Dear Diana,
Greetings from Al-Ain the oasis city of the Middle East. Regarding your
posting on Cidex and Alkacide you might find the following link useful.
http://www.bham.ac.uk/HIRL/alkacide
This is one of the web pages of the Hospital Infection Research Laboratory,
Birmingham, UK. The results of their research on a topic related to your
posting can be found here. I am copying some of their results which I
thought may be relevent to your posting. I must confess that I am not an
expert in hospital infection control in detail although I am aware of the
general principles.
------------------------------------------------------------------------
Hospital Infection Research Laboratory
City Hospital NHS Trust
Dudley Road
BIRMINGHAM B18 7QH
MAY 1994
To test the efficacy of an enzymatic detergent (Alkazyme) and a
glutaraldehyde based disinfectant (Alkacide) for the cleansing and
disinfection of endoscopes. The performance of these agents will be
compared with other current, widely used detergents and disinfectants.
The evaluation will be conducted as follows:
1 To determine the sporicidal activity of Alkacide and a widely used 2%
activated alkaline glutaraldehyde.
2 To compare automated cleansing and disinfection procedures using Alkazyme
and Alkacide with a widely used neutral detergent and 2% glutaraldehyde
procedure.
3 To compare cleansing with Alkazyme and Alkacide with other widely used
neutral and enzymatic detergents and disinfectants.
STUDY 1
To determine the sporicidal activity of Alkacide and a widely used 2%
activated alkaline glutaraldehyde
Five percent Alkacide, although more stable than Asep, was considerably less
effective as a sporicide. The immersion times to destroy 105 - 108 Bacillus
subtilis spores using Alkacide were 6 hr in the suspension test and 8 - 24
hr in the more stringent surface test. The 2% activated alkaline
glutaraldehyde was effective in 1 hr when freshly prepared and in less than
3 hr at the end of its post activation life of 14 days.
STUDY 3
To compare automated cleansing and disinfection procedures using Alkazyme
and Alkacide with a widely used neutral detergent and 2% glutaraldehyde
procedure
Cleaning and disinfection with Alkazyme and Alkacide proved at least as good
as processing with Hospec neutral detergent and 2% glutaraldehyde. Both
decontamination regimes achieved reductions of greater than 7 log10 which is
considered acceptable when monitoring the performance of machines or
disinfectants.
CONCLUSION
The sporicidal activity of Alkacide in suspension and surface tests is
inferior to 2% alkaline activated glutaraldehyde. A contact time of
approximately 8 hr is required to destroy the test spores (106) at room
temperature. However, the product was very stable over its 14 day post
preparation life with no deterioration in sporicidal activity.
Reducing the glutaraldehyde concentration below the 2% normally used (eg
Cidex, Asep, Totacide 28) reduces irritancy and sensitisation but this
usually reduces antimicrobial efficacy and longer contact times may be
necessary for the more tolerant pathogenic species eg Mycobacteria and
Clostridial spores. Using 8% glutaraldehyde (Alkacide concentrate) and a 5%
dilution of this ie 0.4% glutaraldehyde will not exclude the need for
exhaust ventilation, enclosed washer disinfectors or personal protective
equipment. Some of this benefit is therefore lost.
Although the tests with the Autodisinfector show neutral detergent and
glutaraldehyde and Alkazyme and Alkacide behave similarly in their
antibacterial activity, these tests were only performed with Ps aeruginosa
which is fairly susceptible to aldehydes. The bench tests with spores show
Alkacide to be slower in action than 2% glutaraldehyde. No tests have been
performed by this laboratory with enteroviruses which may be more stringent,
discriminatory and yet still relevant. Tests are currently underway to
establish the mycobactericidal activity of Alkacide and the results will be
added to the report in due course. Mycobacterium tuberculosis and atypical
mycobacteria are particularly relevant when disinfecting bronchoscopes.
Results of these tests, and an endorsement of instrument compatibility, are
required before Alkazyme and Alkacide could be recommended as an alternative
cleaning and disinfection regime to detergent and 2% glutaraldehyde for
flexible fibreoptic endoscopes.
C R Bradley J R Babb A P Fraise
MANUFACTURERS' COMMENTS
The sporicidal activity of Alkacide in suspension and surface tests is
inferior to 2% alkaline activated glutaraldehyde. A contact time of
approximately 8 hr is required to destroy the test spores (106) at room
temperature. However, the product was very stable over its 14 day post
preparation life with no deterioration in sporicidal activity.
------------------------------------------------------------------------
You might also find the following two references from the Birmingham group
useful.
Babb JR, Bradley CR. Endoscope decontamination: where do we go from here? J
Hosp Infect 1995 Jun;30 Suppl:543-51
Babb J, Bradley CR. A review of glutaraldehyde alternatives. Br J Theatre
Nurs 1995 Oct;5(7):20-1, 24
Another resource you could try is
[log in to unmask] which is the discussion group of the UK consultants
in communicable diseases who deal with these issues every day. Please let me
know if you want me to forward your request to their list.
I hope your committee makes an informed decision on the choice of the
disinfectant which will provide value for money (VFM) to your patients in
Peru. Good luck in your efforts and apologies for the lengthy reply.
Cheers & regards,
Badri
Dr.P.Badrinath M.D.,M.Phil.,(Epid) PhD(Cantab)
Clinical Assistant Professor and Epidemiologist,
Department of Community Medicine,
UAE University, PO Box 17666, Al Ain,
United Arab Emirates.
Tel: 00 971 3 7039 652
Fax: 00 971 3 7672022.
http://myprofile.cos.com/badrishanthi
"For an excellent review of the current medical literature, go to Journals
Scan www.uaeu.ac.ae/jscan/index.htm" - BMJ 3rd June 2000,Reviews(Netlines)
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