Infection prevention and potassium permanganate. 14 In a recent
publication, the Karpinski Adaptation Index (KAI) was applied to determine activity and adaptation potential of commercially used concentrations of common substances, present in antiseptics and disinfectants, against Pseudomonas aeruginosa. This index provides quantitative assessment of the adaptation level in relation to the commercial concentration of the active compound.15,16
An interesting finding
of this publication is that sodium hypochlorite, together with potassium permanganate, can achieve high KAI values (≥1) which suggests the potential for very high risk of resistance development when those agents are used repeatedly and incorrectly.17
What to expect from ideal disinfectant? Proven efficacy: For many decades it was almost impossible to compare efficacy of disinfectants, due to lack of standardisation in the field of chemical disinfectants efficacy testing. Before standardisation, each product claimed efficacy based on different methodologies: l In house methods – company specific, with limited validation and often designed to favour preferred chemistry.
l National Standards – developed on their own by respective countries.
l Basic tests – MICs and MBCs, without taking into consideration in-use conditions, including temperature and interfering substances. Such tests often gave false positive or false negative results.
The first efficacy testing standards were developed in 1980s; however, harmonisation started in 1990s with EN norms implementation.
Material compatibility: In the current healthcare environment, a lot of modern devices and equipment are in daily use. In the majority of cases, this equipment is made out of plastics,
elastomers or a combination of different materials. This poses a challenge for infection prevention professionals. Disinfectants not only need to have proven efficacy against harmful pathogens, it also needs to be material friendly to ensure it does not damage sensitive and often very expensive equipment. Special attention needs to be paid to sodium
hypochlorite-based (bleach) products which have very limited material compatibility, and can cause damage to metals and plastics. Alcohol-based products should also be used carefully as they have very limited compatibility with plastics and often can cause stress cracking.18 Poor material compatibility of disinfectants
leads to increased costs of equipment repairs or even exchange, which can contribute significantly to financial losses. However, surface damage caused by corrosion can also facilitate pathogen growth and biofilm formation, which can lead to further spread of HCAIs.19
User and patients’ safety: Healthcare workers use disinfectants dozen times over the shift. In critical areas like ICUs, products are used in the presence of patients. Careful selection of products, taking into consideration safety profile, as well as way of application, is crucial. Sodium hypochlorite-based (bleach) products
are known for their reactivity with organic matter and their potential to form chlorinated organic compounds, which can prove to be carcinogenic. Respiratory risk is another important factor.
Since these products are used repeatedly throughout a shift and often in areas where patients are present, spray application should be avoided, as it produces airborne aerosols that can be readily inhaled and may increase health risks.20
Using trigger spray bottles many times
per day can also lead to wrist issues, due to repetitive strain.21
Future of disinfection Recently launched disinfectants, based on stabilised chlorine dioxide, deserve significant attention. These patented formulations offer a full spectrum of efficacy (including bacterial spores under EN 17126, EN 17846), demonstrate strong activity against biofilms, and maintain broad material compatibility. Unlike bleach, they do not create carcinogenic halogenated organic compounds, instead decomposing into water and sodium chloride after reaction.
Conclusion Disinfection is one of the most effective and consistently validated interventions for preventing MDRO infections and therefore one of the key pillars in AMR strategies. A growing body of evidence – from the CDC’s
prevention guidelines, to systematic reviews and advanced research - demonstrates that disinfection: l Disrupts pathogen transmission chains, reducing colonisation and infection rates.
l Remains effective regardless of antibiotic resistance, since MDROs do not inherently resist disinfectants.
l Acts synergistically with contact precautions, hand hygiene, and body decolonisation within intervention bundles.
l Protects vulnerable populations, particularly in ICUs and outbreak scenarios.
l Supports regional containment strategies, preventing cross-facility MDRO dissemination.
l Requires rigorous evaluation of disinfectant efficacy, as pathogens may adapt to some chemicals.
April 2026 I
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