A systematic review of chlorine-based surface disinfection efficacy to inform recommendations for low-resource outbreak settings

Background: Infectious diseases can be transmitted via fomites (contaminated surfaces/objects); disinfection can interrupt this transmission route. However, disinfection guidelines for low-resource outbreak settings are inconsistent and not evidence-based. Methods: A systematic review of surface disinfection efficacy studies was conducted to inform low-resource outbreak guideline development. Due to variation in experimental procedures, outcomes were synthesized in a narrative summary focusing on chlorine-based disinfection against 7 pathogens with potential to produce outbreaks in low-resource settings (Mycobacterium tuberculosis, Vibrio cholerae, Salmonella spp., hepatitis A virus, rotavirus, norovirus, and Ebola virus). Results: Data were extracted from 89 laboratory studies and made available, including 20 studies on relevant pathogens used in combination with surrogate data to determine minimum target concentration time (CT) factors. Stainless steel (68%) and chlorine-based disinfectants (56%) were most commonly tested. No consistent trend was seen in the influence of chlorine concentration and exposure time on disinfection efficacy. Disinfectant application mode; soil load; and surface type were frequently identified as influential factors in included studies. Conclusions: This review highlights that surface disinfection efficacy estimates are strongly influenced by each study's experimental conditions. We therefore recommend laboratory testing to be followed by field based testing/monitoring to ensure effectiveness is achieved in situ. (C) 2020 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc.

Automated summary

This study conducted a systematic review of surface disinfection efficacy studies in low-resource outbreak settings, focusing on the effect of chlorine-based disinfection on 7 potential pathogens. The experimental conditions significantly influenced the disinfection efficacy estimates, suggesting the need for field-based testing after laboratory testing to ensure effectiveness in situ.