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Abstract

Background

Contamination of hospital surfaces by clinically-relevant pathogens represents a major concern in healthcare facilities, due to its impact on transmission of healthcare-associated infections (HAIs) and to the growing drug resistance of HAI-associated pathogens. Routinely used chemical disinfectants show limitations in controlling pathogen contamination, due to their inefficacy in preventing recontamination and selection of resistant strains. Recently we observed that an innovative approach, based on a cleanser added with spores of non-pathogenic probiotic Bacilli, was effective in stably counteracting the growth of several pathogens contaminating hospital surfaces.

Methods

Here, we wanted to study the impact of the Bacillus-based cleanser on the drug-resistance features of the healthcare pathogens population. In parallel, the ability of cleanser-derived Bacilli to infect hospitalized patients was also investigated.

Results

Collected data showed that Bacilli spores can germinate on dry inanimate surfaces, generating the bacterial vegetative forms which counteract the growth of pathogens and effectively substitute for them on treated surfaces. Strikingly, this procedure did not select resistant species, but conversely induced an evident decrease of antibiotic resistance genes in the contaminating microbial population. Also importantly, all the six HAI-positive patients hosted in the treated areas resulted negative for probiotic Bacilli, thus adding evidences to their safety-to-use.

Conclusions

These results indicate that this probiotic-based procedure is active not only in controlling surface microbial contamination but also in lowering drug-resistant species, suggesting that it may have relevant clinical and therapeutical implications for the management of HAIs.

Introduction.

Contaminated environmental surfaces represent a reservoir for several healthcare associated pathogens, and therefore may provide an important potential source for transmission of healthcare associated infections (HAIs), which are one of the most frequent complications occurring in healthcare facilities worldwide, affecting 5–15% of all hospitalized patients in high-income countries [].

Multiple studies have demonstrated that more than 50% of hospital room surfaces are inadequately cleaned and disinfected when chemical germicides are used [], and that surfaces in rooms of patients colonized or infected with clinically-relevant healthcare-associated pathogens are frequently contaminated. The presence and survival of nosocomial pathogens on surfaces has been recently reviewed [], showing that important hospital pathogens, including Methicillin Resistant Staphylococcus aureus (MRSA), Vancomycin Resistant Enterococci (VRE), Pseudomonas spp., Acinetobacter spp., and even viruses (i.e. Norovirus), retain their infectivity for days to weeks on dry inanimate surfaces, and that Clostridium difficile spores may survive on environmental surfaces for months.

The proportion of hospital surfaces contaminated with the different pathogens varies among published reports. The presence of MRSA strains was reported in 1–27% of surfaces in patient rooms and up to 64% in burn units with MRSA-positive patients []. Up to 70% of environmental sites were found positive in rooms with VRE-colonized patients []. Cdifficile positivity has been demonstrated in up to 75% of rooms hosting patients with Cdifficile infection (CDI)[]. Acinetobacter spp. environmental contamination in outbreak settings has been observed in 3–50% of analyzed sites []. In addition, recent studies have reported that the observed levels of surface contamination are very similar, despite whether the surface was a high, medium or low touch surface [], and that the surface of the sampled area can influence the final results, as shown for Cdifficile quantification [].

Due to persistent contamination of healthcare surfaces and to their role in the possible transmission of pathogens, many attempts have aimed to control surface contamination, and several methods have been proposed and studied for the improved cleaning and disinfection of room surfaces [], including the use of ‘self-disinfecting’ surfaces, developed to reduce the bioburden on environmental surfaces and comprising heavy metals (silver, copper), germicide impregnated materials, altered topography, and light-activated antimicrobial coatings [].

Overall, most of the proposed techniques are based on the use of chemical compounds, which are accompanied by a non-negligible environmental impact []. Furthermore, these methods have been proved effective for the immediate abatement of the majority of pathogens, but result ineffective in preventing recontamination phenomena, which are ultimately responsible for the persistence of contaminating microorganisms on hospital surfaces and for the associated transmission of pathogens and onset of HAIs.

The elimination of surface contamination as a source for patient-to-patient transmission of nosocomial pathogens is therefore a very difficult task, due to frequent recontamination processes associated to the presence of colonized patients and/or of infected visiting people and healthcare personnel. In addition, a major global concern in HAIs management is represented by the antimicrobial resistance characterizing the pathogens which are often involved in their onset. This aspect has been extensively studied, due to the fact that the phenomenon of multi-drug resistance has been constantly and rapidly growing in the recent decades. Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by different microorganisms. In particular, a high proportion of HAIs are caused by highly resistant bacteria such as MRSA or multidrug-resistant Gram-negative bacteria []. Thus, given the recent and fast evolution of multi-resistant pathogens in healthcare facilities, there is an urgent need for sustainable and effective alternatives to the cleaning and disinfection chemicals used today.

Recently, we analyzed the efficacy of a new approach, based on the use of non-pathogenic microorganisms of the Bacillus genus added to sustainable detergents, in a system named Probiotic Cleaning Hygiene System (PCHS). Such method was proved effective in counteracting surface recontamination by diverse pathogens, stably decreasing their presence of about 80–90% compared to the microbial load detected on surfaces treated with conventional cleanser/disinfectants []. However, its influence on the characteristics and resistance of the microbial population residing on the treated surfaces, were not elucidated. To this aim, the present work was addressed to study the impact of the PCHS approach on the microbiota ecosystem contaminating hospital surfaces, with a particular focus on the antibiotic resistance features of the contaminating population. In addition, we also investigated the safety of use of PCHS-Bacillus species, by monitoring both the potential acquisition of genetic resistances over time and their presence in HAIs patient.

The results showed that PCHS Bacillus spores have the ability to germinate on inanimate surfaces, and confirmed that PCHS Bacillus induce a profound abatement of the nosocomial pathogens on hospital surfaces. Notably, they did not induce resistance in the remaining microbial population, but rather they caused an impressive decrease in the antibiotic resistance genes originally present in the microbiota of the treated surfaces. Furthermore, PCHS Bacillus did not acquire resistance genes over time, suggesting that they are not inclined to have genetic exchange with the other bacteria, and they were not detected in the six HAIs patients analyzed, adding evidences that they can very rarely be associated to systemic pathological infections in hospitalized patients.