C. diff spore disinfection: balancing efficacy with safety

Chlorine bleach has long been the standard chemical for Clostridium difficile disinfection. Unfortunately, whilst efficacious, bleach is also corrosive. New technologies are emerging that do not sacrifice safety for efficacy. And they are redefining the way we view powerful disinfection chemistry. Sporicide Plus™ belongs to the classification of strong disinfectants called sporicidals. They are specifically designed to kill bacterial spores such as C. diff without the risks associated with bleach.

Clostridium difficile (C. diff) is a resistant superbug linked with hospital acquired complications including infection and mortality. The C. diff bacterium proliferates in the gastrointestinal tract after antibiotic therapy and forms spores that are shed and spread via the faecal-oral route.

The spores find their way to the affected patient’s fingertips, bedrails and nearby surfaces. They are resistant to most disinfectants and may persist for many months. They are transferred by the hands of others to different rooms. Once acquired and ingested by a susceptible individual, the spores germinate. The infection may progress through infectious diarrhoea to toxic megacolon and the cycle repeats¹.

High-touch surfaces in the patient zone contribute to infection risk^2,3. It follows that more frequent disinfection at the point of care is important if we are to lower hospital acquired complication rates and optimise patient outcomes. But traditional disinfectant chemistry may be too overpowering to use at the bedside, especially with a patient in situ.

The presence of bacterial spores adds a layer of complexity to bedside disinfection, especially while patients are present. Killing spores demands a proven, fast-acting sporicidal disinfectant. Unfortunately, traditional chemistries are notable for their toxicity and odour. Modern healthcare delivery, where patient safety and risk mitigation is paramount, may be best served by a discreet chemical approach with no odour.

Choosing the right sporicidal product is a critical step in the disinfection of rooms occupied by individuals with C. diff. The disinfectant must be effective against key pathogens of concern, get the job done within realistic contact times and not sacrifice the safety of patients, visitors, staff or surfaces⁴.

Accelerated hydrogen peroxide is the active ingredient in Sporicide Plus, a new registered sporicidal disinfectant with efficacy claims against a range of pathogens including C. diff spores. Accelerated hydrogen peroxide offers a proven balance of efficacy and safety while delivering sustainability and outstanding cleaning capability⁵.

The active ingredient in Sporicide Plus breaks down after use, leaving no residual active for C. diff to interact with. This is important because prolonged exposure to low levels of disinfectant residue are thought to be necessary for organisms to develop resistance⁴.

Sporicide Plus has a 1-minute⁶ contact time and is simple to use. The correct process may involve a dual approach — Sporicide Plus liquid with microfibre on general surfaces and Sporicide Plus Wipes on high-touch surfaces at the point of care. It is recommended that cleaners specifically target rooms where there is a high index of suspicion that the patient has a C. diff infection.

Reducing hospital acquired complications relies on budgetary input from cost centres including environmental cleaning, hand hygiene, perioperative asepsis and antimicrobial stewardship. Safety has a price, and new disinfection technologies will challenge some of those budgets, especially in the environmental services space. But such challenges become insignificant when compared to the human and financial costs associated with adverse patient events.

The Australian national guidelines for infection prevention suggest that either bleach or a TGA-registered hospital-grade disinfectant with specific claims for that organism be used for C. diff⁷. Bleach certainly has a place in health care. However, non-corrosive options may be more appropriate for high-touch surfaces at the point of care, especially if the patient is in the room.

Sporicide Plus is available from Diversey. Visit www.vericlean.com.au

References:

1. Gilbert L, Clostridium difficile Infection Laboratory Case Definition. Australian Government Department of Health, Feb 2016.
2. Otter JA, Yezli S, Salkeld JAG, et al. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. American Journal of Infection Control, 2013; 41: S6-S11.
3. Mitchell BG, Dancer SJ, Anderson M, et al. Risk of organism acquisition from prior room occupants: A systematic review and meta-analysis. Journal of Hospital Infection, 2015; 91: 211-217.
4. Rutala WA & Weber DJ, Selection of the Ideal Disinfectant. Infection Control and Hospital Epidemiology, 2014; 35: 855-865
5. Boyce JM et al. Prospective cluster controlled crossover trial to compare the impact of an improved hydrogen peroxide disinfectant and a quaternary ammonium-based disinfectant on surface contamination and healthcare outcomes. American Journal of Infection Control, 2017; 45: 1006-1010
6. In clean conditions
7. NHMRC, Australian Guidelines for the Prevention & Control of Infection in Healthcare, 2010; 74

Ivan Obreza is the Infection Prevention Consultant and Senior Clinical Advisor for Diversey Australia. He is a former Paediatric Cardiac Intensive Care Nurse and NSW Ambulance Paramedic. Ivan was also the editor of the NSW Ambulance Institute Journal.