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Denkel LA, Voss A, Caselli E, Dancer SJ, Leistner R, Gastmeier P, Widmer AF. Can probiotics trigger a paradigm shift for cleaning healthcare environments? A narrative review. Antimicrob Resist Infect Control 2024; 13:119. [PMID: 39380032 PMCID: PMC11462747 DOI: 10.1186/s13756-024-01474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 09/25/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND The environment of healthcare institutions plays a major role in the transmission of multidrug resistant organisms (MDRO) and likely in subsequent healthcare-associated infections (HAIs). Probiotic cleaning products are a novel option for environmental cleaning. They represent a sustainable and biodegradable alternative to conventional chemical disinfectants for controlling microbial bioburden, and preventing pathogen transmission in hospital environments. High-quality studies including randomized clinical trials (RCT) triggered a summary with expert recommendations until further studies allow a critical review and meta-analysis of the data. METHODS Infection control experts from five European countries summarized available data as of June 2023. Authors presented their published RCTs, reviewed the existing literature on probiotic cleaning, summarized the results and identified knowledge gaps and subsequent research needs. RESULTS Probiotic cleaning was similarly effective for reducing HAI-related pathogens, enveloped viruses such as SARS-CoV-2 and MDRO in environmental samples compared to conventional chemical disinfectants. More importantly, probiotic cleaning was non-inferior to disinfectants in terms of preventing HAI in a large RCT. In addition, probiotic cleaning has also been shown to reduce antimicrobial resistance genes (ARG), costs and antimicrobial consumption in other hospital trials. They are biodegradable, do not require any protection for chemical hazards, and are compliant with occupational health. A paradigm shift, however, requires a very strong evidence to justify for such a change. In the past, this evidence was limited by the heterogeneity of study design, products, protocols, and few studies on clinical outcomes used in the trials. Furthermore, the regulatory, safety, and quality aspects of probiotic cleaning products are not, yet, completely defined and require clearing by authorities. CONCLUSION To date, probiotic cleaning is a breakthrough technology and a biological alternative for chemical disinfectant when treating hospital environment. It may also have a positive effect on MDRO transmission. However, the different compositions of probiotic products will require standardization, and more robust data should be generated to support these promising results on different compositions. This may trigger a paradigm shift in cleaning of healthcare institutions from chemical to biological control of the hospital environment.
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Affiliation(s)
- Luisa A Denkel
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany.
- National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Andreas Voss
- Department of Medical Microbiology and Infection Control, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabetta Caselli
- Section of Microbiology, Department of Chemical, Pharmaceutical, and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | | | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Andreas F Widmer
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Swissnoso - Swiss National Center for Infection Prevention, Bern, Switzerland
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Senneby E, Holmberg A, Thörnqvist A, Fraenkel CJ. Decontamination of patient bathroom surfaces with 405 nm violet-blue light irradiation in a real-life setting. J Hosp Infect 2024; 152:93-98. [PMID: 39098393 DOI: 10.1016/j.jhin.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Irradiation with violet-blue light (VBL), in the spectrum of 405-450 nm, has been reported to be effective against pathogenic bacteria. AIM To investigate whether VBL irradiation could reduce the level of surface contamination at seven shared patient bathrooms in two wards at a hospital in Sweden. METHODS Repeated sampling of five separate surfaces (door handle, tap water handle, floor, toilet seat, and toilet armrest) was performed in the bathrooms where 405 nm light-emitting diode spotlights had been installed. A prospective study with a cross-over design was carried out, which included two study periods, first with the spotlights either switched on or off and a second study period with the opposite spotlight status. FINDINGS In total, 665 surface samples were collected during the study (133 samples per surface). Bacterial growth was found in 84% of all samples. The most common findings were coagulase-negative staphylococci and Bacillus spp. The median number of colony-forming units (cfu)/cm2 was 15 (interquartile range: 5-40) for all surfaces. In our main outcome, mean cfu/cm2 of all surfaces in a bathroom, no difference was observed with or without VBL. Clean surfaces (<5 cfu/cm2) were more commonly observed in bathrooms with VBL, also when controlling for confounding factors. No difference was observed in the number of heavily contaminated surfaces. CONCLUSION This study did not safely demonstrate an additive effect on bacterial surface levels when adding VBL to routine cleaning in shared patient bathrooms.
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Affiliation(s)
- E Senneby
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden; Department of Clinical Microbiology, Infection Control and Prevention, Region Skåne, Lund, Sweden.
| | - A Holmberg
- Department of Clinical Microbiology, Infection Control and Prevention, Region Skåne, Lund, Sweden; Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - A Thörnqvist
- Department of Clinical Microbiology, Infection Control and Prevention, Region Skåne, Lund, Sweden
| | - C-J Fraenkel
- Department of Clinical Microbiology, Infection Control and Prevention, Region Skåne, Lund, Sweden; Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
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Zhang Y, Gao Z, He L. Optical detection and enumeration of Escherichia coli and Salmonella enterica using a low-magnification light microscope. J Microbiol Methods 2024; 226:107041. [PMID: 39277021 DOI: 10.1016/j.mimet.2024.107041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 08/12/2024] [Accepted: 09/10/2024] [Indexed: 09/17/2024]
Abstract
A rapid and cost-effective method for detecting bacterial cells from surfaces is critical to food safety, clinical hygiene, and pharmacy quality. Herein, we established an optical detection method based on a gold chip coating with 3-mercaptophenylboronic acid (3-MPBA) to capture bacterial cells, which allows for the detection and quantification of bacterial cells with a standard light microscope under low-magnification (10×) objective lens. Then, integrate the developed optical detection method with swab sampling to detect bacterial cells loading on stainless-steel surfaces. Using Salmonella enterica (SE1045) and Escherichia coli (E. coli OP50) as model bacterial cells, we achieved a capture efficiency of up to 76.0 ± 2.0 % for SE1045 cells and 81.1 ± 3.3 % for E. coli OP50 cells at 103 CFU/mL upon the optimized conditions, which slightly decreased with the increasing bacterial concentrations. Our assay showed good linear relationships between the concentrations of bacterial cells with the cell counting in images in the range of 103 -107 CFU/mL for SE1045, and 103 -108 CFU/mL for E. coli OP50 cells. The limit of detection (LOD) was 103 CFU/mL for both SE1045 and E. coli OP50 cells. A further increase in sensitivity in detecting E. coli OP50 cells was achieved through a heat treatment, enabling the LOD to be reduced as low as 102 CFU/mL. Furthermore, a preliminary application succeeded in assessing bacterial contamination on stainless-steel surfaces following integration with the approximately 40 % recovery rate, suggesting prospects for evaluating the bacteria from surfaces. The entire process was completed within around 2 h, costing merely a few dollars per sample. Considering the low cost of standard light microscopes, our method holds significant potential for practical industrial applications in bacterial contamination control on surfaces, especially in low-resource settings.
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Affiliation(s)
- Yuzhen Zhang
- Department of Food Science, University of Massachusetts, Amherst, MA 01003, USA
| | - Zili Gao
- Department of Food Science, University of Massachusetts, Amherst, MA 01003, USA
| | - Lili He
- Department of Food Science, University of Massachusetts, Amherst, MA 01003, USA..
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Belay MM, Ambelu A, Mekonen S, Karbana G, Yemane B. Investigating Microbial Contamination of Indoor Air, Environmental Surfaces, and Medical Equipment in a Southwestern Ethiopia Hospital. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302241266052. [PMID: 39055115 PMCID: PMC11271106 DOI: 10.1177/11786302241266052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024]
Abstract
Introduction Healthcare-associated infections, primarily caused by microorganisms, are widespread in healthcare facilities. These infections pose a significant challenge, especially in low and middle-income countries, and have a detrimental impact on patient outcomes. It is crucial to assess the level of microbial load and associated factors to prevent the spread of these infections. The objective of this study was to assess the microbial load and identify the factors associated with it in various wards at Jimma Medical Center. Method A cross-sectional study conducted at Jimma Medical Center. Indoor air samples were collected using the settle plate method with a 1/1/1 scheme. Inanimate surfaces and medical equipment were sampled using Swabs from a 10 × 10 cm area. A total of 268 samples were collected from 10 rooms. Pertinent information regarding the associated factors was gathered using an observational checklist. A multiple linear regression model was used to identify any associations with the microbial load. Result Out of the total samples, 181 (67.5%) tested positive for culture, and 270 microbes were isolated. The average load of bacteria and fungi in the indoor air ranged from 124.4 to 1607 and 96 to 814.6 Colony-forming unit (CFU)/m3, respectively. The mean total aerobic colony counts of bacteria and fungi from all surfaces in the wards ranged from 5.25 to 43.3 CFU/cm2. Crowdedness [β = 2.748 (95% Confidence Interval (CI): 1.057-4.44)], the presence of waste material [β = 1.747 (95% CI: 0.213-3.282)], and an unclean room [β = 2.505 (95% CI: 0.990-4.019)] were significantly associated with the microbial load. Conclusion The microbial load detected in indoor air, inanimate surfaces and medical equipment was posing potential health risks. Consequently, it is recommended to implement regular microbial surveillance of the hospital environment and enhance the infection prevention program to mitigate these concerns.
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Affiliation(s)
- Mekdes Mekonen Belay
- Department of Public Health, College of Medicine and Health Science, Werabe University, Werabe, Ethiopia
| | - Argaw Ambelu
- Water and Health Division, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seblework Mekonen
- Water and Health Division, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gedeno Karbana
- Department of Environmental Health, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Bethlehem Yemane
- Department of Environmental Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Ilyes ZATLA, Lamia BOUBLENZA, Wafaa LEMERINI, Chahinez TRIQUI. GLO GERM AND COVID-19: ILLUMINATING HYGIENE AND PROMOTING TRANSMISSION AWARENESS. Afr J Infect Dis 2024; 18:1-4. [PMID: 39156735 PMCID: PMC11327910 DOI: 10.21010/ajidv18i2s.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 08/20/2024] Open
Abstract
Background Maintaining effective surface hygiene and preventing contamination is of paramount importance. Our study introduces Glo Germ, a versatile product available in various forms, which possesses the unique ability to reveal hidden truths under ultraviolet light, enhance understanding of hygiene, and spread awareness of COVID-19 transmission and preventive measures. Materials and Methods A comprehensive study was conducted to assess different surface cleaning techniques' effectiveness. Glo Germ, containing a fluorescent dye activated by ultraviolet light, was used to visualize germ spread and compare disinfectant cleaners' efficacy. The study encompassed diverse surfaces and materials, aiming to identify optimal cleaning techniques for each context. Furthermore, a small illustrative study was conducted during a COVID-19 awareness presentation involving students. Glo Germ was applied to hands, revealing its subsequent spread to faces and surfaces. This visual experiment effectively emphasized hand hygiene and mask-wearing importance. Results Results indicated that while water alone achieved satisfactory cleaning results, using detergent and the appropriate cleaning tools further improved efficacy. Notably, adhering to consistent patterns and applying pressure during cleaning proved essential. The student demonstration showed how contaminants spread quickly, highlighting hand hygiene's significance and the potential extent of contamination through sneezing. Conclusion Glo Germ inclusion in these experiments highlights its potential in educating about surface cleaning and microbial transmission, offering an interactive and engaging approach to promoting personal hygiene and fostering illness prevention awareness.
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Affiliation(s)
- ZATLA Ilyes
- Laboratory of Microbiology applied to the Food Industry, Biomedical and the Environment, Faculty of Natural and Life Sciences, Earth and Universe Sciences. Department of Biology. University of Tlemcen, Algeria
| | - BOUBLENZA Lamia
- Laboratory of Microbiology applied to the Food Industry, Biomedical and the Environment, Faculty of Natural and Life Sciences, Earth and Universe Sciences. Department of Biology. University of Tlemcen, Algeria
| | - LEMERINI Wafaa
- Laboratory of Organic Chemistry, Natural Substances analysis, Faculty of Natural and Life Sciences, Earth and Universe Sciences. Department of Biology. University of Tlemcen, Algeria
| | - TRIQUI Chahinez
- Laboratory of Physiology, Physiopathology and Biochemistry of Nutrition, Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe, University of Tlemcen, Algeria
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Ma LL, Wei YY, Li J, Sun YY, Liu SR, Ma KM, Leung PHM, Tao XM. Clinical study of antibacterial medical textiles containing polyhydroxyalkanoate oligomers for reduction of hospital-acquired infections. J Hosp Infect 2024; 149:144-154. [PMID: 38705475 DOI: 10.1016/j.jhin.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/25/2024] [Accepted: 04/10/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION The prevention and control of hospital-acquired infections remain a significant challenge worldwide, as textiles used in hospital wards are highly involved in transmission processes. This paper reports a new antibacterial medical fabric used to prepare hospital pillowcases, bottom sheets and quilt covers for controlling and reducing hospital-acquired infections. METHOD The medical fabric was composed of blended yarns of staple polyester (PET) and degradable poly(3-hydroxybutyrate co-3-hydroxyvalerate) (PHBV)/polylactic acid (PLA) fibres, which were coated with polylactide oligomers (PLAO), which are environmentally friendly and safe antimicrobial agents with excellent thermal stability in high-temperature laundry. A clinical trial was conducted, with emphasis on the bacterial species that were closely related to the infection cases in the study hospital. RESULT After 7 days of use, 94% of PET/PHBV/PLA-PLAO fabric retained <20 colony-forming units/100 cm2 of the total bacterial amount, meeting hygiene and cleanliness standards. CONCLUSION This study demonstrates the potential of fabrics containing polyhydroxyalkanoate oligomers as highly effective, safe and long-lasting antimicrobial medical textiles that can effectively reduce the incidence of hospital-acquired infections.
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Affiliation(s)
- L L Ma
- Research Institute for Intelligent Wearable Systems, School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
| | - Y-Y Wei
- Department of Nursing, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - J Li
- Research Institute for Intelligent Wearable Systems, School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
| | - Y-Y Sun
- Department of Nursing, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - S R Liu
- Research Institute for Intelligent Wearable Systems, School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
| | - K M Ma
- Research Institute for Intelligent Wearable Systems, School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
| | - P H-M Leung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - X M Tao
- Research Institute for Intelligent Wearable Systems, School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China.
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Watkin S, Cloutman-Green E, Kiernan M, Ciric L. Trends in viable microbial bioburden on surfaces within a paediatric bone marrow transplant unit. J Hosp Infect 2024; 148:167-177. [PMID: 38621514 DOI: 10.1016/j.jhin.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Despite their role being historically overlooked, environmental surfaces have been shown to play a key role in the transmission of pathogens causative of healthcare-associated infection. To guide infection prevention and control (IPC) interventions and inform clinical risk assessments, more needs to be known about microbial surface bioburdens. AIM To identify the trends in culturable bacterial contamination across communal touch sites over time in a hospital setting. METHODS Swab samples were collected over nine weeks from 22 communal touch sites in a paediatric bone marrow transplant unit. Samples were cultured on Columbia blood agar and aerobic colony counts (ACC) per 100 cm2 were established for each site. Individual colony morphologies were grouped and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or 16s rDNA sequencing. FINDINGS Highest mean counts were observed for sites associated with ward management activity and computer devices (3.29 and 2.97 ACC/100 cm2 respectively). A nurses' station keyboard had high mean ACC/100 cm2 counts (10.67) and diversity, while laundry controls had high mean ACC/100 cm2 counts (4.70) and low diversity. Micrococcus luteus was identified in all sampling groups. Clinical staff usage sites were contaminated with similar proportions of skin and environmental flora (52.19-46.59% respectively), but sites associated with parental activities were predominantly contaminated by environmental microflora (86.53%). CONCLUSION The trends observed suggest patterns in microbial loading based on site activities, surface types and user groups. Improved understanding of environmental surface contamination could help support results interpretation and IPC interventions, improving patient safety.
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Affiliation(s)
- S Watkin
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK.
| | - E Cloutman-Green
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK; Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Kiernan
- Richard Wells Research Centre, University of West London, London, UK
| | - L Ciric
- Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK
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Okomo U, Gon G, Darboe S, Sey ICM, Nkereuwem O, Leigh L, Camara N, Makalo L, Keita A, Dancer SJ, Graham W, Aiken AM. Assessing the impact of a cleaning programme on environmental hygiene in labour and neonatal wards: an exploratory study in The Gambia. Antimicrob Resist Infect Control 2024; 13:36. [PMID: 38589973 PMCID: PMC11003010 DOI: 10.1186/s13756-024-01393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/31/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Effective surface cleaning in hospitals is crucial to prevent the transmission of pathogens. However, hospitals in low- and middle-income countries face cleaning challenges due to limited resources and inadequate training. METHODS We assessed the effectiveness of a modified TEACH CLEAN programme for trainers in reducing surface microbiological contamination in the newborn unit of a tertiary referral hospital in The Gambia. We utilised a quasi-experimental design and compared data against those from the labour ward. Direct observations of cleaning practices and key informant interviews were also conducted to clarify the programme's impact. RESULTS Between July and September 2021 (pre-intervention) and October and December 2021 (post-intervention), weekly surface sampling was performed in the newborn unit and labour ward. The training package was delivered in October 2021, after which their surface microbiological contamination deteriorated in both clinical settings. While some cleaning standards improved, critical aspects such as using fresh cleaning cloths and the one-swipe method did not. Interviews with senior departmental and hospital management staff revealed ongoing challenges in the health system that hindered the ability to improve cleaning practices, including COVID-19, understaffing, disruptions to water supply and shortages of cleaning materials. CONCLUSIONS Keeping a hospital clean is fundamental to good care, but training hospital cleaning staff in this low-income country neonatal unit failed to reduce surface contamination levels. Further qualitative investigation revealed multiple external factors that challenged any possible impact of the cleaning programme. Further work is needed to address barriers to hospital cleaning in low-income hospitals.
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Affiliation(s)
- Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Atlantic Boulevard, Fajara, The Gambia.
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK.
| | - Giorgia Gon
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Saffiatou Darboe
- Research Microbiology Laboratory, MRC Unit The Gambia at LSHTM, Fajara, The Gambia
- AMR Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Isatou C M Sey
- Research Microbiology Laboratory, MRC Unit The Gambia at LSHTM, Fajara, The Gambia
| | - Oluwatosin Nkereuwem
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Atlantic Boulevard, Fajara, The Gambia
| | - Lamin Leigh
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Nfamara Camara
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Atlantic Boulevard, Fajara, The Gambia
| | - Lamin Makalo
- Department of Paediatrics, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Abdoulie Keita
- Department of Obstetrics and Gynaecology, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Stephanie J Dancer
- Department of Microbiology, NHS Lanarkshire and School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Wendy Graham
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Alexander M Aiken
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
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Santinon C, Borges A, Simões M, Gonçalves ASC, Beppu MM, Vieira MGA. Visible-light photoactivated proanthocyanidin and kappa-carrageenan coating with anti-adhesive properties against clinically relevant bacteria. Int J Biol Macromol 2024; 263:130611. [PMID: 38447837 DOI: 10.1016/j.ijbiomac.2024.130611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/14/2024] [Accepted: 03/02/2024] [Indexed: 03/08/2024]
Abstract
The increase of bacterial resistance to antibiotics is a growing concern worldwide and the search for new therapies could cost billions of dollars and countless lives. Inert surfaces are major sources of contamination due to easier adhesion and formation of bacterial biofilms, hindering the disinfection process. Therefore, the objective of this study was to develop a photoactivatable and anti-adhesive kappa-carrageenan coating using proanthocyanidin as a photosensitizer. The complete reduction (>5-log10 CFU/cm3) of culturable cells of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa pathogens was achieved after 30 min of exposure to visible light (420 nm; 30 mW/cm2) with 5 % (w/v) of the photosensitizer. Cell membrane damage was confirmed by measuring potassium leakage, epifluorescence microscopy and bacterial motility analysis. Overall, visible light irradiation on coated solid surfaces mediated by proanthocyanidin showed no cytotoxicity and inactivated clinically important pathogens through the generation of reactive oxygen species, inhibiting bacterial initial adhesion. The developed coating is a promising alternative for a wide range of applications related to surface disinfection and food biopreservation.
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Affiliation(s)
- Caroline Santinon
- ªSchool of Chemical Engineering, University of Campinas - UNICAMP, Albert Einstein Av., 500, 13083-852 Campinas, SP, Brazil
| | - Anabela Borges
- LEPABE-Laboratory for Process Engineering, Environment, Biotechnology and Energy, Department of Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias, s/n, 4200-465 Porto, Portugal
| | - Manuel Simões
- LEPABE-Laboratory for Process Engineering, Environment, Biotechnology and Energy, Department of Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias, s/n, 4200-465 Porto, Portugal
| | - Ariana S C Gonçalves
- LEPABE-Laboratory for Process Engineering, Environment, Biotechnology and Energy, Department of Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias, s/n, 4200-465 Porto, Portugal
| | - Marisa Masumi Beppu
- ªSchool of Chemical Engineering, University of Campinas - UNICAMP, Albert Einstein Av., 500, 13083-852 Campinas, SP, Brazil
| | - Melissa Gurgel Adeodato Vieira
- ªSchool of Chemical Engineering, University of Campinas - UNICAMP, Albert Einstein Av., 500, 13083-852 Campinas, SP, Brazil.
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10
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Moreira da Silva J, Menezes J, Fernandes L, Marques C, Costa SS, Timofte D, Amaral A, Pomba C. Dynamics of bla OXA-23 gene transmission in Acinetobacter spp. from contaminated veterinary environmental surfaces: an emerging One Health threat? J Hosp Infect 2024; 146:116-124. [PMID: 38365067 DOI: 10.1016/j.jhin.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii is a common pathogen associated with healthcare-acquired infections, and robust infection prevention and control protocols exist in human healthcare settings. In contrast, infection prevention and control (IPC) standards are limited in veterinary medicine, necessitating further investigation. AIM Examine the possible transmission of carbapenem-resistant Acinetobacter spp. in a veterinary practice where a cat was diagnosed with an OXA-23-producing A. baumannii ST2 strain. METHODS Environmental samples together with nasal and hand swabs from the veterinary personnel were collected. All swabs were screened for the presence of extended-spectrum-β-lactamase- and carbapenemase-producing Enterobacterales, meticillin-resistant staphylococcus and multi-drug-resistant Acinetobacter spp. Whole-genome sequencing was performed for carbapenemase-producing strains. RESULTS Of the veterinary staff, 60% carried meticillin-resistant Staphylococcus epidermidis. Environmental evaluation showed that 40% (N=6/15) of the surfaces analysed by contact plates and 40% (N=8/20) by swabs failed the hygiene criteria. Assessment of the surfaces revealed contamination with five OXA-23-producing Acinetobacter spp. strains: an OXA-23-producing Acinetobacter schindleri on the weight scale in the waiting room; and four OXA-23-producing Acinetobacter lwoffii strains, on different surfaces of the treatment room. The blaOXA-23 gene was located on the same plasmid-carrying Tn2008 across the different Acinetobacter spp. strains. These plasmids closely resemble a previously described OXA-23-encoding plasmid from a human Portuguese nosocomial Acinetobacter pittii isolate. Distinctly, the OXA-23-producing A. baumannii ST2 clinical strain had the resistant gene located on Tn2006, possibly inserted on the chromosome. CONCLUSION The detection of an OXA-23-producing A. baumannii ST2 veterinary clinical strain is of concern for companion animal health and infection, prevention and control. This study established the dynamic of transmission of the plasmid-mediated blaOXA-23 gene on critical surfaces of a small animal veterinary practice. The genetic resemblance to a plasmid found in human nosocomial settings suggests a potential One Health link.
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Affiliation(s)
- J Moreira da Silva
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; AL4AnimalS - Associate Laboratory for Animal and Veterinary Sciences, Lisbon, Portugal
| | - J Menezes
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; AL4AnimalS - Associate Laboratory for Animal and Veterinary Sciences, Lisbon, Portugal
| | - L Fernandes
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; AL4AnimalS - Associate Laboratory for Animal and Veterinary Sciences, Lisbon, Portugal
| | - C Marques
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; AL4AnimalS - Associate Laboratory for Animal and Veterinary Sciences, Lisbon, Portugal; Faculty of Veterinary Medicine, Lusófona University, University Centre of Lisbon, Lisbon, Portugal
| | - S S Costa
- Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisbon, Portugal
| | - D Timofte
- Institute of Infection, Veterinary and Ecological Sciences, Department of Veterinary Anatomy, Physiology and Pathology, School of Veterinary Science, University of Liverpool, Leahurst, UK
| | - A Amaral
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; AL4AnimalS - Associate Laboratory for Animal and Veterinary Sciences, Lisbon, Portugal; Science and Technology School, University of Évora, Évora, Portugal
| | - C Pomba
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal; AL4AnimalS - Associate Laboratory for Animal and Veterinary Sciences, Lisbon, Portugal; Genevet™, Veterinary Molecular Diagnostic Laboratory, Carnaxide, Portugal.
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11
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Ishino N, Miyaji C, Ogata M, Inada M, Nagata M, Shimamoto M. Applicability of the ATP assay in monitoring the cleanliness of hospital environments. Infect Dis Health 2024; 29:32-38. [PMID: 37989685 DOI: 10.1016/j.idh.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/24/2023] [Accepted: 09/24/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The adenosine triphosphate (ATP) assay is widely used for simple and rapid evaluation of the cleanliness of environmental surfaces. However, there remain concerns regarding the reliability of the ATP assay in hospital settings. This study aimed to assess whether the ATP assay could detect inadequate cleaning within hospital environments as well as monitor the effectiveness of routine cleaning. METHODS The cleanliness of seven types of high-touch surfaces in operating rooms that were routinely cleaned was evaluated by testing the ATP assay and aerobic colony counts (ACC). For pressure redistribution mattresses (Soft-nurse®) that were found to be particularly at risk of infection, cleaning methods were improved, and the effectiveness of these improvements was monitored using the same two methods. RESULTS The ATP assay quantitatively detected contamination on seven high-touch surfaces but showed no correlation with ACC. However, a significant positive correlation between luminescence and ACC was found on one specific surface, allowing for determining a theoretical cutoff value. Additionally, the ATP assay effectively identified the risk of future infection, which the ACC test could not assess. CONCLUSIONS The ATP assay can monitor the effectiveness of routine cleaning by setting a theoretical cutoff value for each subject. The method provides quantitative and meaningful values when used with an understanding of its limitations.
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Affiliation(s)
- Naoaki Ishino
- Faculty of Health and Medical Sciences, Hokuriku University, 1-1 Taiyogaoka, Kanazawa, Ishikawa 920-1180, Japan; Division of Respiratory and Circulatory Systems, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-ku, Osaka 530-8480, Japan.
| | - Chiharu Miyaji
- Department of Nursing, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-ku, Osaka 530-8480, Japan
| | - Megumi Ogata
- Department of Nursing, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-ku, Osaka 530-8480, Japan
| | - Miki Inada
- Department of Nursing, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-ku, Osaka 530-8480, Japan
| | - Mayu Nagata
- Department of Nursing Management, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-ku, Osaka 530-8480, Japan
| | - Mayumi Shimamoto
- Department of Nursing, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-ku, Osaka 530-8480, Japan
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Odeh Z, Abatli S, Qadi M. Radiology Department: A Potential Source of Multidrug-Resistant Microorganisms: A Cross-Sectional Study at Tertiary Hospital, Palestine. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:4441338. [PMID: 38146333 PMCID: PMC10749721 DOI: 10.1155/2023/4441338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/10/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023]
Abstract
Introduction Globally, healthcare facilities face a great challenge in the form of hospital-acquired infections (HAIs). Aside from the morbidity and mortality they cause, these illnesses are also extremely costly. Research on infection transmission in the medical field has been considerable, but not so much in the radiology department. Aim This study aims to identify the presence of multidrug-resistant (MDR) microbes on surfaces that are frequently touched in computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), plain X-ray examination rooms, and portable radiography that are susceptible to contamination as well as to investigate the potential dangers of contracting MDR organisms to patients and healthcare providers. Materials and Method. In this study, 160 swab samples were collected from the radiology department during May and June 2022. Samples were obtained from 80 predefined surfaces twice within and outside of CT and MRI examination rooms as well as from US and plain X-ray machines and portable X-ray machines. Samples were taken at 7:00 a.m. using cotton swabs following the regular cleaning procedure. Bacterial colony-forming units (CFUs) per square centimeter were calculated after swabbing a 100 cm2 surface. Results Nearly all of the surfaces tested had bacterial CFUs. The highest contamination rate was found on keyboards ranging from (1.2-8) CFU/cm2, the sides of patient tables (1.2-20) CFU/cm2, knee coil (2.4-3) CFU/cm2, and patient leg supports (1.2-8) CFU/cm2. A noticeable increase in the contamination was noticed in June compared to May, and this was consistent with the increase in the number of isolated patients in the hospital, the workload in the radiology department, and the number of patients referred to the hospital. In our study, none of the examined sites showed contamination with MDR Gram-negative bacteria such as extended-spectrum beta-lactamases producing Enterobacterales (ESPL) or Carbapenemase-producing Enterobacterales (CPE). On the other hand, methicillin-resistant Staphylococcus (MRS), vancomycin-resistant Staphylococcus (VRS), and vancomycin-resistant Enterococcus (VRE) were detected. Conclusion All of the radiology department equipment and sites could be a source of bacterial infection including MDR, so the obligatory and committed disinfection protocol must be revised and implemented in the morning and between patients.
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Affiliation(s)
- Zena Odeh
- Department of Medical and Health Sciences, Faculty of Graduate Studies, An-Najah National University, P.O. Box. 7, Nablus, State of Palestine
- Department of Radiology, An-Najah National University Hospital, Nablus, State of Palestine
| | - Safaa Abatli
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box. 7, Nablus, State of Palestine
| | - Mohammad Qadi
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box. 7, Nablus, State of Palestine
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Hailemichael T, Girma L, Fissiha P, Geteneh A, Kassa T. Isolation of virulent phages against multidrug-resistant Acinetobacter baumannii recovered from inanimate objects of Jimma Medical Center, Southwest Ethiopia. BMC Infect Dis 2023; 23:820. [PMID: 37993809 PMCID: PMC10666304 DOI: 10.1186/s12879-023-08823-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Because of the multidrug resistance features of Acinetobacter baumannii, endurance to diverse conditions, and causing health fatalities in healthcare settings, the global health system is looking for the development of new antimicrobials for such bacteria. As the new antimicrobial drugs pipeline is running dry, it is imperative to look for eco-friendly bio-control strategies. In this regard, phages are one to combat the biofilm producer and MDR A. baumannii. Thus, the study aimed to isolate and examine the role of phages against biofilm producers and MDR A. baumannii from inanimate objects at Jimma Medical Center (JMC), Ethiopia. METHOD Institution-based cross-sectional study was conducted from June to November 2019. A total of 309 swab samples were collected from inanimate objects and the environment in JMC. Isolation of A. baumannii, antimicrobial susceptibility testing, and biofilm detection were carried out according to standard protocol. Kirby Bauer disk diffusion and microliter plate were methods for AST and biofilm detection, respectively. Specific phage was isolated and characterized from sewage at JMC compound. The data were analyzed by SPSS version 25.0, and chi-square (X2) cross-tabulation was used to determine the correlation of variables. A P-value of < 0.05 was considered a statistically significant association. RESULT A. baumannii from inanimate objects and surfaces of different environments at JMC was detected in 6.5% of the samples. From 20 of the isolates, 85% were biofilm producers, and 60% were MDR. The lytic phage isolated specifically against A. baumannii was found host specific, and thermally stable ranging from 10-50°C. The phage was active against 42% of MDR A. baumannii, 40% of both biofilm-producing and MDR A. baumannii (MDRAB), and 35.3% of the biofilm-producing isolates. CONCLUSION The good activity of phages towards MDRAB isolates, its biofilm degradation capability, thermal stability, and host specificity in our study encourages viewing the potential use of phages as a bio-control agent besides the routine cleansing agents. Therefore, we recommend isolation of specific phages in the eradication of MDRAB from health facilities with additional efforts to characterize in detail and assess their efficacy in animal models.
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Affiliation(s)
- Terefe Hailemichael
- Department of Medical Laboratory Science, Mizan Aman College of Health Sciences, Aman, Ethiopia
| | - Lencho Girma
- Department of Medical Laboratory Science, College of Health Sciences, Bonga University, Bonga, Ethiopia
| | - Paulos Fissiha
- Amhara Public Health Institute (APHI), Bahir Dar, Ethiopia
| | - Alene Geteneh
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Tesfaye Kassa
- School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
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14
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Redondo González O, Martínez Ramírez NM, Alhama Blanco PJ. Non-touch treatment to solve the persistent contamination of culture plates with Aspergillus niger in a clinical microbiology laboratory of Spain. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:115734-115744. [PMID: 37889415 DOI: 10.1007/s11356-023-30433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
A pseudo-outbreak of Aspergillus caused by false positive cultures can have a high sanitary impact. We determined the effectiveness (fungal load elimination) of a non-touch disinfection system, vs conventional disinfection methods, to solve steady contamination of culture plates with Aspergillus niger at a clinical microbiology laboratory. Routine cleaning-disinfection (RCD), intensive cleaning-disinfection (ICD), and terminal airborne disinfection (TAD) were employed in stages. Air sampling was carried out before and after each procedure. The effectiveness of TAD on contact surfaces was tested by surface sampling. After RCD, ICD, and TAD, there was a mean decrease of 5.4 (95% CI = 1.8-9.0), 19.2 (95% CI = 12.4-26.0), and 4.4 (95% CI = 2.5-6.3) CFU per tested area, and 46.2%, 21.7%, and 95.5% of contaminated areas became sterile, respectively. There was a mean decrease of 30.6 CFU per tested surface (p < 0.0007) and 50% of tested surfaces became sterile. Global effectiveness of RCD, ICD, and TAD was 68.8% (95% CI = 68.5-69.1), 82.2% (95% CI = 82.1-82.3), and 99.0% (95% CI = 98.8-99.2), respectively. The effectiveness was higher with TAD (4.1 CFU/cm2 less than with ICD; p = 0.0290). No further contamination has occurred since then. When construction and renovation activities are discarded and RCD and ICD practices are insufficient, non-touch disinfection remove residual dust contamination and avoid recurrence.
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Affiliation(s)
- Olga Redondo González
- Preventive Medicine Service, University Hospital of Guadalajara, C/ Donantes de Sangre S/N, 19002, Guadalajara, Spain.
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid-Barcelona Highway 33,600, 28805, Alcalá de Henares (Madrid), Spain.
| | | | - Pablo J Alhama Blanco
- Electro-Medical Maintenance Service, University Hospital of Guadalajara, C/ Donantes de Sangre S/N, 19002, Guadalajara, Spain
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15
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Carling PC, Parry MF, Olmstead R. Environmental approaches to controlling Clostridioides difficile infection in healthcare settings. Antimicrob Resist Infect Control 2023; 12:94. [PMID: 37679758 PMCID: PMC10483842 DOI: 10.1186/s13756-023-01295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023] Open
Abstract
As today's most prevalent and costly healthcare-associated infection, hospital-onset Clostridioides difficile infection (HO-CDI) represents a major threat to patient safety world-wide. This review will discuss how new insights into the epidemiology of CDI have quantified the prevalence of C. difficile (CD) spore contamination of the patient-zone as well as the role of asymptomatically colonized patients who unavoidable contaminate their near and distant environments with resilient spores. Clarification of the epidemiology of CD in parallel with the development of a new generation of sporicidal agents which can be used on a daily basis without damaging surfaces, equipment, or the environment, led to the research discussed in this review. These advances underscore the potential for significantly mitigating HO-CDI when combined with ongoing programs for optimizing the thoroughness of cleaning as well as disinfection. The consequence of this paradigm-shift in environmental hygiene practice, particularly when combined with advances in hand hygiene practice, has the potential for significantly improving patient safety in hospitals globally by mitigating the acquisition of CD spores and, quite plausibly, other environmentally transmitted healthcare-associated pathogens.
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16
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Dancer SJ. Hospital cleaning: past, present, and future. Antimicrob Resist Infect Control 2023; 12:80. [PMID: 37608396 PMCID: PMC10464435 DOI: 10.1186/s13756-023-01275-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION The importance of hospital cleaning for controlling healthcare-associated infection (HAI) has taken years to acknowledge. This is mainly because the removal of dirt is inextricably entwined with gender and social status, along with lack of evidence and confusion over HAI definitions. Reducing so-called endogenous infection due to human carriage entails patient screening, decolonisation and/or prophylaxis, whereas adequate ventilation, plumbing and cleaning are needed to reduce exogenous infection. These infection types remain difficult to separate and quantitate. Patients themselves demonstrate wide-ranging vulnerability to infection, which further complicates attempted ranking of control interventions, including cleaning. There has been disproportionate attention towards endogenous infection with less interest in managing environmental reservoirs. QUANTIFYING CLEANING AND CLEANLINESS Finding evidence for cleaning is compromised by the fact that modelling HAI rates against arbitrary measurements of cleaning/cleanliness requires universal standards and these are not yet established. Furthermore, the distinction between cleaning (soil removal) and cleanliness (soil remaining) is usually overlooked. Tangible bench marking for both cleaning methods and all surface types within different units, with modification according to patient status, would be invaluable for domestic planning, monitoring and specification. AIMS AND OBJECTIVES This narrative review will focus on recent history and current status of cleaning in hospitals. While its importance is now generally accepted, cleaning practices still need attention in order to determine how, when and where to clean. Renewed interest in removal and monitoring of surface bioburden would help to embed risk-based practice in hospitals across the world.
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Affiliation(s)
- Stephanie J Dancer
- Department of Microbiology, NHS Lanarkshire & School of Applied Sciences, Edinburgh Napier University, Scotland, UK.
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17
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Nygren E, Gonzales Strömberg L, Logenius J, Husmark U, Löfström C, Bergström B. Potential sources of contamination on textiles and hard surfaces identified as high-touch sites near the patient environment. PLoS One 2023; 18:e0287855. [PMID: 37418451 PMCID: PMC10328241 DOI: 10.1371/journal.pone.0287855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/14/2023] [Indexed: 07/09/2023] Open
Abstract
The hospital environment represents an important mediator for the transmission of healthcare-associated infections through direct and indirect hand contact with hard surfaces and textiles. In this study, bacteria on high-touch sites, including textiles and hard surfaces in two care wards in Sweden, were identified using microbiological culture methods and 16S rDNA sequencing. During a cross-sectional study, 176 high-touch hard surfaces and textiles were identified and further analysed using microbiological culture for quantification of total aerobic bacteria, Staphylococcus aureus, Clostridium difficile and Enterobacteriacae. The bacterial population structures were further analysed in 26 samples using 16S rDNA sequencing. The study showed a higher frequency of unique direct hand-textile contacts (36 per hour), compared to hard surfaces (2.2 per hour). Hard surfaces met the recommended standard of ≤ 5 CFU/cm2 for aerobic bacteria and ≤ 1 CFU/cm2 for S. aureus (53% and 35%, respectively) to a higher extent compared to textiles (19% and 30%, respectively) (P = 0.0488). The number of bacterial genera was higher on textiles than on the hard surfaces. Staphylococcus (30.4%) and Corynebacterium (10.9%) were the most representative genera for textiles and Streptococcus (13.3%) for hard surfaces. The fact that a big percentage of the textiles did not fulfil the criteria for cleanliness, combined with the higher bacterial diversity, compared to hard surfaces, are indicators that textiles were bacterial reservoirs and potential risk vectors for bacterial transmission. However, since most of the bacteria found in the study belonged to the normal flora, it was not possible to draw conclusions of textiles and hard surfaces as sources of healthcare associated infections.
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Affiliation(s)
- Erik Nygren
- RISE Research Institutes of Sweden, Agriculture and Food, Borås, Sweden
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18
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Roberts LW, Enoch DA, Khokhar F, Blackwell GA, Wilson H, Warne B, Gouliouris T, Iqbal Z, Török ME. Long-read sequencing reveals genomic diversity and associated plasmid movement of carbapenemase-producing bacteria in a UK hospital over 6 years. Microb Genom 2023; 9:mgen001048. [PMID: 37405394 PMCID: PMC10438816 DOI: 10.1099/mgen.0.001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/22/2023] [Indexed: 07/06/2023] Open
Abstract
Healthcare-associated infections (HCAIs) affect the most vulnerable people in society and are increasingly difficult to treat in the face of mounting antimicrobial resistance (AMR). Routine surveillance represents an effective way of understanding the circulation and burden of bacterial resistance and transmission in hospital settings. Here, we used whole-genome sequencing (WGS) to retrospectively analyse carbapenemase-producing Gram-negative bacteria from a single hospital in the UK over 6 years (n=165). We found that the vast majority of isolates were either hospital-onset (HAI) or HCAI. Most carbapenemase-producing organisms were carriage isolates, with 71 % isolated from screening (rectal) swabs. Using WGS, we identified 15 species, the most common being Escherichia coli and Klebsiella pneumoniae. Only one significant clonal outbreak occurred during the study period and involved a sequence type (ST)78 K. pneumoniae carrying bla NDM-1 on an IncFIB/IncHI1B plasmid. Contextualization with public data revealed little evidence of this ST outside of the study hospital, warranting ongoing surveillance. Carbapenemase genes were found on plasmids in 86 % of isolates, the most common types being bla NDM- and bla OXA-type alleles. Using long-read sequencing, we determined that approximately 30 % of isolates with carbapenemase genes on plasmids had acquired them via horizontal transmission. Overall, a national framework to collate more contextual genomic data, particularly for plasmids and resistant bacteria in the community, is needed to better understand how carbapenemase genes are transmitted in the UK.
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Affiliation(s)
- Leah W. Roberts
- European Molecular Biology Laboratory's European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
- Department of Medicine, University of Cambridge, England, UK
| | - David A. Enoch
- Clinical Microbiology & Public Health Laboratory, UK Health Security Agency, Cambridge, UK
| | - Fahad Khokhar
- Centre for Therapeutic Immunology and Infectious Diseases, University of Cambridge, Cambridge, UK
| | | | - Hayley Wilson
- Department of Medicine, University of Cambridge, England, UK
| | - Ben Warne
- Department of Medicine, University of Cambridge, England, UK
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Theodore Gouliouris
- Department of Medicine, University of Cambridge, England, UK
- Clinical Microbiology & Public Health Laboratory, UK Health Security Agency, Cambridge, UK
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Zamin Iqbal
- European Molecular Biology Laboratory's European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, UK
| | - M. Estée Török
- Department of Medicine, University of Cambridge, England, UK
- Clinical Microbiology & Public Health Laboratory, UK Health Security Agency, Cambridge, UK
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Maurici M, Pica F, D'Alò GL, Cicciarella Modica D, Distefano A, Gorjao M, Simonelli MS, Serafinelli L, De Filippis P. Bacterial Contamination of Healthcare Students' Mobile Phones: Impact of Specific Absorption Rate (SAR), Users' Demographics and Device Characteristics on Bacterial Load. Life (Basel) 2023; 13:1349. [PMID: 37374131 DOI: 10.3390/life13061349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
We quantitatively and qualitatively evaluated the bacterial contamination of mobile phones (MPs) in relation to users' demographics, habits, and device characteristics by administering questionnaires to 83 healthcare university students and sampling their MPs by following a cross-sectional design. The heterotrophic plate count (HPC) at 22 °C (HPC 22 °C) and 37 °C (HPC 37 °C), Enterococci, Gram-negative bacteria, and Staphylococci were evaluated. Higher bacterial loads were detected for HPC 37 °C and Staphylococci (416 and 442 CFU/dm2, respectively), followed by HPC 22 °C, Enterococci, and Gram-negative bacteria; the vast majority of samples were positive for HPC 37 °C, HPC 22 °C, and Staphylococci (98%), while Enterococci (66%) and Gram-negative bacteria (17%) were detected less frequently. A statistically significant positive correlation (r = 0.262, p < 0.02) was found between the European head specific absorption rate (SAR) and both HPC 37 °C and Staphylococci; Enterococci showed a strong, significant correlation with HPC 37 °C, HPC 22 °C, and Gram-negative bacteria (r = 0.633, 0.684, 0.884) and a moderate significant correlation with Staphylococci (r = 0.390). Significant differences were found between HPC 22 °C and the type of internship attendance, with higher loads for Medicine. Students with a daily internship attendance had higher HPC 22 °C levels than those attending <6 days/week. Our study showed that bacteria can survive on surfaces for long periods, depending on the user's habits and the device's characteristics.
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Affiliation(s)
- Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesca Pica
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Gian Loreto D'Alò
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- District 6, Local Health Authority Roma 2, 00100 Rome, Italy
| | | | - Alessandra Distefano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Margarida Gorjao
- School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Maria Sofia Simonelli
- School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Livio Serafinelli
- School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Patrizia De Filippis
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
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Jang JH, Jeong IS, Kang CM. The effect of decontamination using quaternary ammonium chloride on the bacterial burden of hospital privacy curtains. Nurs Health Sci 2023. [PMID: 37263618 DOI: 10.1111/nhs.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 06/03/2023]
Abstract
This quasi-experimental study aimed to identify the effect of decontamination using quaternary ammonium chloride (QAC) on bacterial burden on hospital privacy curtains. The objects were the high-touch edges of 66 polyester curtains in inpatient wards. The decontamination was performed daily (n = 22), twice-weekly (n = 22), or not performed (n = 22) for 28 days. The bacterial burden on the curtains was measured based on the number of bacteria, the proportion of curtains with >2.5 colony-forming unit/cm2 , and the proportion of curtains with multidrug-resistant organisms (MDROs). As a result, the daily or twice-weekly decontamination groups showed a significantly lower increase in bacterial burden than the no-decontamination group overall and at all four posttest times. On day 28, daily decontamination showed a lower increase in the number of bacteria (p < 0.001) and proportions of curtains with >2.5 colony form units/cm2 (p < 0.001) than the no-decontamination condition, and in the number of curtains with MDROs than twice-weekly decontamination. In conclusion, decontamination of curtains using QAC helps reduce bacterial burden, and daily decontamination is recommended up to 28 days after installation.
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Affiliation(s)
- Jin-Hwa Jang
- Infection Control Unit, Dongnam Institute of Radiological & Medical Sciences, Busan, Republic of Korea
| | - Ihn Sook Jeong
- College of Nursing, Pusan National University, Yangsan, Gyeongsangnam-do, Republic of Korea
| | - Chan Mi Kang
- College of Nursing, Pusan National University, Yangsan, Gyeongsangnam-do, Republic of Korea
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21
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Weber J, Henssler L, Zeman F, Pfeifer C, Alt V, Nerlich M, Huber M, Herbst T, Koller M, Schneider-Brachert W, Kerschbaum M, Holzmann T. Nanosilver/DCOIT-containing surface coating effectively and constantly reduces microbial load in emergency room surfaces. J Hosp Infect 2023; 135:90-97. [PMID: 36958698 DOI: 10.1016/j.jhin.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Colonization of near-patient surfaces in hospitals plays an important role as a source of healthcare-associated infections. Routine disinfection methods only result in short-term elimination of pathogens. AIM To investigate the efficiency of a newly developed antimicrobial coating containing nanosilver in long-term reduction of bacterial burden in hospital surfaces to close the gap between routine disinfection cycles. METHODS In this prospective, double-blinded trial, frequently touched surfaces of a routinely used treatment room in an emergency unit of a level-I hospital were treated with a surface coating (nanosilver/DCOIT-coated surface, NCS) containing nanosilver particles and another organic biocidal agent (4,5-dichloro-2-octyl-4-isothiazolin-3-one, DCOIT), whereas surfaces of another room were treated with a coating missing both the nanosilver- and DCOIT-containing ingredient and served as control. Bacterial contamination of the surfaces was examined using contact plates and liquid-based swabs daily for a total trial duration of 90 days. After incubation, total microbial counts and species were assessed. FINDINGS In a total of 2880 antimicrobial samples, a significant reduction of the overall bacterial load was observed in the NCS room (median: 0.31 cfu/cm2; interquartile range: 0.00-1.13) compared with the control coated surfaces (0.69 cfu/cm2; 0.06-2.00; P < 0.001). The nanosilver- and DCOIT-containing surface coating reduced the relative risk of a critical bacterial load (defined as >5 cfu/cm2) by 60% (odds ratio 0.38, P < 0.001). No significant difference in species distribution was detected between NCS and control group. CONCLUSION Nanosilver-/DCOIT-containing surface coating has shown efficiency for sustainable reduction of bacterial load of frequently touched surfaces in a clinical setting.
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Affiliation(s)
- J Weber
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L Henssler
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany.
| | - F Zeman
- Center of Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - C Pfeifer
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany; Department of Orthopedic Trauma and Hand Surgery, Innklinikum Altötting-Mühldorf, Altötting, Germany
| | - V Alt
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Nerlich
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Huber
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - T Herbst
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Koller
- Center of Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - W Schneider-Brachert
- Institute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - M Kerschbaum
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - T Holzmann
- Institute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
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22
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van der Schoor AS, Severin JA, Klaassen CHW, Gommers D, Bruno MJ, Hendriks JM, Voor In 't Holt AF, Vos MC. Environmental contamination with highly resistant microorganisms after relocating to a new hospital building with 100% single-occupancy rooms: A prospective observational before-and-after study with a three-year follow-up. Int J Hyg Environ Health 2023; 248:114106. [PMID: 36621268 DOI: 10.1016/j.ijheh.2022.114106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Inanimate surfaces within hospitals can be a source of transmission for highly resistant microorganisms (HRMO). While many hospitals are transitioning to single-occupancy rooms, the effect of single-occupancy rooms on environmental contamination is still unknown. We aimed to determine differences in environmental contamination with HRMO between an old hospital building with mainly multiple-occupancy rooms and a new hospital building with 100% single-occupancy rooms, and the environmental contamination in the new hospital building during three years after relocating. METHODS Environmental samples were taken twice in the old hospital, and fifteen times over a three-year period in the new hospital. Replicate Organism Direct Agar Contact-plates (RODACs) were used to determine colony forming units (CFU). Cotton swabs premoistened with PBS were used to determine presence of methicillin-resistant Staphylococcus aureus, carbapenemase-producing Pseudomonas aeruginosa, highly resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii, and vancomycin-resistant Enterococcus faecium. All identified isolates were subjected to whole genome sequencing (WGS) using Illumina technology. RESULTS In total, 4993 hospital sites were sampled, 724 in the old and 4269 in the new hospital. CFU counts fluctuated during the follow-up period in the new hospital building, with lower CFU counts observed two- and three years after relocating, which was during the COVID-19 pandemic. The CFU counts in the new building were equal to or surpassed the CFU counts in the old hospital building. In the old hospital building, 24 (3.3%) sample sites were positive for 49 HRMO isolates, compared to five (0.1%) sample sites for seven HRMO isolates in the new building (P < 0.001). In the old hospital, 89.8% of HRMO were identified from the sink plug. In the new hospital, 71.4% of HRMO were identified from the shower drain, and no HRMO were found in sinks. DISCUSSION Our results indicate that relocating to a new hospital building with 100% single-occupancy rooms significantly decreases HRMO in the environment. Given that environmental contamination is an important source for healthcare associated infections, this finding should be taken into account when considering hospital designs for renovations or the construction of hospitals.
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Affiliation(s)
- Adriënne S van der Schoor
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Corné H W Klaassen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Johanna M Hendriks
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Casini B, Tuvo B, Scarpaci M, Totaro M, Badalucco F, Briani S, Luchini G, Costa AL, Baggiani A. Implementation of an Environmental Cleaning Protocol in Hospital Critical Areas Using a UV-C Disinfection Robot. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4284. [PMID: 36901293 PMCID: PMC10001687 DOI: 10.3390/ijerph20054284] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
Improving the cleaning and disinfection of high-touch surfaces is one of the core components of reducing healthcare-associated infections. The effectiveness of an enhanced protocol applying UV-C irradiation for terminal room disinfection between two successive patients was evaluated. Twenty high-touch surfaces in different critical areas were sampled according to ISO 14698-1, both immediately pre- and post-cleaning and disinfection standard operating protocol (SOP) and after UV-C disinfection (160 sampling sites in each condition, 480 in total). Dosimeters were applied at the sites to assess the dose emitted. A total of 64.3% (103/160) of the sampling sites tested after SOP were positive, whereas only 17.5% (28/160) were positive after UV-C. According to the national hygienic standards for health-care setting, 9.3% (15/160) resulted in being non-compliant after SOP and only 1.2% (2/160) were non-compliant after UV-C disinfection. Operation theaters was the setting that resulted in being less compliant with the standard limit (≤15 colony-forming unit/24 cm2) after SOP (12%, 14/120 sampling sites) and where the UV-C treatment showed the highest effectiveness (1.6%, 2/120). The addition of UV-C disinfection to the standard cleaning and disinfection procedure had effective results in reducing hygiene failures.
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Affiliation(s)
- Beatrice Casini
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Benedetta Tuvo
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Michela Scarpaci
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Michele Totaro
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Federica Badalucco
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Silvia Briani
- Hospital Management, University Hospital of Pisa, 56126 Pisa, Italy
| | - Grazia Luchini
- Hospital Management, University Hospital of Pisa, 56126 Pisa, Italy
| | - Anna Laura Costa
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Angelo Baggiani
- Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
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24
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Wiatrowski M, Rosiak E, Czarniecka-Skubina E. Surface Hygiene Evaluation Method in Food Trucks as an Important Factor in the Assessment of Microbiological Risks in Mobile Gastronomy. Foods 2023; 12:772. [PMID: 36832855 PMCID: PMC9955632 DOI: 10.3390/foods12040772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
Street food outlets are characterised by poor microbiological quality of the food and poor hygiene practices that pose a risk to consumer health. The aim of the study was to evaluate the hygiene of surfaces in food trucks (FT) using the reference method together with alternatives such as PetrifilmTM and the bioluminescence method. TVC, S. aureus, Enterobacteriaceae, E. coli, L. monocytogenes, and Salmonella spp. were assessed. The material for the study consisted of swabs and prints taken from five surfaces (refrigeration, knife, cutting board, serving board, and working board) in 20 food trucks in Poland. In 13 food trucks, the visual assessment of hygiene was very good or good, but in 6 FTs, TVC was found to exceed log 3 CFU/100 cm2 on various surfaces. The assessment of surface hygiene using various methods in the food trucks did not demonstrate the substitutability of culture methods. PetrifilmTM tests were shown to be a convenient and reliable tool for the monitoring of mobile catering hygiene. No correlation was found between the subjective visual method and the measurement of adenosine 5-triphosphate. In order to reduce the risk of food infections caused by bacteria in food trucks, it is important to introduce detailed requirements for the hygiene practices used in food trucks, including techniques for monitoring the cleanliness of surfaces coming into contact with food, in particular cutting boards and work surfaces. Efforts should be focused on introducing mandatory, certified training for food truck personnel in the field of microbiological hazards, appropriate methods of hygienisation, and hygiene monitoring.
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Affiliation(s)
| | | | - Ewa Czarniecka-Skubina
- Department of Food Gastronomy and Food Hygiene, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS), 166 Nowoursynowska Str., 02-787 Warsaw, Poland
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25
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Sarwar S, Saleem S, Shahzad F, Jahan S. Identifying and elucidating the resistance of Staphylococcus aureus isolated from hospital environment to conventional disinfectants. Am J Infect Control 2023; 51:178-183. [PMID: 35644295 DOI: 10.1016/j.ajic.2022.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Staphylococcus aureus is a nosocomial pathogen, detection and elucidation of its resistance mechanisms to conventional disinfectants may aid in limiting its spread on environmental surfaces in health care settings. In the current study, disinfectant susceptibility of S. aureus strains isolated from the hospital environment as well as possible associations between the presence of disinfectant-resistance genes and reduced susceptibility to disinfectants was investigated. METHODS A total of 245 samples were collected from the hospital environmental surfaces. The minimum inhibitory (MIC) and bactericidal concentrations (MBC) of disinfectants against S. aureus isolates were determined using the micro-broth dilution method. The qac genes (qacA, qacE, and qacΔE1) were detected by PCR and confirmed by sanger sequencing. RESULTS A total of 47 S. aureus strains were isolated, with more than 85% of them showing methicillin resistance. The qacA, qacE, and qac∆E1 genes were found in 23.4%, 29.7%, and 4.2% isolates respectively. All the isolates with qac genes had higher MIC and MBC values to selected disinfectants. CONCLUSIONS Significant methicillin resistant S. aureus (MRSA) contamination in the hospital environment was detected. Furthermore, higher qac gene frequencies were found in MRSA isolates that also correlated with higher MIC/MBC values to different disinfectants. The study proposes that hospitals should develop policies to determine disinfectant MICs against the common environmental isolates to contain the spread of resistant strains.
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Affiliation(s)
- Samreen Sarwar
- Department of Microbiology, University of Health Sciences, Lahore, Punjab, Pakistan.
| | - Sidrah Saleem
- Department of Microbiology, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Faheem Shahzad
- Department of Immunology, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Shah Jahan
- Department of Immunology, University of Health Sciences, Lahore, Punjab, Pakistan
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26
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Watson F, Wilks SA, Keevil CW, Chewins J. Evaluating the environmental microbiota across four National Health Service hospitals within England. J Hosp Infect 2023; 131:203-212. [PMID: 36343745 DOI: 10.1016/j.jhin.2022.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Hospital surfaces contaminated with microbial soiling, such as dry surface biofilms (DSBs), can act as a reservoir for pathogenic micro-organisms, and inhibit their detection and removal during routine cleaning. Studies have recognized that such increases in bioburden can hinder the impact of disinfectants and mask the detection of potential pathogens. Cleanliness within healthcare settings is often determined through routine culture-based analysis, whereby surfaces that exhibit >2.5 colony-forming units (CFU) per cm2 pose a risk to patient health; therefore, any underestimation could have detrimental effects. This study quantified microbial growth on high-touch surfaces in four hospitals in England over 19 months. This was achieved using environmental swabs to sample a variety of surfaces within close proximity of the patient, and plating these on to non-specific low nutrient detection agar. The presence of DSBs on surfaces physically removed from the environment was confirmed using real-time imaging through episcopic differential interference contrast microscopy combined with epifluorescence. Approximately two-thirds of surfaces tested exceeded the limit for cleanliness (median 2230 CFU/cm2), whilst 83% of surfaces imaged with BacLight LIVE/DEAD staining confirmed traces of biofilm. Differences in infection control methods, such as choice of surface disinfectants and cleaning personnel, were not reflected in the microbial variation observed and resulting risk to patients. This highlights a potential limitation in the effectiveness of the current standards for all hospital cleaning, and further development using representative clinical data is required to overcome this limitation.
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Affiliation(s)
- F Watson
- School of Biological Sciences, University of Southampton, Southampton, UK; Bioquell UK Ltd, Andover, UK
| | - S A Wilks
- School of Health Sciences, University of Southampton, Southampton, UK
| | - C W Keevil
- School of Biological Sciences, University of Southampton, Southampton, UK
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27
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Fahy S, O’Connor JA, Lucey B, Sleator RD. Hospital Reservoirs of Multidrug Resistant Acinetobacter Species-The Elephant in the Room! Br J Biomed Sci 2023; 80:11098. [PMID: 37020476 PMCID: PMC10069268 DOI: 10.3389/bjbs.2023.11098] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/09/2023] [Indexed: 04/07/2023]
Abstract
Environmental contamination is estimated to contribute to up to 20% of all hospital acquired infections. Acinetobacter baumannii is an example of one the most prevalent opportunistic pathogens causing severe and persistent infections in immunocompromised patients. It has proven ability to form biofilms, has significant associated multi-drug resistance and is able to transfer mobile genetic elements to other clinically relevant pathogens. All of these factors point to a definite utility of A. baumannii as an indicator organism for effectiveness of decontamination regimens as well as environmental screening. There is an increased cost, both financial and clinical, associated with multi drug resistant organisms, carbapenem resistant A. baumannii. With a dearth of new antimicrobials in development, now is the time to radically transform and lead the introduction of scientifically based environmental screening and microbiological verified decontamination to control the dissemination of further resistance.
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Affiliation(s)
- S. Fahy
- Department of Clinical Microbiology, Mercy University Hospital, Cork, Ireland
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
| | - J. A. O’Connor
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
| | - B. Lucey
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
- *Correspondence: B. Lucey,
| | - R. D. Sleator
- Department of Biological Sciences, Munster Technological University, Cork, Ireland
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28
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Maphossa V, Langa JC, Simbine S, Maússe FE, Kenga D, Relvas V, Chicamba V, Manjate A, Sacarlal J. Environmental bacterial and fungal contamination in high touch surfaces and indoor air of a paediatric intensive care unit in Maputo Central Hospital, Mozambique in 2018. Infect Prev Pract 2022; 4:100250. [PMID: 36204713 PMCID: PMC9530480 DOI: 10.1016/j.infpip.2022.100250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/03/2022] [Indexed: 12/01/2022] Open
Abstract
Background The hospital environment serves as a reservoir of microorganisms which may be associated with healthcare-associated infections (HCAI). The study of environmental contamination with microorganisms is a method for the assessment of hospital environmental hygiene. We sought to evaluate the environmental colonisation of a national reference hospital unit, using the total aerobic colony count (ACC) and the isolated microorganisms, as assessment tools. Methods A cross-sectional study was conducted in the Paediatric Intensive Care Unit (PICU) of the Hospital Central de Maputo during a four-week period in 2018. Surfaces and air were sampled before and after room cleaning, using swabs and passive air method. Those samples were processed at the microbiology laboratory where total ACC levels were evaluated, and microorganisms were isolated, identified and assessed for antibiotic susceptibility. Discussion Comparison of the total median ACC of the indoor air (287 cfu/m3 before and 195 cfu/m3 after) and surfaces (0.38 cfu/cm2 before and 0.33 cfu/cm2 after) before and after room cleaning did not show significant differences (P>0.05). Microorganisms of epidemiological importance, including coagulase negative staphylococci (CoNS), Klebsiella pneumoniae and Serratia odorifera were isolated and all of these three were multi-drug resistant (MDR). Conclusion The results showed controlled contamination levels on high touch surfaces in the patient environment and a high level of contamination of the indoor air suggesting deficiencies in the PICU environmental decontamination process. There was evidence of the presence of fungi and MDR species of epidemiological importance in the context of HCAI.
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Affiliation(s)
- Vânia Maphossa
- Centro de Treino de Polana Caniço, Instituto Nacional de Saúde, Mozambique
| | - José Carlos Langa
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Samuel Simbine
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Fabião Edmundo Maússe
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Darlene Kenga
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Ventura Relvas
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Valéria Chicamba
- Paediatric Intensive Care Unit, Hospital Central de Maputo, Mozambique
| | - Alice Manjate
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Jahit Sacarlal
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
- Corresponding author.
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29
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Alfy MM, El Sayed SB, El-Shokry M. Assessing decontamination practices at a medical microbiology research laboratory. JOURNAL OF BIOSAFETY AND BIOSECURITY 2022. [DOI: 10.1016/j.jobb.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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30
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Hiwar W, King M, Kharrufa H, Tidswell E, Fletcher LA, Noakes CJ. The impact of ventilation rate on reducing the microorganisms load in the air and on surfaces in a room-sized chamber. INDOOR AIR 2022; 32:e13161. [PMID: 36437677 PMCID: PMC9828490 DOI: 10.1111/ina.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Hospital-acquired infections (HAIs) are a global challenge incurring mortalities and high treatment costs. The environment plays an important role in transmission due to contaminated air and surfaces. This includes microorganisms' deposition from the air onto surfaces. Quantifying the deposition rate of microorganisms enables understanding surface contamination and can inform strategies to mitigate the infection risk. We developed and validated a novel Automated Multiplate Passive Air Sampling (AMPAS) device. This enables sequences of passive deposition samples to be collected over a controlled time period without human intervention. AMPAS was used with air sampling to measure the effect of ventilation rate and spatial location on the deposition rate of aerosolized Staphylococcus aureus in a 32 m3 chamber. Increasing the ventilation rate from 3 to 6 ACH results in a reduction of microbial load in the air and on surfaces by 45% ± 10% and 44% ± 32%, respectively. The deposition rate onto internal surfaces λd was calculated as 1.38 ± 0.48 h-1 . Samples of airborne and surface microorganisms taken closer to the ventilation supply showed a lower concentration than close to the extract. The findings support the importance of controlling the ventilation and the environmental parameters to mitigate both air and surface infection risks in the hospital environment.
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Affiliation(s)
- Waseem Hiwar
- School of Civil EngineeringUniversity of LeedsLeedsUK
| | | | - Harith Kharrufa
- Informatics and Telecommunications Public Company (ITPC)MOCMosulIraq
| | - Emma Tidswell
- School of Civil EngineeringUniversity of LeedsLeedsUK
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Zanen LA, Kusters JG, Overgaauw PAM. Zoonotic Risks of Sleeping with Pets. Pathogens 2022; 11:pathogens11101149. [PMID: 36297206 PMCID: PMC9606909 DOI: 10.3390/pathogens11101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Pets are increasingly becoming part of the family and interactions between pets and their owners is changing. This results in extended and more intimate contact between owners and their pets, which give rise to zoonotic risks. Objective: To establish the presence of potential zoonotic pathogens in pets that sleep with their owner. Methods: As a pilot study, a group of 28 healthy dogs and 22 healthy cats were monitored for the presence of the zoonotic parasites Cheyletiella, Ctenocephalides spp. and Toxocara spp., the dermatophyte Microsporum canis, and the bacteria Clostridium difficile, Salmonella spp., Campylobacter jejuni and Enterobacteriaceae. This was investigated by taking samples from the fur, the footpads and the animal bed. The owners filled in a questionnaire. Results: In total, 29 of the 50 pets (58%) slept on the bed, of which 15 pets (30%) slept in the bed (under the blankets). A total of 19/22 dogs (86%) and 7/22 cats (32%) tested positive for Enterobacteriaceae on the fur or footpads. Fleas were found in 5/22 of the cats’ (23%) and 2/28 of the dogs’ (7%) favourite sleeping spots. High levels of aerobic colonies were found, up to 216 colony forming units/cm2. Other pathogens were not found in this study. Conclusions: The results of this preliminary study confirm literature reports that pets may constitute a potential risk in the transmission of zoonotic pathogens to their owner, especially during direct contact when sleeping in the same bed. Owners should therefore be informed about these risks and educated to interact with their pets in a more responsible way.
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Affiliation(s)
- Lucie A. Zanen
- Department Population Health Sciences, Division of Veterinary Public Health, Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
| | - Johannes G. Kusters
- Department of Medical Microbiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Paul A. M. Overgaauw
- Department Population Health Sciences, Division of Veterinary Public Health, Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands
- Correspondence:
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Saseendran Nair S, Anand V, De Silva K, Wiles S, Swift S. The antibacterial potency and antibacterial mechanism of a commercially available surface-anchoring quaternary ammonium salt (SAQAS)-based biocide in vitro. J Appl Microbiol 2022; 133:2583-2598. [PMID: 35870145 PMCID: PMC9796750 DOI: 10.1111/jam.15729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/06/2022] [Accepted: 07/18/2022] [Indexed: 01/07/2023]
Abstract
AIMS To determine the antimicrobial potency of a surface-anchored quaternary ammonium salt (SAQAS)-based biocide during in vitro wet and dry fomite assays and to determine the mechanism of killing bacteria on the surface. METHODS AND RESULTS Wet and dry fomite assays were established in vitro for a commercially available biocide (SAQAS-A) applied to glass and low-density polyethylene (LDPE) surfaces. Both wet and dry fomite tests showed the active killing of Gram-positive and Gram-negative bacteria but not endospores. Assays measuring membrane permeability (ATP and DNA release), bacterial membrane potential and bacterial ROS production were correlated with the time-to-kill profiles to show SAQAS-A activity in suspension and applied to a surface. CONCLUSIONS SAQAS-A is an effective biocide against model strains of vegetative bacteria. The killing mechanism for SAQAS-A observed minimal membrane depolarization, a surge in ROS production and assessment of membrane permeability supported the puncture of cells in both suspension and surface attachment, leading to cell death. SIGNIFICANCE AND IMPACT OF THE STUDY SAQAS represents effective surface biocides against single challenges with bacteria through a mechanical killing ability that supports real-world application if their durability can be demonstrated to maintain residual activity.
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Affiliation(s)
- Shilpa Saseendran Nair
- Department of Molecular Medicine and PathologyWaipapa Taumata Rau University of AucklandAucklandNew Zealand
| | - Vikash Anand
- Department of Molecular Medicine and PathologyWaipapa Taumata Rau University of AucklandAucklandNew Zealand
| | - Karnika De Silva
- NZ Product Accelerator, Faculty of EngineeringWaipapa Taumata Rau University of AucklandAucklandNew Zealand
| | - Siouxsie Wiles
- Department of Molecular Medicine and PathologyWaipapa Taumata Rau University of AucklandAucklandNew Zealand
| | - Simon Swift
- Department of Molecular Medicine and PathologyWaipapa Taumata Rau University of AucklandAucklandNew Zealand
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Koja G, Piligriu F, Simaku A, Qyra S, Abazaj E. Assessment of Microbial Load in Regional Hospitals in Albania. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background
Contaminated hospital indoor environments can expose patients to microorganisms and different infections. The aimed study was to assess the microbial load in hospital facilities inside Albania Regional Hospitals during the period 2017-2019.
Methods
A cross-sectional study was conducted during the period 2017-2019 for the assessment of microbial contamination in operating rooms, resuscitation, and delivery rooms in 12 regional hospitals in Albania. One thousand and three hundred microbiological specimens were collected from air and surfaces using 5% sheep blood agar (Oxoid, UK) and processed at IPH microbiology laboratory following the standard bacteriological procedures Data were analyzed using Statistical Software Package for Social Sciences (SPSS) version 23.
Results
Out of the total number of samples, 1148 (88.3%) were collected from surfaces and 152 (11.7%) were from the air. Bacterial growth was identified in 314 (24.2%) out of 1300 samples (95% CI 21.89–26.62). From the total site samples processed during the study period, bacterial growth showed 282 (89.8%) samples from surfaces and 32 (10.2%) air samples. There was found a significant association p-value =0.035. Regarding the sampling place collection, the largest number were collected in operating rooms (60.3%) followed by emergency rooms (28.2%), ICUs (7.7%), and maternity units (3.8%). Gram-negative isolates were predominant at 235 (74.8%), while the Gram-positive were at 60 (19.1%). E. coli was the most frequent bacterial isolate (50%) followed by Pseudomonas aeruginosa (23.6%), Staphylococcus aureus (19.1%), and Klebsiella pneumoniae (1.3%). Also, we found a fungal agent such as Aspergillus in 19 (6.1%) samples. The isolated bacteria's overall drug resistance profile revealed that 66.8% of gram-positive bacteria were resistant to two or more antimicrobial drugs tested.
Conclusion
This study revealed that the surface and air and air within different wards of the hospitals studied were contaminated with different types of bacteria. Bacterial loads on the surface and air exceeded normal limits. Additionally, the study pointed out high levels of antimicrobial resistance to the drugs commonly prescribed for isolates. Therefore, intervention strategies need to be strengthened to expand infection prevention practices in hospitals. Continuous monitoring and monitoring of in-hospital pathogen types and susceptibility patterns should be performed on a very regular basis.
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Environmental sampling practices of innate hospital surfaces. A need for guidance and consensus? A survey conducted by the ESCMID Study Group for Nosocomial Infections (ESGNI). J Hosp Infect 2022; 128:92-95. [DOI: 10.1016/j.jhin.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022]
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Solomon S, Stachel A, Kelly A, Mraz J, Aguilar P, Gardner J, Medefindt J, Horrocks A, Sterling S, Aguero-Rosenfeld M, Phillips M. The Evaluation of Electrolyzed Water, Sodium Dichloroisocyanurate and Peracetic Acid with Hydrogen Peroxide for the Disinfection of Patient Room Surfaces. Am J Infect Control 2022; 51:367-371. [PMID: 35777575 DOI: 10.1016/j.ajic.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sporicidal disinfectants are necessary to control Clostridioides difficile and Candida auris. Novel application methods such as electrostatic sprayers may increase disinfection effectiveness. We employed a standardized protocol to assess three sporicidal disinfectants: electrolyzed water (EW), sodium dichloroisocyanurate (NaDCC) and peracetic acid/hydrogen peroxide (PAA/H2O2). METHODS The study was conducted at two New York City hospitals (1,082 total beds) over an 18-month period. The three chemicals were applied by housekeeping personnel following the hospital protocol; the use of electrostatic sprayers was incorporated into EW and NaDCC. In randomly selected rooms, five surfaces were sampled for microbial colony counts after cleaning. Data analyses were performed using negative binomial logistic regression. RESULTS We collected 774 samples. NaDCC-disinfected surfaces had a lower mean colony count (14 CFU) compared to PAA/H2O2 (18 CFU, p=0.36) and EW (37 CFU, p<.001). PAA/H2O2 and EW had more samples with any growth (both p<.05) compared to NaDCC. NaDCC applied with wipes and an electrostatic sprayer had the lowest number of samples with no growth and <2.5 CFU/cm2 (difference not significant). CONCLUSIONS The use of NaDCC for surface disinfection resulted in the lowest bacterial colony counts on patient room high touch surfaces in our study.
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Affiliation(s)
- Sadie Solomon
- Department of Infection Prevention and Control, NYU Langone Health, New York NY, USA; Hospital Operations, NYU Langone Health, New York NY, USA
| | - Anna Stachel
- Department of Infection Prevention and Control, NYU Langone Health, New York NY, USA
| | - Anne Kelly
- Department of Infection Prevention and Control, NYU Langone Health, New York NY, USA
| | - Joe Mraz
- Building Services Department, NYU Langone Health, New York NY, USA
| | - Peter Aguilar
- Building Services Department, NYU Langone Health, New York NY, USA
| | - Julia Gardner
- Hospital Operations, NYU Langone Health, New York NY, USA
| | - Judith Medefindt
- Department of Infection Prevention and Control, NYU Langone Health, New York NY, USA
| | - Amy Horrocks
- Hospital Operations, NYU Langone Health, New York NY, USA
| | - Stephanie Sterling
- Department of Infection Prevention and Control, NYU Langone Health, New York NY, USA; Department of Medicine, Division of Infectious Diseases, NYU Grossman School of Medicine, New York NY, USA
| | - Maria Aguero-Rosenfeld
- Department of Pathology, NYU Grossman School of Medicine, New York NY, USA; Clinical Laboratories, NYU Langone Health, New York NY, USA
| | - Michael Phillips
- Department of Infection Prevention and Control, NYU Langone Health, New York NY, USA; Department of Medicine, Division of Infectious Diseases, NYU Grossman School of Medicine, New York NY, USA.
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Saadi S, Allem R, Sebaihia M, Merouane A, Bakkali M. Bacterial contamination of neglected hospital surfaces and equipment in an Algerian hospital: an important source of potential infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:1373-1381. [PMID: 33648396 DOI: 10.1080/09603123.2021.1885631] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 01/30/2021] [Indexed: 06/12/2023]
Abstract
Hospital surfaces are heavily contaminated with bacteria, which are a potential source of nosocomial infections. This study was undertaken to identify bacterial communities isolated from neglected hospital surfaces after cleaning routine in a Algerian public hospital. Screening of bacterial contamination in patient bed (PB), reception land-line phones (TF), door handles (DH) and medical equipment (ME) during five months generated 108 inocula. Isolates obtained were identified based on biochemical characteristics and confirmed by analysis of 16S rRNA sequences. Statistical analysis was performed to reveal possible relationship between bacterial diversity and swabbed surfaces. Our findings showed a high prevalence of bacteria in various hospital surfaces, reaching (65.25%), where a highest contaminated surface was the PB (47.22%) and a lowest contaminated was TF (5.55%). Gram negative bacteria were the dominant group (62.03%) mainly represented by Entrobacteriaceae (42.59%), whereas Staphylococcus aureus belonging to Gram positive was the main expanded pathogen with (15.74%).
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Affiliation(s)
- Somia Saadi
- Laboratory of Molecular Biology, Genomics and Bioinformatics, Department of Biology, Faculty of Natural and Life Sciences, Hassiba Benbouali University, Chlef, Algeria
| | - Rachida Allem
- Laboratory of Natural Bioresources, Faculty of Nature and Life Sciences, Hassiba Benbouali University, Chlef, Algeria
| | - Mohammed Sebaihia
- Laboratory of Molecular Biology, Genomics and Bioinformatics, Department of Biology, Faculty of Natural and Life Sciences, Hassiba Benbouali University, Chlef, Algeria
| | - Abdelaziz Merouane
- Laboratory of Natural Bioresources, Faculty of Nature and Life Sciences, Hassiba Benbouali University, Chlef, Algeria
| | - Mohammed Bakkali
- Departamento de Genetica, Facultad de Ciencias, Universidad de Granada Fuentenueva S/N, 18071, Granada, Spain
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Fungwithaya P, Sontigun N, Boonhoh W, Boonchuay K, Wongtawan T. Antimicrobial resistance in Staphylococcus pseudintermedius on the environmental surfaces of a recently constructed veterinary hospital in Southern Thailand. Vet World 2022; 15:1087-1096. [PMID: 35698521 PMCID: PMC9178593 DOI: 10.14202/vetworld.2022.1087-1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Aim: Staphylococcus pseudintermedius is a zoonotic bacterium commonly found in animals, especially dogs. These bacteria can survive on environmental surfaces for several months. The infection of S. pseudintermedius from the environment is possible, but properly cleaning surface objects can prevent it. This study aimed to investigate the prevalence of methicillin-resistant S. pseudintermedius (MRSP) in the environment of a recently constructed veterinary hospital in Southern Thailand, where we hypothesized that the prevalence of MRSP might be very low. Materials and Methods: At three different time points, 150 samples were collected from different environmental surfaces and wastewater across the veterinary hospital. The collection was done after the hospital’s cleaning. Bacteria were purified in the culture before being identified as species by biochemical tests and polymerase chain reaction (PCR). Next, the antimicrobial-resistant profile was performed using an automated system (Vitek 2). Finally, the antimicrobial resistance genes were identified using PCR. Results: Fifteen colonies of S. pseudintermedius were isolated from the surfaces of eight floors, four tables, two chairs, and one rebreathing tube. Fourteen colonies (93.3%) were multidrug-resistant (MDR) and carried the blaZ gene (93.3%). The majority of colonies were resistant to benzylpenicillin (93.3%), cefovecin (93.3%), ceftiofur (93.3%), kanamycin (93.3%), and neomycin (93.3%). Notably, only four colonies (26.7%) were methicillin-susceptible S. pseudintermedius, whereas 11 colonies (73.3%) were MRSP and carried both the mecA and blaZ genes. Five MRSP (45.5%) were resistant to at least 14 antimicrobial drugs, represented as extensively drug-resistant (XDR) bacteria. Ten of eleven MRSP (90.9%) were Staphylococcal chromosomal mec type V, while another displayed untypeable. Despite the routine and extensive cleaning with detergent and disinfectant, MRSP isolates were still detectable. Conclusion: Many isolates of MRSP were found in this veterinary hospital. Almost all of them were MDR, and nearly half were XDR, posing a threat to animals and humans. In addition, the current hospital cleaning procedure proved ineffective. Future research should be conducted to determine the bacterial biofilm properties and bacterial sensitivity to certain detergents and disinfectants.
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Affiliation(s)
- Punpichaya Fungwithaya
- Centre of Excellence Research for Melioidosis and other Microorganism, Walailak University, Nakhon Si Thammarat 80160, Thailand; Centre for One Health, Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Narin Sontigun
- Centre of Excellence Research for Melioidosis and other Microorganism; Walailak University, Nakhon Si Thammarat 80160, Thailand; Centre for One Health, Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Worakan Boonhoh
- Centre for One Health, Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Kanpapat Boonchuay
- Centre for One Health, Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Tuempong Wongtawan
- Centre of Excellence Research for Melioidosis and other Microorganism, Walailak University, Nakhon Si Thammarat 80160, Thailand; Centre for One Health, Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
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Gon G, Dansero L, Aiken AM, Bottomley C, Dancer SJ, Graham WJ, Ike OC, Lewis M, Meakin N, Okafor O, Uwaezuoke NS, Okwor TJ. A Better Disinfectant for Low-Resourced Hospitals? A Multi-Period Cluster Randomised Trial Comparing Hypochlorous Acid with Sodium Hypochlorite in Nigerian Hospitals: The EWASH Trial. Microorganisms 2022; 10:microorganisms10050910. [PMID: 35630355 PMCID: PMC9146012 DOI: 10.3390/microorganisms10050910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 12/10/2022] Open
Abstract
Environmental hygiene in hospitals is a major challenge worldwide. Low-resourced hospitals in African countries continue to rely on sodium hypochlorite (NaOCl) as major disinfectant. However, NaOCl has several limitations such as the need for daily dilution, irritation, and corrosion. Hypochlorous acid (HOCl) is an innovative surface disinfectant produced by saline electrolysis with a much higher safety profile. We assessed non-inferiority of HOCl against standard NaOCl for surface disinfection in two hospitals in Abuja, Nigeria using a double-blind multi-period randomised cross-over study. Microbiological cleanliness [Aerobic Colony Counts (ACC)] was measured using dipslides. We aggregated data at the cluster-period level and fitted a linear regression. Microbiological cleanliness was high for both disinfectant (84.8% HOCl; 87.3% NaOCl). No evidence of a significant difference between the two products was found (RD = 2%, 90%CI: -5.1%-+0.4%; p-value = 0.163). We cannot rule out the possibility of HOCl being inferior by up to 5.1 percentage points and hence we did not strictly meet the non-inferiority margin we set ourselves. However, even a maximum difference of 5.1% in favour of sodium hypochlorite would not suggest there is a clinically relevant difference between the two products. We demonstrated that HOCl and NaOCl have a similar efficacy in achieving microbiological cleanliness, with HOCl acting at a lower concentration. With a better safety profile, and potential applicability across many healthcare uses, HOCl provides an attractive and potentially cost-efficient alternative to sodium hypochlorite in low resource settings.
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Affiliation(s)
- Giorgia Gon
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (A.M.A.); (C.B.); (W.J.G.)
- Correspondence:
| | - Lucia Dansero
- Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy;
| | - Alexander M. Aiken
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (A.M.A.); (C.B.); (W.J.G.)
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (A.M.A.); (C.B.); (W.J.G.)
| | - Stephanie J. Dancer
- Department of Microbiology, NHS Lanarkshire, Airdrie ML6 0JS, UK;
- School of Applied Science, Edinburgh Napier University, Edinburgh EH10 5DT, UK
| | - Wendy J. Graham
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (A.M.A.); (C.B.); (W.J.G.)
| | - Olivia C. Ike
- Nigeria Centre for Disease Control, Abuja 240102, Nigeria; (O.C.I.); (O.O.); (T.J.O.)
| | - Michelle Lewis
- Aqualution Systems Limited, Duns TD11 3HS, UK; (M.L.); (N.M.)
| | - Nick Meakin
- Aqualution Systems Limited, Duns TD11 3HS, UK; (M.L.); (N.M.)
| | - Obiora Okafor
- Nigeria Centre for Disease Control, Abuja 240102, Nigeria; (O.C.I.); (O.O.); (T.J.O.)
| | | | - Tochi Joy Okwor
- Nigeria Centre for Disease Control, Abuja 240102, Nigeria; (O.C.I.); (O.O.); (T.J.O.)
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Klassert TE, Zubiria-Barrera C, Neubert R, Stock M, Schneegans A, López M, Driesch D, Zakonsky G, Gastmeier P, Slevogt H, Leistner R. Comparative analysis of surface sanitization protocols on the bacterial community structures in the hospital environment. Clin Microbiol Infect 2022; 28:1105-1112. [PMID: 35272014 DOI: 10.1016/j.cmi.2022.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 02/10/2022] [Accepted: 02/20/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES In hospital hygiene it remains unclear to which extent surface contamination might represent a potential reservoir for nosocomial pathogens. This study investigates the effects of different sanitization strategies on the microbial structures and the ecological balance of the environmental microbiome in the clinical setting. METHODS Three cleaning regimes (disinfectants, detergents and probiotics) were applied subsequently in 9 independent patient rooms at a neurological ward (Charité, Berlin). Weekly sampling procedures included 3 different environmental sites: floor, doorhandle and sink. Characterization of the environmental microbiota and detection of antibiotic resistance genes (ARGs) were performed by 16S rRNA sequencing and multiplex Taq-Man qPCR assays, respectively. RESULTS Our results showed a displacement of the intrinsic environmental microbiota after probiotic sanitization, which reached statistical significance in the sink samples (Median 16S-rRNA copies = 138.3; IQR: 24.38-379.5) when compared to traditional disinfection measures (Median 16S-rRNA copies = 1343; IQR: 330.9-9479; p<0.05). This effect was concomitant with a significant increase of the alpha-diversity metrics in both the floor (p<0.001) and the sink samples (p<0.01) during the probiotic strategy. We did not observe a sanitization-dependent change of relative pathogen abundance at any tested site, but a significant reduction of the total ARGs counts in the sink samples during probiotic cleaning (mean ARGs/sample: 0.095 ± 0.067) when compared to the disinfection strategy (mean ARGs/sample: 0.386 ± 0.116; p<0.01). CONCLUSIONS The data presented in this study suggest the probiotic sanitization as interesting strategy in hospital hygiene management to be further analyzed and validated in randomized clinical studies.
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Affiliation(s)
- Tilman E Klassert
- Jena University Hospital, ZIK Septomics, Host Septomics, Jena, Germany.
| | | | - Robert Neubert
- Jena University Hospital, ZIK Septomics, Host Septomics, Jena, Germany
| | - Magdalena Stock
- Jena University Hospital, ZIK Septomics, Host Septomics, Jena, Germany
| | - Antony Schneegans
- Jena University Hospital, ZIK Septomics, Host Septomics, Jena, Germany
| | - Mercedes López
- University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Spain
| | | | | | - Petra Gastmeier
- Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Hortense Slevogt
- Jena University Hospital, ZIK Septomics, Host Septomics, Jena, Germany; Department of Respiratory Medicine, Medizinische Hochschule Hannover, Germany
| | - Rasmus Leistner
- Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Germany
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Antimicrobial Photodynamic Coatings Reduce the Microbial Burden on Environmental Surfaces in Public Transportation—A Field Study in Buses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042325. [PMID: 35206511 PMCID: PMC8872155 DOI: 10.3390/ijerph19042325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 12/17/2022]
Abstract
Millions of people use public transportation daily worldwide and frequently touch surfaces, thereby producing a reservoir of microorganisms on surfaces increasing the risk of transmission. Constant occupation makes sufficient cleaning difficult to achieve. Thus, an autonomous, permanent, antimicrobial coating (AMC) could keep down the microbial burden on such surfaces. A photodynamic AMC was applied to frequently touched surfaces in buses. The microbial burden (colony forming units, cfu) was determined weekly and compared to equivalent surfaces in buses without AMC (references). The microbial burden ranged from 0–209 cfu/cm2 on references and from 0–54 cfu/cm2 on AMC. The means were 13.4 ± 29.6 cfu/cm2 on references and 4.5 ± 8.4 cfu/cm2 on AMC (p < 0.001). The difference in microbial burden on AMC and references was almost constant throughout the study. Considering a hygiene benchmark of 5 cfu/cm2, the data yield an absolute risk reduction of 22.6% and a relative risk reduction of 50.7%. In conclusion, photodynamic AMC kept down the microbial burden, reducing the risk of transmission of microorganisms. AMC permanently and autonomously contributes to hygienic conditions on surfaces in public transportation. Photodynamic AMC therefore are suitable for reducing the microbial load and closing hygiene gaps in public transportation.
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Assessment of cleaning methods on bacterial burden of hospital privacy curtains: a pilot randomized controlled trial. Sci Rep 2021; 11:21866. [PMID: 34750366 PMCID: PMC8575993 DOI: 10.1038/s41598-021-01198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/25/2021] [Indexed: 11/08/2022] Open
Abstract
Healthcare-associated infections (HAIs) are an important global issue, leading to poor patient outcomes. A potential route of transmission of HAIs is through contact with hospital privacy curtains. The aim of this study is to evaluate cleaning on reduction of curtain bacterial burden. In this pilot cluster randomized controlled trial we compared the bacterial burden between three groups of 24 curtains on a regional burn/plastic surgery ward. A control group was not cleaned. Two groups were cleaned at 3-4 day intervals with either disinfectant spray or wipe. The primary outcome was the difference in mean CFU/cm2 between day 0 to day 21. The secondary outcome was the proportion of curtains contaminated with Methicillin-resistant Staphylococcus aureus (MRSA). By day 21, the control group was statistically higher (2.2 CFU/cm2) than spray (1.3 CFU/cm2) or wipe (1.5 CFU/cm2) (p < 0.05). After each cleaning at 3-4 day intervals, the bacterial burden on the curtains reduced to near day 0 levels; however, the level increased again over the intervening 3-4 days. By day 21, 64% of control curtains were contaminated with MRSA compared to 10% (spray) and 5% (wipe) (p < 0.05). This study show that curtains start clean and progressively become contaminated with bacteria. Regularly cleaning curtains with disinfectant spray or wipes reduces bacterial burden and MRSA contamination.
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Firesbhat A, Tigabu A, Tegene B, Gelaw B. Bacterial profile of high-touch surfaces, leftover drugs and antiseptics together with their antimicrobial susceptibility patterns at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. BMC Microbiol 2021; 21:309. [PMID: 34749674 PMCID: PMC8573887 DOI: 10.1186/s12866-021-02378-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background The hospital environment serves as a source of nosocomial infections, which pose a major therapeutic challenge. Although many bacteria species are common in hospital environments, their distribution, frequency, and antimicrobial susceptibility pattern from high-touch surfaces, leftover drugs, and antiseptics in different wards remain largely unknown. Hence, the aim of this study was to assess the magnitude and frequency of bacterial contaminants and their antimicrobial susceptibility patterns. Methods A total of 384 samples were collected from five selected wards and processed according to standard bacteriological procedures. Samples were collected from high-touch surface using swabs and inoculated on Blood agar, MacConkey agar, Chocolate agar and Mannitol salt agar plates, and incubated at 37 °C for 24 h. On the other hand, the leftover drugs and 80% ethanol samples were collected using sterile cotton swab immersed in sterile tryptone soy broth then inoculated on culture medias and incubated at 37 °C for 24 h. Identification of bacteria species was done using the morphological characteristics, Gram stain, and biochemical tests while antimicrobial susceptibility tests were done using modified Kirby-Bauer disk diffusion technique following the Clinical Laboratory Standards Institute 2021guidelines. Results Among the 384 samples processed, 102 (26.6%) were culture positive and a total of 114 bacterial isolates were identified. Gram-positive bacterial isolates were predominant, 64.9%, while Gram-negatives were 35.1%. The most frequently isolated bacteria were coagulase negative Staphylococci (38.6%) followed by S. aureus (13.2%) and P. aeruginosa (11.4%). On the other hand, the proportion of bacteria isolated from surgical ward, post-natal ward, orthopedic ward, trauma ward, and neonatal intensive care unit ward were 24.6, 21, 20.2, 18.4,15.8%, respectively. Sinks were mainly contaminated with Klebsiella species (81.8%) and A. baumannii (55.6%), while A. baumannii (22.2%) was the most contaminant for 80% ethanol. Gram-positive bacteria had significantly high resistance levels to penicillin (67.6%), cotrimoxazole (67.8%), and cefepime (80%). On the other hand, Gram-negative bacteria revealed the highest resistance levels to tetracycline (82.4%), amoxicillin-clavulanic acid (76.5%), cefepime (66.7%), ceftazidime (67.5%), and piperacillin (92.3%). Moreover, the proportion of multidrug resistant bacteria isolates was 44.7%. Conclusions Data of the present study showed that coagulase negative Staphylococci was the dominant bacterial isolates followed by S. aureus and P. aeruginosa. The proportion of multi-drug resistant bacteria isolates was relatively high. Therefore, appropriate infection prevention and control measures should be implemented.
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Affiliation(s)
- Atsedewoyn Firesbhat
- Unit of Biomedical Sciences, College of Veterinary Medicine and Animal Sciences, University of Gondar, P O. box: 196, Gondar, Ethiopia
| | - Abiye Tigabu
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P O. box: 196, Gondar, Ethiopia.
| | - Birhanemeskel Tegene
- Department of Medical Microbiology, St. Paul's Hospital Millennium Medical College, P. O. box 1271, Addis Abeba, Ethiopia
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P O. box: 196, Gondar, Ethiopia
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Health Care Environmental Hygiene: New Insights and Centers for Disease Control and Prevention Guidance. Infect Dis Clin North Am 2021; 35:609-629. [PMID: 34362536 DOI: 10.1016/j.idc.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Recent research has significantly clarified the impact of optimizing patient-zone environmental hygiene. New insights into the environmental microbial epidemiology of many hospital-associated pathogens, especially Clostridioides difficile, have clarified and quantified the role of ongoing occult pathogen transmission from the near-patient environment. The recent development of safe, broadly effective surface chemical disinfectants has led to new opportunities to broadly enhance environmental hygiene in all health care settings. The Centers for Disease Control and Prevention has recently developed a detailed guidance to assist all health care settings in implementing optimized programs to mitigate health care-associated pathogen transmission from the near-patient surfaces.
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Browne KL, Crowley JD, Tan CJ, O'Sullivan CB, Walsh WR. Effect of ultraviolet-C light on the environmental bacterial bioburden in various veterinary facilities. Am J Vet Res 2021; 82:582-588. [PMID: 34166087 DOI: 10.2460/ajvr.82.7.582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effect of a mobile UV-C disinfection device on the environmental bacterial bioburden in veterinary facilities. SAMPLES 40 swab samples of surfaces from the operating theaters of 3 veterinary hospitals and 1 necropsy laboratory. PROCEDURES Various surfaces were swabbed, and collected material was eluted from the swabs in PBSS. Then, an aliquot of the sample fluid was processed with a bacteria-specific rapid metabolic assay to quantify bacterial bioburden. Each site was then treated with UV-C light with an automated disinfection device for approximately 45 minutes. The same surfaces were swabbed following UV-C treatment, and bioburden was quantified. The bioburden at additional time points, including after a second UV-C treatment, was determined for the small animal operating theater. RESULTS All surfaces at all sites had a persistent viable bacterial population following manual cleaning. Disinfection with UV-C achieved a mean bioburden reduction of 94% (SD, 5.2%; range, 91% to 95%) for all surfaces, compared with manual disinfection alone. Repeated UV-C treatment of the small animal operating theater reduced mean bioburden by 99% (SD, 0.8%), including no detectable bacteria on 4 of 10 surfaces. CONCLUSIONS AND CLINICAL RELEVANCE Disinfection with UV-C light may be a beneficial adjunct method for terminal disinfection of veterinary operating theaters to reduce environmental bioburden. (Am J Vet Res 2021;82:582-588).
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Affiliation(s)
- Katrina L Browne
- From the Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- From the School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia
| | - James D Crowley
- From the Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Sydney Veterinary Emergency and Specialists, Rosebery, NSW 2018, Australia
| | - Christopher J Tan
- From the Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Sydney Veterinary Emergency and Specialists, Rosebery, NSW 2018, Australia
| | | | - William R Walsh
- From the Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
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Odoyo E, Matano D, Georges M, Tiria F, Wahome S, Kyany’a C, Musila L. Ten Thousand-Fold Higher than Acceptable Bacterial Loads Detected in Kenyan Hospital Environments: Targeted Approaches to Reduce Contamination Levels. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136810. [PMID: 34201911 PMCID: PMC8297338 DOI: 10.3390/ijerph18136810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
Microbial monitoring of hospital surfaces can help identify target areas for improved infection prevention and control (IPCs). This study aimed to determine the levels and variations in the bacterial contamination of high-touch surfaces in five Kenyan hospitals and identify the contributing modifiable risk factors. A total of 559 high-touch surfaces in four departments identified as high risk of hospital-acquired infections were sampled and examined for bacterial levels of contamination using standard bacteriological culture methods. Bacteria were detected in 536/559 (95.9%) surfaces. The median bacterial load on all sampled surfaces was 6.0 × 104 CFU/cm2 (interquartile range (IQR); 8.0 × 103–1.0 × 106). Only 55/559 (9.8%) of the sampled surfaces had acceptable bacterial loads, <5 CFU/cm². Cleaning practices, such as daily washing of patient sheets, incident rate ratio (IRR) = 0.10 [95% CI: 0.04–0.24], providing hand wash stations, IRR = 0.25 [95% CI: 0.02–0.30], having running water, IRR = 0.19 [95% CI: 0.08–0.47] and soap for handwashing IRR = 0.21 [95% CI: 0.12–0.39] each significantly lowered bacterial loads. Transporting dirty linen in a designated container, IRR = 72.11 [95% CI: 20.22–257.14], increased bacterial loads. The study hospitals can best reduce the bacterial loads by improving waste-handling protocols, cleaning high-touch surfaces five times a day and providing soap at the handwash stations.
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Affiliation(s)
- Erick Odoyo
- United States Army Medical Research Directorate-Africa, Nairobi P.O. Box 606-00621, Kenya; (E.O.); (M.G.); (F.T.); (C.K.)
| | - Daniel Matano
- Kenya Medical Research Institute, Nairobi P.O. Box 54848-00200, Kenya;
| | - Martin Georges
- United States Army Medical Research Directorate-Africa, Nairobi P.O. Box 606-00621, Kenya; (E.O.); (M.G.); (F.T.); (C.K.)
| | - Fredrick Tiria
- United States Army Medical Research Directorate-Africa, Nairobi P.O. Box 606-00621, Kenya; (E.O.); (M.G.); (F.T.); (C.K.)
| | - Samuel Wahome
- Independent Researcher, Nairobi P.O. Box 64-20300, Kenya;
| | - Cecilia Kyany’a
- United States Army Medical Research Directorate-Africa, Nairobi P.O. Box 606-00621, Kenya; (E.O.); (M.G.); (F.T.); (C.K.)
| | - Lillian Musila
- United States Army Medical Research Directorate-Africa, Nairobi P.O. Box 606-00621, Kenya; (E.O.); (M.G.); (F.T.); (C.K.)
- Correspondence:
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Antimicrobial susceptibility of bacterial pathogens isolated from healthcare workers' cellphones. Infect Dis Now 2021; 51:596-602. [PMID: 34091094 DOI: 10.1016/j.idnow.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/07/2021] [Accepted: 05/27/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate bacterial isolates, antibiotic susceptibility, and disease transmission risk in healthcare workers using cellphones. METHODS A total of 70 cellphones were received from the hospital staff. Samples were collected from the phones with a sterile cotton swab moistened with physiological saline solution. Samples were inoculated in a bacteriological culture medium and incubated at 37.5°C for 24-48hours. Identification of microorganisms was performed by traditional methods and VITEK 2 device. Kirby-Bauer disk diffusion method was used to determine antibiotic susceptibility. RESULTS A total of 26 species and 170 microorganisms were isolated from 66 cellphones from which bacterial growths were obtained: coagulase-negative staphylococci (n=63, 37%) (most commonly Staphylococcus epidermidis: 25/63), Micrococcus luteus (n=25, 14.7%), Tetracoccus (n=24, 14.1%), Kocuria spp. (n=24, 14.1%), Corynebacterium diphtheriae (n=7, 4.1%), Leuconostoc mesenteroides (n=5, 3.0%), S. aureus (n=4, 2.3%), Enterococcus spp. (n=5, 2.9%), Acinetobacter spp. (n=7, 4.1%), Klebsiella pneumoniae (n=2, 1.2%), Actinomyces spp. (n=1, 0.6%), Pseudomonas aeruginosa (n=1, 0.6%), Morganella morganii (n=1, 0.6%), and Alcaligenes faecalis (n=1, 0.6%). Gram-positive isolates were all susceptible to the antibiotics used, whereas Gram-negative isolates were all resistant to ceftazidime. CONCLUSION Hands and/or cellphones of healthcare staff can be contaminated with various types of microorganisms. We recommend proper hand washing and disinfection to prevent bacterial pathogens spread within the hospital.
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Robakowska M, Bronk M, Tyrańska-Fobke A, Ślęzak D, Kraszewski J, Balwicki Ł. Patient Safety Related to Microbiological Contamination of the Environment of a Multi-Profile Clinical Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073844. [PMID: 33917580 PMCID: PMC8038759 DOI: 10.3390/ijerph18073844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
Nosocomial infections pose a serious burden for hospitals, patients, and the entire society. The aim of the study was to assess the microbiological cleanliness of the hospital environment through quantitative and qualitative analysis of microbiological contamination of air and surfaces in inpatient treatment facilities, based on the example of a large clinical hospital in Poland. Data were collected between 2012 and 2018 in premises of a large teaching hospital in Gdansk using the sedimentation method and the impact method using the Aerideal apparatus (Biomerieux). In the analyzed clinical center, the microbiological cleanliness tests in most of the hospital rooms in the analyzed period showed an acceptable number of saprophytic microorganisms. Of all the tested samples, 1159 (21.8%) were positive, indicating the presence of microorganisms in the tested sample. Species potentially pathogenic for hospital patients were identified, constituting 20.8% of all positive samples (4.6% of all samples). Significantly higher proportion of microorganisms potentially dangerous to patients were isolated from sanitary facilities. Due to the potentially pathogenic microorganisms detected in the tested samples, the authors suggest that in the analyzed hospital, the areas requiring a specific level of microbiological purity should be designated and described, with [specifically] defined cleaning and disinfection protocols.
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Affiliation(s)
- Marlena Robakowska
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (M.R.); (Ł.B.)
| | - Marek Bronk
- Laboratory of Clinical Microbiology, University Center of Laboratory Medicine, University Clinical Center in Gdańsk, 80-952 Gdańsk, Poland;
| | - Anna Tyrańska-Fobke
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Correspondence: (A.T.-F.); (D.Ś.)
| | - Daniel Ślęzak
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Correspondence: (A.T.-F.); (D.Ś.)
| | | | - Łukasz Balwicki
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (M.R.); (Ł.B.)
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Putzer D, Coraça-Huber D, Huber C, Boschert H, Thaler M, Nogler M. The spatial distribution of aerosols in high-speed bone burring with external irrigation. J Microbiol Methods 2021; 184:106205. [PMID: 33774109 DOI: 10.1016/j.mimet.2021.106205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/25/2022]
Abstract
It is well-known that the use of high-speed burring devices with irrigation used in bone surgery produces aerosols, and can toss tissue particles into space. The aim of this study was to assess the spatial vertical contamination in the sterile operation field while using a high-speed cutting device at various locations. A fresh porcine knee was resected for 10 min with a high-speed burring device. To determine the spatial contamination distribution bacteria were used as a tracer. In this novel method for detecting environmental contamination droplets of the contaminated irrigation solution were collected on vertically mounted Petri dishes and the number of colony-forming units was counted. Contamination of varying intensity was observed throughout the room. The highest contamination was found perpendicular to the bur rotation axis in a distance 0.5 m from the bur, at a height of 1.4 m. Around this spot, colony-forming units count isotropically drops to less than 100 CFUs at an area of 0.5 m in diameter. The contamination decreases with increasing distance to the bur head and a main direction of contamination was identified. Placing critical sterile objects in the highly contaminated space during and after bone resection procedures should be avoided whenever possible.
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Affiliation(s)
- David Putzer
- Medical University of Innsbruck, Department of Orthopaedic and Traumatology - Experimental Orthopaedics, Sonnenburgstrasse 16, 6020 Innsbruck, Austria.
| | - Débora Coraça-Huber
- Medical University of Innsbruck, Department of Orthopaedic and Traumatology - Experimental Orthopaedics, Sonnenburgstrasse 16, 6020 Innsbruck, Austria
| | - Cora Huber
- Stryker Leibinger GmbH & Co. KG, Bötzinger Strasse 41, 79111 Freiburg, Germany
| | - Harald Boschert
- Stryker Leibinger GmbH & Co. KG, Bötzinger Strasse 41, 79111 Freiburg, Germany
| | - Martin Thaler
- Medical University of Innsbruck, Department of Orthopaedic and Traumatology, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Michael Nogler
- Medical University of Innsbruck, Department of Orthopaedic and Traumatology - Experimental Orthopaedics, Sonnenburgstrasse 16, 6020 Innsbruck, Austria
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Antimicrobial efficacy and durability of copper formulations over one year of hospital use. Infect Control Hosp Epidemiol 2021; 43:79-87. [PMID: 33715655 DOI: 10.1017/ice.2021.52] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate 3 formulations of copper (Cu)-based self-sanitizing surfaces for antimicrobial efficacy and durability over 1 year in inpatient clinical areas and laboratories. DESIGN Randomized control trial. SETTING We assessed 3 copper formulations: (1) solid alloy 80% Cu-20% Ni (integral copper), (2) spray-on 80% Cu-20% Ni (spray-on) and (3) 16% composite copper-impregnated surface (CIS). In total, 480 coupons (1 cm2) of the 3 products and control surgical grade (AISI 316) stainless steel were inserted into gaskets and affixed to clinical carts used in patient care areas (including emergency and maternity units) and on microbiology laboratory bench work spaces (n = 240). The microbial burden and assessment of resistance to wear, corrosion, and material compatibility were determined every 3 months. Participants included 3 tertiary-care Canadian adult hospital and 1 pediatric-maternity hospital. RESULTS Copper formulations used on inpatient units statistically significantly reduced bacterial bioburden compared to stainless steel at months 3 and 6. Only the integral copper product had significantly less bacteria than stainless steel at month 12. No statistically significant differences were detected in microbial burden between copper formulations and stainless-steel coupons on microbiology laboratory benches where bacterial counts were low overall. All mass changes and corrosion rates of the formulations were acceptable by engineering standards. CONCLUSIONS Copper surfaces vary in their antimicrobial efficacy after 1 year of hospital use. Frequency of cleaning and disinfection influence the impact of copper; the greatest reduction in microbial bioburden occurred in clinical areas compared to the microbiology laboratory where cleaning and disinfection were performed multiple times daily.
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50
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Raji MA, Suaifan G, Shibl A, Weber K, Cialla-May D, Popp J, Al-Kattan K, Zourob M. Aptasensor for the detection of Methicillin resistant Staphylococcus aureus on contaminated surfaces. Biosens Bioelectron 2021; 176:112910. [PMID: 33395571 DOI: 10.1016/j.bios.2020.112910] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/15/2022]
Abstract
There is mounting evidence that contaminated hospital environment plays a crucial role in the transmission of nosocomial pathogens such as MRSA. The institution of infection control protocols is predicated on the early laboratory detection of the pathogen from relevant samples. Processing of environmental samples for the presence of bacterial contaminants in the clinical environment is poorly standardized when compared with analysis of clinical samples. The various laboratory methods available for processing environmental samples are difficult to standardized and most require a long turnaround time before results are available. In this study, we present a report of the performance of a novel pathogen aptasensor swab designed to qualitatively and quantitatively detect MRSA, on contaminated non-absorbable surfaces. The visual detection limit of the MRSA aptasensor swab was less than 100 CFU/ml and theoretically using a standard curve, was 2 CFU/ml. A relatively short turnaround time of 5 min was established for the assay while the linear range of quantitation was 102-105 CFU/ml. Engineered aptasensor targets MRSA selectively and binds to none of the other tested bacterial pathogen, on a multi-contaminated surface. This novel detection tool was easy to use and relatively cheap to produce.
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Affiliation(s)
- Muhabat Adeola Raji
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Al Zahrawi Street, Al Maather, Al Takhassusi Rd, Riyadh, 11533, Saudi Arabia
| | - Ghadeer Suaifan
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, The University of Jordan, Amman-Jordan, P.O. Box 11942, Amman, Jordan
| | - Atef Shibl
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Al Zahrawi Street, Al Maather, Al Takhassusi Rd, Riyadh, 11533, Saudi Arabia
| | - Karina Weber
- InfectoGnostics Research Campus Jena, Center for Applied Research, Friedrich-Schiller-University, Philosophenweg7, Jena, 07743, Germany; Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany; Leibniz Institute of Photonic Technology, Member of the Leibniz Research Alliance, Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
| | - Dana Cialla-May
- InfectoGnostics Research Campus Jena, Center for Applied Research, Friedrich-Schiller-University, Philosophenweg7, Jena, 07743, Germany; Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany; Leibniz Institute of Photonic Technology, Member of the Leibniz Research Alliance, Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
| | - Jürgen Popp
- InfectoGnostics Research Campus Jena, Center for Applied Research, Friedrich-Schiller-University, Philosophenweg7, Jena, 07743, Germany; Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743, Jena, Germany; Leibniz Institute of Photonic Technology, Member of the Leibniz Research Alliance, Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
| | - Khaled Al-Kattan
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Al Zahrawi Street, Al Maather, Al Takhassusi Rd, Riyadh, 11533, Saudi Arabia
| | - Mohammed Zourob
- Department of Chemistry, College of Science, Alfaisal University, Al Zahrawi Street, Al Maather, Al Takhassusi Rd, Riyadh, 11533, Saudi Arabia; King Faisal Specialist Hospital and Research Center, Zahrawi Street, Al Maather, Riyadh, 12713, Saudi Arabia.
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