Healthcare environments are inevitably exposed to many different microorganisms, which can have negative repercussions for vulnerable patients, as well as causing premature deterioration and odours in frequently touched equipment. Regular cleaning and decontamination are essential to help reduce the bioburden of these microbes, but traditional disinfectants only offer limited residual activity once the surface dries, making them a ‘one-hit wonder’. In this article, we’ll take a look at how antimicrobial technologies can be built into the various materials typically found in patient areas during manufacture, complementing traditional cleaning in the fight against microbial growth and proliferation
Surface cleaning and handwashing
Programmes to control the spread of harmful microbes in healthcare facilities typically include thorough routine surface cleaning and handwashing practices, or simply using disposable equipment, but the direct patient environment is just as important for preventing the proliferation of these microorganisms. This extends right down to the furnishings, fabrics, and privacy curtains within each hospital cubicle or room. Inanimate surfaces can become soiled after contact with another contaminated surface, or from airborne sources, including nasal or respiratory droplets. Inadequate cleaning and sanitation can also allow microbes to adhere and thrive, leading to biofilm formation.
Complementary solutions for cleaner healthcare environments
Typical disinfectants only kill microbes present on a surface at the time of cleaning, and have limited residual activity once the treated surface dries. This means that microbial populations quickly rebound to their initial levels within just a few hours after cleaning. In addition to normal cleaning practices, antimicrobial technologies can be incorporated into products during manufacture, providing long-lasting protection that continuously inhibits the growth of harmful microorganisms for the duration of a product’s useful lifetime. The antimicrobial treatment does not wash off, wear away, or leach out of the product, complementing traditional regular cleaning, and enhancing both its durability and serviceable lifespan. In fact, studies have shown that built-in antimicrobial treatments in healthcare equipment reduce the population of bacteria – such as methicillin-resistant S. aureus (MRSA), E. coli, and VRE – by up to 99.9%.1 These technologies can be integrated into numerous high-touch surfaces in the direct patient environment, such as medical equipment, beds, uniforms, and control panels.
Issues with privacy curtains
Much effort has been made within healthcare to minimise the spread of bacteria by managing their growth on high-touch surfaces, including privacy curtains. Clinical curtains are designed to act as a physical and visual barrier, to give patients the privacy they need in a very public place. However, they are often touched by both patients and members of staff throughout the day, and thus do not stay fresh for long, and can quickly accumulate odours and unsightly stains. Additionally, privacy curtains may only be changed if they are visibly soiled, which can cause them to become a reservoir for microbes. As a case in point, one study found that 92% of hospital privacy curtains are contaminated with bacteria in less than a week of regular use.2 In 2002, an outbreak of multi-drug resistant Acinetobacter baumanii in an intensive care unit in Birmingham was directly linked to contaminated curtains and dry fabrics.3 Single-use products or excessive laundering can help curb the issue, but this is impractical, expensive, and bad for the environment.
Antimicrobial silver technology
Long-lasting cleanliness can be achieved with the help of antimicrobial silver technology – such as Microban’s SilverShield – which can be added to nonwoven fabrics at the stage of manufacture, actively eliminating bacterial growth on the surface of the curtain for its usable lifetime. The antimicrobial capacity of silver has been known for centuries, and it was even used in ancient medicine for applications such as wound dressings, long before the existence of microbes was understood. Silver ions are thought to interact with membrane-related enzymes to prevent the growth and proliferation of microbes, and their multi-modal attack reduces the risk of triggering the development of new drug-resistant strains. Silver ion technology demonstrates an inhibitory action against a wide range of both Gram-positive and Gram-negative bacterial strains, including MRSA, and is not affected by harsh cleaning chemicals. The antimicrobial additive is carefully balanced with other important curtain features, such as fire retardance, so that quality, safety, and material durability, are not sacrificed, giving patients and staff further reassurance
Putting healthcare’s best foot forward
Medical professionals and their uniforms can act as one of the most mobile vectors for microbes within hospitals; a study that looked at the uniforms of over 100 hospital staff found that up to 60% were colonised with bacteria, including multi-drug resistant microorganisms.4 In some countries, such as the UK, domestic laundering of scrubs is standard, which means that personnel may bring potentially harmful organisms home with them on a regular basis. In response to this high-risk situation, antimicrobial uniform footwear has been designed specifically for use by healthcare workers. The antimicrobial product protection is integrated into each shoe, so that it remains active even after general wear and tear or washing. This technology has been proven to be effective against a wide range of pathogens, including S. aureus, and thus helps to minimise the risk of cross-contamination between surfaces in healthcare settings, while improving the cleanliness of the shoes between washes.
Gaining the upper hand
Another built-in antimicrobial solution is zinc, which is recognised by the Biocidal Products Regulations in Europe for its broad-spectrum efficacy against bacteria and fungi. Zinc pyrithione technology – such as Microban’s ZPTech – has already been incorporated into hard-coated polyester films that can be used for graphics applications, including machineuser interfaces. This durable, scratchresistant film has been applied to a variety of high-touch surfaces in healthcare settings that often have a large microbial bioburden, such as door push panels, touchscreens, and handheld control sets for adjustable beds. The technology is not affected by the manufacturing processes, or continual everyday use, and thus remains effective for the usable lifetime of the item.
Looking ahead to a cleaner future
A systematic, multi-modal approach to cleaning is imperative in creating cleaner and more durable healthcare environments. Microbial control precautions in hospitals need to consider every possible vector and reservoir of contamination. Built-in antimicrobial product protection can make up for the limited residual activity offered by traditional disinfectants, helping to control the growth of the harmful microbes that also cause product deterioration, odours, and stains. These technologies can be added to both soft and hard furnishings, complementing regular cleaning strategies to ensure optimum microbial control and greater peace of mind.
Jonathan Clapp
Jonathan Clapp is the International senior technical manager at Microban. Leveraging more than 20 years’ experience in polymer engineering, he provides frontline technical support to product manufacturers across Europe and Asia. This includes overseeing the successful integration of antimicrobial additives into a range of products and surfaces within healthcare environments. He holds a BEng degree in Polymer Science and Technology
References
1 The Benefits of Antimicrobial Protection. Available from: https://www.microban. com/antimicrobial-solutions/overview/ benefits-of-antimicrobial-protection.
2 Ohl M. et al. Hospital privacy curtains are frequently and rapidly contaminated with potentially pathogenic bacteria. Am J Infect Control 2012; 40:904-906.
3 Das I. et al. Carbapenem-resistant Acinetobacter and role of curtains in an outbreak in intensive care units. J Hosp Infect 2002: 50 (2):110-114.
4 Wiener-Well Y et al. Nursing and physician attire as possible source of nosocomial infections. Am J Infect Control 2011: 39 (7):555-559.