Reducing healthcare-associated infections incidence by a probiotic-based sanitation system: A multicentre, prospective, intervention study

Abstract

Healthcare Associated Infections (HAI) are a global concern, further threatened by the increasing drug resistance of HAI-associated pathogens. On the other hand, persistent contamination of hospital surfaces contributes to HAI transmission, and it is not efficiently controlled by conventional cleaning, which does not prevent recontamination, has a high environmental impact and can favour selection of drug-resistant microbial strains. In the search for effective approaches, an eco-sustainable probiotic-based cleaning system (Probiotic Cleaning Hygiene System, PCHS) was recently shown to stably abate surface pathogens, without selecting antibiotic-resistant species. The aim of this study was to determine whether PCHS application could impact on HAI incidence. A multicentre, pre-post interventional study was performed for 18 months in the Internal Medicine wards of six Italian public hospitals (January 1st 2016—June 30th 2017). The intervention consisted of the substitution of conventional sanitation with PCHS, maintaining unaltered any other procedure influencing HAI control. HAI incidence in the pre and post-intervention period was the main outcome measure. Surface bioburden was also analyzed in parallel. Globally, 11,842 patients and 24,875 environmental samples were surveyed. PCHS was associated with a significant decrease of HAI cumulative incidence from a global 4.8% (284 patients with HAI over 5,930 total patients) to 2.3% (128 patients with HAI over 5,531 total patients) (OR = 0.44, CI 95% 0.35–0.54) (P<0.0001). Concurrently, PCHS was associated with a stable decrease of surface pathogens, compared to conventional sanitation (mean decrease 83%, range 70–96.3%), accompanied by a concurrent up to 2 Log drop of surface microbiota drug-resistance genes (P<0.0001; Pc = 0.008). Our study provides findings which support the impact of a sanitation procedure on HAI incidence, showing that the use of a probiotic-based environmental intervention can be associated with a significant decrease of the risk to contract a HAI during hospitalization. Once confirmed in larger experiences and other target populations, this eco-sustainable approach might be considered as a part of infection control and prevention (IPC) strategies.Trial registration—ISRCTN International Clinical Trials Registry, ISRCTN58986947.

Introduction of NGS in Environmental Surveillance for Healthcare-Associated Infection Control

“…In this regard, we recently showed that abating microbial contamination and its AMR in the hospital environment, using a cleaning procedure, was associated with a significant reduction of HAI incidence [19] suggesting that it could be used as a potential strategy for infection control and prevention.…”

“…Molecular methods based on DNA technologies might overcome such limitations, providing accurate information in real time and helping to characterize in detail the whole microbial population colonizing hospital surfaces. To address this aim, specific PCRs and real-time PCRs have been set up and developed [19,22,24,25]. However, the advent of modern technologies based on DNA sequencing has considerably improved microbiome investigation allowing definition of complex populations in deep detail [26], and could also be employed for environmental surveillance [22].…”

Microbial Exchange via Fomites and Implications for Human Health

“…Unlike antimicrobials that kill microbes, probiotic cleaners that contain spores from Bacillus species (i.e., B. subtilis, B. pumilus, and B. megaterium) are thought to work primarily through biological competition to prevent the survival and proliferation of pathogenic bacteria [97,98]. Probiotic cleaners have been found to be more effective than traditional cleaning methods, with several studies demonstrating that their use decreased pathogen load on surfaces by an average of 90% more than conventional chemical cleaners (ranging from 70 to 99%; [99,100]). Furthermore, Caselli et al (2019) showed that in hospitals where probiotic cleaners were used, the abundance of antibiotic resistance genes on treated surfaces was reduced by up to 99% [101].…”

From one species to another: A review on the interaction between chemistry and microbiology in relation to cleaning in the built environment

“…115,116 However, current literature lacks experimental design detail or rigor; one study did not include any experimental or technical replication and was not able to provide statistical support for reduction claims. 117,118 However, compliance to hospital cleaning procedures is a persistent issue, and it is unclear from the reported study designs whether the probiotic treatment reduced pathogen biomass and hospital acquired infections, or simply the retraining of cleaning staff, though minimal, for use of the probiotic cleaning which caused a re-adherence to cleaning protocols was sufficient to decrease bacterial load. 117,118 However, compliance to hospital cleaning procedures is a persistent issue, and it is unclear from the reported study designs whether the probiotic treatment reduced pathogen biomass and hospital acquired infections, or simply the retraining of cleaning staff, though minimal, for use of the probiotic cleaning which caused a re-adherence to cleaning protocols was sufficient to decrease bacterial load.…”

“…116 This same combination of bacilli showed a significant reduction in CFU/m 2 as well as fewer reported hospital acquired infections during the treatment phase. 117,118 However, compliance to hospital cleaning procedures is a persistent issue, and it is unclear from the reported study designs whether the probiotic treatment reduced pathogen biomass and hospital acquired infections, or simply the retraining of cleaning staff, though minimal, for use of the probiotic cleaning which caused a re-adherence to cleaning protocols was sufficient to decrease bacterial load. 54,[119][120][121] The previous study, which did use replication, also utilized randomized cleaning product treatments to which hospital cleaning staff were blind, and a return to conventional cleaning methods after a probiotic treatment, 115 providing demonstrable promise to the use of PCHS in field trials.…”