Antimicrobial surfaces and their potential in reducing the role of the inanimate environment in the incidence of hospital-acquired infections

Environmental surfaces and their role in the epidemiology of hospital-acquired infections (HAIs) have become an area of great scientific interest, particularly in light of the much publicised cases of infections due to methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile in UK hospitals. This feature article sets out to examine the role of surfaces and the inanimate environment in the spread of HAIs, and looks at various antimicrobial techniques being researched to reduce microbial contamination of surfaces. Preventative measures such as coatings which reduce initial microbial adhesion to surfaces will be considered alongside actively antimicrobial measures which inactivate microorganisms already adherent to a surface. The principal focus of this feature article will be given to light-activated antimicrobial surfaces such as the photocatalyst TiO2 and surfaces with embedded photosensitisers. Surfaces which release antimicrobial compounds or metal ions such as silver and copper are also examined, alongside materials which kill microbes upon contact. The widespread research and development of these antimicrobial surfaces is of great importance in maintaining acceptable levels of hygiene in hospitals and will help to fight the spread of HAIs via the contamination of inanimate surfaces in the healthcare environment.

[1]  H. Martiny,et al.  Survival of MRSA on sterile goods packaging. , 2001, The Journal of hospital infection.

[2]  Cesar Pulgarin,et al.  Bactericidal action of illuminated TiO2 on pure Escherichia coli and natural bacterial consortia: post-irradiation events in the dark and assessment of the effective disinfection time , 2004 .

[3]  J. Robertson Diamond-like amorphous carbon , 2002 .

[4]  M. Upmann,et al.  Oberflächenkeimgehalte und Betriebshygiene in einem Zerlegebetrieb für Schweinefleisch : 2. Mitteilung , 1998 .

[5]  I. Parkin,et al.  Titania and tungsten doped titania thin films on glass; active photocatalysts , 2003 .

[6]  W. Sanborn THE RELATION OF SURFACE CONTAMINATION TO THE TRANSMISSION OF DISEASE. , 1963, American journal of public health and the nation's health.

[7]  D. Talon The role of the hospital environment in the epidemiology of multi-resistant bacteria. , 1999, The Journal of hospital infection.

[8]  Carlene A. Muto,et al.  SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus , 2003, Infection Control & Hospital Epidemiology.

[9]  C J Griffith,et al.  An evaluation of hospital cleaning regimes and standards. , 2000, The Journal of hospital infection.

[10]  Ivan P. Parkin,et al.  Self-cleaning coatings , 2005 .

[11]  Shaoyi Jiang,et al.  Inhibition of bacterial adhesion and biofilm formation on zwitterionic surfaces. , 2007, Biomaterials.

[12]  Robert A. Weinstein,et al.  Contamination, Disinfection, and Cross-Colonization: Are Hospital Surfaces Reservoirs for Nosocomial Infection? , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[13]  C. W. Keevil,et al.  Inactivation of Influenza A Virus on Copper versus Stainless Steel Surfaces , 2007, Applied and Environmental Microbiology.

[14]  R. Fries,et al.  Survey on the hygienic status of plastic doors of a pig abattoir. , 2006, Journal of food protection.

[15]  A. Fraise,et al.  Writing pens are an unlikely vector of cross-infection with methicillin resistant Staphylococcus aureus (MRSA) , 1999, The Journal of hospital infection.

[16]  I. Parkin,et al.  Atmospheric pressure chemical vapour deposition of vanadium nitride and oxynitride films on glass from reaction of VCl4 with NH3 , 2001 .

[17]  S. Oie,et al.  Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus. , 2002, The Journal of hospital infection.

[18]  Michael T. Wilson,et al.  Cellulose Acetate Containing Toluidine Blue and Rose Bengal Is an Effective Antimicrobial Coating when Exposed to White Light , 2006, Applied and Environmental Microbiology.

[19]  G. Nychas,et al.  Microbial ecology of food contact surfaces and products of small-scale facilities producing traditional sausages. , 2008, Food microbiology.

[20]  C. Keevil,et al.  Potential use of copper surfaces to reduce survival of epidemic meticillin-resistant Staphylococcus aureus in the healthcare environment. , 2006, The Journal of hospital infection.

[21]  R. Katsarava,et al.  The use of a novel biodegradable preparation capable of the sustained release of bacteriophages and ciprofloxacin, in the complex treatment of multidrug‐resistant Staphylococcus aureus‐infected local radiation injuries caused by exposure to Sr90 , 2005, Clinical and experimental dermatology.

[22]  A. Okada,et al.  Inhibition of biofilm formation using newly developed coating materials with self-cleaning properties. , 2008, Dental materials journal.

[23]  Edward J. Wolfrum,et al.  Bactericidal mode of titanium dioxide photocatalysis , 2000 .

[24]  A. Klibanov,et al.  Practical Aspects of Hydrophobic Polycationic Bactericidal “Paints” , 2008, Applied biochemistry and biotechnology.

[25]  S. Béni,et al.  Stethoscopes and otoscopes--a potential vector of infection? , 1997, Family practice.

[26]  H. Kisch,et al.  Visible-light photocatalysis by modified titania. , 2002, Chemphyschem : a European journal of chemical physics and physical chemistry.

[27]  R. Katsarava,et al.  A novel sustained‐release matrix based on biodegradable poly(ester amide)s and impregnated with bacteriophages and an antibiotic shows promise in management of infected venous stasis ulcers and other poorly healing wounds , 2002, International journal of dermatology.

[28]  H. Ayçiçek,et al.  Comparison of results of ATP bioluminescence and traditional hygiene swabbing methods for the determination of surface cleanliness at a hospital kitchen. , 2006, International journal of hygiene and environmental health.

[29]  R. Asahi,et al.  Visible-Light Photocatalysis in Nitrogen-Doped Titanium Oxides , 2001, Science.

[30]  D. Mckenzie,et al.  Hemocompatibility and anti-bacterial properties of silver doped diamond-like carbon prepared by pulsed filtered cathodic vacuum arc deposition , 2007 .

[31]  M. Madigan,et al.  Brock Biology of Microorganisms , 1996 .

[32]  Cesar Pulgarin,et al.  Field solar E-coli inactivation in the absence and presence of TiO2: is UV solar dose an appropriate parameter for standardization of water solar disinfection? , 2004 .

[33]  A. Klibanov Permanently microbicidal materials coatings , 2007 .

[34]  Michael T. Wilson,et al.  The antimicrobial properties of light-activated polymers containing methylene blue and gold nanoparticles. , 2009, Biomaterials.

[35]  R. Clark,et al.  Inactivation of Escherichia coli by titanium dioxide photocatalytic oxidation , 1993, Applied and environmental microbiology.

[36]  K. Takahashi,et al.  Bacterial contamination in the environment of food factories processing ready-to-eat fresh vegetables. , 1999, Journal of food protection.

[37]  Itaru Honma,et al.  Superhydrophobic perpendicular nanopin film by the bottom-up process. , 2005, Journal of the American Chemical Society.

[38]  Andrew Mills,et al.  Thick titanium dioxide films for semiconductor photocatalysis , 2003 .

[39]  J. Speier,et al.  Destruction of microorganisms by contact with solid surfaces , 1982 .

[40]  T. Matsunaga,et al.  Continuous-sterilization system that uses photosemiconductor powders , 1988, Applied and environmental microbiology.

[41]  A. Lloyd,et al.  Bacterial adhesion to phosphorylcholine-based polymers with varying cationic charge and the effect of heparin pre-adsorption , 2005, Journal of materials science. Materials in medicine.

[42]  S. Dancer,et al.  Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. , 2008, The Lancet. Infectious diseases.

[43]  G. C. Miller,et al.  Photocatalytic inactivation of coliform bacteria and viruses in secondary wastewater effluent , 1995 .

[44]  S. Silver,et al.  Bacterial silver resistance: molecular biology and uses and misuses of silver compounds. , 2003, FEMS microbiology reviews.

[45]  C. Donskey,et al.  Acquisition of Nosocomial Pathogens on Hands After Contact With Environmental Surfaces Near Hospitalized Patients , 2004, Infection Control & Hospital Epidemiology.

[46]  Dacheng Ren,et al.  Inhibition of Escherichia coli Biofilm Formation by Self-Assembled Monolayers of Functional Alkanethiols on Gold , 2007, Applied and Environmental Microbiology.

[47]  G. Whitesides,et al.  Self-Assembled Monolayers That Resist the Adsorption of Proteins and the Adhesion of Bacterial and Mammalian Cells , 2001 .

[48]  C. Robertson,et al.  A microbiological evaluation of hospital cleaning methods , 2007, International journal of environmental health research.

[49]  C. Keevil,et al.  Survival of Listeria monocytogenes Scott A on metal surfaces: implications for cross-contamination. , 2006, International journal of food microbiology.

[50]  Alice N. Neely,et al.  Survival of Enterococci and Staphylococci on Hospital Fabrics and Plastic , 2000, Journal of Clinical Microbiology.

[51]  Andrew Mills,et al.  An overview of semiconductor photocatalysis , 1997 .

[52]  S. Dancer,et al.  How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals , 2003, Journal of Hospital Infection.

[53]  Raymond Bonnett,et al.  Photosensitizers of the porphyrin and phthalocyanine series for photodynamic therapy , 1995 .

[54]  S. Oie,et al.  Survival of methicillin-resistant Staphylococcus aureus (MRSA) on naturally contaminated dry mops. , 1996, The Journal of hospital infection.

[55]  P. Ordejón,et al.  Designed Self‐Doped Titanium Oxide Thin Films for Efficient Visible‐Light Photocatalysis , 2002 .

[56]  B. Robinson,et al.  The Management And Control Of Hospital Acquired Infection In Acute Nhs Trusts In England , 2001 .

[57]  K. W. Kwong,et al.  Ambient Light Reduction Strategy to Synthesize Silver Nanoparticles and Silver-Coated TiO2 with Enhanced Photocatalytic and Bactericidal Activities , 2003 .

[58]  R. Hauert A review of modified DLC coatings for biological applications , 2003 .

[59]  Qi Zhao,et al.  Evaluation of bacterial adhesion on Si-doped diamond-like carbon films , 2007 .

[60]  C. Keevil,et al.  Survival of Clostridium difficile on copper and steel: futuristic options for hospital hygiene. , 2008, The Journal of hospital infection.

[61]  M. Wilson Photolysis of oral bacteria and its potential use in the treatment of caries and periodontal disease. , 1993, The Journal of applied bacteriology.

[62]  B. Oppenheim,et al.  Rapid recontamination with MRSA of the environment of an intensive care unit after decontamination with hydrogen peroxide vapour. , 2007, The Journal of hospital infection.

[63]  D. Pang,et al.  Cell Damage Induced by Photocatalysis of TiO2 Thin Films , 2003 .

[64]  Bishara S Atiyeh,et al.  Effect of silver on burn wound infection control and healing: review of the literature. , 2007, Burns : journal of the International Society for Burn Injuries.

[65]  T. Walley,et al.  The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation. , 2008, Health technology assessment.

[66]  Cesar Pulgarin,et al.  Photocatalytical inactivation of E. coli: effect of (continuous-intermittent) light intensity and of (suspended-fixed) TiO2 concentration , 2003 .

[67]  R. Donlan,et al.  Using Bacteriophages To Reduce Formation of Catheter-Associated Biofilms by Staphylococcus epidermidis , 2006, Antimicrobial Agents and Chemotherapy.

[68]  A. Grill Review of the tribology of diamond-like carbon , 1993 .

[69]  D. Bolton,et al.  The incidence of significant foodborne pathogens in domestic refrigerators , 2007 .

[70]  N. N. Greenwood,et al.  Chemistry of the elements , 1984 .

[71]  R. Stone Stalin's Forgotten Cure , 2002, Science.

[72]  Jason J. Keleher,et al.  Photo-catalytic preparation of silver-coated TiO2 particles for antibacterial applications , 2002 .

[73]  I. Parkin,et al.  Spectral and photocatalytic characteristics of TiO_2 CVD films on quartz , 2002, Photochemical & photobiological sciences : Official journal of the European Photochemistry Association and the European Society for Photobiology.

[74]  W. Barthlott,et al.  Purity of the sacred lotus, or escape from contamination in biological surfaces , 1997, Planta.

[75]  E W Abel,et al.  Reduction of bacterial adhesion on modified DLC coatings. , 2008, Colloids and surfaces. B, Biointerfaces.

[76]  W. Rutala,et al.  Environmental study of a methicillin-resistant Staphylococcus aureus epidemic in a burn unit , 1983, Journal of clinical microbiology.

[77]  I. Parkin,et al.  Anatase thin films on glass from the chemical vapor deposition of titanium(IV) chloride and ethyl acetate , 2003 .

[78]  P. Rountree The effect of desiccation on the viability of Staphylococcus aureus , 1963, Journal of Hygiene.

[79]  J. Boyce,et al.  Environmental Contamination Due to Methicillin-Resistant Staphylococcus aureus Possible Infection Control Implications , 1997, Infection Control & Hospital Epidemiology.

[80]  S. Wilks,et al.  The survival of Escherichia coli O157 on a range of metal surfaces. , 2005, International journal of food microbiology.

[81]  M. Lechevallier,et al.  Evidence for the role of copper in the injury process of coliform bacteria in drinking water , 1984, Applied and environmental microbiology.

[82]  Michael T. Wilson Light-Activated Antimicrobial Coating for the Continuous Disinfection of Surfaces , 2003, Infection Control & Hospital Epidemiology.

[83]  T. Nakajima,et al.  Photoelectrochemical sterilization of microbial cells by semiconductor powders , 1985 .

[84]  K. Hirota,et al.  Coating of a surface with 2-methacryloyloxyethyl phosphorylcholine (MPC) co-polymer significantly reduces retention of human pathogenic microorganisms. , 2005, FEMS microbiology letters.

[85]  George M. Whitesides,et al.  Polymeric Thin Films That Resist the Adsorption of Proteins and the Adhesion of Bacteria , 2001 .

[86]  Lewis,et al.  Phosphorylcholine-based polymers and their use in the prevention of biofouling. , 2000, Colloids and surfaces. B, Biointerfaces.

[87]  H. Suh,et al.  Bacterial adhesion on PEG modified polyurethane surfaces. , 1998, Biomaterials.

[88]  Ivan P. Parkin,et al.  Atmospheric Pressure Chemical Vapor Deposition of Crystalline Monoclinic WO3 and WO3-x Thin Films from Reaction of WCl6 with O-Containing Solvents and Their Photochromic and Electrochromic Properties , 2005 .

[89]  S. Aisenberg,et al.  Ion‐Beam Deposition of Thin Films of Diamondlike Carbon , 1971 .

[90]  Qi Zhao,et al.  Bacterial adhesion on silicon-doped diamond-like carbon films , 2007 .

[91]  Edward J. Wolfrum,et al.  Mineralization of Bacterial Cell Mass on a Photocatalytic Surface in Air , 1998 .

[92]  M. Litter,et al.  Photocatalytic bactericidal effect of TiO2 on Enterobacter cloacae: Comparative study with other Gram (−) bacteria , 2003 .

[93]  P. Çıragil,et al.  Bacterial contamination of computers and telephones in a university hospital in Turkey. , 2006, The Journal of hospital infection.

[94]  J. Parker,et al.  Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit. , 2000, American journal of infection control.

[95]  D Watling,et al.  Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. , 2004, The Journal of hospital infection.

[96]  Jianzhu Chen,et al.  Polymeric coatings that inactivate both influenza virus and pathogenic bacteria , 2006, Proceedings of the National Academy of Sciences.

[97]  D. Y. Goswami,et al.  Enhanced photocatalytic inactivation of bacterial spores on surfaces in air , 2005, Journal of Industrial Microbiology and Biotechnology.

[98]  J. Carlet,et al.  Bacterial Contamination of Hospital Physicians' Stethoscopes , 1999, Infection Control & Hospital Epidemiology.

[99]  J. Costerton,et al.  Biofilms: Survival Mechanisms of Clinically Relevant Microorganisms , 2002, Clinical Microbiology Reviews.