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Tables
- Table 1.
Summary of studies comparing the effects of cleaning agents on Clostridium difficile spores
STUDY AGENTS INCLUDED METHODS OUTCOMES Fawley et al,20 2007 Anionic surfactant and NaDCC (1000 mg/L free chlorine)*
Detergent and hypochlorite*
NaDCC alone (1000 mg/L free chlorine)*
Nonionic surfactant and phosphate
Hydrogen peroxide (concentration not provided)Solution of mature spores were exposed to cleaning agents for 0, 10, 20, and 30 min, cleaned then incubated anaerobically for 48 h; results interpreted in comparison to nonexposed control preparations All 3 chlorine-containing agents inactivated vegetative cells and spores within 10 min of exposure; exposure to detergent (nonionic surfactant and phosphate) or hydrogen peroxide resulted in no difference in the number of viable spores compared with controls at 30 min Perez et al,21 2005 Chlorine dioxide equal to 600 mg/L free chlorine*
Acidified bleach equal to 5000 mg/L free chlorine*
Domestic bleach in 3 dilutions (5000 mg/L free chlorine, 3000 mg/L free chlorine, and 1000 mg/L free chlorine)*
7% hydrogen peroxideSpores were grown anaerobically and heated to kill vegetative cells; stainless steel disks were contaminated with spore suspension and exposed to cleaning agents for 10, 15, or 30 min; after neutralizing the cleaning agent, agar plates were inoculated with the contents of each disk and incubated for 2 and 5 d Acidified bleach, regular bleach (5000 mg/L free chlorine), and 7% hydrogen peroxide inactivated spores within 10 min of exposure; chlorine dioxide and domestic bleach at 3000 mg/L and 1000 mg/L free chlorine were all able to inactivate spores; however, exposure times were longer (up to 30 min) Block,22 2004 0.26% peracetic acid—a biocide with manufacturer claims of sporicidal activity
NaDCC tablets (1000 mg/L free chlorine)*Spores were grown anaerobically on blood agar plates and harvested by suspending the cultures in methanol; equal aliquots of spore suspensions were dried on stainless steel disks and PVC floor covering material; each material was exposed to the test solutions for 3, 5, or 10 min, after which time remaining viable spores were counted Neither agent was effective in eradicating the spores, although both agents reduced spore counts; on stainless steel, at 10 min, peracetic acid exposure resulted in a 6 log10 reduction in viable spores compared with a 0.7 log10 reduction in viable spores with NaDCC (P = .011); on PVC, the log10 reduction in viable spores for peracetic acid (2.7) and NaDCC (0.9) were not statistically different Wullt et al,23 2003 70% isopropanol
2% glutaraldehyde
0.26% peracetic acid
Acidified nitriteC difficile bacteria and spores were grown anaerobically on blood agar for 48 h; vegetative cells were killed using ethanol, and spores were suspended in water to which disinfecting agents were added for 5, 15, and 30 min before being inactivated Glutaraldehyde, peracetic acid, and acidified nitrite reduced spore counts by 99% after 15-min exposure; glutaraldehyde has been associated with dermatitis and symptoms of asthma secondary to exposure; isopropanol showed no effect on spore viability even after 30-min exposure -
NaDCC—sodium dichloroisocyanurate, PVC—polyvinyl chloride.
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↵* Chlorine-releasing product.
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STUDY AGENTS INCLUDED METHODS OUTCOMES Mayfield et al,27 2000 Unbuffered 1:10 hypochlorite solution*
Quaternary ammonium solution9-month before-and-after design comparing cleaning with hypochlorite or detergent on rates of CDAD; 3 units were included (bone marrow transplant, neurosurgical ICU, and general medicine) Before use of hypochlorite, rates of CDAD were 8.6, 3.0, and 1.3 cases per 1000 patient-days for bone marrow transplant, neurosurgical ICU, and general medicine, respectively; after implementing the hypochlorite cleaning protocol, CDAD rates fell to 3.3 (HR 0.37, 95% CI 0.19–0.74) for bone marrow transplant, but did not change significantly on the other units; on return to the original disinfectant protocol in the bone marrow transplant unit, rates of CDAD returned to prestudy levels of 8.1 cases per 1000 patient-days Wilcox et al,28 2003 Hypochlorite disinfectant*
Neutral detergent2-year ward-based crossover study comparing effects of environmental cleaning with either hypochlorite or detergent on CDI One ward experienced a drop in CDI incidence from 8.9 to 5.3 cases per 100 admissions (P < .05); the other ward showed an increase in CDI incidence to 4.7 from 3.5 per 100 admissions (P < .05) McMullen et al,29 2007 Quaternary ammonium detergent
Household bleach (diluted to 5000 mg/L free chlorine) and hypochlorite containing towels to clean equipment such as computers and monitoring equipment in patient rooms*5-month before-and-after study comparing effects of changing to a chlorine-releasing cleaning agent from a detergent cleaner in a medical ICU and surgical ICU following an outbreak of CDAD The outbreak resulted in an increase in the monthly rates of CDAD to 16.6 and 10.4 cases per 1000 patient-days from 5.3 and 2.5 cases per 1000 patient-days, respectively; postintervention, rates in the medical ICU and surgical ICU were 3.7 and 2.2 cases per 1000 patient-days, respectively -
CDAD—Clostridium difficile–associated diarrhea, CDI—Clostridium difficile infection, CI—confidence interval, HR—hazard ratio, ICU—intensive care unit.
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↵* Chlorine-releasing product.
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