title: An Increase in Healthcare-Associated Clostridium difficile Infection Associated with Use of a Defective Peracetic Acid-Based Surface Disinfectant.
abstract: BACKGROUND We investigated an increase in the incidence of healthcare-associated Clostridium difficile infection (CDI) that occurred following a change from a bleach disinfectant to a peracetic acid-based disinfectant. OBJECTIVE To evaluate the efficacy of the peracetic acid-based disinfectant. DESIGN Laboratory-based product evaluation. METHODS The commercial peracetic acid-based product is activated on site by mixing a small volume of concentrated hydrogen peroxide and peracetic acid present in a "SmartCap" reservoir with the remaining contents of the container. We measured concentrations of peracetic acid in newly activated and in-use product and determined the stability of nonactivated and activated product. We tested the efficacy of the product against C. difficile spores using the American Society for Testing and Materials standard quantitative carrier disk test method. RESULTS Measured concentrations of peracetic acid (50-800 parts per million [ppm]) were significantly lower than the level stated on the product label (1,500 ppm), and similar results were obtained for containers from multiple lot numbers and from another hospital. Product with peracetic acid levels below 600 ppm had significantly reduced activity against C. difficile spores. Peracetic acid concentrations were reduced markedly after storage of either activated or nonactivated product for several weeks. The Environmental Protection Agency confirmed the finding of low disinfectant levels and ordered discontinuation of sale of the product. CONCLUSION Use of a defective peracetic acid-based surface disinfectant may have contributed to an increase in healthcare-associated CDI. Our findings highlight the importance of evaluating the efficacy of liquid disinfectants in healthcare settings. Infect Control Hosp Epidemiol 2017;38:300-305.
authors.affiliation: 1Research Service,Louis Stokes Veterans' Affairs Medical Center,Cleveland,Ohio.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Cadnum
authors.affiliation: 1Research Service,Louis Stokes Veterans' Affairs Medical Center,Cleveland,Ohio.
authors.forename: Annette L
authors.initials: AL
authors.lastname: Jencson
authors.affiliation: 2Infection Control Department,Louis Stokes Veterans' Affairs Medical Center,Cleveland,Ohio.
authors.forename: Marguerite C
authors.initials: MC
authors.lastname: O'Donnell
authors.affiliation: 2Infection Control Department,Louis Stokes Veterans' Affairs Medical Center,Cleveland,Ohio.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Flannery
authors.affiliation: 1Research Service,Louis Stokes Veterans' Affairs Medical Center,Cleveland,Ohio.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Nerandzic
authors.affiliation: 3Geriatric Research, Education, and Clinical Center,Louis Stokes Veterans' Affairs Medical Center,Cleveland,Ohio.
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
mesh_terms: D016360:Clostridioides difficile / Q000187:drug effects; D003015:Clostridium Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D004202:Disinfectants / Q000592:standards*; D004203:Disinfection / Q000379:methods; D006801:Humans; D006861:Hydrogen Peroxide / Q000494:pharmacology*; D015994:Incidence; D057052:Medical Device Recalls; D009820:Ohio; D010463:Peracetic Acid / Q000494:pharmacology*; D013171:Spores, Bacterial / Q000187:drug effects; D062606:Tertiary Care Centers
chemical_list: D004202:Disinfectants; D006861:Hydrogen Peroxide; D010463:Peracetic Acid