The effect of Perasafe® and sodium dichloroisocyanurate (NaDCC) against spores of Clostridium difficile and Bacillus atrophaeus on stainless steel and polyvinyl chloride surfaces
Introduction
Nosocomial diarrhoea due to Clostridium difficile is recognized as a significant cause of hospital-acquired morbidity in many centres,1 including ours.2 The manner of transmission between patients and care givers poses difficult problems for infection control teams. Accumulation and persistence of spores in the hospital environment is one factor contributing to this situation,3., 4., 5. making cleaning and decontamination important in controlling cross-infection due to this organism.6., 7.
The agent most frequently used for environmental decontamination of C. difficile spores is hypochlorite (HOCl) in various formulations.6., 7., 8. The use of so-called organic chlorine-releasing agents has not been promoted, presumably as compounds such as sodium dichloroisocyanurate (NaDCC) are less effective than HOCl in spore inactivation.9., 10. The choice of NaDCC for this study was determined by the observation that it is in common use in Israeli hospitals for situations in which environmental decontamination is required. Furthermore, Bloomfield and Uso11 showed that NaDCC has a distinct advantage over HOCl, being less susceptible to inactivation by organic material.
The manufacturer's claim of a useful sporicidal effect for the recently introduced product Perasafe® (Antec International, Sudbury, UK), its ease of preparation and lack of odour, suggested it might be a useful agent for dealing with spores of C. difficile in the environment. It would therefore be of interest to compare the effect of Perasafe with NaDCC on C. difficile spores dried on surfaces of materials frequently found in the patient environment in the hospital. For this purpose, stainless steel and the polyvinyl chloride (PVC) floor covering in use at our hospital were chosen. For comparison, we used Bacillus atrophaeus, previously known as Bacillus globigii and Bacillus subtilis var. niger, which has frequently served as a test organism in evaluating disinfection and sterilization processes. This species has also been used recently as a surrogate for Bacillus anthracis in a study of hand decontamination.12
Section snippets
Biocides
Perasafe is a mixed formulation described by the manufacturer as a peroxygen system generating peracetyl ions in equilibrium at pH 8.0 equivalent to peracetic acid at 0.26%. The solution also contains hydrogen peroxide and acetic acid. Perasafe was freshly prepared before each experiment from the powder according to the manufacturer's instructions. NaDCC at a concentration of 1000 ppm available chlorine was prepared for each experiment from Presept® tablets (Johnson and Johnson, Shefayim,
Results
NaDCC had little effect on C. difficile spores after 10 min exposure, on both steel and PVC surfaces. Its effect on spores of B. atrophaeus was somewhat greater, although at 10 min, the log10 reduction factor achieved was only 1.5. In general, Perasafe appeared to fare better (Figure 1, Figure 2).
Discussion
Environmental spore control may contribute to reducing the risk or incidence of C. difficile-associated disease in hospital settings, although the data are not consistent. In an early study,8 disinfection of a ward with hypochlorite at a concentration of 500 ppm available chlorine was associated with a 79% reduction of positive environmental cultures compared with pre-intervention rates, and cessation of an outbreak. Mayfield et al.6 claimed an effect for hypochlorite in reducing the incidence
Acknowledgements
This study was supported by a grant from Antec International, Sudbury, UK.
References (24)
- et al.
Epidemiology of Clostridium difficile-associated infections
Clin Microbiol Infect
(2001) - et al.
Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea
Am J Med
(1996) - et al.
Prospective evaluation of environmental contamination by Clostridium difficile in isolation side rooms
J Hosp Infect
(2001) - et al.
Comparison of the effect of detergent versus hypochlorite cleaning on environmental contamination and incidence of Clostridium difficile infection
J Hosp Infect
(2003) - et al.
The antibacterial properties of sodium hypochlorite and sodium dichloroisocyanurate as hospital disinfectants
J Hosp Infect
(1985) - et al.
Evaluation of microbicidal activity of a new disinfectant: Sterilox 2500 against Clostridium difficile spores, Helicobacter pylori, vancomycin-resistant Enterococcus species, Candida albicans and several Mycobacterium species
J Hosp Infect
(1999) - et al.
Evaluation of chlorhexidine and povidone iodine activity against methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecalis using a surface test
J Hosp Infect
(2000) - et al.
In-use evaluation of Perasafe compared with Cidex in fibre optic bronchoscope disinfection
J Hosp Infect
(2003) - et al.
In-vitro evaluation of Perasafe compared with 2% alkaline glutaraldehyde against Mycobacterium spp
J Hosp Infect
(2003) - et al.
Comparison of the disinfectant efficacy of Perasafe and 2% glutaraldehyde in in vitro tests
J Hosp Infect
(2003)
Development of reproducible test inocula for disinfectant testing
Int Biodeterioration Biodegradation
Factors associated with nosocomial diarrhea and Clostridium difficile-associated disease on the adult wards of an urban tertiary care hospital
Eur J Clin Microbiol Infect Dis
Cited by (33)
Preventing the spread of life-threatening gastrointestinal microbes on the surface of a continuously self-disinfecting block polymer
2023, Journal of Colloid and Interface ScienceComparative stability and efficacy of selected chlorine-based biocides against Escherichia coli in planktonic and biofilm states
2017, Food Research InternationalCitation Excerpt :Regarding the biofilm control action of NADCC and SH, a comparison of previous studies proposed a lower biofilm control action than NEOW or CD. Block (2004) used 1000 ppm NaDCC to remove Clostridium difficile and Bacillus atrophaeus from SS surfaces in a 10 min treatment and obtained reductions of 1 and 1.5 log CFU, respectively. Ungurs et al. (2011) obtained similar results, 2.19 log CFU reduction of C. difficile biofilms from SS surfaces when applying 1000 ppm NaDCC for 20 min.
Hospital management of Clostridium difficile infection: A review of the literature
2015, Journal of Hospital InfectionCitation Excerpt :Guidelines recommend unbuffered 1:10 hypochlorite solution to disinfect surfaces.35,52 Hypochlorite solution has been found to be more effective than other types of environmental disinfectants, particularly in endemic situations.24,31,49,53–55 Compliance with recommended procedures should be monitored routinely.
The effectiveness of sodium dichloroisocyanurate treatments against Clostridium difficile spores contaminating stainless steel
2011, American Journal of Infection ControlCitation Excerpt :Inconsistencies in the evidence of how best to reduce the C difficile spore burden in the hospital environment probably arise from the use of different disinfectant products, methods used in the preparation of the spores, and recovery of the inocula after treatment. However, a consensus may be drawn from previous studies that higher concentrations of CRAs, than are currently recommended, should be used with regimented exposure times to consistently achieve high levels of decontamination of soiled surfaces.13,18-20 In this study, we have highlighted the importance of contact time and chlorine concentration in reducing the C difficile spore burden and demonstrated the significant role of wiping in combating C difficile in the environment.
Efficacy of three surface disinfectants against spores of Clostridium difficile ribotype 027
2011, International Journal of Hygiene and Environmental HealthCitation Excerpt :To determine the sporicidal activity of disinfectants other species are usually used in efficacy tests such as Clostridium sporogenes (Anonym, 1995a, b), B. subtilis (Anonym, 1995a, b; prEN 14347, 2004) or B. cereus (prEN 14347, 2004). In a comparison between the species, the spores of C. sporogenes were found to be rather susceptible (Perez et al., 2005) whereas the spores of C. difficile were described to have a similar resistance of chemical disinfectants compared to the spores of B. subtilis (Block, 2004; Perez et al., 2005). We found that the spore of C. difficile ribotype 027 is not more difficult to kill compared to spores of other C. difficile strains as shown with one surface disinfectant.