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Annali Di Igiene : Medicina Preventiva... 2019Healthcare associated infections (HAIs) represent a serious problem for public health, as they increase the morbidity and mortality rates, present a relevant financial... (Review)
Review
BACKGROUND
Healthcare associated infections (HAIs) represent a serious problem for public health, as they increase the morbidity and mortality rates, present a relevant financial burden, and significantly contribute to the antimicrobial resistance.
METHODS
The aim of this review was to investigate the literature about HAIs, with particular reference to hospital environments and the role of cleaning and disinfection procedures. Hospital environments are an essential reservoir for HAIs cross transmission, and the application of appropriate procedures related to hand hygiene and disinfection/sterilization of surfaces and instruments remain key strategies for controlling HAIs.
RESULTS
Different procedures, based on the risk associated with the healthcare procedure, are recommended for hand hygiene: washing with soap and water, antiseptic rubbing with alcohol-based disinfectants, antiseptic and surgical hand washing. Environmental surfaces can be treated with different products, and the mostly used are chlorine-based and polyphenolic disinfectant. The reprocessing of instruments is related to their use according to the Spaulding's classification. In addition, scientific evidence demonstrated the great relevance of the "bundles" (small set of practices performed together) in controlling HAIs.
CONCLUSIONS
Research agenda should include the improvement of well-known effective preventive procedures and the development of new bundles devoted to high-risk procedures and specific microorganisms.
Topics: Cross Infection; Disinfectants; Disinfection; Equipment Contamination; Hand Disinfection; Hospitals; Humans; Public Health
PubMed: 31304524
DOI: 10.7416/ai.2019.2305 -
Lancet (London, England) Feb 2017Patients admitted to hospital can acquire multidrug-resistant organisms and Clostridium difficile from inadequately disinfected environmental surfaces. We determined the... (Randomized Controlled Trial)
Randomized Controlled Trial
Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study.
BACKGROUND
Patients admitted to hospital can acquire multidrug-resistant organisms and Clostridium difficile from inadequately disinfected environmental surfaces. We determined the effect of three enhanced strategies for terminal room disinfection (disinfection of a room between occupying patients) on acquisition and infection due to meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, C difficile, and multidrug-resistant Acinetobacter.
METHODS
We did a pragmatic, cluster-randomised, crossover trial at nine hospitals in the southeastern USA. Rooms from which a patient with infection or colonisation with a target organism was discharged were terminally disinfected with one of four strategies: reference (quaternary ammonium disinfectant except for C difficile, for which bleach was used); UV (quaternary ammonium disinfectant and disinfecting ultraviolet [UV-C] light except for C difficile, for which bleach and UV-C were used); bleach; and bleach and UV-C. The next patient admitted to the targeted room was considered exposed. Every strategy was used at each hospital in four consecutive 7-month periods. We randomly assigned the sequence of strategies for each hospital (1:1:1:1). The primary outcomes were the incidence of infection or colonisation with all target organisms among exposed patients and the incidence of C difficile infection among exposed patients in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT01579370.
FINDINGS
31 226 patients were exposed; 21 395 (69%) met all inclusion criteria, including 4916 in the reference group, 5178 in the UV group, 5438 in the bleach group, and 5863 in the bleach and UV group. 115 patients had the primary outcome during 22 426 exposure days in the reference group (51·3 per 10 000 exposure days). The incidence of target organisms among exposed patients was significantly lower after adding UV to standard cleaning strategies (n=76; 33·9 cases per 10 000 exposure days; relative risk [RR] 0·70, 95% CI 0·50-0·98; p=0·036). The primary outcome was not statistically lower with bleach (n=101; 41·6 cases per 10 000 exposure days; RR 0·85, 95% CI 0·69-1·04; p=0·116), or bleach and UV (n=131; 45·6 cases per 10 000 exposure days; RR 0·91, 95% CI 0·76-1·09; p=0·303) among exposed patients. Similarly, the incidence of C difficile infection among exposed patients was not changed after adding UV to cleaning with bleach (n=38 vs 36; 30·4 cases vs 31·6 cases per 10 000 exposure days; RR 1·0, 95% CI 0·57-1·75; p=0·997).
INTERPRETATION
A contaminated health-care environment is an important source for acquisition of pathogens; enhanced terminal room disinfection decreases this risk.
FUNDING
US Centers for Disease Control and Prevention.
Topics: Clostridioides difficile; Clostridium Infections; Cross Infection; Cross-Over Studies; Disinfectants; Disinfection; Drug Resistance, Multiple, Bacterial; Female; Humans; Male; Middle Aged; Patients' Rooms; Quaternary Ammonium Compounds; Sodium Hypochlorite; Ultraviolet Rays; United States
PubMed: 28104287
DOI: 10.1016/S0140-6736(16)31588-4 -
The Science of the Total Environment Jun 2023Despite advances in medicine and innovations in many underpinning fields including disease prevention and control, the Spaulding classification system, originally... (Review)
Review
A review of Spaulding's classification system for effective cleaning, disinfection and sterilization of reusable medical devices: Viewed through a modern-day lens that will inform and enable future sustainability.
Despite advances in medicine and innovations in many underpinning fields including disease prevention and control, the Spaulding classification system, originally proposed in 1957, remains widely used for defining the disinfection and sterilization of contaminated re-usable medical devices and surgical instruments. Screening PubMed and Scopus databases using a PRISMA guiding framework generated 272 relevant publications that were used in this review. Findings revealed that there is a need to evolve how medical devices are designed, and processed by cleaning, disinfection (and/or sterilization) to mitigate patient risks, including acquiring an infection. This Spaulding Classification remains in use as it is logical, easily applied and understood by users (microbiologists, epidemiologists, manufacturers, industry) and by regulators. However, substantial changes have occurred over the past 65 years that challenge interpretation and application of this system that includes inter alia emergence of new pathogens (viruses, mycobacteria, protozoa, fungi), a greater understanding of innate and adaptive microbial tolerance to disinfection, toxicity risks, increased number of vulnerable patients and associated patient procedures, and greater complexity in design and use of medical devices. Common cited examples include endoscopes that enable non- or minimal invasive procedures but are highly sophisticated with various types of materials (polymers, electronic components etc), long narrow channels, right angle and heat-sensitive components and various accessories (e.g., values) that can be contaminated with high levels of microbial bioburden and patient tissues after use. Contaminated flexible duodenoscopes have been a source of several significant infection outbreaks, where at least 9 reported cases were caused by multidrug resistant organisms [MDROs] with no obvious breach in processing detected. Despite this, there is evidence of the lack of attention to cleaning and maintenance of these devices and associated equipment. Over the last few decades there is increasing genomic evidence of innate and adaptive resistance to chemical disinfectant methods along with adaptive tolerance to environmental stresses. To reduce these risks, it has been proposed to elevate classification of higher-risk flexible endoscopes (such as duodenoscopes) from semi-critical [contact with mucous membrane and intact skin] to critical use [contact with sterile tissue and blood] that entails a transition to using low-temperature sterilization modalities instead of routinely using high-level disinfection; thus, increasing the margin of safety for endoscope processing. This timely review addresses important issues surrounding use of the Spaulding classification system to meet modern-day needs. It specifically addresses the need for automated, robust cleaning and drying methods combined with using real-time monitoring of device processing. There is a need to understand entire end-to-end processing of devices instead of adopting silo approaches that in the future will be informed by artificial intelligence and deep-learning/machine learning. For example, combinational solutions that address the formation of complex biofilms that harbour pathogenic and opportunistic microorganisms on the surfaces of processed devices. Emerging trends are addressed including future sustainability for the medical devices sector that can be enabled via a new Quintuple Helix Hub approach that combines academia, industry, healthcare, regulators, and society to unlock real world solutions.
Topics: Humans; Artificial Intelligence; Cross Infection; Disinfectants; Disinfection; Endoscopes; Equipment Contamination
PubMed: 36963674
DOI: 10.1016/j.scitotenv.2023.162976 -
Viruses Aug 2022The pandemic due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has emerged as a serious global public health issue. Besides the high transmission rate... (Review)
Review
The pandemic due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has emerged as a serious global public health issue. Besides the high transmission rate from individual to individual, indirect transmission from inanimate objects or surfaces poses a more significant threat. Since the start of the outbreak, the importance of respiratory protection, social distancing, and chemical disinfection to prevent the spread of the virus has been the prime focus for infection control. Health regulatory organizations have produced guidelines for the formulation and application of chemical disinfectants to manufacturing industries and the public. On the other hand, extensive literature on the virucidal efficacy testing of microbicides for SARS-CoV-2 has been published over the past year and a half. This review summarizes the studies on the most common chemical disinfectants and their virucidal efficacy against SARS-CoV-2, including the type and concentration of the chemical disinfectant, the formulation, the presence of excipients, the exposure time, and other critical factors that determine the effectiveness of chemical disinfectants. In this review, we also critically appraise these disinfectants and conduct a discussion on the role they can play in the COVID-19 pandemic.
Topics: COVID-19; Disinfectants; Disinfection; Humans; Pandemics; SARS-CoV-2
PubMed: 36016342
DOI: 10.3390/v14081721 -
Indian Journal of Ophthalmology Mar 2021The instrumentation used in ophthalmic clinics can be a source of epidemics in health care set up. Contact tonometry with Schiotz or Applanation tonometer is associated... (Review)
Review
The instrumentation used in ophthalmic clinics can be a source of epidemics in health care set up. Contact tonometry with Schiotz or Applanation tonometer is associated with nosocomial epidemic keratoconjunctivitis outbreaks. Recently identified SARS-CoV-2 (COVID -19) spreads mainly via the respiratory route and fomites and can transmit through other body fluids, including tear film. Various ophthalmic instruments can become a common source of spreading cross infections. Chemical disinfection is one of the most common methods employed to decontaminate instruments and environmental surfaces and prevent transmission of infectious pathogens to patients through medical and surgical instruments. Various chemical disinfectants are available with a varied spectrum to work on a different group of organisms. In this article, we briefly cover commonly used chemical disinfectants in ophthalmic practice like Alcohol (Ethyl Alcohol, Isopropyl Alcohol), Chlorine-based solution (mainly Sodium Hypochlorite), Glutaraldehyde, Hydrogen Peroxide, Formaldehyde, Iodophors, and Quaternary Ammonium Compounds.
Topics: COVID-19; Cross Infection; Disease Transmission, Infectious; Disinfectants; Disinfection; Humans; Ophthalmology; Pandemics
PubMed: 33595464
DOI: 10.4103/ijo.IJO_1549_20 -
International Journal of Environmental... Oct 2021Healthcare-associated infections (HAIs) contribute to patient morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths costing USD $28-34... (Review)
Review
Healthcare-associated infections (HAIs) contribute to patient morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths costing USD $28-34 billion annually in the United States alone. There is little understanding as to if current environmental surface disinfection practices reduce pathogen load, and subsequently HAIs, in critical care settings. This evidence map includes a systematic review on the efficacy of disinfecting environmental surfaces in healthcare facilities. We screened 17,064 abstracts, 635 full texts, and included 181 articles for data extraction and study quality assessment. We reviewed ten disinfectant types and compared disinfectants with respect to study design, outcome organism, and fourteen indictors of study quality. We found important areas for improvement and gaps in the research related to study design, implementation, and analysis. Implementation of disinfection, a determinant of disinfection outcomes, was not measured in most studies and few studies assessed fungi or viruses. Assessing and comparing disinfection efficacy was impeded by study heterogeneity; however, we catalogued the outcomes and results for each disinfection type. We concluded that guidelines for disinfectant use are primarily based on laboratory data rather than a systematic review of in situ disinfection efficacy. It is critically important for practitioners and researchers to consider system-level efficacy and not just the efficacy of the disinfectant.
Topics: Cross Infection; Delivery of Health Care; Disinfectants; Disinfection; Health Facilities; Humans
PubMed: 34769620
DOI: 10.3390/ijerph182111100 -
Antimicrobial Resistance and Infection... 2019"Ready-to-use" disinfecting wipes (also known as pre-impregnated disinfecting wipe) are broadly used in food industry and domestic situations. Their application in... (Review)
Review
BACKGROUND
"Ready-to-use" disinfecting wipes (also known as pre-impregnated disinfecting wipe) are broadly used in food industry and domestic situations. Their application in hospitals and healthcare centres for decontamination of medical devices and surfaces is steadily increasing because of their convenient implementation in practice and reliable performance. Beside their acceptable compliance and easy application, literature reported the disinfection failure due to the interaction between textile substrate and active ingredients, which can highly increase the risk of an infection outbreak. This review aims to call attention to the wide range of variables affecting the disinfectant-impregnated wipes' (DIWs) disinfection performances in hospitals.
METHODS
A systematic literature search based on the five categories i. wipes, ii. disinfectants, iii. Application methods, iv. interaction between wipes and active ingredients and v. wiping strategy which can possibly influence the disinfection effectiveness of DIWs was conducted by Google scholar. Studies regarding the efficacy evaluation of DIWs in clinical applications were also reviewed from the National Centre for Biotechnology Information database.
RESULTS
Variables that impact on the disinfection performance of disinfectant-impregnated wipes in surface disinfection in hospitals were summarised and critically discussed. In addition to the information, current disinfectant-impregnated wipes' decontamination efficacy test standards were reviewed, and different standards exposed some disadvantage in their testing design.
CONCLUSION
Various parameters contribute to the impact of DIWs disinfection performance in practice. The interaction between disinfectant active ingredients and the wiping materials barricades their broad application in hospitals. More studies of the DIWs' disinfection efficacy in clinical practice are in need. Current standards evaluating the DIWs' efficacy are required to improve for more realistic condition simulation and differentiating between mechanical removal of inoculum from a surface and chemical inactivation of the test microbe.
Topics: Cross Infection; Disinfectants; Disinfection; Environmental Microbiology; Equipment Contamination; Humans
PubMed: 31452873
DOI: 10.1186/s13756-019-0595-2 -
Revue Scientifique Et Technique... Jun 1995Disinfection of equine premises provides a challenge to farm managers, in view of the variety of surfaces which may be contaminated and the wide variety of horse... (Review)
Review
Disinfection of equine premises provides a challenge to farm managers, in view of the variety of surfaces which may be contaminated and the wide variety of horse pathogens. Of the commonly occurring infectious diseases for which disinfection and disease control are especially important, rotavirus diarrhoea, salmonellosis and strangles are the most difficult to control. Phenolic disinfectants have been scientifically demonstrated to be effective in the presence of organic matter and are also virucidal. When used after thorough cleaning and rinsing of stall surfaces, phenolics have proved effective in controlling outbreaks of disease. In addition, 10% iodophors used for washing hands and cleaning equipment are also virucidal and bactericidal. Quaternary ammonium compounds, chlorhexidine, bleach and pine oil are readily available commercially, but are ineffective disinfectants in the presence of the organic matter encountered on horse farms.
Topics: Animal Husbandry; Animals; Bacterial Infections; Disease Outbreaks; Disinfectants; Disinfection; Horse Diseases; Horses; Housing, Animal; Virus Diseases
PubMed: 7579639
DOI: 10.20506/rst.14.2.846 -
Molecules (Basel, Switzerland) Feb 2022Electrolyzed water (EW) is a new type of cleaning and disinfecting agent obtained by means of electrolysis with a dilute sodium chloride solution. It has low cost and... (Review)
Review
Electrolyzed water (EW) is a new type of cleaning and disinfecting agent obtained by means of electrolysis with a dilute sodium chloride solution. It has low cost and harm to the human body and is also friendly to the environment. The anode produces acidic electrolyzed water (AEW), which is mainly used to inhibit bacterial growth and disinfect. The cathode provides basic electrolyzed water (BEW), which is implemented to promote human health. EW is a powerful multifunctional antibacterial agent with a wide range of applications in the medicine, agriculture, and food industry. Studies in vitro and in vivo show that it has an inhibitory effect on pathogenic bacteria and viruses. Therefore, EW is used to prevent chronic diseases, while it has been found to be effective against various kinds of infectious viruses. Animal experiments and clinical trials clearly showed that it accelerates wound healing, and has positive effects in oral health care, anti-obesity, lowering blood sugar, anti-cancer and anti-infectious viral diseases. This review article summarizes the application of EW in treating bacteria and viruses, the prevention of chronic diseases, and health promotion.
Topics: Animals; Anti-Infective Agents; Disease Management; Disinfectants; Disinfection; Electrolysis; Food Microbiology; Humans; Hydrogen-Ion Concentration; Water; Water Microbiology
PubMed: 35209015
DOI: 10.3390/molecules27041222 -
Journal of the American Association For... Nov 2022Floor cleaning and disinfection are essential components of maintaining animal health status and meeting regulatory requirements in research vivaria. However, best...
Floor cleaning and disinfection are essential components of maintaining animal health status and meeting regulatory requirements in research vivaria. However, best practices for method, frequency, and evaluation techniques have not been established. Reuse of cotton string mop and bucket systems has been implicated in spreading contamination in the human hospital setting. We evaluated 4 different combinations of disinfectant and mop systems commonly used in rodent vivaria. Eight housing rooms were mopped a total of 4 times using one of the following methods: quaternary ammonium compound (QUAT) and cotton string mop (QC), QUAT and microfiber mop (QM), hydrogen peroxide disinfectant (HPD) and cotton string mop (HC), or HPD and microfiber mop (HM). ATP and RODAC samples of the floor were taken before and after mopping. The time to mop each room, floor drying time, and the amount of disinfectant used were recorded. The QC method was associated with significantly more bacterial contamination while all other methods significantly reduced bacterial contamination. The QC method performed significantly worse in reducing bacterial contamination as compared with all other methods when cotton mop heads were reused. All methods except QC significantly reduced ATP levels, with the HC and HM methods being significantly more effective at reducing ATP levels than the QC and QM methods. Costs were similar for the QC, QM, and HM methods. The results of this study indicate that reuse of cotton string mop heads with QUAT increases floor contamination while HPD is effective for up to 3 reuses. Single use microfiber mops were effective with both QUAT and HPD but did not result in more effective cleaning or disinfection than cotton string mops.
Topics: Humans; Animals; Disinfection; Floors and Floorcoverings; Disinfectants; Quaternary Ammonium Compounds; Bacteria; Adenosine Triphosphate
PubMed: 36319080
DOI: 10.30802/AALAS-JAALAS-22-000042