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SUMNIARY
The chemical disinfection of virus-contaminated non-porous inanimate surfaces
was investigated using coxsackievirus B3, adenovirus type 5, parainfluenzavirus
type 3 and coronavirus 229E as representatives of important nosocomial viral
pathogens. A 10 ,ul amount of the test virus, suspended in either faeces or mucin,
was placed onto each stainless steel disk (about 1 cm in diameter) and the
inoculum allowed to dry for 1 h under ambient conditions. Sixteen disinfectant
formulations were selected for this study based on the findings of an earlier
investigation with a human rotavirus. After 1 min exposure to 20,u1 of the
disinfectant, the virus from the disks was immediately eluted into tryptose
phosphate broth and plaque assayed. Using an efficacy criterion of a 3 log10 or
greater reduction in virus infectivity titre and irrespective of the virus suspending
medium, only the following five disinfectants proved to be effective against all the
four viruses tested: (1) 2 % glutaraldehyde normally used as an instrument soak,
(2) a strongly alkaline mixture of 05 % sodium o-benzyl-p-chlorophenate and
0-6 % sodium lauryl sulphate, generally used as a domestic disinfectant cleaner for
hard surfaces, (3) a 0 04 % solution of a quaternary ammonium compound
containing 7 % hydrochloric acid, which is the basis of many toilet bowl cleaners.
(4) chloramine T at a minimum free chlorine level of 3000 p.p.m. and (5) sodium
hypochlorite at a minimum free chlorine concentration of 5000 p.p.m. Of those
chemicals suitable for use as topical antiseptics, 70 % ethanol alone or products
containing at least 70% ethanol were ineffective only against coxsackievirus B3.
These results emphasize the care needed in selecting chemical disinfectants for
routine use in infection control.
INTROD)UCTION
Outbreaks of viral infections in institutional settings arc quite common andl it
is not unusual for more than one virus to be circulating simultaneously within a
given institution (Meissner et al. 1984; Payne, Grilli & Smith, 1984). The exact
means of spread of viral agents in many such outbreaks still remain unclear, but,
for many viral pathogens, multiple vehicles mav be involved. Evidence suggests
that virus-contaminated surfaces may play a role (Pattison et al. 1974; Maynard,
1976; Hall, Douglas & Geiman, 1980; England, 1982; Pancic, Carpenter & Came,
494 S. A. SATTAR AND OTIIERS
1980; Hutto et al. 1986; Sattar et al. 1986; Sattar & Springthorpe. 19877; Anisari
et al. 1988a). Even when aerosolization of infeetious virus oceurs. settling of coarse
particles results in the contamination of surfaces. Tfherefore. chemical (lisinfection
of environmnental surfaces as well as hand antisepsis are routinely )ractised in ani
effort to )revent anid control the spread of infectious diseases, atnd may l)eb
particularly important in the case of viral infections, where the inimlitnal infective
dose is often very low (Westwood & Sattar, 1976; Graham. I)ufour & Estes. 1987:
WVard et al. 1986).
Although many commercial disi nfectants are teste(d for their l)acteri idal
efficacyv, their virucidal potential is rarely examiine(l. \Ve have previouslv
demonstrate(d that inan v commercial products are ineffective for the disinfection
of rotavirus-contaminated inanimate surfaces (Lloyd-Evans. Springthorpe &
Sattar. 1986) and skiin (Ansari et al. 1988b). In this investigation a selected Irantlge
of disinfectants was tested to determine whether the trends observed with
rotaviruses coul(i be extend(ed to other types of hutmain pathogenic viruises known
to cause outbreaks in institutions.
Sin(ce the structure and composition of a given virus determninie the degree of its
susceptibility to various classes of chemical disinfectants, four rel)resentatixe
human pathogenic viruses were choseni according to the following criteria: (I)
should belong to a virus group which is known to cause outbreaks of disease in
institutional settings such as hospitals. nursing hotnes anid day-care centres, (2)
should grow to relatively high titres in cell culture an(1 permnit (uantitation by
plaque assay and (3) should be capable of surviving onI fomites long einough to
allow virus transmission, and (4) should not require a high level of biohazard
containment. On this basis. coxsackievirus 133 (C13-3) was selected to represent the
enteroviruses which are conisi(lered to be relatively resistant to chemnic al
disinfection, and adenovirus type 5 (AD-5) was used to rep)resent adlenoviruses
which have intermediate susceptibility to disinfectants.
Even though enveloped viruses are known to be more rea(lilv inactivate(l b)v
chemical disinfcctants than non-enveloped viruses, their susceptibility may l)e
overestimated when they are dried onto surfaces in their natural organic loa(l.
Two different types of enveloped virus, parainfluenzavirus ty)pe 3 (HPIV 1\-3) aind
human coronavirus 229-E (HCV-229E). were chosen. As a cause of lower
respiratory tract infections in young children, parainfluenzaviruses are only
second in importance to RSNV, and their ability to spread in iiistitutional
communities is also well documented (Mufson, Alocega & Krause, 1973: I)e
Fabritis et al. 1979; Aleissner et al. 1984; WHO. 1985; Ford-Jones. 1987).
Inistitutional outbreaks of respiratory (Kaye. Alarsh & IDowdle. 1971 ; Wenzl et atl.
1974). and possibly enteric (Vaucher et at. 1982). coronavirus infections have also
been recorded.
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Disinfection of virus-contaminated surfaces 497
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I)isinfection of virus-contaminated surfaces 499
D)isitifectant.s
The disinfeetants used were selected on the basis of previous work wvith a human
rotaxvirus (Springthorpe et al. 1986; Llod-dEvans, Springthorpe & Sattar, 1986);
they are listed in T'able 1 und(ler their active ingredients. Trade names are not given
to avoid recommen(ding a particular product when other similar formulations may
be available but have not beeni tested. Furthermore, many disinfectants are
markete(d on a local or nationial rather than an international basis, and the samne
fortmulation may be sol(d under a variety of trade names in different countries. In
ad(lition. some of the disinfectants listed in Table 1 are not commercial
formulations, but are modifications where the nature of the modificatioil and the
concentration of additives may have be(en suggested by competing products. rhe
nature of the (liluent. if any, can markedly affect the virucidal activitv of a
disinifectant (Sattar et al. 1983: Wallis et al. 1963). Disinfectants were (lilute(l
accor(ling to the manutfacturers' instructions. using tap) water except where 70)0/
ethanol is in(licated as an active inigredient and (liluent. l)eterminations of
available chlorine by the DI'D methodtused a commercial kit (Hach (Chemical
Coompany. Amnes. IA. UtSA).
Tes4 pJroedlrei
The test procedure was mnodified only! slightly from that used previously (Lloyd-
Evans. Springthorpe & Sattar, 1986). The virus suspension (10 ,ul) was (lde)osite(d
onlto the centre of each dlisk held in a horizontal position and the inoculum allowed
to air dry for I h un(ler ambient, conditions. The contaminat,ed area on the clisk
was overlaid with 20I,u of the disinfectant. After 1 min of contact at rooim
temperature (22-24 °C) each disk, with the virus and( disinfectant still in place,
was (lropp)e(l into a vial containing 1 ml of tryptose phosphate broth (TPlB ; L)ifco)
for virus elution. Tlhis immediatelyodiluted and neutralized the disinfectant an(l
allowcd efficicnt recovcrv of thc inoculated virus.
ethanol alone and it was also effective against human rotaviruses (Lloyd-Evans.
Springthorpe & Sattar, 1986). Due to the potent bactericidal properties of
chlorhexidine salts and their residual activity on the skin, their importance in
antisepsis.particularly
topical two in alcoholic solution, cannot be underestimate(l.
The phenolics were selected because they were among 4 of the17 phenolics
which proved to be effective against human rotavirus in suspension (Springthorpe
etal. 1986). However. on surfaces oneThe w
was effective and the other as not (Lloyd-
Evans, Springthorpe & Sattar. 1986). results of the present one was study with thetwo
products tested alone showed the same dramatic difference; effective
against all the test viruses while the other was not effective against any. The
relative concentrations of thephenolics (05 %. vw/v for the effetive product
compared with 00160/0. w/v) are assumed to be responsible for this differen(ce
against
because addition of 0'6% SD)S to theineffective product made it effective
product
HP'1V-3 and HCV-299E onlv. Addition of ethanol to the ineffective gave
it the same spectrum of efficacy against the tested viruses as ethanol alone.
D)isinfection impliesa that pathogen concentrations havebeen re(duce(d to levels
'whichno longer pose risk to the susceptible host. Apart from specialized clinical
oIn
an(d research laboratories. Infieldviewapplication of disinfectants
an(d
is inevitably
previous
inanimate surfaces or skin. results
of the obtained here in
1983:,Schurmann
studies (Kirchhoff. 1969: Nakao et al. 1978; Klein & Deforest.
& Eggers. 1983: Lloyd-Evans. Springthorpe & Sattar. 1986). it is essential that
disinfectants ares teste(d on contarninatedl carriers, although suspension tests -nay
be useful for initial screeninig of formnulations e
(Springthorpet al. 1986).
r1'he known susceptibility of many disinfectant chemicals
should
neutralization
to
cltirinig
always (onduictedl
be
by
organic soil suggests that testing of these chemicals
with a realistic challeinge. Although the organic loa(ds preseint naturally-shed
loadls. mucus.
these
disinfectant tests were olesigned to simulate natural organic
virts. already embedded in an organic matrix such as faeces or
e\ eni more resistant to inactivation than when the virus is adl(le(1 externally
may be
to that
miatrix. 'r'hereforc. caution should be
efficacy directlv from the laboratory to the field.
exercised in extrapolating
Noneotheless, is mnost likely
disinfectant
laboratory tests are
capable of (listinguishing which of a range of (lisinfe(tants
chemical
to be effe(tive inexamine
thefiel(l. and( of showinginadequate concentrations. Laboratory
but fiel(d are
tests therefore the potential of(lisinifectant
effi(acv.
solutions trials
ne(essary to determine their true (lisinfectant efficacv
No stan(lar(1 metho(ls are available for testing agaiinst
Disinfection of virus-contaminated surfaces 503
vilrlses even those in routine use for bactericidal efficacy are unId(ler review. AIn
nigf(ent Ineed( exists for testing prot!ocols which use clinically relevant con(litions
anid( contact timnes and( can reliably predict field efficacy. Many clinicians believe
that most (lisinfectants are equally efftective in the field: wve (10 nIot think this is
t'ti(e. Thew iajority of antimicrobial chemicals sol(1 in Noith America are either
(ltiaternarv ainmoniium compounds (38%/n) or phenolics (20%) which behave very
loorly as surface virucidies under simulated fiel(d conditiotis. It is. however.
lifficult to (lefinie what role effective disinfection could play inldisease prevention
becauise the presenit spectrum of (lisease transmnission exists where many of the
disinfectants are iniadequate. Formulations use(d in this study were carefully
'selected after a systematic survey of many products; selection base(1 only on
a(lvertising or sales advice is likely to be a lottery at best. Because the miniinal
inifective dose for manyv viruses is extremely low. and the numbers shed in bo(dy
secretions and excretions may be high. disinifectants, used routinely for controlling
a I(d1)eventinlg the spread of viral inlfectioins in areas sutch as (lavare centres
(Klein. 1986) and(l hospital nieoniatal anid critical care facilities shouild be (hoseln
vith oreat (are.
AC(NN()WLEEI)(ENIENTS
This stu(lyr was supporte(l by a grant from the Nationial Health Research
Development Program of Health and Welfare (Canadla. \We thank Roussel (Cana(la
for the complimentary supplies of Cidomycin.
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