Antiseptic Stewardship for Surface Disinfectants

Surface disinfectants can be based on different types of biocidal active substances 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 reported only in outbreak situations or in special care units for products based on different types of biocidal agents, but not for routine use on hospital floors, surfaces in patient rooms or wards. A low adaptive response combined with mostly an inhibition of biofilm formation and removal of existing biofilm cannot be attributed to any of the biocidal active substances. Overall, on surfaces where biofilm formation should be inhibited, the use of 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 also have a low selection pressure and can moderately remove biofilm, but they increased biofilm formation in a relevant number of species. They seem to be suitable for surfaces where the enhancement of biofilm formation is of minor importance. Benzalkonium chloride seems to be the least suitable biocidal active substance, taking into account the often observed strong and stable adaptive response, the cross-tolerance with other biocidal active substances and the inconclusive effect on biofilm formation and removal.