RESUMEN
Clostridium difficile continues to cause infections in healthcare and other settings. Its spores survive well indoors and require sporicidal chemicals for infection control. However, proper testing of disinfectants is impeded due to difficulties in obtaining viable spores of high enough quality and titers to meet current regulations for sporicidal claims. A new liquid medium (Clospore) has been developed, based on a systematic review of the compositions of 20 other available media. C. difficile spores grown in the new medium and treated with a mixture of lysozyme and trypsin yielded final suspensions with > 10(9) CFU/mL of viable spores, with a purity of > 91% as tested by spore-staining and phase-contrast microscopy. The spores showed a biological decay rate of about 0.1 log10/month when dried on metal disks and stored indoors (air temperature 23 +/- 2 degrees C; relative humidity 52.76 +/- 15.08%). Heating the purified spore suspensions to 70 degrees C for 10 min to inactivate any vegetative cells showed no spore activation or inactivation. The spores could be stored for at least 14 months either refrigerated (4 degrees C) or frozen (-20 or -80 degrees C) in 50% (v/v) ethanol with virtually no loss in viability. The resistance of the enzyme-treated spores to three levels of sodium hypochlorite (1000, 3000, and 5000 ppm), using a standardized quantitative carrier test, was almost identical to that of the spores concentrated by centrifugation alone. The described procedure has been successfully applied to four standard (ATCC) and six clinical strains of C. difficile.
Asunto(s)
Clostridioides difficile/fisiología , Medios de Cultivo/química , Técnicas Bacteriológicas , Esporas Bacterianas/fisiologíaRESUMEN
Microbicides for reprocessing heat-sensitive medical devices, such as flexible endoscopes, must be mycobactericidal to reduce the risk of nosocomial infections. Suspension test methods currently used for efficacy evaluation lack the stringency required for assessing inactivation of mycobacteria on surfaces. The quantitative carrier test method reported here is based on mycobacteria-contaminated reference carrier disks of brushed stainless steel. Each disk was contaminated with 10 microL of a suspension of Mycobacterium terrae containing a soil load. Each disk with a dried inoculum was placed in a glass or Teflon vial, and then overlaid with 50 microL of the test formulation or 50 microL saline for the control carriers. Five test and 3 control disks were used in each run. At the end of the contact time, each vial received 9.95 mL neutralizer solution with 0.1% Tween-80 to stop the reaction and perform the initial microbicide dilution. The inoculum was eluted by mixing on a Vortex mixer for 60 s, and the eluates and saline used to subsequently wash the vials and the funnels were membrane-filtered. Filters were placed on plates of Middlebrook 7H11 agar and incubated at 37 degrees C for at least 30 days before colonies were counted and log10 reductions were calculated in colony-forming units. Tests with a range of commercially available products, having claims against mycobacteria, or believed to be broad-spectrum microbicides, showed that the method gave reproducible results. Products used included oxidizing agents (sodium hypochlorite and an iodophore), a phenolic, a quaternary ammonium compound, and ortho-phthalaldehyde. This method represents a much more realistic evaluation than the currently used quantitative suspension test method for the evaluation of mycobactericidal formulations for registration and, when performed at different product concentrations, allows an assessment of any safety margin or risks in using the test formulation in the field.
Asunto(s)
Antiinfecciosos/análisis , Antiinfecciosos/farmacología , Microbiología Ambiental , Pruebas de Sensibilidad Microbiana , Mycobacterium/efectos de los fármacos , Desinfectantes/análisis , Diseño de Equipo , Yodo/química , Oxígeno/química , Fenol/química , Reproducibilidad de los Resultados , Proyectos de Investigación , Microbiología del Suelo , Temperatura , Factores de TiempoRESUMEN
BACKGROUND: Clostridium difficile is an increasingly common nosocomial pathogen, and its spores are resistant to common environmental surface disinfectants. Many high-level disinfectants (eg, aldehydes) are unsuitable for environmental decontamination because they need several hours of contact to be sporicidal. This study tested the potential of selected oxidative microbicides to inactivate C. difficile spores on hard surfaces in relatively short contact times at room temperature. METHODS: The spores of a clinical isolate of C. difficile were tested using disks (1 cm diameter) of brushed stainless steel in a quantitative carrier test. The spores of C. sporogenes and Bacillus subtilis, common surrogates for evaluating sporicides, were included for comparison. The clostridia were grown separately in Columbia broth (CB), and B. subtilis was grown in a 1:10 dilution of CB. Each disk received 10 microL test spores with an added soil load, and the inoculum was dried. One disk each was placed in a glass vial and overlaid with 50 microL test formulation; controls received an equivalent volume of normal saline with 0.1% Tween 80. At the end of the contact time the microbicide was neutralized, the inoculum recovered from the disks by vortexing, the eluates were membrane filtered, and the filters placed on plates of recovery medium. The colony-forming units (CFU) on the plates were recorded after 5 days of incubation. The performance criterion was > or = 6 log(10) (> or = 99.9999%) reduction in the viability titer of the spores. The microbicides tested were domestic bleach with free-chlorine (FC) levels of 1000, 3000, and 5000 mg/L; an accelerated hydrogen peroxide (AHP)-based product with 70,000 mg/L H2O2 (Virox STF); chlorine dioxide (600 mg/L FC); and acidified domestic bleach (5000 mg/L FC). RESULTS: Acidified bleach and the highest concentration of regular bleach tested could inactivate all the spores in < or = 10 minutes; Virox STF could do the same in < or = 13 minutes. Regular bleach with 3000 mg/L FC required up to 20 minutes to reduce the viability of the all the spores tested to undetectable levels; chlorine dioxide and the lowest concentration of regular bleach tested needed approximately 30 minutes for the same level of activity. CONCLUSIONS: Acidified bleach, Virox STF, and regular bleach (3000-5000 mg/L FC) could inactivate C. difficile spores on hard environmental surfaces in approximately 10 to 15 minutes under ambient conditions. All of these products are strong oxidizers and should be handled with care for protection of staff, but acidified and regular bleach with high levels of FC also release chlorine gas, which can be hazardous if inhaled by staff or patients.
Asunto(s)
Clostridioides difficile/efectos de los fármacos , Desinfectantes/farmacología , Esporas Bacterianas/efectos de los fármacos , Compuestos de Cloro/farmacología , Clostridioides difficile/crecimiento & desarrollo , Relación Dosis-Respuesta a Droga , Microbiología Ambiental , Peróxido de Hidrógeno/farmacología , Óxidos/farmacología , Hipoclorito de Sodio/farmacologíaRESUMEN
For well over a decade, many deficiencies have been identified in current AOAC methods used to assess the microbicidal activities of chemical disinfectants on medical devices and environmental surfaces. This report discusses the development of quantitative carrier tests (QCT) designed to address these concerns. Decontamination of surfaces with dried inocula is invariably more difficult than when microorganisms are in suspension. For medical device as well as environmental decontamination, microbicides are used on contaminated surfaces, thus making it necessary to evaluate their microbicidal action on representative carrier materials contaminated with a dried challenge microorganism(s). Our approach is a 2-tiered QCT. The first tier (QCT-1) uses relatively ideal conditions to assess performance of the microbicide for screening purposes; the test uses smooth glass surfaces and quantities of disinfectant in excess of those likely to be experienced in the field. The second tier of testing (QCT-2) is more stringent because it uses (1) disks of brushed stainless steel as carriers, (2) only 50 microL of the test formulation on each carrier as compared to 1 mL in QCT-1, and (3) an added soil load to simulate the presence of residual body fluids or accumulated surface dirt. This review also discusses the factors that affect disinfection of medical devices and environmental surfaces in the context of the methodology used to evaluate the potency of microbicides. Specific recommendations for discussion are included, and performance criteria are suggested based on a risk-reduction approach for different classes of disinfectants. The focus is on improving the relevance of the test methodology to actual field use of disinfectants for devices and facilities in health care, and potentially in other settings. It is hoped that this review and its recommendations will initiate needed discussion and resolution of the many issues identified.
Asunto(s)
Técnicas de Química Analítica/métodos , Desinfectantes/farmacología , Desinfección , Pruebas de Sensibilidad Microbiana/métodos , Técnicas de Química Analítica/normas , Descontaminación/métodos , Desinfectantes/química , Desinfectantes/normas , Microbiología Ambiental , Contaminación de Equipos/prevención & control , Virus de la Hepatitis B/metabolismo , Humanos , Humedad , Concentración de Iones de Hidrógeno , Recién Nacido , Sensibilidad y Especificidad , Esterilización , Temperatura , Factores de TiempoRESUMEN
Suspension tests for virucidal activity of chemical germicides are easier to perform, but they normally do not present the test product with a strong enough challenge. In contrast, carrier tests, where the test virus is dried on an animate or inanimate surface, offer the test formulation a higher level of challenge because it first has to penetrate successfully the inoculum to gain access to and inactivate the target organism on the carrier. Since pathogens in nature are normally found adsorbed to surfaces and/or embedded in organic or cellular debris, the results of carrier tests are more relevant to predicting the activity of chemical germicides under field situations. The method described below uses discs (1 cm in diameter) of brushed stainless steel discs as carriers. Ten micro l of the test virus in a soil load is placed on each disc and the inoculum dried under ambient conditions. The dried inoculum is then exposed to 50 micro l of the test formulation or a control solution for a defined contact time at the specified temperature. EBSS (0.95 ml) is added to each carrier holder to dilute/neutralize the germicide, the inoculum eluted and the eluates titrated in cell cultures to determine the degree of loss in virus viability. At least five test and three control carriers are used in each test. Controls are also included to test for toxicity of the test formulation to the host cells and any interference sub-cytotoxic levels of the formulation may have on the ability of the virus to infect the cells. The method has been used with several types of human and animal pathogenic viruses to test the activity of all major classes of chemical germicides against them.
Asunto(s)
Antivirales/farmacología , Desinfectantes/farmacología , Pruebas de Sensibilidad Microbiana/métodos , Rhinovirus/efectos de los fármacos , Rotavirus/efectos de los fármacos , Técnicas de Cultivo de Célula , Humanos , Metales , Rhinovirus/patogenicidad , Rotavirus/patogenicidad , AceroRESUMEN
Enteric and respiratory viruses are among the most frequent causes of human infections, and hands play an important role in the spread of these and many other viral diseases. Regular and proper hand hygiene by caregivers and food handlers in particular is essential to decontaminate hands and potentially interrupt such spread. What would be considered a proper decontamination of hands? Handwashing with regular soap and water is often considered sufficient, but what of hygienic handwash and handrub antiseptic products? Are they more effective? The evidence suggests that some clearly are. Activity against bacteria may not reflect the ability of hygienic hand antiseptics to deal with viruses, especially those that are nonenveloped. In spite of the acknowledged importance of hands as vehicles for viruses, there is a lack of suitable regulatory mechanism for handwash or handrub products to make claims of efficacy against viruses. This is in contrast with the ability of general-purpose disinfectants to make antiviral claims, although transmission of viruses from surfaces other than those of reusable medical devices may play only a minor role in virus transmission. This review discusses the (1). recent information on the relative importance of viruses as human pathogens, particularly those causing enteric and respiratory infections; (2). the survival of relevant viruses on human hands in comparison with common gram-negative and gram-positive bacteria; (3). the potential of hands to transfer or receive such contamination on casual contact; (4). role of hands in the spread of viruses; (5). the potential of hygienic measures to eliminate viruses from contaminated hands; (6). relative merits of available protocols to assess the activity of hygienic hand antiseptics against viruses; and (7). factors considered crucial in any tests to assess the activity of hygienic hand antiseptics against viruses. In addition, this review proposes surrogate viruses in such testing and discusses issues for additional consideration by researchers, manufacturers, end-users, and regulators.