Antiseptic Stewardship for Surface Disinfectants

  • Günter KampfEmail author


Surface disinfectants can be based on different types of biocidal agents such as benzalkonium chloride, DDAC, glutaraldehyde, alcohols, hydrogen peroxide, silver (mostly in combination with hydrogen peroxide), peracetic acid and sodium hypochlorite. A health benefit was described in outbreak situations or on special care units for products based on different types of biocidal agents. A low adaptive response in combination with mostly an inhibition of biofilm formation and removal of existing biofilm can be attributed to none of the biocidal agents. Overall, on surfaces where biofilm formation should be inhibited the use or peracetic acid seems to be the most appropriate option (low selection pressure, mainly inhibition of biofilm formation, mainly moderate removal of biofilm). Hydrogen peroxide and sodium hypochlorite have also a low selection pressure and can moderately remove biofilm but they increased biofilm formation in more species. They seem to be appropriate on surfaces where enhancement of biofilm formation is of minor relevance. Benzalkonium chloride seems to be the least suitable biocidal agent taking into account the frequently observed strong and stable adaptive response, cross-tolerance to some other biocidal agents and selected antibiotics and the inconclusive effect on biofilm formation and removal.


  1. 1.
    Apisarnthanarak A, Zack JE, Mayfield JL, Freeman J, Dunne WM, Little JR, Mundy LM, Fraser VJ (2004) Effectiveness of environmental and infection control programs to reduce transmission of Clostridium difficile. Clin Infect Dis: Off Publ Infect Dis Soc Am 39:601–602CrossRefGoogle Scholar
  2. 2.
    Bloß R, Meyer S, Kampf G (2010) Adsorption of active ingredients from surface disinfectants to different types of fabrics. J Hosp Infect 75:56–61CrossRefPubMedGoogle Scholar
  3. 3.
    Boyce JM (2016) Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals. Antimicrob Resist Infect Control 5:10. Scholar
  4. 4.
    Boyce JM (2018) Alcohols as surface disinfectants in healthcare settings. Infect Control Hosp Epidemiol 39(3):323–328. Scholar
  5. 5.
    Chmielarczyk A, Higgins PG, Wojkowska-Mach J, Synowiec E, Zander E, Romaniszyn D, Gosiewski T, Seifert H, Heczko P, Bulanda M (2012) Control of an outbreak of Acinetobacter baumannii infections using vaporized hydrogen peroxide. J Hosp Infect 81(4):239–245. Scholar
  6. 6.
    Cobrado L, Pinto Silva A, Pina-Vaz C, Rodrigues A (2018) Effective Disinfection of a Burn Unit after Two Cases of Sepsis Caused by Multi-Drug-Resistant Acinetobacter baumannii. Surg Infect. Scholar
  7. 7.
    Dettenkofer M, Wenzler S, Amthor S, Antes G, Motschall E, Daschner FD (2004) Does disinfection of environmental surfaces influence nosocomial infection rates? A systematic review. Am J Infect Control 32(2):84–89CrossRefPubMedGoogle Scholar
  8. 8.
    Engelbrecht K, Ambrose D, Sifuentes L, Gerba C, Weart I, Koenig D (2013) Decreased activity of commercially available disinfectants containing quaternary ammonium compounds when exposed to cotton towels. Am J Infect Control 41(10):908–911. Scholar
  9. 9.
    Horejsh D, Kampf G (2011) Efficacy of three surface disinfectants against spores of Clostridium difficile ribotype 027. Int J Hyg Environ Health 214(2):172–174. S1438-4639(10)00128-8 [pii]. [doi]
  10. 10.
    Kampf G, Degenhardt S, Lackner S, Jesse K, von Baum H, Ostermeyer C (2014) Poorly processed reusable surface disinfection tissue dispensers may be a source of infection. BMC Infect Dis 14(1):37. 1471-2334-14-37 [pii]. [doi]
  11. 11.
    Kampf G, Degenhardt S, Lackner S, Ostermeyer C (2014) Effective processing or reusable dispensers for surface disinfection tissues - the devil is in the details. GMS Hyg Infect Control 9(1):DOC09Google Scholar
  12. 12.
    Kean R, Sherry L, Townsend E, McKloud E, Short B, Akinbobola A, Mackay WG, Williams C, Jones BL, Ramage G (2018) Surface disinfection challenges for Candida auris: an in-vitro study. J Hosp Infect 98(4):433–436. Scholar
  13. 13.
    KRINKO am Robert Koch Institut (2004) Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flächen. Bundesgesundheitsblatt 47(1):51–61CrossRefGoogle Scholar
  14. 14.
    Ledwoch K, Dancer SJ, Otter JA, Kerr K, Roposte D, Maillard JY (2018) Beware Biofilm! Dry biofilms containing bacterial pathogens on multiple healthcare surfaces; a multicentre study. J Hosp Infect.
  15. 15.
    Liu WL, Liang HW, Lee MF, Lin HL, Lin YH, Chen CC, Chang PC, Lai CC, Chuang YC, Tang HJ (2014) The impact of inadequate terminal disinfection on an outbreak of imipenem-resistant Acinetobacter baumannii in an intensive care unit. PLoS ONE 9(9):e107975. Scholar
  16. 16.
    Mayfield JM, Leet T, Miller J, Mundy LM (2000) Environmental control to reduce transmission of Clostridium difficile. Clin Infect Dis 31:995–1000CrossRefPubMedGoogle Scholar
  17. 17.
    Otter JA, Vickery K, Walker JT, deLancey Pulcini E, Stoodley P, Goldenberg SD, Salkeld JA, Chewins J, Yezli S, Edgeworth JD (2015) Surface-attached cells, biofilms and biocide susceptibility: implications for hospital cleaning and disinfection. J Hosp Infect 89(1):16–27. Scholar
  18. 18.
    Quinn MM, Henneberger PK, Braun B, Delclos GL, Fagan K, Huang V, Knaack JL, Kusek L, Lee SJ, Le Moual N, Maher KA, McCrone SH, Mitchell AH, Pechter E, Rosenman K, Sehulster L, Stephens AC, Wilburn S, Zock JP (2015) Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention. Am J Infect Control 43(5):424–434. Scholar
  19. 19.
    Vickery K, Deva A, Jacombs A, Allan J, Valente P, Gosbell IB (2012) Presence of biofilm containing viable multiresistant organisms despite terminal cleaning on clinical surfaces in an intensive care unit. J Hosp Infect 80(1):52–55. Scholar

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Institute of Hygiene and Environmental MedicineUniversity of GreifswaldGreifswaldGermany

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