An Overview of the Options for Antimicrobial Hard Surfaces in Hospitals - Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections - page 136

rods, including Acinetobacter baumannii . Several different approaches are
available for improving hospital hygiene, including improving the effectiveness of
existing methods and a range of new approaches, including novel disinfectants.
A complimentary approach is the introduction of antimicrobial surfaces (AMS),
which exert a continuous reduction on the level of microbial contamination
on hospitals surfaces. There are several approaches to making a hospital surface
'antimicrobial': permanently 'manufacture in' an agent with antimicrobial activity;
periodically apply an agent with antimicrobial activity; or physically alter the
properties of a surface to make it less able to support microbial contamination
and/or easier to clean. Promising options for AMS in healthcare settings include
metals (principally copper or silver), chemicals (organosilanes, quaternary ammo-
nium compounds, light-activated antimicrobials, and polycationic polymers) and
physical alteration of the surface to reduce microbial attachment or improve clean-
ability. Before widespread adoption of AMS, promising candidates require rigorous
in vitro and in situ assessment, including an evaluation of their clinical impact and
cost effectiveness. Copper alloy surfaces are the most closely evaluated option for
AMS, and have demonstrated in vitro activity against a range of pathogens (although
their sporicidal capacity remains equivocal), evidence of efficacy in in situ studies
and their introduction has been associated with a reduction in healthcare-associated
infections (HAI). However, their long-term durability, acceptability and cost-
effectiveness have not been evaluated formally. Finding and evaluating the optimal
AMS will require a multidisciplinary approach, involving industrial partners,
materials scientists, healthcare scientists and epidemiologists to refine and test the
available options.

List of Abbreviations

AMS Antimicrobial surfaces
CFU Colony forming units
DLC Diamond-like carbon
EPA Environmental Protection Agency
HAI Healthcare-associated infections
HPV Hydrogen peroxide vapour
ICU Intensive care unit
MDRO Multidrug-resistant organisms (MDROs)
MRSA Methicillin-resistant Staphylococcus aureus
PEG Polyethylene glycol
PHMB Polyhexamethylene biguanide
QAC Quaternary ammonium compound
R-GNR Resistant Gram-negative rods (R-GNR)
TAC Total aerobic count

VRE Vancomycin-resistant enterococci