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INFECTION PREVENTION AND CONTROL


lethal concentrations ‘did not significantly alter the distribution of susceptibility to QAC [quaternary ammonium compounds] or to a range of other biocides.’17


This view


is supported by the Scientific Committee on Emerging and Newly Identified Risks that indicated the use of antimicrobials did not cause a link to antibiotic resistance or cause the development of pathogenic organisms. The body of evidence from multiple


regulatory bodies and academic groups indicates that the use of embedded antimicrobials is not linked to development of antibiotic resistance. These two classes of antimicrobials do not directly influence the same groups of microbes or act in similar manners. Embedded antimicrobials target multiple organisms, multiple cellular components, and have a role in the environment. It is for these reasons that embedded antimicrobials do not create resistance patterns that are shared with antibiotic resistance development for patients. The utilisation of antimicrobial-treated


surfaces combined with disinfectant antimicrobials provides a system-based approach to solving the problems associated with the patient environment being a vector for disease transmission.18


Embedded antimicrobial efficacy To prove the efficacy of antimicrobials, efficacy protocols have been developed by numerous international and national standard organisations including, but not limited to: l International Standards Organization (ISO)


l American Standards and Test Methods (ASTM)


l American Association of Textile Colorist and Chemists (AATCC)


l Japanese Embedded Standard (JIS)


Protocols are developed with input from numerous groups including companies, embedded end users and consumers. The general standards are developed with input from embedded and subject matter experts. For standards dealing with microorganisms, microbiologists from academia and industry gather together to work through method development. Each group works strenuously to develop methods that are robust, reproducible, and representative of efficacy throughout use. These methods go through rigorous review cycles and it takes years to have a final standard available for widespread use. With the widespread adoption of


antimicrobials in multiple industries, most organisations have a group dedicated to method development for antimicrobials specifically. It is through organisations like AATCC, ASTM and ISO, that there is effective, self-policing throughout the


58


Staphylococcus aureus


7 6 5 4 3 2 1


0 0 1 4 Hours


7 6 5 4 3 2 1


0 0 1 4 Hours Figure 1. ISO 22196 efficacy associated with Microban-treated articles.


industry. This is evident in peer-reviewed and approved test methods that allow reproducible demonstration of surface antimicrobial and product preservation attributes.


Embedded antimicrobials can result in significant bacterial reduction on moulded articles within hours. Articles treated with Microban antimicrobial technology were tested against untreated articles utilising the ISO 22196. Samples were inoculated with either Escherichia coli (Gram-negative) or Staphylococcus aureus (Gram-positive) and held at 36˚C for the indicated time. The treated articles demonstrated a 90% reduction on gram negative and Gram-positive organisms within four hours. Overall, there was a 99% reduction in both bacterial populations throughout a 24-hour period (Fig 1). Antimicrobial efficacy is not solely attributable to one test that occurs immediately after manufacture. Once an antimicrobial is incorporated into an end product, that product endures multiple tests for durability. Durability tests are associated with each end use. An antimicrobial for a textile application will be rated based on durability to home launderings with commercially available detergents. A cutting board application will be measured on durability to dish


washing and scraping, whereas a grout will be exposed to multiple rounds of moisture exposure. Outdoor applications must also pass several rounds of intense UV exposure to ensure that the material is not affected, and microbial efficacy is maintained.


Conclusion The stakes are high at any hospital for controlling HCAIs. Improved handwashing regimens have provided a reduction in HCAIs to date, allowing for increased focus on additional areas for improvement. One key area is that of inanimate surfaces, referred to as fomites, surrounding the patient. Fomites have been a proven vector of transmission for harmful bacteria and need key consideration in the fight against HCAIs. Adherence to disinfection regimens and manufacturer recommendations will be integral in reducing overall bioburden within the patient environment. Innovations within the disinfection space that provide continuous disinfection will be vital in reducing HCAI occurrence associated with the patient environment. Embedded antimicrobials provide a


proven and complementary solution for the healthcare industry in the continual


IFHE DIGEST 2020 8 24 Escherichia coli 8 24


l Control l Microban®


treated


l Control l Microban®


treated


Log10


(CFU)


Log10


(CFU)


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