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Most disinfection wipes do not kill C. difficile

Most disinfection wipes do not kill C. difficile

Most hospital grade disinfection wipes do not work on Clostridium difficile.  Stethoscopes, blood pressure cuffs, toilets, beds, chairs, hospital surfaces of all types require continuous disinfection to prevent the spread of disease.

Many people working in hospitals do not know the limitations of the standard disinfection wipes. I did not. Nor did many of those I spoke with.
 

About Clostridium Difficile

Clostridium difficile (C. difficile or C. diff) is a bacteria that causes unstoppable diarrhea. It is highly contagious and spread via spore in the infected patient’s poop. A severe complication is mega-colon (when your colon swells, and is at risk of rupture).  This can be lethal. 

C. difficile is not rare. Each day hospitals screen stool samples from suspecting patients. Patients are placed on 'isolation protocols' if they are confirmed or suspected to be "C. difficile positive".

C. difficile outbreaks happen on hospital wards. They place all patients at risk of a healthcare acquired complication. In Canada each case can add $12,000-15,000[1]. A high percentage of those with the condition, experience a relapse.

P.S. - the Gold Standard treatment for recurrent C. difficile is a fecal transplant. If interested, video here:

VICE: Fecal Medicine  |  Cued up to 15m3s for series on fecal transplants  |  15 min


Correct Wipes

In most hospitals I see typical 'high disinfection level' wipes on the disinfectant carts - such as Oxivir TB, Caviwipes, Virox, Clorox Hydrogen Peroxide. These work on most micro-organisms, but do not work on C. difficile.

The Wood Wyant "Disinfection Levels vs Products" chart shows which organisms are killed by the different products (used often in Canada).

This summary chart is by Wood Wyant  |  Original PDF here.


Correct Technique

Each product has its own specifications.

Contact Time: the duration a disinfectant must remain wet on the surface for it to kill. As you see in the chart above, each product has its own contact time varying from 1 to 10 minutes.

Surface Preparation Protocol: each product has it's own specifications depending on its composition.  Bleach wipes are labelled with "pre-cleaning" requirement (ie. wipe surface down prior to the 'disinfection' step). Hydrogen Peroxide wipes do not require pre-cleaning unless there is gross contamination. Alcohol wipes require pre-cleaning if there is body fluid contamination. 

I don't think enough people are aware of these requirements, as I haven't seen them followed in practice. Does it matter if proper technique is follow. Generally not - the wipes are just cleaning off sweat and dirt. But other times it may be hepatitis, influenza, tuberculosis, or C. diff where you wish the products disinfection properties were fully active. 
 

Cost Difference

I was surprised there is reasonably minimal cost difference in the C diff approved wipes vs the standard high-level hospital grade wipes.

When compared on a per square inch basis, C. diff wipes are 1 to 1.2x the price of non-C. diff wipes.

When compared on a 'per wipe' cost they are 1.2x to 1.5x more expensive. (Each manufacture makes wipes different dimensions leading to this wider cost spread).

Cross product comparison is complicated by the fact that C. difficile wipes are bleach based. Technically according to manufacture instructions the surface requires 'pre-cleaning' before 'disinfection'. This means using twice as many wipes. 

The total cost difference between products is somewhere between 1- 3x. In real world dollars this is the difference between 10 cents vs 30 cents a wipe.

Only patients with (or suspected of having) C. diff require the higher cost wipes.
 

Toilet bowl cleaners

I think it is more widespread known that a sporadical (C. difficile killing) toilet bowl cleaner is required for disinfecting toilets. If your hospital does not use one on toilets and bedpans from C. diff positive patients you are inviting diarrhea and misery.


Thank you: to Tim at Wood Wyant for his assistance in research on this article and their helpful Disinfection Level vs Products chart.


[1]   Incidence and Costs of Clostridium difficile Infections in Canada. Open Forum Infectious Disease. Sept 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4503917/

Disinfection wipe containers require restraining brackets

Disinfection wipe containers require restraining brackets

No, Caviwipes & Oxivir wipes do not cause cancer

No, Caviwipes & Oxivir wipes do not cause cancer