The effect of hospital biocide sodium dichloroisocyanurate on the viability and properties of Clostridium difficile spores

Effective elimination of bacteria on hard surfaces by the combined use of bacteriophages and chemical disinfectants

Hospital-acquired infections (HAIs) represent one of the significant causes of morbidity and mortality worldwide, and controlling pathogens in the hospital environment is of great importance. Currently, the standard disinfection method in the hospital environment is chemical disinfection. However, disinfectants are usually not used strictly according to the label, making them less effective in disinfection. Therefore, there is an emergent need to find a better approach that can be used in hospitals to control pathogenic bacteria in the clinical environment. Bacteriophages (phages) are effective in killing bacteria and have been applied in the treatment of bacterial infections but have not received enough attention regarding the control of contamination in the clinical environment. In this study, we found that various phages remain active in the presence of chemical disinfectants. Moreover, the combined use of specific phages and chemical disinfectants is more effective in removing bacterial biofilms and eliminating bacteria on hard surfaces. Thus, this proof-of-concept study indicates that adding phages directly to chemical disinfectants might be an effective and economical approach to enhance clinical environment disinfection.

IMPORTANCE

In this study, we investigated whether the combination of bacteriophages and chemical disinfectants can enhance the efficacy of reducing bacterial contamination on hard surfaces in the clinical setting. We found that specific phages are active in chemical disinfectants and that the combined use of phages and chemical disinfectants was highly effective in reducing bacterial presence on hard surfaces. As a proof-of-concept, we demonstrated that adding specific phages directly to chemical disinfectants is an effective and cost-efficient strategy for clinical environment disinfection.

Clostridioides difficile spores tolerate disinfection with sodium hypochlorite disinfectant and remain viable within surgical scrubs and gown fabrics

Clostridioides difficile is the most common cause of antibiotic-associated diarrhoea globally. Its spores have been implicated in the prevalence of C. difficile infection due to their resistance and transmission ability between surfaces. Currently, disinfectants such as chlorine-releasing agents (CRAs) and hydrogen peroxide are used to decontaminate and reduce the incidence of infections in clinical environments. Our previous research demonstrated the ability of C. difficile spores to survive exposure to recommended concentrations of sodium dichloroisocyanurate in liquid form and within personal protective fabrics such as surgical gowns; however, the present study examined the spore response to clinical in-use concentrations of sodium hypochlorite. Spores were exposed to a 10 min contact time of 1000, 5000 and 10 000 p.p.m. sodium hypochlorite, and spore recovery was determined. To understand whether biocide-exposed spores transmitted across clinical surfaces in vitro , biocide-exposed spores were spiked onto surgical scrubs and patient gowns and recovery was determined by a plate transfer assay. Scanning electron microscopy was used to establish if there were any morphological changes to the outer spore coat. The results revealed that viable biocide-exposed C. difficile spores can be recovered from surgical scrubs and patient gowns, with no observable changes to spore morphology, highlighting the potential of these fabrics as vectors of spore transmission. This study demonstrates that alternative strategies should be urgently sought to disinfect C. difficile spores to break the chain of transmission in clinical environments.

Clostridioides difficile spore germination: initiation to DPA release

Germination by Clostridioides difficile spores is an essential step in pathogenesis. Spores are metabolically dormant forms of bacteria that resist severe conditions. Work over the last 10 years has elucidated that C. difficile spores germinate thorough a novel pathway. This review summarizes our understanding of C. difficile spore germination and the factors involved in germinant recognition, cortex degradation and DPA release.

Inactivation of Spores and Vegetative Forms of Clostridioides difficile by Chemical Biocides: Mechanisms of Biocidal Activity, Methods of Evaluation, and Environmental Aspects

Clostridioides difficile infections (CDIs) are the most common cause of acquired diseases in hospitalized patients. Effective surface disinfection, focused on the inactivation of the spores of this pathogen, is a decisive factor in reducing the number of nosocomial cases of CDI infections. An efficient disinfection procedure is the result of both the properties of the biocidal agent used and the technology of its implementation as well as a reliable, experimental methodology for assessing the activity of the biocidal active substance based on laboratory models that adequately represent real clinical conditions. This study reviews the state of knowledge regarding the properties and biochemical basis of the action mechanisms of sporicidal substances, with emphasis on chlorine dioxide (ClO₂). Among the analyzed biocides, in addition to ClO₂, active chlorine, hydrogen peroxide, peracetic acid, and glutaraldehyde were characterized. Due to the relatively high sporicidal effectiveness and effective control of bacterial biofilm, as well as safety in a health and environmental context, the use of ClO₂ is an attractive alternative in the control of nosocomial infections of CD etiology. In terms of the methods of assessing the biocidal effectiveness, suspension and carrier standards are discussed.

Insights into the enhancement of waste activated sludge dewaterability using sodium dichloroisocyanurate and dodecyl dimethyl ammonium chloride: Performance, mechanism, and implication

Sludge dewatering is essential for reduction of sludge volume to cut the cost of transportation and disposal. Combined application of sodium dichloroisocyanurate (DCCNa) and dodecyl dimethyl ammonium chloride (DDAC) was attempted to promote sludge dewatering performance and physicochemical properties for the first time in this work. The results showed that capillary suction time (CST) and moisture content of dewatered sludge cake (Mc) decreased to 15.9 s and 61.54% compared to 144.5 s and 90.39% of raw sludge, respectively, with the addition of optimal dosage of 150 mg DCCNa/g DS and 125 mg DDAC/g DS. The conditioning mechanism of combined treatment was elucidated by investigating the variations of extracellular polymeric substances (EPS) composition, flocs morphological structure, rheological behavior, moisture distribution and Fourier transform infrared (FTIR) of sludge. It could be found that sludge floc cells were decomposed and bound water was released after DCCNa treatment. The bound water content was further decreased with the presence of DDAC. In addition, DDAC not only increased the zeta potential and flowability of sludge, but also reduced the surface tension and interact with oxygen-containing functional groups in sludge. As a result, the sludge dewaterability was significantly improved. Moreover, the calorific value analysis of dewatered sludge cake indicated that combined conditioning of DCCNa and DDAC presented the advantage of incineration disposal.

A sodium dichloroisocyanurate-based conditioning process for the improvement of sludge dewaterability and mechanism studies

Sludge dewatering is necessary to reduce the volume of sludge for cost-effective transport and ultimate disposal. In this study, a novel combined chemical conditioning process was proposed to improve sludge dewatering performance in which sludge flocs were destructed by sodium dichloroisocyanurate (DCCNa) and re-flocculated by Al₂(SO₄)₃ and the mechanism was elucidated. The results showed that sludge capillary suction time (CST) dropped to 15.4 s and moisture content of dewatered sludge cake (Mc) deceased to 71.01% respectively, after the application of combined conditioning with the optimal dosage of 200 mg DCCNa/g dry solids (DS) and 80 mg Al₂(SO₄)₃/g DS. With chemical conditioning, sludge physicochemical properties were greatly changed. With the DCCNa application, the percentage of low-molecular-weight substances in soluble extracellular polymeric substances (S-EPS) increased. Also, the sludge zeta potential dropped from -16.85 mV to -25.45 mV and the median particle size (D50) decreased from 54.1 μm to 51.6 μm. However, the subsequent conditioning by Al₂(SO₄)₃ dosing not only led to an increment of 18% in the portion of macromolecules in S-EPS, but also increased the zeta potential and D50 to -10.74 mV and 53.2 μm, respectively. The bound water content in sludge declined from 2.92 g/g DS to 1.98 g/g DS after combined conditioning. We concluded that DCCNa disintegrated the sludge flocs and microbial cells leading to the release of bound water, fine particles and organic substances with negative charge, and the fine colloidal particles can be flocculated into large dense aggregations with the dosing of Al₂(SO₄)₃. In summary, the proposed combined conditioning provided a highly effective and environmental friendly approach to improve the sludge dewatering performance.

Biocide Use in the Antimicrobial Era: A Review

Biocides are widely used in healthcare and industry to control infections and microbial contamination. Ineffectual disinfection of surfaces and inappropriate use of biocides can result in the survival of microorganisms such as bacteria and viruses on inanimate surfaces, often contributing to the transmission of infectious agents. Biocidal disinfectants employ varying modes of action to kill microorganisms, ranging from oxidization to solubilizing lipids. This review considers the main biocides used within healthcare and industry environments and highlights their modes of action, efficacy and relevance to disinfection of pathogenic bacteria. This information is vital for rational use and development of biocides in an era where microorganisms are becoming resistant to chemical antimicrobial agents.

Biocide Resistance and Transmission of Clostridium difficile Spores Spiked onto Clinical Surfaces from an American Health Care Facility

Clostridium difficile is the primary cause of antibiotic-associated diarrhea globally. In unfavorable environments, the organism produces highly resistant spores which can survive microbicidal insult. Our previous research determined the ability of C. difficile spores to adhere to clinical surfaces, finding that spores had markedly different hydrophobic properties and adherence abilities. Investigation into the effect of the microbicide sodium dichloroisocyanurate on C. difficile spore transmission revealed that sublethal concentrations increased spore adherence without reducing viability. The present study examined the ability of spores to transmit across clinical surfaces and their response to an in-use disinfection concentration of 1,000 ppm of chlorine-releasing agent sodium dichloroisocyanurate. In an effort to understand if these surfaces contribute to nosocomial spore transmission, surgical isolation gowns, hospital-grade stainless steel, and floor vinyl were spiked with 1 × 10⁶ spores/ml of two types of C. difficile spore preparations: crude spores and purified spores. The hydrophobicity of each spore type versus clinical surface was examined via plate transfer assay and scanning electron microscopy. The experiment was repeated, and spiked clinical surfaces were exposed to 1,000 ppm sodium dichloroisocyanurate at the recommended 10-min contact time. Results revealed that the hydrophobicity and structure of clinical surfaces can influence spore transmission and that outer spore surface structures may play a part in spore adhesion. Spores remained viable on clinical surfaces after microbicide exposure at the recommended disinfection concentration, demonstrating ineffectual sporicidal action. This study showed that C. difficile spores can transmit and survive between various clinical surfaces despite appropriate use of microbicides.IMPORTANCE Clostridium difficile is a health care-acquired organism and the causative agent of antibiotic-associated diarrhea. Its spores are implicated in fecal to oral transmission from contaminated surfaces in the health care environment due to their adherent nature. Contaminated surfaces are cleaned using high-strength chemicals to remove and kill the spores; however, despite appropriate infection control measures, there is still high incidence of C. difficile infection in patients in the United States. Our research examined the effect of a high-strength biocide on spores of C. difficile which had been spiked onto a range of clinically relevant surfaces, including isolation gowns, stainless steel, and floor vinyl. This study found that C. difficile spores were able to survive exposure to appropriate concentrations of biocide, highlighting the need to examine the effectiveness of infection control measures to prevent spore transmission and to consider the prevalence of biocide resistance when decontaminating health care surfaces.