Synergistic efficacy of 405 nm light and chlorinated disinfectants for the enhanced decontamination of Clostridium difficile spores

The ability of Clostridium difficile to form highly resilient spores which can survive in the environment for prolonged periods causes major contamination problems. Antimicrobial 405 nm light is being developed for environmental decontamination within hospitals, however further information relating to its sporicidal efficacy is required. This study aims to establish the efficacy of 405 nm light for inactivation of C. difficile vegetative cells and spores, and to establish whether spore susceptibility can be enhanced by the combined use of 405 nm light with low concentration chlorinated disinfectants. Vegetative cells and spore suspensions were exposed to increasing doses of 405 nm light (at 70–225 mW/cm2) to establish sensitivity. A 99.9% reduction in vegetative cell population was demonstrated with a dose of 252 J/cm2, however spores demonstrated higher resilience, with a 10-fold increase in required dose. Exposures were repeated with spores suspended in the hospital disinfectants sodium hypochlorite, Actichlor and Tristel at non-lethal concentrations (0.1%, 0.001% and 0.0001%, respectively). Enhanced sporicidal activity was achieved when spores were exposed to 405 nm light in the presence of the disinfectants, with a 99.9% reduction achieved following exposure to 33% less light dose than required when exposed to 405 nm light alone. In conclusion, C. difficile vegetative cells and spores can be successfully inactivated using 405 nm light, the sporicidal efficacy can be significantly enhanced when exposed in the presence of low concentration chlorinated disinfectants. Further research may lead to the potential use of 405 nm light decontamination in combination with selected hospital disinfectants to enhance C. difficile cleaning and infection control procedures

Clinical studies of the high-intensity narrow-spectrum light environmental decontamination system (HINS-light EDS), for continuous disinfection in the burn unit inpatient and outpatient settings

Infections are the leading cause of morbidity and mortality in burn patients and prevention of contamination from exogenous sources including the hospital environment is becoming increasingly emphasised. The High-Intensity Narrow-Spectrum light Environmental Decontamination System (HINS-light EDS) is bactericidal yet safe for humans, allowing continuous disinfection of the environment surrounding burn patients. Environmental samples were collected from inpatient isolation rooms and the outpatient clinic in the burn unit, and comparisons were then made between the bacterial contamination levels observed with and without use of the HINS-light EDS. Over 1000 samples were taken. Inpatient studies, with sampling carried out at 0800 h, demonstrated a significant reduction in the average number of bacterial colonies following HINS-light EDS use of between 27% and 75%, (p<0.05). There was more variation when samples were taken at times of increased activity in the room. Outpatient studies during clinics demonstrated a 61% efficacy in the reduction of bacterial contamination on surfaces throughout the room during the course of a clinic (p=0.02). The results demonstrate that use of the HINS-light EDS allows efficacious bacterial reductions over and above that achieved by standard cleaning and infection control measures in both inpatient and outpatient settings in the burn unit

The prevalences of Salmonella Genomic Island 1 variants in human and animal Salmonella Typhimurium DT104 are distinguishable using a Bayesian approach

Throughout the 1990s, there was an epidemic of multidrug resistant Salmonella Typhimurium DT104 in both animals and humans in Scotland. The use of antimicrobials in agriculture is often cited as a major source of antimicrobial resistance in pathogenic bacteria of humans, suggesting that DT104 in animals and humans should demonstrate similar prevalences of resistance determinants. Until very recently, only the application of molecular methods would allow such a comparison and our understanding has been hindered by the fact that surveillance data are primarily phenotypic in nature. Here, using large scale surveillance datasets and a novel Bayesian approach, we infer and compare the prevalence of Salmonella Genomic Island 1 (SGI1), SGI1 variants, and resistance determinants independent of SGI1 in animal and human DT104 isolates from such phenotypic data. We demonstrate differences in the prevalences of SGI1, SGI1-B, SGI1-C, absence of SGI1, and tetracycline resistance determinants independent of SGI1 between these human and animal populations, a finding that challenges established tenets that DT104 in domestic animals and humans are from the same well-mixed microbial population

New proof-of-concept in viral inactivation: virucidal efficacy of 405 nm light against feline calicivirus as a model for norovirus decontamination

The requirement for novel decontamination technologies for use in hospitals is ever present. One such system uses 405 nm visible light to inactivate microorganisms via ROS-generated oxidative damage. Although effective for bacterial and fungal inactivation, little is known about the virucidal effects of 405 nm light. Norovirus (NoV) gastroenteritis outbreaks often occur in the clinical setting, and this study was designed to investigate potential inactivation effects of 405 nm light on the NoV surrogate, feline calicivirus (FCV). FCV was exposed to 405 nm light whilst suspended in minimal and organically-rich media to establish the virucidal efficacy and the effect biologically-relevant material may play in viral susceptibility. Antiviral activity was successfully demonstrated with a 4 Log10 (99.99%) reduction in infectivity when suspended in minimal media evident after a dose of 2.8 kJ cm−2. FCV exposed in artificial faeces, artificial saliva, blood plasma and other organically rich media exhibited an equivalent level of inactivation using between 50–85% less dose of the light, indicating enhanced inactivation when the virus is present in organically-rich biologically-relevant media. Further research in this area could aid in the development of 405 nm light technology for effective NoV decontamination within the hospital environment

Enhanced decontamination of C. difficile spores on surfaces via the synergistic action of 405nm light and disinfectants

The ability of C. difficile to form spores which can survive for prolonged periods causes significant environmental contamination problems. 405nm light has wide antimicrobial activity against vegetative bacteria, and is being developed for environmental decontamination within hospitals. As expected, spores are more resilient to inactivation. This study aims to establish whether spore susceptibility can be enhanced by combining 405nm light with low concentration chlorinated disinfectants: sodium hypochlorite, Actichlor and Tristel. Spore suspensions were seeded onto surfaces including PVC, stainless steel and vinyl flooring. Disinfectant was added to the surface, and the samples were then exposed to 405nm light at irradiances of ~0.2-225 mWcm-2. Control samples were exposed to 405nm light alone, and disinfectants alone, to establish the sporicidal activity of each agent, and to demonstrate the synergistic effect when combined. Results demonstrated increased sporicidal activity of 405nm light and low-concentration sodium hypochlorite and Actichlor against C. difficile seeded on vinyl flooring and PVC surfaces, with approximately 3-log10 reductions achieved with up to 66% lower doses than achieved with light alone. Tristel demonstrated limited synergy on vinyl and PVC, whilst all three disinfectants demonstrated minimal synergy on stainless steel. Results are also reported for lower intensity light, as used in the clinical environment. In conclusion, the sporicidal efficacy of 405nm light is enhanced when used alongside chlorinated disinfectants. Further research could potentially lead to the use of lower strength chlorinated disinfectants in combination with 405nm light to provide enhanced decontamination of C. difficile spores in the clinical environment

Decontamination of the hospital environment : new technologies for infection control

Environmental contamination is being increasingly recognized as a significant source of healthcare-associated infection (HAI). Cross-contamination of the patient from the environment can result from the direct transfer of organisms from the air and surfaces, or indirectly from the hospital environment via contact with healthcare workers or equipment. Traditional methods of environmental decontamination, including cleaning with disinfectants, and the standard infection control procedures implemented by modern Health Services, are critical to controlling the spread of potentially pathogenic microbial contaminants from environmental sources to the patient; however there is constant pressure to maintain, and indeed, improve on the standards that are in place to ensure optimal patient care. To address this issue, much research has been directed towards the development and testing of novel ‘whole-room’ environmental decontamination methods which could be used to enhance hospital hygiene, and consequently reduce the risk of HAI-acquisition from environmental sources. Gaseous methods such as the use of hydrogen peroxide, chlorine dioxide, ozone and steam, as well as ultraviolet and violet-blue visible light methods have all been laboratory tested, and to varying extents, clinically evaluated to assess their efficacy for environmental decontamination. This review article considers these different decontamination technologies, discussing their mechanism of action, antimicrobial efficacy, and advantages and limitations, with a view to providing the reader with a comprehensive overview of the technological advances being developed to reduce the levels of environmental contamination around patient areas, thus aiding in the fight against healthcare-associated infection

Impact of recurrent Clostridium difficile infection: hospitalization and patient quality of life

Objectives: Data quantifying outcomes of recurrent Clostridium difficile infection (rCDI) are lacking. We sought to determine the UK hospital resource use and health-related quality of life (HrQoL) associated with rCDI hospitalisations. Patients and methods: A non-interventional study in 6 UK acute hospitals collected retrospective clinical and resource use data from medical records of 64 adults hospitalised for rCDI and 64 matched inpatient controls with a first episode only (f)CDI. Patients were observed from the index event (date rCDI/fCDI confirmed) for 28-days (or death, if sooner); UK-specific reference costs were applied. HrQoL was assessed prospectively in a separate cohort of 30 patients hospitalised with CDI, who completed the EQ-5D-3L questionnaire during their illness. Results: The median total management cost (post-index) was £7,539 and £6,294 for rCDI and fCDI, respectively (cost difference, p=0.075); median length of stay (LOS) was 21 days and 15.5 days, respectively (p=0.269). The median cost difference between matched rCDI and fCDI cases was £689 (IQR=£-1,873-£3,954). Subgroup analysis demonstrated the highest median costs (£8,542/patient) in severe rCDI cases. CDI management costs were driven primarily by hospital LOS, which accounted for >85% of costs in both groups. Mean EQ-5D index values were 46% lower in CDI patients compared with UK population values (0.42 and 0.78, respectively); EQ-VAS scores were 38% lower (47.82 and 77.3, respectively). Conclusions: CDI has considerable impact on patients and healthcare resources. This multicentre study provides a contemporaneous estimate of the real-world UK costs associated with rCDI management, which are substantial and comparable to fCDI costs

Serendipitous detection of an overdensity of Herschel-SPIRE 250 micron sources south of MRC1138-26

We report the serendipitous detection of a significant overdensity of Herschel-SPIRE 250 micron sources in the vicinity of MRC1138-26. We use an adaptive kernel density estimate to quantify the significance, including a comparison with other fields. The overdensity has a size of ~3.5-4' and stands out at ~5sigma with respect to the background estimate. No features with similar significance were found in four extragalactic control fields: GOODS-North, Lockman, COSMOS and UDS. The chance of having a similar overdensity in a field with the same number but randomly distributed sources is less than 2%. The clump is also visible as a low surface brightness feature in the Planck 857 GHz map. We detect 76 sources at 250 micron (with a signal-to-noise ratio greater than 3), in a region of 4' radius; 43 of those are above a flux density limit of 20 mJy. This is a factor of 3.6 in excess over the average in the four control fields, considering only the sources above 20 mJy. We also find an excess in the number counts of sources with 250 micron flux densities between 30 and 40 mJy, compared to deep extragalactic blank-field number counts. Assuming a fixed dust temperature (30 K) and emissivity (beta=1.5) a crude, blackbody-derived redshift distribution, zBB, of the detected sources is significantly different from the distributions in the control fields and exhibits a significant peak at zBB ~ 1.5, although the actual peak redshift is highly degenerate with the temperature. We tentatively suggest, based on zBB and the similar S250/S350 colours of the sources within the peak, that a significant fraction of the sources in the clump may be at a similar redshift. Since the overdensity lies ~7' south of the z=2.16 Spiderweb protocluster MRC1138-26, an intriguing possibility (that is presently unverifiable given the data in hand) is that it lies within the same large-scale structure.(abridged)Comment: 10 pages, 8 figures, accepted for publication in MNRA

Dye Sensitization of Nanocrystalline Titanium Dioxide with Osmium and Ruthenium Polypyridyl Complexes

A series of osmium polypyridyl complexes having various ground-state reduction potentials has been synthesized and used to sensitize nanoporous titanium dioxide electrodes to solar illumination. The spectral response and current vs potential properties of electrodes modified with these dyes have been compared with the behavior of their ruthenium analogues. The trends can be explained by the differences in absorption spectra and ground-state redox potentials. The osmium complexes appear to be promising candidates for further optimization in operating photoelectrochemical cells for solar energy conversion applications. Of the materials studied, all complexes having ground-state redox potentials in methanol more positive than ∼0.4 V vs aqueous SCE were able to sustain oxidation of I-/I_3- with a high steady-state quantum yield. For electrodes with very low dye coverages, the open-circuit voltage was mainly determined by the rate of reduction of I_2, whereas for high dye coverages, the open-circuit voltage depended on the nature of the complex and on the dye loading level