title: Evaluation of the effectiveness of common hospital hand disinfectants against methicillin-resistant Staphylococcus aureus, glycopeptide-intermediate S. aureus, and heterogeneous glycopeptide-intermediate S. aureus.
abstract: BACKGROUND
  The presence of methicillin-resistant Staphylococcus aureus (MRSA) and glycopeptide-intermediate S. aureus (GISA) in hospitals poses a significant challenge to hospital infection control teams. The use of disinfectants for both surface and hand cleaning is an essential part of the infection control measures.
  
  
  OBJECTIVE
  To evaluate the effectiveness of common hospital hand disinfectants against MRSA, GISA, and heterogeneous GISA (hGISA).
  
  
  METHODS
  For methicillin-susceptible S. aureus (MSSA), MRSA, GISA, and hGISA, the levels of susceptibility to hand disinfectants and their active ingredients were determined. Suspension tests were performed on commercial handwashing products.
  
  
  RESULTS
  Minimum inhibitory concentrations (MICs) of 2-propanol, chlorhexidine, and hexachlorophene were similar for all phenotypes. The MICs of cetrimide and triclosan were higher for the MRSA, GISA, and hGISA strains than for the MSSA strain. The MICs for the chlorhexidine-containing agents Hibisol and Hibiscrub (AstraZeneca) and for the propanol-containing agent Sterillium (Medline) were 1-2-fold lower for the MSSA strains than for the MRSA, GISA, and hGISA strains. Suspension tests showed that the GISA and hGISA strains were less susceptible to the triclosan-containing agent Aquasept (SSL) than were the MRSA and MSSA strains, with resistance increasing with glycopeptide resistance. Products containing Betadine (Purdue) were more effective against the GISA and hGISA strains than against the MRSA and MSSA strains, especially after the strain was exposed to the product for 30 seconds.
  
  
  CONCLUSIONS
  Using the EN 1040 standard criteria for the performance of disinfectants, we determined that all agents, except 50% Aquasept for hGISA and 0.33% hexachlorophene for GISA, performed effectively. However, the GISA and hGISA strains were less susceptible to triclosan-containing products, compared with the MRSA stains, but were more susceptible to products containing Betadine.
authors.affiliation: NPHS Microbiology Cardiff, University Hospital Wales, United Kingdom. mandy.wootton@nphs.wales.nhs.uk
authors.forename: Mandy
authors.initials: M
authors.lastname: Wootton
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Walsh
authors.forename: Eleri M
authors.initials: EM
authors.lastname: Davies
authors.forename: Robin A
authors.initials: RA
authors.lastname: Howe
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D004202:Disinfectants / Q000494:pharmacology*; D006020:Glycopeptides / Q000494:pharmacology*; D006235:Hand Disinfection; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D004202:Disinfectants; D006020:Glycopeptides