EP0186 - Thermo-desinfecting machines – lack of efficacy for the removal of C.
difficile spores
Rafael Perdiz¹, RN; Jorge Sampaio², MD, Phd; Mirian Dalben Corradi¹, MD, Msc; Andrea Alfaya Acuna¹, RN; Renata Desordi Lobo¹, RN, Phd; Maria Beatriz Dias1, MD, Phd.
1 - Hospital Sírio Libanês; 2 - Fleury Diagnostic Medicine; E-mail: jorge.sampaio@grupofleury.com.br; biagsd@gmail.com
Background: C. difficile infection (CDI) is a leading
healthcare associated infection, with about half a
million cases in USA and a high prevalence in North
hemisphere hospitals. Sírio-Libanês Hospital is a
private 400 bed tertiary hospital, loicated in São
Paulo, Brazil. The CDI incidence is 8.8 CDI/10,000
patient days, high by Brazillian benchmarks. We
take many measures to avoid C. difficile transmission
between patients, including sterilization of bedpans
and male urinals, which constitute a high workload
for the central sterilization service. Therefore we
evaluated the efficacy of two automatic thermo-
disinfecting machines, which would be placed in the
wards, in order to diminish this central service
demand.
Material/methods: The two machines had similar
technical characteristics: Arcania® Clinox 3A Auto (5
minute cycle at 90oC max temp) and Getinge® FD
1600 (8 minute cycle at 91oC max temp). A fecal
suspension was sterilized in autoclave and then
contaminated with spores from a clinical strain of C.
difficile in other to obtain a final concentration of 107
/ml. The fecal suspension with spores was utilized to
contaminate bedpans and urinals. After
contamination, devices were let at ambient
temperature for 24 hours and then submitted to
disinfection in the machines (Figure).
The detergents utilized were:
- Sekumatic® (acid pH 3), Liquezime® (multi-
enzymatic pH 9.5) and Prolistica® (alkaline pH > 13)
3 cycles each detergent, with the Arcania® machine;
- ArjoHuntleigh® (alkaline pH 14) - 3 cycles, with
the Getinge® machine.
Before the cycles a positive control was obtained from the spore suspension. In each load a Media with and without thaurocholate agreed in
sterile urinal was included to serve as a negative control and to check for potential contamination 71/81 (87.6%) culture pairs.
during the disinfecting cycle. Cultures were collected with Rodac® plates with C. difficile
moxalactam norfloxacin agar (Thermo) with and without sodium thaurocholate. Thaurocholate was Conclusions:
added in order to improve spore germination. Swabs were utilized to sample hard to reach areas. - Contrary to previously published data(1,2),
After each cycle in both machines, a point close to the draining area was sampled with a Rodac our results show that neither thermo-
plate. Plates were incubated in anaerobiosis for three days at 36˚C. Species identification was disinfecting machine nor the different
confirmed by MALDI-ToF (Bruker). detergent solutions showed efficacy in
removing the C. difficile spores from
contaminated bedpans and urinals.
- Sterile urinals placed in the same cycle
came out contaminated with C. difficile.
- After a disinfecting cycle C. difficile spores
were recovered from the thermo-desinfecting
machines except when Liquezime® was
used in the Clinox 3A Auto Arcania®.
Figure – Wokflow used in this study. - According to our data the use of these
automated thermo-disinfecting machines
Results: Results are detailed in Table.
was not effective in removing C. difficile
Table – Performance of thermo-disinfecting machines on C. difficile spores removal. spores and may contribute to foster its
Detergent solution Liquezime® Sekumatic® Prolistica® ArjoHuntleigh® dissemination in hospitals.
Thermo-disinfecting machine Clinox 3A Clinox 3A Clinox 3A
FD 1600
Auto Auto Auto References
Getinge®
Variables Arcania® Arcania® Arcania® 1.Alfa MJ, Olson N, Buelow-Smith L. Simulated-use testing
of bedpan and urinal washer disinfectors: Evaluation of
Positive controls (spore suspension) 1/1(100%) 1/1(100%) 1/1(100%) 3/3 (100%) Clostrium difficile spore survival and cleaning efficacy. Am J
Infect Control, 2008;36:5-11.
Contaminated devices tested (N) 15 15 15 9 2.Alfa MJ, Olson N, Buelow-Smith L, Murray B. Alkaline
Devices with C. difficile growth after detergent combined with a routine ward bedpan washer
100% 93.3% 93.3% 88.9% disinfector cycle eradicates Clostridium difficile spores from
disinfection cycle (%)
the surface of plastic bedpans. Am J Infect Control, 2013:
Negative controls (sterile urinals) 41:381-383.
which grew C. difficile after 3/3 (100%) 1/ 2 (50%) 3/3 (100%) 3/3 (100%)
disinfection cycle (%) Financing sources: Hospital Sírio Libanês and
Machine contamination Fleury Diagnostic Medicine. Machines and
(culture of drainage area with C. 0/3 (0%) 3/3 (100%) 2/3(66.6%) 3/3 (100%) detergents were provided by the thermo-desinfecting
difficile after the disinfecting cycle) machines manufacturers