An Overview of the Options for Antimicrobial Hard Surfaces in Hospitals

Abstract

Contaminated surfaces make an important contribution to the transmission of several important pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile and a number of resistant Gram-negative rods, including Acinetobacter baumannii. Several different approaches are available for improving hospital hygiene, including improving the effectiveness of existing methods and a range of new approaches, including novel disinfectants. A complimentary approach is the introduction of antimicrobial surfaces (AMS), which exert a continuous reduction on the level of microbial contamination on hospitals surfaces. There are several approaches to making a hospital surface ‘antimicrobial’: permanently ‘manufacture in’ an agent with antimicrobial activity; periodically apply an agent with antimicrobial activity; or physically alter the properties of a surface to make it less able to support microbial contamination and/or easier to clean. Promising options for AMS in healthcare settings include metals (principally copper or silver), chemicals (organosilanes, quaternary ammonium compounds, light-activated antimicrobials, and polycationic polymers) and physical alteration of the surface to reduce microbial attachment or improve cleanability. Before widespread adoption of AMS, promising candidates require rigorous in vitro and in situ assessment, including an evaluation of their clinical impact and cost effectiveness. Copper alloy surfaces are the most closely evaluated option for AMS, and have demonstrated in vitro activity against a range of pathogens (although their sporicidal capacity remains equivocal), evidence of efficacy in in situ studies and their introduction has been associated with a reduction in healthcare-associated infections (HAI). However, their long-term durability, acceptability and cost-effectiveness have not been evaluated formally. Finding and evaluating the optimal AMS will require a multidisciplinary approach, involving industrial partners, materials scientists, healthcare scientists and epidemiologists to refine and test the available options.