Wipes are Better Than Sprays for Disinfecting Against C. difficile

A study published in the June 2017 issue of Antimicrobial Resistance & Infection Control, has revealed that when it comes to cleaning products that work against Clostridium difficile (C. difficile) wipes are better than sprays.

Because of rising C. difficile incidence in the past decade, coupled with rising costs, effective infection control measures are in demand, the researchers noted. According to the researchers, “the yearly national excess hospital cost associated with hospital-onset C. difficile is estimated to be €4 billion for Europe, $1 billion in the United States, and $280 million in Canada.”

In general, standard disinfection procedure suggests using an unbuffered 1:10 dilution of hypochlorite, which is known to lead to reduction of C. difficile. They write, “it is known that hypochlorite does not enhance sporulation and when used for environmental disinfection leads to a significant reduction of C. difficile-associated diarrhea. However, hypochlorite has to be used in excessive concentrations to be effective, thereby increasing its toxic and corrosive properties. Therefore, alternative agents are needed to eradicate spores of C. difficile.”

For their study, the researchers tested 4 sporicidal disinfectants, such as wipes and sprays, in order to examine their efficacy against spores of distinctive C. difficile PCR ribotypes. The team first looked at hydrogen peroxide 1.5% (Aseptix Sterimax Sporicide wipes); glucoprotamin 1.5% (Incidin plus wipes); a mixture of ethanol, propane and N-alkyl amino propyl glycine (Bacillol 30 tissues); and finally, a mixture of didecyldimonium chloride, benzalkonium chloride, polyaminopropyl, biguanide and dimenthicone as active ingredients (Formula 429 spray).

The researchers purposely contaminated tiles using a test solution with the specific C. difficile strains (PCR ribotypes 010, 014 or 027). The investigators allowed the tiles to dry for 1 hour and then the tiles were wiped or sprayed with one of the test products, following the manufacturer’s instructions. After 5 minutes, microbiological cultures were performed by the study authors.

Microbial count reduction of C. difficile PCR ribotype 010 was the highest, no matter the disinfection method. This was followed by reduction of C. difficile 014 and then 027. The researchers concluded that the ribotypes 014 and 027 were more difficult to eradicate than type 010.

Type 027, in particular, is known for its “hypervirulence,” the study authors wrote, compared to 010 which does not produce toxins and does not trigger C. difficile infection in humans. Ribotype 014 is the most prevalent (17%) PCR ribotype in the Netherlands, where the study took place.

The most effective disinfection method proved to be the hydrogen peroxide wipe, which even beat out the hydrogen peroxide spray. Additionally, the researchers found that wipes performed better than the sprays with the same active ingredient.

An argument could be made that using the sprays also included the use of paper towels for wiping the tiles, but the researchers cited another study which compared microfibers, cotton cloths, sponge cloths, and paper towels for their decontamination abilities and the researchers on that study did not find a significant difference.

There was a slight difference in relative light unit (RLU) reduction between the wipes and sprays: the wipes had a higher RLU reduction, but no significant different for RLU reduction was discovered between the 3 ribotypes.

“Impregnated cleaning / disinfection wipes generally outperform ready-to-use sprays, even if based on the same active ingredient, and should thus be preferred over sprays for the daily cleaning/ disinfection in rooms of patients with C. difficile infection,” the researchers wrote. “Future studies should use these more resilient types of C. difficile to ensure the needed in vivo effect.”