INF ECTION P R EVENTION
cleaning and disinfection procedures is heightened without the use of AMCs.
Current knowledge of AMCs There are many different types of AMC, including: anti-adhesive surfaces (such as zwitterions or superhydrophobicity), biocide-releasing surfaces (such as quorum- sensing systems or triggered release) and contact-killing surfaces (such as phages or polymer brushes).1
Some of the chemical
technologies employed within AMCs and described within literature include: active eluting agents (such as ions or nanoparticles of copper, silver, chloride, iodine, zinc or antibiotics), light-activated molecules (such as photosensitisers or TiO2) and immobilised molecules that become effective upon interaction (such as peptides or quaternary ammonium polymers).6,7
When assessing and choosing an antimicrobial coating, it is important to evaluate the impacts of the safe-by-design (SbD) criteria: contribution to unwanted acquisition of resistance, toxicity and long- term stability.8
SbD is not a new concept
and has been used across industries such as aircraft, railway and construction. SbD is essentially the removal of possible health and safety risks associated with a specific process or product, accounting for these potential issues in early design phases.8 AmiCI (Antimicrobial Coating Innovations) is a COST action to investigate the use of AMCs in the prevention of infectious diseases.9
and silver ions, have long been known for their antimicrobial properties, further work was needed to assess their value in healthcare. Copper and silver ions have been used in previous applications such as biofilm retardation in medical devices, textiles and the marine industry.10
Information pertaining
to the use of AMCs within healthcare settings is still being developed and promising studies are emerging.11,12
Other non-leaching
A COST action is a programme set up via the ‘COST’ (European Cooperation in Science and Technology) organisation and funded by the EU. The AMiCI COST Action represented a gathering of 33 countries across Europe that allowed for unbiased evaluation and a range of perspectives across the broad range of activities associated with AMCs.9 Although certain AMCs, such as copper
antimicrobial technologies, such as Zoono, are also becoming more prevalent, providing an enhanced level of protection between standard infection and prevention control practices, remaining active on the surface for multi-touch protection.
Identification of future research/ applications
While there is clear evidence of antimicrobial
resistance causing a global health risk, the current strategies for management and mitigation does not include use of AMCs, focusing instead on good hand hygiene, efficient cleaning protocols and antimicrobial stewardship.13
There has recently been
recognition regarding the potential application of AMCs within the healthcare environment and the potential impact upon HCAIs and reinfections.14
One issue that has come to light as a result of the AMiCI investigation is that for hygiene professionals, AMCs are considered mysterious and undefined.10
Another
highlighted area for concern for healthcare managers in the cost-benefit ratio based on the current evidence that is available. Therefore, this highlights that a change in attitudes, and a greater understanding of the use and potential benefits of using AMCs is needed in order for these to be utilised as part of infection prevention programmes. As the risk of AMR and infection is increasing globally, in part as a result of the COVID-19 pandemic, the risk of microorganisms to global health has been made significantly more prevalent than it was when the AMiCI programme started (2016). What has been highlighted over recent years by industry experts is the need to manage existing antimicrobials carefully and the requirement for novel therapies. The utilisation of AMCs, that are non-specific but broad reaching, within healthcare settings could enable a lower risk of pathogen transmission via both fomites and hands between staff, patients and visitors.10 Certain studies have highlighted the ability for both SARS-CoV-2 and human coronavirus 229E (a closely related coronavirus strain) to survive on surfaces for up to five days, including plastic, stainless steel, glass and
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