Efficacy of hospital cleaning agents and germicides against epidemic Clostridium difficile strains

Infect Control Hosp Epidemiol. 2007 Aug;28(8):920-5. doi: 10.1086/519201. Epub 2007 Jun 15.


Objective: To compare the effects of hospital cleaning agents and germicides on the survival of epidemic Clostridium difficile strains.

Methods: We compared the activity of and effects of exposure to 5 cleaning agents and/or germicides (3 containing chlorine, 1 containing only detergent, and 1 containing hydrogen peroxide) on vegetative and spore forms of epidemic and non-epidemic C. difficile strains (3 of each). We carried out in vitro exposure experiments using a human fecal emulsion to mimic conditions found in situ.

Results: Cleaning agent and germicide exposure experiments yielded very different results for C. difficile vegetative cells, compared with those for spores. Working-strength concentrations of all of the agents inhibited the growth of C. difficile in culture. However, when used at recommended working concentrations, only chlorine-based germicides were able to inactivate C. difficile spores. C. difficile epidemic strains had a greater sporulation rate than nonepidemic strains. The mean sporulation rate, expressed as the proportion of a cell population that is in spore form, was 13% for all strains not exposed to any cleaning agent or germicide, and it was significantly increased by exposure to cleaning agents or germicides containing detergent alone (34%), a combination of detergent and hypochlorite (24%), or hydrogen peroxide (33%). By contrast, the mean sporulation rate did not change substantially after exposure to germicides containing either a combination of detergent and dichloroisocyanurate (9%) or dichloroisocyanurate alone (15%).

Conclusions: These results highlight differences in the activity of cleaning agents and germicides against C. difficile spores and the potential for some of these products to promote sporulation.

Publication types

  • Comparative Study

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Clostridium difficile / drug effects*
  • Cross Infection / prevention & control
  • Detergents / pharmacology
  • Humans
  • Hydrogen Peroxide / pharmacology
  • Microbial Sensitivity Tests
  • Sodium Hypochlorite / pharmacology
  • Spores, Bacterial / drug effects*


  • Anti-Bacterial Agents
  • Detergents
  • Hydrogen Peroxide
  • Sodium Hypochlorite