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      Effectiveness of surface coatings containing silver ions in bacterial decontamination in a recovery unit

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          Abstract

          Background

          HAIs remain a frequent complication for hospitalised patients and pose a challenge that must be tackled by our health systems.

          Methods

          Quasi-experimental study. In order to determine the antimicrobial effectiveness of surface coating agents containing silver ions (BactiBlock®) the degree of contamination of several surfaces in two ICU wards was compared.

          The association between application of Bactiblock® and surface contamination was analysed using a relative risk (RR). Multivariate logistic regressions were performed for each product applied and each sampling location to adjust for the RR of the contamination of surfaces treated with Bactiblock® for the independent variables.

          Results

          Surface contamination was observed in 31.5% of treated samples and 27.4 of untreated samples. Contamination was equally prominent on bedside Tables (38.7%), bed rails (38.4%) and sinks (38.3%), while the walls showed minimum contamination (2.6%). For beds under isolation protocols, contamination was higher (32.6%) than when no protocol was followed (26.5%) but the difference was not significant ( p = 0.148). After stratification for application method and adjusting the multivariate models for period of the study and presence of isolated patients, the risk of contamination after the intervention increased when the coating agent was applied using a spray (OR = 1.79; 95% CI: 1.08-2.95, particularly in a dry and rugged surface such as that of bedside Tables (OR = 2.59; 95% CI: 1.22-5.52); and decreased when the product was applied using a roller on a smooth and continuously cleaned (or wet) Surface (OR = 0.42; 95% CI: 0.19-0.92).

          Conclusion

          Coating of hospital surfaces with substances containing silver ions may reduce bacterial growth. However, the effectiveness of the coating agent is affected by application method and environmental conditions and the type and cleanness of the surface.

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          Most cited references23

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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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            Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis.

            Quantifying the benefit of early antibiotic treatment is crucial for decision making and can be assessed only in observational studies. We performed a systematic review of prospective studies reporting the effect of appropriate empirical antibiotic treatment on all-cause mortality among adult inpatients with sepsis. Two reviewers independently extracted data. Risk of bias was assessed using the Newcastle-Ottawa score. We calculated unadjusted odds ratios (ORs) with 95% confidence intervals for each study and extracted adjusted ORs, with variance, methods, and covariates being used for adjustment. ORs were pooled using random-effects meta-analysis. We examined the effects of methodological and clinical confounders on results through subgroup analysis or mixed-effect meta-regression. Seventy studies were included, of which 48 provided an adjusted OR for inappropriate empirical antibiotic treatment. Inappropriate empirical antibiotic treatment was associated with significantly higher mortality in the unadjusted and adjusted comparisons, with considerable heterogeneity occurring in both analyses (I(2) > 70%). Study design, time of mortality assessment, the reporting methods of the multivariable models, and the covariates used for adjustment were significantly associated with effect size. Septic shock was the only clinical variable significantly affecting results (it was associated with higher ORs). Studies adjusting for background conditions and sepsis severity reported a pooled adjusted OR of 1.60 (95% confidence interval = 1.37 to 1.86; 26 studies; number needed to treat to prevent one fatal outcome, 10 patients [95% confidence interval = 8 to 15]; I(2) = 46.3%) given 34% mortality with inappropriate empirical treatment. Appropriate empirical antibiotic treatment is associated with a significant reduction in all-cause mortality. However, the methods used in the observational studies significantly affect the effect size reported. Methods of observational studies assessing the effects of antibiotic treatment should be improved and standardized.
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              The increasing use of silver-based products as antimicrobial agents: a useful development or a cause for concern?

              Ian Chopra (2007)
              Silver first gained regulatory approval for use as an antimicrobial agent in the early 20th century, but its usage diminished with the introduction of antibiotics in the 1940s. Recently, however, topical silver has gained popularity once again, principally in the management of open wounds. This has been largely due to the spread of methicillin-resistant Staphylococcus aureus and the resultant reduction in first-line antibiotic prescribing. The increase in the use of topical silver has raised issues concerning silver resistance, together with questions about the standardization of antimicrobial testing methods for silver. Issues related to silver product testing include a failure to establish standard procedures for determining MIC values, an absence of recognized breakpoints, a lack of conformity in the way different products release silver and variations in the effects of microbiological media on silver release and the measurement of inhibitory activity. The clinical incidence of silver resistance remains low, and emergence of resistance can be minimized if the level of silver ions released from products is high and the bactericidal activity rapid.
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                Author and article information

                Contributors
                +34 963 637 412 , rm.orti@ucv.es
                juliomunozmiguel@gmail.com
                Journal
                Antimicrob Resist Infect Control
                Antimicrob Resist Infect Control
                Antimicrobial Resistance and Infection Control
                BioMed Central (London )
                2047-2994
                13 June 2017
                13 June 2017
                2017
                : 6
                : 61
                Affiliations
                [1 ]ISNI 0000 0004 1804 6963, GRID grid.440831.a, Social Medicine and Public Health Department, , Universidad Católica de Valencia San Vicente Mártir, ; C/ Espartero,7, Valencia, 46007 Spain
                [2 ]GRID grid.411308.f, Preventive Medicine Department, , Hospital Clínico Universitario de Valencia, ; Valencia, Spain
                Author information
                http://orcid.org/0000-0003-2211-7413
                Article
                217
                10.1186/s13756-017-0217-9
                5470207
                e3a096ca-06a4-44dd-9fc5-de97c500cb7d
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 January 2017
                : 31 May 2017
                Categories
                Research
                Custom metadata
                © The Author(s) 2017

                Infectious disease & Microbiology
                antimicrobial activity,silver ions,risk assessment,environmental contamination,surface coating,healthcare-associated infection

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