The Novel Coronavirus: An Alert for Pacifiers' Disinfection

Abstract Objective: To evaluate the best strategy for pacifier disinfection methods. Material and Methods: The literature search was conducted on MEDLINE/PubMed, Scielo, Lilacs, Web of Science, and Scopus databases to find all relevant articles published over the past 20 years, based on PRISMA guidelines. Two reviewers extracted data independently by using a standardized form. The following factors were recorded: country of study, type of study, pacifier material, sample number, microorganisms analyzed, decontamination methods used, method accessibility and results found. Results: A total of 121 articles were obtained from all databases. The selected documents underwent a final screening, resulting in 8 articles. The method of disinfection analyzed by the literature were: 3.5% neutral detergent, apple cider vinegar 70% spray, boiling water during 15 minutes, sodium hypochlorite 2.5, hydrogen peroxide 70% spray, chlorhexidine 0.12%, Brushtox®, sterile water and microwave. Conclusion: Because of the broad methods for pacifier disinfection and different levels of accessibility to disinfectant agents, the pacifier consensus for decontamination remains unclear. Although the disinfection methods are diverse, the methods suggested to its disinfection were identified and described in this article.

Control of bacterial biofilms formed on pacifiers by antimicrobial solutions in spray.

BACKGROUND: The aim was to evaluate the use of vinegar, hydrogen peroxide and sodium bicarbonate solutions for the disinfection of pacifiers. DESIGN: Different types and concentrations of the substances were screened in planktonic and biofilm for antimicrobial activity on Streptococcus mutans, Staphylococcus pyogenes, Staphylococcus aureus and Escherichia coli. Also, the effect of the most effective substance was tested against polymicrobial biofilms aiming to mimic the multispecies colonization found in a pacifier. RESULTS: Based on the agar diffusion test, minimal inhibitory concentration (MIC) and minimal microbicide concentration assays, 70% apple vinegar (70%AV) and 70% hydrogen peroxide (70%HP) were selected (P < 0.05). All tested solutions were able to significantly reduce viable cells of S. pyogenes, S. mutans and E. coli from the biofilms A statistically significant reduction of viable cells in S. aureus biofilms were observed after treatment with 70%AV in comparison to the other treatments. When compared to other microbial species, it was found that 70%HP was particularly effective against E. coli. The solution of 70%HP was able to reduce the viable cells of Enterobacteriaceae/pseudomonas of a polymicrobial biofilm formed from a pacifier. The other solutions were not effective in relation to control group. CONCLUSION: Solutions of 70% HP showed to be a good alternative for chlorhexidine digluconate for the disinfection of pacifiers.

Decontaminating breast pump kits: new guidance.

Various methods can be used to decontaminate breast pump milk collection kits and items related to infant feeding but they have some drawbacks and risks. In 2015, the Joint Working Group of the Healthcare Infection Society and Infection Prevention Society published guidance to support the safe decontamination of this equipment at home and in hospital. This article summarises its recommendations for health professionals to use and communicate to other groups, such as parents and carers.

Microbial contamination and disinfection methods of pacifiers.

OBJECTIVES: To evaluate the microbial contamination of pacifiers by Mutans Streptococci(MS) and the efficacy of different methods for their disinfection. METHODS: Twenty-eight children were assigned to a 4-stage changeover system with a 1-week interval. In each stage, children received a new pacifier and the parents were instructed to maintain their normal habits for 1 week. After this time, the pacifiers were subjected to the following 4 disinfection methods: spraying with 0.12% chlorhexidine solution, Brushtox or sterile tap water, and immersion in boiling tap water for 15 minutes. Microbiological culture for MS and Scanning Electron Microscopy (SEM) were performed. The results were analyzed statistically by Friedman's non-parametric test (a=0.05). RESULTS: The 0.12% chlorhexidine spray was statistically similar to the boiling water (p>0.05) and more effective than the Brushtox spray and control (p<0.05). The analysis of SEM showed the formation of a cariogenic biofilm in all groups with positive culture. CONCLUSIONS: Pacifiers become contaminated by MS after their use by children and should be disinfected routinely. Spraying with a 0.12% chlorhexidine solution and immersion in boiling water promoted better disinfection of the pacifiers compared with a commercial antiseptic toothbrush cleanser (Brushtox).

Microbial contamination and disinfection methods of pacifiers

Objectives To evaluate the microbial contamination of pacifiers by Mutans Streptococci(MS) and the efficacy of different methods for their disinfection.Methods Twenty-eight children were assigned to a 4-stage changeover system with a 1-week interval. In each stage, children received a new pacifier and the parents were instructed to maintain their normal habits for 1 week. After this time, the pacifiers were subjected to the following 4 disinfection methods: spraying with 0.12% chlorhexidine solution, Brushtox® or sterile tap water, and immersion in boiling tap water for 15 minutes. Microbiological culture for MS and Scanning Electron Microscopy (SEM) were performed. The results were analyzed statistically by Friedman’s non-parametric test (a=0.05).Results The 0.12% chlorhexidine spray was statistically similar to the boiling water (p>0.05) and more effective than the Brushtox®spray and control (p<0.05). The analysis of SEM showed the formation of a cariogenic biofilm in all groups with positive culture.Conclusions Pacifiers become contaminated by MS after their use by children and should be disinfected routinely. Spraying with a 0.12% chlorhexidine solution and immersion in boiling water promoted better disinfection of the pacifiers compared with a commercial antiseptic toothbrush cleanser (Brushtox®).

Dummy (pacifier) use and sudden infant death syndrome: potential advantages and disadvantages.

The large decline in deaths due to the sudden infant death syndrome (SIDS) in the last 20 years in many countries is largely due to risk-reduction advice resulting from observational studies that examined the relationship between infant care practices and SIDS. Most of this advice remains largely uncontroversial and educators and researchers in this field are in agreement as to the specific recommendations that should be given to parents and health professionals. However, advice surrounding the apparent protective effect of dummies (also known as pacifiers) has been controversial. Several systematic reviews have demonstrated a strong association between the lack of a pacifier being used by the infant for the final sleep and SIDS, but it is not clear how pacifiers confer protection or if this is a marker for something as yet unmeasured. The Epidemiology and Physiology Working Groups of the International Society for the Study and Prevention of Perinatal and Infant Death (ISPID) are comprised of leading SIDS researchers with an objective to provide evidence-based position statements surrounding the factors associated with SIDS (http://www.ispid.org/) and risk-reduction strategies. The evidence, discussion and conclusions from these working groups regarding dummies (pacifiers) are described below to help inform this debate and describe the future evidence required so that we might find a common recommendation about dummies (pacifiers) and SIDS.

Análise estrutural e microbiológica de chupetas de crianças de creches públicas e particulares / Análisis estructural y microbiológico de los chupetes de los niños en las guarderías públicas y privadas / Structural and microbiological analysis of children´s pacifiers in public and private nursery schools

Introdução: o uso de chupetas pode trazer riscos à saúde de crianças, resultando em infecções oportunistas e acidentes. Objetivo: avaliar as condições estruturais e microbiológicas de chupetas de crianças de creches públicas e particulares da cidade de Imperatriz, Maranhão, Brasil. Métodos: trinta chupetas de crianças de creches pública (n = 15) e particular (n = 15) foram avaliadas quanto à adequação às normas brasileiras, presença de sujeira e níveis de contaminação por estreptococos do grupo mutans, Candida sp. e Enterococcus sp. Um questionário direcionado aos pais e cuidadores investigou os cuidados realizados quanto ao uso das chupetas. Resultados: as chupetas analisadas encontraram-se de acordo com a normatização vigente (100 porcento). As chupetas apresentaram-se contaminadas pelos três grupos de microrganismos estudados (>15 porcento), com maior prevalência (p < 0,05) para Candida sp (93,3 porcento). Não foi observada diferença estatisticamente significante entre o tipo de creche e a presença de contaminação ou sujeira das chupetas (p > 0,05). Conclusão: as condições estruturais e a contaminação das chupetas não variaram entre os tipos de creche, verificando-se que as condições de higiene e os cuidados necessários ao manejo das chupetas eram inadequados, apesar da adequação à legislação vigente. A escola e o cirurgião-dentista apresentam papel fundamental na mudança dessa condição(AU)

Introducción: el uso del chupete puede plantear riesgos para la salud de los niños, dando lugar a infecciones oportunistas y accidentes. Objetivo: evaluar las condiciones estructurales y microbiológicas de los chupetes de los niños en las guarderías públicas y privadas en la ciudad de Imperatriz, Maranhão, Brasil. Métodos: treinta chupetes de niños en las guarderías públicas (n = 15) y privadas (n = 15), se evaluaron teniendo en cuenta la adecuación a las normas brasileñas, la presencia de suciedad, y la presencia de contaminación por estreptococos del grupo mutans, Candida sp. y Enterococcus sp. Mediante un cuestionario dirigido a los padres y cuidadores, se investigaron los cuidados que se observan para el uso de chupetes. Resultados: los chupetes analizados cumplieron de acuerdo con la regulación actual (100 por ciento). Estuvieron contaminados por los tres grupos de microorganismos estudiados (> 15 por ciento), con mayor prevalencia (p < 0,05) para Candida sp (93,3 por ciento). No se encontraron diferencias estadísticamente significativas entre el tipo de cuidado de los niños y la presencia de suciedad o contaminación de los chupetes (p > 0,05). Conclusión: las condiciones morfológicas y la contaminación de los chupetes no variaron entre los tipos de guarderías, verificando que la higiene y el cuidado necesario para la gestión de los chupetes fueron insuficientes a pesar de la adecuación a las normas brasileñas. La escuela y los dentistas tienen una importante responsabilidad en modificar esta situación(AU)

Introduction: the use of pacifiers can cause risks to children health, resulting in opportunistic infections and accidents. Objective: our paper intends to evaluate the structural and microbiological conditions of children pacifiers at public and private nursery schools, in the city of Imperatriz, Maranhão, Brazil. Methods: thirty children pacifiers from public (n = 15) and private (n = 15) nursery schools, were evaluated considering their adequacy to Brazilian standards such as presence of dirt, and presence of infectivity by mutans streptococci group, Candida sp. and Enterococcus sp. The care provided for the use of pacifiers was asked to the parents and caregivers through a questionnaire. Results: the analyzed pacifiers met the Brazilian standards (100 percent). Pacifiers were infected by the three groups of microorganisms studied (>15 percent), with higher prevalence (p < 0.05) to Candida sp (93.3 percent). There was no statistically significant difference between the type of nursery school and the presence of dirt or infectivity of pacifiers (p > 0.05). Conclusion: the morphological conditions and contamination of pacifiers did not vary between the types of nursery schools, verifying that the necessary hygiene and care to the management of these pacifiers were inadequate despite the suitability to Brazilian standards. Sschool and dentists have an important hole in modifying this condition(AU)

Pacifier cleaning practices and risk of allergy development.

OBJECTIVE: Immune stimulation through exposure to commensal microbes may protect against allergy development. Oral microbes may be transferred from parents to infants via pacifiers. We investigated whether pacifier cleaning practices affected the risk of allergy development. METHODS: A birth-cohort of 184 infants was examined for clinical allergy and sensitization to airborne and food allergens at 18 and 36 months of age and, in addition, promptly on occurrence of symptoms. Pacifier use and pacifier cleaning practices were recorded during interviews with the parents when the children were 6 months old. The oral microbiota of the infants was characterized by analysis of saliva samples collected at 4 months of age. RESULTS: Children whose parents "cleaned" their pacifier by sucking it (n = 65) were less likely to have asthma (odds ratio [OR] 0.12; 95% confidence interval [CI] 0.01-0.99), eczema (OR 0.37; 95% CI 0.15-0.91), and sensitization (OR 0.37; 95% CI 0.10-1.27) at 18 months of age than children whose parents did not use this cleaning technique (n = 58). Protection against eczema remained at age 36 months (hazard ratio 0.51; P = .04). Vaginal delivery and parental pacifier sucking yielded independent and additive protective effects against eczema development. The salivary microbiota differed between children whose parents cleaned their pacifier by sucking it and children whose parents did not use this practice. CONCLUSIONS: Parental sucking of their infant's pacifier may reduce the risk of allergy development, possibly via immune stimulation by microbes transferred to the infant via the parent's saliva.

Efficacy of microwaves and chlorhexidine for disinfection of pacifiers and toothbrushes: an in vitro study.

PURPOSE: The purpose of this study was to evaluate, in vitro, the contamination of toothbrushes and pacifiers by Streptococcus mutans, and the efficacy of microwave and chlorhexidine for their disinfection. MATERIALS AND METHODS: Sixty pacifiers and 60 toothbrushes were contaminated with S. mutans and then divided into groups according to the disinfection protocol: Group 1-chlorhexidine solution; group 2-microwave sterilization; and group 3-sterile tap water. The devices were evaluated microbiologically after disinfection for the survival of S. mutans colonies and were examined. The results were analyzed statistically by ANOVA and Turkey test. RESULTS: The results of both types of evaluation showed a large number of S. mutans colonies after spraying with sterile tap water, and chlorhexidine spraying and microwaving were effective in eliminating colonies. Groups 1 and 2 were statistically similar to each other (p > 0.05) and differed significantly from group 3 (p < 0.05). CONCLUSION: The 0.12% chlorhexidine solution spray and 7 minutes of microwave irradiation were almost equally effective for disinfection of pacifiers and toothbrushes.

Efficacy of microwaves and chlorhexidine on the disinfection of pacifiers and toothbrushes: an in vitro study.

PURPOSE: The purpose of this study was to evaluate, in vitro, the contamination of toothbrushes and pacifiers by Streptococcus mutans, and the efficacy of microwave and chlorhexidine for their disinfection. METHODS: Sixty pacifiers and 60 toothbrushes were contaminated with S mutans and then divided into groups according to the disinfection protocol: Group 1-chlorhexidine solution; Group 2-microwave sterilization; and Group 3-sterile tap water. The devices were evaluated microbiologically as to the formation of S mutans colonies/biofilms and were examined by scanning electron microscopy. The results were submitted for statistical analysis by Friedman's test at a 5% significance level. RESULTS: The results of both types of evaluation showed a large number of S mutans colonies/biofilms after spraying with sterile tap water, and chlorhexidine spraying and microwaving were effective in eliminate colonies/biofilms. Groups 1 and 2 were statistically similar to each other (P>.05) and differed significantly from Group 3 (P<.05). CONCLUSIONS: The 0.12% chlorhexidine solution spray and 7 minutes of microwave irradiation were effective for disinfection of pacifiers and toothbrushes.

Biofilm formation by Candida species on silicone surfaces and latex pacifier nipples: an in vitro study.

The present study assessed the growth and development of biofilm formation by isolates of C. albicans, C. glabrata and C. parapsilosis on silicone and latex pacifier nipples. The silicone and latex surfaces were evaluated by scanning electronic microscopy (SEM). The plastic component of the nipple also seems to be an important factor regarding the biofilm formation by Candida spp. The biofilm growth was measured using the MTT reduction reaction. C. albicans was found to have a slightly greater capacity of forming biofilm compared to the other Candida species. Analysis of the pattern of biofilm development by C. albicans, C. glabrata and C. parapsilosis on latex and silicon pacifier shields showed an increased biofilm formation regarding the latter substrate. Silicone was shown to be more resistant to fungal colonization, particularly in the case of C. parapsilosis, despite the lack of any statistically significant differences (P > 0.05). In addition, silicone has a smoother surface compared to latex, whose surface was found to be rugose and irregular.

Pacifiers: a microbial reservoir.

The permanent contact between the nipple part of pacifiers and the oral microflora offers ideal conditions for the development of biofilms. This study assessed the microbial contamination on the surface of 25 used pacifier nipples provided by day-care centers. Nine were made of silicone and 16 were made of latex. The biofilm was quantified using direct staining and microscopic observations followed by scraping and microorganism counting. The presence of a biofilm was confirmed on 80% of the pacifier nipples studied. This biofilm was mature for 36% of them. Latex pacifier nipples were more contaminated than silicone ones. The two main genera isolated were Staphylococcus and Candida. Our results confirm that nipples can be seen as potential reservoirs of infections. However, pacifiers do have some advantages; in particular, the potential protection they afford against sudden infant death syndrome. Strict rules of hygiene and an efficient antibiofilm cleaning protocol should be established to answer the worries of parents concerning the safety of pacifiers.