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Disinfectants, Sanitizers & Practices

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Disinfectants, Sanitizers & Practices Disinfectants, Sanitizers & Practices for Creating Safe Living Environment in COVID-19 Period Ankush Gupta HBCSE (TIFR), May 30, 2020 HBCSE Disclaimer This presentation includes: • the information based on research literature (and not on first hand experiments by me, unless mentioned). • results applicable for external use on materials or human skin only, NOT for disease treatment or applications inside human bodies. • only substances that are being used at household level or public spaces. Substances specifically used in clinical/surgical settings are not discussed here in detail. HBCSE Types of Human Coronaviruses (HCoVs) HBCSE Seven known types of HCoVs First human Coronavirus HCoV-B814 (sample not preserved) identified in 1965. Later, four Coronaviruses were found prevalent in humans 1) HCoV-229E (similar to B814), 2) HCoV-OC43 3) HCoV-NL63 4) HCoV-HKU1 These are responsible for common cold (running nose), and respiratory problems. New Coronaviruses 5) SARS-CoV (that caused Severe Acute Respiratory Syndrome, or SARS) killed ~800 people in 2003 6) MERS-CoV (that causes Middle East Respiratory Syndrome, or MERS) ~858 deaths since 2012 7) SARS-CoV-2 (the novel coronavirus that causes coronavirus disease 2019, or COVID-19) • van der Hoek L (2007). Human coronaviruses: what do they cause? Antiviral Therapy 12(4 Pt B):651-8. • https://www.cdc.gov/coronavirus/types.html (accessed May 17, 2020) • https://www.who.int/emergencies/mers-cov/en/ (accessed May 17, 2020) HBCSE Structure of SARS CoV-2 3 major components: Proteins, Lipid envelop and RNA 3D medical animation still shot showing 2019 novel Coronavirus Structure. Avijit Ranjan, CC BY-SA 4.0 https://commons.wikimedia.org/wiki/File:3D_medical_animation_coronavirus_structure.jpg (accessed May 17, 2020) HBCSE Viruses are technically not living organisms (unlike other micro-organisms) Inactivation of Virus means… …altering its chemical structure so that it cannot infect HBCSE SARS-CoV (the 2003 variant) Inactivated (~5 log or 105 times reduction) by . Heat treatment at >70 °C (30 minutes ) at 25 °C and 37 °C by . Acidic conditions below pH = 3. (1 hour) . Alkaline conditions above pH = 12. (1 hour) Study 1 . formalin and glutaraldehyde (1-2 days) . UV(λ = 254 nm) exposure (10-15 minutes) at 4 °C, inactivation not complete with pH = 3 and formalin/glutaraldehyde Study 2 1. M. E.R. Darnell, et al. (2004). Inactivation of the coronavirus Detection that induces severe acute respiratory syndrome, SARS-CoV. Limit Journal of Virological Methods 121(1), 85. 2. A.-M. Pagat, et al. (2007). Evaluation of SARS-Coronavirus Decontamination Procedures. Applied Biosafety, 12(2), 100. HBCSE SARS-CoV (the 2003 variant) pH ~13.0 . Alkaline treatment (at 37 °C) pH ~13.5 - at pH = 11, negligible effect in 1 hour - at pH = 12, 5 log reduction in 1 hour Study 2 - at pH = 13, instantaneous 3 log reduction 1. M. E.R. Darnell, et al. (2004). Inactivation of the coronavirus that induces severe acute respiratory syndrome, SARS-CoV. Journal of Virological Methods 121(1), 85. 2. A.-M. Pagat, et al. (2007). Evaluation of SARS-Coronavirus Decontamination Procedures. Applied Biosafety, 12(2), 100. HBCSE A review of 22 studies on human coronaviruses (before SARS-CoV2) indicated inactivation ( > 3 log reduction) within 1 minute of contact by a) 62-71% Ethanol b) 0.5% Hydrogen Peroxide c) 0.1% Sodium Hypochlorite d) 0.23% Povidone Iodine Other biocidal agents (such as following) were less effective a) 0.05 - 0.2% Benzalkonium Chloride (conflicting results) b) 0.02% Chlorhexidine Digluconate HBCSE Stability of SARS-CoV 2 (The Novel Coronavirus) 30 min at 56 °C or 5 min at 70 °C was sufficient for inactivation All trials done 3 times. N.D. = Not done; U = Undetectable A virus titre of 6.0/mL approximately means ~106 virus per mL of inoculum • A.W.H. Chin et al. (2020). Stability of SARS-CoV-2 in different Environmental Conditions. Lancet Microbe (Published Online April 2), https://doi.org/10.1016/S2666-5247(20)30003-3 HBCSE Stability of SARS-CoV 2 (The Novel Coronavirus) In general, the virus was more stable on smooth surfaces. • A.W.H. Chin et al. (2020). Stability of SARS-CoV-2 in different Environmental Conditions. Lancet Microbe (Published Online April 2), https://doi.org/10.1016/S2666-5247(20)30003-3 HBCSE Stability of SARS-CoV 2 (The Novel Coronavirus) Surface Persistence Persistence (Study 1) (Study 2) Paper/Tissue paper 1 hour Copper 4 hours Cloth 1 day Wood 1 day Cardboard 1 day Glass 2 days Bank Note 2 days Plastic 4 days 3 days Stainless Steel 4 days 3 days 1.A.W.H. Chin et al. (2020). Stability of SARS-CoV-2 in different Mask (outside) 7 days Environmental Conditions. Lancet Microbe (Published Online April 2), https://doi.org/10.1016/S2666-5247(20)30003-3 Mask (inside) 4 days 2.N. van Doremalen et al. (2020). Aerosol and surface stability of Aerosols 4 hours SARS-CoV-2 as compared with SARS-CoV-1. New England Journal of Medicine 382, 1564. https://doi.org/10.1056/NEJMc2004973 HBCSE Stability of SARS-CoV 2 (The Novel Coronavirus) # Only 1 of the 3 trials was +ve. U = Undetectable • A.W.H. Chin et al. (2020). Stability of SARS-CoV-2 in different Environmental Conditions. Lancet Microbe (Published Online April 2), https://doi.org/10.1016/S2666-5247(20)30003-3 HBCSE But we have now many reasons to study disinfectants… most importantly because we now need to clean, disinfect, sterilize and at some places, sanitize at large scales. HBCSE Decision making for Cleaning/Disinfection/Sanitization Practices requires choosing: • Formulations: Pure substance or solutions (aqueous/non-aqueous) • Amount/concentrations • Frequency of use • Modes of application 1. Spraying in air 2. Spraying on surfaces 3. Applying and Scrubbing (on surfaces) 4. Soak washing • Safety protocols for persons (doing the cleaning) Here we look at important properties of effective substances for SARS-CoV2 to help you make above decisions for your needs. HBCSE Health Concerns from Disinfectants’ uses There are risks to COVID patients due to secondary infections that are resistant to antibiotics (often picked from hospitals and highly disinfected spaces). UCSF Institute for Health & Aging, UC Berkeley Center for Environmental Research and Children's Health, Informed Green Solutions, and California Department of Pesticide Regulation (2013). Green Cleaning, Sanitizing, and Disinfecting: A Toolkit for Early Care and Education, University of California, San Francisco School of Nursing: San Francisco,. HBCSE More Reasons for Care in Using Disinfectants • Risk to Human health (as discussed before) • Disinfection not being achieved (even with high concentration/amount) • Decay/breakdown of cleaning chemicals in handling/storage (losing potency) • Damage to materials (reaction of chemicals with surfaces) • Harm to natural environment and ecology (we need many microorganisms including viruses around us to survive!) HBCSE Some Common Cleaning/Disinfecting Chemicals (effective for SARS-CoV2) HBCSE Alcohols Mode of Action: • Ethanol and isopropyl alcohol most effective Denaturing and coagulating (methanol less effective) proteins • Optimum concentration 60-90% (pure alcohol ineffective—water is necessary!) • Not effective against spores (hence insufficient for wounds and clinical settings) Precautions: • Evaporate fast (& minimum 20 seconds contact required), hence not suitable for hot surfaces • Flammable—hence must be stored in cool, well-ventilated area • Not to be used near hot appliances (such as ovens and cooking stoves) • Can damage certain plastics, rubber parts of instruments. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html (accessed May 23, 2020) HBCSE H Sodium Hypochloride Na+ OCl– Cl—O (Hypo, NaOCl, Bleach) Mode of Action: HOCl reacts with proteins, • Reaction with water enzymes, DNA, and lipids inactivating microbes within 0.1 sec NaOCl + H2O HOCl + NaOH • Reacts strongly with acids Decomposition conditions Precautions - produces chlorine and related gas At pH <11 Don’t mix with acids Temperatures ~> 25 °C Store at cool place, avoid hot places Problems: Contact with metals Don’t store or dilute with metal containers - Unstable, decomposes with time Light exposure Store in dark places - Risk to humans & other organisms - Chlorine resistance develops with regular use over few days (already known in bacteria for decades): thus use after soap/detergent cleaning is advised H. F. Ridgway And B. H. Olson (1982). Chlorine resistance patterns of bacteria from two drinking water distribution systems, Applied And Environmental Microbiology, 44(4), 972 . https://aem.asm.org/content/aem/44/4/972.full.pdf HBCSE H Hydrogen Peroxide Mode of Action: O—O • Used in dentistry, laundry and in many household cleaners and Free radicals attack lipids, H bleaching agents. membranes and nucleic acids; higher concentrations can overtake the • With higher concentrations, effective against all microbes (yeast, fungus, spores and viruses). cellular defences by enzymes. • Decomposes to water and oxygen (Final products safe!). • In vapourized form, can be used to disinfect N-95 masks (which should not be done using alcohol or bleach solution!) Decomposition conditions Precautions • Not effective on Biofilms (big source of Presence of enzymes Store in clean containers hospital infections). Hence scrubbing needed. Temperatures ~> 25 °C Store at cool place, avoid hot places • Old solutions may have lower strength. Contact with metals Don’t store or dilute in metal containers Light exposure Store in dark containers and places
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