Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-18T03:00:16.423Z Has data issue: false hasContentIssue false
  • English
  • Français

An Increase in Healthcare-Associated Clostridium difficile Infection Associated with Use of a Defective Peracetic Acid–Based Surface Disinfectant

Published online by Cambridge University Press:  21 November 2016

Jennifer L. Cadnum ,
Annette L. Jencson ,
Marguerite C. O’Donnell ,
Elizabeth R. Flannery ,
Michelle M. Nerandzic  and
Curtis J. Donskey
Jennifer L. Cadnum
Affiliation:
Research Service, Louis Stokes Veterans’ Affairs Medical Center, Cleveland, Ohio
Annette L. Jencson
Affiliation:
Research Service, Louis Stokes Veterans’ Affairs Medical Center, Cleveland, Ohio
Marguerite C. O’Donnell
Affiliation:
Infection Control Department, Louis Stokes Veterans’ Affairs Medical Center, Cleveland, Ohio
Elizabeth R. Flannery
Affiliation:
Infection Control Department, Louis Stokes Veterans’ Affairs Medical Center, Cleveland, Ohio
Michelle M. Nerandzic
Affiliation:
Research Service, Louis Stokes Veterans’ Affairs Medical Center, Cleveland, Ohio
Curtis J. Donskey*
Affiliation:
Geriatric Research, Education, and Clinical Center, Louis Stokes Veterans’ Affairs Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
*
Address correspondence to Curtis J. Donskey, MD, Geriatric Research, Education and Clinical Center, Louis Stokes Veterans’ Affairs Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106 (curtisd123@yahoo.com).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

We investigated an increase in the incidence of healthcare-associated Clostridium difficile infection (CDI) that occurred following a change from a bleach disinfectant to a peracetic acid–based disinfectant.

OBJECTIVE

To evaluate the efficacy of the peracetic acid–based disinfectant.

DESIGN

Laboratory-based product evaluation.

METHODS

The commercial peracetic acid–based product is activated on site by mixing a small volume of concentrated hydrogen peroxide and peracetic acid present in a “SmartCap” reservoir with the remaining contents of the container. We measured concentrations of peracetic acid in newly activated and in-use product and determined the stability of nonactivated and activated product. We tested the efficacy of the product against C. difficile spores using the American Society for Testing and Materials standard quantitative carrier disk test method.

RESULTS

Measured concentrations of peracetic acid (50–800 parts per million [ppm]) were significantly lower than the level stated on the product label (1,500 ppm), and similar results were obtained for containers from multiple lot numbers and from another hospital. Product with peracetic acid levels below 600 ppm had significantly reduced activity against C. difficile spores. Peracetic acid concentrations were reduced markedly after storage of either activated or nonactivated product for several weeks. The Environmental Protection Agency confirmed the finding of low disinfectant levels and ordered discontinuation of sale of the product.

CONCLUSION

Use of a defective peracetic acid–based surface disinfectant may have contributed to an increase in healthcare-associated CDI. Our findings highlight the importance of evaluating the efficacy of liquid disinfectants in healthcare settings.

Infect Control Hosp Epidemiol 2017;38:300–305

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 300 - 305
Copyright
© 2016 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

REFERENCES

1. Donskey, CJ. Does improving surface cleaning and disinfection reduce health care-associated infections? Am J Infect Control 2013;41:S12–S19.CrossRefGoogle ScholarPubMed
2. Dubberke, ER, Carling, PC, Carrico, R, et al. Strategies to prevent C. difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:628–645.CrossRefGoogle Scholar
3. Rutala, WA, Weber, DJ. Uses of inorganic hypochlorite (bleach) in health-care facilities. Clin Microbiol Rev 1997;10:597–610.Google Scholar
4. Deshpande, A, Mana, TS, Cadnum, JL, et al. Evaluation of a sporicidal peracetic acid/hydrogen peroxide-based daily disinfectant cleaner. Infect Control Hosp Epidemiol 2014;35:1414–1416.Google Scholar
5. Deshpande, A, Mana, TSC, Cadnum, JL, et al. Effectiveness of spray application of a novel sporicidal disinfectant cleaner. Paper presented at ID Week 2013; October 2013; Philadelphia, PA.Google Scholar
6. ASTM E2197. Standard quantitative disk carrier test method for determining bactericidal, virucidal, fungicidal, mycobactericidal, and sporicidal activities of chemicals. ASTM International website. http://www.astm.org/DATABASE.CART/HISTORICAL/E2197-02.htm. Published 2011. Accessed October 25, 2016.Google Scholar
7. Fortin, A. Stop sale, use, or removal order issued to sBioMed, LLC. Environmental Protection Agency website. https://www.epa.gov/enforcement/stop-sale-use-or-removal-order-issued-sbiomed-llc. Published 2015. Accessed October 25, 2016.Google Scholar
8. Sitzlar, B, Deshpande, A, Fertelli, D, Kundrapu, S, Sethi, AK, Donskey, CJ. An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms. Infect Control Hosp Epidemiol 2013;34:459–465.Google Scholar
9. Rutala, WA, Gergen, MF, Weber, DJ. Efficacy of different cleaning and disinfection methods against Clostridium difficile spores: importance of physical removal versus sporicidal inactivation. Infect Control Hosp Epidemiol 2102;33:1255–1258.Google Scholar
10. Cadnum, JL, Hurless, KN, Kundrapu, S, Donskey, CJ. Transfer of Clostridium difficile spores by nonsporicidal wipes and improperly used bleach wipes. Infect Control Hosp Epidemiol 2013;34:441–442.CrossRefGoogle Scholar
11. Boyce, JM, Sullivan, L, Booker, A, Baker, J. Quaternary ammonium disinfectant issues encountered in an environmental services department. Infect Control Hosp Epidemiol 2016;37:340–342.Google Scholar
12. Engelbrecht, K, Ambrose, D, Sifuentes, L, et al. Decreased activity of commercially available disinfectants containing quaternary ammonium compounds when exposed to cotton towels. Am J Infect Control 2013;41:908–911.Google Scholar
13. Gerba, CP. Quaternary ammonium biocides: efficacy in application. Appl Environ Microbiol 2015;81:464–469.Google Scholar