title: Novel strategies for enhanced removal of persistent Bacillus anthracis surrogates and Clostridium difficile spores from skin.
abstract: BACKGROUND
  Removing spores of Clostridium difficile and Bacillus anthracis from skin is challenging because they are resistant to commonly used antimicrobials and soap and water washing provides only modest efficacy. We hypothesized that hygiene interventions incorporating a sporicidal electrochemically generated hypochlorous acid solution (Vashe(®)) would reduce the burden of spores on skin.
  
  
  METHODS
  Hands of volunteers were inoculated with non-toxigenic C. difficile spores or B. anthracis spore surrogates to assess the effectiveness of Vashe solution for reducing spores on skin. Reduction in spores was compared for Vashe hygiene interventions versus soap and water (control). To determine the effectiveness of Vashe solution for removal of C. difficile spores from the skin of patients with C. difficile infection (CDI), reductions in levels of spores on skin were compared for soap and water versus Vashe bed baths.
  
  
  RESULTS
  Spore removal from hands was enhanced with Vashe soak (>2.5 log10 reduction) versus soap and water wash or soak (~2.0 log10 reduction; P<0.05) and Vashe wipes versus alcohol wipes (P<0.01). A combined approach of soap and water wash followed by soaking in Vashe removed >3.5 log10 spores from hands (P<0.01 compared to washing or soaking alone). Bed baths using soap and water (N =26 patients) did not reduce the percentage of positive skin cultures for CDI patients (64% before versus 57% after bathing; P =0.5), whereas bathing with Vashe solution (N =21 patients) significantly reduced skin contamination (54% before versus 8% after bathing; P =0.0001). Vashe was well-tolerated with no evidence of adverse effects on skin.
  
  
  CONCLUSIONS
  Vashe was safe and effective for reducing the burden of B. anthracis surrogates and C. difficile spores on hands. Bed baths with Vashe were effective for reducing C. difficile on skin. These findings suggest a novel strategy to reduce the burden of spores on skin.
authors.affiliation: Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America. michellenerandzi@aim.com
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Nerandzic
authors.forename: Elze
authors.initials: E
authors.lastname: Rackaityte
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Jury
authors.forename: Kevin
authors.initials: K
authors.lastname: Eckart
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
mesh_terms: D001408:Bacillus anthracis / Q000302:isolation & purification*; D001494:Baths; D016360:Clostridioides difficile / Q000302:isolation & purification*; D018592:Cross-Over Studies; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control; D006225:Hand / Q000382:microbiology; D006235:Hand Disinfection / Q000379:methods; D006801:Humans; D006920:Hygiene; D006997:Hypochlorous Acid / Q000494:pharmacology*; D008297:Male; D016877:Oxidants / Q000494:pharmacology; D012867:Skin / Q000187:drug effects* / Q000382:microbiology; D012915:Soaps; D012996:Solutions; D013171:Spores, Bacterial / Q000302:isolation & purification*; D016896:Treatment Outcome; D014867:Water
chemical_list: D016877:Oxidants; D012915:Soaps; D012996:Solutions; D014867:Water; D006997:Hypochlorous Acid