Current issues in testing, selection and use of microbicides in infection control: a critical review

Abstract

Infectious diseases remain a major threat to human health and, indeed, many aspects of modern life are increasing our vulnerability and exposure to a variety of frank and opportunistic pathogens. This, together with rampant antibiotic resistance and reduced prospects for new therapies and vaccines, is increasing our reliance on microbicides as a part of preventive strategies. However, a closer scrutiny of microbicide use reveals flaws in 'official' methods for product registration, validity of label claims of microbicidal activity as well as short- and long-term health and environmental safety of many chemicals widely used for the purpose. This review is a critical look at these issues, with particular emphasis on microbicides used for environmental surface and medical device disinfection in healthcare settings. It summarises current approaches to developing better ways of testing microbicides and to attain global harmonisation of testing and product registration. It also highlights the known and potential dangers of microbicide use in the workplace and the factors to consider in the selection and application of such formulations to optimise safety and effectiveness in the field. A better awareness of the general safety issues must precede any continued reliance on microbicides in infection control. The information herein should help: infection control committees in their training, education and advisory services; materials managers in the purchase of suitable and safe products; infection control practitioners in microbicide use for enhanced workplace, patient and environmental safety; manufacturers in designing safer products and in making their labels more user-friendly, and; regulators in updating and refining the process of registration of microbicides. With the increasing reliance on microbicides in infection control, well-informed end-users are crucial to ensure that chemicals used for the purpose are handled as effectively and safely as possible.