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.

Contact time and disinfectant formulation significantly impact the efficacies of disinfectant towelettes against Candida auris on hard, non-porous surfaces.

There has been an increase in Candida auris healthcare-associated infections, which result from cross-contamination from surfaces and equipment. In this study, we tested the efficacies of EPA-registered disinfectant towelettes products that are increasingly used for infection control against C. auris at a range of contact times following modifications to standard EPA protocol MB-33-00. Hydrogen peroxide (HP)-based disinfectant towelettes were more efficacious against C. auris than the quaternary ammonium chloride (QAC)-alcohol-based disinfectant towelettes irrespective of tested contact times. Thirty s contact time was significantly less effective in reducing C. auris compared to 1-, 2-, 3-, and 10-min contact times. However, there were no statistically significant differences in the level of disinfection among 1-min and longer contact times regardless of product chemistry. None of the products achieved a standard six-log10 reduction at any tested contact times. Overall, the HP-based disinfectant towelette was significantly more fungicidal than the QAC-alcohol-based disinfectant towelette. For all product types, 30 s contact time did not achieve the same level of disinfection as 1-min or longer contact times. Overall, disinfectant towelette efficacy is dependent upon product formulation and contact time.

Evaluation of automated floor cleaning, disinfection, and application methods against Staphylococcus aureus.

BACKGROUND: Optimization of automated floor disinfection practices using different application methods and product types is important to ensure that pathogens such as Staphylococcus aureus do not transfer from contaminated floors to other high contact areas resulting in healthcare-associated infections (HAIs). We hypothesized that there would be significant differences among the disinfectants and a cleaner under different application methods. Also, performance of application methods would be dependent upon type of product used. METHODS: We tested and compared efficacies of 5 EPA registered disinfectants and one cleaner using an automated Taski 455B floor cleaner against S aureus ATCC 6538 on 2 meters of contaminated vinyl flooring using 3 application methods. RESULTS: Hydrogen peroxide and quaternary ammonium compounds were more efficacious against S aureus than the neutral cleaner. There were no significant differences among the sampling areas tested and application methods regardless of product type. Mean log10 densities recovered from different machine parts and wastewater collected were statistically higher for the cleaner than disinfectants. CONCLUSIONS: All disinfectants had more bactericidal efficacy than the cleaner for all sampling zones on the tested floor. Overall, performance of the floor machine is dependent upon the type of product used.

Hydrogen peroxide, sodium dichloro-s-triazinetriones and quaternary alcohols significantly inactivate the dry-surface biofilms of Staphylococcus aureus and Pseudomonas aeruginosa more than quaternary ammoniums.

Globally, healthcare-associated infections (HAI) are the most frequent adverse outcome in healthcare delivery. Although bacterial biofilms contribute significantly to the incidence of HAI, few studies have investigated the efficacy of common disinfectants against dry-surface biofilms (DSB). The objective of this study was to evaluate the bactericidal efficacy of seven Environmental Protection Agency (EPA)-registered liquid disinfectants against DSB of Staphylococcus aureus and Pseudomonas aeruginosa. We hypothesized that overall, there will be significant differences among the bactericidal efficacies of tested disinfectants by product type and active ingredient class. We also hypothesized that depending on the species, higher bactericidal efficacies against DSB will be exhibited after 24 h of dehydration compared to 72 h. Wet-surface biofilms of S. aureus and P. aeruginosa were grown following EPA-MLB-SOP-MB-19 and dehydrated for 24 and 72 h to establish DSB. Seven EPA-registered disinfectants were tested against dehydrated DSB following EPA-MLB-SOP-MB-20. Overall, quaternary ammonium plus alcohol, sodium dichloro-s-triazinetrione and hydrogen peroxide products were more efficacious against DSB than quaternary ammoniums for both tested species. While there was no significant difference in the log10 reductions between 24 and 72 h S. aureus biofilms, significantly higher log10 reductions were observed when products were challenged with 24 h P. aeruginosa DSB compared to 72 h P. aeruginosa DSB. Species type, active ingredient class and dry time significantly impact disinfectant efficacy against DSB of S. aureus or P. aeruginosa.

Disinfectant wipes transfer Clostridioides difficile spores from contaminated surfaces to uncontaminated surfaces during the disinfection process.

BACKGROUND: Pre-wetted disinfectant wipes are increasingly being used in healthcare facilities to help address the risk of healthcare associated infections (HAIs). However, HAIs are still a major problem in the US with Clostridioides difficile being the most common cause, leading to approximately 12,800 deaths annually in the US. An underexplored risk when using disinfectant wipes is that they may cross-contaminate uncontaminated surfaces during the wiping process. The objective of this study was to determine the cross-contamination risk that pre-wetted disinfectant towelettes may pose when challenged with C. difficile spores. We hypothesized that although the tested disinfectant wipes had no sporicidal claims, they will reduce spore loads. We also hypothesized that hydrogen peroxide disinfectant towelettes would present a lower cross-contamination risk than quaternary ammonium products. METHODS: We evaluated the risk of cross-contamination when disinfectant wipes are challenged with C. difficile ATCC 43598 spores on Formica surfaces. A disinfectant wipe was used to wipe a Formica sheet inoculated with C. difficile. After the wiping process, we determined log10 CFU on previously uncontaminated pre-determined distances from the inoculation point and on the used wipes. RESULTS: We found that the disinfectant wipes transferred C. difficile spores from inoculated surfaces to previously uncontaminated surfaces. We also found that wipes physically removed C. difficile spores and that hydrogen peroxide disinfectants were more sporicidal than the quaternary ammonium disinfectants. CONCLUSION: Regardless of the product type, all disinfectant wipes had some sporicidal effect but transferred C. difficile spores from contaminated to otherwise previously uncontaminated surfaces. Disinfectant wipes retain C. difficile spores during and after the wiping process.

A rapid model for developing dry surface biofilms of Staphylococcus aureus and Pseudomonas aeruginosa for in vitro disinfectant efficacy testing.

BACKGROUND: Bacterial biofilms persistent on dry environmental surfaces in healthcare facilities play an important role in the occurrence of healthcare associated infections (HAI). Compared to wet surface biofilms and planktonic bacteria, dry surface biofilms (DSB) are more tolerant to disinfection. However, there is no official method for developing DSB for in vitro disinfectant efficacy testing. The objectives of this study were to (i) develop an in vitro model of DSB of S. aureus and P. aeruginosa for disinfectant efficacy testing and (ii) investigate the effect of drying times and temperatures on DSB development. We hypothesized that a minimum six log10 density of DSB could be achieved on glass coupons by desiccating wet surface biofilms near room temperatures. We also hypothesized that a DSB produced by the model in this study will be encased in extracellular polymeric substances (EPS). METHODS: S. aureus ATCC-6538 and P. aeruginosa ATCC-15442 wet surface biofilms were grown on glass coupons following EPA MLB SOP MB-19. A DSB model was developed by drying coupons in an incubator and viable bacteria were recovered following a modified version of EPA MLB SOP MB-20. Scanning electron microscopy was used to confirm the EPS presence on DSB. RESULTS: Overall, a minimum of six mean log10 densities of DSB for disinfectant efficacy were recovered per coupon after drying at different temperatures and drying times. Regardless of strain, temperature and dry time, 86% of coupons with DSB were confirmed to have EPS. CONCLUSION: A rapid model for developing DSB with characteristic EPS was developed for disinfectant efficacy testing against DSB.

Cross-contamination by disinfectant towelettes varies by product chemistry and strain.

BACKGROUND: Disinfectant products are used frequently on environmental surfaces (e.g. medical equipment, countertops, patient beds) and patient care equipment within healthcare facilities. The purpose of this study was to assess the risk of cross-contamination of Staphylococcus aureus and Pseudomonas aeruginosa during and after disinfection of predetermined surface areas with ready-to-use (RTU) pre-wetted disinfectant towelettes. METHODS: This study tested six disinfectant towelette products against S. aureus ATCC CRM-6538 and P. aeruginosa strain ATCC-15442 on Formica surfaces. Each disinfectant was evaluated on a hard nonporous surface and efficacy was measured every 0.5 m2 using a modified version of EPA MLB SOP-MB-33 to study the risk of cross-contamination. RESULTS: We found that all of the wipes used in this study transferred S. aureus and P. aeruginosa from an inoculated surface to previously uncontaminated surfaces. Disinfectant towelettes with certain chemistries also retained a high level of viable bacteria after disinfection of the surface area. The cross-contamination risk also varied by product chemistry and bacterial strain. CONCLUSION: Disinfectant wipes can cross-contaminate hard nonporous surfaces and retain viable bacterial cells post-disinfection, especially over larger surface areas. This highlights a need to further investigate the risk disinfectant wipes pose during and post-disinfection and guidance on maximum surface areas treated with a single towelette.

Assessment of early onset surface damage from accelerated disinfection protocol.

Background: The objective of this study was to evaluate the extent and potential mechanisms of early onset surface damage from simulated wiping typical of six-months of routine disinfection and to assess the subsequent microbial risk of surfaces damaged by disinfectants. Methods: Eight common material surfaces were exposed to three disinfectants and a neutral cleaner (neutral cleaner, quaternary ammonium, hydrogen peroxide, sodium hypochlorite) in accelerated aging tests to simulate a long-term disinfection routine. Materials were also immersed in dilute and concentrated chemical solutions to induce surface damage. Surfaces were chemically and physically characterized to determine extent of surface damage. Bactericidal efficacy testing was performed on the Quat-based disinfectant using a modified version of EPA standard operating procedure MB-25-02. Results: The wiping protocol increased surface roughness for some material surfaces due to mechanical abrasion of the wiping cloth. The increased roughness did not correlate with changes in bactericidal efficacy. Chemical damage was observed for some surface-disinfectant combinations. The greatest observed effects from disinfectant exposure was in changes in wettability or water contact angle. Conclusions: Early onset surface damage was observed in chemical and physical characterization methods. These high-throughput material measurement methods were effective at assessing nanoscale disinfectant-surface compatibility which may go undetected though routine macroscale testing.

There is no additional bactericidal efficacy of Environmental Protection Agency-registered disinfectant towelettes after surface drying or beyond label contact time.

BACKGROUND: Disinfectant towelettes are commonly used for surface disinfection to prevent health care-associated infections; however, there is limited consensus as to whether a surface needs to remain wet for the full label contact time after the disinfectant towelette has been used in order for complete efficacy to be achieved. The purpose of this study was to quantify the effect of contact time, including times before and after a product dries, on bactericidal efficacy of 6 towelette products registered by the Environmental Protection Agency . METHODS: Six disinfectant towelette products were tested at varying contact times, including defined label contact times. Quantitative Environmental Protection Agency MB-33-00 was used to measure disinfectant efficacy against Staphylococcus aureus on Formica. Complete dry time for each disinfectant was measured gravimetrically. RESULTS: There were significant differences in dry times among the towelette products; contact time did not have a significant effect on bactericidal efficacy. There was no longitudinal effect when a disinfectant's contact time was greater than defined label contact time, irrespective of whether the product was wet or dry on the surface. DISCUSSION: Overall, bactericidal efficacy varied by towelette product tested and surface area wiped. Wiping larger surface areas may lead to decreased bactericidal efficacy but is product dependent. CONCLUSIONS: There was no additional bactericidal effect after a product dried, indicating that extended contact times beyond when the product dries will not enhance disinfection.

Hydrogen peroxide and sodium hypochlorite disinfectants are more effective against Staphylococcus aureus and Pseudomonas aeruginosa biofilms than quaternary ammonium compounds.

Background: Antimicrobial disinfectants are used as primary treatment options against pathogens on surfaces in healthcare facilities to help prevent healthcare associated infections (HAIs). On many surfaces, pathogenic microorganisms exist as biofilms and form an extracellular matrix that protects them from the antimicrobial effects of disinfectants. Disinfectants are used as all-purpose antimicrobials though very few specifically make biofilm efficacy claims. The objective of this study was to evaluate the efficacy of eight registered disinfectants (six registered by the Environmental Protection Agency and two products registered in by the European Chemical Agency) with general bactericidal claims, but currently no biofilm efficacy claims, against Staphylococcus aureus ATTC-6538 and Pseudomonas aeruginosa ATCC-15442 biofilms. We hypothesized that hydrogen peroxide and sodium hypochlorite disinfectant products would be more effective than quaternary ammonium chlorides. Methods: This study tested the bactericidal efficacy of eight registered disinfectant products against S. aureus ATCC-6538 and P. aeruginosa ATCC-15442 grown on glass coupons using a Center for Disease Control (CDC) biofilm reactor and EPA MLB SOP MB-19. Bactericidal efficacy was determined after treating coupons with disinfectants following standard EPA MLB SOP MB-20. Results: Overall, sodium hypochlorite and hydrogen peroxide disinfectants had significantly higher bactericidal efficacies than quaternary ammonium chloride disinfectants. We also found that all tested disinfectants except for quaternary ammonium chloride disinfectants met and exceeded the EPA standard for bactericidal efficacy against biofilms. Conclusion: In general, bactericidal efficacy against biofilms differed by active ingredient. The efficacies of sodium hypochlorite and hydrogen peroxide disinfectants did not vary between strains, but there were significant differences between strains treated with quaternary ammonium chloride disinfectants.

Surface area wiped, product type, and target strain impact bactericidal efficacy of ready-to-use disinfectant Towelettes.

Background: Disinfectant products are often used on environmental surfaces (e.g. countertops, patient beds) and patient care equipment in healthcare facilities to help prevent the transmission of healthcare-associated infections. Ready-to-use (RTU) disinfectants in the form of pre-wetted towelettes are increasingly popular among healthcare facilities. Currently, the EPA does not require disinfectant manufacturers to include a recommended maximum surface area per towelette on their product labels. The objective of this study was to investigate the efficacy of disinfectant towelette products on a hard non-porous surface across different coverage areas using a quantitative EPA method. We hypothesized that there would be significant differences in the efficacy of disinfectant towelette products, and that the greater surface area(s) wiped would result in reduced bactericidal efficacy. Methods: This study tested ten disinfectant towelette products against Staphylococcus aureus strain ATCC CRM-6538 and Pseudomonas aeruginosa strain ATCC 15442 on Formica surfaces. Defined surface areas were wiped and the towelette weighed before and after wiping to determine the amount of liquid released. Bactericidal efficacy testing was also performed after wiping following standard EPA protocols. Results: We found that disinfectant product, area of surface wiped, and strain impacted the bactericidal efficacy achieved. Disinfectant product type and area of surface wiped significantly impacted the percent of liquid released per ft2from the towelette. Conclusion: Overall, bactericidal efficacy varied by towelette product, surface area wiped, and strain. This study also found that wiping larger surface areas may lead to decreased bactericidal efficacy. Further research is needed to test its implication.

Strain, disinfectant, concentration, and contact time quantitatively impact disinfectant efficacy.

Background: Transmission of healthcare-associated infections caused by antibiotic- and multi-drug resistant (MDR) pathogens (e.g. Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa) are a major concern in patient care facilities. Disinfectant usage is critical to control and prevent pathogen transmission, yet the relationships among strain, disinfectant type, contact time, and concentration are not well-characterized. We hypothesized that there would be significant differences in disinfectant efficacy among clinically relevant strains under off-label disinfectant conditions, but there would be less no differences among at registered label use concentrations and contact times. The purpose of this study was to quantify the effect of disinfectant concentration and contact time on the bactericidal efficacy of clinically relevant strains of S. aureus and P. aeruginosa. Methods: Accelerated hydrogen peroxide (AHP), quaternary ammonium compounds (Quat), and sodium hypochlorite were tested at label and reduced contact times and concentrations against four MDR P. aeruginosa strains and four MRSA strains. Quantitative EPA method MB-25-02 was used to measure disinfectant efficacy reported as log10 reduction. Results: Both off-label disinfectant concentrations and contact times significantly affected efficacy of all disinfectants tested. Bactericidal efficacy varied among MRSA and P. aeruginosa strains. Conclusions: The quantitative disinfectant efficacy method used highlights the inter-strain variability that exists within a bacterial species. It also underscores the need for a disinfectant validation method that takes these variances into account.

Effects of contact time and concentration on bactericidal efficacy of 3 disinfectants on hard nonporous surfaces.

This study investigated the influence of contact time and concentration on bactericidal efficacy of 3 types of disinfectants (accelerated hydrogen peroxide [AHP], quaternary ammonium compounds [Quats], and sodium hypochlorite) on stainless steel surfaces using Environmental Protection Agency procedure MB-25-02. We found that bactericidal efficacy was not reduced at contact times or concentrations immediate lower than label use values, but all 3 disinfectants were significantly less bactericidal at significantly lower than label use contact times and concentrations. Overall, the bactericidal efficacy of the sodium hypochlorite disinfectant was most tolerant to the decreases of contact times and concentrations, followed closely by AHP disinfectant, and Quat disinfectant was most affected by contact time and concentration.