Critical physiological factors influencing the outcome of antimicrobial testing according to ISO 22196 / JIS Z 2801

Evaluating antimicrobial efficacy in medical devices: The critical role of simulating in use test conditions

Biofilm infections represent the greatest risk associated with medical devices and implants, constituting 65 %-70 % of all device associated infections. Efforts to develop antimicrobial technologies for biomedical applications aim to reduce infection rates, antibiotic use, and the induction of antimicrobial resistance. However, standard laboratory test conditions often overestimate efficacy, highlighting the need for experimental designs that simulate real-world settings. To this end, we evaluated four commercially available antimicrobial materials containing silver (AG1, AG2, AG3) or zinc (ZN1) to assess their ability to mitigate microbial proliferation in for longer duration or multi-use medical devices. The materials' homogeneity and surface topography were characterized through Scanning Electron Microscopy (SEM) coupled with Energy Dispersive Spectroscopy (EDS) and Atomic Force Microscopy (AFM). Antimicrobial efficacy was tested using a modified ISO 22196 protocol under clinically relevant conditions and a dry contact test developed to mimic in-use conditions for many extracorporeal medical devices. Results revealed homogeneous elemental distributions in AG1, AG2, and ZN1, and heterogeneous clusters for AG3. Surface roughness was highest for AG2 (170.1 nm), followed by TPE control (155.3 nm), ZN1 (83.51 nm) and silicone control (66.74 nm). All test materials demonstrated antimicrobial efficacies against S. aureus and E. coli, but not against C. albicans. In the dry contact assay, only AG2 proved effective against E. coli, and P. aeruginosa, underlining the role of humidity in antimicrobial action. Results were further corroborated by measurement of ion release by the materials at various temperatures, revealing greater release at higher temperatures. These outcomes emphasize the importance of testing antimicrobial materials under in use conditions to minimize discrepancies between laboratory results and clinical outcomes. Our findings provide a valuable framework for testing and integrating these materials into next-generation multi-use medical devices.

Systematic study on the evaluation method of surface antibacterial activity based on the fluorescent observation of bacterial growth

Antibacterial and antiviral coating materials have attracted increasing attention for the prevention of infections caused by frequently touched surfaces in communities and hospitals. The standard assessment procedure for antibacterial surfaces involves bacterial culture on a film-covered substrate followed by transfer onto agar for colony counting (ISO22196:2011). However, this assessment lacks temporal and spatial information regarding bacterial growth, resulting in an incomplete and inaccurate evaluation of the antibacterial activity of the surface. In this study, we develop a novel evaluation procedure for antibacterial substrates that enables in situ visualization of bacterial growth on a surface with centimeter-scale spatial information using fluorescent protein-expressing bacterial cells and an image acquisition setup. The effects of equipment parameters on bacterial growth are systematically investigated to establish the standard evaluation conditions. Based on the optimized parameters, a quantitative evaluation of the antibacterial activity of the coating material is successfully demonstrated. The proposed method is expected to be useful in investigating the spatial and temporal distribution of bacterial growth on substrates.

A new method for testing non-porous surfaces for their antimicrobial efficacy using an aerosol-generating spray chamber

The application of antimicrobial surfaces requires proof of their effectivity by in vitro methods in laboratories. One of the most common test methods is ISO 22196:2011, which represents a simple and inexpensive protocol by applying the bacterial suspension with known volume and concentration covered under a polyethylene film on the surfaces. The incubation is then conducted under defined humidity conditions for 24 h. Another approach for testing non-porous surfaces is the newly published ISO 7581:2023. With this protocol, a "dry test" is achieved by spreading and drying 1 μL of a bacterial suspension on the surfaces. A comprehensive evaluation of both standard protocols was conducted. This showed that they have some limitations and often do not include realistic test conditions that refer to the final product. Accordingly, the objective of this study was to develop a novel testing procedure that uses the spraying of a suspension inside of a chamber to generate aerosols with a precisely defined bacterial or yeast load. The samples to be analyzed are covered with small droplets that dry up within a few minutes and thus enable very reproducible contamination of the surfaces. The test series was carried out with low-alloyed carbon steel and glass without antimicrobial substances against two different Escherichia coli and Staphylococcus epidermidis strains and one Candida albicans strain to evaluate the new method. The results provided reproducible and reliable results in the setup carried out. This test method represents a valuable alternative for the assessment of non-porous surfaces in a manner that more closely reflects real-world conditions (e.g., simulation of aerosol formation by sneezing).

Evaluation of the Antibacterial and Cell Culture Properties of Anodic Porous Alumina Prepared in Concentrated H2SO4

The antibacterial activity of anodic porous alumina (APA) prepared using phosphoric, oxalic, and sulfuric acids was tested, and it was found that APA prepared using sulfuric acid had the highest antibacterial activity against Staphylococcus aureus and Escherichia coli. In addition, the results of the antibacterial test using APA prepared with different concentrations of sulfuric acid showed that APA prepared in concentrated sulfuric acid exhibited significantly higher antibacterial activity. APA formed in concentrated sulfuric acid also showed excellent antibacterial activity even at a high culture medium concentration, at which bacterial cells tend to multiply easily. Trace amounts of Al and S that leached out to the culture medium from APA prepared in concentrated sulfuric acid did not affect the antibacterial activity of APA, indicating that the APA surface exhibits excellent antibacterial activity. It was shown that the surface of APA prepared in concentrated sulfuric acid had excellent culture properties for fibroblasts while exhibiting antibacterial activity. APA prepared in concentrated sulfuric acid can be used in various applications that require excellent antibacterial activity as well as on surfaces that suppress bacterial growth and selectively cultivate target cells.

Antimicrobial non-porous surfaces: a comparison of the standards ISO 22196:2011 and the recently published ISO 7581:2023

The application of antimicrobial surfaces requires the proof of their effectivity by in vitro methods in laboratories. One of the most well-known test methods is ISO 22196:2011, which represents a simple and inexpensive protocol by applying the bacterial suspension with known volume and concentration covered under a polyethylene film on the surfaces. The incubation is then done under defined humidity conditions for 24 h. Another approach for testing of non-porous surfaces is the newly published ISO 7581:2023. A "dry test" is achieved through spreading and drying 1 μL of a bacterial suspension on the surface. In this study, low alloyed carbon steel, polyethylene terephthalate (PET), and glass specimens were tested uncoated (reference) and coated with zinc according to both ISOs to compare and to evaluate the advantages and disadvantages of each one of them. Although ISO 7581:2023 allows a more realistic test environment than ISO 22196:2011, the reproducibility of the results is not given due to the low application volume. In addition, not all bacterial strains are equally suitable for this testing type. Individual adaptations to the protocols, including incubation conditions (time, temperature, or relative humidity), testing strains and volume, seem necessary to generate conditions that simulate the final application. Nevertheless, both ISOs, if used correctly, provide a good basis for estimating the antimicrobial efficacy of non-porous surfaces.

Evaluation of antibacterial activity and influencing factors of normal and nanostructured copper-based materials

Background

Copper-based materials have garnered extensive recognition for their effective nature against microorganisms and their minimal toxicity. However, the evaluation for their antibacterial activity is still in its nascent stages, and the evaluation results based on existing criteria are not representative of real-world application.

Aim

To evaluate the antibacterial activity and primary determinants of influence of copper-based materials in order to investigate their practical antibacterial activity and potential mechanisms of such materials.

Methods

Staphylococcus aureus and Escherichia coli bacterial suspensions were applied via inoculation onto the surfaces of normal and nanostructured copper foil. Following incubation of the inoculated surfaces under diverse experimental conditions-including varying compositions of the bacterial suspension, the use of chemical neutralizers, the existence of organic interferents, and low temperature and humidity-surviving bacteria were enumerated. Using the scanning electron microscopy and X-ray photoelectron spectroscopy, the surface changes of copper-based materials were examined.

Findings

Following 1 h of exposure to 37 °C and 90% relative humidity, Staphylococcus aureus was reduced by 4.45 log10 on normal copper foil, while all of the bacteria were eradicated on nanostructured copper foil. In addition, it was discovered that preparing a bacterial suspension with PBS results in a significant number of Escherichia coli fatalities during the test, whereas using TPS promotes the bacteria's normal growth. Furthermore, the outcomes of the antibacterial activity test were diminished when chemical neutralization was employed, and the presence of organic interferents had distinct impacts on normal copper foil and nanostructured copper foil. Additionally, low temperatures and humidity diminished the antibacterial activity of copper foil, whereas normal copper foil produced significantly better results.

Conclusion

While copper-based materials exhibit robust antibacterial activity as determined by standard assays, their efficacy in real-world applications is subject to various influencing mechanisms. In order to objectively evaluate the antibacterial activity of copper-based materials and provide precise guidance for their development and practical application, it is essential to regulate test conditions with targeted.

Sensor system for analysis of biofilm sensitivity to ampicillin

The resistance of biofilms to antibiotics is a key factor that makes bacterial infections unsusceptible to antimicrobial therapy. The results of classical tests of cell sensitivity to antibiotics cannot be used to predict therapeutic success in infections associated with biofilm formation. We describe a simple and rapid method for the real-time evaluation of bacterial biofilm sensitivity to antibiotics, with Pseudomonas putida and ampicillin as examples. The method uses an electric biosensor to detect the difference between changes in the biofilm electric polarizability, thereby evaluating antibiotic sensitivity. The electric signals showed that P. putida biofilms were susceptible to ampicillin and that at high antibiotic concentrations, the biofilms differed markedly in their susceptibility (dose-dependent effect). The sensor also detected differences between biofilms before and after ampicillin treatment. The electric-signal changes enabled us to describe the physical picture of the processes occurring in bacterial biofilms in the presence of ampicillin. The approach used in this study is promising for evaluating the activity of various compounds against biofilms, because it permits a conclusion about the antibiotic sensitivity of biofilm bacteria to be made in real time and in a short period (analysis time, not longer than 20 min). An added strong point is that analysis can be done directly in liquid, without preliminary sample preparation. KEY POINTS: • Sensor system to analyze biofilm antimicrobial susceptibility is described. • The signal change depended on the ampicillin concentration (dose-dependent effect). • The sensor allows real-time determination of the antibiofilm effect of ampicillin.

Assessing Antimicrobial Efficacy on Plastics and Other Non-Porous Surfaces: A Closer Look at Studies Using the ISO 22196:2011 Standard

The survival and spread of foodborne and nosocomial-associated bacteria through high-touch surfaces or contamination-prone sites, in either healthcare, domestic or food industry settings, are not always prevented by the employment of sanitary hygiene protocols. Antimicrobial surface coatings have emerged as a solution to eradicate pathogenic bacteria and prevent future infections and even outbreaks. Standardised antimicrobial testing methods play a crucial role in validating the effectiveness of these materials and enabling their application in real-life settings, providing reliable results that allow for comparison between antimicrobial surfaces while assuring end-use product safety. This review provides an insight into the studies using ISO 22196, which is considered the gold standard for antimicrobial surface coatings and examines the current state of the art in antimicrobial testing methods. It primarily focuses on identifying pitfalls and how even small variations in methods can lead to different results, affecting the assessment of the antimicrobial activity of a particular product.

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.

Demonstrating the In Vitro and In Situ Antimicrobial Activity of Oxide Mineral Microspheres: An Innovative Technology to Be Incorporated into Porous and Nonporous Materials

The antimicrobial activity of surfaces treated with zinc and/or magnesium mineral oxide microspheres is a patented technology that has been demonstrated in vitro against bacteria and viruses. This study aims to evaluate the efficiency and sustainability of the technology in vitro, under simulation-of-use conditions, and in situ. The tests were undertaken in vitro according to the ISO 22196:2011, ISO 20473:2013, and NF S90-700:2019 standards with adapted parameters. Simulation-of-use tests evaluated the robustness of the activity under worst-case scenarios. The in situ tests were conducted on high-touch surfaces. The in vitro results show efficient antimicrobial activity against referenced strains with a log reduction of >2. The sustainability of this effect was time-dependent and detected at lower temperatures (20 ± 2.5 °C) and humidity (46%) conditions for variable inoculum concentrations and contact times. The simulation of use proved the microsphere's efficiency under harsh mechanical and chemical tests. The in situ studies showed a higher than 90% reduction in CFU/25 cm² per treated surface versus the untreated surfaces, reaching a targeted value of <50 CFU/cm². Mineral oxide microspheres can be incorporated into unlimited surface types, including medical devices, to efficiently and sustainably prevent microbial contamination.

Antimicrobial and Antiviral Properties of Triclosan-Containing Polymer Composite: Aging Effects of pH, UV, and Sunlight Exposure

The present study deals with the synthesis and characterization of a polymer composite based on an unsaturated ester loaded with 5 wt.% triclosan, produced by co-mixing on an automated hardware system. The polymer composite's non-porous structure and chemical composition make it an ideal material for surface disinfection and antimicrobial protection. According to the findings, the polymer composite effectively inhibited (100%) the growth of Staphylococcus aureus 6538-P under exposure to physicochemical factors, including pH, UV, and sunlight, over a 2-month period. In addition, the polymer composite demonstrated potent antiviral activity against human influenza virus strain A and the avian coronavirus infectious bronchitis virus (IBV), with infectious activities of 99.99% and 90%, respectively. Thus, the resulting triclosan-loaded polymer composite is revealed to have a high potential as a surface-coating non-porous material with antimicrobial properties.

Interlaboratory reproducibility of a touch-transfer assay for the assessment of antimicrobial surfaces

BACKGROUND

Various assay methods have been developed to study antimicrobial activity based on contamination of surfaces with different amounts of liquid bacterial suspensions. Since surfaces with frequent hand contact are typically touched in a dry state in clinical settings, these tests may be inappropriate at assessing effectiveness to reduce pathogen transmission.

AIM

To investigate a surface previously confirmed to display antimicrobial activity even after drying of small volumes of bacterial suspension (Egger antimicrobial surfaces: EAS) under conditions modelling dry contamination using a touch-transfer method.

METHODS

EAS, an antimicrobial copper alloy, as well as a negative control were examined to assess interlaboratory test reproducibility.

FINDINGS

Significantly fewer bacteria on EAS after touch transfer and some differences in the touch transmission were detected between the two laboratories. However, an identical assessment of effectiveness for EAS came from both laboratories. Interestingly, despite previously detected antimicrobial efficacy of EAS and the antimicrobial copper alloy after liquid contamination, insufficient activity was observed under dry conditions during a contact time of 4 h by both laboratories. Experiments under standardized air humidity in one laboratory revealed at least for copper a strong influence of humidity on antimicrobial activity. These data indicate that procedures involving contamination of surfaces with organisms suspended in liquids are not directly comparable to dry contamination.

CONCLUSION

Since, in the real world of a hospital, organisms are typically transferred between dry surfaces, further standardization of the touch-transfer method is worthwhile for a better understanding of the efficacy of such surfaces.

The Influence of 2-Methacryloyloxyethyl Phosphorylcholine Polymer Materials on Orthodontic Friction and Attachment of Oral Bacteria

There is no clinical evidence of the usage of 2-methacryloyloxyethyl phosphorylcholine (MPC) polymers in dental practice. We performed in vitro studies to determine whether the application of an MPC coating to stainless steel orthodontic wires confers low-friction and antimicrobial properties to these wires. The friction test on MPC-coated wires was performed using a precision universal/tensile tester. MPC polymer was coated on a 50 × 50 mm stainless steel plate, and samples were assessed using an antimicrobial activity test. To verify the effect of MPC polymer-treated wires on experimental tooth movement models in vitro, examinations were performed on typodonts to determine the improvement in tooth movement efficiency. The polymer treatment wire groups demonstrated significantly enhanced tooth movement compared with the untreated wire groups, at both 50 g and 100 g traction forces. The results indicated that MPC coating inhibited the attachment of oral bacteria, such as Streptococcus mutans, on a stainless steel plate. Additionally, the coating seemed to improve the efficiency of tooth movement by reducing the occurrence of friction. The application of an MPC coating onto stainless steel wires, which are used as orthodontic materials, may reduce static friction and bacterial adherence to the oral cavity and improve tooth movement.

Anodized Aluminum Surface with Topography-Mediated Antibacterial Properties

Topography-mediated antibacterial surfaces that inactivate bacteria by physical contact have gained attention in recent years. Contrary to conventional antibacterial coatings, topography-mediated antibacterial surfaces do not suffer from coating instability and possible toxicity problems. In this study, a one-step hard anodization process has been deployed to fabricate a topography-mediated antibacterial aluminum surface. By optimizing anodization parameters, such as the concentration of the electrolyte, current density, and anodization time, desirable features of micronanoscale morphology were achieved. The optimum conditions of anodized aluminum that provided pores of a diameter of 151 ± 37 nm effectively killed 100% of E. coli bacteria.

Antimicrobial Properties of the Triclosan-Loaded Polymeric Composite Based on Unsaturated Polyester Resin: Synthesis, Characterization and Activity

The manufacturing of sanitary and household furniture on a large scale with inherently antimicrobial properties is an essential field of research. This work focuses on the synthesis of polymer composites based on the unsaturated polyester of resin loaded with 5 wt.%-Triclosan produced by a co-mixing approach on automated technological complex with a potential for broad applications. According to findings, the polymer composite has a non-porous structure (surface area < 1.97 m2/g) suitable for sanitary applications to reduce the growth of bacteria. The chemical composition confirmed the presence of major elements, and the inclusion of Triclosan was quantitatively confirmed by the appearance of chlorine on XRF (1.67 wt.%) and EDS (1.62 wt.%) analysis. Thermal analysis showed the difference of 5 wt.% in weight loss, which confirms the loading of Triclosan into the polymer matrix. The polymer composite completely inhibited the strains of S. aureus 6538-P, S. aureus 39, S. epidermidis 12228, and Kl. Pneumoniae 10031 after 5-min contact time. The antimicrobial effects against Kl. pneumoniae 700603, Ps. aeruginosa 9027 and Ps. aeruginosa TA2 strains were 92.7%, 85.8% and 18.4%, respectively. The inhibition activity against C. albicans 10231 and C. albicans 2091 was 1.6% and 82.4%, respectively; while the clinical strain of C. albicans was inhibited by 92.2%. The polymer composite loaded with 5 wt.%-Triclosan displayed a stability over the period that illustrates the possibility of washing the composite surface.

Combining microscopy assays of bacteria-surface interactions to better evaluate antimicrobial polymer coatings

Validation of the antimicrobial performance of contact-killing polymer surfaces through experimental determination of bacterial adhesion or viability is essential for their targeted development and application. However, there is not yet a consensus on a single most appropriate evaluation method or procedure. Combining and benchmarking previously reported assays could reduce the significant variation and misinterpretation of efficacy data obtained from different methods. In this work, we systematically investigated the response of bacteria cells to anti-adhesive and antiseptic polymer coatings by combining (i) bulk solution-based, (ii) thin-film spacer-based and (iii) direct contact assays. In addition, we evaluated the studied assays using a five-point scoring framework that highlights key areas for improvement. Our data suggest that combined microscopy assays provide a more comprehensive representation of antimicrobial performance, thereby helping to identify effective types of antibacterial polymer coatings. Importance We present and evaluate a combination of methods for validating the efficacy of antimicrobial surfaces. Antimicrobial surfaces/coatings based on contact-killing components can be instrumental to functionalise a wide range of products. However, there is not yet a consensus on a single, most appropriate method to evaluate their performance. By combining three microscopy methods, we were able to discern contact killing effects at the single cell level that were not detectable by conventional bulk microbiological analyses. The developed approach is considered advantageous for the future targeted development of robust and sustainable antimicrobial surfaces.

Facile Route to Effective Antimicrobial Aluminum Oxide Layer Realized by Co-Deposition with Silver Nitrate

The emergence and spreading of the SARS-CoV-2 pandemic has forced the focus of attention on a significant issue: the realization of antimicrobial surfaces for public spaces, which do not require extensive use of disinfectants. Silver represents one of the most used elements in this context, thanks to its excellent biocidal performance. This work describes a simple method for the realization of anodized aluminum layers, whose antimicrobial features are ensured by the co-deposition with silver nitrate. The durability and the chemical resistance of the samples were evaluated by means of several accelerated degradation tests, such as the exposure in a salt spray chamber, the contact with synthetic sweat and the scrub test, highlighting the residual influence of silver in altering the protective behavior of the alumina layers. Furthermore, the ISO 22196:2011 standard was used as the reference protocol to set up an assay to measure the effective antibacterial activity of the alumina-Ag layers against both Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria, even at low concentrations of silver. Finally, the Ag-containing aluminum oxide layers exhibited excellent antimicrobial performances also following the chemical–physical degradation processes, ensuring good durability over time of the antimicrobial surfaces. Overall, this work introduces a simple route for the realization of anodized aluminum surfaces with excellent antibacterial properties.

Impact of surface topography on the bacterial attachment to micro- and nano-patterned polymer films

The development of antimicrobial surfaces has become a high priority in recent times. There are two ongoing worldwide health crises: the COVID-19 pandemic provoked by the SARS-CoV-2 virus and the antibiotic-resistant diseases provoked by bacteria resistant to antibiotic-based treatments. The need for antimicrobial surfaces against bacteria and virus is a common factor to both crises. Most extended strategies to prevent bacterial associated infections rely on chemical based-approaches based on surface coatings or biocide encapsulated agents that release chemical agents. A critical limitation of these chemistry-based strategies is their limited effectiveness in time while grows the concerns about the long-term toxicity on human beings and environment pollution. An alternative strategy to prevent bacterial attachment consists in the introduction of physical modification to the surface. Pursuing this chemistry-independent strategy, we present a fabrication process of surface topographies [one-level (micro, nano) and hierarchical (micro+nano) structures] in polypropylene (PP) substrates and discuss how wettability, topography and patterns size influence on its antibacterial properties. Using nanoimprint lithography as patterning technique, we report as best results 82 and 86% reduction in the bacterial attachment of E. coli and S. aureus for hierarchically patterned samples compared to unpatterned reference surfaces. Furthermore, we benchmark the mechanical properties of the patterned PP surfaces against commercially available antimicrobial films and provide evidence for the patterned PP films to be suitable candidates for use as antibacterial functional surfaces in a hospital environment.

Evaluation of the time-dependent efficacy of commercial denture or orthodontic appliance cleansers: An in vitro study

The aim of this study was to evaluate the antimicrobial, stain and protein removal efficacy of denture or orthodontic appliance cleansers using in vitro test methods. Experimental cleansers were applied for experimental time in each evaluation method. To evaluate the microorganism removal efficacy, C. albicans and S. mutans removal rate was calculated from the specimen surface. Stain and protein removal rate was calculated using the spectrophotometer. Experimental cleansers significantly affected the microorganism removal rate for both C. albicans and S. mutans, as well as the stain and protein removal rates, at each experimental time (p<0.05). As the application time increased, the stain and protein removal rates of all experimental cleansers significantly increased (p<0.05). The present study provided in vitro evaluation methods to assess the efficacy of denture or orthodontic appliance cleansers. Also, manufacturers and researchers can predict clinical outcomes and ensure proper hygiene management of dentures or orthodontic appliances.

Antimicrobial Activity of a Novel Cu(NO3)2-Containing Sol-Gel Surface under Different Testing Conditions

In this study, assessment of the antimicrobial activity of a novel, plasma-cured 2.5% (w/v) Cu(NO₃)₂-containing sol–gel surface was performed. In contrast to state-of-the-art sol–gel coatings, the plasma curing led to a gradient in cross-linking with the highest values at the top of the coating. As a result, the coating behaved simultaneously hard, scratch-resistant, and tough, the latter due to the more flexible bulk of the coating toward the substrate. Further, the diffusion and permeation through the coating also increased toward the substrate. In our study, tests according to ISO 22196 showed antibacterial activity of the 2.5% (w/v) Cu(NO₃)₂-containing sol–gel surface against all bacterial strains tested, and we expanded the testing further using a “dry” evaluation without an aqueous contact phase, which confirmed the antimicrobial efficacy of the 2.5% (w/v) Cu(NO₃)₂-containing sol–gel surface. However, further investigation under exposure to soiling with the addition of 0.3% albumin, used to simulate organic load, led to a significant impairment in the antibacterial effect under both tested conditions. Furthermore, re-testing of the surface after disinfection with 70% ethanol led to a total loss of antibacterial activity. Our results showed that besides the mere application of an antimicrobial agent to a surface coating, it is also necessary to consider the future use of these surfaces in the experimental phase combining industry and science. Therefore, a number of tests corresponding to the utilization of the surface should be obligative on the basis of this assessment.

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.

Antiviral nanoparticles for sanitizing surfaces: A roadmap to self-sterilizing against COVID-19

Nanoparticles provide new opportunities in merging therapeutics and new materials, with current research efforts just beginning to scratch the surface of their diverse benefits and potential applications. One such application, the use of inorganic nanoparticles in antiseptic coatings to prevent pathogen transmission and infection, has seen promising developments. Notably, the high reactive surface area to volume ratio and unique chemical properties of metal-based nanoparticles enables their potent inactivation of viruses. Nanoparticles exert their virucidal action through mechanisms including inhibition of virus-cell receptor binding, reactive oxygen species oxidation and destructive displacement bonding with key viral structures. The prevention of viral outbreaks is one of the foremost challenges to medical science today, emphasizing the importance of research efforts to develop nanoparticles for preventative antiviral applications. In this review, the use of nanoparticles to inactivate other viruses, such as influenza, HIV-1, or norovirus, among others, will be discussed to extrapolate broad-spectrum antiviral mechanisms that could also inhibit SARS-CoV-2 pathogenesis. This review analyzes the published literature to highlight the current state of knowledge regarding the efficacy of metal-based nanoparticles and other antiviral materials for biomedical, sterile polymer, and surface coating applications.

Controlled release, antimicrobial activity, and oral mucosa irritation of cetylpyridinium chloride-montmorillonite incorporated in a tissue conditioner

This study examined the controlled release of cetylpyridinium chloride (CPC) from a tissue conditioner (TC) containing CPC-montmorillonite (CPC-Mont), the associated antimicrobial activity, and oral mucosa irritation. The CPC release test was performed daily for 28 days in three test solutions: distilled water, 0.2 M NaCl, and 0.2 M HCl. The antimicrobial activities for 7, 14, 21, and 28 days against Candida albicans, Staphylococcus aureus, and Streptococcus mutans were assessed according to the JIS Z 2801/ISO 22196 standard. An oral mucosa irritation test was conducted using cheek pouches in five male hamsters according to the ISO 10993-10:2010 standard. The amount of CPC released each day and the cumulative amount released over 28 days (6.12 mg) were less than the daily safe maximum of sore throat medicines (8 mg). Additionally, TC with CPC-Mont could sustain antimicrobial activity against adherent bacteria for 14 days and has no oral mucosa irritation potential.

How Do We Determine the Efficacy of an Antibacterial Surface? A Review of Standardised Antibacterial Material Testing Methods

Materials that confer antimicrobial activity, be that by innate property, leaching of biocides or design features (e.g., non-adhesive materials) continue to gain popularity to combat the increasing and varied threats from microorganisms, e.g., replacing inert surfaces in hospitals with copper. To understand how efficacious these materials are at controlling microorganisms, data is usually collected via a standardised test method. However, standardised test methods vary, and often the characteristics and methodological choices can make it difficult to infer that any perceived antimicrobial activity demonstrated in the laboratory can be confidently assumed to an end-use setting. This review provides a critical analysis of standardised methodology used in academia and industry, and demonstrates how many key methodological choices (e.g., temperature, humidity/moisture, airflow, surface topography) may impact efficacy assessment, highlighting the need to carefully consider intended antimicrobial end-use of any product.

Surface Minimal Bactericidal Concentration: A comparative study of active glasses functionalized with different-sized silver nanoparticles

In this work the quantification of antimicrobial properties of differently sized AgNPs immobilized on a surface was studied. Three different sizes of spheroidal AgNPs with a diameter of (6, 30 and 52) nm were synthetized and characterized with UV-vis, SEM, TEM and ICP-MS. The MIC (Minimal Inhibitory Concentration) and MBC (Minimal Bactericidal Concentration) against Escherichia coli were investigated. Then, the antibacterial efficacy (R) of amino-silanized glasses coated with different amounts of the three sizes of AgNPs were quantified by international standard ISO 22196 adapted protocol against E. coli, clarifying the relationship between size and antibacterial properties of immobilized AgNPs on a surface. The total amount of silver present on glasses with an R ∼ 6 for each AgNPs size was quantified with ICP-MS and this was considered the Surface MBC (SMBC), which were found to be (0.023, 0.026 and 0.034) μg/cm² for (6, 30 and 52) nm AgNPs, respectively. Thus, this study demonstrates that active surfaces with a bactericidal effect at least ≥ 99.9999 % could be obtained using an amount of silver almost 100 times lower than the MBC found for colloidal AgNPs. The immobilization reduces the aggregation phenomena normally occuring in liquid media, maximizing the exposed specific superficial area of the AgNPs and their direct contact with bacterial cells. Starting from this glass model system, our work could broaden the way to the development of a wide range of antibacterial materials with very low amount of silver that can be safely applied in biomedical and food packaging fields.

Antibacterial activity testing methods for hydrophobic patterned surfaces

One strategy to decrease the incidence of hospital-acquired infections is to avoid the survival of pathogens in the environment by the development of surfaces with antimicrobial activity. To study the antibacterial behaviour of active surfaces, different approaches have been developed of which ISO 22916 is the standard. To assess the performance of different testing methodologies to analyse the antibacterial activity of hydrophobic surface patterned plastics as part of a Horizon 2020 European research project. Four different testing methods were used to study the antibacterial activity of a patterned film, including the ISO 22916 standard, the immersion method, the touch-transfer inoculation method, and the swab inoculation method, this latter developed specifically for this project. The non-realistic test conditions of the ISO 22916 standard showed this method to be non-appropriate in the study of hydrophobic patterned surfaces. The immersion method also showed no differences between patterned films and smooth controls due to the lack of attachment of testing bacteria on both surfaces. The antibacterial activity of films could be demonstrated by the touch-transfer and the swab inoculation methods, that more precisely mimicked the way of high-touch surfaces contamination, and showed to be the best methodologies to test the antibacterial activity of patterned hydrophobic surfaces. A new ISO standard would be desirable as the reference method to study the antibacterial behaviour of patterned surfaces.

An ex vivo model of medical device-mediated bacterial skin translocation

The skin is a barrier and part of the immune system that protects us from harmful bacteria. Because indwelling medical devices break this barrier, they greatly increase the risk of infection by microbial pathogens. To study how these infections can be prevented through improved clinical practices and medical device technology, it is important to have preclinical models that replicate the early stages of microbial contamination, ingress, and colonization leading up to infection. At present, there are no preclinical ex vivo models specifically developed to simulate conditions for indwelling medical devices. Translocation of pathogens from outside the body across broken skin to normally sterile internal compartments is a rate-limiting step in infectious pathogenesis. In this work, we report a sensitive and reproducible ex vivo porcine skin-catheter model to test how long antimicrobial interventions can delay translocation. Skin preparation was first optimized to minimize tissue damage. The presence of skin dramatically decreased bacterial migration time across the polyurethane catheter interface from > 96 h to 12 h. Using visual colony detection, fluorescence, a luminescent in vitro imaging system, and confocal microscopy, the model was used to quantify time-dependent differences in translocation for eluting and non-eluting antimicrobial catheters. The results show the importance of including tissue in preclinical biofilm models and help to explain current gaps between in vitro testing and clinical outcomes for antimicrobial devices.

Litsea cubeba fruit essential oil and its major constituent citral as volatile agents in an antimicrobial packaging material

Food packaging films were coated with polyvinyl acetate (PVA) containing different concentrations of citral or Litsea (L.) cubeba essential oil (EO). Antimicrobial contact trials in style of ISO22916 were performed. Citral coatings achieved bactericidal effects against Escherichia coli (2.1 log) and Staphylococcus aureus (4.3 log) at concentrations of 20%_DM. L. cubeba inactivated more than 4 log cycles of both bacteria at a concentration of 20%_DM. To determine the antimicrobial activity across the gas phase, a unique method for volatile agents was developed, adapting ISO22196. GC/MS measurements were performed to supplement microbiological tests in a model packaging system with a defined 220 ml headspace (HS). HS-equilibrium concentrations of 1.8 μg/ml_Air were found for 20%_{DM '}citral-coatings, resulting in antimicrobial effects of 3.8 log against of E. coli. Saccharomyces cerevisiae (4.74 log) and Aspergillus niger (4.29 log) were more effectively inactivated by 3%_DM and 5%_DM coatings. In an application trial with strawberries, simulating a headspace packaging, growth inhibitory effects on the yeast and mold microbiota were found for the 20%_DM coatings.

MBEC Versus MBIC: the Lack of Differentiation between Biofilm Reducing and Inhibitory Effects as a Current Problem in Biofilm Methodology

Background

Biofilms are communities of aggregated, matrix-embedded microbial cells showing a high tolerance to an in principle adequate antibiotic therapy, often resulting in treatment failure. A major challenge in the management of biofilm-associated infections is the development of adequate, standardized biofilm susceptibility testing assays that are clinically meaningful, i.e. that their results correlate with treatment outcome. Different biofilm susceptibility endpoint parameters like the minimal biofilm eradication concentration (MBEC) or the minimal biofilm inhibitory concentration (MBIC) have been suggested as a guide for treatment of biofilm-associated infections, however with inconsistent perception and use among biofilm researchers, leading to confusion and contradictions among different anti-biofilm component studies and clinical trials.

Findings

Evaluation of anti-biofilm effects is mostly based on the untreated reference growth control biofilm measured at the same endpoint as the treated biofilm, neglecting the possible change of the untreated reference biofilm from the time point of pre-antimicrobial exposure to the measured endpoint. In this commentary, we point out the importance of individual quantification of mature, established biofilms before antimicrobial treatment for each biofilm model in order to draw conclusions on the measured biofilm effect size, i.e. biofilm reducing (MBEC) or biofilm inhibitory (MBIC) effects.

Conclusion

The assessment of pre-treatment biofilms contributes to a standardized use of biofilm susceptibility endpoint parameters, which is urgently needed to improve the clinical validity of future anti-biofilm assays.