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Efficacy of Hospital Cleaning Agents and Germicides Against Epidemic Clostridium difficile Strains

Published online by Cambridge University Press:  02 January 2015

Warren N. Fawley
Affiliation:
Department of Microbiology, the General Infirmary, Old Medical School, Leeds, United Kingdom
Sarah Underwood
Affiliation:
Faculty of Biological Sciences, Institute of Molecular and Cellular Biology, University of Leeds, Leeds, United Kingdom
Jane Freeman
Affiliation:
Department of Microbiology, the General Infirmary, Old Medical School, Leeds, United Kingdom
Simon D. Baines
Affiliation:
Faculty of Biological Sciences, Institute of Molecular and Cellular Biology, University of Leeds, Leeds, United Kingdom
Katie Saxton
Affiliation:
Faculty of Biological Sciences, Institute of Molecular and Cellular Biology, University of Leeds, Leeds, United Kingdom
Keith Stephenson
Affiliation:
Faculty of Biological Sciences, Institute of Molecular and Cellular Biology, University of Leeds, Leeds, United Kingdom
Robert C. Owens Jr.
Affiliation:
Maine Medical Center, Portland, Maine
Mark H. Wilcox
Affiliation:
Department of Microbiology, the General Infirmary, Old Medical School, Leeds, United Kingdom Faculty of Biological Sciences, Institute of Molecular and Cellular Biology, University of Leeds, Leeds, United Kingdom
Corresponding

Abstract

Objective.

To compare the effects of hospital cleaning agents and germicides on the survival of epidemic Clostridium difficile strains.

Methods.

We compared the activity of and effects of exposure to 5 cleaning agents and/or germicides (3 containing chlorine, 1 containing only detergent, and 1 containing hydrogen peroxide) on vegetative and spore forms of epidemic and non-epidemic C. difficile strains (3 of each). We carried out in vitro exposure experiments using a human fecal emulsion to mimic conditions found in situ.

Results.

Cleaning agent and germicide exposure experiments yielded very different results for C. difficile vegetative cells, compared with those for spores. Working-strength concentrations of all of the agents inhibited the growth of C. difficile in culture. However, when used at recommended working concentrations, only chlorine-based germicides were able to inactivate C. difficile spores. C. difficile epidemic strains had a greater sporulation rate than nonepidemic strains. The mean sporulation rate, expressed as the proportion of a cell population that is in spore form, was 13% for all strains not exposed to any cleaning agent or germicide, and it was significantly increased by exposure to cleaning agents or germicides containing detergent alone (34%), a combination of detergent and hypochlorite (24%), or hydrogen peroxide (33%). By contrast, the mean sporulation rate did not change substantially after exposure to germicides containing either a combination of detergent and dichloroisocyanurate (9%) or dichloroisocyanurate alone (15%).

Conclusions.

These results highlight differences in the activity of cleaning agents and germicides against C. difficile spores and the potential for some of these products to promote sporulation.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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