News and insights

The role of the environment in the transmission of multi-resistant microorganisms in hospital facilities

  • 11.12.2020
  • Insights

The role of the environment in the transmission of multi-resistant microorganisms in hospitals has been a subject of study and research for a long time now, considering the increase in the occurrence of nosocomial infections in the past few years. Namely, numerous scientific studies show that surfaces in hospital facilities play a major role in the contamination, persistence and dissemination of several microorganisms, thus representing a steady source of pathogenic agents in healthcare facilities (1).
There are many kinds of infectious microorganisms which contaminate hospital settings, and include some strains which have developed the ability to resist most antibiotics currently available, thus circumventing the effectiveness of the treatment therapy administered by medical personnel.
Among multi-resistent bacteria, Gram-negative bacteria are the most accountable for nosocomial infections - Escherichia Coli, whose cephalosporin-resistance percentage reaches 30%, Klebsiella (60%) and Acinetobacter baumanii, over half of whose strains is characterized by the resistance to several categories of antibiotics. With a view to hospital contamination, Gram-positive bacteria such as methicillin-resistant Staphyloccocus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), Actinobacter spp. and Clostridium difficile, or viral agents such as Norovirus are also of major concern.
In Italy the likelihood to develop a nosocomial infection during hospitalization is 6% (2), with cases ranging from 450,000 to 700,000 per year (3), and an estimate of approximately 7,800 deaths per year due to hospital-acquired infections.
Based on these data our country ranks first in Europe for the occurrence of nosocomial infections, and it must be noted that this unpleasant record is due to microorganisms that are resistant to most antibiotics.
There are several factors that contribute to the transmission of these pathogens – their ability to colonise lifeless surfaces and patients (Actinobacter spp., MRSA, VRE, Clostridium difficile) and, though transitorily, operators’ hands; their low infectious dose (especially of Clostridium difficile and Norovirus); the microorganisms’ ability to survive in the environment for long periods, even months, while maintaining their infectious ability and/or virulence; and, last but not least, their resistance to the disinfectants used for sanitation in hospitals (4).
At present, surface contamination in hospital settings is fought by using detergent compounds or chemical disinfectants which, however, prove to be only limitedly effective and moreover cause a non-negligible environmental impact. The ability of several disinfectants to select microbial strains which are resistant to that very disinfectant is now ascertained (5). Though the effectiveness of the said reagents in the abatement of surface pathogens is still acceptable (but never reaching 100%) they are ineffective in preventing bacterial recontamination, which generally occurs every 30 minutes, thus actually causing the persistence of pathogenic microorganisms.
Based on these data it is then clear that sanitization by means of chemical agents cannot guarantee a safe, healthy hospital environment, as it is unable to maintain the environment sanitized over time.
Hence, it is self-evident that alternative methods need to be found, which can effectively fight pathogen contamination, persistence and transmission in hospital settings.
Driven by this need, our research led us to develop an innovative self-sanitizing coating, based on a natural active ingredient which is highly effective in contrasting bacterial resistance.
Therefore, trying to reduce infection hazard for hospitalized patients to a minimum and prevent the increase in resistance to drugs and environmental impact, treating hospital surfaces with self-sanitizing products based on natural active ingredients, which may slow down or even stop bacterial dissemination, appears the most effective and cost-effective choice.

(1) Bacterial contamination of inanimate surfaces and equipment in the intensive care unit. Russotto V, Cortegiani A, Raineri SM, Giarratano A. J Intensive Care. 2015 Dec 10;3:54. doi: 10.1186/s40560-015-0120-5. eCollection 2015. Review. (2) Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, Colomb-Cotinat M, Kretzschmar ME, Devleesschauwer B, Cecchini M, Ouakrim DA, Oliveira TC, Struelens MJ, Suetens C, Monnet DL; Burden of AMR Collaborative Group. Lancet Infect Dis. 2019 Jan;19(1):56-66. doi: 10.1016/S1473-3099(18)30605-4. Epub 2018 Nov 5. (3) Report Italiano PPS2 2016/2017 - Studio di prevalenza italiano sulle infezioni correlate all’assistenza e sull’uso di antibiotici negli ospedali per acuti – Protocollo ECDC (4) Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Am J Infect Control. 2010 Jun;38(5 Suppl 1):S25-33. doi: 10.1016/j.ajic.2010.04.196. Review. (5) Varying activity of chlorhexidine-based disinfectants against Klebsiella pneumoniae clinical isolates and adapted strains. Bock LJ, Wand ME, Sutton JM. J Hosp Infect. 2016 May;93(1):42-8. doi: 10.1016/j.jhin.2015.12.019. Epub 2016 Jan 21