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How Does a Photocatalytic Antimicrobial Coating Affect Environmental Bioburden in Hospitals?

Published online by Cambridge University Press:  12 February 2018

Matthew Reid ,
Vanessa Whatley ,
Emma Spooner ,
Alan M. Nevill ,
Michael Cooper ,
Jeremy J. Ramsden  and
Stephanie J. Dancer
Matthew Reid
Affiliation:
New Cross Hospital, The Royal Wolverhampton NHS Trust, England
Vanessa Whatley
Affiliation:
New Cross Hospital, The Royal Wolverhampton NHS Trust, England
Emma Spooner
Affiliation:
New Cross Hospital, The Royal Wolverhampton NHS Trust, England
Alan M. Nevill
Affiliation:
Faculty of Education, Health and Wellbeing, University of Wolverhampton, England
Michael Cooper
Affiliation:
New Cross Hospital, The Royal Wolverhampton NHS Trust, England
Jeremy J. Ramsden*
Affiliation:
Clore Laboratory, University of Buckingham, England
Stephanie J. Dancer
Affiliation:
Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, Scotland School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland
*
Address correspondence to Prof. J. J. Ramsden, University of Buckingham, MK18 1EG, UK (jeremy.ramsden@buckingham.ac.uk).
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Abstract

BACKGROUND

The healthcare environment is recognized as a source for healthcare-acquired infection. Because cleaning practices are often erratic and always intermittent, we hypothesize that continuously antimicrobial surfaces offer superior control of surface bioburden.

OBJECTIVE

To evaluate the impact of a photocatalytic antimicrobial coating at near-patient, high-touch sites in a hospital ward.

SETTING

The study took place in 2 acute-care wards in a large acute-care hospital.

METHODS

A titanium dioxide-based photocatalytic coating was sprayed onto 6 surfaces in a 4-bed bay in a ward and compared under normal illumination against the same surfaces in an untreated ward: right and left bed rails, bed control, bedside locker, overbed table, and bed footboard. Using standardized methods, the overall microbial burden and presence of an indicator pathogen (Staphylococcus aureus) were assessed biweekly for 12 weeks.

RESULTS

Treated surfaces demonstrated significantly lower microbial burden than control sites, and the difference increased between treated and untreated surfaces during the study. Hygiene failures (>2.5 colony-forming units [CFU]/cm2) increased 2.6% per day for control surfaces (odds ratio [OR], 1.026; 95% confidence interval [CI], 1.009–1.043; P=.003) but declined 2.5% per day for treated surfaces (OR, 0.95; 95% CI, 0.925–0.977; P<.001). We detected no significant difference between coated and control surfaces regarding S. aureus contamination.

CONCLUSION

Photocatalytic coatings reduced the bioburden of high-risk surfaces in the healthcare environment. Treated surfaces became steadily cleaner, while untreated surfaces accumulated bioburden. This evaluation encourages a larger-scale investigation to ascertain whether the observed environmental amelioration has an effect on healthcare-acquired infection.

Infect Control Hosp Epidemiol 2018;39:398–404

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 4 , April 2018 , pp. 398 - 404
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Plowman, R, Graves, N, Griffin, MA, et al. The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed. J Hosp Infect 2001;47:198–209.CrossRefGoogle ScholarPubMed
2. Dancer, SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev 2014;27:665–689.Google Scholar
3. Dancer, SJ. How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals. J Hosp Infect 2004;56:10–15.Google Scholar
4. Dancer, SJ. Importance of the environment in methicillin-resistant Staphylococcus aureus (MRSA) acquisition: the case for hospital cleaning. Lancet Infect Dis 2008;8:101–113.CrossRefGoogle ScholarPubMed
5. Donskey, CJ. Does improving surface cleaning and disinfection reduce healthcare-associated infections? Am J Infection Control 2013;41:S12–S19.Google Scholar
6. Dancer, SJ. Dos and don’ts for hospital cleaning. Curr Opin Infect Dis 2016;29:415–423.Google Scholar
7. Stewart, M, Bogusz, A, Hunter, J, et al. Microbiological effect of cleaning near-patient sites with electrolysed water. Infect Control Hosp Epidemiol 2014;35:1505–1510.Google Scholar
8. Hota, B, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Interventional evaluation of environmental contamination by vancomycin-resistant enterococci: failure of personnel, product, or procedure? J Hosp Infect 2009;71:123–131.CrossRefGoogle ScholarPubMed
9. Boyce, JM, Havill, NL, Lipka, A, Havill, H, Rizani, R. Variations in hospital daily cleaning practices. Infect Control Hosp Epidemiol 2010;31:99–101.Google Scholar
10. Ramsden, JJ. Photocatalytic antimicrobial coatings. Nanotechnol Percept 2015;11:146–168.Google Scholar
11. Hashimoto, K, Irie, H, Fujishima, A. TiO2 photocatalysis: a historical overview and future prospects. Jap J Appl Phys 2005;44:8269–8285.CrossRefGoogle Scholar
12. Ramsden, JJ. Can bacteria develop resistance to photocatalytically generated reactive oxygen species? J Biol Phys Chem 2017;17:47–51.Google Scholar
13. Pulgarin, C, Kiwi, J, Nadtochenko, V. Mechanism of photocatalytic bacterial in activation on TiO2 films involving cell-wall damage and lysis. Appl Catal B 2012;128:179–183.Google Scholar
14. Leng, CW, Soe, TA, Wui, LW, et al. Efficacy of titanium dioxide components in preventing environmental contamination by meticillin resistant Staphylococcus aureus (MRSA). Int J Infect Control 2013;9:1–8.Google Scholar
15. Wolfrum, EJ, Huang, J, Blake, DM, et al. Photocatalytic oxidation of bacteria, bacterial and fungal spores, and model biofilm components to carbon dioxide on titanium dioxide-coated surfaces. Envir Sci Technol 2002;36:3412–3419.CrossRefGoogle ScholarPubMed
16. Petti, S, Messano, GA. Nano-TiO2-based photocatalytic disinfection of environmental surfaces contaminated by methicillin-resistant Staphylococcus aureus . J Hosp Infect 2016;93:78–82.Google Scholar
17. Huslage, K, Rutala, WA, Sickbert-Bennett, E, Weber, DJ. A quantitative approach to defining “high-touch” surfaces in hospitals. Infect Control Hosp Epidemiol 2010;31:850–853.CrossRefGoogle ScholarPubMed
18. Primary and MVX technical specification 2016. Kitakyushu, Japan: Maeda-Kougyou; 2016.Google Scholar
19. Bogusz, A, Stewart, M, Hunter, J, et al. How quickly do hospital surfaces become contaminated after detergent cleaning? Healthcare Infect 2013;18:3–9.CrossRefGoogle Scholar
20. Lewis, T, Griffith, C, Gallo, M, Weinbren, M. A modified benchmark for evaluating the cleaning of some hospital environmental surfaces. J Hosp Infect 2008;69:156–163.CrossRefGoogle ScholarPubMed
21. Ramsden, JJ. Bioinformatics: An Introduction. London: Springer; 2015;chap 6.Google Scholar
22. Glover, RE, Smith, RR, Jones, MV, Jackson, SK, Rowlands, CC. And EPR investigation of surfactant action on bacterial membranes. FEMS Microbiol Lett 1999;177:57–62.Google Scholar
23. Dancer, SJ. Missing a trick? Response to: ‘Disinfectant wipes are appropriate to control microbial bioburden from surfaces.’ J Hosp Infect 2016;92:208–209.Google Scholar
24. Hurst, K, Smith, A, Casey, A, Fenton, K, Scholefield, H, Smith, S. Calculating staffing requirements. Nursing Management 2008;15:26–34.Google Scholar
25. Altman, DG, Royston, P. The cost of dichotomizing continuous variables. BMJ 2006;332:1080.CrossRefGoogle Scholar
26. Dancer, SJ, White, L, Robertson, C. Monitoring environmental cleanliness on two surgical wards. Int J Environ Health Res 2008;18:357–364.Google Scholar
27. Bagley, SC, White, H, Golomb, BA. Logistic regression in the medical literature: standards for use and reporting, with particular attention to one medical domain. J Clin Epidemiol 2001;54:979–985.CrossRefGoogle ScholarPubMed
28. Edwards, AWF. Likelihood. Cambridge: University Press; 1972.Google Scholar
29. Griffith, CJ, Cooper, RA, Gilmore, J, Davies, C, Lewis, M. An evaluation of hospital cleaning regimes and standards. J Hosp Infect 2000;45:19–28.Google Scholar
30. Boyce, JM, Havill, NL, Havill, HL, Mangione, E, Dumigan, DG, Moore, BA. Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices. Infect Control Hosp Epidemiol 2011;32:1187–1193.Google Scholar
31. de Jong, B, et al. Pre–post evaluation of effects of a titanium dioxide coating on environmental contamination of an intensive care unit: the TITANIC study. J Hosp Infect 2017. pii: S0195-6701(17):30194–30199; doi: 10.1016/j.jhin.2017.04.008.Google Scholar
32. Sunada, K, Watanabe, T, Hashimoto, K. Studies on photokilling of bacteria on TiO2 thin film. J Photochem Photobiol A 2003;156:227–233.CrossRefGoogle Scholar
33. Dunlop, PSM, Sheeran, CP, Byrne, JA, McMahon, MAS, Boyle, MA, McGuigan, KG. Inactivation of clinically relevant pathogens by photocatalytic coatings. J Photochem Photobiol A 2010;216:303–310.Google Scholar
34. Ojajärvi, J, Mäkelä, P, Rantasalo, I. Failure of hand disinfection with frequent hand washing: a need for prolonged field studies. J Hyg Camb 1977;79:107–119.Google Scholar
35. Larson, E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis 1999;29:1287–1294.Google Scholar
36. Wang, Y-L, Chen, W-C, Chen, Y-Y, et al. Bacterial contamination on surfaces of public areas in hospitals. J Hosp Infect 2010;74:195–196.Google Scholar
37. Williams, GJ, Denyer, SP, Hosein, IK, Hill, DW, Maillard, J-Y. Limitations of the efficacy of surface disinfection in the healthcare setting. Infect Control Hosp Epidemiol 2009;30:570–573.Google Scholar
38. Stevens, N, Priest, CI, Sedev, R, Ralston, J. Wettability of photoresponsive titanium dioxide surfaces. Langmuir 2003;19:3272–3275.Google Scholar