Biocide resistance is an increasing concern. However, it is currently unknown if an elevated MIC value for an isolate correlates with a lower log10 reduction in suspension tests or carrier tests. The aim of this review was therefore to evaluate if isolates with a suspected tolerance to a biocidal active substance reveal an elevated MIC value and an impaired efficacy in suspension tests and carrier tests. A Medline search was done on 6 July 2022 using the following terms: “resistance biocidal MIC suspension” (16 hits), “resistance biocidal MIC carrier” (22 hits), “resistance biocidal suspension carrier” (41 hits), “tolerance biocidal MIC suspension” (1 hit), “tolerance biocidal MIC carrier” (4 hits) and “tolerance biocidal suspension carrier” (3 hits). Studies were included when a tolerance or resistance to the biocidal active substance or disinfectant was suspected and at least two of the three endpoints were evaluated in parallel in comparison to the control isolates. In three out of five studies, the elevated MIC values did not correlate with an impaired bactericidal efficacy against the biocide-tolerant isolates. In three out of five studies, an impaired activity in the suspension tests was described that correlated with an impaired efficacy in the carrier tests (peracetic acid-tolerant K. pneumoniae and glutaraldehyde-tolerant M. chelonae; the two other studies did not allow a comparison. Overall, the results from the suspension tests and tests under practical conditions allowed to determine a clinically relevant resistance.
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Reusable surface disinfectant tissue dispensers are used in hospitals in many countries because they allow immediate access to pre-soaked tissues for targeted surface decontamination. On the other hand disinfectant solutions with some active ingredients may get contaminated and cause outbreaks. We determined the frequency of contaminated surface disinfectant solutions in reusable dispensers and the ability of isolates to multiply in different formulations. Reusable tissue dispensers with different surface disinfectants were randomly collected from healthcare facilities. Solutions were investigated for bacterial contamination. The efficacy of two surface disinfectants was determined in suspension tests against two isolated species directly from a contaminated solution or after 5 passages without selection pressure in triplicate. Freshly prepared use solutions were contaminated to determine survival of isolates. 66 dispensers containing disinfectant solutions with surface-active ingredients were collected in 15 healthcare facilities. 28 dispensers from nine healthcare facilities were contaminated with approximately 107 cells per mL of Achromobacter species 3 (9 hospitals), Achromobacter xylosoxidans or Serratia marcescens (1 hospital each). In none of the hospitals dispenser processing had been adequately performed. Isolates regained susceptibility to the disinfectants after five passages without selection pressure but were still able to multiply in different formulations from different manufacturers at room temperature within 7 days. Neglecting adequate processing of surface disinfectant dispensers has contributed to frequent and heavy contamination of use-solutions based on surface active ingredients. Tissue dispenser processing should be taken seriously in clinical practice.
Abstract Background Effective neutralization in testing hand hygiene preparations is considered to be a crucial element to ensure validity of the test results, especially with the difficulty to neutralize chlorhexidine gluconate. Aim of the study was to measure the effect of chemical neutralization under practical test conditions according to EN 1500. Methods We have investigated two ethanol-based hand rubs (product A, based on 61% ethanol and 1% chlorhexidine gluconate; product B, based on 85% ethanol). The efficacy of products (application of 3 ml for 30 s) was compared to 2-propanol 60% (v/v) (two 3 ml rubs of 30 s each) on hands artificially contaminated with Escherichia coli using a cross-over design with 15 volunteers. Pre-values were obtained by rubbing fingertips for 1 minute in liquid broth. Post-values were determined by sampling immediately after disinfection in liquid broth with and without neutralizers (0.5% lecithin, 4% polysorbate 20). Results The neutralizers were found to be effective and non-toxic. Without neutralization in the sampling fluid, the reference disinfection reduced the test bacteria by 3.7 log 10 , product B by 3.3 log 10 and product A by 4.8 log 10 (P = 0.001; ANOVA). With neutralization the reference disinfection reduced the test bacteria by 3.5 log 10 , product B by 3.3 log 10 and product A by 2.7 log 10 (P = 0.011; ANOVA). In comparison to the reference treatment Product B lead to a lower mean reduction than the reference disinfection but the difference was not significant (P > 0.1; Wilcoxon-Wilcox test). Without neutralizing agents in the sampling fluid, product A yielded a significantly higher reduction of test bacteria (4.8; P = 0.02) as compared to the situation with neutralizing agents (2.7; P = 0.033). Conclusion The crucial step of neutralization lies in the sampling fluid itself in order to stop any residual bacteriostatic or bactericidal activity immediately after the application of the preparation, especially with chlorhexidine gluconate-containing preparations. This is particularly important at short application times such as the 30 s.
The coronavirus disease 2019 (COVID-19) pandemic has caused a huge demand for alcohol-based hand rubs, medical gloves, face masks, and gowns in healthcare and from the public. More and more hospitals face a serious shortage of these articles. We propose a risk-adapted approach to ensure adequate patient and healthcare worker safety for as long as possible.
Reusable surface disinfectant (SD) tissue dispensers are used in hospitals in many countries because they allow immediate access to soaked tissues for targeted surface decontamination.
