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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 ,
Sarah Underwood ,
Jane Freeman ,
Simon D. Baines ,
Katie Saxton ,
Keith Stephenson ,
Robert C. Owens Jr.  and
Mark H. Wilcox
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
*
Department of Microbiology, University of Leeds and the General Infirmary, Old Medical School, Leeds, LSI 3EX, UK ([email protected])
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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
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 8 , August 2007 , pp. 920 - 925
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1. Communicable Disease Surveillance Centre. Voluntary reporting of Clostridium difficile, England, Wales, and Northern Ireland: 2004. Commun Dis Rep CDR Wkly 2005;15:1–3. Available at: http://www.hpa.org.uk/CDR/. Accessed June 12, 2007.Google Scholar
2. Archibald, LK, Banerjee, SN, Jarvis, WR. Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987-2001. J Infect Dis 2004;189:1585–1589.CrossRefGoogle ScholarPubMed
3. Wilcox, MH, Cunniffe, JG, Trundle, C, Redpath, C. Financial burden of hospital-acquired Clostridium difficile infection. J Hosp Infect 1996;34:23–30.CrossRefGoogle ScholarPubMed
4. Kyne, L, Hamel, MB, Polavaram, R, Kelly, CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile . Clin Infect Dis 2002;34:346–353.CrossRefGoogle ScholarPubMed
5. Cartmill, TDI, Panigrahi, H, Worsley, MA, McCann, DC, Nice, CN, Keith, E. Management and control of a large outbreak of diarrhoea due to Clostridium difficile . J Hosp Infect 1994;27:1–15.CrossRefGoogle ScholarPubMed
6. Samore, MH, Venkataraman, L, DeGirolami, PC, Arbeit, RD, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:32–40.CrossRefGoogle ScholarPubMed
7. Wilcox, MH, Fawley, WN, Wigglesworth, N, Parnell, P, Verity, P, Freeman, J. Comparison of effect of detergent versus hypochlorite cleaning on environmental contamination and incidence of Clostridium difficile infection. J Hosp Infect 2003;54:109–114.CrossRefGoogle ScholarPubMed
8. Russell, AD. Bacterial resistance to disinfectants: present knowledge and future problems. J Hosp Infect 1999;43(suppl):S57–68.CrossRefGoogle ScholarPubMed
9. Department of Health and Public Health Laboratory Service Joint Working Group. Clostridium difficile Infection: Prevention and Management. Heywood, UK: BAPS Health Publications Unit; 1994. Available at: http://www.hpa.org.uk/infections/topics_az/clostridium_difficile. Accessed June 12, 2007.Google Scholar
10. Stubbs, SL, Brazier, JS, O'Neill, GL, Duerden, BI. PCR targeted to the 16S-23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes. J Clin Microbiol 1999;37:461–463.CrossRefGoogle Scholar
11. Wullt, M, Burman, LG, Laurell, MH, Akerlund, T. Comparison of AP-PCR typing and PCR-ribotyping for estimation of nosocomial transmission of Clostridium difficile . J Hosp Infect 2003;55:124–130.CrossRefGoogle ScholarPubMed
12. Johnson, S, Samore, MH, Farrow, KA, et al. Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med 1999;341:1645–1651.CrossRefGoogle ScholarPubMed
13. Kato, H, Kato, N, Watanabe, K, et al. Analysis of Clostridium difficile isolates from nosocomial outbreaks at three hospitals in diverse areas of Japan. J Clin Microbiol 2001;39:1391–1395.CrossRefGoogle ScholarPubMed
14. Brazier, JS. The epidemiology and typing of Clostridium difficile . J Antimicrob Chemother 1998;41 (suppl C):47–57.CrossRefGoogle ScholarPubMed
15. van Dijck, P, Avesani, V, Delmee, M. Genotyping of outbreak-related and sporadic isolates of Clostridium difficile belonging to serogroup C. J Clin Microbiol 1996;34:3049–3055.CrossRefGoogle ScholarPubMed
16. Barbut, F, Corthier, G, Charpak, Y, et al. Prevalence and pathogenicity of Clostridium difficile in hospitalized patients: a French multicenter study. Arch Intern Med 1996;156:1449–1454.CrossRefGoogle ScholarPubMed
17. Communicable Disease Surveillance Centre. Outbreak of Clostridium difficile infection in a hospital in South East England. Commun Dis Rep CDR Wkly 2005;15:1–2. Available at http://www.hpa.org.uk/cdr/archives/archive05/News/news2405.htm. Accessed June 12, 2007.Google Scholar
18. McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile . N Engl J Med 2005;353:2433–2441.CrossRefGoogle ScholarPubMed
19. Pépin, J, Valiquette, L, Alary, ME, et al. Clostridium difficile-associated diarrhoea in a region of Quebec from 1991 to 2003: a changing pattern of diseases severity. CMAJ 2004;171:466–472.CrossRefGoogle Scholar
20. Pépin, J, Alary, ME, Valiquette, L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 2005;40:1591–1597.CrossRefGoogle ScholarPubMed
21. van Steenbergen, J, Debast, S, van Kregten, R, van den Berg, J, Notermans, D. Kuijper, E. Isolation of Clostridium difficile ribotype 027, toxinotype III in the Netherlands after increase in C. difficile–associated diarrhoea. Euro Surveill 2005;10:E050714.1.Google ScholarPubMed
22. Wilcox, MH, Fawley, WN. Hospital disinfectants and spore formation by Clostridium difficile . Lancet 2000;356:1324.CrossRefGoogle ScholarPubMed
23. Baines, SD, Freeman, J, Wilcox, MH. Effects of piperacillin/tazobactam on Clostridium difficile growth and toxin production in a human gut model. I Antimicrob Chemother 2005;55:974–982.CrossRefGoogle Scholar
24. Hota, B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis 2004;39:1182–1189.Google ScholarPubMed
25. Wilcox, MH, Fawley, WN, Parnell, P. Value of lysozyme agar incorporation and alkaline thioglycollate exposure for the environmental recovery of Clostridium difficile . I Hosp Infect 2000;44:65–69.CrossRefGoogle ScholarPubMed
26. Rutala, WA, Gergen, MF, Weber, DJ. Inactivation of Clostridium difficile spores by disinfectants. Infect Control Hosp Epidemiol 1993;14:36–39.CrossRefGoogle ScholarPubMed
27. Perez, J, Springthorpe, VS, Sattar, SA. Activity of selected oxidizing mi-crobicides against the spores of Clostridium difficile: relevance to environmental control. Am J Infect Control 2005;33:320–325.CrossRefGoogle ScholarPubMed
28. Block, C. The effect of Perasafe and sodium dichloroisocyanurate (NaDCC) against spores of Clostridium difficile and Bacillus atrophaeus on stainless steel and polyvinyl chloride surfaces. J Hosp Infect 2004;57:144–148.CrossRefGoogle ScholarPubMed
29. Otter, JA, French, GL, Adams, NM, Watling, D, Parks, MJ. Hydrogen peroxide vapour decontamination in an overcrowded tertiary care referral centre: some practical answers. J Hosp Infect 2006;62:384–385.CrossRefGoogle Scholar
30. Mayfield, JL, Leet, T, Miller, J, Mundy, LM. Environmental control to reduce transmission of Clostridium difficile . Clin Infect Dis 2000;331:995–1000.CrossRefGoogle Scholar
31. Kaatz, GW, Gitlin, SD, Schaberg, DR, Wilson, KH, Kauffman, CA, Seo, SM. Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol 1988;127:1289–1293.CrossRefGoogle ScholarPubMed
32. Fawley, WN, Wilcox, MH. Molecular epidemiology of endemic Clostridium difficile infection. Epidemiol Infect 2001;126:343–350.CrossRefGoogle ScholarPubMed
33. Bloomfield, SF, Uso, EE. The antibacterial properties of sodium hypochlorite and sodium dichloroisocyanurate as hospital disinfectants. J Hosp Infect 1985;6:20–30.CrossRefGoogle ScholarPubMed