Clostridium difficile-Efficacia di Sporicidal

Efficacy of ‘‘sporicidal’’ wipes against

Clostridium difficile

Harsha Siani, BSc, Callum Cooper, BSc, and Jean-Yves Maillard, PhD

Cardiff, United Kingdom

Background: Hospital-acquired infections associated with Clostridium difficile cause severe morbidity and mortality. The current

control of C difficile endospores with liquid sporicides might have limited efficacy in the health care environment. Sporicidal wipes

might offer additional control of surface bioburden and are now increasingly used, although there is little information about their

efficacy against spores in practice.

Methods: Ten wipes were tested for sporicidal efficacy using a recently developed 3-stage protocol that measures the ability of the

wipe to remove microbial bioburden from a surface, the potential for microbial transfer from the wipe to other surfaces, and the

sporicidal activity of the wipe. Scanning electron microscopy was used to visualize the association of spores with the wipe fibers,

and light scattering was used to measure the size of spore aggregates released from the wipes.

Results: The ability of the sporicidal wipes to remove C difficile spores from an inanimate surface ranged from 0.22 to 4.09 log10

spores removed within 10 seconds. One wipe did not remove any spores. None of the wipes demonstrated high sporicidal activity

(ie, .4 log10 reduction) within 5 minutes of contact time, except for a control wipe soaked in 5,000-ppm sodium hypochlorite.

Only one wipe demonstrated some sporicidal activity after 5 minutes, with a 1.50 and a 3.74 log10 reduction in spore number

of C difficile NCTC12727 and R20291 (ribotype 027), respectively. All but one wipe demonstrated that spores could be repeatedly

transferred to other surfaces. Light-scattering data provided evidence that some wipes were able to break up spore aggregates, potentially

releasing more spores onto the surface. Electron microscopy micrographs showed that spores might be loosely associated

with some wipes, explaining the rapid release.

Conclusion: Although the use of sporicidal wipes might offer additional control of microbial burden on surfaces, current efficacy

tests might be inadequate to reflect the activity of these wipes in practice. This can lead to the use of wipes that might not be appropriate

for applications in the health care environment. Tighter control of labeling and appropriate efficacy tests are needed

before antimicrobial wipes are released to the market.

Key Words: Activity; surface disinfection; impregnated wipes; endospores.

Copyright ª 2011 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights

reserved. (Am J Infect Control 2011;39:212-8.)

Clostridium difficile has been associated with severe

morbidity and mortality in the health care environment.

The use of effective cleaning regimens and surface

disinfection helps minimize the spread of

pathogens and ultimately decrease the risk to patients

and staff. It also contributes to decreasing the financial

burden associated with treatment and longer hospital

stays.1-3 The persistence of C difficile endospores on

surfaces after disinfection2-5 presents an additional obstacle

to the successful implementation of cleaning/

disinfection procedures. Bacterial endospores are

considered among the most resistant life forms to surface

disinfection and sterilization6 because of their

structure and properties.7 Thus, all cleaning/disinfection

regimens need to be proven effective to prevent

the presence/survival and spread of spore-forming

pathogenic bacteria and other microorganisms.8-10 Although

sporicidal properties have been claimed for a

number of microbicides, only a few of these have a reportedly

rapid action (ie, within seconds).10 Hypochlorites

are among the most widely used disinfectants in

the health care environment.11 Sodium hypochlorite

has demonstrated some success in decreasing C difficile

incidence12,13 and surface contamination,14 but the efficacy

of liquid disinfectants is severely hampered by

the limited contact time that typically can be achieved

in a busy health care environment.

Antimicrobial wipes are increasingly used to clean/

disinfect surfaces proximal to patients in health care

settings. Some antimicrobial wipes purportedly have

a dual action, providing both cleaning and disinfection.

Such products might be efficacious in removing a microbial

bioburden from a surface; however, observations

of their use in hospitals indicate that their

antimicrobial activity might be limited due to short

application times and repeated use on multiple

From theWelsh School of Pharmacy, Cardiff University, Cardiff, United

Kingdom.

Address correspondence to Jean-Yves Maillard, PhD, Welsh School of

Pharmacy, Cardiff University, King Edward VII Avenue, Cardiff CF10

3NB, United Kingdom. E-mail: Questo indirizzo email è protetto dagli spambots. E' necessario abilitare JavaScript per vederlo. .

Funding for this study was provided by GAMA Healthcare, London,

United Kingdom.

Conflict of interest: None to report.

0196-6553/$36.00

Copyright ª 2011 by the Association for Professionals in Infection

Control and Epidemiology, Inc. Published by Elsevier Inc. All rights

reserved.

doi:10.1016/j.ajic.2011.01.006

212

 

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