Infection Control Today

SEP 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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18 ICT September 2018 www.infectioncontroltoday.com active air sampling (P = 0.04) at higher bed occupancy is also unsurprising. However, there was no association between surface counts and people-traffc, nor between passive air data and people-traffc. This may have been due to the method used for auditing footfall in ICU. People-traffc was measured beside the nurses' station, which is situated away from beds and sampling points. Furthermore, air samples were collected in the morning, which illustrates a major limitation of the study. A previous study in a naturally ventilated ward showed that airborne bioburden fuctuated signifcantly with activity during the day and yielded values that were considerably higher than this study." The researchers suggest that passive air sampling provides quantitative data analogous to that obtained from surfaces. Settle plates could serve as a proxy for routine environmental screening to determine the infection risk in the ICU. Antimicrobial-Driven Surface Modifcations in the Healthcare Environment Adlhart, et al. (2018) conducted a literature review of the impact of antimicrobial-driven surface modifications in the healthcare environment. As the researchers explain, "A state-of-the-art innovation to combat pathogenic bacteria is the creation of self-disinfecting surfaces through the appli- cation of coatings with antibiofouling and/or bactericidal properties. Bactericidal coatings are interesting in healthcare because of the capability of these coatings to kill pathogens upon contact. Many different chemical strategies and technologies for antibacterial coatings are described in the literature. For instance, antibacterial coatings may contain active eluting agents (e.g. ions or nanopar- ticles of silver, copper, zinc, or antibiotics, chloride, iodine), immobilized molecules that become active upon contact (e.g. quaternary ammonium polymers or peptides), or light-activated molecules (e.g. TiO2 or photosensitizers). In addition to chemical modifcations, the topography of a surface can by itself signifcantly affect its hygienic status, either in a benefcial manner (reducing microbial retention) or otherwise (increasing retention). As such, modifcations of surfaces to enhance antimicrobial properties should always take into account the effect of surface wear on subsequent fouling and cleanability. Therefore, efforts should be undertaken to characterize typical wear, assess interactions with the most likely micro-organisms in that environment, and defne the most appropriate and least damaging cleaning and sanitizer regimes. The best way to achieve such outcomes is to ensure that multidisciplinary expertise is integrated into developmental processes, and that testing methods are appropriately robust." The researchers found that chemical modifcations to achieve functional antimi- crobial coatings were classifed according to their functional principle as: anti-adhesive, contact active, and biocide release. The majority of chemical modifcations includes hydrogels or poly(ethylene glycol) (PEG) to repel approaching microbes, metals (in particular, silver and copper), antimicrobial peptides (AMPs), quaternary ammonium compounds (QACs), and nanoparticles. Adlhart, et al. (2018) emphasize that, "…an effective antimicrobial coating must achieve a multitude of characteristics: be able to control the pathogenic population of a surface; be stable (mechanically, tribo- logically and chemically) in the wide range of hospital settings; minimize (eco)toxico- logical hazards and risks of antimicrobial resistance emergence; be affordable and easily implemented. Future technological developments should hence aim at tackling most, if not all, of these points. The ultimate goal of the antimicrobial coating, namely the prevention of thousands of deaths occurring as a direct consequence of HAI in healthcare facilities, cannot be tackled by the coating alone. But a tremendous common effort involving coating technology providers, clinical and cleaning staff as well as the responsible handling of antibiotics – to name merely the clinical and agricultural sectors among many others – is required. Re garding th e a b ilit y to co ntro l th e pathogenic population of a surface, very promising strategies have emerged. One of these is widely known as selective killing, or the ability of antimicrobial surfaces to target only those species that are deemed to cause a risk to patients or hospital staff. Strategies such as the use of quorum sensing at a threshold concentration to release an antimicrobial compound have recently appeared. Others, such as the modulation of the colonization consortia as a whole to inhibit the dominance of pathogens, in a strategy similar to the one used to control the human microbiome, should start appearing as microbial ecological concepts are better deciphered." The researchers issue a caveat: "Depending on their intended use, antimicrobial surfaces will be challenged by a number of factors. For instance, door handles are in intermittent contact with hands, but nonetheless are not expected to be exposed to as much wear as bed linens, that should be washed on a daily basis. Studies on the weariness or robustness of the different materials under different conditions are available, but they require further methodological standardization to allow for a more meaningful interpretation of the results. Overall, the novel strategies that are continuously being developed in the area of nanosurfaces bring some hope to the feld of antimicrobial control, while decreasing microbial resistance to antibiotics and associated infections in clinical settings. It is then crucial to provide suitable standardized assessment tests and a fast transition of these strategies from the lab bench to the market, by conjugating efforts between academia and industry." References: Adlhart C, Verran J, et al. Surface modifcations for antimicrobial effects in the healthcare setting: a critical overview. Journal of Hospital Infection. Vol. 99, No. 3, Pages 239-249. July 2018. Allen M, Hall L, Halton K and Graves N. Improving hospital environmental hygiene with the use of a targeted multi-modal bundle strategy. Infection, Disease & Health. Volume 23, Issue 2, June 2018, Pages 107-113. Doll M, Stevens M and Bearman G. Review: Environmental cleaning and disinfection of patient areas. International Journal of Infectious Diseases. Vol. 67, Pages 52-57. February 2018. Kenters N, T.Gottlieb T, Hopman J, Mehtar S, Schweizer ML, et al. An international survey of cleaning and disinfection practices in the healthcare environment. Journal of Hospital Infection. Article in press, 2018. Pedersen L, Masroor N, Cooper K, Patrick A, Razjouyan F, Doll M, Stevens MP, and Bearman G. Brief Report: Barriers and perceptions of environmental cleaning: An environmental services perspective. American Journal of Infection Control. Online July 3, 2018. Smith J, Adams CF, King MF, Noakes CJ, Robertson C and Dancer SJ. Is there an association between airborne and surface microbes in the critical care environment? Journal of Hospital Infection. Online April 9, 2018. Wille I, Mayr A, Kreidl P, et al. Cross-sectional point prevalence survey to study the environmental contamination of nosocomial pathogens in intensive care units under real-life conditions. Journal of Hospital Infection. Vol. 98, No. 1. Pages 90-95. January 2018. Ò Bactericidal coatings are interesting in healthcare because of the capability of these coatings to kill pathogens upon contact.

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