efficacy of disinfectant towelettes when tested under conditions reflective of realistic use

BACKGROUND

Disinfectant towelettes are increasingly being used as a means to prevent transmission of clinically important pathogens which could lead to healthcare-associated infections (HAIs). However, the efficacy of disinfectant towelette products when tested under realistic use conditions is understudied. A test model was designed to replicate realistic wiping conditions. The objective of this study was to determine the impact of varied contact time on disinfectant towelette efficacy under these conditions.

METHODS

Five product types were tested against Staphylococcus aureus (ATCC 6538) and Pseudomonas aeruginosa (ATCC 15,442) at five contact times (30 s, one min, two min, three min, and 10 min) on hard, non-porous laminate templates to determine the impact of contact time on disinfectant towelette efficacy when tested under realistic use.

RESULTS

Product type had a significant impact on the efficacy of disinfectant towelettes when tested under conditions reflective of realistic use. The effect of contact time was limited and no differences in efficacy were seen at a contact time of one min compared with the other contact times tested. Only one disinfectant towelette product achieved a mean 5-log reduction under the tested conditions.

CONCLUSION

Efficacy of disinfectant towelettes was primarily impacted by product type when applied in a model designed to replicate realistic use in which only a limited effect of contact time was observed. There is a need for further investigation into which factors have the greatest impact on disinfectant towelette efficacy when applied in clinical settings.

An Enhanced Strategy for Daily Disinfection in Acute Care Hospital Rooms: A Randomized Clinical Trial

IMPORTANCE

Environmental contamination is a source of transmission between patients, health care practitioners, and other stakeholders in the acute care setting.

OBJECTIVE

To compare the efficacy of an enhanced daily disinfection strategy vs standard disinfection in acute care hospital rooms.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial (RCT) was conducted in acute care hospital rooms at Duke University Hospital in Durham, North Carolina, from November 2021 to March 2022. Rooms were occupied by patients with contact precautions. Room surfaces (bed rails, overbed table, and in-room sink) were divided into 2 sides (right vs left), allowing each room to serve as its own control. Each side was randomized 1:1 to the intervention group or control group.

INTERVENTIONS

The intervention was a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe. It was applied in addition to routine disinfection for the intervention group. The control group received no intervention beyond routine disinfection.

MAIN OUTCOMES AND MEASURES

The primary outcome was the total contamination, measured in colony-forming units (CFUs) on the bed rails, overbed table, and sink on study day 1. The secondary outcomes were the proportion of sample areas with positive test results for clinically important pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and carbapenem-resistant Enterobacteriaceae; the similarity in baseline contamination between sample area sides on study day 0 before application of the intervention, and the proportion of sample areas with removed UV luminescent gel on study day 1.

RESULTS

A total of 50 study rooms occupied by 50 unique patients (median [IQR] age, 61 [45-69] years; 26 men [52%]) with contact precautions were enrolled. Of these patients, 41 (82%) were actively receiving antibiotics, 39 (78%) were bedridden, and 28 (56%) had active infections with study-defined clinically important pathogens. On study day 1, the median (IQR) total CFUs for the intervention group was lower than that for the control group (3561 [1292-7602] CFUs vs 5219 [1540-12 364] CFUs; P = .002). On study day 1, the intervention side was less frequently contaminated with patient-associated clinically important pathogens compared with the control side of the room (4 [14%] vs 11 [39%]; P = .04).

CONCLUSIONS AND RELEVANCE

Results of this RCT demonstrated that a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe decreased the environmental bioburden in acute care hospital rooms compared with routine disinfection. The findings warrant large-scale RCTs to determine whether enhanced daily disinfection strategies can decrease patient acquisition and adverse patient outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05560321.

The Environmental Footprint Of Single versus Reusable Cloths For Clinical Surface Decontamination: A Life Cycle Approach

Global sustainability is a major health concern facing our planet today. The healthcare sector is a significant contributor to environmentally damaging activity. Reusable cloths should be considered as an environmentally friendly alternative to the predominantly used single-use surface wipes in cleaning and disinfection of environmental surfaces in healthcare settings. To understand its feasibility, a rapid review of current policies on surface decontamination in healthcare settings was conducted. A life cycle impact assessment (LCIA) was then carried out to compare the impact of reusable cotton and microfibre cloths versus conventional single-use cloths, with three compatible disinfectants. Seven countries were included in the rapid review of policies. For the LCIA, inputs, outputs, and processes across the life cycle were included, using EcoInvent database v3.7.1 and open LCIA software. Sixteen European-recommended environmental impact categories and eight human health categories were considered. Infection prevention policies examined do not require single-use wipes for cleaning and disinfection. The disinfectant with the highest environmental impact was isopropyl-alcohol. The most environmentally-sustainable option for clinical surface decontamination was the microfibre cloth when used with a quaternary ammonium compound. The least environmentally sustainable option was cotton with isopropyl-alcohol. Impacts were primarily attributed with the use of the disinfectant agent and travel processes.

Dual species dry surface biofilms; Bacillus species impact on Staphylococcus aureus survival and surface disinfection

AIMS

Dry surface biofilms (DSB) survive on environmental surfaces throughout hospitals, able to resist cleaning and disinfection interventions. This study aimed to produce a dual species DSB and explore the ability of commercially available wipe products to eliminate pathogens within a dual species DSB and prevent their transfer.

METHODS AND RESULTS

Staphylococcus aureus was grown with two different species of Bacillus on stainless steel discs, over 12 days using sequential hydration and dehydration phases. A modified version of ASTM 2967-15 was used to test six wipe products including one water control with the Fitaflex Wiperator. Staphylococcus aureus growth was inhibited when combined with Bacillus subtilis. Recovery of S. aureus on agar from a dual DSB was not always consistent. Our results did not provide evidence that Bacillus licheniformis protected S. aureus from wipe action. There was no significant difference of S. aureus elimination by antimicrobial wipes between single and dual species DSB. B. licheniformis was easily transferred by the wipe itself and to new surfaces both in a single and dual species DSB, whilst several wipe products inhibited the transfer of S. aureus from wipe. However, S. aureus direct transfer to new surfaces was not inhibited post-wiping.

CONCLUSIONS

Although we observed that the dual DSB did not confer protection of S. aureus, we demonstrated that environmental species can persist on surfaces after disinfection treatment. Industries should test DSB against future products and hospitals should consider carefully the products they choose.

SIGNIFICANCE AND IMPACT OF THE STUDY

To our knowledge, this is the first study reporting on the production of a dual species DSB. Multispecies DSB have been identified throughout the world on hospital surfaces, but many studies focus on single species biofilms. This study has shown that DSB behave differently to hydrated biofilms.

A review of HTM 01-05 through an environmentally sustainable lens

Patients deserve to be treated in a safe and clean environment with consistent standards of care every time they receive treatment. It is essential that the risk of person-to-person transmission of infections be minimised, yet it is also essential that planetary harm (and therefore public harm) is minimised with respect to resource consumption, air pollution, environmental degradation etc.In 2013, the Department of Health introduced the Health Technical Memorandum (HTM) 01-05 providing dental practices with advice on patient safety when decontaminating reusable instruments in primary care. This paper provides a commentary on HTM 01-05 and similar decontamination guidance. We believe all decontamination documents needs to reflect the so-called 'triple bottom line' - the finance, social cost and impact on the planet.The authors provide an environmental commentary on a number of items mentioned in decontamination documents, including autoclaves (including the use of helix tests), disposable paper towels, undertaking hand hygiene, using a log book, plastic bag use, the use of personal protective equipment, remote decontamination units, single use instruments, single use wipes, disinfection chemicals (for example, sodium hypochlorite) thermal disinfection and wrapping of instruments.It is hoped, in the spirit of the ever-increasing numbers of papers published to highlight how healthcare (and dentistry) could become more sustainable, that these critiques will be taken in the spirit of providing a beginning of further discussion from an environmental perspective.

Efficacy of EPA-registered disinfectants against two human norovirus surrogates and Clostridioides difficile endospores

AIMS

To determine the efficacy of a panel of nine EPA-registered disinfectants against two human norovirus (HuNoV) surrogates (feline calicivirus [FCV] and Tulane virus [TuV]) and Clostridioides difficile endospores.

METHODS AND RESULTS

Nine EPA-registered products, five of which contained H2 O2 as active ingredient, were tested against infectious FCV, TuV and C. difficile endospores using two ASTM methods, a suspension and carrier test. Efficacy claims against FCV were confirmed for 8 of 9 products. The most efficacious product containing H2 O2 as ingredient achieved a >5.1 log reduction of FCV and >3.1 log reduction of TuV after 5 min, and >6.0 log reduction of C. difficile endospores after 10 min. Of the five products containing H2 O2 , no strong correlation (R2  = 0.25, p = 0.03) was observed between disinfection efficacy and H2 O2 concentration. Addition of 0.025% ferrous sulphate to 1% H2 O2 solution improved efficacy against FCV, TuV and C. difficile.

CONCLUSION

Disinfectants containing H2 O2 are the most efficacious disinfection products against FCV, TuV and C. difficile endospores. Product formulation, rather than the concentration of H2 O2 in a product, impacts the efficacy of a disinfection product.

SIGNIFICANCE AND IMPACT OF STUDY

H2 O2 -based disinfectants are efficacious against surrogate viruses for HuNoV and C. difficile endospores.

Efficacy assessment of different time-cycles of nebulized hydrogen peroxide against bacterial and yeast biofilm

BACKGROUND

The prevention of healthcare-associated infections requires a continuous effort. In order to achieve better practical results, the control of environmental microbial biofilms with effective disinfection strategies should be addressed.

AIM

This study aims to test the efficacy of different time-cycles of nebulized H₂O₂ against bacterial and yeast dry biofilm.

METHODS

The efficacy of a standard cycle (SC) and of a fast cycle (FC) of nebulized H₂O₂ was compared. Microbial biofilms were previously grown on different material coupons. The biofilm metabolic activity was determined by XTT assay and the biofilm total biomass by crystal violet assay.

FINDINGS

Regarding the efficacy of nebulized H₂O₂ against biofilms, the mean reduction of metabolic activity of the SC was 55.2% (±19.4%), comparing to a reduction of 50.4% (±17.7%) of the FC. The mean reduction of total biomass of the SC was 45.5% (±22.7%), versus 46.7% (±21.7%) of the FC. No statistical significant differences were found when comparing the tested cycles and distinct materials.

CONCLUSION

H₂O₂ nebulization was found to exhibit a good efficacy against healthcare-associated microbial dry biofilms. Moreover, similar efficacies were found between the tested cycles.