BackgroundHealthcare-Associated Infections (HAIs) are one of the most frequent complications occurring in healthcare facilities. Contaminated environmental surfaces provide an important potential source for transmission of many healthcare-associated pathogens, thus indicating the need for new and sustainable strategies.AimThis study aims to evaluate the effect of a novel cleaning procedure based on the mechanism of biocontrol, on the presence and survival of several microorganisms responsible for HAIs (i.e. coliforms, Staphyloccus aureus, Clostridium difficile, and Candida albicans) on hard surfaces in a hospital setting.MethodsThe effect of microbial cleaning, containing spores of food grade Bacillus subtilis, Bacillus pumilus and Bacillus megaterium, in comparison with conventional cleaning protocols, was evaluated for 24 weeks in three independent hospitals (one in Belgium and two in Italy) and approximately 20000 microbial surface samples were collected.ResultsMicrobial cleaning, as part of the daily cleaning protocol, resulted in a reduction of HAI-related pathogens by 50 to 89%. This effect was achieved after 3–4 weeks and the reduction in the pathogen load was stable over time. Moreover, by using microbial or conventional cleaning alternatively, we found that this effect was directly related to the new procedure, as indicated by the raise in CFU/m2 when microbial cleaning was replaced by the conventional procedure. Although many questions remain regarding the actual mechanisms involved, this study demonstrates that microbial cleaning is a more effective and sustainable alternative to chemical cleaning and non-specific disinfection in healthcare facilities.ConclusionsThis study indicates microbial cleaning as an effective strategy in continuously lowering the number of HAI-related microorganisms on surfaces. The first indications on the actual level of HAIs in the trial hospitals monitored on a continuous basis are very promising, and may pave the way for a novel and cost-effective strategy to counteract or (bio)control healthcare-associated pathogens.

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In this paper the authors describe the program of epidemiological overseeing of the surgical site infections activated in the operating department of the Cento Hospital (Ferrara). The purpose of the program is to systematically collect the data related to the frequency and distribution of the infections contracted during a surgical intervention and to analyze the environmental factors correlated to them, the concentration of particles and of UFC, the characteristics of the ventilation system, the number of people in the room, the type of clothing, the systems of cleaning and disinfection, the type of intervention etc. The objective of the research consists of identifying the actions for prevention of the infections and to get an indicator of the quality of the surgical activities. Since the greatest obstacle to this kind of activity is related to the man-hour cost for the information collection, researchers of the University of Ferrara and the Cento hospital have setup an electronic system of automatic acquisition of the field data using computer technologies of different types (RFID-Radio Frequency IDentification sensor, PC pocket, net computer and programs). The management of continuous relief of the pollution level established in the operating rooms during every intervention, the automatic acquisitions of the main environmental parameters (temperature, relative humidity, instant air flow rate of climatization plant, state of the doors, level of pressurization of the room, level of stoppage of the absolute filters etc.) and of the clinical overview of the patient allow detailed knowledge of the conditions in which every surgical intervention is developed. Particular attention is paid to the state of hypothermia of the patient that is monitored in continuously before, during and after the operation, since according to some authors this determines an increase in the probability of contamination of the wound. The surgical wound is controlled daily in the hospital up to the moment of patient release and every three months for one year from the intervention, so as to record possible complication. This adopted strategy allows to verification in the respect of the behavioral protocols of the medical and nursing personnel.