The activity of povidone-iodine has been demonstrated against human coronaviruses 229E and OC43 303. A study also showed complete inactivation of the SARS coronavirus by 70% ethanol and povidone-iodine with an exposure times of 1 minute and 2.5% glutaraldehyde with an exposure time of 5 minute 304. Because the SARS coronavirus is stable in feces and urine at room temperature for at least 1–2 days (WHO, 2003; http://www.who.int/csr/sars/survival_2003_05_04/en/index.html), surfaces might be a possible source of contamination and lead to infection with the SARS coronavirus and should be disinfected. Until more precise information is available, environments in which SARS patients are housed should be considered heavily contaminated, and rooms and equipment should be thoroughly disinfected daily and after the patient is discharged. EPA-registered disinfectants or 1:100 dilution of household bleach and water should be used for surface disinfection and disinfection on noncritical patient-care equipment. High-level disinfection and sterilization of semicritical and critical medical devices, respectively, does not need to be altered for patients with known or suspected SARS. Free-living amoeba can be pathogenic and can harbor agents of pneumonia such as Legionella pneumophila. Limited studies have shown that 2% glutaraldehyde and peracetic acid do not completely inactivate Acanthamoeba polyphaga in a 20-minute exposure time for high-level disinfection. If amoeba are found to contaminate instruments and facilitate infection, longer immersion times or other disinfectants may need to be considered 305. Inactivation of Bioterrorist Agents Publications have highlighted concerns about the potential for biological terrorism306, 307. CDC has categorized several agents as “high priority” because they can be easily disseminated or transmitted from person to person, cause high mortality, and are likely to cause public panic and social disruption 308. These agents include Bacillus anthracis (the cause of anthrax), Yersinia pestis (plague), variola major (smallpox), Clostridium botulinum toxin (botulism), Francisella tularensis (tularemia), filoviruses (Ebola hemorrhagic fever, Marburg hemorrhagic fever); and arenaviruses (Lassa [Lassa fever], Junin [Argentine hemorrhagic fever]), and related viruses308. A few comments can be made regarding the role of sterilization and disinfection of potential agents of bioterrorism309. First, the susceptibility of these agents to germicides in vitro is similar to that of other related pathogens.
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For example, variola is similar to vaccinia 72, 310, 311 and B. anthracis is similar to B. atrophaeus (formerly B. subtilis)312, 313. B. subtilis spores, for instance, proved as resistant as, if not more resistant than, B. anthracis spores (>6 log10 reduction of B. anthracis spores in 5 minutes with acidified bleach [5,250 ppm chlorine])313. Thus, one can extrapolate from the larger database available on the susceptibility of genetically similar organisms314. Second, many of the potential bioterrorist agents are stable enough in the environment that contaminated environmental surfaces or fomites could lead to transmission of agents such as B. anthracis, F. tularensis, variola major, C. botulinum toxin, and C. burnetti 315. Third, data suggest that current disinfection and sterilization practices are appropriate for managing patient-care equipment and environmental surfaces when potentially contaminated patients are evaluated and/or admitted in a health-care facility after exposure to a bioterrorist agent. For example, 25Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 sodium hypochlorite can be used for surface disinfection