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Schneider G, Vieira LG, de Carvalho HEF, de Sousa ÁFL, Watanabe E, de Andrade D, Silveira RCDCP. Textiles impregnated with antimicrobial substances in healthcare services: systematic review. Front Public Health 2023; 11:1130829. [PMID: 37250068 PMCID: PMC10213888 DOI: 10.3389/fpubh.2023.1130829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background Antimicrobial textiles have proved to be a promising biosafety strategy. Thus, the current study was focused on identifying which antimicrobial substances impregnated in textiles used in healthcare services confer efficacy in reducing the microbial load present in these textiles and/or the Healthcare-Associated Infection (HAI) rates, when compared to conventional textiles. Methods A systematic review of intervention studies using MEDLINE via the PubMed portal, EMBASE, CINAHL, Web of Science, Scopus, Google Scholar and medRxiv. The studies identified were selected according to eligibility criteria and submitted to data extraction and methodological quality evaluation through Joanna Briggs Institute specific tools. The outcomes were synthesized qualitatively. Results 23 studies were selected to comprise the final sample, in which antimicrobial textiles were used by hospitalized patients, by health professionals during work shifts and in inanimate healthcare environments. Conclusions Copper, silver, zinc oxide, titanium and silver-doped titanium impregnated in textiles used by patients confer efficacy in reducing the microbial load of these textiles and/or the HAI rates. Quaternary ammonium, chlorhexidine, silver and copper together, quaternary ammonium, alcohols and isothiazolone derivatives together, chitosan and dimethylol dimethyl hydantoin together, all impregnated in textiles used by health professionals confer efficacy in reducing the microbial load of these textiles. Quaternary ammonium impregnated in textiles used in inanimate healthcare environments confers efficacy in reducing the microbial load of these textiles.
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Affiliation(s)
- Guilherme Schneider
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | - Álvaro Francisco Lopes de Sousa
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, New University of Lisbon, Lisbon, Portugal
- Institute of Education and Research, Hospital Sírio Libanês, São Paulo, Brazil
| | - Evandro Watanabe
- School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Denise de Andrade
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
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Schneider G, Bim FL, Sousa ÁFLD, Watanabe E, Andrade DD, Fronteira I. The use of antimicrobial-impregnated fabrics in health services: an integrative review. Rev Lat Am Enfermagem 2021; 29:e3416. [PMID: 33852687 PMCID: PMC8040786 DOI: 10.1590/1518-8345.4668.3416] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/19/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: to analyze evidence concerning the feasibility of antimicrobial-impregnated fabrics in preventing and controlling microbial transmission in health services. Method: an integrative review using the following databases: MEDLINE (via PubMed), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Latin American and Caribbean Health Sciences Literature (LILACS), regardless of language and date of publication. Seven studies were included in the analysis to verify the types of fabrics and substances used to impregnate the fabrics, applicability in health services, and decrease in microbial load. Results: silver nanoparticles and copper oxide are the main antimicrobial substances used to impregnate the fabrics. The patients’ use of these fabrics, such as in bed and bath linens and clothing, was more effective in reducing antimicrobial load than in health workers’ uniforms. Conclusion: the use of these antimicrobial-impregnated textiles, especially by patients, is a viable alternative to prevent and control microbial transmission in health services. Implementing these fabrics in health workers’ uniforms requires further studies, however, to verify its effectiveness in decreasing microbial load in clinical practice.
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Affiliation(s)
- Guilherme Schneider
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Felipe Lazarini Bim
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Álvaro Francisco Lopes de Sousa
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Lisboa, Portugal.,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Evandro Watanabe
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Denise de Andrade
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Inês Fronteira
- Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Lisboa, Portugal
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Prehospital infection control and prevention in Denmark: a cross-sectional study on guideline adherence and microbial contamination of surfaces. Scand J Trauma Resusc Emerg Med 2018; 26:71. [PMID: 30185205 PMCID: PMC6126008 DOI: 10.1186/s13049-018-0541-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022] Open
Abstract
Background Prehospital acute care and treatment have become more complex, and while invasive procedures are standard procedures, focus on infection control and prevention is scarce. We aimed to evaluate guideline adherence, microbial contamination, and associated risk factors. Methods In a nationwide cross-sectional study, we evaluated guideline adherence to thorough cleaning (TC) once a day, and moderate cleaning (MC) in-between patient courses. Microbial contamination on hand-touch sites (HTS) and provider-related sites (PRS) was assessed by total aerobic colony forming units (CFU) and presence of selected pathogens, using swab and agar imprints. Also, microbial contamination was assessed in relation to potential risk factors. Results 80 ambulances and emergency medical service (EMS) providers were enrolled. Adherence to guidelines regarding TC was 35%, but regarding MC it was 100%. In total, 129 (27%) of 480 HTS presented a total CFU > 2.5/cm2 and/or pathogenic growth, indicating hygiene failures. The prevalence of selected pathogens on HTS was: S. aureus 7%; Enterococcus 3% and Enterobacteriaceae 1%. Total CFU on the PRS ranged from 0 to 250/cm2, and the prevalence of pathogens was 18% (S. aureus 15%, Enterococcus 3% and Enterobacteriaceae 0.3%). Methicillin-resistant S. aureus was found in one sample, and Vancomycin-resistant Enterococcus in two. No Enterobacteriaceae with extended-spectrum beta-lactamases were recorded. Conclusion Guideline adherence was suboptimal, and many HTS did not comply fully with proposed standards for cleanliness. Pathogens were demonstrated on both HTS and PRS, indicating that the EMS may be a source of infection in hospitalized patients. Moreover, cleaning effort and time appears associated with microbial contamination, but a comprehensive investigation of risk factors is needed.
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Heudorf U, Gasteyer S, Müller M, Serra N, Westphal T, Reinheimer C, Kempf V. Handling of laundry in nursing homes in Frankfurt am Main, Germany, 2016 - laundry and professional clothing as potential pathways of bacterial transfer. GMS HYGIENE AND INFECTION CONTROL 2017; 12:Doc20. [PMID: 29238652 PMCID: PMC5715555 DOI: 10.3205/dgkh000305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: In accordance with the German Infection Protection Act, the treatment and handling of laundry was checked by the Public Health Department in 2016 in all Frankfurt nursing homes with special focus on the staff's clothing. Methods: On-site visits and surveys were conducted in all 44 nursing homes in Frankfurt/Main, Germany, and random microbiological examinations of 58 reprocessed and 58 already worn protective gowns were performed to determine the numbers of the colony forming units (cfu) and microbiological differentiation of the pathogen species. Results: 41 (93%) of the 44 homes tested had contracted a certified laundry service. 23 (52%) of the homes also ran a laundry of their own; in 21 of these, laundry was reprocessed and disinfected in an industrial washing machine. Regular technical or microbiological tests were carried out in 16 or 12 of the home-owned laundries, respectively. Only 31 homes (70%) provided uniforms for their employees. The staff's clothing was processed in 25 homes by the external laundry, in 9 homes by the internal laundry, and in 12 homes, the nursing staff had to do this privately at their own home. Used coats exhibited significantly higher contamination than freshly prepared ones (median: 80 vs. 2 cfu/25 cm2; P 95 percentile: 256 cfu vs. 81 cfu/25 cm2). Clothing prepared in private homes showed significantly higher contamination rates than those washed in the certified external laundry or in the nursing homes themselves (Median: 16 cfu/25 cm2 vs. 0.5-1 cfu/25 cm2). Conclusion: Considering various publications on pathogen transfers and outbreaks due to contaminated laundry in medical facilities, the treatment of laundry, in particular the uniforms, must be given more attention, also in nursing homes for the elderly. The private reprocessing of occupational clothing by the employees at home must be rejected on hygienic principles, and is furthermore prohibited by law in Germany.
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Affiliation(s)
- Ursel Heudorf
- Public Health Department of the City of Frankfurt/Main, Germany
| | | | - Maria Müller
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Nicole Serra
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Tim Westphal
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Claudia Reinheimer
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Volkhard Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany
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Mitchell A, Spencer M, Edmiston C. Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of the literature. J Hosp Infect 2015; 90:285-92. [PMID: 25935701 PMCID: PMC7132459 DOI: 10.1016/j.jhin.2015.02.017] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/25/2015] [Indexed: 11/13/2022]
Abstract
Healthcare workers (HCWs) wear uniforms, such as scrubs and lab coats, for several reasons: (1) to identify themselves as hospital personnel to their patients and employers; (2) to display professionalism; and (3) to provide barrier protection for street clothes from unexpected exposures during the work shift. A growing body of evidence suggests that HCWs' apparel is often contaminated with micro-organisms or pathogens that can cause infections or illnesses. While the majority of scrubs and lab coats are still made of the same traditional textiles used to make street clothes, new evidence suggests that current innovative textiles function as an engineering control, minimizing the acquisition, retention and transmission of infectious pathogens by reducing the levels of bioburden and microbial sustainability. This paper summarizes recent literature on the role of apparel worn in healthcare settings in the acquisition and transmission of healthcare-associated pathogens. It proposes solutions or technological interventions that can reduce the risk of transmission of micro-organisms that are associated with the healthcare environment. Healthcare apparel is the emerging frontier in epidemiologically important environmental surfaces.
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Affiliation(s)
- A Mitchell
- International Safety Center, The Public's Health, Apopka, FL, USA.
| | - M Spencer
- Infection Preventionist Consultants, Boston, MA, USA
| | - C Edmiston
- Department of Surgery, Surgical Microbiology and Hospital Epidemiology Research Laboratory, Medical College of Wisconsin, Milwaukee, WI, USA
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Borkow G, Monk A. Fighting nosocomial infections with biocidal non-intrusive hard and soft surfaces. World J Clin Infect Dis 2012; 2:77-90. [DOI: 10.5495/wjcid.v2.i4.77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Approximately 7 million people worldwide acquire a healthcare associated infection each year. Despite aggressive monitoring, hand washing campaigns and other infection control measures, nosocomial infections (NI) rates, especially those caused by antibiotic resistant pathogens, are unacceptably high worldwide. Additional ways to fight these infections need to be developed. A potential overlooked and neglected source of nosocomial pathogens are those found in non-intrusive soft and hard surfaces located in clinical settings. Soft surfaces, such as patient pyjamas and beddings, can be an excellent substrate for bacterial and fungal growth under appropriate temperature and humidity conditions as those present between patients and the bed. Bed making in hospitals releases large quantities of microorganisms into the air, which contaminate the immediate and non-immediate surroundings. Microbes can survive on hard surfaces, such as metal trays, bed rails and door knobs, for very prolonged periods of time. Thus soft and hard surfaces that are in direct or indirect contact with the patients can serve as a source of nosocomial pathogens. Recently it has been demonstrated that copper surfaces and copper oxide containing textiles have potent intrinsic biocidal properties. This manuscript reviews the recent laboratory and clinical studies, which demonstrate that biocidal surfaces made of copper or containing copper can reduce the microbiological burden and the NI rates.
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