Current and emergent strategies for disinfection of hospital environments

Abreu, Ana Cristina; Tavares, Rafaela R.; Borges, Anabela; Mergulhão, Filipe; Simões, Manuel

doi:10.1093/jac/dkt281

Cited by 152 publications

(118 citation statements)

References 135 publications

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“…icrobial contamination on surfaces is a recurring problem within health, pharmaceutical, and food industry sectors (1,2,3). Thus, decontamination is a crucial step to ensure the sterility of food processing equipment, minimize spread of pathogens, and prevent the transmission of nosocomial infections (4).…”

mentioning

confidence: 99%

Improvement of Biological Indicators by Uniformly Distributing Bacillus subtilis Spores in Monolayers To Evaluate Enhanced Spore Decontamination Technologies

Raguse

Fiebrandt

Stapelmann

et al. 2016

Appl Environ Microbiol

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f Novel decontamination technologies, including cold low-pressure plasma and blue light (400 nm), are promising alternatives to conventional surface decontamination methods. However, the standardization of the assessment of such sterilization processes remains to be accomplished. Bacterial endospores of the genera Bacillus and Geobacillus are frequently used as biological indicators (BIs) of sterility. Ensuring standardized and reproducible BIs for reliable testing procedures is a significant problem in industrial settings. In this study, an electrically driven spray deposition device was developed, allowing fast, reproducible, and homogeneous preparation of Bacillus subtilis 168 spore monolayers on glass surfaces. A detailed description of the structural design as well as the operating principle of the spraying device is given. The reproducible formation of spore monolayers of up to 5 ؋ 10 7 spores per sample was verified by scanning electron microscopy. Surface inactivation studies revealed that monolayered spores were inactivated by UV-C (254 nm), low-pressure argon plasma (500 W, 10 Pa, 100 standard cubic cm per min), and blue light (400 nm) significantly faster than multilayered spores were. We have thus succeeded in the uniform preparation of reproducible, highly concentrated spore monolayers with the potential to generate BIs for a variety of nonpenetrating surface decontamination techniques. Microbial contamination on surfaces is a recurring problem within health, pharmaceutical, and food industry sectors (1, 2, 3). Thus, decontamination is a crucial step to ensure the sterility of food processing equipment, minimize spread of pathogens, and prevent the transmission of nosocomial infections (4). Common decontamination and disinfection procedures that are widely used for microbial inactivation include high temperatures, chemicals, or ionizing radiation (reviewed in reference 5). In order to ensure the efficiency and to validate the continuous functionality of a disinfection or sterilization procedure, biological testing standards are required. Bacterial spores are frequently used as a biological indicator (BI) of sterility, primarily because bacterial spores exhibit elevated resistance to chemical and physical methods of sterilization (6-11). Hence, a process that achieves full spore inactivation ensures complete elimination of other contaminating microorganisms.Variations in the performance of a BI have been reported repeatedly (12, 13). Besides variations in the intrinsic resistance properties of the microorganisms conferred, for instance, by variations in genetic traits or alteration of sporulation conditions (14), extrinsic factors also may affect the performance of BIs and, subsequently, the accurate determination of spore resistance and inactivation. For example, the sterilization results may be altered by poor choices of the carrier material for spore deposition (13,15) and, in particular, the BI manufacturing procedure (16). The method by which spores are mounted on carriers also is extremely impo...

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mentioning

confidence: 99%

Improvement of Biological Indicators by Uniformly Distributing Bacillus subtilis Spores in Monolayers To Evaluate Enhanced Spore Decontamination Technologies

Raguse

Fiebrandt

Stapelmann

et al. 2016

Appl Environ Microbiol

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“…(VRE), Acinetobacter baumannii and C. difficile can persist on dry surfaces for up to 4-5 months. 23,36 Patients admitted to rooms previously occupied by VRE or MRSA carriers have a two-to three-fold increased risk of acquisition, and similar rates are seen for A. baumannii, Pseudomonas aeruginosa and, as discussed above, C. difficile. 37,38 Molecular typing of MRO outbreaks has linked the environment, hands of HCW, and patient isolates.…”

Section: Antibiotic Use and Active C Difficile Infectionmentioning

confidence: 82%

“…Bacteria resident in biofilm require up to 1000-fold higher disinfectant concentrations to be eradicated. 23 Protracted outbreaks are well described and when a CPE environmental source is suspected, an intensive search and destroy approach is needed. Occasionally, engineering solutions, including toilet, sink or drain removal are necessary.…”

Section: The Environmental Reservoirmentioning

confidence: 99%

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Healthcare‐acquired infections: prevention strategies

Fernando

Gray

Gottlieb

2017

Internal Medicine Journal

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Healthcare‐acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health‐care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi‐resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence‐based antimicrobial use; infection prevention strategies, to control MRO – particularly methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant Enterococcus spp. (VRE) and, more recently, multi‐resistant Gram‐negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co‐ordination at a national level. HAI prevention needs to be multi‐modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.

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“…Applications include the control of biofouling and microbial contamination in industry (1) as well as clinical antisepsis (2)(3)(4). They are also used extensively in the domestic environment as hygiene adjuncts and preservatives in a range of formulations, including oral care products (5), hand sanitizers (6), and hard-surface cleaners (7).…”

mentioning

confidence: 99%

Variable Effects of Exposure to Formulated Microbicides on Antibiotic Susceptibility in Firmicutes and Proteobacteria

Forbes

Knight

Cowley

et al. 2016

Appl Environ Microbiol

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Microbicides are broad-spectrum antimicrobial agents that generally interact with multiple pharmacological targets. While they are widely deployed in disinfectant, antiseptic, and preservative formulations, data relating to their potential to select for microbicide or antibiotic resistance have been generated mainly by testing the compounds in much simpler aqueous solutions. In the current investigation, antibiotic susceptibility was determined for bacteria that had previously exhibited decreased microbicide susceptibility following repeated exposure to microbicides either in formulation with sequestrants and surfactants or in simple aqueous solution. Statistically significant increases in antibiotic susceptibility occurred for 12% of bacteria after exposure to microbicides in formulation and 20% of bacteria after exposure to microbicides in aqueous solutions, while 22% became significantly less susceptible to the antibiotics, regardless of formulation. Of the combinations of a bacterium and an antibiotic for which British Society for Antimicrobial Chemotherapy breakpoints are available, none became resistant. Linear modeling taking into account phylogeny, microbicide, antibiotic, and formulation identified small but significant effects of formulation that varied depending on the bacterium and microbicide. Adaptation to formulated benzalkonium chloride in particular was more likely to increase antibiotic susceptibility than adaptation to the simple aqueous solution. In conclusion, bacterial adaptation through repeated microbicide exposure was associated with both increases and decreases in antibiotic susceptibility. Formulation of the microbicide to which the bacteria had previously adapted had an identifiable effect on antibiotic susceptibility, but it effect was typically small relative to the differences observed among microbicides. Susceptibility changes resulting in resistance were not observed. IMPORTANCEThe safety of certain microbicide applications has been questioned due to the possibility that microbicide exposure could select for microbicide and antibiotic resistance. Evidence that this may happen is based mainly on in vitro experiments where bacteria have been exposed to microbicides in aqueous solution. Microbicides are, however, normally deployed in products formulated with surfactants, sequestrants, and other compounds. While this may influence the frequency and extent of susceptibility changes, few studies reported in the literature have assessed this. In the current investigation, therefore, we have investigated changes in antibiotic susceptibility in bacteria which exhibited decreased microbicide susceptibility following repeated exposure to microbicides in simple aqueous solutions and in formulation. We report that the microbicide formulation had an identifiable effect on antibiotic susceptibility, but it was typically small relative to the differences observed among microbicides. We did not observe susceptibility changes resulting in resistance.

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Current and emergent strategies for disinfection of hospital environments

Cited by 152 publications

References 135 publications

Improvement of Biological Indicators by Uniformly Distributing Bacillus subtilis Spores in Monolayers To Evaluate Enhanced Spore Decontamination Technologies

Improvement of Biological Indicators by Uniformly Distributing Bacillus subtilis Spores in Monolayers To Evaluate Enhanced Spore Decontamination Technologies

Healthcare‐acquired infections: prevention strategies

Variable Effects of Exposure to Formulated Microbicides on Antibiotic Susceptibility in Firmicutes and Proteobacteria

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