Hostname: page-component-5cf477f64f-rdph2 Total loading time: 0 Render date: 2025-04-03T15:28:23.104Z Has data issue: false hasContentIssue false
  • English
  • Français

Alcohols as Surface Disinfectants in Healthcare Settings

Published online by Cambridge University Press:  28 January 2018

John M. Boyce
John M. Boyce*
Affiliation:
JM Boyce Consulting, Middletown, Connecticut
*
Address correspondence to John M. Boyce, MD, 62 Sonoma Ln, Middletown, CT 0645 (jmboyce69@gmail.com).
Get access Rights & Permissions [Opens in a new window]

Abstract

Isopropyl alcohol and ethyl alcohol have been used as low-level disinfectants in healthcare settings for many years. Recent studies have found that ethyl alcohol inhibits protein synthesis in Escherichia coli by direct effects on ribosomes and RNA polymerase and that 60%–70% solutions have in vitro efficacy against murine norovirus, Ebola virus, and several coronaviruses. Alcohol prep pads or towelettes containing isopropyl or ethyl alcohol and water have been used primarily for disinfection of small noncritical items due to a concern regarding their rapid evaporation rates and associated short contact times. Sterile alcohol solutions are used mostly for disinfection of compounding pharmacies and controlled areas. One new Environmental Protection Agency (EPA)–registered cleaner/disinfectant formulation differs from other alcohol-based disinfectants by virtue of having a 30-second contact time for multiple pathogens and a toxicity rating of category IV. Multiple disinfectants containing ethyl alcohol and/or isopropyl alcohol combined with other active agents such as quaternary ammonium or phenolic compounds are widely used for disinfecting environmental surfaces in healthcare facilities.

Infect Control Hosp Epidemiol 2018;39:323–328

Type
Review Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 3 , March 2018 , pp. 323 - 328
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Otter, JA, Yezli, S, French, GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol 2011;32:687–699.Google Scholar
2. Weber, DJ, Anderson, D, Rutala, WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis 2013;26:338–344.Google Scholar
3. Donskey, CJ. Does improving surface cleaning and disinfection reduce health care-associated infections? Am J Infect Control 2013;41:S12–S19.Google Scholar
4. Dancer, SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev 2014;27:665–690.Google Scholar
5. Boyce, JM. Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control 2016;5:10.Google Scholar
6. Kanamori, H, Rutala, WA, Weber, DJ. The role of patient care items as a fomite in healthcare-associated outbreaks and infection prevention. Clin Infect Dis 2017;65:1412–1419.Google Scholar
7. Rutala, WA, Weber, DJ. Selection of the ideal disinfectant. Infect Control Hosp Epidemiol 2014;35:855–865.CrossRefGoogle ScholarPubMed
8. Rutala, WA, Weber, DJ. Monitoring and improving the effectiveness of surface cleaning and disinfection. Am J Infect Control 2016;44:e69–e76.Google Scholar
9. Rutala, WA, Weber, DJ. Disinfection, sterilization, and antisepsis: an overview. Am J Infect Control 2016;44:e1–e6.Google Scholar
10. Rutala, WA, Weber, DJ. Use of inorganic hypochlorite (bleach) in health-care facilities. Clin Microbiol Rev 1997;10:597–610.Google Scholar
11. Gerba, CP. Quaternary ammonium biocides: efficacy in application. Appl Environ Microbiol 2015;81:464–469.Google Scholar
12. Ali, Y, Dolan, MJ, Fendler, EJ, Larson, EL. Alcohols. In Block SS, editor Disinfection, Sterilization and Preservation. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. Pp 229–254.Google Scholar
13. Sehulster, L, Chinn, RY, CDC, HICPAC. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2003;52(RR-10):1–42.Google Scholar
14. Rutala, WA, Weber, DJ. and the Healthcare Infection Control Practices Advisory Committee. Guideline for disinfection and sterilization in healthcare facilities, 2008. Centers for Disease Control and Prevention website. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines.pdf. Published 2008. Accessed December 6, 2017.Google Scholar
15. Price, PB. Ethyl alcohol as a germicide. Arch Surg 1939;38:528–542.Google Scholar
16. Harrington, C, Walker, H. The germicidal action of alcohol. Boston Med Surg J 1903;148:548–552.CrossRefGoogle Scholar
17. Price, PB. Reevaluation of ethyl alcohol as a germicide. Arch Surg 1950;60:492–502.Google Scholar
18. Morton, HE. The relationship of concentration and germicidal efficiency of ethyl alcohol. Ann N Y Acad Sci 1950;53:191–196.Google Scholar
19. O’Hare, KD, Spedding, PL. Evaporation of a binay liquid mixture. Chem Engineer J 2017;48:1–9.Google Scholar
20. EPA Product performance test guidelines OCSPP 810.2200: disinfectants for use on hard surfaces efficacy data recommendations. Environmental Protection Agency website. https://www.regulations.gov/document?D=EPA-HQ-OPPT-2009-0150-0021. Published 2015. Accessed December 6, 2017.Google Scholar
21. Rotter, M. Arguments for the alcoholic hand disinfection. J Hosp Infect 2001;28(Suppl A):S4–S8.Google Scholar
22. Haft, RJ, Keating, DH, Schwaegler, T, et al. Correcting direct effects of ethanol on translation and transcription machinery confers ethanol tolerance in bacteria. Proc Natl Acad Sci U S A 2014;111:E2576–E2585.Google Scholar
23. McDonnell, G, Russell, AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999;12:147–179.CrossRefGoogle ScholarPubMed
24. Nerandzic, MM, Sunkesula, VC, TS, C, Setlow, P, Donskey, CJ. Unlocking the sporicidal potential of ethanol: induced sporicidal activity of ethanol against Clostridium difficile and bacillus spores under altered physical and chemical conditions. PLoS One 2015;10:e0132805.Google Scholar
25. Doerrbecker, J, Friesland, M, Ciesek, S, et al. Inactivation and survival of hepatitis C virus on inanimate surfaces. J Infect Dis 2011;204:1830–1838.Google Scholar
26. Kurtz, JB, Lee, TW, Parsons, AJ. The action of alcohols on rotavirus, astrovirus and enterovirus. J Hosp Infect 1980;1:321–325.Google Scholar
27. Rabenau, HF, Steinmann, J, Rapp, I, Schwebke, I, Eggers, M. Evaluation of a virucidal quantitative carrier test for surface disinfectants. PLoS One 2014;9:e86128.Google Scholar
28. Magulski, T, Paulmann, D, Bischoff, B, et al. Inactivation of murine norovirus by chemical biocides on stainless steel. BMC Infect Dis 2009;9:107.Google Scholar
29. Zonta, W, Mauroy, A, Farnir, F, Thiry, E. Comparative virucidal efficacy of seven disinfectants against murine norovirus and feline calicivirus, surrogates of human norovirus. Food Environ Virol 2016;8:1–12.CrossRefGoogle ScholarPubMed
30. Belliot, G, Lavaux, A, Souihel, D, Agnello, D, Pothier, P. Use of murine norovirus as a surrogate to evaluate resistance of human norovirus to disinfectants. Appl Environ Microbiol 2008;74:3315–3318.Google Scholar
31. Cook, BW, Cutts, TA, Nikiforuk, AM, et al. The disinfection characteristics of Ebola virus outbreak variants. Sci Rep 2016;6:38293.CrossRefGoogle ScholarPubMed
32. Hulkower, RL, Casanova, LM, Rutala, WA, Weber, DJ, Sobsey, MD. Inactivation of surrogate coronaviruses on hard surfaces by health care germicides. Am J Infect Control 2011;39:401–407.Google Scholar
33. Rabenau, HF, Cinatl, J, Morgenstern, B, et al. Stability and inactivation of SARS coronavirus. Med Microbiol Immunol 2005;194:1–6.Google Scholar
34. Rutala, WA. Association for Professionals in Infection Control and Epidemiology guideline for selection and use of disinfectants. 1994, 1995, and 1996 APIC Guidelines Committee. Am J Infect Control 1996;24:313–342.Google Scholar
35. Pesticide product and label system. Environmental Protection Agency website. https://iaspub.epa.gov/apex/pesticides/f?p=PPLS:1. Published 2017. Accessed September 10, 2017.Google Scholar
36. Dolan, SA, Dowell, E, Littlehorn, C, et al. Notes from the field: contamination of alcohol prep pads with Bacillus cereus Group and Bacillus species—Colorado, 2010. MMWR 2017;60:347.Google Scholar
37. FDA alerts health care professionals and patients not to use alcohol pads or benzalkoniym chloride towelettes manufactured by Foshan Flying Medical Products. Food and Drug Administration website. https://www.fda.gov/drugs/drugsafety/ucm574386.htm. Published 2017. Accessed November 28, 2017.Google Scholar
38. Marschall, J, Mermel, LA, Fakih, M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35(Suppl 2):S89–S107.Google Scholar
39. Sweet, MA, Cumpston, A, Briggs, F, Craig, M, Hamadani, M. Impact of alcohol-impregnated port protectors and needleless neutral pressure connectors on central line-associated bloodstream infections and contamination of blood cultures in an inpatient oncology unit. Am J Infect Control 2012;40:931–934.Google Scholar
40. Wright, MO, Tropp, J, Schora, DM, et al. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control 2013;41:33–38.Google Scholar
41. Martino, A, Thompson, L, Mitchell, C, et al. Efforts of a unit practice council to implement practice change utilizing alcohol impregnated port protectors in a burn ICU. Burns 2017;43:956–964.Google Scholar
42. Kastango, ES, Douglass, K, Patel, K, et al. Safer sterile compounding: choosing and using disinfectants for the cleanroom. Int J Pharm Compd 2015;19:268–278.Google Scholar
43. Petersen, BT, Cohen, J, Hambrick, RD III, et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update. Gastrointest Endosc 2017;85:282–294.Google Scholar
44. Alhmidi, H, Koganti, S, Cadnum, JL, et al. Evaluation of a novel alcohol-based surface disinfectant for disinfection of hard and soft surfaces in healthcare facilities. Open Forum Infect Dis 2017;4:ofx054.Google Scholar
45. Koganti, S, Alhmidi, H, Tomas, ME, et al. Evaluation of an ethanol-based spray disinfectant for decontamination of cover gowns prior to removal. Infect Control Hosp Epidemiol 2017;38:364–366.Google Scholar
46. Kohn, WG, Collins, AS, Cleveland, JL, et al. Guidelines for infection control in dental health-care settings, 2003. MMWR Recomm Rep 2003;52:1–61.Google Scholar
47. Slaughter, RJ, Mason, RW, Beasley, DM, Vale, JA, Schep, LJ. Isopropanol poisoning. Clin Toxicol (Phila) 2014;52:470–478.CrossRefGoogle ScholarPubMed
48. Quinot, C, Dumas, O, Henneberger, PK, et al. Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses. Occup Environ Med 2017;74:130–137.Google Scholar
49. Maier, A, Ovesen, JL, Allen, CL, et al. Safety assessment for ethanol-based topical antiseptic use by health care workers: evaluation of developmental toxicity potential. Regul Toxicol Pharmacol 2015;73:248–264.Google Scholar
50. Pires, D, Bellissimo-Rodrigues, F, Pittet, D. Ethanol-based handrubs: safe for patients and health care workers. Am J Infect Control 2016;44:858–859.Google Scholar
51. Weber, DJ, Consoli, SA, Rutala, WA. Occupational health risks associated with the use of germicides in health care. Am J Infect Control 2016;44:e85–e89.Google Scholar