Reducing healthcare-associated infections incidence by a probiotic-based sanitation system: A multicentre, prospective, intervention study.

Elisabetta Caselli,Giovanni Villone,Nelso Trua,Sante Mazzacane,Silvio Brusaferro,Silvano Nola,Gabriele Pelissero,Filippo Berloco,Rosanna Tarricone,Alessandro Conte,Lorenzo Tognon,Luca Arnoldo,Maddalena Coccagna,Paola Antonioli,Vincenza La Fauci,John Conly

doi:10.1371/journal.pone.0199616

Abstract

Healthcare Associated Infections (HAI) are a global concern, further threatened by the increasing drug resistance of HAI-associated pathogens. On the other hand, persistent contamination of hospital surfaces contributes to HAI transmission, and it is not efficiently controlled by conventional cleaning, which does not prevent recontamination, has a high environmental impact and can favour selection of drug-resistant microbial strains. In the search for effective approaches, an eco-sustainable probiotic-based cleaning system (Probiotic Cleaning Hygiene System, PCHS) was recently shown to stably abate surface pathogens, without selecting antibiotic-resistant species. The aim of this study was to determine whether PCHS application could impact on HAI incidence. A multicentre, pre-post interventional study was performed for 18 months in the Internal Medicine wards of six Italian public hospitals (January 1st 2016—June 30th 2017). The intervention consisted of the substitution of conventional sanitation with PCHS, maintaining unaltered any other procedure influencing HAI control. HAI incidence in the pre and post-intervention period was the main outcome measure. Surface bioburden was also analyzed in parallel. Globally, 11,842 patients and 24,875 environmental samples were surveyed. PCHS was associated with a significant decrease of HAI cumulative incidence from a global 4.8% (284 patients with HAI over 5,930 total patients) to 2.3% (128 patients with HAI over 5,531 total patients) (OR = 0.44, CI 95% 0.35–0.54) (P<0.0001). Concurrently, PCHS was associated with a stable decrease of surface pathogens, compared to conventional sanitation (mean decrease 83%, range 70–96.3%), accompanied by a concurrent up to 2 Log drop of surface microbiota drug-resistance genes (P<0.0001; Pc = 0.008). Our study provides findings which support the impact of a sanitation procedure on HAI incidence, showing that the use of a probiotic-based environmental intervention can be associated with a significant decrease of the risk to contract a HAI during hospitalization. Once confirmed in larger experiences and other target populations, this eco-sustainable approach might be considered as a part of infection control and prevention (IPC) strategies.Trial registration—ISRCTN International Clinical Trials Registry, ISRCTN58986947.

Highlights

Healthcare-associated infections (HAIs) are a global concern impairing the clinical outcome of up to 15% of all hospitalized patients in the world [1]
A sanitation approach based on eco-sustainable detergents containing spores of Bacillus probiotics (Probiotic Cleaning Hygiene System, PCHS) was recently studied, showing that it is safe for hospitalized patients [26], it can stably decrease surface pathogens up to 90% more than conventional disinfectants [27, 28], and it does not select for resistant strains, rather reducing them [29], without increasing sanitation costs [27, 30]
11,842 patients were surveyed, all hospitalized in the Internal Medicine wards of the enrolled hospitals, this aimed to analyze the incidence of HAIs in a more homogeneous patients’ sample possible

Summary

Introduction

Healthcare-associated infections (HAIs) are a global concern impairing the clinical outcome of up to 15% of all hospitalized patients in the world [1]. The ‘health’ of hospital surfaces has been re-thought as the health of the human body, considering that, rather than eradicating all pathogens, replacing them by beneficial microbes might be more effective in preventing infections [24, 25] Toward this principle, a sanitation approach based on eco-sustainable detergents containing spores of Bacillus probiotics (Probiotic Cleaning Hygiene System, PCHS) was recently studied, showing that it is safe for hospitalized patients [26], it can stably decrease surface pathogens up to 90% more than conventional disinfectants [27, 28], and it does not select for resistant strains, rather reducing them [29], without increasing sanitation costs [27, 30]

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