A Probiotic-Based Sanitation System for the Reduction of Healthcare Associated Infections and Antimicrobial Resistances: A Budget Impact Analysis.

Rosanna Tarricone,Elisabetta Caselli,Sante Mazzacane,Luca Arnoldo,Carla Rognoni

doi:10.3390/pathogens9060502

Rosanna Tarricone, Elisabetta Caselli + Show 3 more

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https://doi.org/10.3390/pathogens9060502

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Abstract

Healthcare associated infections (HAIs) and antibiotic resistance have high social and economic burdens. Healthcare environments play an important role in the transmission of HAIs. The Probiotic Cleaning Hygiene System (PCHS) has been shown to decrease hospital surface pathogens up to 90% vs. conventional chemical cleaning (CCC). This study compares PCHS to CCC as to reduction of HAIs and their severity, related antibiotic resistances, and costs. Incidence rates of HAIs/antibiotic resistances were estimated from a previously conducted multicenter pre-post (6 months CCC + 6 months PCHS) intervention study, after applying the propensity score matching technique. A budget impact analysis compared the current scenario of use of CCC with future scenarios considering increasing utilization of PCHS, from 5% to 50% in the next five years, from a hospital perspective in Italy. The cumulative incidence of HAI was 4.6% and 2.4% (p < 0.0001) for CCC (N = 4160) and PCHS (N = 4160) (OR = 0.47, CI 95% 0.37–0.60), with severe HAIs of 1.57% vs. 1% and antibiotic resistances of 1.13% vs. 0.53%, respectively. Increased use of PCHS over CCC in Italian internal medicine/geriatrics and neurology departments in the next 5 years is expected to avert at least about 31,000 HAIs and 8500 antibiotic resistances, and save at least 14 million euros, of which 11.6 for the treatment of resistant HAIs. Innovative, environmentally sustainable sanitation systems, like PCHS, might substantially reduce antibiotic resistance and increase protection of health worldwide.

Highlights

In times of COVID-19, there is no better moment to talk of infectious diseases and antimicrobial resistance (AMR)
The study developed in two phases: a 6-month pre-intervention investigation phase, in which hospitals maintained conventional chemical cleaning (CCC) procedures based essentially on the use of chlorine-based products, and a 6-month intervention phase (PCHS), which involved the use of the Probiotic Cleaning Hygiene System (PCHS) system
Surveillance in 2018, the percentages of resistance to the main classes of Enterococcus faecalis, Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa antibiotics for the eight pathogens under surveillance (Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis, Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter species) remain higher than the European average, the trend is declining compared to previous years [6]

Summary

Introduction

In times of COVID-19, there is no better moment to talk of infectious diseases and antimicrobial resistance (AMR). AMR is a cause of serious concern for all healthcare organizations regarding clinical, social and economic costs, so much to be considered a real health emergency of the millennium. AMR happens when microorganisms, upon exposure to antimicrobial drugs, become resistant to Pathogens 2020, 9, 502; doi:10.3390/pathogens9060502 www.mdpi.com/journal/pathogens. Microorganisms that develop AMR are sometimes referred to as “superbugs”. The medicines become ineffective and infections persist in the body, increasing the risk of spread to others and the risk of death [1]. The Organisation for Economic Co-operation and Development (OECD) estimated that around

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