International Journal of Infection Control

Risk management for transmission of infection from inanimate surfaces in healthcare facilities Assanta et al.

www.ijic.info ISSN 1996-9783

Original Article

Comparison of efficacy profiles for minimum lethal

concentrations (MLCs) of some commonly used
commercial hospital microbicidal detergent-disinfectant
products for disinfectants and sporicidal activity

Francis Deshaies1, Darakhshan Ahmad2, Richard Massicotte2, Gilbert Pichette1,2,

Pierre Belhumeur1, Mafu Akier Assanta3
1
Université de Montréal, Deartment of Microbiology and Immunology Montréal Canada
2
HSCM-CPRS-LECINO, 5400, boul. Gouin Ouest, Montréal, Canada
3
Food Research and Development Centre, Agriculture and Agri-Food Canada, QC, Canada

doi: 10.3396/ijic.v8i2.013.12

Abstract
In an effort to evaluate and control the potential hazard and inherent risk of environmental transmission
and spread of nosocomial infections by contact with hitherto “non-critical” inanimate/environmental surfaces
in the hospital and healthcare facilities (commode, bed, bowl of toilet etc.), the microbicidal efficacies of
six disinfectants products commonly used in local hospital facilities was tested. The commercially available
detergent-disinfectants (one chlorine-based, one phenol-based, two quaternary ammonium compounds
(QACs), generation 3 and generation 4 and, two hydrogen peroxide-based) were evaluated at different
concentrations using use-dilution method for evaluating the minimum lethal concentrations (MLCs). Results
from these in vitro germicidal exposure experiments indicate that all six disinfectants tested were at the MLCs of
these disinfectants in proportion to the recommended strengths varied significantly and yielded very different
performance values for different test strains. This knowledge could prove to be of significance in assessing the
risks associated with the use, and the incidental failure thereof, of different disinfectants used in the healthcare
facilities. The results from our study highlight differences in the activity of germicides against different bacterial
strains. These results indicate that the choice of disinfectant agents and the hospital decontamination protocols
can markedly affect the prevalence and environmental distribution of pathogens and that this could be better
managed if a proper assessment of the risk associated with the use of disinfectants at off-recommended
strengths conditions is taken into account in providing guidance towards and seeking satisfactory resolutions
to the incidence of breach of manufacturers’ recommendations.

Corresponding author
Mafu Akier Assanta
Food Research and Development Centre, Agriculture and Agri-Food Canada, 3600 Casavant Boulevard
West, St-Hyacinthe, QC, Canada J2S 8E3 | Tel.: 450-773-7730 ext 138
Email: Akierassanta.mafu@agr.gc.ca

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Risk management for transmission of infection from inanimate surfaces in healthcare facilities Assanta et al.

Key words
DISEASE TRANSMISSION – infections; CROSS INFECTION – prevention and control; DISINFECTANTS;
MICROBIAL SENSITIVITY TESTS

Introduction trade names, all tested for their efficacy according to

Disinfectants play a vital role in global infection guidance documents developed by various regulatory
control as a crucial armament against transmission of bodies, worldwide.
nosocomial pathogens/ infections combating global
disease outbreaks. Recent decades have accumulated During the registration of a disinfectant, regulatory
a wealth of knowledge on pathogens, pathogen bodies, throughout the world, through their guidelines
transmission and control of outbreaks of nosocomial that manufacturers have to follow, look into efficacy
infections, disinfection mechanism and disinfectants data and labelling details. However, the reality is that
containing a variety of active antimicrobial ingredients. in between the manufacturers’ detailed directions/
We have witnessed development of regulatory guidance recommendations and the point of use (at the
documents, and commerce of effective detergent-/ healthcare facilities), a number of risk factors impact
disinfectant products with demonstrated efficacy the outcomes, the infection control offsets, resulting
against a broad spectrum of pathogens. However, into nosocomial infection outbreaks, of various nature,
we still constantly hear of, and duly “acknowledge”, of various frequencies, over the board, globally, as the
the incidence of disease spread/outbreaks due to message consistently seems to get lost in transmission/
“insufficient disinfection” incidences.1-5 communications. All marketed products do come
with detailed directions for their optimal application
Several reviews and reports clearly reveal, and efficient use, and are often sold packaged in
emphasize and establish that indirect transmission concentrated dosage forms with manufacturer
via contaminated, “inappropriately decontaminated” recommended working strengths and use-dilution
or inanimate “noncritical” objects, environmental information.
surfaces plays an important role in nosocomial spread
of diseases worldwide.6-9 Inappropriate choices However, from the risk management point of view,
and inadequate protocols for the disinfection of the effectiveness range inherent in their use at
inanimate surfaces have been a constant and major “off-/beyond-manufacturer-recommended optimal
source of outbreaks of nosocomial infections. We conditions”, encountered at the point of use, can not
can not overemphasize that “proper disinfection” is be evaluated unless informative data is available for
of utmost importance, rather crucial, to interrupt the their efficacies at off-recommended conditions and
environmental transmission of pathogens.10-17 But why incidental scenarios. Such as, use of off-recommended
is proper disinfection of these potential environmental concentrations can be envisioned if a disinfectant is
surface reservoirs still so difficult? not diluted properly and used at below or above the
recommended concentration, not applied properly,
There are, as well, reports suggesting that subinhibitory not stored under appropriate temperature, not kept
levels of disinfectants may induce sporulation and/ properly after the stock container is opened, etc.
or germination of Clostridium difficile spores.1 This
may be one possible explanation why even with The intrinsic impact of such possible off-/ beyond-
the availability of highly efficient disinfectants the recommended scenarios in the transmission of
environmental infection transmission is still often not nosocomial pathogens is difficult to evaluate because
controlled 100% of the time. Thus, the reasons could of lack of comparative efficacy data for marketed
be many and varied. disinfectant products targeted for healthcare facilities.

There is quite a variety of liquid chemical disinfectants The present study was undertaken as a first step to
that are commercially available under a variety of generate informative data on off-standard working-

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conditions, using modified microscale versions of Disinfectants tested

European Standard methods (NF EN 1040:2005, NF EN Six commonly used antimicrobial products of
14347:2005).18,19 Suspension tests are often preferred to commercial grade from four different groups of
carrier tests as the bacteria are uniformly exposed to the active ingredients (one phenol-based, two quaternary
disinfectant. Six commercially available disinfectants, ammonium-based, one chlorine-based and two
belonging to four different groups of active ingredients, hydrogen-peroxide-based), all sold in concentrated
(phenol-based), (two quaternary ammonium-based), dosage forms, representing different classes of
(chlorine-based), and (two hydrogen-peroxide-based), disinfectants, were obtained from the local distributors,
most commonly used in Quebec hospitals and (see Table I) hospitals. For quaternary ammonium
healthcare facilities, were selected for this comparative category, we used two types of product: The generation
study. The study was targeted to determine the minimal 3 product is a mixture of equal quantities of a first and
lethal concentrations (MLCs) of all products against the second generation of product. The resulting blend
four selected bacterial species and spores of a clinical provides a greater biocidal activity.21 Generation
isolate of C. difficile. 4 refers to a new mixture of equal parts of didecyl
dimethyl ammonium chloride and chloride dioctyl.
Materials and Methods Generation 4 has a greater germicidal activity to
the other three generations, in addition to increased
Bacterial Isolates, growth and sporulation media and tolerance to environmental conditions: the presence of
culture conditions organics and dilution in hard water.21
Bacterial isolates used in this study were,
Staphylococcus aureus (ATCC #25923), Enterococcus Microbicidal Efficacy Test /Assay conditions
faecalis (ATCC #19453), Escherichia coli (ATCC Bactericidal and sporicidal efficacy test assays
#25922), Pseudomonas aeruginosa (ATCC #27853) were performed essentially following the protocol
and Clostridium difficile (CD1) (clinical isolate from described in NF EN104018 and NF EN 1434719 albeit
Honoré-Mercier Hospital, St-Hyacinthe, Quebec, at a microscale level using a 96-well microtiter plate.
Canada). The culture media and growth conditions The assays were performed at 20˚C. Each assay mix
were as described in NF EN 104018 and NF EN contained 20 µL of bacterial or spore suspension, 20
1434719 with modifications to adapt the technique to µL of water and 160 µL of the disinfectant. At the end
a microscale level. of a given contact time, 20 µL of the assay mix was
transferred to the second row of wells of the plate
Precultures were prepared from stock cultures stored at containing 20 µL of water and 160 µL of D/E (Dey-
-80ºC, by streaking on appropriate media plates, then Engley broth) neutralizing buffer22 (D/E neutralizing
inoculating into liquid TSB (Tryptic Soy Broth) or BHI buffer proved to be efficient in neutralizing all
(Brain Heart Infusion) media and incubation at 37ºC, disinfectant at the highest concentration without
aerobically or anaerobically as required. The cultures affecting the survival of bacterial strains used in
were grown overnight (18-24 hours) in liquid TSB or this study). After 5 minutes of neutralization period,
BHI media, harvested by centrifugation, washed three samples of 20 µL of the suspension was plated onto
times, resuspended in the Tryptone-buffer to an OD620 TSA (Tryptic Soy Agar) or BHI plates and incubated for
of ~0.1 (~5x108 cell/mL) using an spectrophotometer 24 hours at 37ºC under required conditions.
and used for bactericidal efficacy assays.
For initial bacterial counts, serial dilutions of the initial
C. difficile was grown anaerobically at 37ºC for four bacterial or spore suspension were plated on TSA or
days in half-strength BHI to induce sporulation. The BHI plates and incubated under required conditions.
spores were harvested, washed twice in cold water Colonies forming units (cfu) per plate were recorded
and treated at 80ºC for 10 minutes to kill the vegetative and the log reduction values were determined to
cells according to NF T72-230.20 For sporicidal evaluate the bactericidal/ sporicidal efficacy under
efficacy assays, a spore suspension adjusted to obtain different assay setups. The assays were done in
a concentration of 1.4 x 106 spores/mL was prepared. duplicated and repeated three times. For determining

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Risk management for transmission of infection from inanimate surfaces in healthcare facilities Assanta et al.

Table I. Concentration of active ingredients in each disinfectant used

Disinfectants Active Substances CAS no Concentration%

Chlorine-based Sodium Hypochlorite 7681-52-9 4,0
Phenole-based Isopropanol 67-63-0 5-10
Benzyl-2 chloro-4 phenol 120-32-1 5-10
Sodium Dodecylbenzenesulfonate 25155-30-0 1-5
o-Phenylphenol 90-43-7 1-5
Quaternary Ammonium 3rd n-Alkyl (60% C14, 30% C16, 5%
generation C12, 5% C18) dimethyl benzyl
ammonium chlorides 68391-01-5 2.25
n-Alkyl (68% C12, 32% C14,)
dimethyl ethylbenzyl ammonium
chlorides 68956-79-6 2.25
Sodium Carbonate 497-19-8 -----
Quaternary Ammonium N-alkylbenzalkonium chloride 68424-85-1 14,8
4th generation Ethanol 64-17-5 1-5
Phosphorique acid 7664-38-2 1-5
Dodécylbenzènesulfonique acid 27176-87-0 1-5
Etidronique acid 2809-21-4 3-7
Accelerated Hydrogen Hydrogen Peroxide 7722-84-1 5–10
Peroxide-based
Bactericide
Accelerated Hydrogen
Peroxide-based
Tuberculocide Hydrogen Peroxide 7722-84-1

* AHP; the difference between bactericide and tuberculocide is in the secret formulation with others products

the MLCs for disinfectants on bacterial strains and results, presented in an order of potency in Table IV,
spores, the dilution range tested was much larger, and clearly demonstrate that the MLCs for all different
contact time was 5 minutes. Furthermore, only 5 µL of commercial disinfectants are much lower than the
the final assay mix was spotted on the agar plate and manufacturers’ recommended working concentrations
the experiment was done in duplicate. under the test conditions used. A strong bactericidal
efficacy was expected under the in vitro conditions
Results used that are not as challenging as the real in-field
conditions (where the challenges include organic and
Determination of the MLCs of the disinfectant inorganic soils, dilution in tap water, different types of
products against four bacterial strains and surface/carrier materials, etc.). For testing, 1X105 cells
C. difficle spores were used. The lack of growth reflects a reduction in
Attempts were made to determine and compare the bacterial load of at least 105 which corresponds to an
effectiveness of the disinfectant products as MLCs acceptable bactericidal activity by the standards of
against four bacterial strains and C. difficile spores at AFNOR.
contact time of 5 minutes and using various dilutions
of the disinfectant products (see II and III), including The effective dilution values (MLCs as a proportion) of
manufactures’ recommended concentration. The the recommended working concentrations to achieve

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Table II. Dilutions of the disinfectants used to determine the MLCs for bactericidal activity

Disinfectant product used Dilutions %

Chlorine-based 0.65, 0.31, 0.15, 0.078
Phenole-based 0.70. 0.35, 0.18, 0.90. 0.43
Quaternary Ammonium 3rd generation 0.05, 0.024, 0.012, 0.006
Quaternary Ammonium 4th generation 0.025, 0.012, 0.006, 0.003
Accelerated Hydrogen Peroxide-based Bactericide 0.78, 0.39, 0.19, 0.097
Accelerated Hydrogen Peroxide-based Tuberculocide 6.25, 3.12, 1.56, 0.78

the MLCs were significantly different among the six However, the other accelerated hydrogen peroxide
disinfectants tested. As presented in Table 4, the phenol based disinfectant (tuberculocide) showed very good
based disinfectant seems to be the least effective efficacy against S. aureus, with 128-fold dilution
as the 5 log reduction was not observed against all of the recommended level (equivalent to 39 mg/L).
bacterial strains at >8-fold dilution of the working Interestingly, the accelerated hydrogen peroxide-
concentration (equivalent to 48:13 mg/L). The two QA- based tuberculocide product always showed stronger
based disinfectants were the most effective at 64-fold efficacy than its counterpart with a 2 times higher
dilution (equivalent to 19mg/l and 6mg/l, respectively) dilution required to achieve MLC.
against three of the bacterial strains, and showed
even better efficacy against P. aeruginosa at 128-fold In order to give a better idea of the efficacy of
dilution of the recommended working concentration disinfectants, their efficacies against four different
(equivalent to 10 mg/L and 3 mg/L, respectively). bacterial strains were compared. Data presented in
Table V clearly demonstrate that the phenol based
The chlorine based disinfectant showed good disinfectant was equally effective against 3 strains and
effectiveness with an MLC corresponding to 64-fold least effective on P. aeruginosa. Activated hydrogen
dilution of the recommended level (equivalent to peroxide based disinfectants were both most effective
82 mg/L) against three strains, and a MLC of 32-fold on S. aureus and least against E. coli. QA-based
dilutions (equivalent to 164 mg/L) for E. faecalis. The generation 4 and generation 3 disinfectants were
MLC levels for the two accelerated hydrogen peroxide both most effective on P. aeruginosa and equally
based disinfectants, exhibited greater variation in effective against the other three test strains. Chlorine
efficacy against different test strains, although the based solution was equally effective against E. coli, P.
trends were similar. The MLC values were the highest aeruginosa, S. aureus and least effective on E. faecalis.
(least effective) for E. coli with 16-fold dilution of the
recommended level (equivalent to 195 mg/L) for the The in vitro germicidal exposure test data for the
accelerated hydrogen peroxide based bactericide. sporicidal efficacy of the six disinfectants against

Table III. Dilutions of the disinfectants used to determine the MLCs for sporicidal activity
Disinfectant product used Dilutions
Chlorine-based 0.100*, 0.050. 0.025, 0.012
Phenole-based 0.014, 0.007*, 0.003, 0.001
Quaternary Ammonium 3rd generation 0.031, 0.016*, 0.008, 0.004
Quaternary Ammonium 4th generation 0.016, 0.008*, 0.004, 0.002
Accelerated Hydrogen Peroxide-based Bactericide 0.125, 0.062*, 0.031, 0.15
Accelerated Hydrogen Peroxide-based Tuberculocide 1.000*, 0.500. 0.250. 0.125
* Manufacture recommended working strength concentrations

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spores of C. difficile, presented in Table VI, indicate that (equivalent to 82mg/L). These results corroborate with
only the chlorine based disinfectant, was sporicidal at those obtained by Fawley et al. that among 5 commercial
almost all dilutions in the series of dilutions tested, detergent/cleaning agents and/or germicides (3
up to 64-fold dilution (equivalent to 82 mg/L), except chlorine-based, 1 nonionic detergent, and 1 hydrogen
the last dilution in the series tested, 128-fold dilution peroxide based: Chlor-clean, Sanichlor, Dispatch,
(equivalent to 41 mg/L), where bacterial growth was Hospec, G-Force, respectively) only the chlorine based
observed. None of the other five disinfectants showed disinfectants were sporicidal against the spores of 6
any sporicidal activity against spores of C. difficile at all strains of C. difficile at working concentrations.1 All 5
concentrations tested, even at concentrations higher product tested, including the detergent, in their study
than the recommended levels, including the activated did inhibit the growth of vegetative cells of C. difficile
hydrogen peroxide based disinfectants. not only at recommended working concentration
but at concentrations several folds lower than the
Discussions and Conclusions recommended strengths. We did similar experiments
Our results demonstrate significant differences in and the results clearly suggested that the vegetative form
microbicidal efficacies of the disinfectants tested at a was very sensitive to all the disinfectants used since
range of concentrations that include higher and lower there was a remarkable decrease in bacterial growth
than recommended working conditions, information with all disinfectants tested (data not shown). Other
that could be useful in evaluating risk associated groups like Perez et al. also reported acidified bleach
with incidences of “improper decontamination” of and regular bleach (3000-5000 ppm) to be sporicidal
healthcare environment. Indeed, some disinfectants against C. difficile spores.23 None of the other five of
such as the phenol-based products loose their efficacy the six disinfectants tested in our study showed any
with only a few dilutions (see Table IV). sporicidal activity against spores of C. difficile at all
concentrations tested, even at concentrations higher
This is particularly important considering the fact than the recommended levels, including peroxide
that the efficiency of disinfectants vary greatly based disinfectants. Oxidizing microbicides has been
depending on nature of the surface being disinfected, shown to be sporicidal against spores of several strains
number and nature of microorganisms present, of C. difficile and B. subtillis at 7000ppm within 10-15
presence of organic soil, duration of exposure and minutes tested under quantitative carrier test method,23
temperature.9-13 So, applying liquid disinfectants on a method implying much greater challenge than those
the surface, in the right concentration, contact time used in our study.
and environment (temperature) is probably not a
guarantee of success. Some other important issues There is a variety of disinfectants (approved and certified
regarding “improper decontamination” procedure by appropriate governmental / regulatory agencies)
based on difference between actual/ in-house/ on- available in the market. However, these disinfectants
site practice and recommended protocols may also contain/ belong to different groups of chemical
accentuate the problem. Some disinfectants such compounds, active pharmaceutical ingredient (API),
as activated hydrogen peroxide-based disinfectant and are sold in different dosage forms (ready to use
may not be suitable for all kinds of pathogens, since or concentrates to be diluted (fresh) and once open,
a lot of variability of efficacy was observed in our shelf life has to be respected, etc.). In addition, the
study regarding this particular class of disinfectant. technical staffs that actually use these disinfectants are
Moreover, Table V clearly demonstrates that pathogens not trained/ well informed of their mode of action and
are not equally sensitive to disinfectant products. This importance of their chemical nature and their intended
emphasizes even more on the importance of choosing use, in order to make a knowledge based decision.
the right disinfectant for the right situation (such as,
specific disease spread or outbreaks). In fact, even the professionals and technical staffs do
not have enough detailed knowledge of the MICs and
The data from the sporicidal efficacy tests of the six MLCs of different marketed disinfectants vis-à-vis at-
disinfectants indicate that only the chlorine based use concentration, as such comparative information
disinfectant, was sporicidal at 64-fold dilution is altogether absent. This has an implication on the

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Table IV. Classification of disinfectants according to their efficacy against various bacteria
Disinfectant efficacy
Manufacturer Fold dilution required
Bacterial recommended MLCs of the product from manufacturer
Disinfectant products
species concentrations (mg/L) recommended
(mg/L) concentrations to
achieve MLCs
Phenol based1 380:100 48:13 8x
Activated hydrogen peroxide 3125 95 16x
based
Activated hydrogen peroxide 5000 1563 32x
E. coli
based tuberculocide
Quat gen 4 1184 19 64x
Quat gen 32 360:360 6:6 64x
Chlorine based 5250 82 64x
Phenol based1 380:100 48:13 8x
Activated hydrogen peroxide 3125 98 32x
based
Activated hydrogen peroxide 5000 78 64x
E. faecalis
based tuberculocide
Quat gen 4 1184 19 64x
Quat gen 32 360:360 6 64x
Chlorine based 5250 164 32x
Phenol based1 380:100 48:13 8x
Activated hydrogen peroxide 3125 98 32x
based
Activated hydrogen peroxide 5000 78 64x
P. aeruginosa
based tuberculocide
Quat gen 4 1184 9 128x
Quat gen 32 360:360 3:3 128x
Chlorine based 5250 82 64x
Phenol based1 380:100 48:13 8x
Activated hydrogen peroxide 3125 49 64x
based
Activated hydrogen peroxide 5000 39 128x
S. aureus
based tuberculocide 64x
Quat gen 4 1184 19 64x
Quat gen 32 360:360 6 64x
Chlorine solution 5250 82

Note: Contact time was 5 minutes.

1
Clorophene: O-phenylphenol
2
Alky dimethyl ethyl bezyl ammonium chloride: Benzalkonium chloride

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Table V. A preview of data on MLCs of the tested disinfectants

Comparative sensitivity of different bacterial strains
Disinfectant products in regard to disinfectant products (based on MLCs )
Phenol based E. coli = E. faecalis = S. aureus = P. aeruginosa
Peroxide hydrogene S. aureus > E. faecalis = P. aeruginosa > E. coli
Peroxide hydrogene S .aureus > E. faecalis = P .aeruginosa > E. coli
tuberculocide
Quat gen 4 P. aeruginosa > E. coli = E. faecalis = S. aureus
Quat gen 3 P. aeruginosa > E. coli = E. faecalis = S. aureus
Chlorine solution E. coli = P. aeruginosa = S. aureus > E. faecalis

standard operating protocols (SOPs), if these do exist, of 6 different disinfectant products used in healthcare
at the point of use locations, and if actually followed, facilities in Quebec, targeted to determine their MLCs
and if audits are made for their proper use/ application, vis-à-vis their recommended use concentrations and
especially under the ever-increasing use of Healthcare contact times. CPRS, a Quebec’s provincial reference
facilities with increased workloads and/or decreased centre in sterilization (not mandated for all disinfections)
number of staff, and increasing technological and is inundated with requests seeking advice for real
material variety and resources available to deal with. life situations at the hospitals where an intelligent
Under such scenarios where an estimate of the situation decision has to be made, sometimes based on limited
/risk is not possible to reach, one ideally intends to information available from the scientific literature.
consider each situation as the worst possible case/ Scarcity of such data or total datagaps, must be filled in
condition, in order to ensure the goal of disinfecting with studies that are informative and of practical use,
all types of materials, all types of microorganisms/ with ease of implication in real life scenarios, by the
pathogens, all levels of soil/ organic matter, etc. decision makers. A lot of work by the researchers and
scientists in the field of disinfectants done for decades
However, there is challenge inherent to such a practice has culminated into guidance documents; there is still
as well. Not all disinfectant groups manifest same lack of data available for in-use/ on-site situations for
level of efficacies on different groups of organisms/ making informed science-based decisions for local
pathogens, for different levels of organic matter/ soil, on point of use applications. Our results demonstrate
different types of surfaces, and these technical details / significant differences in microbicidal efficacies of
information are not available to professionals/decision these disinfectants at a range of concentrations and
makers on purchase of products for their facilities and/ contact times that include higher and lower than
or to guide and instruct the actual user because of the recommended working conditions, information that
datagap(s). In an attempt to shed light /provide insight could be useful/exploited in evaluating risk associated
and fill in useful information into this datagap, as an with incidences of “improper decontamination” of
initial first step, for an efficient (effective, appropriate, healthcare environment.
safe and economical) use of surface disinfectant at
their point of use in healthcare institutions, we have Acknowledgements
started an on-going study at the HSCM-CPRS (Hospital The authors would like to thank the Groupe d’hygiène
of Sacré-Coeur de Montreal-Centre provincial de et salubrité at Hôpital Sacré-Cœur de Montréal as well
référence en stérélisation). as the Service des activités de soutien et du partenariat
of the Ministère de la Santé et des Services sociaux du
The work presented here is an initial first set of data from Québec for their financial support, which made this
an in vitro comparative study on bactericidal efficacies project possible.

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Table VI. Sporicidal efficacy profiles of various disinfectants against C. difficile spores1
at different concentrations

Disinfectant products Concentration (mg/L) Bacterial Growth

5250* -
2625 (2x dilution) -
1312 (4x dilution) -

Chlorine-based 656 (8x dilution) -

(Free chlorine 5.25%) 328 (16x dilution) -
164 (32x dilution) -
82 (64x dilution) -
41 (128x dilution) +
380:100* +
Phenole-based) 760 : 200 (double strength) +
(Clorophene 5.45%: O-phenylphenol
1.47%) 190 : 50 (2x dilution) +
95 : 25 (4x dilution) +
360 : 360* +
Quaternary Ammonium 3 generation (Alky 720 : 720 (double strength)
rd
+
dimethyl ethyl bezyl ammonium chloride
2.25%: Benzalkonium chloride 2.25%) 180 : 180 (2x dilution) +
90 : 90 (4x dilution) +
1184* +

Quaternary Ammonium 4th generation 2368 (double strength) +

(Benzalkonium chloride 14.8%) 592 (2x dilution) +
296 (4x dilution) +
3125* +

Peroxide 6250 (double strength) +

(AHP 0.5% ) 1562 (2x dilution) +
781 (4x dilution) +
5000* +

Peroxide tuberculocide 2500 (2x dilution) +

(AHP 0.5%) 1250 (4x dilution) +
625 (8x dilution) +
*Manufacture-recommended Use-Dilution concentration.
1 Bactericidal efficacy was also tested on the vegetative form of C. difficile, but the presence of spores in the cell suspension made the interpretation
of the result difficult. However, the results clearly suggested that the vegetative form was very sensitive to all the disinfectants used since there was a
remarkable decrease in bacterial growth with all disinfectants tested (data not shown).

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Risk management for transmission of infection from inanimate surfaces in healthcare facilities Assanta et al.

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