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      “Life-like” assessment of antimicrobial surfaces by a new touch transfer assay displays strong superiority of a copper alloy compared to silver containing surfaces

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          Abstract

          Transmission of bacteria from inanimate surfaces in healthcare associated environments is an important source of hospital acquired infections. A number of commercially available medical devices promise to fulfill antibacterial activity to reduce environmental contamination. In this study we developed a touch transfer assay modeling fingerprint transmission to investigate the antibacterial activity of surfaces, with confirmed antibacterial activity by a modified ISO 22196 (JIS Z 2801) assay to test such surfaces under more realistic conditions. Bacteria were taken up from a dry standardized primary contaminated surface (PCS) with disinfected fingers or fingers covered with sterile and moistened cotton gloves. Subsequently, bacteria were transferred by pressing on secondary contaminated surfaces (SCS) with or without potential antibacterial activity and the relative reduction rate was determined after 24 h. A stable transmission rate between PCS and SCS was observed using moistened sterile gloves. A copper containing alloy displayed at least a tenfold reduction of the bacterial load consistently reaching less than 2.5 cfu/cm 2. In contrast, no significant reduction of bacterial contamination by silver containing surfaces and matured pure silver was observed in the touch transfer assay. With the touch transfer assay we successfully established a new reproducible method modeling cross contamination. Using the new method we were able to demonstrate that several surfaces with confirmed antimicrobial activity in a modified ISO 22196 (JIS Z 2801) assay lacked effectiveness under defined ambient conditions. This data indicate that liquid based assays like the ISO 22196 should be critically reviewed before claiming antibacterial activity for surfaces in the setting of contamination of dry surfaces by contact to the human skin. We suggest the newly developed touch transfer assay as a new additional tool for the assessment of potential antimicrobial surfaces prior utilization in hospital environments.

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          Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination.

          There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.
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            The role played by contaminated surfaces in the transmission of nosocomial pathogens.

            Studies in the 1970s and 1980s suggested that environmental surface contamination played a negligible role in the endemic transmission of healthcare-associated infections. However, recent studies have demonstrated that several major nosocomial pathogens are shed by patients and contaminate hospital surfaces at concentrations sufficient for transmission, survive for extended periods, persist despite attempts to disinfect or remove them, and can be transferred to the hands of healthcare workers. Evidence is accumulating that contaminated surfaces make an important contribution to the epidemic and endemic transmission of Clostridium difficile, vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, Pseudomonas aeruginosa, and norovirus and that improved environmental decontamination contributes to the control of outbreaks. Efforts to improve environmental hygiene should include enhancing the efficacy of cleaning and disinfection and reducing the shedding of pathogens. Further high-quality studies are needed to clarify the role played by surfaces in nosocomial transmission and to determine the effectiveness of different interventions in reducing associated infection rates.
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              The role of the surface environment in healthcare-associated infections.

              This article reviews the evidence demonstrating the importance of contamination of hospital surfaces in the transmission of healthcare-associated pathogens and interventions scientifically demonstrated to reduce the levels of microbial contamination and decrease healthcare-associated infections.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: Validation
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: Validation
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: Validation
                Role: ConceptualizationRole: Formal analysisRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                14 November 2017
                2017
                : 12
                : 11
                : e0187442
                Affiliations
                [1 ] University Medical Center Hamburg-Eppendorf, Institute for Medical Microbiology, Virology and Hygiene, Department of Hospital Hygiene, Hamburg, Germany
                [2 ] German Center for Infection Research, Partner site Hamburg-Lübeck-Borstel, Germany
                [3 ] University Hospital of Schleswig-Holstein, Campus Lübeck, Clinic for Medical Microbiology and Infectiology, Lübeck, Germany
                [4 ] Drägerwerk AG & Co. KGaA, Lübeck, Germany
                [5 ] University Lübeck, Center for Infection and Inflammation Research (ZIEL), Lübeck, Germany
                VIT University, INDIA
                Author notes

                Competing Interests: MR and TW are employed by Drägerwerk AG & Co. KGaA who also provided funding and research materials for this study. JK joined an advisory board meeting of the Drägerwerk AG & Co. KGaA. ST, WK and SS were employed by Drägerwerk AG & Co. KGaA during internships and/or their thesis in the working group of JK. MR and TW are members of the Research Unit of the Drägerwerk AG & Co. KGaA. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

                Author information
                http://orcid.org/0000-0002-2591-6387
                Article
                PONE-D-17-16946
                10.1371/journal.pone.0187442
                5685567
                29135999
                43e9bde1-317d-4095-9d19-16b62e1c9ed1
                © 2017 Knobloch et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 May 2017
                : 19 October 2017
                Page count
                Figures: 3, Tables: 0, Pages: 11
                Funding
                Funded by: Drägerwerk AG & Co. KGaA
                Award Recipient :
                The study was funded by the Drägerwerk AG & Co. KGaA. The funder provided support in the form of salaries for authors [ST, WK, SS, MR, and TW] and by consumables. The funding of the study by the Drägerwerk AG & Co. KGaA does not alter our adherence to PLOS ONE policies on sharing data and materials. No financial interests of the funder influenced the design of the newly developed touch transfer assay. No financial interests of the funder influenced the data analysis. The decision to publish, and the preparation of the manuscript was not influenced by financial interests of the funder. The specific roles of these authors are articulated in the ‘author contributions’ section. There was no additional external funding received for this study and the rest of the study was financed by the regular budget resources of the Clinic for Medical Microbiology and Infectiology at the University Hospital of Schleswig-Holstein, Campus Lübeck.
                Categories
                Research Article
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Antimicrobials
                Antibacterials
                Biology and Life Sciences
                Microbiology
                Microbial Control
                Antimicrobials
                Antibacterials
                Medicine and Health Sciences
                Infectious Diseases
                Nosocomial Infections
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Antimicrobials
                Biology and Life Sciences
                Microbiology
                Microbial Control
                Antimicrobials
                Physical Sciences
                Materials Science
                Metallurgy
                Alloys
                Copper Alloys
                Physical Sciences
                Chemistry
                Chemical Elements
                Silver
                Biology and Life Sciences
                Anatomy
                Integumentary System
                Skin
                Medicine and Health Sciences
                Anatomy
                Integumentary System
                Skin
                Physical Sciences
                Materials Science
                Materials by Structure
                Ceramics
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Bacterial Pathogens
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Bacterial Pathogens
                Custom metadata
                All relevant data are within the paper and its Supporting Information file. A detailed protocol of the new method is available at protocols.io ( dx.doi.org/10.17504/protocols.io.i59cg96).

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