Environmental cleaning to prevent hospital-acquired infections on non-intensive care units: a pragmatic, single-centre, cluster randomized controlled, crossover trial comparing soap-based, disinfection and probiotic cleaning

Leistner, Rasmus; Kohlmorgen, Britta; Brodzinski, A.; Schwab, Frank J.; Lemke, Elke; Zakonsky, Gregor; Gastmeier, Petra

doi:10.1016/j.eclinm.2023.101958

Cited by 17 publications

(19 citation statements)

References 41 publications

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“…Notably, these declines in the abundance of AMR genes and resistant bacterial strains were not observed with chemical disinfectant use [8]. To the contrary, no statistical differences in HAIs or antimicrobial-resistant bacteria were found across treatment groups when non-ICU wards were treated with PBS, chemical disinfectants or plain soap [83].…”

Section: Resultsmentioning

confidence: 86%

“…Although the number of studies assessing PBS in practice are limited, the results described above and referenced in Table 1 demonstrate the ability of PBS to successfully modulate and stably rebalance the hospital microbiome, reduce pathogen burden and AMR genes and decrease HAIs. Even the least striking results indicate that PBS is just as effective as chemical disinfectants and significantly more health-and environmentally friendly [83]. Accordingly, the potential of also employing PBS in our homes, schools, workplaces and other built environments is compelling and should be investigated.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, once a PBS system is adopted, consistency in application is required to maintain the prophylactic sanitation benefits. Chemical disinfectants can kill Bacillus vegetative cells and significantly reduce Bacillus spore numbers [75,77,83,86]. Vandini et al (2014) observed that once PBS protocols were switched back to conventional chemical disinfectant protocols, pathogens numbers increased to pre-PBS levels [71].…”

Section: Discussionmentioning

confidence: 99%

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Probiotic-Based Sanitation in the Built Environment—An Alternative to Chemical Disinfectants

Ramos

Frantz

2023

Applied Microbiology

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The use of conventional chemical disinfectants is a common practice in built environments and has drastically increased in response to the COVID-19 pandemic. While effective for instantaneous disinfection, the application of chemical disinfectants to indoor surfaces is associated with recontamination and is prone to select for antimicrobial-resistant pathogens. In contrast, probiotic-based sanitation (PBS) relies on the premise that probiotic bacteria, namely apathogenic Bacillus spp., when combined with eco-friendly detergents and applied to indoor surfaces can outcompete and exclude pathogens. Recent in situ studies assessing PBS in healthcare settings have demonstrated overwhelmingly positive results, including significant reductions in pathogen burden, antimicrobial-resistant genes and nosocomial infections, yet these studies are limited in duration and scope. Here, we review results of Bacillus-based PBS in practice, identify knowledge gaps and discuss the considerations for the widespread use of PBS in built environments. In a time when indoor cleaning and disinfection has come to the forefront, PBS may offer an attractive, effective and sustainable alternative to conventional chemical disinfectants.

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Section: Resultsmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Probiotic-Based Sanitation in the Built Environment—An Alternative to Chemical Disinfectants

Ramos

Frantz

2023

Applied Microbiology

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“…The 32 publications noted in Table 1 ( Falagas and Makris, 2009 ; Manning et al, 2009 ; Kohli, 2013 ; Vandini et al, 2014a , b ; Arvanitakis, 2015 ; La Fauci et al, 2015 ; Caselli et al, 2016 ; Afinogenova et al, 2018 ; Al-Marzooq et al, 2018 , 2019 ; Caselli et al, 2018 ; D'Accolti et al, 2018 , 2019 , 2021 , 2022 , 2023 ; Rodolfi and Caselli, 2018 ; Caselli et al, 2019 ; Dural-Erem et al, 2019 ; Kleintjes et al, 2019 ; Rognoni et al, 2019 ; Caselli and Purificato, 2020 ; Kleintjes et al, 2020 ; Razenberg et al, 2020 ; Stone et al, 2020 ; Tarricone et al, 2020 ; Klassert et al, 2022 ; Soffritti et al, 2022 ; Caselli, 2023 ; Leistner et al, 2023 ; Ramos and Frantz, 2023 ) include an opinion ( Falagas and Makris, 2009 ), two patents ( Manning et al, 2009 ; Rodolfi and Caselli, 2018 ), a commentary ( Caselli and Purificato, 2020 ), a report ( Razenberg et al, 2020 ), two reviews ( D’Accolti et al, 2022 ; Ramos and Frantz, 2023 ), two book chapters ( Kohli, 2013 ; Arvanitakis, 2015 ), three conference abstracts of previously published results ( Al Marzooq et al, 2019 ; Rognoni et al, 2019 ; Caselli, 2023 ), and in vitro assays and hospital-based studies. A total of five publications assessed the efficiency of microbial-based sanitization products using in vitro assays with common healthcare-associated pathogens ( La Fauci et al, 2015 ; D'Accolti et al, 2018 , 2021 ; Dural-Erem et al, 2019 ; Stone et al, 2020 ).…”

Section: Search Strategy and Results Of Literature Overviewmentioning

confidence: 99%

A critical assessment of microbial-based antimicrobial sanitizing of inanimate surfaces in healthcare settings

Fijan,

Kürti,

Rozman

et al. 2024

Front. Microbiol.

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The global rise in antimicrobial resistance (AMR) poses a significant public health threat, especially in healthcare settings, where controlling the spread of antimicrobial genes is crucial. While person-to-person transmission remains the primary route for healthcare-associated infections (HAIs), hospital surfaces serve as key reservoirs for antimicrobial-resistant microorganisms. Regular cleaning and disinfection of these surfaces are essential. Microbial-based products for sanitizing hospital surfaces have emerged as promising tools to combat HAIs and AMR. However, a review of 32 publications found inconsistencies and potential risks. A total of 15 publications included hospital-based trials, while the rest were either in vitro or in situ assays, reviews, book chapters, or commentaries. In most of the hospital-based studies, specific strains of applied microorganisms were not identified, and the term “probiotic” was inaccurately used. These products mainly featured spores from Bacillus and Priestia genera, which was mainly hypothesized to work through competitive exclusion. Most hospital-based studies have shown that the application of microbial-based products resulted in a significant reduction in pathogens on surfaces, thereby contributing to a decrease in the incidence of healthcare-associated infections (HAIs). Further research is however needed to understand the effectiveness, mechanisms of action, and safety of microbial-based sanitizing agents. Strain-level identification is crucial for safety assessments, yet many reviewed products lacked this information. Consequently, there is a need for rigorous safety evaluations within existing regulatory frameworks to ensure the efficacy and safety of microbial-based cleaning products in healthcare settings.

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“…Recently, several groups rather tried to use probiotics to promote beneficial microbes (Caselli et al, 2016 ; D'Accolti et al, 2023 ; Leistner et al, 2023 ). However, using probiotics on building surfaces or the subway no longer works, because the city, because of how it is built, exerts a selective pressure on the microbiota.…”

Section: Building With Sciencementioning

confidence: 99%

The invisible life

Guerrieri,

Libert

2024

Front. Microbiol.

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Environmental cleaning to prevent hospital-acquired infections on non-intensive care units: a pragmatic, single-centre, cluster randomized controlled, crossover trial comparing soap-based, disinfection and probiotic cleaning

Cited by 17 publications

References 41 publications

Probiotic-Based Sanitation in the Built Environment—An Alternative to Chemical Disinfectants

Probiotic-Based Sanitation in the Built Environment—An Alternative to Chemical Disinfectants

A critical assessment of microbial-based antimicrobial sanitizing of inanimate surfaces in healthcare settings

The invisible life

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