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An Increase in Healthcare-Associated Clostridium difficile Infection Associated with Use of a Defective Peracetic Acid–Based Surface Disinfectant

  • Jennifer L. Cadnum (a1), Annette L. Jencson (a1), Marguerite C. O’Donnell (a2), Elizabeth R. Flannery (a2), Michelle M. Nerandzic (a1) and Curtis J. Donskey (a3) (a4)...



We investigated an increase in the incidence of healthcare-associated Clostridium difficile infection (CDI) that occurred following a change from a bleach disinfectant to a peracetic acid–based disinfectant.


To evaluate the efficacy of the peracetic acid–based disinfectant.


Laboratory-based product evaluation.


The commercial peracetic acid–based product is activated on site by mixing a small volume of concentrated hydrogen peroxide and peracetic acid present in a “SmartCap” reservoir with the remaining contents of the container. We measured concentrations of peracetic acid in newly activated and in-use product and determined the stability of nonactivated and activated product. We tested the efficacy of the product against C. difficile spores using the American Society for Testing and Materials standard quantitative carrier disk test method.


Measured concentrations of peracetic acid (50–800 parts per million [ppm]) were significantly lower than the level stated on the product label (1,500 ppm), and similar results were obtained for containers from multiple lot numbers and from another hospital. Product with peracetic acid levels below 600 ppm had significantly reduced activity against C. difficile spores. Peracetic acid concentrations were reduced markedly after storage of either activated or nonactivated product for several weeks. The Environmental Protection Agency confirmed the finding of low disinfectant levels and ordered discontinuation of sale of the product.


Use of a defective peracetic acid–based surface disinfectant may have contributed to an increase in healthcare-associated CDI. Our findings highlight the importance of evaluating the efficacy of liquid disinfectants in healthcare settings.

Infect Control Hosp Epidemiol 2017;38:300–305


Corresponding author

Address correspondence to Curtis J. Donskey, MD, Geriatric Research, Education and Clinical Center, Louis Stokes Veterans’ Affairs Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106 (


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