Antimicrobial surfaces to prevent healthcare-associated infections: a systematic review

Healthcare as a driver, reservoir and amplifier of antimicrobial resistance: opportunities for interventions

Antimicrobial resistance (AMR) is a global health challenge that threatens humans, animals and the environment. Evidence is emerging for a role of healthcare infrastructure, environments and patient pathways in promoting and maintaining AMR via direct and indirect mechanisms. Advances in vaccination and monoclonal antibody therapies together with integrated surveillance, rapid diagnostics, targeted antimicrobial therapy and infection control measures offer opportunities to address healthcare-associated AMR risks more effectively. Additionally, innovations in artificial intelligence, data linkage and intelligent systems can be used to better predict and reduce AMR and improve healthcare resilience. In this Review, we examine the mechanisms by which healthcare functions as a driver, reservoir and amplifier of AMR, contextualized within a One Health framework. We also explore the opportunities and innovative solutions that can be used to combat AMR throughout the patient journey. We provide a perspective on the current evidence for the effectiveness of interventions designed to mitigate healthcare-associated AMR and promote healthcare resilience within high-income and resource-limited settings, as well as the challenges associated with their implementation.

An Antimicrobial Copper-Plastic Composite Coating: Characterization and In Situ Study in a Hospital Environment

A method has been proposed for creating an operationally durable copper coating with antimicrobial properties for the buttons of electrical switches based on the gas dynamic spray deposition of copper on acrylonitrile butadiene styrene (ABS) plastic. It is shown that during the coating process, a polymer film is formed on top of the copper layer. Comparative in situ studies of microbial contamination have shown that the copper-coated buttons have a significant antimicrobial effect compared to standard buttons. Analysis of swabs over a 22-week study in a hospital environment showed that the frequency of contamination for a copper-coated button with various microorganisms was 2.7 times lower than that of a control button. The presented results allow us to consider the developed copper coating for plastic switches an effective alternative method in the fight against healthcare-associated infections.

Hygiene requirements for cleaning and disinfection of surfaces: recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute

This recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) addresses not only hospitals, but also outpatient health care facilities and compiles current evidence. The following criteria are the basis for the indications for cleaning and disinfection: Infectious bioburden and tenacity of potential pathogens on surfaces and their transmission routes, influence of disinfecting surface cleaning on the rate of nosocomial infections, interruption of cross infections due to multidrug-resistant organisms, and outbreak control by disinfecting cleaning within bundles. The criteria for the selection of disinfectants are determined by the requirements for effectiveness, the efficacy spectrum, the compatibility for humans and the environment, as well as the risk potential for the development of tolerance and resistance. Detailed instructions on the organization and implementation of cleaning and disinfection measures, including structural and equipment requirements, serve as the basis for their implementation. Since the agents for surface disinfection and disinfecting surface cleaning have been classified as biocides in Europe since 2013, the regulatory consequences are explained. As possible addition to surface disinfection, probiotic cleaning, is pointed out. In an informative appendix (only in German), the pathogen characteristics for their acquisition of surfaces, such as tenacity, infectious dose and biofilm formation, and the toxicological and ecotoxicological characteristics of microbicidal agents as the basis for their selection are explained, and methods for the evaluation of the resulting quality of cleaning or disinfecting surface cleaning are presented.

Redox Active Zn@MOFs as Spontaneous Reactive Oxygen Species Releasing Antimicrobials

The rapid development of antimicrobial resistance (AMR) among infectious pathogens has become a major threat and challenge in healthcare systems globally. A strategy distinct from minimizing the overuse of antimicrobials involves the development of novel antimicrobials with a mode of action that prevents the development of AMR microbial strains. Reactive oxygen species (ROS) are formed as a natural byproduct of the cellular aerobic metabolism. However, it becomes pathological when ROS is produced at excessive levels. Exploiting this phenomenon, research on redox-active bactericides has been demonstrated to be beneficial. Materials that release ROS via photodynamic, thermodynamic, and photocatalytic interventions have been developed as nanomedicines and are used in various applications. However, these materials require external stimuli for ROS release to be effective as biocides. In this paper, we report novel zinc-based metal organic framework (Zn@MOF) particles that promote the spontaneous release of active ROS species. The synthesized Zn@MOF spontaneously releases superoxide anions and hydrogen peroxide, exhibiting a potent antimicrobial efficacy against various microbes. Zn@MOF-incorporated plastic films and coatings show excellent, long-lasting antimicrobial potency even under continuous microbial challenge and an aging process. These disinfecting surfaces maintain their antimicrobial properties even after 500× surface wipes. Zn@MOF is also biocompatible and safe on the skin, illustrating its broad potential applications in medical technology and consumer care applications.

Antibacterial activity of solid surfaces is critically dependent on relative humidity, inoculum volume, and organic soiling

Antimicrobial surface materials potentially prevent pathogen transfer from contaminated surfaces. Efficacy of such surfaces is assessed by standard methods using wet exposure conditions known to overestimate antimicrobial activity compared to dry exposure. Some dry test formats have been proposed but semi-dry exposure scenarios e.g. oral spray or water droplets exposed to ambient environment, are less studied. We aimed to determine the impact of environmental test conditions on antibacterial activity against the model species Escherichia coli and Staphylococcus aureus. Surfaces based on copper, silver, and quaternary ammonium with known or claimed antimicrobial properties were tested in conditions mimicking microdroplet spray or larger water droplets exposed to variable relative air humidity in the presence or absence of organic soiling. All the environmental parameters critically affected antibacterial activity of the tested surfaces from no effect in high-organic dry conditions to higher effect in low-organic humid conditions but not reaching the effect size demonstrated in the ISO 22169 wet format. Copper was the most efficient antibacterial surface followed by silver and quaternary ammonium based coating. Antimicrobial testing of surfaces using small droplet contamination in application-relevant conditions could therefore be considered as one of the worst-case exposure scenarios relevant to dry use surfaces.

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.

Toxicity Mechanisms of Copper Nanoparticles and Copper Surfaces on Bacterial Cells and Viruses

Copper is a metal historically used to prevent infections. One of the most relevant challenges in modern society are infectious disease outbreaks, where copper-based technologies can play a significant role. Currently, copper nanoparticles and surfaces are the most common antimicrobial copper-based technologies. Despite the widespread use of copper on nanoparticles and surfaces, the toxicity mechanism(s) explaining their unique antimicrobial properties are not entirely known. In general, toxicity effects described in bacteria and fungi involve the rupture of membranes, accumulation of ions inside the cell, protein inactivation, and DNA damage. A few studies have associated Cu-toxicity with ROS production and genetic material degradation in viruses. Therefore, understanding the mechanisms of the toxicity of copper nanoparticles and surfaces will contribute to developing and implementing efficient antimicrobial technologies to combat old and new infectious agents that can lead to disease outbreaks such as COVID-19. This review summarizes the current knowledge regarding the microbial toxicity of copper nanoparticles and surfaces and the gaps in this knowledge. In addition, we discuss potential applications derived from discovering new elements of copper toxicity, such as using different molecules or modifications to potentiate toxicity or antimicrobial specificity.

Quaternary Ammonium Compounds: A Chemical Class of Emerging Concern

Quaternary ammonium compounds (QACs), a large class of chemicals that includes high production volume substances, have been used for decades as antimicrobials, preservatives, and antistatic agents and for other functions in cleaning, disinfecting, personal care products, and durable consumer goods. QAC use has accelerated in response to the COVID-19 pandemic and the banning of 19 antimicrobials from several personal care products by the US Food and Drug Administration in 2016. Studies conducted before and after the onset of the pandemic indicate increased human exposure to QACs. Environmental releases of these chemicals have also increased. Emerging information on adverse environmental and human health impacts of QACs is motivating a reconsideration of the risks and benefits across the life cycle of their production, use, and disposal. This work presents a critical review of the literature and scientific perspective developed by a multidisciplinary, multi-institutional team of authors from academia, governmental, and nonprofit organizations. The review evaluates currently available information on the ecological and human health profile of QACs and identifies multiple areas of potential concern. Adverse ecological effects include acute and chronic toxicity to susceptible aquatic organisms, with concentrations of some QACs approaching levels of concern. Suspected or known adverse health outcomes include dermal and respiratory effects, developmental and reproductive toxicity, disruption of metabolic function such as lipid homeostasis, and impairment of mitochondrial function. QACs' role in antimicrobial resistance has also been demonstrated. In the US regulatory system, how a QAC is managed depends on how it is used, for example in pesticides or personal care products. This can result in the same QACs receiving different degrees of scrutiny depending on the use and the agency regulating it. Further, the US Environmental Protection Agency's current method of grouping QACs based on structure, first proposed in 1988, is insufficient to address the wide range of QAC chemistries, potential toxicities, and exposure scenarios. Consequently, exposures to common mixtures of QACs and from multiple sources remain largely unassessed. Some restrictions on the use of QACs have been implemented in the US and elsewhere, primarily focused on personal care products. Assessing the risks posed by QACs is hampered by their vast structural diversity and a lack of quantitative data on exposure and toxicity for the majority of these compounds. This review identifies important data gaps and provides research and policy recommendations for preserving the utility of QAC chemistries while also seeking to limit adverse environmental and human health effects.

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.

Analysis of Cellular Damage Resulting from Exposure of Bacteria to Graphene Oxide and Hybrids Using Fourier Transform Infrared Spectroscopy

With the increase in antimicrobial resistance, there is an urgent need to find new antimicrobials. Four particulate antimicrobial compounds, graphite (G), graphene oxide (GO), silver-graphene oxide (Ag-GO) and zinc oxide-graphene oxide (ZnO-GO) were tested against Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus. The antimicrobial effects on the cellular ultrastructure were determined using Fourier transform infrared spectroscopy (FTIR), and selected FTIR spectral metrics correlated with cell damage and death arising from exposure to the GO hybrids. Ag-GO caused the most severe damage to the cellular ultrastructure, whilst GO caused intermediate damage. Graphite exposure caused unexpectedly high levels of damage to E. coli, whereas ZnO-GO exposure led to relatively low levels of damage. The Gram-negative bacteria demonstrated a stronger correlation between FTIR metrics, indicated by the perturbation index and the minimal bactericidal concentration (MBC). The blue shift of the combined ester carbonyl and amide I band was stronger for the Gram-negative varieties. FTIR metrics tended to provide a better assessment of cell damage based on correlation with cellular imaging and indicated that damage to the lipopolysaccharide, peptidoglycan and phospholipid bilayers had occurred. Further investigations into the cell damage caused by the GO-based materials will allow the development of this type of carbon-based multimode antimicrobials.

Bioinspired nanoflakes with antifouling and mechano-bactericidal capacity

Pathogenic bacteria contamination ubiquitously occurs on high-contact surfaces in hospitals and has long been a threat to public health, inducing severe nosocomial infections that cause multiple organ dysfunction and increased hospital mortality. Recently, nanostructured surfaces with mechano-bactericidal properties have shown potential for modifying material surfaces to fight against the spread of pathogenic microorganisms without the risk of triggering antibacterial resistance. Nevertheless, these surfaces are readily contaminated by bacterial attachment or inanimate pollutants like solid dust or common fluids, which has greatly weakened their antibacterial capabilities. In this work, we discovered that the nonwetting Amorpha fruticosa leaf surfaces are equipped with mechano-bactericidal capacity by means of their randomly-arranged nanoflakes. Inspired by this discovery, we reported an artificial superhydrophobic surface with similar nanofeatures and superior antibacterial abilities. Compared to conventional bactericidal surfaces, this bioinspired antibacterial surface was synergistically accompanied by antifouling performances, which significantly prevent either initial bacterial attachment or inanimate pollutants like dust covering and fluid contaminants. Overall, the bioinspired antifouling nanoflakes surface holds promise as the design of next-generation high-touch surface modification that effectively reduces the transmission of nosocomial infections.

Nanosilver/DCOIT-containing surface coating effectively and constantly reduces microbial load in emergency room surfaces

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.

Innovation for infection prevention and control-revisiting Pasteur's vision

Louis Pasteur has long been heralded as one of the fathers of microbiology and immunology. Less known is Pasteur's vision on infection prevention and control (IPC) that drove current infection control, public health, and much of modern medicine and surgery. In this Review, we revisited Pasteur's pioneering works to assess progress and challenges in the process and technological innovation of IPC. We focused on Pasteur's far-sighted conceptualisation of the hospital as a reservoir of microorganisms and amplifier of transmission, aseptic technique in surgery, public health education, interdisciplinary working, and the protection of health services and patients. Examples from across the globe help inform future thinking for IPC innovation, adoption, scale up and sustained use.

Airborne transmission of biological agents within the indoor built environment: a multidisciplinary review

The nature and airborne dispersion of the underestimated biological agents, monitoring, analysis and transmission among the human occupants into building environment is a major challenge of today. Those agents play a crucial role in ensuring comfortable, healthy and risk-free conditions into indoor working and leaving spaces. It is known that ventilation systems influence strongly the transmission of indoor air pollutants, with scarce information although to have been reported for biological agents until 2019. The biological agents' source release and the trajectory of airborne transmission are both important in terms of optimising the design of the heating, ventilation and air conditioning systems of the future. In addition, modelling via computational fluid dynamics (CFD) will become a more valuable tool in foreseeing risks and tackle hazards when pollutants and biological agents released into closed spaces. Promising results on the prediction of their dispersion routes and concentration levels, as well as the selection of the appropriate ventilation strategy, provide crucial information on risk minimisation of the airborne transmission among humans. Under this context, the present multidisciplinary review considers four interrelated aspects of the dispersion of biological agents in closed spaces, (a) the nature and airborne transmission route of the examined agents, (b) the biological origin and health effects of the major microbial pathogens on the human respiratory system, (c) the role of heating, ventilation and air-conditioning systems in the airborne transmission and (d) the associated computer modelling approaches. This adopted methodology allows the discussion of the existing findings, on-going research, identification of the main research gaps and future directions from a multidisciplinary point of view which will be helpful for substantial innovations in the field.

Current and potential approaches on assessing airflow and particle dispersion in healthcare facilities: a systematic review

An indoor environment in a hospital building requires a high indoor air quality (IAQ) to overcome patients' risks of getting wound infections without interrupting the recovery process. However, several problems arose in obtaining a satisfactory IAQ, such as poor ventilation design strategies, insufficient air exchange, improper medical equipment placement and high door opening frequency. This paper presents an overview of various methods used for assessing the IAQ in hospital facilities, especially in an operating room, isolation room, anteroom, postoperative room, inpatient room and dentistry room. This review shows that both experimental and numerical methods demonstrated their advantages in the IAQ assessment. It was revealed that both airflow and particle tracking models could result in different particle dispersion predictions. The model selection should depend on the compatibility of the simulated result with the experimental measurement data. The primary and secondary forces affecting the characteristics of particle dispersion were also discussed in detail. The main contributing forces to the trajectory characteristics of a particle could be attributed to the gravitational force and drag force regardless of particle size. Meanwhile, the additional forces could be considered when there involves temperature gradient, intense light source, submicron particle, etc. The particle size concerned in a healthcare facility should be less than 20 μm as this particle size range showed a closer relationship with the virus load and a higher tendency to remain airborne. Also, further research opportunities that reflect a more realistic approach and improvement in the current assessment approach were proposed.

Disinfectants role in the prevention of spreading the COVID ‐19 and other infectious diseases: The need for functional polymers!

The spreading of coronavirus through droplets and aerosols of an infected person is a well‐known mechanism. The main protection methods from this virus are using disinfectants/sanitizers, face masks, keeping social distance, and vaccination. With the rapid mutations of the virus accompanied by its features and contagions changing, new advanced functional materials development is highly needed. The usage of disinfectants/sanitizers in excess generates poisonous effects among the general public. Effective and simultaneously, human‐friendly sanitizers or disinfectants are required to prevent the poisoning and the associated issues. They minimize the toxic effects of the currently available materials by rapid action, high potential, long‐term stability, and excellent biocompatible nature. Here, we summarize the available antiviral materials, their features, and their limitations. We highlight the need to develop an arsenal of advanced functional antiviral polymers with intrinsic bioactive functionalities or released bioactive moieties in a controlled manner for rapid and long‐term actions for current and future anticipated viral outbreaks.

Bacterial contamination of the smartphones of healthcare workers in a German tertiary-care hospital before and during the COVID-19 pandemic

Background

Assuming that hygiene measures have improved significantly due to COVID-19, we aimed to investigate bacterial colonization on smartphones (SPs) owned by healthcare workers (HCWs) before and during the pandemic.

Methods

Employing a before-and-after study design, randomly selected HCWs were included. Devices underwent sampling under real-life conditions, without prior manipulation. Swabs were collected in 2012 (pre-pandemic) and 2021 to determine microbial colonization. Isolates were identified by MALDI-TOF mass spectrometry and underwent microbiological susceptibility testing.

Results

The final analysis included 295 HCWs (67% female, mean age 34 years) from 26 wards. Bacterial contamination was present on 293 of 295 SP screens (99.3%). The proportion of clinically relevant bacterial pathogens (eg Staphylococcus aureus, enterococci, Enterobacterales, non-fermenting bacteria) ranged from 21.2% in 2012 to 39.8% in 2021. Resistance profiles revealed a proportion of multidrug-resistant bacteria such as MRSA and VRE of less than 2%. The comparison of before-and-after sampling showed a significant increase in smartphone use during work from 2012 to 2021 with a simultaneous increase in cleaning intensity, probably as a result of the COVID-19 pandemic.

Conclusions

Bacterial contamination of SPs within the hospital is of concern and can serve as a source of cross-contamination. Hence, in addition to excellent hand hygiene, SPs must be carefully disinfected after handling in healthcare. Behavioral changes related to the COVID-19 pandemic could have a significant impact if implemented sustainably in everyday clinical practice.

Antimicrobial TiN-Ag Coatings in Leather Insole for Diabetic Foot

This work reports on TiN-Ag antimicrobial coatings deposited by d.c. magnetron sputtering on leather used for insoles on the footwear industry, studies involving the antimicrobial properties of Ag-based functionalized leathers by sputtering techniques are shown. The X-ray diffraction (XRD) results suggested the presence of crystalline fcc-TiN phase for the sample without silver, and also a fcc-Ag phase in the samples containing silver. According to the Scanning Electron Microscopy (SEM) analysis, the coatings were homogeneous and dispersed Ag clusters were detected on the surface of samples with silver content above 8 at. %. The Inductively coupled plasma-optical emission spectrometry (ICP-OES) analysis showed that the ionization of silver over time depends on the morphology of the coatings. The samples did not present cytotoxicity and only samples with incorporated silver presented antibacterial and antifungal activity, highlighting the potential of the TiN-Ag insole coatings for diseases such as diabetic foot.

From Copper Tolerance to Resistance in Pseudomonas aeruginosa towards Patho-Adaptation and Hospital Success

The hospital environment constitutes a reservoir of opportunistic pathogens responsible for healthcare-associated infections (HCAI) such as Pseudomonas aeruginosa (Pa). Pa persistence within technological niches, the increasing emergence of epidemic high-risk clones in HCAI, the epidemiological link between plumbing strains and clinical strains, make it a major nosocomial pathogen. Therefore, understanding the mechanisms of Pa adaptation to hospital water systems would be useful in preventing HCAI. This review deciphers how copper resistance contributes to Pa adaptation and persistence in a hospital environment, especially within copper water systems, and ultimately to its success as a causative agent of HCAI. Numerous factors are involved in copper homeostasis in Pa, among which active efflux conferring copper tolerance, and copper-binding proteins regulating the copper compartmentalization between periplasm and cytoplasm. The functional harmony of copper homeostasis is regulated by several transcriptional regulators. The genomic island GI-7 appeared as especially responsible for the copper resistance in Pa. Mechanisms of copper and antibiotic cross-resistance and co-resistance are also identified, with potential co-regulation processes between them. Finally, copper resistance of Pa confers selective advantages in colonizing and persisting in hospital environments but also appears as an asset at the host/pathogen interface that helps in HCAI occurrence.

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.

Antimicrobial coatings for environmental surfaces in hospitals: a potential new pillar for prevention strategies in hygiene

Recent reports provide evidence that contaminated healthcare environments represent major sources for the acquisition and transmission of pathogens. Antimicrobial coatings (AMC) may permanently and autonomously reduce the contamination of such environmental surfaces complementing standard hygiene procedures. This review provides an overview of the current status of AMC and the demands to enable a rational application of AMC in health care settings. Firstly, a suitable laboratory test norm is required that adequately quantifies the efficacy of AMC. In particular, the frequently used wet testing (e.g. ISO 22196) must be replaced by testing under realistic, dry surface conditions. Secondly, field studies should be mandatory to provide evidence for antimicrobial efficacy under real-life conditions. The antimicrobial efficacy should be correlated to the rate of nosocomial transmission at least. Thirdly, the respective AMC technology should not add additional bacterial resistance development induced by the biocidal agents and co- or cross-resistance with antibiotic substances. Lastly, the biocidal substances used in AMC should be safe for humans and the environment. These measures should help to achieve a broader acceptance for AMC in healthcare settings and beyond. Technologies like the photodynamic approach already fulfil most of these AMC requirements.

High-Resolution Microscopical Studies of Contact Killing Mechanisms on Copper-Based Surfaces

The mechanisms of bacterial contact killing induced by Cu surfaces were explored through high-resolution studies based on combinations of the focused ion beam (FIB), scanning transmission electron microscopy (STEM), high-resolution TEM, and nanoscale Fourier transform infrared spectroscopy (nano-FTIR) microscopy of individual bacterial cells of Gram-positive Bacillus subtilis in direct contact with Cu metal and Cu5Zn5Al1Sn surfaces after high-touch corrosion conditions. This approach permitted subcellular information to be extracted from the bioinorganic interface between a single bacterium and Cu/Cu5Zn5Al1Sn surfaces after complete contact killing. Early stages of interaction between individual bacteria and the metal/alloy surfaces include cell leakage of extracellular polymeric substances (EPSs) from the bacterium and changes in the metal/alloy surface composition upon adherence of bacteria. Three key observations responsible for Cu-induced contact killing include cell membrane damage, formation of nanosized copper-containing particles within the bacteria cell, and intracellular copper redox reactions. Direct evidence of cell membrane damage was observed upon contact with both Cu metal and Cu5Zn5Al1Sn surfaces. Cell membrane damage permits copper to enter into the cell interior through two possible routes, as small fragmentized Cu₂O particles from the corrosion product layer and/or as released copper ions. This results in the presence of intracellular copper oxide nanoparticles inside the cell. The nanosized particles consist primarily of CuO with smaller amounts of Cu₂O. The existence of two oxidation states of copper suggests that intracellular redox reactions play an important role. The nanoparticle formation can be regarded as a detoxification process of copper, which immobilizes copper ions via transformation processes within the bacteria into poorly soluble or even insoluble nanosized Cu structures. Similarly, the formation of primarily Cu(II) oxide nanoparticles could be a possible way for the bacteria to deactivate the toxic effects induced by copper ions via conversion of Cu(I) to Cu(II).

Evaluation of the ZnO Nanopillar Surface for Disinfection Applications

Much attention has been devoted to the synthesis and antimicrobial studies of nanopatterned surfaces. However, factors contributing to their potential and eventual application, such as large-scale synthesis, material durability, and biocompatibility, are often neglected in such studies. In this paper, the ZnO nanopillar surface is found to be amenable to synthesis in large forms and stable upon exposure to highly accelerated lifetime tests (HALT) without any detrimental effect on its antimicrobial activity. Additionally, the material is effective against clinically isolated pathogens and biocompatible in vivo. These findings illustrate the broad applicability of ZnO nanopillar surfaces in the common equipment used in health-care and consumer industries.

Preliminary Study on Light-Activated Antimicrobial Agents as Photocatalytic Method for Protection of Surfaces with Increased Risk of Infections

Preventing and controlling the spread of multidrug-resistant (MDR) bacteria implicated in healthcare-associated infections is the greatest challenge of the health systems. In recent decades, research has shown the need for passive antibacterial protection of surfaces in order to reduce the microbial load and microbial biofilm development, frequently associated with transmission of infections. The aim of the present study is to analyze the efficiency of photocatalytic antimicrobial protection methods of surfaces using the new photocatalytic paint activated by light in the visible spectrum. The new composition is characterized by a wide range of analytical methods, such as UV-VIS spectroscopy, electron microscopy (SEM), X-ray powder diffraction (PXRD) or X-ray photoelectron spectroscopy (XPS). The photocatalytic activity in the UV-A was compared with the one in the visible light spectrum using an internal method developed on the basis of DIN 52980: 2008-10 standard and ISO 10678—2010 standard. Migration of metal ions in the composition was tested based on SR EN1186-3: 2003 standard. The new photocatalytic antimicrobial method uses a type of photocatalytic paint that is active in the visible spectral range and generates reactive oxygen species with inhibitory effect against all tested microbial strains.

Nanostructured Copper Surface Kills ESKAPE Pathogens and Viruses in Minutes

In the search for a fast contact-killing antimicrobial surface to break the transmission pathway of lethal pathogens, nanostructured copper surfaces were found to exhibit the desired antimicrobial properties. Compared with plain copper, these nanostructured copper surfaces with Cu(OH)₂ nano-sword or CuO nano-foam were found to completely eliminate pathogens at a fast rate, including clinically isolated drug resistant species. Additionally these nanostructured copper surfaces demonstrated potential antiviral properties when assessed against bacteriophages, as a viral surrogate, and murine hepatitis virus, a surrogate for SARS-CoV-2. The multiple modes of killing, physical killing and copper ion mediated killing contribute to the superior and fast kinetics of antimicrobial action against common microbes, and ESKAPE pathogens. Prototypes for air and water cleaning with current nanostructured copper surface have also been demonstrated.

Long-term antimicrobial effectiveness of a silver-impregnated foil on high-touch hospital surfaces in patient rooms

Background

The hospital environment has got more attention as evidence as source for bacterial transmission and subsequent hospital-acquired infection increased. Regular cleaning and disinfection have been proposed to lower the risk of infection, in particular for gram-positive bacteria. Auto-disinfecting surfaces would allow to decrease survival of pathogens, while limiting resource to achieve a safe environment in patient rooms.

Methods

A controlled trial to evaluate the antimicrobial effectiveness of a polyvinyl chloride foil containing an integrated silver-based agent (containing silver ions 2%) on high-touch surfaces in patient rooms.

Results

The overall log reduction of the mean values was 1.8 log₁₀ CFU, the median 0.5 log₁₀ CFU comparing bioburden of control vs antimicrobial foil (p < 0.01). Important pathogens were significantly less likely recovered from the foil, in particular enterococci. These effects were present even after 6 months of in-use.

Conclusions

A foil containing an integrated silver-based agent applied to high-touch surfaces effectively results in lower recovery of important pathogens from such surfaces over a 6-month study period.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13756-021-00956-1.

Bacterial Pathogens and Their Antimicrobial Resistance Patterns of Inanimate Surfaces and Equipment in Ethiopia: A Systematic Review and Meta-analysis

BACKGROUND

Hospital-acquired infections have remained a serious cause of mortality, morbidity, and extended hospitalization. Bacterial contamination of inanimate surfaces of the hospital environment and equipment is considered a major contributing factor to the development of several nosocomial infections worldwide. The hospital environment and many devices are an important reservoir of many clinically important bacterial agents including multidrug-resistant pathogens. Therefore, this systematic review and meta-analysis are aimed at investigating bacterial pathogens and their antimicrobial resistance patterns of inanimate surfaces and equipment in Ethiopia.

METHODS

An exhaustive literature search was carried out using the major electronic databases including PubMed, Web of Science, MEDLINE, EMBASE, CINAHL, Google Scholar, Cochrane Library, Scopus, and Wiley online library to identify potentially relevant studies without date restriction. Original articles which address the research question were identified, screened, and included using the PRISMA flow diagram. Data extraction was prepared in Microsoft Excel, and data quality was assessed by using 9-point Joanna Briggs Institute critical appraisal tools. Then, data were exported to STATA 16.0 software for analyses of pooled estimation of outcome measures. Estimation of outcome measures at a 95% confidence interval was performed using DerSimonian-Laird's random-effects model. Finally, results were presented via text, figures, and tables.

RESULTS

A total of 18 studies with 3058 bacterial isolates recovered from 3423 swab specimens were included for systematic review and meta-analysis. The pooled prevalence of bacterial contamination of inanimate surfaces and equipment was found 70% (95% CI: 59, 82). Among the Gram-negative bacterial species, the prevalence of ampicillin-resistant K. pneumoniae was the highest 80% (95% CI: 78, 92) followed by Citrobacter species 78% (95% CI: 57, 83).

CONCLUSION

This study has shown a high prevalence of bacterial contamination of inanimate surfaces and equipment in Ethiopia.

A novel methodology to study antimicrobial properties of high-touch surfaces used for indoor hygiene applications-A study on Cu metal

Metal-based high-touch surfaces used for indoor applications such as doorknobs, light switches, handles and desks need to remain their antimicrobial properties even when tarnished or degraded. A novel laboratory methodology of relevance for indoor atmospheric conditions and fingerprint contact has therefore been elaborated for combined studies of both tarnishing/corrosion and antimicrobial properties of such high-touch surfaces. Cu metal was used as a benchmark material. The protocol includes pre-tarnishing/corrosion of the high touch surface for different time periods in a climatic chamber at repeated dry/wet conditions and artificial sweat deposition followed by the introduction of bacteria onto the surfaces via artificial sweat droplets. This methodology provides a more realistic and reproducible approach compared with other reported procedures to determine the antimicrobial efficiency of high-touch surfaces. It provides further a possibility to link the antimicrobial characteristics to physical and chemical properties such as surface composition, chemical reactivity, tarnishing/corrosion, surface roughness and surface wettability. The results elucidate that bacteria interactions as well as differences in extent of tarnishing can alter the physical properties (e.g. surface wettability, surface roughness) as well as the extent of metal release. The results clearly elucidate the importance to consider changes in chemical and physical properties of indoor hygiene surfaces when assessing their antimicrobial properties.

Antibacterial and Antiviral Functional Materials: Chemistry and Biological Activity toward Tackling COVID-19-like Pandemics

The ongoing worldwide pandemic due to COVID-19 has created awareness toward ensuring best practices to avoid the spread of microorganisms. In this regard, the research on creating a surface which destroys or inhibits the adherence of microbial/viral entities has gained renewed interest. Although many research reports are available on the antibacterial materials or coatings, there is a relatively small amount of data available on the use of antiviral materials. However, with more research geared toward this area, new information is being added to the literature every day. The combination of antibacterial and antiviral chemical entities represents a potentially path-breaking intervention to mitigate the spread of disease-causing agents. In this review, we have surveyed antibacterial and antiviral materials of various classes such as small-molecule organics, synthetic and biodegradable polymers, silver, TiO2, and copper-derived chemicals. The surface protection mechanisms of the materials against the pathogen colonies are discussed in detail, which highlights the key differences that could determine the parameters that would govern the future development of advanced antibacterial and antiviral materials and surfaces.

Analyses of the Effect of Peptidoglycan on Photocatalytic Bactericidal Activity Using Different Growth Phases Cells of Gram-Positive Bacterium and Spheroplast Cells of Gram-Negative Bacterium

We conducted photocatalytic experiments focusing on the peptidoglycan layer to elucidate the details of the mechanism of photocatalytic sterilization. The previous study of our laboratory suggested that the presence of the peptidoglycan layer increases the bactericidal effect. To further verify it, the following experiments were performed: experiments on cells with different peptidoglycan layer thickness used Lactobacillus plantarum cells with different growth phases, experiments on cells with the thin peptidoglycan layer used Escherichia coli cells and spheroplast cells from which the peptidoglycan layer was removed from E. coli cells. The bactericidal effects increased as the growth progresses of L. plantarum. It was confirmed by TEM that the thickness of the peptidoglycan layer increased with cell growth. The survival rates of E. coli intact cells were significantly lower than those of spheroplast cells. These results strongly suggest that the peptidoglycan layer enhances the photocatalytic bactericidal effect. As a result of allowing the photocatalytic reaction to act on peptidoglycan, the amount of hydroxyl radical was smaller, and the amount of hydrogen peroxide was higher than in the absence of peptidoglycan. It is suggested that peptidoglycan may convert produced hydroxyl radical to hydrogen peroxide.

Antimicrobial coating is associated with significantly lower aerobic colony counts in high-touch areas in an orthopedic ward environment

BACKGROUND

Hospital acquired infections (HAI) are the most common complication found in the hospital environment. The aim of the study was to examine whether the use of an antimicrobial coating in high-touch areas in an orthopedic ward could reduce bacterial growth and HAI.

METHODS

From December 2017 to February 2018, HAI were registered on two orthopedic wards. A second registration was performed from December 2018 to February 2019. On the second occasion, an antimicrobial organosilane coating was applied just before the study period and thereafter weekly on one ward, while the other ward served as a control. Twenty defined high-touch areas on each ward were cultured before treatment and after 1, 2, 4, 8, 12, 14 and 16 weeks. Samples were cultured for aerobic colony counts, Staphylococcus aureus and E. coli.

RESULTS

The total aerobic colony counts were 47% lower on the treated ward compared with the non-treated ward over the study period (p = 0.02). The colony counts for Staphylococcus aureus and E. coli were low on both wards. During the first registration period, the incidence of HAI was 22.7% and 20.0% on the non-treated and subsequently treated ward respectively. On the second occasion, after treatment, the incidence was 25.0% and 12.5% (treated ward) respectively (p = 0.0001).

CONCLUSIONS

The use of a long-lasting antimicrobial organosilane coating appears to reduce the bioburden and reduce HAI. Since the incidence of HAI varies substantially over time, longer observation times are needed.

Antibacterial Cotton Fabric Functionalized with Copper Oxide Nanoparticles

Textiles functionalized with cupric oxide (CuO) nanoparticles have become a promising option to prevent the spread of diseases due to their antimicrobial properties, which strongly depend on the structure and morphology of the nanoparticles and the method used for the functionalization process. This article presents a review of work focused on textiles functionalized with CuO nanoparticles, which were classified into two groups, namely, in situ and ex situ. Moreover, the analyzed bacterial strains, the resistance of the antimicrobial properties of textiles to washing processes, and their cytotoxicity were identified. Finally, the possible antimicrobial mechanisms that could develop in Gram-positive and Gram-negative bacteria were described.

Hot-melt extrusion of photodynamic antimicrobial polymers for prevention of microbial contamination

Infectious disease outbreaks within healthcare facilities can exacerbate patient illness and, in some cases, can be fatal. Contaminated surfaces and medical devices can act as a reservoir for transmission of pathogens and have been linked to the rising incidence of healthcare-acquired infections. Antimicrobial surfaces can reduce microbial contamination and transmission and have emerged as a crucial component in healthcare infection control in recent years. The aim of this study was to manufacture antimicrobial polymer surfaces containing the photosensitiser, toluidine blue O (TBO), using hot-melt extrusion (HME). Several concentrations of TBO were combined with a range of medically relevant polymers via HME. TBO-polymer extrudates displayed no significant differences in thermal properties and surface wettability relative to non-loaded polymers. Minimal leaching of TBO from the surface was confirmed through in vitro release studies. Antibacterial activity was observed to vary according to the polymer and concentration of incorporated TBO, with PEBAX® polymers modified with 0.1% w/w TBO demonstrating promising reductions of >99.9% in viable bacterial adherence of a range of common nosocomial pathogens, including Staphylococcus aureus, Staphylococcus epidermidis, Acinetobacter baumannii and Escherichia coli. This study demonstrates the use of HME as a facile alternative method to common encapsulation strategies for the production of light-activated antimicrobial polymer surfaces. This method can be easily translated to large-scale manufacture and, in addition, the polymers constitute promising antimicrobial base materials for the rapidly growing additive manufacturing industries.

Effects of environmental cleaning bundles on reducing healthcare-associated Clostridioides difficile infection: a systematic review and meta-analysis

Environmental contamination with Clostridioides difficile plays an important role in the transmission of C. difficile infection (CDI) in healthcare and long-term care facilities, which results in prolonged length of stay, higher risk of mortality and increased healthcare costs. Environmental cleaning bundles are introduced to improve environmental cleanliness. This study aimed to evaluate whether environmental cleaning bundles applied in hospital, community and long-term care settings reduce the incidence of healthcare-associated CDI compared with conventional cleaning practices. Relevant databases, websites and trial registration platforms were searched. Two reviewers conducted study screening and selection, data collection, risk of bias assessment and evidence quality assessment independently. Meta-analyses were conducted using Review Manager 5.3. Ten eligible studies [one randomized controlled trial (RCT) and nine non-RCTs] were included. No significant effect of environmental cleaning bundles on the CDI incidence rate was found [risk ratio (RR)=0.96, 95% confidence interval (CI) 0.71-1.29; studies=2; I²=49%; very low quality]. However, the removal of surface markers was improved significantly (RR=1.55, 95% CI 1.30-1.84; studies=3; I²=98%; very low quality), and the percentage of CDI rooms with positive cultures of C. difficile (RR=0.16, 95% CI 0.08-0.31; studies=4; I²=7%; moderate quality) was reduced significantly after the implementation of environmental cleaning bundles. Environmental cleaning bundles may consequently be helpful in improving the thoroughness of cleaning of environmental surfaces in hospital and long-term care settings. More well-conducted RCTs are expected to provide stronger evidence.

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.

Rapid screening and characterization of bacteria associated with hospital cockroaches (Blattella germanica L.) using MALDI-TOF mass spectrometry

AIMS

The study aimed to explore the diversity of culturable microbiota colonizing the alimentary tract and outer surfaces of German cockroaches (Blattella germanica) captured in a health care facility.

METHODS AND RESULTS

Microbial identification was conducted using Matrix Assisted Laser Desorption-Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) Biotyper and 16S rRNA sequencing. A total of 181 bacteria strains were isolated from 25 cockroach specimens and the MALDI-TOF MS-based assay yielded direct identification of 96·5% (175 out of 181) of the strains at the species level. The proteomic fingerprinting mainly revealed strains belonged to Gram-negative Enterobacteria (103) with six different genera that were characterized including Citrobacter, Klebsiella, Kluyevera, Leclercia, Morganella and Serratia. In addition, Pseudomonas sp. strains ranked in second with 29·8% (54 strains) followed by Staphylococcus sp. (6·62%) and Enterococcus sp. (1·65%). A large number of these bacteria (n = 90, 49·72%) was found in cockroaches captured in the maternity ward, whereas 45 strains (24·8%) were recovered in the paediatric ward. Altogether, 24 bacterial species were identified from both the external surface and digestive tract of the insect, of which Serratia marcescens presented the major group (n = 80, 44·19%) followed by Pseudomonas aeruginosa (n = 53, 29·28%) and Klebsiella oxytoca (n = 9, 4·94%).

CONCLUSION

The findings showed a high prevalence of bacterial pathogens harboured in the body and alimentary tract of B. germanica captured in a health care facility.

SIGNIFICANCE AND IMPACT OF THE STUDY

This investigation shows the possible role of German cockroaches as a source for bacterial pathogens, increasing the likelihood of direct transmission of healthcare associated infections, and thereby representing a public health risk. In addition, the present study revealed a high discriminatory power of the mass spectra investigation and a competent bacterial typing tool that extends phenotypic and genotypic approaches, which allows new possibilities for fast and accurate diagnosis in medical entomology.

Effectiveness of Copper-Impregnated Solid Surfaces on Lowering Microbial Bio-Burden Levels in an Acute Care Hospital

Background

Microbial bio-burden on high-touch surfaces in patient rooms may lead to acquisition of health care-associated infections in acute care hospitals. This study examined the effect of a novel copper-impregnated solid material (16%-20% copper oxide in a polymer-based resin) on bacterial contamination on high-touch surfaces in patient rooms in an acute care hospital.

Methods

Five high-touch surfaces were sampled for aerobic bacterial colonies (ABCs) 3 times per day over a 3-day period in 16 rooms with copper installed and 16 rooms with standard noncopper laminate installed on high-touch surfaces. A Bayesian multilevel negative binomial regression model was used to compare ABC plate counts from copper-impregnated surfaces with standard hospital laminate surfaces.

Results

The mean and median (interquartile range [IQR]) ABC counts from copper-impregnated surfaces were 25.5 and 11 (4-27), and for standard hospital laminate surfaces they were 60.5 and 29 (10-74.3). The negative binomial regression model-estimated incidence rate for ABC counts on plates taken from copper-impregnated surfaces was 0.40 (0.21-0.70) times the incidence rate of ABC counts on plates taken from standard hospital laminate surfaces.

Conclusions

Copper-impregnated solid surfaces may reduce the level of microbial contamination on high-touch surfaces in patient rooms in the acute care environment, as our study demonstrated a decline in microbial bio-burden on samples taken from copper-impregnated compared with standard hospital laminate high-touch surfaces.

Selection of resistance by antimicrobial coatings in the healthcare setting

Antimicrobial touch surfaces have been introduced in healthcare settings with the aim of supporting existing hygiene procedures, and to help combat the increasing threat of antimicrobial resistance. However, concerns have been raised over the potential selection pressure exerted by such surfaces, which may drive the evolution and spread of antimicrobial resistance. This review highlights studies that indicate risks associated with resistance on antimicrobial surfaces by different processes, including evolution by de-novo mutation and horizontal gene transfer, and species sorting of inherently resistant bacteria dispersed on to antimicrobial surfaces. The review focuses on antimicrobial surfaces made of copper, silver and antimicrobial peptides because of the practical application of copper and silver, and the promising characteristics of antimicrobial peptides. The available data point to a potential for resistance selection and a subsequent increase in resistant strains via cross-resistance and co-resistance conferred by metal and antibiotic resistance traits. However, translational studies describing the development of resistance to antimicrobial touch surfaces in healthcare-related environments are rare, and will be needed to assess whether and how antimicrobial surfaces lead to resistance selection in these settings. Such studies will need to consider numerous variables, including the antimicrobial concentrations present in coatings, the occurrence of biofilms on surfaces, and the humidity relevant to dry-surface environments. On-site tests on the efficacy of antimicrobial coatings should routinely evaluate the risk of selection associated with their use.

Simple Fabrication of Transparent, Colorless, and Self-Disinfecting Polyethylene Terephthalate Film via Cold Plasma Treatment

Cross-infection following cross-contamination is a serious social issue worldwide. Pathogens are normally spread by contact with germ-contaminated surfaces. Accordingly, antibacterial surface technologies are urgently needed and have consequently been actively developed in recent years. Among these technologies, biomimetic nanopatterned surfaces that physically kill adhering bacteria have attracted attraction as an effective technological solution to replace toxic chemical disinfectants (biocides). Herein, we introduce a transparent, colorless, and self-disinfecting polyethylene terephthalate (PET) film that mimics the surface structure of the Progomphus obscurus (sanddragon) wing physically killing the attached bacteria. The PET film was partially etched via a 4-min carbon tetrafluoride (CF4) plasma treatment. Compared to a flat bare PET film, the plasma-treated film surface exhibited a uniform array structure composed of nanopillars with a 30 nm diameter, 237 nm height, and 75 nm pitch. The plasma-treated PET film showed improvements in optical properties (transmittance and B*) and antibacterial effectiveness over the bare film; the transparency and colorlessness slightly increased, and the antibacterial activity increased from 53.8 to 100% for Staphylococcus aureus, and from 0 to 100% for Escherichia coli. These results demonstrated the feasibility of the CF4 plasma-treated PET film as a potential antibacterial overcoating with good optical properties.

The effect of copper-oxide-treated soft and hard surfaces on the incidence of healthcare-associated infections: a two-phase study

BACKGROUND

Copper-oxide-impregnated linens and hard surfaces within the hospital environment have emerged as a novel technology to reduce environmental contamination and thereby potentially reduce the risk of healthcare-associated infections (HCAIs).

METHODS

This was a two-phase study. Phase 1 was a prospective, cluster-randomized, cross-over clinical trial in which one pod (eight beds) of our general ICU (GICU) utilized copper-oxide-impregnated linens whereas the other pod (eight beds) used standard hospital linens. Phase 2 was a two-year before-after study, following the relocation of three ICUs into a new ICU tower in which all the hard surfaces were treated with copper oxide (in addition to copper-impregnated linens). HCAIs were recorded using the National Healthcare Safety Network definitions.

FINDINGS

A total of 1282 patients were enrolled in phase 1. There was no difference in the rate of HCAI between the patients who received standard compared with copper oxide linen. In phase 2 there was a significant reduction in the number of infections due to Clostridioides difficile (2.4 per 1000 vs 0.7 per 1000 patient-days; incidence rate ratio: 3.3; 95% confidence interval: 1.4-8.7; P = 0.002) but no difference in the rate of central-line-associated bloodstream infections nor of catheter-associated urinary tract infections.

CONCLUSION

Copper-oxide-impregnated linens alone had no effect on the rate of HCAI. Our data suggest that copper-oxide-treated hard surfaces reduced the rate of infections due to C. difficile; however, important confounders cannot be excluded.

In vitro evaluation of antimicrobial efficacy and durability of three copper surfaces used in healthcare

Antimicrobial properties of solid copper (Cu) surfaces against various microorganisms have been demonstrated, but little is known about the durability and relative antimicrobial efficacy of different Cu formulations currently used in healthcare. The aim of this study was to assess whether three different formulations of copper-bearing alloys (integral, spray-on and Cu-impregnated surfaces) and a stainless steel control differed in their antimicrobial efficacy, durability, and compatibility with hospital-grade cleaner/disinfectants. The U.S. Environmental Protection Agency draft protocol for the evaluation of bactericidal activity of Cu containing alloys was modified to more accurately reflect cleaning methods in healthcare. The three different Cu alloys were evaluated using 25 × 25 × 3 mm disks subjected to one year of simulated cleaning and disinfection using the Wiperator™ with microfiber cloths presoaked in three common hospital disinfectants: accelerated hydrogen peroxide, quaternary ammonium, or sodium hypochlorite solutions. Bactericidal activity was evaluated using Staphylococcus aureus and Pseudomonas aeruginosa. While all Cu formulations exhibited some antimicrobial activity, integral and spray-on Cu alloys showed the greatest efficacy. Assessments of durability included documentation of changes in mass, morphological changes by scanning electron microscopy, chemical composition alteration by energy-dispersive x-ray spectroscopy, and surface roughness alteration using profilometry over one year of simulated use. The integral Cu alloy had the least mass loss (0.20% and 0.19%) and abrasion-corrosion rate (6.28 and 6.09 μm/yr) compared to stainless steel. The integral product also showed the highest durability. Exposure to disinfectants affected both the antimicrobial efficacy and durability of the various copper products.

Iron-based nano-structured surfaces with antimicrobial properties

Bactericidal nanopillar array surfaces of FeOOH and Fe₂O₃ have been prepared as a cicada wing mimic. An even simpler structure-based antimicrobial surface was also made by coating with sea urchin-like FeOOH and Fe₂O₃ particles with a binder.

Nanomaterials as a new opportunity for protecting workers from biological risk

Healthcare-Associated Infections (HAIs) represent a frequent complication for hospitalized patients and more rarely for workers. In recent years, substantial scientific evidence has been reached regarding the role played by the inanimate surfaces, especially those touched in patient-care areas, in the transmission of nosocomial pathogens. Therefore, it is essential to find new collective protective measures to minimize microbial contamination in healthcare facilities, thereby preventing the spread of multi-drug resistant bacteria. We present an overview of the major nano-enabled AntiMicrobial Coatings (AMCs) which may be used as collective protective measures in healthcare setting, discussing also some aspects related to their effectiveness and safety. AMCs may be classified within three groups on base of their mechanism of action: surfaces releasing active compound, contact-killing surfaces and anti-adhesive surfaces. To date, little information is available on the effectiveness of AMCs to reduce the risk of HAIs since the most of studies do not reach conclusive results on their beneficial effects. Moreover, the lack of standard protocols for assessing antimicrobial efficacy and poor data about the interaction between AMCs and disinfectants prevent their placing on the market. Further studies are needed for assessing risks and benefits of AMCs as collective protective measures in healthcare setting.

Bacterial cellulose films with ZnO nanoparticles and propolis extracts: Synergistic antimicrobial effect

This study aimed to obtain possible materials for future antimicrobial food packaging applications based on biodegradable bacterial cellulose (BC). BC is a fermentation product obtained by Gluconacetobacter xylinum using food or agricultural wastes as substrate. In this work we investigated the synergistic effect of zinc oxide nanoparticles (ZnO NPs) and propolis extracts deposited on BC. ZnO NPs were generated in the presence of ultrasounds directly on the surface of BC films. The BC-ZnO composites were further impregnated with ethanolic propolis extracts (EEP) with different concentrations.The composition of raw propolis and EEP were previously determined by gas-chromatography mass-spectrometry (GC-MS), while the antioxidant activity was evaluated by TEAC (Trolox equivalent antioxidant capacity). The analysis methods performed on BC-ZnO composites such as scanning electron microscopy (SEM), thermo-gravimetrically analysis (TGA), and energy-dispersive X-ray spectroscopy (EDX) proved that ZnO NPs were formed and embedded in the whole structure of BC films. The BC-ZnO-propolis films were characterized by SEM and X-ray photon spectroscopy (XPS) in order to investigate the surface modifications. The antimicrobial synergistic effect of the BC-ZnO-propolis films were evaluated against Escherichia coli, Bacillus subtilis, and Candida albicans. The experimental results revealed that BC-ZnO had no influence on Gram-negative and eukaryotic cells.

Impact of a Novel Antimicrobial Surface Coating on Health Care–Associated Infections and Environmental Bioburden at 2 Urban Hospitals

Background

Approximately 1 in 25 people admitted to a hospital in the United States will suffer a health care–associated infection (HAI). Environmental contamination of hospital surfaces contributes to HAI transmission. We investigated the impact of an antimicrobial surface coating on HAIs and environmental bioburdens at 2 urban hospitals.

Methods

A transparent antimicrobial surface coating was applied to patient rooms and common areas in 3 units at each hospital. Longitudinal regression models were used to compare changes in hospital-onset multidrug-resistant organism bloodstream infection (MDRO-BSI) and Clostridium difficile infection (CDI) rates in the 12 months before and after application of the surface coating. Incidence rate ratios (IRRs) were compared for units receiving the surface coating application and for contemporaneous control units. Environmental samples were collected pre- and post-application to identify bacterial colony forming units (CFUs) and the percent of sites positive for select, clinically relevant pathogens.

Results

Across both hospitals, there was a 36% decline in pooled HAIs (combined MDRO-BSIs and CDIs) in units receiving the surface coating application (IRR, 0.64; 95% confidence interval [CI], .44–.91), and no decline in the control units (IRR, 1.20; 95% CI, .92–1.55). Following the surface application, the total bacterial CFUs at Hospitals A and B declined by 79% and 75%, respectively; the percentages of environmental samples positive for clinically relevant pathogens also declined significantly for both hospitals.

Conclusions

Statistically significant reductions in HAIs and environmental bioburdens occurred in the units receiving the antimicrobial surface coating, suggesting the potential for improved patient outcomes and persistent reductions in environmental contamination. Future studies should assess optimal implementation methods and long-term impacts.

Bacteria accumulate copper ions and inhibit oxide formation on copper surface during antibacterial efficiency test

Copper surface after antibacterial test against E. coli was examined in the aspect of corrosion. Results from scanning electron microscope (SEM), grazing incidence X-ray diffractometer (GIXRD) and Raman spectroscopy together confirmed less oxidation on copper surface with the presence of E. coli. The inhibition of the cuprous oxide (Cu₂O) layer instead ensured the continuous exposure of copper surface, letting localised corrosion attacks observable and causing a stronger release of copper ions. These phenomena are attributed to the fact that E. coli act as ions reservoirs since high amount of copper accumulation were found by energy dispersive X-ray spectroscopy (EDS).