Self-disinfecting surfaces: review of current methodologies and future prospects

Physicochemical methods for disinfection of contaminated surfaces - a way to control infectious diseases

This paper represents the reviews of recent advancements in different physicochemical methods for disinfecting contaminated surfaces, which are considered to be responsible for transmitting different bacterial, viral, and fungal infectious diseases. Surface disinfection can be achieved by applying chemicals, UV-based processes, ionization radiation (gamma-ray, X-ray and electron beam), application of self-disinfecting surfaces, no-touch room disinfection methods, and robotic disinfection methods for built-in settings. Application of different chemicals, such as alcohols, hydrogen peroxide, peracetic acid, quaternary ammonium salts, phenol, and iodine solution, are common and economical. However, the process is time-consuming and less efficient. The use of UVC light (wavelength: 200-280 nm, generated by low vapor mercury lamps or pulse xenon light) has gained much attention for disinfecting fomites worldwide. In recent times, the combination of UV and H2O2, based on the principle of the advanced oxidation process, has been applied for disinfecting inanimate surfaces. The process is very efficient and faster than chemical and UV processes. Heavy metals like copper, silver, zinc, and other metals can inactivate microbes and are used for surface modification to produce self-disinfecting surfaces and used in healthcare facilities. In combination with UVB (280-315 nm) and UVA (315-400 nm), titanium oxide has been utilized for disinfecting contaminated surfaces. Ionization radiation, one of the advanced methods, can be used in disinfecting medical devices and drugs. Post-COVID-19 pandemic, the no-touch and robotic disinfection methods utilizing chemicals or UVC lights have received much importance in built-in settings. Among these methods, surface disinfection by applying chemicals by fogging/vaporization and UV radiation methods has been widely reported in the literature compared to other methods.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40201-024-00893-2.

Utilizing Rapid Hydrogen Peroxide Generation from 6-Hydroxycatechol to Design Moisture-Activated, Self-Disinfecting Coating

A coating that can be activated by moisture found in respiratory droplets could be a convenient and effective way to control the spread of airborne pathogens and reduce fomite transmission. Here, the ability of a novel 6-hydroxycatechol-containing polymer to function as a self-disinfecting coating on the surface of polypropylene (PP) fabric was explored. Catechol is the main adhesive molecule found in mussel adhesive proteins. Molecular oxygen found in an aqueous solution can oxidize catechol and generate a known disinfectant, hydrogen peroxide (H2O2), as a byproduct. However, given the limited amount of moisture found in respiratory droplets, there is a need to enhance the rate of catechol autoxidation to generate antipathogenic levels of H2O2. 6-Hydroxycatechol contains an electron donating hydroxyl group on the 6-position of the benzene ring, which makes catechol more susceptible to autoxidation. 6-Hydroxycatechol-coated PP generated over 3000 μM of H2O2 within 1 h when hydrated with a small amount of aqueous solution (100 μL of PBS). The generated H2O2 was three orders of magnitude higher when compared to the amount generated by unmodified catechol. 6-Hydroxycatechol-containing coating demonstrated a more effective antimicrobial effect against both Gram-positive (Staphylococcus aureus and Staphylococcus epidermidis) and Gram-negative (Pseudomonas aeruginosa and Escherichia coli) bacteria when compared to unmodified catechol. Similarly, the self-disinfecting coating reduced the infectivity of both bovine viral diarrhea virus and human coronavirus 229E by as much as a 2.5 log reduction value (a 99.7% reduction in viral load). Coatings containing unmodified catechol did not generate sufficient H2O2 to demonstrate significant virucidal effects. 6-Hydroxycatechol-containing coating can potentially function as a self-disinfecting coating that can be activated by the moisture present in respiratory droplets to generate H2O2 for disinfecting a broad range of pathogens.

Disinfection and sterilization: New technologies

BACKGROUND

Adherence to professional guidelines and/or manufacturer's instructions for use regarding proper disinfection and sterilization of medical devices is crucial to preventing cross transmission of pathogens between patients. Emerging pathogens (e.g., Candida auris) and complex medical devices provide new challenges.

METHODS

A search for published English articles on new disinfection and sterilization technologies was conducted by Google, Google scholar and PubMed.

RESULTS

Several new disinfection methods or products (e.g., electrostatic spraying, new sporicides, colorized disinfectants, "no touch" room decontamination, continuous room decontamination) and sterilization technologies (e.g., new sterilization technology for endoscopes) were identified.

CONCLUSIONS

These technologies should reduce patient risk.

úNo touch..Ñ methods for health care room disinfection: Focus on clinical trials

BACKGROUND

Hospital patient room surfaces are frequently contaminated with multidrug-resistant organisms. Since studies have demonstrated that inadequate terminal room disinfection commonly occurs, ..úno touch..Ñ methods of terminal room disinfection have been developed such as ultraviolet light (UV) devices and hydrogen peroxide (HP) systems.

METHODS

This paper reviews published clinical trials of ..úno touch..Ñ methods and ..úself-disinfecting..Ñ surfaces.

RESULTS

Multiple papers were identified including clinical trials of UV room disinfection devices (N.ß=.ß20), HP room disinfection systems (N.ß=.ß8), handheld UV devices (N.ß=.ß1), and copper-impregnated or coated surfaces (N.ß=.ß5). Most but not all clinical trials of UV devices and HP systems for terminal disinfection demonstrated a reduction of colonization/infection in patients subsequently housed in the room. Copper-coated surfaces were the only ..úself-disinfecting..Ñ technology evaluated by clinical trials. Results of these clinical trials were mixed.

DISCUSSION

Almost all clinical trials reviewed used a ..úweak..Ñ design (eg, before-after) and failed to assess potential confounders (eg, compliance with hand hygiene and environmental cleaning).

CONCLUSIONS

The evidence is strong enough to recommend the use of a ..úno-touch..Ñ method as an adjunct for outbreak control, mitigation strategy for high-consequence pathogens (eg, Candida auris or Ebola), or when there are an excessive endemic rates of multidrug-resistant organisms.

Assessment of antibacterial properties and skin irritation potential of anodized aluminum impregnated with various quaternary ammonium

The importance of the inert environment in the transmission of pathogens has been reassessed in recent years. To reduce cross-contamination, new biocidal materials used in high touch surfaces (e.g., stair railings, door handles) have been developed. However, their impact on skin remains poorly described. The present study aimed to evaluate the antibacterial properties and the risk of skin irritation of two materials based on hard-anodized aluminum (AA) impregnated with quaternary ammonium compound solutions (QAC#1 or QAC#2). The QAC#1 or QAC#2 solutions vary in composition, QAC#2 being free of dioctyl dimethyl ammonium chloride (Dio-DAC) and octyl decyl dimethyl ammonium chloride (ODDAC). Unlike AA used as a control, both AA-QAC#1 and AA-QAC#2 had excellent and rapid antibacterial efficacy, killing 99.9 % of Staphylococcus aureus and Escherichia coli bacteria, in 15 s and 1 min, respectively. The impregnation solutions (QAC#1 and QAC#2) did not show any skin sensitizing effect on transformed human keratinocytes. Nevertheless, these solutions as well as the materials (AA-QAC#1, AA-QAC#2), and the liquid extracts derived from them, induced a very rapid cytotoxicity on L929 murine fibroblasts (>70 % after 1 h of contact) as shown by LDH, MTS and neutral red assays. This cytotoxicity can be explained by the fast QACs release occurring when AA-QAC#1 and AA-QAC#2 were immersed in aqueous medium. To overcome the limitation of assays based on liquid condition, an in vitro skin irritation assay on reconstructed human epidermis (RHE) was developed. The effect of the materials upon their direct contact with the epidermis grown at the liquid-air interface was determined by evaluating tissue viability and quantifying interleukin-1 alpha (IL-1α) which is released in skin during injury or infection. AA-QAC#1 induced a significant decrease in RHE viability, close to OECD and ISO 10993-10 acceptability thresholds and enhanced the pro-inflammatory IL-1α secretion compared with AA-QAC#2. Finally, these results were corroborated by in vivo assays on mice using erythema and edema visual scores, histological observations, and epidermal thickness measurement. AA had no effect on the skin, while a stronger irritation was induced by AA-QAC#1 compared with AA-QAC#2. Hence, these materials were classified as moderate and slight irritants, respectively. In summary, this study revealed that AA-QAC#2 without Dio-DAC and ODDAC could be a great candidate for high touch surface applications, showing an extremely effective and rapid bactericidal activity, without inducing adverse effects for skin tissue.

Effects of Ageing in Disinfectant Solution on the Corrosion Resistance and Antimicrobial Behavior of Copper Alloys

This work studies two copper-based alloys as potential antimicrobial weapons for sectors where surface hygiene is essential. Effects of different alloying elements addition at the same Cu content (92.5% by weight) on the corrosion resistance and the antibacterial performance of two copper alloys were studied in an aerated disinfectant solution (0.25% v/v Aniosurf Premium (D)) by electrochemical corrosion, X-ray photoelectron spectroscopy (XPS), time-of-flight secondary ion mass spectroscopy (ToF-SIMS) and antibacterial tests. Results showed that the nature of the alloying elements had a clear influence on the corrosion resistance and antibacterial performance. Electrochemical impedance results and surface analyses demonstrate the presence of organic compounds bound on the substrate and that a film covers part of the total active surface and may act as a protective barrier by preventing the interaction between metal and solution, decreasing the antimicrobial performance of copper-based materials. Low zinc and silicon contents in copper alloys allows for better aging behavior in D solution while maintaining good antibacterial performance. The XPS and ToF-SIMS results indicated that artificial aging in disinfectant enhanced Cu enrichment in the organic film formed, which could effectively stimulate the release of Cu ions from the surface.

Surfaces with instant and persistent antimicrobial efficacy against bacteria and SARS-CoV-2

Surfaces contaminated with bacteria and viruses contribute to the transmission of infectious diseases and pose a significant threat to global public health. Modern day disinfection either relies on fast-acting (>3-log reduction within a few minutes), yet impermanent, liquid-, vapor-, or radiation-based disinfection techniques, or long-lasting, but slower-acting, passive antimicrobial surfaces based on heavy metal surfaces, or metallic nanoparticles. There is currently no surface that provides instant and persistent antimicrobial efficacy against a broad spectrum of bacteria and viruses. In this work, we describe a class of extremely durable antimicrobial surfaces incorporating different plant secondary metabolites that are capable of rapid disinfection (>4-log reduction) of current and emerging pathogens within minutes, while maintaining persistent efficacy over several months and under significant environmental duress. We also show that these surfaces can be readily applied onto a variety of desired substrates or devices via simple application techniques such as spray, flow, or brush coating.

Silver-Polymethylhydrosiloxane-Quaternary Ammonium Coating on Anodized Aluminum with Excellent Antibacterial Property

Multidrug-resistant bacteria are known to survive on high-touch surfaces for days, weeks, and months, contributing to the rise in nosocomial infections. Inducing antibacterial property in such surfaces can presumably reduce the overall microbial burden and subsequent nosocomial infections in hygiene critical environments. In the present study, a one-pot sol-gel process has been deployed to incorporate silver (Ag) and quaternary ammonium salt (QUAT) bactericides in a polymethylhydrosiloxane (PMHS) matrix. The Ag-PMHS-QUAT nanocomposite was coated on anodized aluminum (AAO/Al) by a simple ultrasound-assisted deposition process. The morphological features and chemical composition of the Ag-PMHS-QUAT nanocomposite have been characterized using SEM, XRD spectroscopy, and attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FTIR) to confirm the formation of Ag-QUAT nanocomposites within the polymeric network of PMHS. The Ag-PMHS-QUAT nanocomposite coating on anodized aluminum oxide (AAO/Al) coupon exhibited superior antibacterial property with a 6-log bacterial reduction compared to the 5-log reduction for the commercially available antimicrobial copper coupon.

Antimicrobial Activity of a Titanium Dioxide Additivated Thermoset

The transmission of pathogens via surfaces poses a major health problem, particularly in hospital environments. Antimicrobial surfaces can interrupt the path of spread, while photocatalytically active titanium dioxide (TiO2) nanoparticles have emerged as an additive for creating antimicrobial materials. Irradiation of such particles with ultraviolet (UV) light leads to the formation of reactive oxygen species that can inactivate bacteria. The aim of this research was to incorporate TiO2 nanoparticles into a cellulose-reinforced melamine-formaldehyde resin (MF) to obtain a photocatalytic antimicrobial thermoset, to be used, for example, for device enclosures or tableware. To this end, composites of MF with 5, 10, 15, and 20 wt% TiO2 were produced by ultrasonication and hot pressing. The incorporation of TiO2 resulted in a small decrease in tensile strength and little to no decrease in Shore D hardness, but a statistically significant decrease in the water contact angle. After 48 h of UV irradiation, a statistically significant decrease in tensile strength for samples with 0 and 10 wt% TiO2 was measured but with no statistically significant differences in Shore D hardness, although a statistically significant increase in surface hydrophilicity was measured. Accelerated methylene blue (MB) degradation was measured during a further 2.5 h of UV irradiation and MB concentrations of 12% or less could be achieved. Samples containing 0, 10, and 20 wt% TiO2 were investigated for long-term UV stability and antimicrobial activity. Fourier-transform infrared spectroscopy revealed no changes in the chemical structure of the polymer, due to the incorporation of TiO2, but changes were detected after 500 h of irradiation, indicating material degradation. Specimens pre-irradiated with UV for 48 h showed a total reduction in Escherichia coli when exposed to UV irradiation.

Preventing healthcare-associated infections by decontaminating the clinical environment

Healthcare-associated infections (HAIs) continue to cause patient harm and at increasing rates. Factors contributing to this increase include suboptimal hand hygiene, antimicrobial resistance, and inadequate decontamination of the patient environment and shared patient equipment. To reduce the risk of HAIs and enhance patient safety, it is important that nurses and other healthcare professionals adhere to infection prevention and control guidance, including decontamination procedures. It is also important to identify and address the barriers that can affect adherence to this guidance. This article discusses effective decontamination of the patient environment and non-critical shared patient equipment, the barriers to adhering to guidance and strategies for improving decontamination procedures.

Development of Silver-Containing Hydroxyapatite-Coated Antimicrobial Implants for Orthopaedic and Spinal Surgery

The prevention of surgical site infections is directly related to the minimization of surgical invasiveness, and is in line with the concept of minimally invasive spine therapy (MIST). In recent years, the incidence of postoperative infections has been increasing due to the increased use of spinal implant surgery in patients at high risk of infection, including the elderly and easily infected hosts, the limitations of poor bone marrow transfer of antibiotics, and the potential for contamination of surgical gloves and instruments. Thus, the development of antimicrobial implants in orthopedic and spinal surgery is becoming more and more popular, and implants with proven antimicrobial, safety, and osteoconductive properties (i.e., silver, iodine, antibiotics) in vitro, in vivo, and in clinical trials have become available for clinical use. We have developed silver-containing hydroxyapatite (Ag-HA)-coated implants to prevent post-operative infection, and increase bone fusion capacity, and have successfully commercialized antibacterial implants for hip prostheses and spinal interbody cages. This narrative review overviews the present status of available surface coating technologies and materials; describes how the antimicrobial, safety, and biocompatibility (osteoconductivity) of Ag-HA-coated implants have been demonstrated for commercialization; and reviews the clinical use of antimicrobial implants in orthopedic and spinal surgery, including Ag-HA-coated implants that we have developed.

Virucidal efficacy of antimicrobial surface coatings against the enveloped bacteriophage Φ6

AIMS

Antimicrobial coatings, for use in combination with routine cleaning and disinfection, were evaluated for their effectiveness in reducing virus concentration on stainless steel surfaces.

METHODS

Twenty antimicrobial coating products, predominantly composed of organosilane quaternary ammonium compounds, were applied to stainless steel coupons, dried overnight and evaluated for efficacy against Φ6, an enveloped bacteriophage. Additionally, two peel and stick polymer-based films, a copper-based film and three copper alloys were evaluated. Efficacy was determined by comparison of recoveries from uncoated (positive control) and coated (test) surfaces.

RESULTS

The results indicated that some of the coating products initially demonstrated >3-log reduction of Φ6; no direct correlation of efficacy was observed with an active ingredient or its concentration. The peel and stick films and copper alloys each demonstrated efficacy in initial testing. However, none of the spray-based products retained efficacy after subjecting the coating to abrasion with either a hypochlorite or quaternary ammonium-based solution applied in accordance with EPA Interim Guidance for Evaluating the Efficacy of Antimicrobial Surface Coatings. Of the products tested for this durability, only one peel and stick polymeric film retained efficacy; the copper alloys were not tested for their durability in this study.

CONCLUSIONS

These results suggest that while some organosilane quaternary ammonium compound-based products demonstrate antiviral efficacy, more research and development is needed to understand effective formulations with sufficient durability to perform as supplements to routine cleaning and disinfection.

Gemini-Mediated Self-Disinfecting Surfaces to Address the Contact Transmission of Infectious Diseases

According to both the Center for Disease Control and the World Health Organization, contact transmission is the primary transmission route of infectious diseases worldwide. Usually, this is mitigated by a schedule of repeated regular sanitization, yet surfaces are easily re-contaminated in the interim between cleanings. One solution to this problem is to generate self-disinfecting surfaces that can display sustained virucidal/antimicrobial properties against pathogens that settle upon them. Quaternary ammonium organosilicon compounds are ideal candidates to achieve this; cationic surfactants are safe and well-established surface disinfectants, while organosilanes are used broadly to form durable coatings with altered surface properties on many different materials. Despite their potential to circumvent the disadvantages of traditional disinfection methods, extant commercially available quaternary ammonium silanes do not display comparable efficacy to the standard surface disinfectants, nor have their respective coatings been demonstrated to meet the Environmental Protection Agency's guidelines for residual/extended efficacy. Inspired by the powerful surface activity of double-headed "gemini" surfactants, here, we present gemini-diquaternary silanes (GQs) with robust residual germicidal efficacy on various surfaces by incorporating a second cationic "head" to the structure of a conventional monoquaternary ammonium silane (MQ). Aqueous solutions of GQs were tested in suspension- and surface-antimicrobial assays against an array of pathogens, including Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). GQ performance was benchmarked against the common disinfectants, ethanol, hydrogen peroxide, hypochlorite, as well as MQ. Solutions of GQs were efficacious when used for immediate disinfection (>10⁶-fold reduction in 15 s). Additionally, GQs were demonstrated to impart durable self-disinfecting properties to a variety of porous and nonporous surfaces, effective after repeated cycles of abrasion and repeated contaminations, and with superior coating ability and activity (>10⁸ higher activity) than that of MQs. GQs as surface treatments show great promise to overcome the limitations of traditional disinfectants in preventing the spread of infectious diseases.

Advances in emerging technologies for the decontamination of the food contact surfaces

Foodborne pathogens could be transferred to food from food contact surfaces contaminated by poor hygiene or biofilm formation. The food processing industry has various conditions favouring microbes' adherence, such as moisture, nutrients, and the microbial inoculums obtained from the raw material. The function of the ideal antimicrobial surface is preventing initial attachment of the microbes, killing the microbes or/and removing the dead bacteria. This review article provides detail about the challenges food industries are facing with respect to food contact materials. It also summarises the merits and demerits of several sanitizing methods developed for industrial use. Furthermore, it reviews the new and emerging techniques that enhance the efficiency of reducing microbial contamination. Techniques such as surface functionalisation, high-intensity ultrasound, cold plasma technologies etc. which have high potential to be used for the decontamination of food contact surfaces are discussed. The emerging designs of antibacterial surfaces provide the opportunity to reduce or eradicate the adhesion of microorganisms. The most important purpose of these surfaces is to prevent the attachment of bacteria and to kill the bacteria that come in contact. These emerging technologies have a high potential for developing safe and inert food contact materials for the food industry.

Rapid antibacterial activity of anodized aluminum-based materials impregnated with quaternary ammonium compounds for high-touch surfaces to limit transmission of pathogenic bacteria

Infections caused by multidrug-resistant bacteria are a major public health problem. Their transmission is strongly linked to cross contamination via inert surfaces, which can serve as reservoirs for pathogenic microorganisms. To address this problem, antibacterial materials applied to high-touch surfaces have been developed. However, reaching a rapid and lasting effectiveness under real life conditions of use remains challenging. In the present paper, hard-anodized aluminum (AA) materials impregnated with antibacterial agents (quaternary ammonium compounds (QACs) and/or nitrate silver (AgNO₃)) were prepared and characterized. The thickness of the anodized layer was about 50 μm with pore diameter of 70 nm. AA with QACs and/or AgNO₃ had a water contact angle varying between 45 and 70°. The antibacterial activity of the materials was determined under different experimental settings to better mimic their use, and included liquid, humid, and dry conditions. AA-QAC surfaces demonstrated excellent efficiency, killing >99.9% of bacteria in 5 min on a wide range of Gram-positive (Staphylococcus aureus, Clostridioides difficile, vancomycin-resistant Enterococcus faecium) and Gram-negative (streptomycin-resistant Salmonella typhimurium and encapsulated Klebsiella pneumoniae) pathogens. AA-QACs showed a faster antibacterial activity (from 0.25 to 5 min) compared with antibacterial copper used as a reference (from 15 min to more than 1 h). We show that to maintain their high performance, AA-QACs should be used in low humidity environments and should be cleaned with solutions composed of QACs. Altogether, AA-QAC materials constitute promising candidates to prevent the transmission of pathogenic bacteria on high-touch surfaces.

Solid State Photoreduction of Silver on Mesoporous Silica to Enhance Antifungal Activity

A solid-state Ultraviolet-photoreduction process of silver cations to produce Ag0 nanostructures on a mesoporous silica is presented as an innovative method for the preparation of efficient environmental anti-fouling agents. Mesoporous silica powder, contacted with AgNO3, is irradiated at 366 nm, where silica surface defects absorb. The detailed characterization of the materials enables us to document the silica assisted photo-reduction. The appearance of a Visible (Vis) band centered at 470 nm in the extinction spectra, due to the surface plasmon resonance of Ag0 nanostructures, and the morphology changes observed in transmission electron microscopy (TEM) images, associated with the increase of Ag/O ratio in energy dispersive X-ray (EDX) analysis, indicate the photo-induced formation of Ag0. The data demonstrate that the photo-induced reduction of silver cation occurs in the solid state and takes place through the activation of silica defects. The activation of the materials after UV-processing is then tested, evaluating their antimicrobial activity using an environmental filamentous fungus, Aspergillus niger. The treatment doubled inhibitory capacity in terms of minimal inhibitory concentration (MIC) and biofilm growth. The antimicrobial properties of silver-silica nanocomposites are investigated when dispersed in a commercial sealant; the nanocomposites show excellent dispersion in the silicon and improve its anti-fouling capacity.

Assessment of antiviral coatings for high-touch surfaces using human coronaviruses HCoV-229E and SARS-CoV-2

A novel and robust approach to evaluate the antiviral activity of coatings was developed, assessing three commercially available leave-on surface coating products for efficacy against human coronaviruses (HCoVs) HCoV-229E and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The assessment is based on three criteria that reflect real-life settings, namely, (i) immediate antiviral effect, (ii) effect after repeated cleaning of the coated surface, and (iii) antiviral activity in the presence of organic material. The results showed that only a copper compound-based coating successfully met all three criteria. A quaternary ammonium compound-based coating did not meet the second criterion, and a coating based on reactive oxygen species showed no antiviral effect. Moreover, the study demonstrated that HCoV-229E is a relevant SARS-CoV-2 surrogate for such experiments. This new approach allows benchmarking of currently available antiviral coatings and future coating developments to avoid unjustified claims. The deployment of efficient antiviral coatings can offer an additional measure to mitigate the risk of transmission of respiratory viruses like SARS-CoV-2 or influenza viruses from high-touch surfaces.

IMPORTANCE SARS-CoV-2, the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic, is transmitted mainly person-to-person through respiratory droplets, while the contribution of fomite transmission is less important than suspected at the beginning of the pandemic. Nevertheless, antiviral-coating solutions can offer an additional measure to mitigate the risk of SARS-CoV-2 transmission from high-touch surfaces. The deployment of antiviral coatings is not new, but what is currently lacking is solid scientific evidence of the efficacy of commercially available self-disinfecting surfaces under real-life conditions. Therefore, we developed a novel, robust approach to evaluate the antiviral activity of such coatings, applying strict quality criteria to three commercially available products to test their efficacies against SARS-CoV-2. We also showed that HCoV-229E is a relevant surrogate for such experiments. Our approach will also bring significant benefit to the evaluation of the effects of coatings on the survival of nonenveloped viruses, which are known to be more tolerant to desiccation and disinfectants and for which high-touch surfaces play an important role.

Penetration of Singlet Oxygen into Films with Oxygen Permeability Coefficient Close to that of Skin

Although its antiviral and antibacterial functions help prevent infection, singlet oxygen (¹ O₂ )-which is generated by the action of light on an endogenous photosensitizer-is cytotoxic. In the present study, we investigated the ability of ¹ O₂ -generated by the action of visible light on a photosensitizer-to penetrate skin. We used two polymer films with oxygen permeability coefficients similar to that of skin-i.e. cellulose acetate (CA) and ethyl cellulose (EC). Both films contained 1,3-diphenylisobenzofuran (DPBF), which was used as an ¹ O₂ probe. ¹ O₂ generated externally did not permeate the films by mere contact. Therefore, we conclude that the potential for ¹ O₂ to penetrate the skin is very low, and films that generate ¹ O₂ are safe and useful for preventing infections by contact. We also proved that ¹ O₂ can move between the layers of integrated polymer films when they are joined together.

Biofouling detection methods that are widely applicable and useful across disciplines: a mini-review

Biofouling, or the build-up of microorganisms in a biofilm at the solid-water or water-air interface, is an interdisciplinary problem. Biofouling causes various issues including clogging systems, contaminating devices, and creating infections that are extremely difficult to treat, to name but a few. Therefore, engineers, pharmacologists, microbiologists, wastewater treatment operators, chemists, food preservative formulators, home and personal care product formulators, and toxicologists all play a role in studying and have an interest in solving biofouling. High-throughput studies on biofilm prevention and removal can take the form of biofilm antimicrobial microdilution susceptibility (BAMS) tests. Due to vested interests of many disciplines, the results from these tests should be applicable and useful to each discipline. This critical review analyses the focuses, biological implications, and metrics required by each discipline. The possible detection methods that could satisfy each desired metric are then summarized. The detection methods were analysed in order to recommend two methods of biofilm detection, Crystal Violet stain and the LIVE/DEAD BacLight stain, which correspond with three metrics including total biomass, log reduction, and the MIC, BPC, MBIC, MBC, BBC, and/or MBEC values. Determining these three metrics for each BAMS test will allow this type of research to be widely applicable and useful across many disciplines.

Fomite Transmission, Physicochemical Origin of Virus-Surface Interactions, and Disinfection Strategies for Enveloped Viruses with Applications to SARS-CoV-2

Inanimate objects or surfaces contaminated with infectious agents, referred to as fomites, play an important role in the spread of viruses, including SARS-CoV-2, the virus responsible for the COVID-19 pandemic. The long persistence of viruses (hours to days) on surfaces calls for an urgent need for effective surface disinfection strategies to intercept virus transmission and the spread of diseases. Elucidating the physicochemical processes and surface science underlying the adsorption and transfer of virus between surfaces, as well as their inactivation, is important for understanding how diseases are transmitted and for developing effective intervention strategies. This review summarizes the current knowledge and underlying physicochemical processes of virus transmission, in particular via fomites, and common disinfection approaches. Gaps in knowledge and the areas in need of further research are also identified. The review focuses on SARS-CoV-2, but discussion of related viruses is included to provide a more comprehensive review given that much remains unknown about SARS-CoV-2. Our aim is that this review will provide a broad survey of the issues involved in fomite transmission and intervention to a wide range of readers to better enable them to take on the open research challenges.

Surface Disinfection to Protect against Microorganisms: Overview of Traditional Methods and Issues of Emergent Nanotechnologies

Sterilization methods for individuals and facilities are extremely important to enable human beings to continue the basic tasks of life and to enable safe and continuous interaction of citizens in society when outbreaks of viral pandemics such as the coronavirus. Sterilization methods, their availability in gatherings, and the efficiency of their work are among the important means to contain the spread of viruses and epidemics and enable societies to practice their activities almost naturally. Despite the effective solutions given by traditional methods of surface disinfection, modern nanotechnology has proven to be an emergent innovation to protect against viruses. On this note, recent scientific breakthroughs have highlighted the ability of nanospray technology to attach to air atoms in terms of size and time-period of existence as a sterilizer for renewed air in large areas for human gatherings. Despite the ability of this method to control the outbreak of infections, the mutation of bactericidal mechanisms presents a great issue for scientists. In recent years, science has explored a more performant approach and techniques based on a surface-resistance concept. The most emergent is the self-defensive antimicrobial known as the self-disinfection surface. It consists of the creation of a bacteria cell wall to resist the adhesion of bacteria or to kill bacteria by chemical or physical changes. Besides, plasma-mediated virus inactivation was shown as a clean, effective, and human healthy solution for surface disinfection. The purpose of this article is to deepen the discussion on the threat of traditional methods of surface disinfection and to assess the state of the art and potential solutions using emergent nanotechnology.

Impact of a dry inoculum deposition on the efficacy of copper-based antimicrobial surfaces

BACKGROUND

The introduction of antimicrobial surfaces into healthcare environments is believed to impact positively on the rate of healthcare-associated infections by significantly decreasing pathogen presence on surfaces.

AIM

To report on a novel efficacy test that uses a dry bacterial inoculum to measure the microbicidal efficacy of antimicrobial surfaces.

METHODS

An aerosolized dry inoculum of Staphylococcus aureus or Acinetobacter baumannii was deposited on copper alloy surfaces or a hospital-grade stainless-steel surface. Surviving bacteria were enumerated following incubation of the inoculated surfaces at an environmentally relevant temperature and relative humidity. Damage caused to bacteria by the aerosolization process and by the different surfaces was investigated.

FINDINGS

Dry inoculum testing showed a <2-log₁₀ reduction in S. aureus or A. baumannii on the copper alloy surfaces tested after 24 h at 20°C and 40% relative humidity. Potential mechanisms of action included membrane damage, DNA damage and arrested cellular respiration. The aerosolization process caused some damage to bacterial cells. Once this effect was taken into account, the antimicrobial activity of copper surfaces was evident.

CONCLUSIONS

Our test provided a realistic deposition of a bacterial inoculum to a surface and, as such, a realistic protocol to assess the efficacy of dry antimicrobial environmental surfaces in vitro.

Antimicrobial surfaces for use on inhabited space craft: A review

Biodegradation of materials on crewed spacecraft can cause disruption, loss of function and lost crew time. Cleaning of surfaces is only partially effective due in accessibility and resource concerns. Commonly affected surfaces are hand-touch sites, waste disposal systems and liquid-handling systems, including condensing heat exchangers. The use of materials on and within such affected systems that reduce the attachment of and degradation by microbes, is an innovative solution to this problem. This review aims to examine both terrestrial and space-based experiments that have aimed to reduce microbial growth which are applicable to the unique conditions of crewed spacecraft. Traditional antimicrobial surfaces such as copper and silver, as well as nanoparticles, long-chain organic molecules and surface topographical features, as well as novel "smart" technologies are discussed. Future missions to cis-lunar and Martian destinations will depend on materials that retain their function and reliability for their success; thus, the use of antimicrobial and antifouling materials is a pivotal one.

A 3D-printed, touch-activated, sanitizer dispensing device for reducing healthcare-acquired infections

Aim: We present a touch-activated, sanitizer dispensing (TSD) device, intended to be mounted on high-touch surfaces, that aims to reduce nosocomial infections. It disinfects the person’s hand touching its surface while being self-sterilizing. Materials & methods: The TSD device consists of an array of 3D-printed, passive, miniaturized, mechanical valves that dispense a small amount of liquid sanitizer when touched. Its mechanical performance and disinfecting efficiency were quantified using simulations and experimental tests. Results & conclusion: The TSD device has a disinfecting efficiency comparable to the standard hand sanitizing approach, reducing the microbiological load by approximately 30-times. It can be easily mounted on high-touch surfaces in a healthcare setting and it is expected to greatly reduce the spread of nosocomial infections.

Disinfectant Activity of A Portable Ultraviolet C Equipment

Healthcare-associated infections (HAIs) can be caused by microorganisms present in common practice instruments generating major health problems in the hospital environment. The aim of this work was to evaluate the disinfection capacity of a portable ultraviolet C equipment (UV Sanitizer Corvent^® -UVSC-) developed to disinfect different objects. For this purpose, six pathogens causing HAIs: Acinetobacter baumannii, Bacillus subtilis, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Candida albicans, were inoculated on slides and discs of different biomaterials (borosilicate, polycarbonate, polyurethane, silicone, Teflon and titanium) and exposed to ultraviolet C radiation. UVSC disinfection was compared with ethanol and chlorhexidine antimicrobial activities following the standards EN14561 and EN14562. Disinfection, established as a reduction of five logarithms from the initial inoculum, was achieved with the UVSC at 120 s of exposure time, with and without the presence of organic matter. The disinfectant effect was observed against S. aureus, P. aeruginosa, E. coli, B. subtilis and C. albicans (reduction >99.999%). Disinfection was also achieved with 70% ethanol and 2% chlorhexidine. As conclusion, UVSC was effective disinfecting the most contaminated surfaces assayed, being a promising alternative for disinfecting hospital materials and inanimate objects that cannot be immersed in liquid biocides, reducing the risk of pathogen transmission.

Advancing antimicrobial strategies for managing oral biofilm infections

Effective control of oral biofilm infectious diseases represents a major global challenge. Microorganisms in biofilms exhibit increased drug tolerance compared with planktonic cells. The present review covers innovative antimicrobial strategies for controlling oral biofilm-related infections published predominantly over the past 5 years. Antimicrobial dental materials based on antimicrobial agent release, contact-killing and multi-functional strategies have been designed and synthesized for the prevention of initial bacterial attachment and subsequent biofilm formation on the tooth and material surface. Among the therapeutic approaches for managing biofilms in clinical practice, antimicrobial photodynamic therapy has emerged as an alternative to antimicrobial regimes and mechanical removal of biofilms, and cold atmospheric plasma shows significant advantages over conventional antimicrobial approaches. Nevertheless, more preclinical studies and appropriately designed and well-structured multi-center clinical trials are critically needed to obtain reliable comparative data. The acquired information will be helpful in identifying the most effective antibacterial solutions and the most optimal circumstances to utilize these strategies.

The Use of Copper as an Antimicrobial Agent in Health Care, Including Obstetrics and Gynecology

Health care-associated infections (HAIs) are a global problem associated with significant morbidity and mortality. Controlling the spread of antimicrobial-resistant bacteria is a major public health challenge, and antimicrobial resistance has become one of the most important global problems in current times. The antimicrobial effect of copper has been known for centuries, and ongoing research is being conducted on the use of copper-coated hard and soft surfaces for reduction of microbial contamination and, subsequently, reduction of HAIs. This review provides an overview of the historical and current evidence of the antimicrobial and wound-healing properties of copper and explores its possible utility in obstetrics and gynecology.

Continuous room decontamination technologies

The contaminated surface environment in the rooms of hospitalized patients is an important risk factor for the colonization and infection of patients with multidrug-resistant pathogens. Improved terminal cleaning and disinfection have been demonstrated to reduce the incidence of health care-associated infections. In the United States, hospitals generally perform daily cleaning and disinfection of patient rooms. However, cleaning and disinfection are limited by the presence of the patient in room (eg, current ultraviolet devices and hydrogen peroxide systems cannot be used) and the fact that after disinfection pathogenic bacteria rapidly recolonize surfaces and medical devices/equipment. For this reason, there has been great interest in developing methods of continuous room disinfection and/or "self-disinfecting" surfaces. This study will review the research on self-disinfecting surfaces (eg, copper-coated surfaces and persistent chemical disinfectants) and potential new room disinfection methods (eg, "blue light" and diluted hydrogen peroxide systems).

Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: A bundle approach

Over the past decade, there is excellent evidence in the scientific literature that contaminated environmental surfaces and noncritical patient care items play an important role in the transmission of several key health care-associated pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter, norovirus, and Clostridium difficile. Thus, surface disinfection of noncritical environmental surfaces and medical devices is one of the infection prevention strategies to prevent pathogen transmission. This article will discuss a bundle approach to facilitate effective surface cleaning and disinfection in health care facilities. A bundle is a set of evidence-based practices, generally 3-5, that when performed collectively and reliably have been proven to improve patient outcomes. This bundle has 5 components and the science associated with each component will be addressed. These components are: creating evidence-based policies and procedures; selection of appropriate cleaning and disinfecting products; educating staff to include environmental services, patient equipment, and nursing; monitoring compliance (eg, thoroughness of cleaning, product use) with feedback (ie, just in time coaching); and implementing a "no touch" room decontamination technology and to ensure compliance for patients on contact and enteric precautions. This article will also discuss new technologies (eg, continuous room decontamination technology) that may enhance our infection prevention strategies in the future.

Fighting AMR in the Healthcare Environment: Microbiome-Based Sanitation Approaches and Monitoring Tools

Healthcare-associated infections (HAIs) affect up to 15% of all hospitalized patients, representing a global concern. Major causes include the persistent microbial contamination of hospital environment, and the growing antimicrobial-resistance (AMR) of HAI-associated microbes. The hospital environment represents in fact a reservoir of potential pathogens, continuously spread by healthcare personnel, visiting persons and hospitalized patients. The control of contamination has been so far addressed by the use of chemical-based sanitation procedures, which however have limitations, as testified by the persistence of contamination itself and by the growing AMR of hospital microbes. Here we review the results collected by a microbial-based sanitation system, inspired by the microbiome balance principles, in obtaining more effective control of microbial contamination and AMR. Whatever the sanitation system used, an important aspect of controlling AMR and HAIs relates to the ability to check any variation of a microbial population rapidly and effectively, thus effective monitoring procedures are also described.

Plasma-Activated Aerosolized Hydrogen Peroxide (aHP) in Surface Inactivation Procedures

INTRODUCTION

Hydrogen peroxide is a strong oxidant that possesses an antimicrobial activity. It has been successfully used in surface/room decontamination processes either under the form of hydrogen peroxide vapor (HPV) or of vaporized hydrogen peroxide (VHP). Aerosolized hydrogen peroxide (aHP) offers a third alternative. The technology relies on the dispersion of aerosols of a hydrogen peroxide solution often complemented with silver cations. aHP provides an inexpensive and safe approach to treat contaminated rooms but sometimes fails to achieve the 6-log10 reduction limit in the number of viable microorganisms.

METHODS

Here, we used a venturi-based aHP generator that generates 4 mm in size aerosols from a 12% plasma-activated hydrogen peroxide solution free of silver cations.

RESULTS & DISCUSSION

We could successfully and constantly inactivate bacterial growth from biological indicators containing at least 106 spores of Geobacillus stearothermophilus placed on stainless steel discs wrapped in Tyvek pouches. We could also show that the biological indicators placed at various locations in a class II biosafety cabinet were equally inactivated, showing that hydrogen peroxide aerosols migrate through HEPA filters.

CONCLUSIONS

Considering that our method for aerosol generation is simple, reproducible, and highly effective at inactivating spores, our approach is expected to serve as a relatively cost effective alternative method for disinfecting potentially contaminated rooms or surfaces.

Nanostructured TiO2 anatase-rutile-carbon solid coating with visible light antimicrobial activity

TiO₂ photocatalyst is of interest for antimicrobial coatings on hospital touch-surfaces. Recent research has focused on visible spectrum enhancement of photocatalytic activity. Here, we report TiO₂ with a high degree of nanostructure, deposited on stainless steel as a solid layer more than 10 μm thick by pulsed-pressure-MOCVD. The TiO₂ coating exhibits a rarely-reported microstructure comprising anatase and rutile in a composite with amorphous carbon. Columnar anatase single crystals are segmented into 15-20 nm thick plates, resulting in a mille-feuilles nanostructure. Polycrystalline rutile columns exhibit dendrite generation resembling pine tree strobili. We propose that high growth rate and co-deposition of carbon contribute to formation of the unique nanostructures. High vapor flux produces step-edge instabilities in the TiO₂, and solid carbon preferentially co-deposits on certain high energy facets. The equivalent effective surface area of the nanostructured coating is estimated to be 100 times higher than standard TiO₂ coatings and powders. The coatings prepared on stainless steel showed greater than 3-log reduction in viable E coli after 4 hours visible light exposure. The pp-MOCVD approach could represent an up-scalable manufacturing route for supported catalysts of functional nanostructured materials without having to make nanoparticles.

Cationic surfactants as antifungal agents

Fungi-in being responsible for causing diseases in animals and humans as well as environmental contaminations in health and storage facilities-represent a serious concern to health security. Surfactants are a group of chemical compounds used in a broad spectrum of applications. The recently considered potential employment of cationic surfactants as antifungal or fungistatic agents has become a prominent issue in the development of antifungal strategies, especially if such surface-active agents can be synthesized in an eco-friendly manner. In this review, we describe the antifungal effect and the reported mechanisms of action of several types of cationic surfactants and also include a discussion of the contribution of these surfactants to the inhibition of yeast-based-biofilm formation. Furthermore, the putative mechanism of arginine-based tensioactive compounds as antifungal agents and their applications are also analyzed.

Electron beam functionalized photodynamic polyethersulfone membranes - photophysical characterization and antimicrobial activity

Polymer membranes are powerful filtration tools in medicine and water treatment. Their efficiency and operational lifetime is limited by biofouling caused by microorganisms. This study describes the development of photodynamical active antimicrobial polymer membranes in a one-pot functionalization step using a well-known photosensitizer (PS). Commercially available polyethersulfone (PES) membranes for microfiltration were doped with the polycationic PS TMPyP using electron beam irradiation. These membranes were characterized in terms of binding stability and quantification of the PS and membrane morphology. Furthermore, the photodynamic ability was verified by time resolved singlet oxygen luminescence scans and successfully tested against the Gram-negative bacterium E. coli under low dose white light illumination resulting in the reduction in cell survival of 6 log10 units. Finally, in preliminarily experiments the photodynamic action against the Gram-positive bacteria M. luteus and the Gram-negative P. fluorescence and the mold C. cladosporioides was demonstrated. These promising results show the high photodynamic potential of electron beam functionalization of PES membranes with TMPyP. It preserves the photodynamic abilities of the immobilized PS resulting in efficient photodynamic inactivation of bacteria and mold on the membrane surface. The uprising worldwide spread of antibiotic resistant bacteria makes the development of new antibacterial strategies an inevitable challenge. The photodynamic inactivation of bacteria and its adaptation for antimicrobial surfaces, e.g. filtration membranes for water treatment, displays many advantages in terms of a wide application range, low mutagenic potential and environmental compatibility.

Antimicrobial activity of a continuous visible light disinfection system

We evaluated the ability of high-intensity visible violet light with a peak output of 405 nm to kill epidemiologically important pathogens. The high irradiant light significantly reduced both vegetative bacteria and spores at some time points over a 72-hour exposure period.

Transmissible silver resistance readily evolves in high-risk clone isolates of Klebsiella pneumoniae

Silver is used extensively in both hospitals and outpatient clinics as a disinfectant coating agent on various devices. Resistance to silver was recently reported as an emerging problem in Enterobacteriaceae. Multidrug-resistant high-risk clones of Klebsiella pneumoniae are common causes of serious healthcare-associated infections worldwide posing a serious threat to patients. In this study, we investigated the capacity of both high-risk (CG14/15 and CG258) and minor clone strains of K. pneumoniae to develop resistance to silver. Resistance was induced in vitro in silver-susceptible but otherwise multidrug-resistant clinical isolates. Genetic alterations in the silver-resistant derivative strains with regard to the silver-susceptible isolates were investigated by whole-genome sequencing. The transferability of high-level resistance to silver was also tested. We demonstrated that the high-level resistance to silver can quickly evolve as a consequence of a single-point mutation either in the cusS gene of the chromosomally encoded CusCFBARS efflux system and/or in the silS gene of the plasmid-encoded Copper Homeostasis and Silver Resistance Island (CHASRI) coding also for a metallic efflux. The minimal inhibitory concentrations (MICs) of the strains increased from 4 mg/L (23.5 μM) AgNO₃ to >8,500 mg/L (>50,000 μM) AgNO₃ during induction. Harboring the CHASRI proved an important selective asset for K. pneumoniae when exposed to silver. Successful conjugation experiments using Escherichia coli K12 J5-3^Rif as recipient showed that high-level silver resistance can transmit between strains of high-risk clones of K. pneumoniae (ST15 and ST11) and isolates from additional species of Enterobacteriaceae. The lack of fitness cost associated with the carriage of the CHASRI in a silver-free environment and the presence of the RelEB toxin-antitoxin system on the conjugative plasmids could advance the dissemination of silver resistance. Our results show that multidrug-resistant high-risk clones of K. pneumoniae are capable of evolving and transmitting high-level resistance to silver. This observation should warrant a more judicious use of silver coated-devices to prevent the extensive dissemination of silver resistance.

Cleaning and disinfection of surfaces in hospitals. Improvement in quality of structure, process and outcome in the hospitals in Frankfurt/Main, Germany, in 2016 compared to 2014

The cleaning and disinfection of surfaces in hospitals is becoming increasingly important in the multi-barrier approach for preventing infection, in addition to hand hygiene and proper reprocessing of medical devices. Therefore, in 2014, the quality of structure, process and outcome of surface preparation was checked in all hospitals in Frankfurt/Main, Germany. Because of great need for improvements, this monitoring was repeated in 2016. The data are presented in comparison to those in 2014.

Methods: All 16 hospitals provided information on the quality of structure. Data on quality of process was obtained through direct observation during cleaning and disinfection of rooms and their bathrooms. Data on quality of result was acquired using the fluorescence method, i.e., marking surfaces with a fluorescent liquid and testing whether this mark has been sufficiently removed by cleaning. The results are compared to those of the 17 hospitals monitored in 2014, before the closing of one of the hospitals.

Results: Quality of structure [data from 2014]: In all hospitals, the employees were trained regularly. In 14 (88%) [12; 71%] of those, the foremen had the required qualifications. In 1 (6%) [6; 35%] hospitals, some uncertainty remained concerning the interface of the cleaning and nursing care services. A complete cleaning was reported to take place in 12 (75%) [12; 70%] hospitals on Saturdays and in 4 (25%) [2; 11%] hospitals on Sundays. Quality of process: During process monitoring, the different surfaces with frequent hand or skin contact were prepared to different extents (91–100%) [70–100%]. Quality of result: 88% [75%] of fluorescent marks were appropriately removed.

Conclusion: Compared to 2014, a clear improvement were seen in 2016, especially in the qualification of the foremen and in terms of clearly defining the interface between cleaning and care services as well as the quality of process and outcome. Nevertheless, regarding the growing importance of proper reprocessing of hospital surfaces for prevention of infections and/or colonizations, further improvements are mandatory, including a program for better education of the cleaning staff.

Ultraviolet-C decontamination of hand-held tablet devices in the healthcare environment using the Codonics D6000™ disinfection system

Mobile phones and tablet computers may be contaminated with micro-organisms and become a potential reservoir for cross-transmission of pathogens between healthcare workers and patients. There is no generally accepted guidance on how to reduce contamination on mobile devices in healthcare settings. Our aim was to determine the efficacy of the Codonics D6000™ UV-C disinfection device. Daily disinfection reduced contamination on screens and on protective cases (test) significantly, but not all cases (control) could be decontaminated. The median aerobic colony count on the control and the test cases was 52 cfu/25 cm² (interquartile range: 33-89) and 22 cfu/25 cm² (10.5-41), respectively, before disinfection.

The efficacy of self-disinfecting bedrail covers in an intensive care unit

BACKGROUND

Hospital surfaces are considered important vectors in the spread of nosocomial pathogens. This study evaluated microbial counts on novel antimicrobial bedrail covers over a 2-week period in a critical care environment.

METHODS

Disposable bedrail covers (Aionx Inc, Hershey, PA) made of a copper and silver polymer and capable of conducting an imperceptible surface potential, were installed in a case-control manner on a series of occupied intensive care unit beds. Seventeen bedrails were covered with the study bedrail surface, and 17 were left uncovered. Two hundred seventy-two microbial surface cultures were obtained from both study and control bedrails and analyzed for microbial growth by bacterial enumeration and speciation.

RESULTS

The bedrails covered with the study surface demonstrated >80% average decrease in colony forming units across the study period of 15 days.

CONCLUSIONS

These novel, detachable bedrail covers successfully demonstrated significant bacterial count reduction in an intensive care unit setting. This may have implications for acquisition of hospital-acquired infections.

New insights on antimicrobial efficacy of copper surfaces in the healthcare environment: a systematic review

OBJECTIVES

Hospital-acquired infections (HAIs) are a major public health issue. The potential of antimicrobial copper surfaces in reducing HAIs' rates is of interest but remains unclear. We conducted a systematic review of studies assessing the activity of copper surfaces (colony-forming unit (CFU)/surface, both in vitro and in situ) as well as clinical studies. In vitro study protocols were analysed through a tailored checklist developed specifically for this review, in situ studies and non-randomized clinical studies were assessed using the ORION (Outbreak Reports and Intervention studies Of Nosocomial infection) checklist and randomized clinical studies using the CONSORT guidelines.

METHODS

The search was conducted using PubMed database with the keywords 'copper' and 'surfaces' and 'healthcare associated infections' or 'antimicrobial'. References from relevant articles, including reviews, were assessed and added when appropriate. Articles were added until 30 August 2016. Overall, 20 articles were selected for review including 10 in vitro, eight in situ and two clinical studies.

RESULTS

Copper surfaces were found to have variable antimicrobial activity both in vitro and in situ, although the heterogeneity in the designs and the reporting of the results prevented conclusions from being drawn regarding their spectrum and activity/time compared to controls. Copper effect on HAIs incidence remains unclear because of the limited published data and the lack of robust designs. Most studies have potential conflicts of interest with copper industries.

CONCLUSIONS

Copper surfaces have demonstrated an antimicrobial activity but the implications of this activity in healthcare settings are still unclear. No clear effect on healthcare associated infections has been demonstrated yet.

Environmental Cleaning in Resource-Limited Settings

Purpose of review

Environmental surfaces in healthcare facilities, particularly in a patient room, are a critical pathway for healthcare-associated pathogen transmission. Despite well-established guides and recommendations regarding environmental surface cleaning and disinfection, there are several challenges in resource-limited settings. This viewpoint article will discuss the practice of environmental cleaning in resource-limited settings including challenges and relationship between environment and healthcare-associated infections in this setting and outlines pre-requisites to overcome these challenges.

Recent findings

Despite several barriers and challenges, environmental cleaning is a crucial component to help reduce transmission of healthcare-associated infections and multi-drug-resistant pathogens as well as emerging infectious disease-associated pathogens in resource-limited settings. However, there is a need to develop a multi-modal strategy together with a mechanism for monitor and feedback to improve the practices of environmental cleaning in resource-limited settings.

Summary

Additional researches on the barriers and implementation gaps and the role of collaborative network as well as how to apply technology would provide significant insights on the practices of environmental cleaning in resource-limited settings.

Branched High Molecular Weight Glycopolypeptide With Broad-Spectrum Antimicrobial Activity for the Treatment of Biofilm Related Infections

There are few therapeutic options to simultaneously tackle Staphylococcus aureus and Pseudomonas aeruginosa, two of the most relevant nosocomial and antibiotic-resistant pathogens responsible for implant, catheters and wound severe infections. The design and synthesis of polymers with inherent antimicrobial activity have gained increasing attention as a safe strategy to treat multi-drug-resistant microbes. Here, we tested the activity of a new polymeric derivative with glycopolypeptide architecture (PAA-VC) bearing l-arginine, vancomycin, and colistin as side chains acting against multiple targets, which give rise to a broad spectrum antimicrobial activity favorably combining specific and nonspecific perturbation of the bacterial membrane. PAA-VC has been tested against planktonic and established biofilms of reference strains S. aureus ATCC 25923 and P. aeruginosa ATCC 15442 and susceptible or antibiotic resistant clinical isolates of the above-mentioned microorganisms. MIC values observed for the conjugate (48-190 and 95-190 nM for P. aeruginosa and S. aureus strains, respectively) showed higher efficacy if compared with the free vancomycin (MICs within 1.07-4.28 μM) and colistin (MICs within 0.63-1.33 μM). Additionally, being highly biocompatible (IC₅₀ > 1000, 430, and 250 μg mL^-1 for PAA-VC, vancomycin and colistin respectively) high-dosage can be adopted for the eradication of infections in patients. This positively influences the anti-biofilm activity of the conjugate leading to a quasi-total eradication of established clinically relevant biofilms (inhibition >90% at 500 μg mL^-1). We believe that the in vitro presented data, especially the activity against established biofilms of two relevant pathogens, the high biocompatibility and the good mucoadhesion properties, would allow the use of PAA-VC as promising candidate to successfully address emerging infections.