Transfer of bacteria from fabrics to hands and other fabrics: development and application of a quantitative method using Staphylococcus aureus as a model

Impact of different hand-drying methods on surrounding environment: aerosolization of virus and bacteria, and transfer to surfaces

BACKGROUND

In recent years, hand drying has been highlighted as a key step in appropriate hand hygiene, as moisture on hands can increase the transfer of micro-organisms from hands to surfaces and vice versa.

AIM

To understand bacterial and viral aerosolization following hand drying, and study the transfer of micro-organisms from hands to surfaces after drying using different methods.

METHODS

Groups of five volunteers had their hands pre-washed with soap, rinsed and dried, then inoculated with a concentrated mixture of Pseudomonas fluorescens and MS2 bacteriophage. Volunteers entered an empty washroom, one at a time, and rinsed their hands with water or washed their hands with soap prior to drying with a jet dryer or paper towels. Each volunteer applied one hand successively to various surfaces, while their other hand was sampled using the glove juice method. Both residual bacteria and viruses were quantified from the washroom air, surface swabs and hand samples.

FINDINGS

P. fluorescens and MS2 bacteriophages were rarely aerosolized while drying hands for any of the drying methods studied. Results also showed limited, and similar, transfer of both micro-organisms studied on to surfaces for all drying methods.

CONCLUSION

The use of jet dryers or paper towels produces low levels of aerosolization when drying hands in a washroom. Similarly, all drying methods result in low transfer to surfaces. While the coronavirus disease 2019 pandemic raised concerns regarding public washrooms, this study shows that all methods tested are hygienic solutions for dry washed hands.

In vitro study on the transmission of multidrug-resistant bacteria from textiles to pig skin

BACKGROUND

The survival of microorganisms on textiles and specifically on healthcare professionals' (HCP) attire has been demonstrated in several studies. The ability of microorganisms to adhere and remain on textiles for up to hours or days raises questions as to their possible role in transmission from textile to skin via HCP to patients.

AIM

To evaluate the presence, survival and transmission of different multidrug-resistant bacteria (MDRB) from HCP attire onto skin.

METHODS

Three MDRB [methicillin-resistant Staphylococcus aureus (MRSA); vancomycin-resistant Enterococcus faecium (VRE); carbapenem-resistant Klebsiella pneumoniae, CRKP)] were inoculated on textiles from scrubs (60% cotton-40% polyester) and white coat (100% cotton) at concentrations of 108 colony-forming units (CFU), 105 CFU, and 103 CFU per mL. The inoculation of swatches was divided in time intervals of 1 min, 5 min, 15 min, 30 min, 1 h, 2 h, 3 h, 4 h, 5 h, and 6 h. At the end of each period, textiles were imprinted onto pig skins and each skin square was inverted onto three different selective chromogenic media. Growth from the pig skin squares was recorded for the 3 MDRB at the three above concentrations, for the whole length of the 6-h experiment.

RESULTS

MRSA was recovered from pig skins at all concentrations for the whole duration of the 6-h study. VRE was recovered from the concentration of 108 CFU/mL for 6 h and from 105 CFU/mL for up to 3 h, while showing no growth at 103 CFU/mL. CRKP was recovered from 108 CFU/mL for 6 h, up to 30 min from 105 CFU/mL and for 1 min from the concentration of 103 CFU/mL.

CONCLUSION

Evidence from the current study shows that MRSA can persist on textiles and transmit to skin for 6 h even at low concentrations. The fact that all MDRB can be sustained and transferred to skin even at lower concentrations, supports that textiles are implicated as vectors of bacterial spread.

Biofilm-Producing Ability of Staphylococcus aureus Obtained from Surfaces and Milk of Mastitic Cows

This study was conducted to evaluate the incidence of mastitis in 153 dairy cows and to evaluate the kinetics of adhesion of isolates obtained from surfaces and milk in comparison with the reference strain (RS), CCM 4223. The surfaces of the floor, teat cup, and cow restraints were aseptically swabbed in three replicates (n = 27). Of the total number of infected cows (n = 43), 11 samples were found to be positive for Staphylococcus aureus, 12 samples tested positive for non-aureus staphylococci, 6 samples tested positive for Streptococcus spp., and 11 samples tested positive for other bacteria (Escherichia coli, Pseudomonas spp.) or a mixed infection. The most represented pathogen in milk (11/43) and on surfaces (14/27) was S. aureus. The kinetics of adhesion of the reference strain and isolates of S. aureus on stainless steel surfaces were determined after 3, 6, 9, 12, 24, and 48 h, and 3, 6, 9, 12, and 15 days of incubation. All strains reached counts higher than 5 Log₁₀ CFU/cm² needed for biofilm formation, except RS (4.40 Log₁₀ CFU/cm²). The isolates of S. aureus revealed a higher capability to form biofilm in comparison with RS during the first 3 h (p < 0.001). Thus, there is a significant difference between the occurrence of S. aureus on monitored surfaces-floor, teat cup, and cow restraints-and the frequency with which mastitis is caused by S. aureus (p < 0.05). This finding raises the possibility that if various surfaces are contaminated by S. aureus, it can result in the formation of biofilm, which is a significant virulence factor.

Textiles as fomites in the healthcare system

Nosocomial infections or healthcare-associated infections (HAIs) are acquired under medical care in healthcare facilities. In hospital environments, the transmission of infectious diseases through textiles such as white coats, bed linen, curtains, and towels are well documented. Textile hygiene and infection control measures have become more important in recent years due to the growing concerns about textiles as fomites in healthcare settings. However, systematic research in this area is lacking; the factors contributing to the transmission of infections through textiles needs to be better understood. The review aims to critically explore textiles as contaminants in healthcare systems, and to identify potential risks they may pose to patients and healthcare workers. It delineates different factors affecting bacterial adherence on fabrics, such as surface properties of bacteria and fabrics, and environmental factors. It also identifies areas that require further research to reduce the risk of HAIs and improve textile hygiene practices. Finally, the review elaborates on the strategies currently employed, and those that can be employed to limit the spread of nosocomial infections through fabrics. Implementing textile hygiene practices effectively in healthcare facilities requires a thorough analysis of factors affecting fabric-microbiome interactions, followed by designing newer fabrics that discourage pathogen load. KEY POINTS: • Healthcare textiles act as a potential reservoir of nosocomial pathogens • Survival of pathogens is affected by surface properties of fabric and bacteria • Guidelines required for fabrics that discourage microbial load, for hospital use.

Transfer of bacteria between fabric and surrogate skin

BACKGROUND

Contaminated textiles serve as fomites in healthcare settings. The extent of transfer of pathogens from fabrics depends on the surface properties of the 2 contact surfaces.

METHODS

In the current study, the effect of surface energy and surface roughness of fabrics on the transfer of Escherichia coli and Staphylococcus aureus to and from textiles to surrogate skin were determined. Three fabrics (100% cotton, 100% polyester, and 50-50 blend of cotton and polyester) having identical constructional parameters, were characterised on the basis of surface roughness, and energy. Assessment of transfer of bacteria was carried out by bringing the matrix seeded with inoculum in contact with the sterilized matrix for a predetermined period of time, followed by dislodging of cells from the recipient surface by vortexing, and plating.

RESULTS AND DISCUSSION

Results showed that 100% polyester attracted the highest number of bacterial cells compared to the others. It also released the maximum number of bacteria upon coming in contact with surrogate skin. Properties of fabrics like absorbency, surface energy, and surface roughness, simultaneously affected transfer.

CONCLUSIONS

It is advisable to minimize the use of 100% polyester in healthcare settings to curb the transfer load of bacteria from one surface to another.

Cotton and Flax Textiles Leachables Impact Differently Cutaneous Staphylococcus aureus and Staphylococcus epidermidis Biofilm Formation and Cytotoxicity

Bacteria can bind on clothes, but the impacts of textiles leachables on cutaneous bacteria remain unknown. Here, we studied for the first time the effects of cotton and flax obtained through classical and soft ecological agriculture on the representatives S. aureus and S. epidermidis bacteria of the cutaneous microbiota. Crude flax showed an inhibitory potential on S. epidermidis bacterial lawns whereas cotton had no effect. Textile fiber leachables were produced in bacterial culture media, and these extracts were tested on S. aureus and S. epidermidis. Bacterial growth was not impacted, but investigation by the crystal violet technique and confocal microscopy showed that all extracts affected biofilm formation by the two staphylococci species. An influence of cotton and flax culture conditions was clearly observed. Flax extracts had strong inhibitory impacts and induced the formation of mushroom-like defense structures by S. aureus. Conversely, production of biosurfactant by bacteria and their surface properties were not modified. Resistance to antibiotics also remained unchanged. All textile extracts, and particularly soft organic flax, showed strong inhibitory effects on S. aureus and S. epidermidis cytotoxicity on HaCaT keratinocytes. Analysis of flax leachables showed the presence of benzyl alcohol that could partly explain the effects of flax extracts.

Evaluation of Salmonella Biofilm Cell Transfer from Common Food Contact Surfaces to Beef Products

ABSTRACT

Meat contamination by Salmonella enterica is a serious public health concern. Available data have suggested that biofilm formation at processing plants and contaminated contact surfaces might contribute to meat contamination. Because transfer from contact surfaces to food products via direct contact has been deemed the most common bacteria transmission route that can lead to contamination, we evaluated the effect of Salmonella biofilm forming ability, contact surface material, and beef surface tissue type on Salmonella biofilm transfer from hard surfaces to beef products. Salmonella biofilms developed on the common contact surfaces stainless steel (SS) and polyvinylchloride (PVC) were transferred consecutively via 30 s of direct contact to either lean muscle or adipose tissue surfaces of 15 pieces of beef trim. The Salmonella biofilm cells could be effectively transferred multiple times from the contact surfaces to the beef trim as indicated by quantifiable Salmonella cells on most meat samples. Biofilm forming ability had the most significant impact (P < 0.05) on transfer efficiency. More cells of Salmonella strains that formed strong biofilms were transferred after each contact and contaminated more meat samples with quantifiable cells compared with strains that formed weak biofilms. Contact surface materials also affected transferability. Salmonella biofilms on SS transferred more efficiently than did those on PVC. In contrast, the two types of meat surface tissues were not significantly different (P > 0.05) in biofilm transfer efficiency. Beef trim samples that were in contact with biofilms but did not have quantifiable Salmonella cells were positive for Salmonella after enrichment culture. Our results indicate the high potential of Salmonella biofilms on common contact surfaces in meat processing plants to cause product cross-contamination.

HIGHLIGHTS

Linen: The New Frontier in Infection Control and Prevention

Personnel follow hospital policies and regulatory guidelines to prevent surgical site infections. However, a potentially contaminated item may be overlooked-the linen. When perioperative team members transport patients to the OR, the linen on the beds and transport carts can contain a variety of microorganisms. Textile surfaces can serve as reservoirs for microorganisms that can be transferred to health care providers, patients, and the environment. These pathogens may then infect patients, particularly those who are immunocompromised or have direct portals of entry (eg, catheters, incision sites). This article provides an overview of how microorganisms that cause health care-associated infections can survive and thrive on hospital linen and related equipment; discusses the linen laundering, transport, and storage processes and best practices; and discusses antimicrobial interventions-including a silver-ion laundering additive that was added as an infection prevention measure to the laundry production cycle at a medical center's contracted laundry facility.

A quantitative microbial risk assessment for touchscreen user interfaces using an asymmetric transfer gradient transmission mode

The ubiquitous use of public touchscreen user interfaces for commercial applications has created a credible risk for fomite-mediated disease transmission. This paper presents results from a stochastic simulation designed to assess this risk. The model incorporates a queueing network to simulate people flow and touchscreen interactions. It also describes an updated model for microbial transmission using an asymmetric gradient transfer assumption that incorporates literature reviewed empirical data concerning touch-transfer efficiency between fingers and surfaces. In addition to natural decay/die-off, pathogens are removed from the system by simulated cleaning / disinfection and personal-touching rates (e.g. face, dermal, hair and clothing). The dose response is implemented with an exponential moving average filter to model the temporal dynamics of exposure. Public touchscreens were shown to pose a considerable infection risk (∼3%) using plausible default simulation parameters. Sensitivity of key model parameters, including the rate of surface disinfection is examined and discussed. A distinctive and important advancement of this simulation was its ability to distinguish between infection risk from a primary contaminated source and that due to the re-deposition of pathogens onto secondary, initially uncontaminated touchscreens from sequential use. The simulator is easily configurable and readily adapted to more general fomite-mediated transmission modelling and may provide a valuable framework for future research.

Data on Transfer of Human Coronavirus SARS-CoV-2 from Foods and Packaging Materials to Gloves Indicate That Fomite Transmission Is of Minor Importance

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is mainly transmitted via droplets and aerosols. To evaluate the role of transmission by fomites, SARS-CoV-2-specific data on transfer rates from surfaces to hands and from hands to face are lacking. Here, we generated quantitatively controlled transfer rates for SARS-CoV-2 from food items (lettuce, ham, and vegetarian meat alternative [VMA]) and packaging materials (cardboard and plastic) to gloves using a wet, dry, and frozen viral inoculum and from glove to glove using a wet viral inoculum. For biosafety reasons, the transfer from surfaces to hands and hands to face was simulated by using gloves. The cumulative transfer rate was calculated by using the data from the first transfer experiment, food or packaging material to glove, and combined with the transfer rate obtained from the second transfer experiment from glove to glove. The cumulative transfer rates from lettuce (4.7%) and ham (3.4%) were not significantly different (P > 0.05) but were significantly higher (P < 0.05) than that from VMA (“wet” or “frozen”). The wet cumulative transfer rate from VMA (1.3%) was significantly higher than the cumulative transfer rate from frozen VMA (0.0011%). No transfer from plastic or cardboard was observed with a dry inoculum. The plastic packaging under wet conditions provided the highest cumulative transfer rate (3.0%), while the cumulative transfer from frozen cardboard was very small (0.035%). Overall, the transfer rates determined in this study suggest a minor role of foods or food packaging materials in infection transmission.

IMPORTANCE The observation of SARS-CoV-2 RNA in swab samples from frozen fish packages in China, confirmed only once by cell culture, led to the hypothesis that food contaminated with SARS-CoV-2 virus particles could be the source of an outbreak. Epidemiological evidence for fomites as infection source is scarce, but it is important for the food industry to evaluate this infection path with quantitative microbial risk assessment (QMRA), using measured viral transfer rates from surfaces to hands and face. The present study provides transfer data for SARS-CoV-2 from various types of foods and packaging materials using quantitative methods that take uncertainties related to the virus recovery from the different surfaces into consideration. The transfer data from this model system provide important input parameters for QMRA models to assess the risk of SARS-CoV-2 transmission from contaminated food items.

Aerosols and Bacteria From Hand Washing and Drying in Indoor Air

Effective hand drying is an important part of hand hygiene that can reduce the risk of infectious disease transmission through cross-contamination of surfaces by wet hands. However, hand drying methods may also cause aerosolisation of pathogenic microorganisms if they are present in washed hands. This study investigated experimentally the impact of washing hands and different hand drying methods on the concentration and size distribution of aerosols and bacteria in indoor air. In this experiment, aerosol and bacteria concentrations were measured in indoor air while volunteers rinsed their hands with water or washed with soap and water prior to drying them with paper towels or jet air dryers. Results showed that the concentration of aerosols and bacteria in air increased with people walking in the room and washing hands, with a further increase during the hand drying process. The concentration of aerosols decreased with particle size, with maximum concentrations after drying hands of 6.63 × 10⁶ ± 6.49 × 10⁵ and 2.28 × 10⁴ ± 9.72 × 10³ particles m⁻³ for sizes 0.3 to <0.5 and ≥5.0 μm, respectively. The concentration of bacteria in indoor air after drying hands increased to a maximum of 3.81 × 10² ± 1.48 × 10² CFU m⁻³ (jet air dryers) and 4.50 × 10² ± 4.35 × 10¹ CFU m⁻³ (paper towels). This study indicates that the increase of aerosols and bacteria in air after drying hands with jet air dryers or paper towels are comparable and not statistically different from concentrations associated with walking and washing hands in the same environment. This work can support the development of hand hygiene practices and guidelines for public washrooms.

Quantifying pathogen infection risks from household laundry practices

Aims

Contaminated laundry can spread infections. However, current directives for safe laundering are limited to healthcare settings and not reflective of domestic conditions. We aimed to use quantitative microbial risk assessment to evaluate household laundering practices (e.g., detergent selection, washing and drying temperatures, and sanitizer use) relative to log₁₀ reductions in pathogens and infection risks during the clothes sorting, washer/dryer loading, folding and storing steps.

Methods and Results

Using published data, we characterized laundry infection risks for respiratory and enteric pathogens relative to a single user contact scenario and a 1.0 × 10⁻⁶ acceptable risk threshold. For respiratory pathogens, risks following cold water wash temperatures (e.g. median 14.4℃) and standard detergents ranged from 2.2 × 10⁻⁵ to 2.2 × 10⁻⁷. Use of advanced, enzymatic detergents reduced risks to 8.6 × 10⁻⁸ and 2.2 × 10⁻¹¹ respectively. For enteric pathogens, however, hot water, advanced detergents, sanitizing agents and drying are needed to reach risk targets.

Significance and Impact of the Study

Conclusions provide guidance for household laundry practices to achieve targeted risk reductions, given a single user contact scenario. A key finding was that hand hygiene implemented at critical control points in the laundering process was the most significant driver of infection prevention, additionally reducing infection risks by up to 6 log₁₀.

Modeling and Experimental Validation of Microbial Transfer via Surface Touch

Surface touch spreads disease-causing microbes, but the measured rates of microbial transfer vary significantly. Additionally, the mechanisms underlying microbial transfer via surface touch are unknown. In this study, a new physical model was proposed to accurately evaluate the microbial transfer rate in a finger-surface touch, based on the mechanistic effects of important physical factors, including surface roughness, surface wetness, touch force, and microbial transfer direction. Four surface-touch modes were distinguished, namely, a single touch, sequential touches (by different recipients), repeated touches (by the same recipient), and a touch with rubbing. The tested transfer rates collated from 26 prior studies were compared with the model predictions based on their experimental parameters, and studies in which the transfer rates were more consistent with our model predictions were identified. New validation experiments were performed by accurately controlling the parameters involved in the model. Four types of microbes were used to transfer between the naked finger and metal surface with the assistance of a purpose-made touch machine. The measured microbial transfer rate data in our new experiments had a smaller standard deviation than those reported from prior studies and were closer to the model prediction. Our novel predictive model sheds light on possible future studies.

3D printing of face shields to meet the immediate need for PPE in an anesthesiology department during the COVID-19 pandemic

Background

Anesthesia providers are at risk for contracting COVID-19 due to close patient contact, especially during shortages of personal protective equipment. We present an easy to follow and detailed protocol for producing 3D printed face shields and an effective decontamination protocol, allowing their reuse.

Methods

The University of Nebraska Medical Center (UNMC) produced face shields using a combination of 3D printing and assembly with commonly available products, and produced a simple decontamination protocol to allow their reuse. To evaluate the effectiveness of the decontamination protocol, we inoculated bacterial suspensions of E. coli and S. aureus on to the face shield components, performed the decontamination procedure, and finally swabbed and enumerated organisms onto plates that were incubated for 12-24 hours. Decontamination effectiveness was evaluated using the average log10 reduction in colony counts.

Results

Approximately 112 face shields were constructed and made available for use in 72 hours. These methods were successfully implemented for in-house production at UNMC and at Tripler Army Medical Center (Honolulu, Hawaii). Overall, the decontamination protocol was highly effective against both E. coli and S. aureus, achieving a ≥4 log10 (99.99%) reduction in colony counts for every replicate from each component of the face shield unit.

Discussion

Face shields not only act as a barrier against the soiling of N95 face masks, they also serve as more effective eye protection from respiratory droplets over standard eye shields. Implementation of decontamination protocols successfully allowed face shield and N95 mask reuse, offering a higher level of protection for anesthesiology providers at the onset of the COVID-19 pandemic.

Conclusions

In a time of urgent need, our protocol enabled the rapid production of face shields by individuals with little to no 3D printing experience, and provided a simple and effective decontamination protocol allowing reuse of the face shields.

Enhanced insect-resistance, UV protection, and antibacterial and antistatic properties exhibited by wool fabric treated with polyphenols extracted from mango seed kernel and feijoa peel

The synthetic dyes, antimicrobial and insect-resistant agents, UV radiation absorbents, and antistatic agents that are used to introduce multifunctional properties to textiles are not only toxic to the environment but also require multi-step treatments to achieve them. Toxic antimicrobials are responsible for the growth of drug-resistant bacteria. Nature-derived polyphenols, such as tannin, could be a viable green alternative. In this work, wool fabrics were treated with a commercial tannic acid (PP-1), and also with gallotannin-rich polyphenols extracted from feijoa fruit peel (PP-2) and mango seed kernel (PP-3) to introduce multifunctional properties, i.e. to make the fabric antistatic, insect-resistant, hydrophilic, and able to absorb harmful UV radiation. The effect of the treatment on the colour, colour intensity, surface resistivity, UV radiation absorption, antibacterial activity, and insect-repellence was systematically evaluated. It was found that PP-3-treated fabric exhibited excellent surface hydrophilicity, antibacterial activity against Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa, and insect-resistant activity against the larvae of Tineola bisselliella. PP-3 treatment also provided comparable UV protection and antioxidant activity but was marginally inferior to the UV protection and antioxidant activity exhibited by the PP-1-treated fabric. The commercial tannic acid treated fabric provided the best antistatic properties but the lowest surface hydrophilicity. The developed treatment could provide a green and sustainable alternative to hazardous UV absorbing, antibacterial and insect-resistant agents used in the textile industry.

Study on the Viable but Non-culturable (VBNC) State Formation of Staphylococcus aureus and Its Control in Food System

A Viable but non-culturable (VBNC) state is a bacterial survival strategy under reverse conditions. It poses a significant challenge for public health and food safety. In this study, the effect of external environmental conditions including acid, nutrition, and salt concentrations on the formation of S. aureus VBNC states at low temperatures were investigated. Different acidity and nutritional conditions were then applied to food products to control the VBNC state formation. Four different concentration levels of each factor (acid, nutrition, and salt) were selected in a total of 16 experimental groups. Nutrition showed the highest influence on the VBNC state formation S. aureus, followed by acid and salt. The addition of 1% acetic acid could directly kill S. aureus cells and inhibit the formation of the VBNC state with a nutrition concentration of 25, 50, and 100%. A propidium monoazide-polymerase chain reaction (PMA-PCR) assay was applied and considered as a rapid and sensitive method to detect S. aureus in VBNC state with the detection limit of 104 CFU/mL.

The role of textiles as fomites in the healthcare environment: a review of the infection control risk

BACKGROUND

Infectious diseases are a significant threat in both healthcare and community settings. Healthcare associated infections (HCAIs) in particular are a leading cause of complications during hospitalisation. Contamination of the healthcare environment is recognised as a source of infectious disease yet the significance of porous surfaces including healthcare textiles as fomites is not well understood. It is currently assumed there is little infection risk from textiles due to a lack of direct epidemiological evidence. Decontamination of healthcare textiles is achieved with heat and/or detergents by commercial or in-house laundering with the exception of healthcare worker uniforms which are laundered domestically in some countries. The emergence of the COVID-19 pandemic has increased the need for rigorous infection control including effective decontamination of potential fomites in the healthcare environment. This article aims to review the evidence for the role of textiles in the transmission of infection, outline current procedures for laundering healthcare textiles and review studies evaluating the decontamination efficacy of domestic and industrial laundering.

METHODOLOGY

Pubmed, Google Scholar and Web of Science were searched for publications pertaining to the survival and transmission of microorganisms on textiles with a particular focus on the healthcare environment.

RESULTS

A number of studies indicate that microorganisms survive on textiles for extended periods of time and can transfer on to skin and other surfaces suggesting it is biologically plausible that HCAIs and other infectious diseases can be transmitted directly through contact with contaminated textiles. Accordingly, there are a number of case studies that link small outbreaks with inadequate laundering or infection control processes surrounding healthcare laundry. Studies have also demonstrated the survival of potential pathogens during laundering of healthcare textiles, which may increase the risk of infection supporting the data published on specific outbreak case studies.

CONCLUSIONS

There are no large-scale epidemiological studies demonstrating a direct link between HCAIs and contaminated textiles yet evidence of outbreaks from published case studies should not be disregarded. Adequate microbial decontamination of linen and infection control procedures during laundering are required to minimise the risk of infection from healthcare textiles. Domestic laundering of healthcare worker uniforms is a particular concern due to the lack of control and monitoring of decontamination, offering a route for potential pathogens to enter the clinical environment. Industrial laundering of healthcare worker uniforms provides greater assurances of adequate decontamination compared to domestic laundering, due to the ability to monitor laundering parameters; this is of particular importance during the COVID-19 pandemic to minimise any risk of SARS-CoV-2 transmission.

Influence of physical variables on the transfer of Salmonella Typhimurium LT2 between potato (Solanum tuberosum) and stainless steel via static and dynamic contact

Bacterial cross-contamination between foods and contact surfaces can increase food safety risk; however, these processes are not well described in terms of fundamental variables. The objective was to determine the effect of sliding speed (3.75, 5.00, or 7.75 mm/s), contact time (5 or 40 s), normal pressure (~1217 to 8869 Pa), and number of sequential contacts on bacterial transfer to/from potato samples and stainless steel surfaces. Potato samples (~11 g, 3 × 3 × 1 cm) were either pulled across a stainless steel plate inoculated with Salmonella Typhimurium LT2 (~6.23 Log CFU/cm²) (dynamic contact) or placed on the inoculated plate for multiple sequential contacts on uninoculated squares (static contact). Salmonella on the potato and steel plate then were quantified by plating on modified trypticase soy agar. Bacterial transfer increased with increasing sliding speed (P = 0.0098) in dynamic tests and with contact time (P < 0.0001) in static tests. Salmonella on the inoculated potatoes decreased (P < 0.0001) from ~6.5 to ~5.5 Log CFU after 18 sequential static contacts with stainless steel. Reporting transfer results based on fundamental variables will improve the overall impact of bacterial transfer research on equipment design, cleaning/sanitation strategies, and overall food safety.

Microbial Barrier Properties of Cotton Fabric-Influence of Weave Architecture

The subject of the paper focuses on the effect of weave architecture on microbial barrier properties of woven fabrics or more precisely on identifying crucial elements of weave architecture that dominantly influence bacteria penetration in dry condition. For that purpose, 12 samples of cotton fabrics were woven and examined. In their structure, all samples had the same yarns (36 tex) in warp and weft, same densities of warp (24 yarns/cm), two weft densities (24 and 20 yarns/cm) and six different basic weave structures. Microbial barrier permeability was determined according to a previously developed test method in cooperation with University Hospital Center Zagreb. Bacterial endospores of apathogenic species of the genus Bacillus: Geobacillusstearothermophilus and Bacillus atrophaeus were used. The effect of weave pattern on microbial barrier properties was significant. Weave patterns, decisively determined the number of influencing pores and its sizes in woven fabrics, as well as the yarn floating which jointly almost perfectly correlated with bacteria penetration through the woven fabric. Multiple linear regression of pore numbers and floating threads produced equations which correspond in 99% to the measuring results for densities 24/24 and 24/20, and more than 98% considering both densities of the set. Among compared weave patterns, satin weave had significantly lower permeability of microorganisms (six–seven times) than basket weave (the highest), for both densities.

Survival of foodborne pathogens on stainless steel soiled with different food residues

Insufficient and ineffective cleaning practices can cause food residues to remain in kitchen and can facilitate bacterial attachment and persistence by protective films. The present study investigated the survival of five major foodborne pathogens on stainless steel coupons, in the presence of cooked rice, whole eggs, and soymilk. Foodborne pathogens showed different survival rates by desiccation and disinfection depending on food residues. Overall, the pathogens showed stronger survival than the control at 0.13-3.97 log CFU/coupon with 5% residues, and at 0.75-5.29 log CFU/coupon with 50% residues. Staphylococcus aureus was not affected by the food residue with showing the least difference in concentration, while Escherichia coli O157:H7 showed the most significant increase by food residue. The cells with cooked rice were observed using FE-SEM, and demonstrated bacterial binding or embedment. All results suggest that food safety can be practically ensured by food residue types and appropriate cleaning and disinfectants.

Quantitative Analysis of Selected Microorganisms Present at Various Sites in a Prosthetics Clinic and Dental Laboratory during Complete Denture Fabrication

Background: Contamination with oral commensals and pathogenic microorganisms, and cross contamination between clinic and laboratory can occur. The amount of contamination has not been determined. Methods: Samples from different clinical and laboratory stages before and after disinfection (17 sites, 10 samples per stage) were collected. Laboratory surfaces and equipment were swabbed for 10 days (11 sites). Swabs were cultured for total mixed flora, Streptococci, Lactobacilli, Staphylococcus aureus, aerobic Gram-negative bacteria (AGNB) and Candida. Knowledge of infection control among staff and students was assessed. Results: Clinic: In total, 30-40% of the samples overall were contaminated with mixed flora and Streptococci of >100 cfu/swab; >100 cfu of AGNB and Candida were present on 6% and 1% of samples; 2% contained <100 cfu of S. aureus. Laboratory: In total, 17-48% of the samples overall were contaminated with mixed flora and Streptococci of >100 cfu/swab; >100 cfu of AGNB were present on 11% of samples; none contained >100 cfu of Candida. Disinfection significantly reduced the level of all organisms. Knowledge of infection control was sufficient, but compliance was poor. Conclusion: Although the count of mixed flora was high, potential pathogens such as S. aureus and Candida were low. In immunocompromised patients, this can become a problem.

A novel comprehensive efficacy test for textiles intended for use in the healthcare setting

Soft surfaces, including textiles are found throughout healthcare settings. Pathogens can survive for long periods of time on textiles, and can be transferred to and from the skin. Antimicrobial fabrics are used as an engineering control to prevent infection. Efficacy testing standards have limitations, including single microorganism challenges, multiple fabric plies tested, and lengthy contact times. We developed a novel method that better models in-use conditions through testing standardized mixtures of pathogens and normal skin microorganisms, artificial soils, and a 15-min contact time. Reproducible growth of all microorganisms from frozen stocks was achieved using this method. A novel rechargeable, monitorable N-halamine cotton cellulose fabric, containing 5885 ± 98 ppm of active chlorine, was evaluated with the new method using PBS, artificial sweat, and artificial sweat plus 5% serum as soil. Pathogens tested included Acinetobacter baumannii, Candida albicans, Escherichia coli, vancomycin-resistant Enterococcus faecalis, methicillin-resistant Staphylococcus aureus, methicillin-susceptible Staphylococcus aureus, and Pseudomonas aeruginosa. Each was tested singly and in the presence of a representative normal skin flora mixture, including: Acinetobacter lwoffii, Corynebacterium striatum, Micrococcus luteus, and Staphylococcus epidermidis. When tested singly, all microorganisms were reduced by 3.00 log₁₀ or greater, regardless of artificial soil. In mixture, 4.00 log₁₀ or greater reductions were achieved for all microorganisms. These results suggest that the novel testing method can be used to provide more comprehensive and realistic efficacy information for antimicrobial textiles intended for use in healthcare. Furthermore, the N-halamine fabric demonstrated efficacy against multiple pathogens, singly and in mixtures, regardless of the presence of artificial soils.

Sterilization efficiency of pathogen-contaminated cottons in a laundry machine

Pathogenic bacteria on abiotic surfaces such as fabrics, bedding, patient wears, and surgical tools are known to increase the risk of bacterial diseases in infants and the elderly. The desiccation tolerance of bacteria affects their viability in cotton. Thus, washing and drying machines are required to use conditions that ensure the sterilization of bacteria in cotton. The objective of this study is to determine the effects of various sterilization conditions of washing and drying machines on the survival of three pathogenic bacteria (Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus) commonly presented in contaminated cotton and two non-pathogenic bacteria (Bacillus subtilis and Escherichia coli) in cotton. High survival rates of A. baumannii and S. aureus in desiccated cotton were observed based on scanning electron microscope and replicate organism direct agar contact assay. The survival rates of A. baumannii and S. aureus exposed in desiccated cotton for 8 h were higher (14.4 and 5.0%, respectively) than those of other bacteria (< 0.5%). All tested bacteria were eradicated at low-temperature (< 40°C) washing with activated oxygen bleach (AOB). However, bacterial viability was shown in low temperature washing without AOB. High-temperature (> 60°C) washing was required to achieve 99.9% of the sterilization rate in washing without AOB. The sterilization rate was 93.2% using a drying machine at 60°C for 4 h. This level of sterilization was insufficient in terms of time and energy efficiency. High sterilization efficiency (> 99.9%) at 75°C for 3 h using a drying machine was confirmed. This study suggests standard conditions of drying machines to remove bacterial contamination in cotton by providing practical data.

Construction of A New Dose-Response Model for Staphylococcus aureus Considering Growth and Decay Kinetics on Skin

In order to determine the relationship between an exposure dose of Staphylococcus aureus (S. aureus) on the skin and the risk of infection, an understanding of the bacterial growth and decay kinetics is very important. Models are essential tools for understanding and predicting bacterial kinetics and are necessary to predict the dose of organisms post-exposure that results in a skin infection. One of the challenges in modeling bacterial kinetics is the estimation of model parameters, which can be addressed using an inverse problem approach. The objective of this study is to construct a microbial kinetic model of S. aureus on human skin and use the model to predict concentrations of S. aureus that result in human infection. In order to model the growth and decay of S. aureus on skin, a Gompertz inactivation model was coupled with a Gompertz growth model. A series of analyses, including ordinary least squares regression, scaled sensitivity coefficient analysis, residual analysis, and parameter correlation analysis were conducted to estimate the parameters and to describe the model uncertainty. Based on these analyses, the proposed model parameters were estimated with high accuracy. The model was then used to develop a new dose-response model for S. aureus using the exponential dose–response model. The new S. aureus model has an optimized k parameter equivalent to 8.05 × 10⁻⁸ with 95^th percentile confidence intervals between 6.46 × 10⁻⁸ and 1.00 × 10⁻⁷.

Graphene Modified Multifunctional Personal Protective Clothing

Personal protective clothing is intended to protect the wearer from various hazards (mechanical, biological, chemical, thermal, radiological, etc.) and inhospitable environmental conditions that may cause harm or even death. There are various types of personal protective clothing, manufactured with different materials based on hazards and end user requirements. Conventional protective clothing has impediments such as high weight, bulky nature, lack of mobility, heat stress, low heat dissipation, high physical stress, diminishing dexterity, diminishing scope of vision, lack of breathability, and reduced protection against pathogens and hazards. By virtue of the superlative properties of graphene, fabrics modified with this material can be an effective means to overcome these limitations and to improve properties such as mechanical strength, antibacterial activity, flame resistance, conductivity, and UV resistance. The limitations of conventional personal protective equipment are discussed, followed by necessary measures which might be taken to improve personal protective equipment (PPE), the unique properties of graphene, methods of graphene incorporation in fabrics, and the current research status and potential of graphene-modified performance textiles relevant to PPE.

From one species to another: A review on the interaction between chemistry and microbiology in relation to cleaning in the built environment

Since the advent of soap, personal hygiene practices have revolved around removal, sterilization, and disinfection-both of visible soil and microscopic organisms-for a myriad of cultural, aesthetic, or health-related reasons. Cleaning methods and products vary widely in their recommended use, effectiveness, risk to users or building occupants, environmental sustainability, and ecological impact. Advancements in science and technology have facilitated in-depth analyses of the indoor microbiome, and studies in this field suggest that the traditional "scorched-earth cleaning" mentality-that surfaces must be completely sterilized and prevent microbial establishment-may contribute to long-term human health consequences. Moreover, the materials, products, activities, and microbial communities indoors all contribute to, or remove, chemical species to the indoor environment. This review examines the effects of cleaning with respect to the interaction of chemistry, indoor microbiology, and human health.

Microbiological evaluation of different hand drying methods for removing bacteria from washed hands

Proper drying of hands after washing is an integral part of hand hygiene. An experimental study on 30 subjects using multiple comparisons of six hand drying methods including 1) drying on own clothes, 2) drying with one paper towel, 3) drying with two paper towels, 4) drying with a warm air dryer while holding hands stationary for 20 s, 5) drying with a warm air dryer while hand rubbing for 20 s, and 6) drying with a jet air dryer until complete dryness was achieved. It aimed to determine the effectiveness of different hand drying methods for removing bacteria from washed hands, so as to identify the optimum method using minimum resources. Our study demonstrated that the use of jet air dryers is the best method to eliminate bacteria on hands, whereas drying hands on one's own clothes is the least effective. Drying hands in a stationary position could remove more bacteria than rubbing hands when using a warm air dryer for 20 s, which mimics people's usual hand-drying practice. No significant difference in bacteria reduction was detected between the use of one or two paper towels for hand drying; therefore, using fewer resources is recommended to maintain environmental sustainability.

Clothing-Mediated Exposures to Chemicals and Particles

A growing body of evidence identifies clothing as an important mediator of human exposure to chemicals and particles, which may have public health significance. This paper reviews and critically assesses the state of knowledge regarding how clothing, during wear, influences exposure to molecular chemicals, abiotic particles, and biotic particles, including microbes and allergens. The underlying processes that govern the acquisition, retention, and transmission of clothing-associated contaminants and the consequences of these for subsequent exposures are explored. Chemicals of concern have been identified in clothing, including byproducts of their manufacture and chemicals that adhere to clothing during use and care. Analogously, clothing acts as a reservoir for biotic and abiotic particles acquired from occupational and environmental sources. Evidence suggests that while clothing can be protective by acting as a physical or chemical barrier, clothing-mediated exposures can be substantial in certain circumstances and may have adverse health consequences. This complex process is influenced by the type and history of the clothing; the nature of the contaminant; and by wear, care, and storage practices. Future research efforts are warranted to better quantify, predict, and control clothing-related exposures.

Biology of Hand-to-Hand Bacterial Transmission

Numerous studies have demonstrated that adequate hand hygiene among hospital staff is the best measure to prevent hand-to-hand bacterial transmission. The skin microbiome is conditioned by the individual physiological characteristics and anatomical microenvironments. Furthermore, it is important to separate the autochthonous resident microbiota from the transitory microbiota that we can acquire after interactions with contaminated surfaces. Two players participate in the hand-to-hand bacterial transmission process: the bacteria and the person. The particularities of the bacteria have been extensively studied, identifying some genera or species with higher transmission efficiency, particularly those linked to nosocomial infections and outbreaks. However, the human factor remains unstudied, and intrapersonal particularities in bacterial transmission have not been yet explored. Herein we summarize the current knowledge on hand-to-hand bacterial transmission, as well as unpublished results regarding interindividual and interindividual transmission efficiency differences. We designed a simple in vivo test based on four sequential steps of finger-to-finger contact in the same person artificially inoculated with a precise bacterial inoculum. Individuals can be grouped into one of three observed transmission categories: high, medium, and poor finger-to-finger transmitters. Categorization is relevant to predicting the ultimate success of a human transmission chain, particularly for the poor transmitters, who have the ability to cut the transmission chain. Our model allowed us to analyze transmission rate differences among five bacterial species and clones that cause nosocomial infections, from which we detected that Gram-positive microorganisms were more successfully transmitted than Gram-negative.

Biofilms and Meat Safety: A Mini-Review

Biofilms are surface-attached microbial communities with distinct properties, which have a tremendous impact on public health and food safety. In the meat industry, biofilms remain a serious concern because many foodborne pathogens can form biofilms in areas at meat plants that are difficult to sanitize properly, and biofilm cells are more tolerant to sanitization than their planktonic counterparts. Furthermore, nearly all biofilms in commercial environments consist of multiple species of microorganisms, and the complex interactions within the community significantly influence the architecture, activity, and sanitizer tolerance of the biofilm society. This review focuses on the effect of microbial coexistence on mixed biofilm formation with foodborne pathogens of major concern in the fresh meat industry and their resultant sanitizer tolerance. The factors that would affect biofilm cell transfer from contact surfaces to meat products, one of the most common transmission routes that could lead to product contamination, are discussed as well. Available results from recent studies relevant to the meat industry, implying the potential role of bacterial persistence and biofilm formation in meat contamination, are reviewed in response to the pressing need to understand the mechanisms that cause "high event period" contamination at commercial meat processing plants. A better understanding of these events would help the industry to enhance strategies to prevent contamination and improve meat safety.

Development of new hydantoin-based biocidal polymers with improved rechargeability and anti-microbial activity

Novel hydantoin based co-polymers containing both amide and imide positions for halogen capture with improved rechargeability and antibacterial activity were developed.

Transfer of Enteric Viruses Adenovirus and Coxsackievirus and Bacteriophage MS2 from Liquid to Human Skin

Enteric viruses (viruses that infect the gastrointestinal tract) are responsible for most water-transmitted diseases. They are shed in high concentrations in the feces of infected individuals, persist for an extended period of time in water, and are highly infective. Exposure to contaminated water directly (through ingestion) or indirectly (for example, through hand-water contacts followed by hand-to-mouth contacts) increases the risk of virus transmission. The work described herein provides a quantitative model for estimating human-pathogenic virus retention on skin following contact with contaminated water. The work will be important in refining the contribution of indirect transmission of virus to risks associated with water-related activities.

Indirect exposure to waterborne viruses increases the risk of infection, especially among children with frequent hand-to-mouth contacts. Here, we quantified the transfer of one bacteriophage (MS2) and two enteric viruses (adenovirus and coxsackievirus) from liquid to skin. MS2, a commonly used enteric virus surrogate, was used to compare virus transfer rates in a volunteer trial to those obtained using human cadaver skin and synthetic skin. MS2 transfer to volunteer skin was similar to transfer to cadaver skin but significantly different from transfer to synthetic skin. The transfer of MS2, adenovirus, and coxsackievirus to cadaver skin was modeled using measurements for viruses attaching to the skin (adsorbed) and viruses in liquid residual on skin (unadsorbed). We find virus transfer per surface area is a function of the concentration of virus in the liquid and the film thickness of liquid retained on the skin and is estimable using a linear model. Notably, the amount of MS2 adsorbed on the skin was on average 5 times higher than the amount of adenovirus and 4 times higher than the amount of coxsackievirus. Quantification of pathogenic virus retention to skin would thus be overestimated using MS2 adsorption data. This study provides models of virus transfer useful for risk assessments of water-related activities, demonstrates significant differences in the transfer of pathogenic virus and MS2, and suggests cadaver skin as an alternative testing system for studying interactions between viruses and skin.

IMPORTANCE Enteric viruses (viruses that infect the gastrointestinal tract) are responsible for most water-transmitted diseases. They are shed in high concentrations in the feces of infected individuals, persist for an extended period of time in water, and are highly infective. Exposure to contaminated water directly (through ingestion) or indirectly (for example, through hand-water contacts followed by hand-to-mouth contacts) increases the risk of virus transmission. The work described herein provides a quantitative model for estimating human-pathogenic virus retention on skin following contact with contaminated water. The work will be important in refining the contribution of indirect transmission of virus to risks associated with water-related activities.

Control of Staphylococcus aureus biofilms by the application of single and combined treatments based in plant essential oils

Effective and environmentally-friendly alternatives to traditional disinfectants are necessary to reduce the pollution and the emergence of antimicrobial-resistant bacterial strains in food-related environments. In the present study, treatments based in single and combined applications of plant essential oils (EOs) were evaluated for control Staphylococcus aureus biofilms. EOs of Lippia sidoides, Thymus vulgaris and Pimenta pseudochariophyllus showed a higher efficacy than peracetic acid and sodium hypochlorite against S. aureus planktonic cells and 24-h-old biofilms formed on polystyrene and stainless steel under food-related conditions. High concentrations of thymol and chavibetol were detected in these EOs, as well as the presence of other antimicrobial compounds such as carvacrol, eugenol, p-cymene, limonene, α-pinene, α-terpineol, terpinen-4-oil and linalool. L. sidoides oil were particularly effective against S. aureus, but doses higher than 2.75% (v/v) were required to completely eradicate 24-h-old biofilms. Binary combinations of L. sidoides, T. vulgaris and P. pseudochariophyllus allowed decrease significantly doses required to reduce 99.99% the number of biofilm cells. Furthermore, peracetic acid increased its efficacy against S. aureus biofilms by the combined application with these EOs. The most effective treatments against S. aureus biofilms were those combining L. sidoides with T. vulgaris or peracetic acid. Therefore, these EO-based treatments can be considered as an effective and environmentally-friendly alternative to control S. aureus biofilms in food-contact surfaces.

Transfer of pathogens to and from patients, healthcare providers, and medical devices during care activity-a systematic review and meta-analysis

OBJECTIVE

The transfer of pathogens may spread antimicrobial resistance and lead to healthcare-acquired infections. We performed a systematic literature review to generate estimates of pathogen transfer in relation to healthcare provider (HCP) activities.

METHODS

For this systematic review and meta-analysis, Medline/Ovid, EMBASE, and the Cochrane Library were searched for studies published before July 7, 2017. We reviewed the literature, examining transfer of pathogens associated with HCP activities. We included studies that (1) quantified transfer of pathogens from a defined origin to a defined destination surface; (2) reported a microbiological sampling technique; and (3) described the associated activity leading to transfer. For studies reporting transfer frequencies, we extracted data and calculated the estimated proportion using Freeman-Tukey double arcsine transformation and the DerSimonian-Laird random-effects model.

RESULTS

Of 13,121 identified articles, 32 were included. Most articles (n=27, 84%) examined transfer from patients and their environment to HCP hands, gloves, and gowns, with an estimated proportion for transfer frequency of 33% (95% confidence interval [CI], 12%-57%), 30% (95% CI, 23%-38%) and 10% (95% CI, 6%-14%), respectively. Other articles addressed transfer involving the hospital environment and medical devices. Risk factor analyses in 12 studies suggested higher transfer frequencies after contact with moist body sites (n=7), longer duration of care (n=5), and care of patients with an invasive device (n=3).

CONCLUSIONS

Recognizing the heterogeneity in study designs, the available evidence suggests that pathogen transfer to HCPs occurs frequently. More systematic research is urgently warranted to support targeted and economic prevention policies and interventions.

Microbial Contamination of a Diving Suit

Pathogenic micro-organisms can easily transfer from the surface of a diver’s skin onto the surfaces of a protective suit. A long-term stay in a hyperbaric chamber during a saturation dive increases the risk of infection if in the chamber there is even a single carrier of disease-causing pathogens.

The conducted research has confirmed that the diving equipment located in Diving Centres is a place of many different bacteria and fungi, including pathogenic ones. The vast majority of microbes found on the surfaces of wetsuits, etc. are commensals (with some being opportunistic organisms). This fact allows us to realise that the surfaces of diving equipment are an excellent “transmission route” for various dermatoses and other diseases. In order to reduce the risk of infection the diving equipment used by various people should be subject to the process of decontamination. The authors recommend decontamination with the use of gaseous hydrogen peroxide which does not cause damage to equipment.

Modeling Transfer of Vibrio Parahaemolyticus During Peeling of Raw Shrimp

This study aimed to qualify the transfer of Vibrio parahaemolyticus during the shrimp peeling process via gloves under 3 different scenarios. The 1st 2 scenarios provided quantitative information for the probability distribution of bacterial transfer rates from (i) contaminated shrimp (6 log CFU/g) to non-contaminated gloves (Scenario 1) and (ii) contaminated gloves (6 log CFU/per pair) to non-contaminated shrimp (Scenario 2). In Scenario 3, bacterial transfer from contaminated shrimp to non-contaminated shrimp in the shrimp peeling process via gloves was investigated to develop a predictive model for describing the successive bacterial transfer. The range of bacterial transfer rate (%) in Scenarios 1 and 2 was 7% to 91.95% and 0.04% to 12.87%, respectively, indicating that the bacteria can be transferred from shrimp to gloves much easier than that from gloves to shrimp. A Logistic (1.59, 0.14) and Triangle distribution (-1.61, 0.12, 1.32) could be used to describe the bacterial transfer rate in Scenarios 1 and 2, respectively. In Scenario 3, a continuously decay patterning with fluctuations as the peeling progressed has been observed at all inoculation levels of the 1st shrimp (5, 6, and 7 log CFU/g). The bacteria could be transferred easier at 1st few peels, and the decreasing bacterial transfer was found in later phase. Two models (exponential and Weibull) could describe the successive bacterial transfer satisfactorily (pseudo-R² > 0.84, RMSE < 1.23, SEP < 10.37). The result of this study can provide information regarding cross-contamination events in the seafood factory.

PRACTICAL APPLICATION

This study presented that Vibrio parahaemolyticus cross-contamination could be caused by gloves during the shrimp peeling process. The bacterial transfer rate distribution and predictive model derived from this work could be used in risk assessment of V. parahaemolyticus to ensure peeled shrimp safety.

Synthesis and polymerization of a new hydantoin monomer with three halogen binding sites for developing highly antibacterial surfaces

Novel three halogen capturing hydantoin monomer-based copolymers were synthesized and evaluated for their antibacterial properties.

An Effective Surrogate Tracer Technique for S. aureus Bioaerosols in a Mechanically Ventilated Hospital Room Replica Using Dilute Aqueous Lithium Chloride

Finding a non-pathogenic surrogate aerosol that represents the deposition of typical bioaerosols in healthcare settings is beneficial from the perspective of hospital facility testing, general infection control and outbreak analysis. This study considers aerosolization of dilute aqueous lithium chloride (LiCl) and sodium chloride (NaCl) solutions as surrogate tracers capable of representing Staphylococcus aureus bioaerosol deposition on surfaces in mechanically ventilated rooms. Tests were conducted in a biological test chamber set up as a replica hospital single patient room. Petri dishes on surfaces were used to collect the Li, Na and S. aureus aerosols separately after release. Biological samples were analyzed using cultivation techniques on solid media, and flame atomic absorption spectroscopy was used to measure Li and Na atom concentrations. Spatial deposition distribution of Li tracer correlated well with S. aureus aerosols (96% of pairs within a 95% confidence interval). In the patient hospital room replica, results show that the most contaminated areas were on surfaces 2 m away from the source. This indicates that the room’s airflow patterns play a significant role in bioaerosol transport. NaCl proved not to be sensitive to spatial deposition patterns. LiCl as a surrogate tracer for bioaerosol deposition was most reliable as it was robust to outliers, sensitive to spatial heterogeneity and found to require less replicates than the S. aureus counterpart to be in good spatial agreement with biological results.

Physico-chemistry of bacterial transmission versus adhesion

Bacterial adhesion is a main problem in many biomedical, domestic, natural and industrial environments and forms the onset of the formation of a biofilm, in which adhering bacteria grow into a multi-layered film while embedding themselves in a matrix of extracellular polymeric substances. It is usually assumed that bacterial adhesion occurs from air or by convective-diffusion from a liquid suspension, but often bacteria adhere by transmission from a bacterially contaminated donor to a receiver surface. Therewith bacterial transmission is mechanistically different from adhesion, as it involves bacterial detachment from a donor surface followed by adhesion to a receiver one. Transmission is further complicated when the donor surface is not covered with a single layer of adhering bacteria but with a multi-layered biofilm, in which case bacteria can be transmitted either by interfacial failure at the biofilm-donor surface or through cohesive failure in the biofilm. Transmission through cohesive failure in a biofilm is more common than interfacial failure. The aim of this review is to oppose surface thermodynamics and adhesion force analyses, as can both be applied towards bacterial adhesion, with their appropriate extensions towards transmission. Opposition of surface thermodynamics and adhesion force analyses, will allow to distinguish between transmission of bacteria from a donor covered with a (sub)monolayer of adhering bacteria or a multi-layered biofilm. Contact angle measurements required for surface thermodynamic analyses of transmission are of an entirely different nature than analyses of adhesion forces, usually measured through atomic force microscopy. Nevertheless, transmission probabilities based on Weibull analyses of adhesion forces between bacteria and donor and receiver surfaces, correspond with the surface thermodynamic preferences of bacteria for either the donor or receiver surface. Surfaces with low adhesion forces such as polymer-brush coated or nanostructured surfaces are thus preferable for use as non-adhesive receiver surfaces, but at the same time should be avoided for use as a donor surface. Since bacterial transmission occurs under a contact pressure between two surfaces, followed by their separation under tensile or shear pressure and ultimately detachment, this will affect biofilm structure. During the compression phase of transmission, biofilms are compacted into a more dense film. After transmission, and depending on the ability of the bacterial strain involved to produce extracellular polymeric substances, biofilm left-behind on a donor or transmitted to a receiver surface will relax to its original, pre-transmission structure owing to the viscoelasticity of the extracellular polymeric substances matrix, when present. Apart from mechanistic differences between bacterial adhesion and transmission, the low numbers of bacteria generally transmitted require careful selection of suitably sensitive enumeration methods, for which culturing and optical coherence tomography are suggested. Opposing adhesion and transmission as done in this review, not only yields a better understanding of bacterial transmission, but may stimulate researchers to more carefully consider whether an adhesion or transmission model is most appropriate in the specific area of application aimed for, rather than routinely relying on adhesion models.

Contamination sources, biofilm-forming ability and biocide resistance of Staphylococcus aureus in tilapia-processing facilities

The major contamination sources, biofilm-forming ability and biocide resistance of Staphylococcus aureus in tilapia-processing plants were evaluated. Twenty-five processing control points were analysed twice in two factories, including whole tilapias, frozen fillets, water and food-contact surfaces. No final product was contaminated with S. aureus. However, high concentrations of S. aureus carrying enterotoxin ( se) genes were found in several processing points of both factories due to the application of inadequate hygienic and handling procedures, which generate a high risk of cross-contamination of the tilapia fillets with staphylococcal enterotoxins. Nine S. aureus strains were characterized by RAPD-PCR using primers AP-7, ERIC-2 and S. A wide diversity of se gene profiles was detected, most strains being multi- se-carriers. All S. aureus strains showed high biofilm-forming ability on stainless steel and polystyrene. Biofilm-forming ability was correlated with the presence of fliC H7 and the type of origin surface (metallic or plastic). A marked resistance of S. aureus to peracetic acid and sodium hypochlorite was also observed, required doses being higher than those recommended by manufacturers to be eradicated. Case-by-case approaches are thus recommended to determine the sources and degree of contamination present in each factory, which would allow applying precise responses that avoid, or at least reduce, the presence of bacterial pathogens and the emergence of antimicrobial resistance.

Transfer of bacteriophage MS2 and fluorescein from N95 filtering facepiece respirators to hands: Measuring fomite potential

Contact transmission of pathogens from personal protective equipment is a concern within the healthcare industry. During public health emergency outbreaks, resources become constrained and the reuse of personal protective equipment, such as N95 filtering facepiece respirators, may be needed. This study was designed to characterize the transfer of bacteriophage MS2 and fluorescein between filtering facepiece respirators and the wearer's hands during three simulated use scenarios. Filtering facepiece respirators were contaminated with MS2 and fluorescein in droplets or droplet nuclei. Thirteen test subjects performed filtering facepiece respirator use scenarios including improper doffing, proper doffing and reuse, and improper doffing and reuse. Fluorescein and MS2 contamination transfer were quantified. The average MS2 transfer from filtering facepiece respirators to the subjects' hands ranged from 7.6-15.4% and 2.2-2.7% for droplet and droplet nuclei derived contamination, respectively. Handling filtering facepiece respirators contaminated with droplets resulted in higher levels of MS2 transfer compared to droplet nuclei for all use scenarios (p = 0.007). MS2 transfer from droplet contaminated filtering facepiece respirators during improper doffing and reuse was greater than transfer during improper doffing (p = 0.008) and proper doffing and reuse (p = 0.042). Droplet contamination resulted in higher levels of fluorescein transfer compared to droplet nuclei contaminated filtering facepiece respirators for all use scenarios (p = 0.009). Fluorescein transfer was greater for improper doffing and reuse (p = 0.007) from droplet contaminated masks compared to droplet nuclei contaminated filtering facepiece respirators and for improper doffing and reuse when compared improper doffing (p = 0.017) and proper doffing and reuse (p = 0.018) for droplet contaminated filtering facepiece respirators. For droplet nuclei contaminated filtering facepiece respirators, the difference in MS2 and fluorescein transfer did not reach statistical significance when comparing any of the use scenarios. The findings suggest that the results of fluorescein and MS2 transfer were consistent and highly correlated across the conditions of study. The data supports CDC recommendations for using proper doffing techniques and discarding filtering facepiece respirators that are directly contaminated with secretions from a cough or sneeze.

Influence of biofilm lubricity on shear-induced transmission of staphylococcal biofilms from stainless steel to silicone rubber

In real-life situations, bacteria are often transmitted from biofilms growing on donor surfaces to receiver ones. Bacterial transmission is more complex than adhesion, involving bacterial detachment from donor and subsequent adhesion to receiver surfaces. Here, we describe a new device to study shear-induced bacterial transmission from a (stainless steel) pipe to a (silicone rubber) tube and compare transmission of EPS-producing and non-EPS-producing staphylococci. Transmission of an entire biofilm from the donor to the receiver tube did not occur, indicative of cohesive failure in the biofilm rather than of adhesive failure at the donor-biofilm interface. Biofilm was gradually transmitted over an increasing length of receiver tube, occurring mostly to the first 50 cm of the receiver tube. Under high-shearing velocity, transmission of non-EPS-producing bacteria to the second half decreased non-linearly, likely due to rapid thinning of the lowly lubricious biofilm. Oppositely, transmission of EPS-producing strains to the second tube half was not affected by higher shearing velocity due to the high lubricity and stress relaxation of the EPS-rich biofilms, ensuring continued contact with the receiver. The non-linear decrease of ongoing bacterial transmission under high-shearing velocity is new and of relevance in for instance, high-speed food slicers and food packaging.

Cleanliness in context: reconciling hygiene with a modern microbial perspective

The concept of hygiene is rooted in the relationship between cleanliness and the maintenance of good health. Since the widespread acceptance of the germ theory of disease, hygiene has become increasingly conflated with sterilization. In reviewing studies across the hygiene literature (most often hand hygiene), we found that nearly all studies of hand hygiene utilize bulk reduction in bacterial load as a proxy for reduced transmission of pathogenic organisms. This treatment of hygiene may be insufficient in light of recent microbial ecology research, which has demonstrated that humans have intimate and evolutionarily significant relationships with a diverse assemblage of microorganisms (our microbiota). The human skin is home to a diverse and specific community of microorganisms, which include members that exist across the ecological spectrum from pathogen through commensal to mutualist. Most evidence suggests that the skin microbiota is likely of direct benefit to the host and only rarely exhibits pathogenicity. This complex ecological context suggests that the conception of hygiene as a unilateral reduction or removal of microbes has outlived its usefulness. As such, we suggest the explicit definition of hygiene as "those actions and practices that reduce the spread or transmission of pathogenic microorganisms, and thus reduce the incidence of disease."

Decontamination of a Diving Suit

When working in chemical or biological environments, contamination is an extremely dangerous issue for the rescue services of the fire department, police and the army.

Modern protective overalls worn by fire fighters or dry “Viking” diving suits made from neoprene or nylon covered with polyurethane, have been proven to ensure sufficient protection. However, once the contaminated area is left, there is a need to perform decontamination of the external and internal surfaces of the protective overalls; in order to ensure the clothing continues to offer a high level of comfort and to retain the durability of said protective clothing, it is of course also necessary to perform a drying procedure.

Moreover, there is a risk of a transfer of pathogenic micro-organisms between persons utilising the same protective clothes, particularly in the case of expensive specialist suits. Micro-organisms which may potentially spread through clothing include intestinal bacteria, such as: Salmonella, Shigella, Campylobacter, E. coli (including E. coli O157), C. difficile, viruses inducing infections of the upper respiratory tract and alimentary tract (noraviruses, rotaviruses, adeno and astroviruses). The risk of infection also involves the presence of the flu viruses, herpesviruses and pathogens transferred through skin, such as S. aureus (including MRSA), yeast-like fungi (Candida albicans), fungal strains inducing Tinea pedis and Tinea corporis [1]. Pathogenic micro-organisms can easily transfer from fabric surface onto the body of a person wearing protective clothing.

From the numerous available techniques of decontamination of surfaces, equipment and protective clothing we propose to use for this purpose gaseous hydrogen peroxide (H2O2), a very effective biocidal agent. In field conditions, typical for the activities of rescue crews of the fire department, police and army we assume utilisation of a portable decontamination chamber enabling performance of a complete decontamination process.

The process lasting approximately 3 hours encompasses 3 phases:

• Drying phase;

• Decontamination with gaseous hydrogen peroxide;

• Catalytic combustion phase of hydrogen peroxide residues to a level safe for the environment.

The integrated humidity and H2O2 level sensors ensure automatic control of the entire process and the unique distribution system of gaseous H2O2 secures full accessibility of the biocidal agent to the external surface of protective clothing as well as its interior. Moreover, the container allows for the conduction of the complete decontamination of the rescue equipment, night vision devices, binoculars, field telephones, radio stations, etc. Upon decontamination cycle completion, we obtain a completely dried suit which can be safely used by another crew member.

Quantifying Bacterial Cross-Contamination Rates between Fresh-Cut Produce and Hands

This study quantifies the cross-contamination rates between fresh-cut produce and hands using a nalidixic acid-resistant nonpathogenic Enterobacter aerogenes and cocktails of rifampin-resistant Salmonella or Escherichia coli O157:H7 strains. Volunteers performed the E. aerogenes experiments (n = 20), and one of the authors performed the Salmonella and E. coli O157:H7 experiments multiple times (n =15 and n =10, respectively). Each participant handled 25 g of fresh-cut carrots, celery, or cantaloupe in two different scenarios. In the first scenario, gloved hands were inoculated with 6 log CFU per hand of the bacteria, and in the second scenario, five 25-g pieces of fresh produce were inoculated to a concentration of 6 log CFU/25 g. The glove juice method was used to quantify the bacterial concentration on the gloved hands. About 30% of E. aerogenes on gloved hands was transferred to the carrots and celery, and 18% of E. aerogenes on gloved hands was transferred to the cantaloupe. When carrots or cantaloupe was inoculated with E. aerogenes , 1% was transferred to gloved hands; from inoculated celery, about 0.3% of E. aerogenes was transferred to gloved hands. There was not a significant difference between E. aerogenes and Salmonella cross-contamination rates (P > 0.05). When gloved hands were contaminated with E. coli O157:H7, about 30% was transferred to carrots, about 10% to celery, and about 3% to cantaloupe. When carrots and celery were inoculated with E. coli O157:H7, about 1% was transferred to gloved hands, but from inoculated cantaloupe only about 0.3% was transferred. Direction of transfer (to versus from produce), difference in type of produce, and differences among the bacterial species all had significant effects on the transfer rate. Understanding transfer rates to and from fresh-cut produce will allow for better risk assessment and management of microbial food safety risk related to fresh-cut produce.