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Dancer SJ. Hospital cleaning: past, present, and future. Antimicrob Resist Infect Control 2023; 12:80. [PMID: 37608396 PMCID: PMC10464435 DOI: 10.1186/s13756-023-01275-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION The importance of hospital cleaning for controlling healthcare-associated infection (HAI) has taken years to acknowledge. This is mainly because the removal of dirt is inextricably entwined with gender and social status, along with lack of evidence and confusion over HAI definitions. Reducing so-called endogenous infection due to human carriage entails patient screening, decolonisation and/or prophylaxis, whereas adequate ventilation, plumbing and cleaning are needed to reduce exogenous infection. These infection types remain difficult to separate and quantitate. Patients themselves demonstrate wide-ranging vulnerability to infection, which further complicates attempted ranking of control interventions, including cleaning. There has been disproportionate attention towards endogenous infection with less interest in managing environmental reservoirs. QUANTIFYING CLEANING AND CLEANLINESS Finding evidence for cleaning is compromised by the fact that modelling HAI rates against arbitrary measurements of cleaning/cleanliness requires universal standards and these are not yet established. Furthermore, the distinction between cleaning (soil removal) and cleanliness (soil remaining) is usually overlooked. Tangible bench marking for both cleaning methods and all surface types within different units, with modification according to patient status, would be invaluable for domestic planning, monitoring and specification. AIMS AND OBJECTIVES This narrative review will focus on recent history and current status of cleaning in hospitals. While its importance is now generally accepted, cleaning practices still need attention in order to determine how, when and where to clean. Renewed interest in removal and monitoring of surface bioburden would help to embed risk-based practice in hospitals across the world.
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Affiliation(s)
- Stephanie J Dancer
- Department of Microbiology, NHS Lanarkshire & School of Applied Sciences, Edinburgh Napier University, Scotland, UK.
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Jann J, Gascon S, Drevelle O, Fradette J, Auclair-Gilbert M, Soucy G, Fortier LC, Faucheux N. Assessment of antibacterial properties and skin irritation potential of anodized aluminum impregnated with various quaternary ammonium. BIOMATERIALS ADVANCES 2023; 150:213433. [PMID: 37104962 DOI: 10.1016/j.bioadv.2023.213433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
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.
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Affiliation(s)
- Jessica Jann
- Department of Chemical and Biotechnological Engineering, Faculty of Engineering, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada; Clinical Research Center of Centre Hospitalier Universitaire de Sherbrooke, 12e avenue N, Sherbrooke, Québec J1H 5N4, Canada
| | - Suzanne Gascon
- Department of Chemical and Biotechnological Engineering, Faculty of Engineering, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada
| | - Olivier Drevelle
- Department of Chemical and Biotechnological Engineering, Faculty of Engineering, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada
| | - Julie Fradette
- Centre de Recherche en Organogénèse Expérimentale de l'Université Laval/LOEX, Centre de Recherche du CHU de Québec-Université Laval, Axe Médecine Régénératrice, 1401, 18(e) rue, Québec City, Québec G1J 1Z4, Canada; Department of Surgery, Faculty of Medicine, Université Laval, 1050 avenue de la Médecine, Québec City, Québec G1V 0A6, Canada
| | | | - Gervais Soucy
- Department of Chemical and Biotechnological Engineering, Faculty of Engineering, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada
| | - Louis-Charles Fortier
- Clinical Research Center of Centre Hospitalier Universitaire de Sherbrooke, 12e avenue N, Sherbrooke, Québec J1H 5N4, Canada; Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3201 rue Jean Mignault, Sherbrooke, Québec J1E 4K8, Canada.
| | - Nathalie Faucheux
- Department of Chemical and Biotechnological Engineering, Faculty of Engineering, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada; Clinical Research Center of Centre Hospitalier Universitaire de Sherbrooke, 12e avenue N, Sherbrooke, Québec J1H 5N4, Canada.
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Jann J, Drevelle O, Chen XG, Auclair-Gilbert M, Soucy G, Faucheux N, Fortier LC. Rapid antibacterial activity of anodized aluminum-based materials impregnated with quaternary ammonium compounds for high-touch surfaces to limit transmission of pathogenic bacteria. RSC Adv 2021; 11:38172-38188. [PMID: 35498065 PMCID: PMC9044312 DOI: 10.1039/d1ra07159a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/22/2021] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Jessica Jann
- Department of Chemical and Biotechnological Engineering, Faculty of Engineering, Université de Sherbrooke 2500 boul. de l'Université Sherbrooke Québec J1K 2R1 Canada .,Clinical Research Center of Centre Hospitalier Universitaire de Sherbrooke 12e Avenue N Sherbrooke Québec J1H 5N4 Canada.,Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Université de Sherbrooke 3201 rue Jean Mignault Sherbrooke Québec J1E 4K8 Canada
| | - Olivier Drevelle
- Department of Chemical and Biotechnological Engineering, Faculty of Engineering, Université de Sherbrooke 2500 boul. de l'Université Sherbrooke Québec J1K 2R1 Canada
| | - X Grant Chen
- Department of Applied Science, University of Quebec in Chicoutimi Saguenay Quebec G7H 2B1 Canada
| | | | - Gervais Soucy
- Department of Chemical and Biotechnological Engineering, Faculty of Engineering, Université de Sherbrooke 2500 boul. de l'Université Sherbrooke Québec J1K 2R1 Canada
| | - Nathalie Faucheux
- Department of Chemical and Biotechnological Engineering, Faculty of Engineering, Université de Sherbrooke 2500 boul. de l'Université Sherbrooke Québec J1K 2R1 Canada .,Clinical Research Center of Centre Hospitalier Universitaire de Sherbrooke 12e Avenue N Sherbrooke Québec J1H 5N4 Canada
| | - Louis-Charles Fortier
- Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Université de Sherbrooke 3201 rue Jean Mignault Sherbrooke Québec J1E 4K8 Canada
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Health Care Environmental Hygiene: New Insights and Centers for Disease Control and Prevention Guidance. Infect Dis Clin North Am 2021; 35:609-629. [PMID: 34362536 DOI: 10.1016/j.idc.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Recent research has significantly clarified the impact of optimizing patient-zone environmental hygiene. New insights into the environmental microbial epidemiology of many hospital-associated pathogens, especially Clostridioides difficile, have clarified and quantified the role of ongoing occult pathogen transmission from the near-patient environment. The recent development of safe, broadly effective surface chemical disinfectants has led to new opportunities to broadly enhance environmental hygiene in all health care settings. The Centers for Disease Control and Prevention has recently developed a detailed guidance to assist all health care settings in implementing optimized programs to mitigate health care-associated pathogen transmission from the near-patient surfaces.
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Widmer AF, Frei R. Evaluating antimicrobial effectiveness in environmental microbiology. Clin Infect Dis 2021; 73:750-751. [PMID: 33423047 DOI: 10.1093/cid/ciab013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andreas F Widmer
- Division of Infectious diseases & hospital epidemiology, University of Basel Hospitals & Clinics, Basel, Switzerland
| | - Reno Frei
- Division of Infectious diseases & hospital epidemiology, University of Basel Hospitals & Clinics, Basel, Switzerland
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