title: Unlocking the Sporicidal Potential of Ethanol: Induced Sporicidal Activity of Ethanol against Clostridium difficile and Bacillus Spores under Altered Physical and Chemical Conditions.
abstract: BACKGROUND
  Due to their efficacy and convenience, alcohol-based hand sanitizers have been widely adopted as the primary method of hand hygiene in healthcare settings. However, alcohols lack activity against bacterial spores produced by pathogens such as Clostridium difficile and Bacillus anthracis. We hypothesized that sporicidal activity could be induced in alcohols through alteration of physical or chemical conditions that have been shown to degrade or allow penetration of spore coats.
  
  
  RESULTS
  Acidification, alkalinization, and heating of ethanol induced rapid sporicidal activity against C. difficile, and to a lesser extent Bacillus thuringiensis and Bacillus subtilis. The sporicidal activity of acidified ethanol was enhanced by increasing ionic strength and mild elevations in temperature. On skin, sporicidal ethanol formulations were as effective as soap and water hand washing in reducing levels of C. difficile spores.
  
  
  CONCLUSIONS
  These findings demonstrate that novel ethanol-based sporicidal hand hygiene formulations can be developed through alteration of physical and chemical conditions.
authors.affiliation: Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Nerandzic
authors.affiliation: Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America; Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Venkata C K
authors.initials: VC
authors.lastname: Sunkesula
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Thriveen Sankar
authors.initials: TS
authors.lastname: C
authors.affiliation: Department of Molecular Biology and Biophysics, University of Connecticut Health Center, Farmington, Connecticut, United States of America.
authors.forename: Peter
authors.initials: P
authors.lastname: Setlow
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America; Geriatric Research, Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America.
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001408:Bacillus anthracis / Q000187:drug effects / Q000502:physiology*; D016360:Clostridioides difficile / Q000187:drug effects / Q000502:physiology*; D000431:Ethanol / Q000494:pharmacology*; D006863:Hydrogen-Ion Concentration; D008826:Microbial Sensitivity Tests; D009994:Osmolar Concentration; D012867:Skin / Q000382:microbiology; D013171:Spores, Bacterial / Q000187:drug effects; D034421:Sus scrofa; D013696:Temperature
chemical_list: D000900:Anti-Bacterial Agents; D000431:Ethanol