Mycobactericidal testing of disinfectants: an update.

Tuberculosis, a major killer in developing countries, is on the rise again in industrialized nations. AIDS, increased use of immunosuppression and the emergence of multiple drug-resistant Mycobacterium tuberculosis (MDR-TB) have further enhanced its significance. TB is projected to cause 3.5 million deaths per year by 2000. Also, other types of mycobacteria are being incriminated in human infections with increasing frequency. Thus, the enhanced risk of nosocomial and iatrogenic spread of mycobacteria is forcing a review of infection control in general and claims of mycobactericidal activity of disinfectants in particular. Mycobacteria are more resistant to disinfection than enveloped viruses and other types of vegetative bacteria, but a proper comparison with non-enveloped viruses requires more data. Flaws in currently used protocols for mycobacterial activity are: (i) a lack of proper quantitation; (ii) unrealistically long contact times at higher than ambient temperatures; (iii) absence of a suitable organic load; (iv) ineffective neutralizers; (v) unsuitable surrogates for M. tuberculosis; (vi) improper recovery media; and (vii) inappropriate types of carriers. Furthermore, we have recently found a product meant for 14 day reuse to become non-mycobactericidal after only a week under actual use in an endoscopy unit. These considerations make the available data on product efficacy unreliable, especially in view of the increasing threat from MDR-TB. Recent findings suggest that the use of Mycobacterium terrae as a surrogate, better recovery media, flat surfaces as carriers, elimination of neutralizers, proper removal of cell clumps and a required > or = 4 log10 reduction in the number of colony forming units of the test bacterium after disinfectant treatment should make mycobacteridal tests more precise and reliable, thus making product registration and selection easier. There is also an urgent need to develop standardized protocols to determine the mycobactericidal activity of disinfectants under conditions of reuse.