Role of the Microbial Burden in the Acquisition and Control of Healthcare Associated Infections: The Utility of Solid Copper Surfaces - Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections - page 69

4.3 No-Touch Disinfection Technologies
In summary, since the seminal paper by Weinstein in 1991, substantial evidence
implicating the environment as a continuous source of risk for the acquisition of
HAI has accumulated to such an extent that there now exists significant interest in
learning how to manage and provide best-practice applications for infection control
for hospitals [ 8 , 12 , 13 , 15 ]. Evident from the previous discussion, microbes have an
intrinsic ability to survive and ultimately colonize common touch surfaces where
acquisition and transport from surfaces to humans is common. Healthcare workers
have the potential to transfer these microbiological contaminants not only from
patient to patient but amongst themselves and back to surfaces, refreshing or adding
to the complexity of the microbial reservoir involved in transmission. There have
been many studies looking at the control of contamination of common hospital
touch surfaces both from hand to surface contact and vice versa. Investigators have
shown that the gloves of nurses frequently collected viable MRSA after touching
inanimate objects near colonized patients [ 16 ]. In concert with aggressive hand
hygiene campaigns recent hygiene guidelines specifically recommend that partic-
ular attention be paid to the disinfection of patient-care surfaces, especially surfaces
designated “high touch objects” (HTOs) as a target of infection prevention and
control [ 78 ]. The guidelines note that such objects could potentially contribute to
secondary transmission by contaminating hands of healthcare workers (HCWs) or
by contacting medical equipment that subsequently contacts patients [ 8 , 29 , 64 , 67 ,
72 , 73 , 90 ]. Routine or daily cleaning coupled with cleaning immediately after
patient discharge (terminal cleaning) of the surfaces and objects within the room
with subsequent application of a hospital grade disinfectant has been an accepted
method for controlling and limiting the spread of infectious agents [ 68 ]. A concen-
tration of between 2.5 and 5 aerobic CFU per square centimeter has been proposed
as the benchmark where bacterial levels below this value are considered to repre-
sent a minimum of risk while concentrations greater are suggestive of an increased
risk of HAI acquisition [ 22 , 44 ].
No touch solutions for the disinfection of at-risk environments within healthcare
settings are quickly gaining acceptance as technologies that have been found to be
an effective and comprehensive addition to systems-based solutions for infection
control. The technologies have been studied in concert with aggressive hand
hygiene campaigns, appropriate routine and terminal cleaning of patient care
environments, and an active surveillance and isolation protocol for patients entering
care who are already colonized with VRE, MRSA, C. difficile or other multi-drug
resistant microbes such as Klebsiella pneumoniae carbapenemase (KPC). As a
consequence of this, one is left to wonder whether or not the antimicrobial effec-
tiveness is providing an additive effect or whether the antimicrobial effectiveness of
these 'no-touch technologies' are acting synergistically.
As the name suggests, no-touch technologies do not come in direct contact with
colonized, contaminated or soiled surfaces. Rather, they distribute their
microbiocidal activity through the atmosphere by either delivering a lethal