The 14 studies that were selected for this review were referred to as E1 to E Eight of them A total effectiveness tests on alcohol disinfection were conducted, out of which Within the 92 efficacy tests, 23 of them The number and percentage of instruments in which microorganisms were detected, and the average microbial load detected after alcohol disinfection in either previously cleaned or uncleaned products, in experimental efficacy or field effectiveness conditions, regarding the studies which were examined here may be seen in Table 2.
E1, E4, E6, and E12, which evaluated effectiveness of alcohol disinfection with no previous cleaning of products, found microorganism growth even after disinfection. One of the studies E5 found no microorganisms after those decontamination procedures. E9, E10, E12, and E13, which evaluated efficacy of alcohol disinfection with no previous cleaning of instruments, found microorganism growth even after disinfection.
E8, E9, E10, E12, and E13, which evaluated efficacy of alcohol disinfection with no previous cleaning of instruments, found microorganism growth even after those decontamination procedures. Table 3 shows the list of health care products which were analyzed in the studies, their total numbers and the number of samples that were found to be contaminated after alcohol disinfection field and experimental , as wells as the bioburden and the microorganisms detected in those samples.
The contaminating agent that was inoculated comprised no organic matter, which is found under real conditions. The tonometers were contaminated with type-I HIV virus , type 1 and 2 herpes simplex virus strains.
The limitations of the respective studies are described in Figure 2. Several techniques were employed to collect samples in the studies which evaluated the effectiveness and efficacy of alcohol disinfection. In the field studies, the following techniques were used: direct plating of the health care product samples in agar plates 6,10 , rubbing a sterile saline solution-soaked sterile compress pad on the product 7 , swab rubbing absent description whether it was sterile or if had been soaked in a certain solution 9 , rubbing phosphate buffered saline-soaked sterile swabs on the product 12 , direct inoculating the health care product in a culture broth 17 , rubbing with a sterile compress pad In the experimental studies, the following collection techniques were used: soaking the health care products tubes in sterile phosphate buffered solution 8 , rubbing with a Letheen broth and Tween neutralizer-soaked sterile swabbing pad 13 , rubbing with a saline-solutionsoaked sterile swab 14 , swab rubbing absent description regarding whether it was sterile or it had been soaked in a certain solution 15 , directly inoculating the health care product in sterile saline solution 16 , direct inoculation of the health care product in a viral transportation medium 17 , sterile compress pad rubbing In one of the studies that information was not described In the experimental studies, the culture media used were the following: Middlebrook 7H11 agar for the analysis of mycobacteria 8 agar type not described 13 , Mitis salivarius agar, MacConkey agar, Baird Parker agar 14 , brain-heart infusion agar BHI 15 , Sabouraud dextrose agar, and BBL agar 16 , Caso-Bouillon fun broth-diluted sample.
After the dilution, plating with blood agar Incubation periods lasted 96 hours 6 , 72 hours 7 , 48 hours 10,12,19 in the field studies which intended to evaluate alcohol effectiveness.
In two field studies incubation periods were not described 9, In the experimental studies, incubation periods used were 24 hours! In one field study 17 and in one experimental study 18 , a 7-day incubation time was used in order to check for the elimination of a mycobacterium species. In the health care practice, alcohol is used as a disinfectant for health care products, in order to prevent crossed transmission of microorganisms to patients in whom such products are used.
This systematic review has concluded the microbiological safety of semi-critical products that are disinfected with alcohol cannot be fully ensured, as some microbial groups detected are believed to be resistant to alcohol. It's worth mentioning that, despite alcohol not being a sterilizing agent, its action promoted the. However, that publication failed to mention the employed rubbing time However, under such conditions, type 5 adenovirus could not be eliminated from the surface of those products However, the literature does not mention the detection of type 5 adenovirus in eyelid specula, after they are disinfected with that type of alcohol, as demonstrated in this review.
In the field studies which were proposed to evaluate the effectiveness of the disinfecting action of alcohol, disinfection was not achieved for the products that had been submitted to previous cleaning The same was verified in experimental studies in which alcohol disinfection was not achieved for Those results do not corroborate the already consolidated recommendation that previously cleaning prior to disinfection consists of a requirement for disinfectants to have their action ensured.
Nonetheless, the active ingredients of those products must directly act on dry contaminating agents in the presence of organic matter in order to be approved and registered as high-level disinfectants in the USA 5. That represents a safety margin, due to the challenge that may be faced in the health care practice.
Therefore, the effectiveness or efficacy of alcohol disinfection, even when it is conducted with no previous cleaning of instruments, is not possible to be reached, as verified in this systematic review, because organic matter is present in the health care practice, at levels which are the same or below the ones which were analyzed in laboratory tests.
Also, the reach of alcohol disinfection, in laboratory and field conditions, either with or without previous cleaning of instruments, may be related to the diversity of health care products, which are classified as semi-critical and differ both in regards to their structures and to the quantity and type of organic matter and microorganisms after such products are used. Those factors were not taken into account in 1 , when authors classified the articles according to their potential risk of acquiring infections, thus simplifying the potential risk levels without taking into consideration the differentiated levels that possibly existed within those categories, in particular the ones considered as semi-critical.
Scientific knowledge so far leads to a reflection on how insufficient it is to use a classification that was proposed in , intended to define guidelines for the processing of articles. The type of procedures in which products have been used, and the microbial and organic load that is found in those products, after being used, are known to result in varying degrees of difficulty in regards to cleaning and disinfecting them - that fact has.
In this literature review, alcohol disinfection was observed to be satisfactory for health care products such as nasopharyngoscopes E2 , laryngoscopes E11 , radiographic films E5 and E10 , and tonometer tips E Those health care products do not have grooves and are not tubular; that is, they are less structurally complex and get in contact with a smaller amount of contaminants as compared to gastrointestinal endoscopes, in which alcohol disinfection was not shown to be satisfactory in this review.
Theoretically, the conduction of previous cleaning favors the action from disinfectants on microorganisms. However, the findings in this review surprisingly do not reinforce such information.
However, out of the previously cleaned devices which were analyzed for alcohol disinfection effectiveness are nasopharyngoscopes which were used with protective covers during exams, which may optimize the cleaning and disinfection process, as the equipment does not directly get in contact with patients' mucous membranes during exams. None of those health care products was found to have microorganisms after decontamination processes.
The presence of protective covers is believed to have influenced those results, and it is a characteristic which differs from the analysis of the remaining equipment.
If we eliminate that variable use of protective cover the percentage contamination of previously cleaned, alcohol disinfected products under field conditions would be Thus, in both conditions experimental and field studies , the percentage detection of microorganisms was higher for previously-cleaned health care products.
Regarding those data, it is worth highlighting that the numbers of previously-cleaned and uncleaned products tested in both groups were different - they were and 64, respectively, for field studies, and 30 and 62 products, respectively, in experimental studies, which yielded higher percentage detection of microorganisms in groups with smaller quantities. Besides that, the evaluated health care products are structurally different, and so are the methodologies that were used to find and analyze microorganisms.
Therefore, interpreting those data must be done with caution. In this review, the methods used for alcohol application were rubbing and immersion, as shown in Table 3. The method regarding immersion in alcohol is not often used in the health care practice, and one of the reasons for that is the volatility of that disinfectant, which leads to the need of replacing solutions with each use.
However, that procedure was not described in two studies using the immersion method. Centers for Disease Control and Prevention. Fenner, F. Structure and Composition of Viruses. Veterinary Virology , pp. Sattar, S. Microbicides and the environmental control of nosocomial viral infections. Widmer A, Frei R. Decontamination, Disinfection, and Sterilization, p AllergyCertifieds opinion When using a hand sanitizer with high concentration of ethanol, the skin will become dry, which can lead to irritative skin and develop dry cracks.
Antiseptics and Disinfectants: Activity, Action, and Resistance. Clin Microbiol Rev. Kampf G, Hollingsworth A.
Comprehensive bactericidal activity of an ethanol-based hand gel in 15 seconds. Ann Clin Microbiol Antimicrob. This website uses cookies to improve your experience. You can opt-out if you wish.
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