Hard-Surface Probiotics Hospital Test

Hard Surface Biocontrol in Hospitals Using Microbial- Based Cleaning Products Alberta Vandini 1 , Robin Temmerman 2,3 , Alessia Frabetti 1 , Elisabetta Caselli 4 , Paola Antonioli 5 , Pier Giorgio Balboni 4 , Daniela Platano 6 , Alessio Branchini 7 , Sante Mazzacane 1 * 1 CIAS Laboratory, Centre for the Study of physical, chemical and microbiological Contamination of Highly Sterile Environments, Department of Architecture, University of Ferrara, Ferrara, Italy, 2 Laboratory of Microbial Ecology and Technology, Ghent University, Ghent, Belgium, 3 Chrisal R & D Department, Lommel, Belgium, 4 Department of Medical Sciences, Microbiology Section, University of Ferrara, Ferrara, Italy, 5 Department of Infection Prevention Control and Risk Management, Ferrara University Hospital, Ferrara, Italy, 6 Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy, 7 Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy Background: Healthcare-Associated Infections (HAIs) are one of the most frequent complications occurring in healthcare facilities. Contaminated environmental surfaces provide an important potential source for transmission of many healthcare- associated pathogens, thus indicating the need for new and sustainable strategies. Aim: This study aims to evaluate the effect of a novel cleaning procedure based on the mechanism of biocontrol, on the presence and survival of several microorganisms responsible for HAIs (i.e. coliforms, Staphyloccus aureus , Clostridium difficile , and Candida albicans ) on hard surfaces in a hospital setting. Methods: The effect of microbial cleaning, containing spores of food grade Bacillus subtilis , Bacillus pumilus and Bacillus megaterium , in comparison with conventional cleaning protocols, was evaluated for 24 weeks in three independent hospitals (one in Belgium and two in Italy) and approximately 20000 microbial surface samples were collected. Results: Microbial cleaning, as part of the daily cleaning protocol, resulted in a reduction of HAI-related pathogens by 50 to 89%. This effect was achieved after 3–4 weeks and the reduction in the pathogen load was stable over time. Moreover, by using microbial or conventional cleaning alternatively, we found that this effect was directly related to the new procedure, as indicated by the raise in CFU/m 2 when microbial cleaning was replaced by the conventional procedure. Although many questions remain regarding the actual mechanisms involved, this study demonstrates that microbial cleaning is a more effective and sustainable alternative to chemical cleaning and non-specific disinfection in healthcare facilities. Conclusions: This study indicates microbial cleaning as an effective strategy in continuously lowering the number of HAI- related microorganisms on surfaces. The first indications on the actual level of HAIs in the trial hospitals monitored on a continuous basis are very promising, and may pave the way for a novel and cost-effective strategy to counteract or (bio)control healthcare-associated pathogens. Citation: Vandini A, Temmerman R, Frabetti A, Caselli E, Antonioli P, et al. (2014) Hard Surface Biocontrol in Hospitals Using Microbial-Based Cleaning Products. PLoS ONE 9(9): e108598. doi:10.1371/journal.pone.0108598 Editor: Gabriele Berg, Graz University of Technology (TU Graz), Austria Received May 25, 2014; Accepted August 23, 2014; Published September 26, 2014 Copyright: ! 2014 Vandini 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. Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files. Funding: This research was financially supported by COPMA scrl, Chrisal NV and the Flemish Institute for the Promotion of Innovation by Science and Technology (IWT - Vlaanderen, Brussels, Belgium). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors declare that they received funding from the Copma scrl commercial company, and that Dr. Robin Temmerman is affiliated to a commercial funder of this study (Chrisal, Lommel, Belgium). This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials. * Email: sante.mazzacane@unife.it Abstract

Introduction Healthcare-Associated Infections (HAIs) are one of the most frequent complications occurring in healthcare facilities and represent a problematic concern regarding the safety and quality of healthcare worldwide [1], as also stated in a recent report by the World Health Organization estimating hospital-wide prevalence in high-income countries at 8% [2]. The European Center for Disease Control point prevalence study confirmed that healthcare- associated infections are a major public health problem in Europe

with a prevalence of 5.7% (4.5–7.4%) which means 81.089 (64.624–105.895) patients with one HAI for each day in European acute care hospitals [3]. In particular, this European survey reported a similar estimation of nosocomial infections for Italy and Belgium, where the percentage of patients with HAIs has been calculated as 6.3% (5.4–7.4%) and 7.1% (6.1–8.3%), respectively [1]. Based on this study, the estimated total annual number of patients with an HAI in European acute care hospitals in 2011– 2012 was 3.2 million, albeit with a wide confidence interval from

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September 2014 | Volume 9 | Issue 9 | e108598

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