Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections PDF
Preview Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections
Gadi Borkow Editor Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections Gadi Borkow Editor Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections Editor GadiBorkow CupronInc. Herzelia,Israel ISBN978-3-319-08056-7 ISBN978-3-319-08057-4(eBook) DOI10.1007/978-3-319-08057-4 SpringerChamHeidelbergNewYorkDordrechtLondon LibraryofCongressControlNumber:2014946414 ©SpringerInternationalPublishingSwitzerland2014 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpart of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionor informationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar methodologynowknownorhereafterdeveloped.Exemptedfromthislegalreservationarebriefexcerpts inconnectionwithreviewsorscholarlyanalysisormaterialsuppliedspecificallyforthepurposeofbeing enteredandexecutedonacomputersystem,forexclusiveusebythepurchaserofthework.Duplication ofthispublicationorpartsthereofispermittedonlyundertheprovisionsoftheCopyrightLawofthe Publisher’s location, in its current version, and permission for use must always be obtained from Springer.PermissionsforusemaybeobtainedthroughRightsLinkattheCopyrightClearanceCenter. 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Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Contents 1 Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 GadiBorkow 2 SurvivalofMicroorganismsonInanimateSurfaces. . . . . . . . . . . . . 7 AxelKramerandOjanAssadian 3 TheRoleofContaminatedSurfacesintheTransmission ofNosocomialPathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 JonathanA.Otter,SaberYezli,andGaryL.French 4 RoleoftheMicrobialBurdenintheAcquisitionandControl ofHealthcareAssociatedInfections:TheUtilityofSolidCopper Surfaces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 MichaelG.Schmidt,AndreaL.Banks,andCassandraD.Salgado 5 BiocidalHardandSoftSurfacesContainingCopperOxide ParticlesfortheReductionofHealthcare-AcquiredPathogens. . . . 85 GadiBorkow 6 BiocidalMechanismsofMetallicCopperSurfaces. . . . . . . . . . . . . . 103 ChristopheEsp´ıritoSanto,NadezhdaGerman,JuttaElguindi, GregorGrass,andChristopherRensing 7 AnOverviewoftheOptionsforAntimicrobialHardSurfaces inHospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 JonathanA.Otter 8 EconomicsofUsingBiocidalSurfaces. . . .. . . . . . .. . . . . .. . . . . .. 167 PanosA.Efstathiou 9 AlternativeRoomDisinfectionModalities–ProsandCons. . . . . . . 187 GeorgeByrns Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 v Chapter 1 Preface GadiBorkow Contents References......................................................................................... 4 Healthcare-acquired infections (HAI) have become a very significant medical concernbothindevelopedandindevelopingcountries,especiallyasmicroorgan- isms have developed high resistance to the existent antibiotics arsenal. While no exactnumbersexist,itisassessedthatmillionsofpeopleworldwideacquireaHAI each year. These infections contribute significantly to morbidity, mortality and hospitalization costs. For example, in the United States alone, it was estimated that ~2 million HAI occur each year by all types of microorganisms, causing or contributing to ~100,000 deaths and adding ~$10 billion in additional healthcare expensesannually[1–3]. InordertoreduceHAIrates,themedicalcommunityhasdevelopedaggressive measures – such as use of disposable equipment, healthcare staff education for improved hygiene, increased number of nurses and infection control personnel, isolationofinfectedpatients,betterventilationmanagement,useofhigh-efficiency particulate air filters, improved disinfection regimens, and use of aggressive anti- biotic control programs. Indeed, all these measures have resulted in significantly lowerHAIrates;however,eveninhospitalswheretheseinfectioncontrolmeasures arerigorouslyimplemented,theHAIratesarestillunacceptablyhigh,anditisclear that the current modalities to eliminate HAIs are not sufficient. The risk of an individual to acquire an infection while in the hospital is still intolerable and additionalwaystofightHAIneedtobedeveloped(Fig.1.1). There is increasing evidence that potentially overlooked and neglected sources of nosocomial pathogens that significantly contribute to HAI are contaminated non-intrusive soft and hard surfaces located in the clinical surroundings, and that G.Borkow,Ph.D.(*) CupronInc.,Hasadnaot10,46733Herzelia,Israel e-mail:[email protected] G.Borkow(ed.),UseofBiocidalSurfacesforReductionofHealthcare 1 AcquiredInfections,DOI10.1007/978-3-319-08057-4_1, ©SpringerInternationalPublishingSwitzerland2014 2 G.Borkow Current Rigorously Implemented Measures to Reduce HAI Rates (cid:129) Hand washing before and after every contact with a patient or object HAI (cid:129) Isolation of infected patients Rates (cid:129) Use disposable and personal protective equipment (cid:129) Use of HEPA filters and better ventilation management (cid:129) Improved disinfection regimens (cid:129) Improved hospital cleaning (cid:129) Increased personnel per patient (cid:129) Increase in infection control personnel (cid:129) Aggressive antibiotic control programs Overlooked and neglected - bio-control of the inanimate environment Years Fig.1.1 HAIarenoteliminatedbythecurrentimplementedmeasures thereisaclearcorrelationbetweentheenvironmentalbioburdenpresentinaclinical setting and the risk of patient of acquiring an infection [4–14]. Thus using self- disinfectingsurfacescanbeaveryimportantadjunctinthefightagainstHAI[15,16]. Copperisanessentialtraceelementneededforthenormalfunctionofallaerobic lifeforms.Itsabilitytocyclebetweentwooxidationstates,Cu1+andCu2+,iskey to a wide array of metalloenzymes that catalyze electron transfer reactions. Conversely,coppercanbehighlytoxicdueinparttoitsabilitytogeneratereactive oxygen species. Thus microorganisms have developed a complex series of mech- anismstoregulatecopperintracellularaccumulationanddistribution[17,18].How- ever, above a certain threshold of exposure to copper, which varies between microorganisms, the microorganisms are killed, sometimes within minutes (e.g.[19–21]),viadifferentmultisiteparallelmechanisms[22]. TheancientGreeksinthetimeofHippocrates(400BC)werethefirsttodiscover thesanitizingpowerofcopper.Theyprescribedcopperforpulmonarydiseasesand for purifying drinking water. Since then copper has been used as a biocide for treatingsoresandskindiseasesandforpurifyingwaterbymanycivilizations,such as the Celts, Phoenicians, Egyptians, Hindus, and Aztecs [23]. By the eighteenth century copper had come into wide clinical use in the Western world for the treatment of mental disorders and afflictions of the lungs. Furthermore, in the eighteenth century it was discovered that no fungi grew on seed grains soaked in coppersulphate.Beginningintheearly1950s[e.g.[24–26]],thebiocidalproperties of copper and copper compounds were demonstrated in controlled laboratory studies. Notably, copper surfaces or copper compounds have been shown to be efficaciousagainsthard-to-killspores[27–33]. Todaycopperbiocideshavebecomeindispensableandmanythousandsoftons areusedannuallyallovertheworldfor(i)preventionofroofmossformation[34]; 1 Preface 3 (ii) wood preservation [35]; (iii) control of green slime in farm ponds, rice fields, irrigation and drainage canals, rivers, lakes and swimming pools [36]; (iv)preventionofdownymildewongrapes[37];and(v)antifoulingpaints[38–40]. Non-soluble copper compounds, such as degradable phosphate glass fibres impregnated with CuO [41, 42], glass coated with thin films of CuO [43], or metallic and copper alloys [20, 32, 44–50] also exert potent biocidal properties, including against hard-to-kill spores [27–33]. Importantly, in March 2008 the U.S. Environmental Protection Agency (EPA) has approved the registration of copperalloysasmaterialswithantimicrobialproperties,thusallowingtheCopper DevelopmentAssociation(CDA)tomakepublichealthclaims[51].Morerecently, Cupron Inc. received similar approvals by the EPA to make public health claims withitscopperoxideinfusedcountertops.Thesepublichealthclaimsacknowledge that alloys containing above 60 % copper and surfaces impregnated with 16 % copper oxide particlesare capable ofkilling more than 99.9 % of harmful, poten- tially deadly bacteria, such as Methicillin-resistant S. aureus (MRSA) within 2 h, andcontinuetokillmorethan99%ofbacteriaevenafterrepeatedcontamination. CopperistheonlymetalthathasreceivedthistypeofEPAregistrations. This book discusses the role of the environment as a potential source for out- breaksofHAIandfocusesontheutilityofsolidcoppersurfacesandcopperoxide impregnated materials in reducing bioburden and fighting HAI. It also reviews otherbiocidalsurfacealternativesandtheeconomicsofusingbiocidalsurfacesina hospitalenvironment.Finally,itdiscussestheprosandconsofexistentdisinfection modalitiesotherthanbiocidalsurfaces. More specifically, in Chap. 2 of this book, Axel Kramer and Ojan Assadian, discuss the ability of pathogenic bacteria, fungi and viruses to persist and survive for long-term periods on inanimate surfaces. They discuss the factors influencing the survival of these pathogens in the environment and the mechanisms by which pathogensaretransmittedfromtheseinanimatesurfacestosusceptiblepatients. InChap.3,JonOtter,SaberYezliandGaryL.Frenchprovideproofthatsurface contaminationbynosocomialpathogensshedbypatientscontributestonosocomial cross-transmission and HAI. They review evidence that improved environmental hygiene can help bring HAI rates down and consider various options to address contaminatedsurfacesinhealthcarefacilities. In Chap. 4, Michael G. Schmidt, Andrea L. Banks, and Cassandra D. Salgado, furtherdiscusstheeffectofenvironmentalcontaminationandHAIandreviewthe studies showing the use of biocidal metallic copper surfaces resulting in dramatic reductionofbioburdenandimportantlyofHAIrates. In Chap. 5, I discuss how regular hospital linens, uniforms and other hospital textilesare aneglected sourceofnosocomialpathogens andhow self-disinfecting biocidaltextilescansignificantlycontributetothereductionofHAI.SpecificallyI review the studies showing that incorporation of copper oxide in hospital textiles can reduce bioburden and HAI rates. I also briefly review the novel successful endowment of biocidal properties to non-porous solid surfaces by impregnating themwithcopperoxideparticles. 4 G.Borkow InChap.6,ChristopheEsp´ıritoSanto,NadezhdaGerman,JuttaElguindi,Gregor Grass,andChristopherRensing,discusswhyontheonehandcopperisanessential element to microorganisms and how copper homeostasis is achieved, and on the other hand how copper exerts its potent biocidal properties, with special focus on the molecular mechanisms underlying bactericidal properties of solid copper surfaces. InChap.7,JonOtterreviewspotentialandexistentbiocidalsurfacealternatives to copper. He discusses what should be the ideal biocidal surface candidate and discusses the pros and cons of each of the existent candidate alternatives, the optimal deployment modes, the surfaces that should be made self-disinfecting surfaces,andhowdowetestandcompareefficacyofantimicrobialsurfaces. InChap.8,PanosA.Efstathiouevaluatestheimpactofusingbiocidalsurfaces in a hospital environment, specifically discussing the use of metallic copper sur- faces in the intensive care units, reaching the conclusion that the use of biocidal surfaceshassignificantpositiveeconomicadvantages. Finally,inChap.9,GeorgeByrnsreviewstheprosandconsofusingchemical fumigationandgermicidalUVCirradiationinhealthcareandotherrelatedsettings. HeraisestheconcernthatwhilebothfumigationandUVirradiationarecapableof killing microorganisms, it is uncertain whether the benefits in terms of overall hospital patient infection rates outweigh the risks and costs associated with these methods, further strengthening the importance of using biocidal self-disinfecting surfacestocombatenvironmentalcontamination. Ihopethisbookwillgivesignificantsupporttothenotionthattheinclusionin clinicalsettingsofself-disinfectingbiocidalhardandsoftsurfacescansignificantly helpinthefightagainsthealthcare-acquiredinfections.Ialsohopeyouwillfindthis bookinformative,comprehensiveandinteresting. References 1.Klevens RM et al (2007) Estimating health care-associated infections and deaths in U.S.hospitals,2002.PublicHealthRep122(2):160–166 2.ReedD,KemmerlySA(2009)Infectioncontrolandprevention:areviewofhospital-acquired infectionsandtheeconomicimplications.OchsnerJ9(1):27–31 3.Zimlichman E et al (2013) Health care-associated infections: a meta-analysis of costs and financialimpactontheUShealthcaresystem.JAMAInternMed173(22):2039–2046 4.BhallaAetal(2004)Acquisitionofnosocomialpathogensonhandsaftercontactwithenviron- mentalsurfacesnearhospitalizedpatients.InfectControlHospEpidemiol25(2):164–167 5.BoyceJM,Potter-BynoeG,ChenevertC,KingT(1997)Environmentalcontaminationdueto methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect ControlHospEpidemiol18(9):622–627 6.EcksteinBCetal(2007)ReductionofClostridiumDifficileandvancomycin-resistantEntero- coccus contamination of environmental surfaces after an intervention to improve cleaning methods.BMCInfectDis7:61
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