Bioburden Levels Research Articles

Enhanced exploration of the mode of action of a five-layer foam dressing: critical properties to support wound healing.

The aim of this in vitro experimental series was to explore the mode of action of a hydrocellular polyurethane foam dressing (HPFD) and how its advanced features support beneficial interactions with the wound bed to address common barriers to wound healing, thus supporting improved clinical outcomes. Multiple in vitro microbiological tests were performed, assessing prevention of bacterial ingress, surface removal of bacteria, bacterial sequestration and retention into the dressing in a clinically relevant environment. Odour molecule concentrations were measured using gas chromatography and further assays explored matrix metalloproteinase (MMP)-9 retention in the dressing using enzyme linked immunosorbent assay. The HPFD demonstrated marked reductions in bioburden levels across multiple tests. These included prevention of bacterial ingress for seven days, removal of surface bacteria and absorption into the dressing. Further tests identified that most bacteria were sequestered into the hyperabsorbent layer (90.5% for Pseudomonas aeruginosa and 89.6% for meticillin-resistant Staphylococcus aureus). Moreover, the majority of bacteria (99.99% for both test organisms) were retained within the dressing, even upon compression. Additional tests demonstrated a marked reduction of odour molecules following incubation with HPFD and total retention of protease MMP-9 within the dressing. Proactive management of the wound environment with an appropriate advanced wound dressing, such as the HPFD examined in these in vitro investigations, can not only help to minimise the barriers to healing, as observed across this test series by direct interaction with the wound bed, but may, as a result, provide an ideal environment for wound progression with minimal disturbance.

Multimodal imaging device to comprehensively assess infection, oxygenation, and wound analytics-A pilot study.

Wound analytics, infection detection, and oxygenation measurement are the three critical prerequisites for appropriate wound care. Although devices that rapidly detect the above-mentioned parameters independently exist, there is no single point-of-care device that is enabled with all the three functionalities. Through this study, we are introducing and evaluating the performance of Illuminate Pro Max-a novel, rapid, hand-held non-contact, point-of-care multimodal imaging device that is equipped to measure the three wound assessment parameters. Here, a total of 60 diabetic foot ulcer patients were imaged using Illuminate Pro Max to detect bioburden and measure StO2 levels and wound dimensions (size and depth). The results were further evaluated against the current gold standard technique for each parameter, that is, culture test to detect bioburden, a transcutaneous oxygen pressure (TcPO2) measuring device-Perimed Periflux 5000 to measure oxygenation, and paper ruler to measure wound size. Culture tests reported 42 samples as infection-positive and 18 samples as infection-negative. On comparing with the culture report, the device showed 88% sensitivity and 86% PPV in detecting the bioburden. Wound dimensions (length and width) were comparable with the paper scale measurements. Wound depth was also reported by the device. The StO2 map generated by the device depicted the tissue oxygenation levels in various regions of the wound. In conclusion, this novel, comprehensive point-of-care multispectral imaging device can be an effective tool for rapid wound assessment which can help in prompt treatment.

Risk-based approach to setting sterile filtration microbial bioburden limits – Focus on biotech-derived products

Holistic concepts should be applied that reduce risks prior to final bioburden testing and sterile filtration, based on enhanced process and product attribute understanding, which could be key to successful bioburden risk management.Key findings of this paper include:oBioburden control and monitoring prior to filter sterilization is necessary for any thermolabile parenteral drug product that cannot be terminally sterilized in the final container. The bioburden limit applied prior to filter sterilization, as recommended in the 2019 EMA guideline “The sterilisation of the medicinal product, active substance, excipient and primary container”, can be interpreted as a specification (i.e., pass/fail criterion) regardless of the sterilizing filter capacity and risk mitigation measures applied during manufacture. It is proposed to interpret the guidance given by the EMA as an action limit of ≤10 CFU/100 mL.oPre-filtration and post-filtration risks and control measures are inter-correlated and should be addressed via an integrated risk assessment. This includes selection of sample test volume, acceptable bioburden levels and sterilizing filter area.oA holistic approach to bioburden risk is recommended, using a two-tier system for low bioburden monitoring prior to sterilization. A low alert level (product/facility history) and a higher action level, at or below the EMA criterion would be appropriate. It is proposed that any excursion warrants a thorough investigation and a case-by-case assessment for product quality impact rather than default rejection.oThe paper describes how detectable bioburden may be mitigated through subsequent effective sterilizing filtration, if the potential for bacterial by-products and their impact on safety and protein stability is assessed.oAs the manufacturing process is highly controlled to limit the potential for bioburden growth prior to filter sterilization, sample volumes less than 100 mL and alternative acceptance levels to ≤10 CFU/100 mL can be justified on the basis of the actual sample subject to testing. This is particularly relevant for small volume product batches.oTesting of bioburden prior to sterile filtration is not the only measure to control the microbial status and to generate sterile product but is a monitoring tool to verify efficacy of the control measures.

Toplam Biyolojik Yük Sayısı için Kontrol Tablosu Yaklaşımını Kullanarak Belediye Dağıtım Hattının Mikrobiyolojik Stabilite Değerlendirmesi

Background: The microbiological quality of municipal water is an important inspection characteristic that must be carefully monitored and controlled to ensure the delivery of acceptable water that is safe for human activities, consumption and further processing. Case presentation: The current case demonstrated the implementation of a special type of attribute control chart for the examination and analysis of long-term data trends of water distribution in a healthcare facility from different pints-of-use. All datasets showed a right-skewed dispersion pattern of data indicating solitary intermittent high values but without any observable Out-Of-Specification (OOS). All water lines failed to follow any known distribution pattern without the need for transformation which had improved the normality and removed the outliers from datasets. The direct approach for visualizing the record of microbiological results was accomplished using Laney-attribute charts. Discussion: Each use point had its unique trend of data by visualizing the mean, pattern, the Upper Control Limit (UCL) and the alarm types. The net quality of the water distribution system in the facility could be deduced from the overall readings that had been averaged and pooled in a single process-behavior chart. Implementation of this trending chart showed a tendency of oscillation pattern for bioburden count that tended to seize in amplitude with possible signs of seasonality. Conclusion: In general, the overall biological stability is improving with time in terms of the Total Microbial Aerobic Count (TAMC). The Bioburden level and the magnitude of fluctuations were decreasing according to the latest monitoring state.

Applied Approach for Assessing Bioburden of the Mars 2020 Parachute Assembly.

The Mars 2020 mission delivered the Perseverance rover to the surface of Mars using a supersonic parachute manufactured at Airborne Systems, California. The Mars 2020 spacecraft, including the flight parachute, was subject to Planetary Protection spore bioburden compliance. Many previous missions with similar parachutes applied manufacturing specifications for calculating bioburden. Although the Mars 2020 parachute was manufactured in an uncontrolled environment, preliminary sampling of a flight-like parachute manufactured in the same facility suggested that the actual spore bioburden levels were potentially orders of magnitude lower than specification values for uncontrolled manufacturing (100,000 spores/m2). Several experiments were designed and carried out throughout the project timeline in an effort to estimate a representative bioburden for the flight parachute. Tests were performed on various parachute materials, including direct sampling and destructive assays of proxy materials. Different bioburden densities were applied to large continuous areas of the canopy, which experienced minimal handling, and seamed areas of the parachute that were likely to experience more handling during the stitching process. In addition, an approach to account for various thermal zones was developed and applied toward calculating log reduction for the parachute assembly. These various methods that were used toward different areas and materials of the Mars 2020 flight parachute provided a nuanced and data-backed estimate of spore bioburden density that can be adopted by future missions.

Environmental Cleaning and Drug-Resistant Bacteria

<p>環境清潔落實與否在預防和控制醫療照護相關感染方面扮演著重要的作用，首先，環境清潔可以減少病原體的存活和繁殖，特別是常見的抗藥性細菌。定期清潔和消毒病房、手術室、護理站等高風險區域，可以有效地減少微生物的存活和繁殖，同時減少醫護人員和病人接觸到病原體的機會，進而減少醫療照護相關感染的發生率，疾病管制署於104年11月公告醫療機構環境清潔感染管制措施指引，衛生福利部自105年病人安全目標六-落實感染管制，其執行策略：定期環境清潔機制，107年更具體地明訂需執行監測環境清潔品質。由此可見，落實環境清潔及有效之監測是感染管制非常重要的一環。目前常用於醫院環境清消品質監測的方式主要分為三類，包括：目視觀察評量法、螢光標示檢測法、微生物負荷殘留檢測法，已有許多文獻發表，透過前述的環境清潔監測方式可改善清潔人員環境清潔落實程度與降低細菌的移生及感染，因此醫療機構必須加強落實環境清潔，進行定期的消毒和清洗，以減少病原體和病菌的存活和繁殖。這可以減少病人感染病原體和病菌的風險，同時減少抗藥性菌株的傳播和擴散。</p> <p> </p><p>Environmental cleaning is key in preventing and controlling health care–associated infections. First, environmental cleaning can reduce the survival and reproduction of pathogens, especially those of common drug-resistant bacteria. The regular cleaning and disinfection of high-risk areas, such as wards, operating rooms, and nursing stations, can effectively reduce bioburden levels. An excellent cleaning environment reduces the risk of medical staff and patients being exposed to pathogens, thereby reducing the incidence of medical care–associated infections. Cleanliness is a goal of disease safety and an strategy for implementing infection control. Since 2017, various stipulations pertaining to the monitoring of environmental cleanliness quality have been implemented. The implementation of environmental cleaning and effective monitoring are crucial aspects of infection control and prevention. At present, the methods commonly used to monitor the quality of hospital environmental cleanliness can mainly be divided into three categories, namely visual observation, fluorescent labeling and detection, and microbial load residue detection. Numerous studies have explored the aforementioned environmental cleaning and monitoring methods and reported that they improved the quality of environmental cleaning by cleaning personnel and reduced bacterial colonization and the spread of bacterial infections or contamination. Accordingly, health care facilities must strengthen their environmental cleaning processes and conduct regular cleaning and disinfection to reduce the survival and reproduction of pathogens. These measures reduce the risk of patients contracting pathogens and the risk of resistant strains spreading.</p> <p> </p>

Assessment of microbial bioburden on portable medical equipment in a hospital setting.

Although routine disinfection of portable medical equipment is required in most hospitals, frontline staff may not be able to disinfect portable medical equipment at a rate that adequately maintains low bioburden on high-use equipment. This study quantified bioburden over an extended time period for two types of portable medical equipment, workstations on wheels and vitals machines, across three hospital wards. Bioburden was quantified via press plate samples taken from high touch surfaces on 10 workstations on wheels and 5 vitals machines on each of 3 medical surgical units. The samples were taken at three timepoints each day over a 4-week period, with random rotation of timepoints and portable medical equipment, such that frontline staff were not aware at which timepoint their portable medical equipment would be sampled. The mean bioburden from the different locations and portable medical equipment was estimated and compared with Bayesian multilevel negative binomial regression models. Model estimated mean colony counts (95% credible interval) were 14.4 (7.7-26.7) for vitals machines and 29.2 (16.1-51.1) for workstations on wheels. For the workstations on wheel, colony counts were lower on the mouse, 0.22 (0.16-0.29), tray, 0.29 (0.22, 0.38), and keyboard, 0.43 (0.32-0.55), when compared to the arm, as assessed by incident rate ratios. Although routine disinfection is required, bioburden is still present across portable medical equipment on a variety of surfaces. The difference in bioburden levels among surfaces likely reflects differences in touch patterns for the different portable medical equipment and surfaces on the portable medical equipment. Although the association of portable medical equipment bioburden to healthcare-associated infection transmission was not assessed, this study provides evidence for the potential of portable medical equipment as a vector for healthcare-associated infection transmission despite hospital disinfection requirements.

Performance equivalence and validation of a rapid microbiological method for detection and quantification of yeast and mold in an antacid oral suspension.

Alternative and rapid microbiological methods are effective and profitable technologies that can be safely use in the pharmaceutical industry. This report studies the efficacy of the Soleris® direct yeast and mold automated method for the quantitative detection of C. albicans and A. brasiliensis at three different microbial bioburden. Validation testing was carried out using an antacid oral suspension (aluminum hydroxide 4% + magnesium hydroxide 4% + simethicone 0.4%). Equivalence of data between detection time vs. colony-forming units was established for both, alternative and conventional methodologies. Using probability of detection, linear Poisson regression, Fisher's test, and multifactorial analysis of variance ANOVA, all results from the rapid method were prove to be in statistical agreement with the reference plating procedures. The limits of detection and quantification were statistically similar for both methods (Fisher's exact test, P >0.05), showing that the alternative method was not inferior in performance to the reference method. Essential validation parameters such as precision (standard deviation < 5, coefficient of variance < 35%), accuracy (>70%), linearity (R2 >0.9025), and ruggedness (ANOVA, P <0.05) were determined. It was proved that all test results obtained from the alternative method were in statistical agreement with the standard plate count method. Thus, this new technology was found to meet all the validation criteria needed to be considered as an alternative method for yeast and mold quantification in the antacid oral suspension tested.

1187. Analysis of the Clonal Recovery Pattern of Enterococcus faecium to Evaluate the Efficacy of Pulsed Xenon Ultraviolet Light (PX-UV) in Bioburden Reduction

Abstract Background Enterococcus faecium (E. faecium) is a common hospital-associated infection (HAI) that can lead to increased costs, morbidity, and mortality. Pulsed Xenon Ultraviolet light (PX-UV) has been shown to reduce bacterial bioburden levels on surfaces. This study aims to assess the effect of the addition of PX-UV to terminal cleaning on the clonal recovery of E. faecium sequence types (STs) using Whole Genome Sequencing (WGS) on patient isolates. Methods During 2017 to 2020 a prospective, randomized, double-blinded, sham-controlled, interventional, crossover trial in 2 separate Detroit hospitals (H1 and H2) compared HAI counts after the addition of either PX-UV or a non-UV sham device to terminal cleaning methods. The trial consisted of a total of 16 units randomized to have either the treatment of PX-UV (Group Q) or the sham control device with no UV (Group W) for 12 months. A washout period (Group R) of 6 months followed and the trial concluded with a 12-month crossover of treatments. A total of 60 E. faecium samples were collected, then WGS was performed by the Illumina Nextseq 550 instrument. de novo assembly was preformed using the SPAdes program. Whole Genome Multilocus Sequence Type (wgMLST) analysis was performed by BioNumerics (v7.6) to construct minimum spanning tree (MST). Results A total of 7 STs were obtained across the 2 hospitals (H1 and H2). ST117, ST17, and ST80 all had more than 10 total recovered isolates, ST117 being the most frequent with 24 isolates. Less than 3 isolates were recovered for all other STs. For all STs, Group Q (PX-UV) had 14, Group R (washout period) had 22, and Group W (non-UV sham) had 24. ST18 was only found in Group Q. ST412, ST584, and ST736 were not found in Group W. The data shows that the intervention PX-UV group had a reduction of clonal recovery by 10 STs as compared to the sham UV group. Table 1:Total number of each sequence type (ST) in H1 and H2 Conclusion The overall reductions in the number of isolates in the real UV units was driven by reductions in the ST117 a predominant strain in a hospital environment reported previously in Detroit and ST80. There were negligible differences in recovery of other ST between the groups. The reduction in clonal recovery of E. faecium isolates in Group Q as compared to Group R might be related to use of PX-UV following terminal room cleaning. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System Keith S. Kaye, MD, MPH, Allecra: Advisor/Consultant|GlaxoSmithKline plc.: Receiving symposia honoraria|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502|Merck: Advisor/Consultant|qpex: Advisor/Consultant|Shionogi: Grant/Research Support|Spero: Advisor/Consultant Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.

Observational study of sterile field bioburden levels during orthopedic arthroplasty surgery in operating rooms complying with current United States ventilation specifications

Airborne contamination from microbe carrying particles (MCPs) is a risk factor for devastating early onset periprosthetic joint infection(PJIs). There are no published guidelines to quantify this risk factor for PJI events. This observational cohort project addresses this gap and utilizes a simple passive system to produce quantitative data from 80 total joint replacement cases performed in operating rooms built to current USA standards. A petri dish-based system inspired by industrial cleanroom technology was deployed. Surgical helmet systems (SHSs) and strict protocols were used in all cases. 450 MCPs/m2 was used as a cutoff for bioburden. This benchmark corresponds to the ultraclean air standard of 10 MCPs/m3. 75/80 cases (94%) achieved desired benchmark levels of bioburden at the wound zone compared to only 52/80 (65%) of back table zones. No surgical site infections (SSI) or PJI events (0/80; 95% CI, 0.00-3.68%) at minimum 18-month (average 25.8 months) follow-up were detected. The current USA ventilation design uses low velocity airflow and appears to achieve ultraclean air conditions at the surgical site but requires SHSs and strict protocols. Higher contamination levels seen in back tables are consistent with this design. This settle plate system may be useful for early onset PJI event investigations and thus lower the incidence of these complications.

Challenges Encountered in the Implementation of Bio-Fluorescent Particle Counting Systems as a Routine Microbial Monitoring Tool.

The transition from traditional growth-based microbial detection methods to continuous bio-fluorescent particle counting methods represents a paradigm shift, because the results will be non-equivalent in terms of microbial counts, and a continuous, rather than periodic, data stream will be available. Bio-fluorescent particle counting technology, a type of rapid microbiological method, uses the detection of the intrinsic fluorescence of microbial cells to enumerate bioburden levels in air or water samples, continuously. The reported unit is commonly referred to as an autofluorescence unit, which is not dependent upon growth, as is the traditional method. The following article discusses challenges encountered when implementing this modern technology, and the perspective from a consortium of four industry working groups on navigating these challenges.

The production of Necator americanus larvae for use in experimental human infection

BackgroundAlthough there is unprecedented interest in experimental human hookworm infection, details of hookworm manufacture and characterisation have been sparsely reported. In this report, we detail the production and characterisation of Necator americanus larvae for use in a recently published clinical trial.MethodsFaeces was obtained from an experimentally infected donor. Faecal hookworm DNA was determined by quantitative PCR. Paired samples were incubated in either sterile water or sterile water mixed with antimicrobials (amphotericin and gentamicin). Coproculture was performed by modified Harada-Mori method. The harvested larvae were then processed in either sterile water or antiseptic solution. Larval yield was then calculated (larvae per gram), larval viability was determined by thermally induced motility assay and microbial burden was determined at the day of harvest, at 48 h and at 7 days.ResultsTwenty-eight faecal cultures were performed over 16 months. The faecal hookworm DNA content was variable over this time. There was no association of larval yield with faecal hookworm DNA content. Pre-treatment of faeces with antimicrobials did not influence larval yield. Larval motility was 85.3% (95% CI 79.3–91.3%). Incubation of larvae in antiseptics did not reduce viability at 14 days with a marginal mean of 68.6% (95% CI 59.1–78.1%) washed in water vs. 63.3% (95% CI 53.8 – 72.9%) when incubated in betadine (p = 0.38). Larvae washed in sterile water did not meet microbial bioburden criteria. Incubation in antiseptic resulted in acceptable microbial bioburden at 48 h but not at 7 days. Although the addition of gentamicin did reduce the microbial bio-burden acceptable levels, it was found to significantly lower larval motility at 7 days compared to incubation in sterile water and motility at 7 days 37.8% (95% CI 4.7–70.9%) vs. 67.3% (95% CI 35.2–99.3%, p < 0.001), respectively.ConclusionsDespite standardised culture methodologies and the use of a single donor, larval yield varied considerably between batches and had no association with faecal hookworm DNA. Larval viability decreases over time and the age of larvae at time of use are likely to be important. Microbial bioburden maybe temporarily reduced by incubation in antiseptics and has little effect on viability. Incubation of larvae in gentamicin is effective at reducing microbial bioburden but is deleterious to larval viability.Graphical

9 Environmental Contamination Reduction Following Standard, Enhanced, and a Novel Cleaning Protocol in a Burn Center

IntroductionBurn patients are extremely vulnerable to hospital acquired infections, some of which may originate from environmental surfaces. Enhanced cleaning practices of surfaces varies from hospital to hospital. In a burn unit, patients are frequently exposed to multiple environments including the patient room, hydrotherapy and treatment rooms (treatment spaces), and the operating room. We sought to evaluate the efficacy of current protocols, including standard cleaning (SC) and cleaning with ultraviolet light application (C+UV) in the patient rooms and treatment spaces, and compare to a novel Hybrid Hydrogen Peroxide (HHP) fogging system in the patient rooms.MethodsThis study was conducted at a regional 12-bed verified adult and pediatric burn center that functions as an intensive care unit and step-down unit, where patients stay during their entire admission. Data from December 2020 to June 2021 was collected from rooms following 17 patient discharges with a minimum of a 2-week hospital stay. Data was collected from 5 preset locations in the patient rooms following either SC or C+UV and after HHP fogging. Baseline data was also collected from 20 preset locations in the treatment spaces following SC and C+UV. Quantitative and qualitative counts (aerobic colony county [ACC], adenosine triphosphate [ATP]), hydrogen peroxide chemical indicators (CIs) and bacterial spore biological indicators (G. stearothermophilus 1x106 spores) were measured.ResultsNo statistically significant difference between SC and C+UV was seen (mean ACC 7.16 and 6.35 respectively; p=0.186). ACC levels were reduced following HHP fogging demonstrating a 98% improvement over SC and C+UV (mean ACC 0.14; p< 0.0001). ATP demonstrated an 88% reduction after HHP fog without manual cleaning. Biological indicators confirmed a 1x106 reduction of bacterial spores, and CIs verified a thorough migration of HHP fog throughout the patient room. Baseline sampling of the treatment spaces following SC and C+UV resulted in a range of 0-70 ACC over 38 swabbed locations, consistent with ACC levels measured in patient rooms (range 0-153). An industry-known location for high bioburden, one sink backsplash swabbed on two separate occasions resulted in >5,700 ACC.ConclusionsIn patient rooms, HHP fogging resulted in a significant reduction in ACC compared to current protocols of SC and C+UV. Baseline sampling of the treatment spaces resulted in ACC levels similar or greater in range to those seen in the patient room, indicating a similar reduction in bioburden levels could be achieved through implementation of HHP fogging. The efficacy and feasibility of HHP fogging in a patient room setting within a burn unit suggests that a protocol for the use of HHP fogging for treatment spaces will likewise be beneficial.

Introduction of Probiotic-Based Sanitation in the Emergency Ward of a Children's Hospital During the COVID-19 Pandemic.

BackgroundAntimicrobial resistance (AMR) represents a major threat to public health, especially in the hospital environment, and the massive use of disinfectants to prevent COVID-19 transmission might intensify this risk, possibly leading to future AMR pandemics. However, the control of microbial contamination is crucial in hospitals, since hospital microbiomes can cause healthcare-associated infections (HAIs), which are particularly frequent and severe in pediatric wards due to children having high susceptibility.AimWe have previously reported that probiotic-based sanitation (PCHS) could stably decrease pathogens and their AMR in the hospital environment, reduce associated HAIs in adult hospitals, and inactivate enveloped viruses. Here, we aimed to test the effect of PCHS in the emergency room (ER) of a children’s hospital during the COVID-19 pandemic.MethodsConventional chemical disinfection was replaced by PCHS for 2 months during routine ER sanitation; the level of environmental bioburden was characterized before and at 2, 4, and 9 weeks after the introduction of PCHS. Microbial contamination was monitored simultaneously by conventional culture-based CFU count and molecular assays, including 16S rRNA NGS for bacteriome characterization and microarrays for the assessment of the resistome of the contaminating population. The presence of SARS-CoV-2 was also monitored by PCR.Results and conclusionsPCHS usage was associated with a stable 80% decrease in surface pathogens compared to levels detected for chemical disinfection (P < 0.01), accompanied by an up to 2 log decrease in resistance genes (Pc < 0.01). The effects were reversed when reintroducing chemical disinfection, which counteracted the action of the PCHS. SARS-CoV-2 was not detectable in both the pre-PCHS and PCHS periods. As the control of microbial contamination is a major issue, especially during pandemic emergencies, collected data suggest that PCHS may be successfully used to control virus spread without simultaneous worsening of the AMR concern.

Environmental Contamination of Contact Precaution and Non-Contact Precaution Patient Rooms in Six Acute Care Facilities.

Environmental contamination is an important source of hospital multidrug-resistant organism (MDRO) transmission. Factors such as patient MDRO contact precautions (CP) status, patient proximity to surfaces, and unit type likely influence MDRO contamination and bacterial bioburden levels on patient room surfaces. Identifying factors associated with environmental contamination in patient rooms and on shared unit surfaces could help identify important environmental MDRO transmission routes. Surfaces were sampled from MDRO CP and non-CP rooms, nursing stations, and mobile equipment in acute care, intensive care, and transplant units within 6 acute care hospitals using a convenience sampling approach blinded to cleaning events. Precaution rooms had patients with clinical or surveillance tests positive for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae or Acinetobacter within the previous 6 months, or Clostridioides difficile toxin within the past 30 days. Rooms not meeting this definition were considered non-CP rooms. Samples were cultured for the above MDROs and total bioburden. Overall, an estimated 13% of rooms were contaminated with at least 1 MDRO. MDROs were detected more frequently in CP rooms (32% of 209 room-sample events) than non-CP rooms (12% of 234 room-sample events). Surface bioburden did not differ significantly between CP and non-CP rooms or MDRO-positive and MDRO-negative rooms. CP room surfaces are contaminated more frequently than non-CP room surfaces; however, contamination of non-CP room surfaces is not uncommon and may be an important reservoir for ongoing MDRO transmission. MDRO contamination of non-CP rooms may indicate asymptomatic patient MDRO carriage, inadequate terminal cleaning, or cross-contamination of room surfaces via healthcare personnel hands.

Systems View of Deconditioning During Spaceflight Simulation in the PlanHab Project: The Departure of Urine 1 H-NMR Metabolomes From Healthy State in Young Males Subjected to Bedrest Inactivity and Hypoxia.

We explored the metabolic makeup of urine in prescreened healthy male participants within the PlanHab experiment. The run-in (5 day) and the following three 21-day interventions [normoxic bedrest (NBR), hypoxic bedrest (HBR), and hypoxic ambulation (HAmb)] were executed in a crossover manner within a controlled laboratory setup (medical oversight, fluid and dietary intakes, microbial bioburden, circadian rhythm, and oxygen level). The inspired O2 (FiO2) fraction next to inspired O2 (PiO2) partial pressure were 0.209 and 133.1 ± 0.3 mmHg for the NBR variant in contrast to 0.141 ± 0.004 and 90.0 ± 0.4 mmHg (approx. 4,000 m of simulated altitude) for HBR and HAmb interventions, respectively. 1H-NMR metabolomes were processed using standard quantitative approaches. A consensus of ensemble of multivariate analyses showed that the metabolic makeup at the start of the experiment and at HAmb endpoint differed significantly from the NBR and HBR endpoints. Inactivity alone or combined with hypoxia resulted in a significant reduction of metabolic diversity and increasing number of affected metabolic pathways. Sliding window analysis (3 + 1) unraveled that metabolic changes in the NBR lagged behind those observed in the HBR. These results show that the negative effects of cessation of activity on systemic metabolism are further aggravated by additional hypoxia. The PlanHab HAmb variant that enabled ambulation, maintained vertical posture, and controlled but limited activity levels apparently prevented the development of negative physiological symptoms such as insulin resistance, low-level systemic inflammation, constipation, and depression. This indicates that exercise apparently prevented the negative spiral between the host’s metabolism, intestinal environment, microbiome physiology, and proinflammatory immune activities in the host.

Application of a Continuously Active Antimicrobial Surface Coating in Two Professional Sports Training Facilities

Background: The role of surface contamination in infections is of interest in healthcare as well as other industries, especially where infections incur high cost. One such industry is professional sports, where infections pose significant risks to players and the organizations that employ them. Sports training facilities experience highly variable occupancy rates due to differing seasonal activities, presenting a measurement challenge because the relationship between occupancy and surface contamination is not well described. In a recent publication, a continuously active antimicrobial (CAA) surface coating demonstrated a reduction in bacterial bioburden in ICUs alongside a reduction in healthcare-associated infections (HAIs). Objective: We investigated the impact of a CAA surface coating on bioburden in 2 professional sports training facilities, despite changes in occupancy. Methods: A CAA surface coating was applied using an electrostatic sprayer to all surfaces in both facilities during a period of high-occupancy at facility A and during low occupancy at facility B. Surface cultures were taken using 3M Sponge-Sticks from lockers, gym equipment, and physiotherapy surfaces before treatment, 4–13 weeks after treatment at facility A and 4–23 weeks after treatment at facility B. Total aerobic bacteria counts were obtained by plating on tryptic soy agar, and geometric means of aerobic plate counts (APCs) were used to compare bioburden before and after treatment at both facilities and for an out-of-efficacy period at facility B (17–23 weeks). Occupancy rates were monitored as person days per week (pd/w) over the course of the study. Results: APC counts at facility A decreased 61% (585 CFU/100 cm2 to 226 CFU/100 cm2) from baseline to posttreatment, and occupancy remained constant (165 pd/w to 171 pd/w). At facility B, there was no significant change in APC (76 CFU/100 cm2 to 80 CFU/100 cm2), although occupancy increased &gt;13,000% during the treatment period (3 pd/w to 386 pd/w). During the out-of-efficacy period at facility B, total bacteria increased 170% (217 CFU/100 cm2) compared to the treatment period, and the occupancy remained relatively constant (344 pd/w). Conclusions: Levels of bioburden were significantly influenced by the application of the CAA surface coating, especially considering the variation in occupancy in both facilities before, during, and after the efficacy period. Facility A saw a significant reduction in bioburden during the treatment period (P &lt; .0001), and a significant increase was observed at facility B during the out-of-efficacy period (P &lt; .0001) despite constant occupancy rates, demonstrating the ability of the surface coating to reduce bioburden levels despite large changes in occupancy.Funding: Allied BioScience, Inc, provided Funding: for this study.Disclosures: Gavri Grossman, Valerie Beck, and Daniel S Watson report salary from Allied BioScience.

The impact of negative‐pressure wound therapy with instillation on wounds requiring operative debridement: Pilot randomised, controlled trial

Presence of bacteria in wounds can delay healing. Addition of a regularly instilled topical solution over the wound during negative‐pressure wound therapy (NPWT) may reduce bioburden levels compared with standard NPWT alone. We performed a prospective, randomised, multi‐centre, post‐market trial to compare effects of NPWT with instillation and dwell of polyhexamethylene biguanide solution vs NPWT without instillation therapy in wounds requiring operative debridement. Results showed a significantly greater mean decrease in total bacterial counts from time of initial surgical debridement to first dressing change in NPWT plus instillation (n = 69) subjects compared with standard NPWT (n = 63) subjects (−0.18 vs 0.6 log10 CFU/g, respectively). There was no significant difference between the groups in the primary endpoint of required inpatient operating room debridements after initial debridement. Time to readiness for wound closure/coverage, proportion of wounds closed, and incidence of wound complications were similar. NPWT subjects had 3.1 times the risk of re‐hospitalisation compared with NPWT plus instillation subjects. This study provides a basis for exploring research options to understand the impact of NPWT with instillation on wound healing.

Airborne Decontamination of an Intensive Care Isolation Room using 405 nm Antimicrobial Light Technology

Lighting systems which incorporate antimicrobial 405nm light have been developed for safe continuous, environmental decontamination, with previous studies demonstrating efficacy for decontamination of frequently-touched surfaces around clinical areas. This study provides first direct evidence of the effects of this decontamination system for control of airborne contamination. The study was conducted in a patient-occupied ICU isolation room over a 15-day period, with air samples collected at set times (before, during and after daily use of the decontamination system). Samples were also collected in the empty room prior to occupation. Environmental monitoring occurred every second day using a sieve-impactor sampler (500L air samples collected every 10-min over 2-hr (n=13)). Room activity was logged and bacterial contamination levels recorded as cfu/m3of air. After 2-day use of the system, airborne contamination significantly decreased from a mean of 905.2 cfu/m3 to 48.8 cfu/m3 (P=0.002). Levels then remained fairly consistent over the remaining period of system use (48.8-189.8 cfu/m3) before significantly rising after the system was turned off for 3-days (P=0.001). Additional samples collected in isolation rooms without the decontamination system demonstrate that the levels of airborne bioburden tend to increase upon increasing patient stay, however low levels were maintained as patient occupation increased when the system was in use. This study provides first direct evidence of the susceptibility of airborne bacteria to 405nm light within a clinical setting. This patient-safe technology has the potential to improve infection control strategies by complementing existing measures, which could reduce the number of infections arising from environmental sources.

Are workers from waste sorting industry really protected by wearing Filtering Respiratory Protective Devices? The gap between the myth and reality

One of the solutions for decreasing the workers' exposure to bioburden is the use of Filtering Respiratory Protective Devices (FRPD). As such it is important to determine whether these devices are fulfilling their protective role. This is the basis of the current study, aimed at characterizing bioburden retained by 120 FRPD (both in interior layers and in exhalation valves) through culture based-methods and molecular tools and also via analysis of antifungal resistance and mycotoxins profile. Our results show that Gram – Bacteria are present at a higher prevalence than total bacteria in both matrixes. Regarding fungal identification, Chrysonilia sitophila presented the highest prevalence on interior layers (55.1% on malt extract agar (MEA) supplemented with chloramphenicol (0.05%); 59.6% on dichloran-glycerol agar (DG18)), whereas on exhalation valves Aspergillus sp. presented the highest prevalence on MEA (6.8%) and C. sitophila on DG18 (36.3%). Among Aspergillus genera, section Fumigati was the one with the highest prevalence in both matrices. Aspergillus sp. was the most prevalent on exhalation valves (75.0% ITRA) in the screening of azole resistance. Fumigati section was the most abundant Aspergillus sp. detected on the interior layers (33.33%, 40 samples out of 120) and on the exhalation valves (1.66%, 2 samples out of 120). The interior layers and exhalation valves from workers with more waste contact showed an increased exposure to bioburden. This study showed that FRPD can have high levels of bioburden, toxigenic fungal strains and Aspergillus sections with reduced susceptibility to the tested azoles and can be used as a passive sampling method since it mimics the results obtained by active methods in previous studies. The gathered information will be useful to prioritize multiple interventions on workers’ education or even on FRPD replacement frequency.