1 - Title page [Seite 5]
2 - Copyright page [Seite 6]
3 - Contents [Seite 7]
4 - List of Contributors [Seite 9]
5 - Preface to the Fifth Edition [Seite 12]
6 - Preface to the First Edition [Seite 13]
7 - SECTION 1: Principles [Seite 15]
7.1 - 1: Historical Introduction [Seite 15]
7.1.1 - Early concepts [Seite 15]
7.1.2 - Chemical disinfection [Seite 16]
7.1.3 - Sterilization [Seite 17]
7.1.4 - Future developments for microbicides [Seite 18]
7.1.5 - References [Seite 18]
7.1.6 - Further reading [Seite 18]
7.2 - 2: Types of Microbicidal and Microbistatic Agents [Seite 19]
7.2.1 - Introduction [Seite 19]
7.2.2 - Phenols [Seite 19]
7.2.2.1 - Chemistry of phenols [Seite 20]
7.2.2.2 - Mode of action [Seite 20]
7.2.2.3 - Sources of phenols: the coal-tar industry [Seite 20]
7.2.2.4 - Properties of phenolic fractions [Seite 20]
7.2.2.5 - Formulation of coal-tar disinfectants [Seite 20]
7.2.2.6 - Modern range of solubilized and emulsified phenolic disinfectants [Seite 21]
7.2.2.7 - Non-coal-tar phenols [Seite 22]
7.2.2.8 - Halo and nitrophenols [Seite 23]
7.2.2.9 - Pine disinfectants [Seite 25]
7.2.2.10 - Bisphenols [Seite 25]
7.2.3 - Organic and inorganic acids: esters and salts [Seite 27]
7.2.3.1 - Chemistry of organic and inorganic acids [Seite 27]
7.2.3.2 - Mode of action [Seite 28]
7.2.3.3 - Individual compounds [Seite 28]
7.2.4 - Aromatic diamidines [Seite 31]
7.2.4.1 - Mode of action [Seite 32]
7.2.4.2 - Propamidine [Seite 32]
7.2.4.3 - Hexamidine diisethionate [Seite 32]
7.2.4.4 - Dibromopropamidine [Seite 32]
7.2.5 - Biguanides [Seite 32]
7.2.5.1 - Mode of action [Seite 32]
7.2.5.2 - Chlorhexidine [Seite 32]
7.2.5.3 - Alexidine [Seite 34]
7.2.5.4 - Polymeric biguanides [Seite 34]
7.2.6 - Surface-active agents [Seite 35]
7.2.6.1 - Cationic agents [Seite 35]
7.2.6.2 - Anionic agents [Seite 37]
7.2.6.3 - Non-ionic surface-active agents [Seite 37]
7.2.6.4 - Amphoteric (ampholytic) agents [Seite 38]
7.2.7 - Aldehydes [Seite 38]
7.2.7.1 - Mode of action [Seite 38]
7.2.7.2 - Glutaraldehyde (pentanedial) [Seite 38]
7.2.7.3 - Formaldehyde (methanal) [Seite 40]
7.2.7.4 - Ortho-phthalaldehyde [Seite 42]
7.2.7.5 - Other aldehydes [Seite 42]
7.2.8 - Microbicidal dyes [Seite 43]
7.2.8.1 - Acridines [Seite 43]
7.2.8.2 - Triphenylmethane dyes [Seite 44]
7.2.8.3 - Quinones [Seite 44]
7.2.8.4 - Halogenated fluorescein (hydroxyxanthene) [Seite 45]
7.2.9 - Halogens [Seite 45]
7.2.9.1 - Iodine compounds [Seite 45]
7.2.9.2 - Chlorine compounds [Seite 47]
7.2.9.3 - Bromine [Seite 49]
7.2.10 - Quinoline and isoquinoline derivatives [Seite 49]
7.2.10.1 - 8-Hydroxyquinoline Derivatives [Seite 49]
7.2.10.2 - 4-Aminoquinaldinium derivatives [Seite 49]
7.2.10.3 - Isoquinoline derivatives [Seite 49]
7.2.11 - Alcohols [Seite 50]
7.2.11.1 - Mode of action [Seite 50]
7.2.11.2 - Ethyl alcohol (ethanol) [Seite 51]
7.2.11.3 - Methyl alcohol (methanol) [Seite 51]
7.2.11.4 - Isopropyl alcohol (isopropanol) [Seite 51]
7.2.11.5 - Benzyl alcohol [Seite 51]
7.2.11.6 - Phenylethanol (phenylethyl alcohol) [Seite 52]
7.2.11.7 - Bronopol [Seite 52]
7.2.11.8 - Phenoxyethanol (phenoxetol) [Seite 52]
7.2.11.9 - Chlorbutanol (chlorbutol) [Seite 52]
7.2.11.10 - 2,4-Dichlorobenzyl alcohol [Seite 52]
7.2.12 - Peroxygens [Seite 52]
7.2.12.1 - Hydrogen peroxide [Seite 52]
7.2.12.2 - Peracetic acid [Seite 53]
7.2.12.3 - Performic acid [Seite 53]
7.2.13 - Chelating agents [Seite 53]
7.2.13.1 - Ethylendiamine tetraacetic acid [Seite 53]
7.2.13.2 - Other chelating agents [Seite 54]
7.2.14 - Permeabilizers [Seite 55]
7.2.14.1 - Polycations [Seite 55]
7.2.14.2 - Lactoferrin [Seite 55]
7.2.14.3 - Transferrin [Seite 55]
7.2.14.4 - Citric and other acids [Seite 55]
7.2.15 - Heavy metal derivatives [Seite 55]
7.2.15.1 - Copper compounds [Seite 56]
7.2.15.2 - Silver compounds [Seite 56]
7.2.15.3 - Mercury compounds [Seite 57]
7.2.15.4 - Tin and its compounds (organotins) [Seite 58]
7.2.15.5 - Titanium [Seite 58]
7.2.16 - Anilides [Seite 58]
7.2.16.1 - Mode of action [Seite 59]
7.2.16.2 - Salicylanilide [Seite 59]
7.2.16.3 - Diphenylureas (carbanilides) [Seite 59]
7.2.17 - Miscellaneous preservatives [Seite 59]
7.2.17.1 - Derivatives of 1,3-dioxane [Seite 59]
7.2.17.2 - Derivatives of imidazole [Seite 60]
7.2.17.3 - Isothiazolones [Seite 61]
7.2.17.4 - Derivatives of hexamine [Seite 62]
7.2.17.5 - Triazines [Seite 63]
7.2.17.6 - Oxazolo-oxazoles [Seite 63]
7.2.17.7 - Sodium hydroxymethylglycinate [Seite 64]
7.2.17.8 - Methylene bisthiocyanate [Seite 64]
7.2.17.9 - Captan [Seite 64]
7.2.17.10 - 1,2-dibromo-2,4-dicyanobutane (Tektamer 38) [Seite 64]
7.2.17.11 - Glucoprotamin [Seite 64]
7.2.17.12 - Essential oils [Seite 64]
7.2.17.13 - General statement [Seite 65]
7.2.18 - Vapor-phase disinfectants [Seite 65]
7.2.18.1 - Ethylene oxide [Seite 65]
7.2.18.2 - Formaldehyde-releasing agents [Seite 65]
7.2.18.3 - Propylene oxide [Seite 67]
7.2.18.4 - Ozone [Seite 67]
7.2.18.5 - Carbon dioxide [Seite 67]
7.2.18.6 - Mode of action [Seite 67]
7.2.19 - Aerial disinfectants [Seite 67]
7.2.20 - Inactivation of prions [Seite 68]
7.2.21 - Other uses of microbicidal and microbistatic agents [Seite 68]
7.2.21.1 - Use in the food, dairy, pharmaceutical and cosmetic industries [Seite 68]
7.2.21.2 - Disinfectants in recreational waters [Seite 68]
7.2.22 - Which microbicidal or microbistatic agent? [Seite 69]
7.2.22.1 - Regulatory requirements [Seite 69]
7.2.22.2 - Which preservative? [Seite 69]
7.2.23 - Other concepts [Seite 69]
7.2.23.1 - Additional considerations [Seite 70]
7.2.23.2 - Nanotechnology [Seite 70]
7.2.24 - References [Seite 71]
7.3 - 3: Factors Affecting the Activities of Microbicides [Seite 85]
7.3.1 - Introduction [Seite 85]
7.3.2 - Factors affecting microbicidal activity during the development of a given formulation [Seite 85]
7.3.2.1 - Culturing microorganisms for test inocula [Seite 86]
7.3.2.2 - Composition of growth medium and physical parameters [Seite 86]
7.3.2.3 - Pretreatments [Seite 86]
7.3.3 - Factors affecting microbicidal activity during field use [Seite 87]
7.3.3.1 - Factors inherent to microbicides [Seite 87]
7.3.3.2 - Factors depending upon treatment conditions [Seite 89]
7.3.3.3 - Factors inherent to microorganisms [Seite 91]
7.3.4 - Factors affecting recovery: microbial viability after microbicide exposure [Seite 94]
7.3.4.1 - Injury repair: viable but non-culturable microorganisms [Seite 94]
7.3.4.2 - Neutralization of microbicidal activity [Seite 94]
7.3.4.3 - Recovery media [Seite 94]
7.3.4.4 - Incubation temperature [Seite 94]
7.3.5 - Conclusions [Seite 95]
7.3.6 - References [Seite 95]
7.4 - 4: Biofilm Recalcitrance: Theories and Mechanisms [Seite 101]
7.4.1 - Introduction [Seite 101]
7.4.2 - The matrix [Seite 102]
7.4.2.1 - Biofilm matrix as a barrier to antibacterial agents [Seite 102]
7.4.2.2 - Biofilm matrix as an interactive barrier to antibacterial penetration [Seite 102]
7.4.2.3 - Enzyme-mediated reaction - diffusion resistance [Seite 102]
7.4.3 - Cellular phenotype in biofilm communities as a moderator of recalcitrance [Seite 103]
7.4.3.1 - Drug-resistant phenotypes [Seite 104]
7.4.3.2 - Efflux pumps [Seite 104]
7.4.3.3 - Quiescence and persistence [Seite 104]
7.4.4 - Biofilms as highly selective environments [Seite 105]
7.4.5 - Conclusions [Seite 106]
7.4.6 - Acknowledgments [Seite 106]
7.4.7 - References [Seite 106]
7.5 - 5: Mechanisms of Action of Microbicides [Seite 109]
7.5.1 - Introduction [Seite 109]
7.5.2 - Methods for studying the mechanism of action of microbicides [Seite 110]
7.5.2.1 - Physical and biochemical approaches to the study of microbicide action [Seite 110]
7.5.2.2 - Molecular approaches to the study of microbicide action [Seite 112]
7.5.2.3 - Variable parameters in mechanism of action studies [Seite 112]
7.5.3 - Uptake, binding and penetration [Seite 112]
7.5.4 - Action on the cell wall [Seite 113]
7.5.5 - Action on the cell membrane [Seite 113]
7.5.5.1 - Leakage of cell constituents [Seite 113]
7.5.5.2 - Inhibition of energy processes [Seite 114]
7.5.6 - Interaction with the cytoplasm [Seite 114]
7.5.6.1 - Protein denaturation and coagulation [Seite 114]
7.5.6.2 - Effects on enzymes [Seite 114]
7.5.6.3 - Effects on nucleic acids [Seite 114]
7.5.6.4 - Effects of microbicides on the microbial transcriptome and proteome [Seite 115]
7.5.7 - Action of individual classes of microbicidal agents [Seite 115]
7.5.7.1 - Oxidizing agents [Seite 115]
7.5.7.2 - Alkylating and halogenating agents [Seite 116]
7.5.7.3 - Metal ion-binding agents [Seite 116]
7.5.7.4 - Nucleic acid-binding agents [Seite 116]
7.5.7.5 - Protein denaturants [Seite 116]
7.5.7.6 - Interaction with lipids [Seite 116]
7.5.8 - Conclusions [Seite 116]
7.5.9 - References [Seite 117]
7.6 - 6: Bacterial Sensitivity and Resistance to Microbicides [Seite 122]
7.6.1 - 6.1: Mechanisms of Bacterial Resistance to Microbicides [Seite 122]
7.6.1.1 - Introduction [Seite 122]
7.6.1.2 - Definitions [Seite 123]
7.6.1.3 - Occurrence of bacterial resistance to microbicides [Seite 123]
7.6.1.4 - Mechanisms of bacterial resistance to microbicides [Seite 124]
7.6.1.4.1 - Principles [Seite 124]
7.6.1.4.2 - Overview [Seite 124]
7.6.1.4.3 - Mechanisms [Seite 124]
7.6.1.4.4 - Induction of gene expression conferring bacterial resistance [Seite 127]
7.6.1.4.5 - Bacterial biofilms [Seite 127]
7.6.1.4.6 - Change in bacterial populations [Seite 127]
7.6.1.5 - Dissemination of resistance [Seite 127]
7.6.1.6 - Measuring bacterial resistance to microbicides [Seite 127]
7.6.1.7 - Cross-resistance to unrelated chemicals [Seite 129]
7.6.1.8 - Conclusions [Seite 129]
7.6.1.9 - References [Seite 129]
7.6.2 - 6.2: Resistance of Bacterial Spores to Chemical Agents [Seite 135]
7.6.2.1 - Introduction [Seite 135]
7.6.2.2 - Spore structure [Seite 135]
7.6.2.2.1 - Exosporium [Seite 136]
7.6.2.2.2 - Coat [Seite 136]
7.6.2.2.3 - Outer membrane [Seite 136]
7.6.2.2.4 - Cortex and germ cell wall [Seite 136]
7.6.2.2.5 - Inner membrane [Seite 136]
7.6.2.2.6 - Core [Seite 137]
7.6.2.3 - Variables affecting spore chemical resistance [Seite 137]
7.6.2.3.1 - Species/strain [Seite 137]
7.6.2.3.2 - Sporulation conditions [Seite 137]
7.6.2.3.3 - Spore purity [Seite 138]
7.6.2.3.4 - Spore storage and recovery conditions [Seite 138]
7.6.2.4 - Mechanisms of spore killing by chemicals [Seite 138]
7.6.2.4.1 - Spore killing by DNA damage [Seite 138]
7.6.2.4.2 - Spore killing by inactivation of spore core enzymes [Seite 139]
7.6.2.4.3 - Spore killing by preventing germination [Seite 139]
7.6.2.4.4 - Spore killing by damage to the inner membrane [Seite 139]
7.6.2.5 - Factors important in spore resistance to various chemicals [Seite 139]
7.6.2.5.1 - Disinfectants [Seite 139]
7.6.2.5.2 - Genotoxic chemicals [Seite 140]
7.6.2.5.3 - Hydrogen peroxide [Seite 141]
7.6.2.5.4 - Oxidizing agents other than hydrogen peroxide [Seite 141]
7.6.2.5.5 - Dialdehydes [Seite 141]
7.6.2.5.6 - Acid and alkali [Seite 141]
7.6.2.5.7 - Plasma [Seite 141]
7.6.2.5.8 - Supercritical carbon dioxide [Seite 141]
7.6.2.5.9 - Factors important in chemical resistance of spores of clostridium species [Seite 142]
7.6.2.6 - Conclusions [Seite 142]
7.6.2.7 - Acknowledgments [Seite 142]
7.6.2.8 - References [Seite 142]
7.6.3 - 6.3: Testing of Chemicals as Mycobactericidal Agents [Seite 145]
7.6.3.1 - Introduction [Seite 145]
7.6.3.2 - Spread of mycobacteria [Seite 146]
7.6.3.3 - Microbicides and mycobacteria [Seite 146]
7.6.3.4 - Testing microbicides against mycobacteria [Seite 146]
7.6.3.5 - Types of tests for mycobactericidal activity [Seite 146]
7.6.3.6 - Standard test protocols for mycobactericidal activity [Seite 147]
7.6.3.6.1 - AOAC International [Seite 147]
7.6.3.6.2 - ASTM international [Seite 147]
7.6.3.6.3 - Quantitative carrier tests of ASTM international [Seite 148]
7.6.3.6.4 - Comité Européean de Normalisation [Seite 149]
7.6.3.7 - Guidance on testing and registration of chemicals as mycobactericides [Seite 149]
7.6.3.7.1 - Health Canada [Seite 149]
7.6.3.7.2 - United States environmental protection agency [Seite 149]
7.6.3.7.3 - United States food and drug administration [Seite 149]
7.6.3.8 - Conclusions [Seite 150]
7.6.3.9 - Acknowledgments [Seite 153]
7.6.3.10 - References [Seite 153]
7.7 - 7: Fungicidal Activity of Microbicides [Seite 156]
7.7.1 - Introduction [Seite 156]
7.7.2 - General fungal ecology [Seite 156]
7.7.3 - Fungicidal activity of microbicides [Seite 157]
7.7.4 - Standards [Seite 157]
7.7.5 - Chemicals with fungicidal activity [Seite 158]
7.7.5.1 - Acids and alkalis [Seite 158]
7.7.5.2 - Alcohols [Seite 159]
7.7.5.3 - Aldehydes [Seite 159]
7.7.5.4 - Halogens [Seite 160]
7.7.5.5 - Metals [Seite 161]
7.7.5.6 - Oxidizing agents [Seite 162]
7.7.5.7 - Phenols [Seite 163]
7.7.5.8 - Surfactants [Seite 163]
7.7.6 - Microbicide resistance in fungi [Seite 164]
7.7.7 - Safety, handling and discharge measurements for fungal microbicides [Seite 164]
7.7.8 - References [Seite 165]
7.8 - 8: Sensitivity and Resistance of Protozoa to Microbicides [Seite 169]
7.8.1 - Introduction [Seite 169]
7.8.2 - General descriptions and life cycles [Seite 169]
7.8.2.1 - Waterborne parasitic protozoa other than amoebae [Seite 169]
7.8.2.2 - Parasitic and free-living amoebae [Seite 171]
7.8.2.3 - Microsporidia [Seite 172]
7.8.2.4 - Dormant-form cell wall structures: a key to understanding resistance to microbicides [Seite 173]
7.8.3 - Sensitivity and resistance of protozoa to microbicides [Seite 175]
7.8.3.1 - Chemical microbicides [Seite 176]
7.8.3.2 - Physical microbicides [Seite 181]
7.8.4 - Conclusions [Seite 184]
7.8.5 - References [Seite 184]
7.9 - 9: Virucidal Activity of Microbicides [Seite 192]
7.9.1 - Introduction [Seite 192]
7.9.2 - Interrupting the spread of viruses with microbicides [Seite 192]
7.9.3 - Evaluation of virucidal activity [Seite 193]
7.9.3.1 - Viral propagation, detection and enumeration [Seite 194]
7.9.3.2 - Virucidal tests and their significance [Seite 194]
7.9.3.3 - Virucidal testing methods [Seite 195]
7.9.3.4 - Approved tests for virucidal activity [Seite 196]
7.9.3.5 - Assessment of virucidal activity with bacteriophages [Seite 197]
7.9.4 - Virucidal efficacy of microbicides [Seite 197]
7.9.5 - Mechanisms of virucidal action [Seite 200]
7.9.5.1 - Viral structures and targets [Seite 201]
7.9.5.2 - Mechanisms of action of microbicides against viruses [Seite 204]
7.9.6 - Other virucidal processes [Seite 210]
7.9.7 - Viral resistance to microbicides [Seite 210]
7.9.7.1 - Viral aggregation [Seite 210]
7.9.7.2 - Other mechanisms [Seite 212]
7.9.7.3 - Multiplicity reactivation [Seite 212]
7.9.8 - Conclusions [Seite 212]
7.9.9 - References [Seite 213]
7.10 - 10: Transmissible Spongiform Encephalopathies and Decontamination [Seite 222]
7.10.1 - Introduction [Seite 222]
7.10.1.1 - Prion diseases [Seite 222]
7.10.1.2 - Agent characteristics [Seite 224]
7.10.1.3 - General considerations [Seite 226]
7.10.2 - Practical considerations in decontamination studies [Seite 227]
7.10.2.1 - General [Seite 227]
7.10.2.2 - Test methods [Seite 228]
7.10.3 - Inactivation methods [Seite 230]
7.10.3.1 - Physical inactivation methods [Seite 230]
7.10.3.2 - Chemical inactivation methods [Seite 233]
7.10.4 - Future perspectives in prion decontamination [Seite 237]
7.10.5 - Parallels with other protein-precipitating diseases [Seite 238]
7.10.6 - References [Seite 238]
7.11 - 11: Microbicides - the Double-edged Sword: Environmental Toxicity and Emerging Resistance [Seite 243]
7.11.1 - Introduction [Seite 243]
7.11.2 - Applications of biocidal products and fate in the environment [Seite 244]
7.11.3 - Differences and similarities in antimicrobial actions [Seite 245]
7.11.4 - Microbicide concentration and bacterial susceptibility [Seite 245]
7.11.4.1 - Effects of Low Concentrations of a Microbicide [Seite 245]
7.11.4.2 - Concentrations of Microbicides in the Environment [Seite 246]
7.11.5 - Microbicides and antimicrobial resistance in bacteria [Seite 246]
7.11.5.1 - General Considerations [Seite 246]
7.11.5.2 - Expression and Overexpression of Efflux Pumps and Other Systems [Seite 247]
7.11.5.3 - Physiological and Metabolic Changes [Seite 247]
7.11.6 - Conclusions [Seite 247]
7.11.7 - References [Seite 248]
8 - SECTION 2: Practice [Seite 250]
8.1 - 12: Evaluation of Antimicrobial Efficacy [Seite 250]
8.1.1 - Introduction [Seite 250]
8.1.2 - Classification of disinfectant tests [Seite 251]
8.1.3 - Primary and secondary testing methods: suspension [Seite 252]
8.1.3.1 - Suspension tests [Seite 252]
8.1.3.2 - Capacity tests [Seite 254]
8.1.4 - Surface (carrier) testing [Seite 255]
8.1.4.1 - Carrier test [Seite 255]
8.1.5 - Non-standard methods for investigating microbicidal activity [Seite 255]
8.1.5.1 - Biochemical methods [Seite 256]
8.1.5.2 - Physical methods [Seite 256]
8.1.5.3 - Discriminatory counting techniques [Seite 256]
8.1.5.4 - Flow cytometry [Seite 256]
8.1.5.5 - Bioluminescence [Seite 256]
8.1.5.6 - Quantitative optical density [Seite 257]
8.1.6 - Conclusions [Seite 257]
8.1.7 - Acknowledgments [Seite 257]
8.1.8 - References [Seite 257]
8.2 - 13: Assessing the Efficacy of Professional Healthcare Antiseptics: a Regulatory Perspective [Seite 261]
8.2.1 - Introduction [Seite 261]
8.2.2 - North American regulatory process [Seite 261]
8.2.2.1 - Canada [Seite 261]
8.2.2.2 - United States of America [Seite 262]
8.2.3 - European Union regulatory process [Seite 262]
8.2.4 - Antiseptics in healthcare settings: why are they needed? [Seite 263]
8.2.4.1 - Scientific methods used by regulatory agencies to assess antiseptic effectiveness [Seite 263]
8.2.5 - Conclusions [Seite 267]
8.2.6 - References [Seite 268]
8.3 - 14: Regulation of Microbicides [Seite 269]
8.3.1 - 14.1: Legislation Affecting Disinfectant Products in Europe: the Biocidal Products Directive and the Registration, Evaluation and Authorization of Chemicals Regulations [Seite 269]
8.3.1.1 - Introduction [Seite 269]
8.3.1.2 - The biocidal products directive [Seite 269]
8.3.1.2.1 - Development of the legislation [Seite 269]
8.3.1.2.2 - Definitions and scope [Seite 269]
8.3.1.2.3 - How does the BPD work? [Seite 269]
8.3.1.2.4 - Legislation evolves [Seite 272]
8.3.1.3 - Registration, evaluation, authorization and restriction of chemicals (REACH) [Seite 273]
8.3.1.3.1 - Development of the legislation [Seite 273]
8.3.1.3.2 - Definitions and scope [Seite 273]
8.3.1.3.3 - How does REACH work? [Seite 273]
8.3.1.3.4 - Downstream users [Seite 274]
8.3.1.3.5 - Safety data sheets [Seite 275]
8.3.1.3.6 - Legislation evolves [Seite 275]
8.3.1.4 - References [Seite 275]
8.3.2 - 14.2: Regulatory Authorization of Hard Surface Disinfectants in Canada [Seite 276]
8.3.2.1 - Introduction [Seite 276]
8.3.2.2 - Disinfectants versus sanitizers [Seite 276]
8.3.2.3 - Legislative and regulatory authority [Seite 278]
8.3.2.3.1 - The food and drugs act [Seite 278]
8.3.2.3.2 - The food and drug regulations [Seite 278]
8.3.2.4 - Premarket review process [Seite 278]
8.3.2.4.1 - Pre-submission meeting [Seite 279]
8.3.2.4.2 - DIN authorization [Seite 279]
8.3.2.4.3 - Regulatory decision [Seite 280]
8.3.2.4.4 - Reconsideration process [Seite 280]
8.3.2.4.5 - Post-DIN changes [Seite 280]
8.3.2.5 - Postmarket regulatory activities [Seite 281]
8.3.2.6 - Emerging pathogens [Seite 281]
8.3.2.7 - Additional sources of information [Seite 281]
8.3.2.8 - Acknowledgments and disclaimer [Seite 281]
8.3.2.9 - References [Seite 281]
8.3.3 - 14.3: United States Regulation of Antimicrobial Pesticides [Seite 283]
8.3.3.1 - Introduction [Seite 283]
8.3.3.2 - Pesticide history [Seite 283]
8.3.3.3 - Environmental protection agency structure [Seite 284]
8.3.3.4 - Antimicrobial pesticides overview [Seite 284]
8.3.3.4.1 - Public health antimicrobial pesticide categories [Seite 284]
8.3.3.4.2 - Emerging pathogens [Seite 285]
8.3.3.5 - Determining whether a product is a pesticide [Seite 285]
8.3.3.6 - Obtaining a pesticide registration [Seite 286]
8.3.3.6.1 - File a registration [Seite 286]
8.3.3.6.2 - Supplemental registration process [Seite 286]
8.3.3.6.3 - Purchase an existing registration [Seite 286]
8.3.3.7 - The registration process [Seite 286]
8.3.3.7.1 - Fulfilling data requirements [Seite 287]
8.3.3.7.2 - EPA review process [Seite 287]
8.3.3.7.3 - Changes to registrations [Seite 288]
8.3.3.8 - Labels [Seite 288]
8.3.3.9 - Registrant obligations [Seite 288]
8.3.3.10 - Antimicrobial testing program [Seite 288]
8.3.3.11 - State pesticide registration [Seite 288]
8.3.3.12 - Treated articles [Seite 288]
8.3.3.13 - Devices [Seite 289]
8.3.3.14 - Minimum risk pesticides [Seite 289]
8.3.3.15 - Nanotechnology [Seite 289]
8.3.3.16 - OECD antimicrobial efficacy methods [Seite 289]
8.3.3.17 - Conclusions [Seite 289]
8.3.3.18 - References [Seite 289]
8.4 - 15: Sterilization Processes [Seite 291]
8.4.1 - 15.1: Heat Sterilization [Seite 291]
8.4.1.1 - Introduction [Seite 291]
8.4.1.2 - Kinetics of heat inactivation [Seite 291]
8.4.1.3 - Microbial susceptibility to heat [Seite 293]
8.4.1.4 - Moist heat [Seite 293]
8.4.1.4.1 - Parenteral products [Seite 294]
8.4.1.4.2 - Non-parenteral products [Seite 295]
8.4.1.4.3 - Dressings [Seite 296]
8.4.1.4.4 - Lumened devices [Seite 298]
8.4.1.5 - Thermal processing of foods [Seite 298]
8.4.1.6 - Combination treatments [Seite 299]
8.4.1.7 - Alternative means for heat delivery and control [Seite 300]
8.4.1.8 - Dry heat [Seite 301]
8.4.1.8.1 - Lyophilization [Seite 302]
8.4.1.9 - Mechanisms of microbial inactivation [Seite 302]
8.4.1.10 - Mechanisms of spore resistance to heat [Seite 303]
8.4.1.11 - Conclusions [Seite 303]
8.4.1.12 - Acknowledgments [Seite 303]
8.4.1.13 - References [Seite 303]
8.4.2 - 15.2: Radiation Sterilization [Seite 308]
8.4.2.1 - Introduction [Seite 308]
8.4.2.2 - Radiation energy [Seite 309]
8.4.2.2.1 - Types of radiation [Seite 309]
8.4.2.2.2 - Units of nuclear radiation [Seite 309]
8.4.2.2.3 - Radiation sources [Seite 309]
8.4.2.2.4 - Sensitivity and resistance of microorganisms to radiation [Seite 310]
8.4.2.2.5 - Mechanisms of lethal action [Seite 311]
8.4.2.2.6 - Choice of radiation dose [Seite 312]
8.4.2.2.7 - Standards and control procedures [Seite 312]
8.4.2.3 - Uses of ionizing radiation [Seite 313]
8.4.2.4 - Ultraviolet radiation [Seite 313]
8.4.2.4.1 - Survival curves following ultraviolet radiation [Seite 314]
8.4.2.4.2 - Sensitivity to ultraviolet radiation [Seite 314]
8.4.2.4.3 - Target site and inactivation [Seite 314]
8.4.2.4.4 - Repair mechanisms [Seite 314]
8.4.2.4.5 - Effect of ultraviolet radiation on bacterial spores [Seite 315]
8.4.2.4.6 - Practical uses of ultraviolet radiation [Seite 316]
8.4.2.5 - Other forms of radiation used in disinfection and sterilization [Seite 316]
8.4.2.6 - Conclusions [Seite 316]
8.4.2.7 - References [Seite 316]
8.4.3 - 15.3: Gaseous Sterilization [Seite 320]
8.4.3.1 - Introduction [Seite 320]
8.4.3.2 - General principles [Seite 321]
8.4.3.2.1 - Characteristics of an ideal low-temperature gaseous sterilizing agent [Seite 321]
8.4.3.2.2 - Types of gaseous sterilizing agent and mechanisms of action [Seite 321]
8.4.3.2.3 - Principal features of sterilizing equipment [Seite 322]
8.4.3.2.4 - Validation [Seite 322]
8.4.3.2.5 - Load release [Seite 322]
8.4.3.2.6 - Biological indicators [Seite 322]
8.4.3.2.7 - Residues of gas sterilants [Seite 322]
8.4.3.3 - Alkylating agents [Seite 322]
8.4.3.3.1 - Ethylene oxide [Seite 322]
8.4.3.3.2 - Formaldehyde [Seite 326]
8.4.3.4 - Oxidizing agents [Seite 329]
8.4.3.4.1 - Hydrogen peroxide gas [Seite 329]
8.4.3.4.2 - Peracetic acid [Seite 331]
8.4.3.4.3 - Gaseous ozone [Seite 333]
8.4.3.4.4 - Chlorine dioxide [Seite 336]
8.4.3.4.5 - Plasma sterilization [Seite 337]
8.4.3.5 - Conclusions [Seite 341]
8.4.3.6 - References [Seite 342]
8.4.4 - 15.4: Gas Plasma Sterilization [Seite 347]
8.4.4.1 - Introduction [Seite 347]
8.4.4.2 - Applications of gas plasma for decontamination [Seite 348]
8.4.4.3 - Sterilization systems that use gas plasma [Seite 349]
8.4.4.3.1 - Hydrogen peroxide gas plasma sterilization [Seite 349]
8.4.4.3.2 - Other oxidizing agent-based plasma systems [Seite 352]
8.4.4.4 - Sterilization with gas plasma [Seite 352]
8.4.4.4.1 - Oxygen [Seite 352]
8.4.4.4.2 - Hydrogen peroxide and peracetic acid [Seite 353]
8.4.4.4.3 - Nitrogen [Seite 353]
8.4.4.4.4 - Other gases [Seite 354]
8.4.4.5 - Mechanisms of action [Seite 354]
8.4.4.6 - Future perspectives [Seite 355]
8.4.4.7 - References [Seite 355]
8.4.5 - 15.5: Filtration Sterilization [Seite 357]
8.4.5.1 - Historical introduction [Seite 357]
8.4.5.2 - Filtration media [Seite 357]
8.4.5.2.1 - Filters of diatomaceous earth [Seite 357]
8.4.5.2.2 - Fibrous pad filters [Seite 358]
8.4.5.2.3 - Sintered or fritted ware [Seite 358]
8.4.5.2.4 - Membrane filters [Seite 358]
8.4.5.3 - Applications and limitations of filtration [Seite 371]
8.4.5.3.1 - Filtration "sterilization" [Seite 371]
8.4.5.3.2 - Non-sterilizing uses of membrane filtration [Seite 374]
8.4.5.4 - Testing of filters [Seite 375]
8.4.5.4.1 - Filters used in liquid sterilization [Seite 375]
8.4.5.4.2 - Filters used in gas "sterilization" [Seite 378]
8.4.5.5 - Designing a filtration system for the preparation of medicinal products [Seite 379]
8.4.5.6 - Acknowledgments [Seite 380]
8.4.5.7 - References [Seite 380]
8.5 - 16: New and Emerging Technologies [Seite 385]
8.5.1 - Introduction [Seite 385]
8.5.2 - General considerations [Seite 386]
8.5.2.1 - Process optimization [Seite 386]
8.5.2.2 - Formulation optimization, including synergism [Seite 387]
8.5.3 - Ultrahigh pressure and supercritical fluids [Seite 387]
8.5.4 - High-voltage electric pulses [Seite 389]
8.5.5 - Other physical processes [Seite 390]
8.5.5.1 - High-intensity light [Seite 390]
8.5.5.2 - Magnetic fields [Seite 390]
8.5.5.3 - Sonication [Seite 391]
8.5.5.4 - Microwaves [Seite 391]
8.5.6 - Gas plasma [Seite 391]
8.5.7 - Vapor-phase oxidants [Seite 392]
8.5.8 - Nitric oxide and nitrogen dioxide [Seite 394]
8.5.9 - Bacteriophages and other biological substances [Seite 394]
8.5.10 - Glucoprotamines [Seite 395]
8.5.11 - Microbicidal surfaces [Seite 395]
8.5.11.1 - Copper and silver [Seite 395]
8.5.11.2 - N-halamines [Seite 396]
8.5.11.3 - Titanium dioxide [Seite 397]
8.5.12 - Conclusions [Seite 397]
8.5.13 - References [Seite 397]
8.6 - 17: Preservation of Medicines and Cosmetics [Seite 402]
8.6.1 - Nature of medicines and cosmetics [Seite 402]
8.6.2 - Consequences of microbial contamination [Seite 404]
8.6.3 - Effect of formulation parameters on microbial contamination and spoilage [Seite 405]
8.6.3.1 - Formulation effects on microbial growth [Seite 405]
8.6.3.2 - Formulation effects on preservative efficacy [Seite 406]
8.6.4 - Use of preservatives in medicines and cosmetics [Seite 409]
8.6.4.1 - Medicines [Seite 410]
8.6.4.2 - Cosmetics [Seite 411]
8.6.4.3 - Potentiation and synergy [Seite 412]
8.6.5 - Regulatory aspects of the preservation of medicines and cosmetics [Seite 413]
8.6.6 - Prediction of preservative efficacy [Seite 414]
8.6.7 - Adverse reactions of users to preservatives [Seite 415]
8.6.8 - References [Seite 416]
8.7 - 18: Sterility Assurance: Concepts, Methods and Problems [Seite 422]
8.7.1 - Introduction [Seite 422]
8.7.2 - Sterile, sterilized [Seite 422]
8.7.3 - Sterility and sterility assurance [Seite 423]
8.7.4 - Factors affecting sterility assurance [Seite 423]
8.7.5 - Sterility assurance in practice [Seite 424]
8.7.6 - Sterility testing [Seite 424]
8.7.7 - Process monitoring and parametric release [Seite 425]
8.7.7.1 - Equipment function tests [Seite 426]
8.7.7.2 - Performance verification tests [Seite 426]
8.7.7.3 - Process validation practices [Seite 428]
8.7.8 - Bioburden estimation [Seite 430]
8.7.9 - Parametric release of product in practice [Seite 430]
8.7.10 - Sterile barrier systems [Seite 431]
8.7.11 - References [Seite 431]
8.8 - 19: Special Problems in Hospital Environments [Seite 432]
8.8.1 - 19.1: Hand Hygiene [Seite 432]
8.8.1.1 - Transmission of healthcare-associated pathogens through hands [Seite 432]
8.8.1.2 - Products and methods for hand antisepsis and infrastructures required for optimal hand hygiene [Seite 433]
8.8.1.3 - Methods to monitor hand hygiene compliance and other hand hygiene indicators [Seite 436]
8.8.1.3.1 - Monitoring hand hygiene by direct observation methods [Seite 437]
8.8.1.3.2 - Indirect monitoring of hand hygiene [Seite 438]
8.8.1.3.3 - Automated monitoring of hand hygiene [Seite 438]
8.8.1.4 - Hand hygiene practices among healthcare workers [Seite 438]
8.8.1.5 - Strategies to improve hand hygiene compliance [Seite 439]
8.8.1.6 - Effectiveness of hand hygiene programs to reduce healthcare-associated infections, including cost-saving issues [Seite 441]
8.8.1.7 - The World Health Organization multimodal hand hygiene improvement strategy and toolkit [Seite 447]
8.8.1.8 - Adverse events related to hand hygiene and in particular to the use of alcohol-based handrubs [Seite 447]
8.8.1.9 - Appendix 19.1 World Health Organization recommendations on hand hygiene in health care [Seite 448]
8.8.1.9.1 - Consensus recommendations [Seite 448]
8.8.1.10 - Disclaimer [Seite 450]
8.8.1.11 - References [Seite 450]
8.8.2 - 19.2: Decontamination of the Environment and Medical Equipment in Hospitals [Seite 459]
8.8.2.1 - Introduction [Seite 459]
8.8.2.2 - A rational approach to disinfection: a disinfectant policy [Seite 460]
8.8.2.2.1 - Objective [Seite 460]
8.8.2.2.2 - Categories of risk to patients and treatment of equipment and environment [Seite 461]
8.8.2.2.3 - Requirements of chemical disinfectants [Seite 461]
8.8.2.2.4 - Choice of a disinfection method [Seite 461]
8.8.2.2.5 - Implementation of the disinfectant policy [Seite 463]
8.8.2.3 - Problems with certain microorganisms [Seite 463]
8.8.2.3.1 - Bacterial spores [Seite 463]
8.8.2.3.2 - Bloodborne viruses, hepatitis A virus and prions [Seite 463]
8.8.2.3.3 - Mycobacteria [Seite 464]
8.8.2.3.4 - Prions [Seite 464]
8.8.2.4 - Contaminated disinfectant solutions [Seite 464]
8.8.2.5 - Treatment of the environment and equipment [Seite 465]
8.8.2.5.1 - Walls, ceilings and floors [Seite 465]
8.8.2.5.2 - Air [Seite 466]
8.8.2.5.3 - Baths, washbowls and toilets [Seite 466]
8.8.2.5.4 - Bedpans and urinals [Seite 466]
8.8.2.5.5 - Crockery and cutlery [Seite 466]
8.8.2.5.6 - Cleaning equipment [Seite 467]
8.8.2.5.7 - Babies' incubators [Seite 467]
8.8.2.5.8 - Respiratory ventilators and associated equipment [Seite 467]
8.8.2.5.9 - Anesthetic equipment [Seite 467]
8.8.2.5.10 - Endoscopes [Seite 468]
8.8.2.5.11 - Miscellaneous items of medical equipment [Seite 468]
8.8.2.6 - Conclusions [Seite 468]
8.8.2.7 - Acknowledgment [Seite 469]
8.8.2.8 - References [Seite 469]
8.8.3 - 19.3: Decontamination of Endoscopes [Seite 473]
8.8.3.1 - Introduction [Seite 473]
8.8.3.2 - Rigid endoscopes [Seite 474]
8.8.3.3 - Flexible endoscopes [Seite 475]
8.8.3.3.1 - Infections associated with flexible endoscopy [Seite 475]
8.8.3.3.2 - Risk assessment [Seite 475]
8.8.3.3.3 - Problems associated with flexible endoscopes [Seite 475]
8.8.3.4 - Decontamination procedure [Seite 475]
8.8.3.4.1 - Steps in the decontamination procedure [Seite 475]
8.8.3.4.2 - Selection of a chemical disinfectant for HLD [Seite 477]
8.8.3.5 - Automated endoscope reprocessors [Seite 478]
8.8.3.5.1 - Typical AER cycle including a validated cleaning cycle [Seite 478]
8.8.3.5.2 - Endoscope washer disinfectors: issues [Seite 478]
8.8.3.6 - Cleaning verification of reprocessed endoscopes [Seite 480]
8.8.3.7 - Staff training [Seite 482]
8.8.3.7.1 - Written procedures [Seite 482]
8.8.3.7.2 - Training [Seite 482]
8.8.3.8 - Acknowledgment [Seite 482]
8.8.3.9 - References [Seite 482]
8.8.4 - 19.4: Issues Associated with the Decontamination of Laundry and Clinical Waste [Seite 485]
8.8.4.1 - Introduction [Seite 485]
8.8.4.2 - Healthcare laundry [Seite 485]
8.8.4.2.1 - Routine healthcare laundry [Seite 485]
8.8.4.2.2 - Categorization of healthcare laundry [Seite 486]
8.8.4.2.3 - Decontamination of laundry [Seite 487]
8.8.4.2.4 - Staff uniforms [Seite 487]
8.8.4.2.5 - Dry cleaning [Seite 488]
8.8.4.2.6 - Washing machines in acute clinical areas [Seite 488]
8.8.4.2.7 - Laundry quality assurance systems [Seite 488]
8.8.4.3 - Clinical waste [Seite 488]
8.8.4.3.1 - Segregation of clinical waste [Seite 488]
8.8.4.3.2 - Infectious waste [Seite 489]
8.8.4.3.3 - Offensive waste [Seite 489]
8.8.4.3.4 - Storage of clinical waste [Seite 489]
8.8.4.3.5 - Transfer documentation [Seite 489]
8.8.4.3.6 - Accidents and incidents [Seite 489]
8.8.4.3.7 - Final disposal method [Seite 489]
8.8.4.3.8 - Types of disposal [Seite 490]
8.8.4.4 - Conclusions [Seite 490]
8.8.4.5 - References [Seite 490]
8.8.4.6 - Further reading [Seite 491]
8.8.5 - 19.5: Treated Recreational Water Venues [Seite 492]
8.8.5.1 - Introduction [Seite 492]
8.8.5.2 - Engineering design considerations [Seite 492]
8.8.5.2.1 - Swimming pools and water parks [Seite 493]
8.8.5.2.2 - Hot tubs and spas [Seite 494]
8.8.5.2.3 - Hot springs and natural pools [Seite 494]
8.8.5.2.4 - Whirlpool baths and birthing pools designed for a single user [Seite 494]
8.8.5.3 - Water chemistry [Seite 494]
8.8.5.4 - Disinfection [Seite 494]
8.8.5.4.1 - Efficacy testing disinfectants [Seite 495]
8.8.5.5 - Health effects [Seite 495]
8.8.5.5.1 - Skin, ear and eye irritation and infection [Seite 495]
8.8.5.5.2 - Gastrointestinal infections [Seite 496]
8.8.5.5.3 - Respiratory irritation and infections [Seite 496]
8.8.5.5.4 - Other infectious diseases [Seite 497]
8.8.5.6 - Management and reporting [Seite 497]
8.8.5.7 - References [Seite 497]
8.9 - 20: Antimicrobial Surfaces and Devices [Seite 499]
8.9.1 - 20.1: Antimicrobial Surfaces [Seite 499]
8.9.1.1 - Introduction [Seite 499]
8.9.1.2 - Passive surfaces [Seite 500]
8.9.1.2.1 - Diamond-like carbon [Seite 500]
8.9.1.2.2 - Polyethylene oxide brush coatings [Seite 500]
8.9.1.2.3 - Bacterial interference [Seite 500]
8.9.1.3 - Reactive surfaces [Seite 501]
8.9.1.3.1 - Challenges associated with the development of reactive surfaces: Urinary catheters [Seite 501]
8.9.1.3.2 - Other reactive surfaces that continuously release antimicrobial agents [Seite 502]
8.9.1.3.3 - Reactive surfaces that kill microorganisms on contact [Seite 503]
8.9.1.3.4 - Reactive surfaces that release antimicrobial agents on command [Seite 505]
8.9.1.3.5 - Reactive surfaces that release antimicrobial agents on demand [Seite 508]
8.9.1.4 - Conclusions [Seite 508]
8.9.1.5 - References [Seite 509]
8.9.2 - 20.2: Antimicrobial Devices [Seite 514]
8.9.2.1 - Introduction [Seite 514]
8.9.2.2 - Definition of medical device [Seite 515]
8.9.2.3 - Biomaterials [Seite 515]
8.9.2.3.1 - Medical device applications of biomaterials [Seite 515]
8.9.2.3.2 - Biomaterials in medical device manufacture [Seite 515]
8.9.2.4 - Complications associated with indwelling medical devices [Seite 517]
8.9.2.4.1 - Mechanical complications [Seite 517]
8.9.2.4.2 - Biocompatibility [Seite 517]
8.9.2.4.3 - Infectious complications [Seite 517]
8.9.2.5 - Healthcare-associated infections [Seite 518]
8.9.2.6 - Device-associated infections: Events following device implantation [Seite 518]
8.9.2.6.1 - Deposition of conditioning film, colonization and biofilm formation [Seite 519]
8.9.2.7 - Clinical management of device-related infections [Seite 519]
8.9.2.8 - Development of antimicrobial biomaterials [Seite 520]
8.9.2.8.1 - Antiseptics [Seite 521]
8.9.2.8.2 - Silver [Seite 521]
8.9.2.8.3 - Antibiotics [Seite 521]
8.9.2.8.4 - Antimicrobial combinations [Seite 522]
8.9.2.9 - Antimicrobial devices [Seite 522]
8.9.2.9.1 - Antimicrobial urological devices [Seite 522]
8.9.2.9.2 - Antimicrobial central venous access devices/catheters [Seite 523]
8.9.2.9.3 - Antimicrobial endotracheal tubes [Seite 523]
8.9.2.9.4 - Antimicrobial orthopedic devices [Seite 524]
8.9.2.9.5 - Antimicrobial peritoneal catheters [Seite 524]
8.9.2.9.6 - Antimicrobial catheters for neurosurgery [Seite 524]
8.9.2.9.7 - Antimicrobial sutures [Seite 525]
8.9.2.10 - The future: Emerging strategies for anti-infective biomaterials [Seite 525]
8.9.2.11 - Conclusions [Seite 526]
8.9.2.12 - References [Seite 526]
8.9.3 - 20.3: Antimicrobial Dressings [Seite 528]
8.9.3.1 - Introduction [Seite 528]
8.9.3.2 - Silver dressings [Seite 529]
8.9.3.3 - Iodine dressings [Seite 531]
8.9.3.4 - Chlorhexidine dressings [Seite 531]
8.9.3.5 - Polyhexamethylene biguanide dressings [Seite 531]
8.9.3.6 - Honey dressings [Seite 532]
8.9.3.7 - Evaluation and safety of wound dressings [Seite 532]
8.9.3.8 - References [Seite 532]
8.9.4 - 20.4: Antimicrobial Textiles and Testing Techniques [Seite 534]
8.9.4.1 - Introduction [Seite 534]
8.9.4.2 - Benefits of antimicrobial agents on textiles [Seite 534]
8.9.4.2.1 - Microbiological growth on Textiles [Seite 535]
8.9.4.2.2 - Microbiological issues associated with manufacturing and raw materials [Seite 535]
8.9.4.2.3 - Natural and synthetic materials [Seite 535]
8.9.4.2.4 - Benefits in the hospital and home [Seite 535]
8.9.4.3 - Antimicrobial agents [Seite 536]
8.9.4.3.1 - Leaching and non-leaching agents [Seite 536]
8.9.4.3.2 - Mode of antimicrobial action [Seite 536]
8.9.4.3.3 - Global regulatory compliance [Seite 536]
8.9.4.4 - Objectives and principles of antimicrobial testing [Seite 537]
8.9.4.4.1 - Tiered antimicrobial testing [Seite 537]
8.9.4.4.2 - Testing via zone of inhibition studies [Seite 537]
8.9.4.5 - Antimicrobial test methods used to measure activity [Seite 538]
8.9.4.5.1 - Inherent "passive" microbial resistance and preservative testing [Seite 538]
8.9.4.5.2 - Measuring "active" microbial properties on textiles [Seite 538]
8.9.4.5.3 - Test methods specific for claim validation [Seite 540]
8.9.4.6 - Conclusions [Seite 541]
8.9.4.7 - References [Seite 542]
8.10 - 21: Other Health Sectors [Seite 544]
8.10.1 - 21.1: Use of Microbicides in Disinfection of Contact Lenses [Seite 544]
8.10.1.1 - Introduction [Seite 544]
8.10.1.2 - Lens care [Seite 545]
8.10.1.3 - Lens care solutions [Seite 545]
8.10.1.3.1 - Active ingredients [Seite 545]
8.10.1.3.2 - Other formulation constituents [Seite 546]
8.10.1.3.3 - Lens care alternatives [Seite 546]
8.10.1.4 - Complications [Seite 546]
8.10.1.4.1 - General [Seite 546]
8.10.1.5 - Qualification of lens care solutions [Seite 547]
8.10.1.5.1 - The ISO stand-alone test [Seite 547]
8.10.1.5.2 - The ISO regimen test [Seite 548]
8.10.1.5.3 - The ISO preservative efficacy/discard date test [Seite 548]
8.10.1.5.4 - Additional testing [Seite 549]
8.10.1.6 - Conclusions [Seite 550]
8.10.1.7 - References [Seite 550]
8.10.2 - 21.2: Special Issues in Dentistry [Seite 551]
8.10.2.1 - Introduction [Seite 551]
8.10.2.2 - Cross-infection [Seite 552]
8.10.2.2.1 - Bloodborne viruses [Seite 552]
8.10.2.2.2 - Transmissible spongiform encephalopathy [Seite 554]
8.10.2.2.3 - Other potential pathogens [Seite 555]
8.10.2.3 - Contamination of the working environment [Seite 556]
8.10.2.3.1 - Aerosols and splatter [Seite 556]
8.10.2.3.2 - Dental unit water lines [Seite 556]
8.10.2.3.3 - Impressions, prosthetics and dental instruments [Seite 557]
8.10.2.3.4 - Clinical waste [Seite 557]
8.10.2.4 - Compliance with infection control measures [Seite 558]
8.10.2.4.1 - Training in infection control [Seite 558]
8.10.2.5 - Recent developments in dental hygiene [Seite 558]
8.10.2.5.1 - Ozonated liquids [Seite 558]
8.10.2.5.2 - Photodynamic therapy [Seite 559]
8.10.2.6 - References [Seite 559]
8.11 - 22: Emerging Natural Technologies [Seite 564]
8.11.1 - 22.1: Natural Products [Seite 564]
8.11.1.1 - Introduction [Seite 564]
8.11.1.2 - Host defense peptides (antimicrobial peptides) [Seite 564]
8.11.1.3 - Natural products of bacterial origin [Seite 565]
8.11.1.3.1 - Bacterial antimicrobial peptides [Seite 565]
8.11.1.3.2 - Enzymes [Seite 566]
8.11.1.4 - Natural products of plant origin [Seite 566]
8.11.1.4.1 - Garlic [Seite 567]
8.11.1.4.2 - Green tea [Seite 569]
8.11.1.4.3 - Essential oils [Seite 569]
8.11.1.5 - Natural products of animal origin [Seite 570]
8.11.1.5.1 - Hive products [Seite 570]
8.11.1.6 - Antimicrobial peptides of animal origin [Seite 573]
8.11.1.6.1 - Human defense peptides [Seite 573]
8.11.1.6.2 - Magainins [Seite 573]
8.11.1.6.3 - Lactoferrin [Seite 573]
8.11.1.6.4 - Maggot therapy or biosurgery [Seite 573]
8.11.1.7 - Conclusions [Seite 574]
8.11.1.8 - References [Seite 574]
8.11.2 - 22.2: Applications of Bacteriophage Technology [Seite 579]
8.11.2.1 - Introduction [Seite 579]
8.11.2.2 - Characteristics of bacteriophages [Seite 579]
8.11.2.2.1 - Lytic and lysogenic cycles [Seite 580]
8.11.2.3 - Applications of bacteriophages [Seite 582]
8.11.2.3.1 - Phage-typing [Seite 582]
8.11.2.3.2 - Bacterial identification [Seite 582]
8.11.2.3.3 - Vaccine production [Seite 582]
8.11.2.3.4 - Phage display and the production of therapeutic antibodies [Seite 583]
8.11.2.4 - Bacteriophage therapy of human bacterial infections [Seite 583]
8.11.2.4.1 - Early experiences of bacteriophage therapy [Seite 583]
8.11.2.4.2 - Drivers for change [Seite 583]
8.11.2.4.3 - Recent clinical experiences with bacteriophages [Seite 584]
8.11.2.5 - Applications in agriculture and animal health [Seite 586]
8.11.2.5.1 - Bacteriophages for the control of bacteria on foods [Seite 586]
8.11.2.5.2 - Bacteriophages to treat infections in animals [Seite 586]
8.11.2.6 - Further applications of bacteriophages [Seite 587]
8.11.2.6.1 - Bacteriophage lysins [Seite 587]
8.11.2.6.2 - Toxin delivery [Seite 587]
8.11.2.7 - Conclusions [Seite 588]
8.11.2.8 - References [Seite 588]
8.12 - 23: Control of Infectious Bioagents [Seite 590]
8.12.1 - Introduction [Seite 590]
8.12.1.1 - Bacillus anthracis [Seite 591]
8.12.1.2 - Foot-and-mouth disease [Seite 591]
8.12.1.3 - Containment approaches [Seite 592]
8.12.2 - Microbicide susceptibility of infectious agents [Seite 592]
8.12.2.1 - Prions [Seite 592]
8.12.2.2 - Bacterial spores [Seite 593]
8.12.2.3 - Vegetative bacteria [Seite 594]
8.12.2.4 - Botulinum toxin [Seite 595]
8.12.2.5 - Viruses [Seite 595]
8.12.2.6 - Summary [Seite 595]
8.12.3 - Decontamination principles [Seite 596]
8.12.3.1 - Containment requirements [Seite 596]
8.12.3.2 - Source reduction [Seite 596]
8.12.3.3 - Surface decontamination technologies [Seite 596]
8.12.3.4 - Large-area decontamination technologies [Seite 596]
8.12.3.5 - Summary [Seite 598]
8.12.4 - Determining the efficiency of the decontamination process [Seite 598]
8.12.4.1 - Summary [Seite 599]
8.12.5 - New and upcoming decontamination technologies [Seite 599]
8.12.5.1 - Green microbicides [Seite 599]
8.12.5.2 - Summary [Seite 600]
8.12.6 - Conclusions [Seite 600]
8.12.7 - References [Seite 601]
9 - Index [Seite 603]
