Healthcare: Antimicrobial Coating

A new weapon in the ward?

Fighting healthcare-associated infections with antimicrobial coatings

Scanning electron micrograph of a human neutrophil ingesting MRSA (purple); potentially life-threatening MRSA infections occur most frequently among patients in healthcare settings. Image credit: NIAID
By Alexandra Nistoroiu

Bacteria beware! Disinfectants and antibiotics are no longer the only strategies in fighting healthcare-associated infections (HAIs). Antimicrobial coatings (AMCs) are proving a promising weapon against bacterial growth in healthcare units. The question remains, however, whether clinicians will find a suitable way of assessing AMC effectiveness, and decrease the risk of further infections among hospital patients. These relatively new tools are the subject of a dedicated session at the 4th European Conference for Science Journalists (ECSJ2017), taking place in Copenhagen from 2630 June 2017.

On any given day, HAIs affect up to 80,000 patients in European hospitals. Over 4 million people acquire an HAI annually, which leads directly to 37,000 deaths, according to the European Centre for Disease Prevention and Control.

Antibiotics are becoming less and less effective, due to antimicrobial resistance. And despite the importance of cleaning, disinfection and hygiene monitoring for frequently-touched surfaces, studies show that less than half of near-patient surfaces are regularly cleaned. We need new approaches in the fight against bacterial agents.

AMCs contain active ingredients that inhibit microorganisms’ ability to grow on a surface. Though commercially available, AMCs have not yet found their way into healthcare facilities. “The main reason is the lack of knowledge among healthcare professionals, and a predominant focus on cleaning and behavioural protocols,” says Johan Molling, a researcher at Zuyd University of Applied Sciences in the Netherlands. “Valid controlled studies on the potential effect of adding a coated environment are lacking,” he adds.

To address this issue, more than 60 universities, research institutes and companies across 29 European countries formed a research network to develop, regulate and use novel AMCs to prevent HAI. The European Commission funds the network through its Cooperation in Science and Technology (COST) programme.

A few pilot studies have examined interventions using AMCs in ‘living lab’ situations (real hospital rooms coated with antimicrobial coatings), but they almost never extend to a whole ward. “It will be quite a challenge to prove that the use of AMCs in these pilot studies results in a reduction in HAIs in a particular ward or hospital,” explains Francy Crijns, chair of the COST programme on the topic, who is organising the ECSJ 2017 sesssion.

Researchers are combining studying ‘living lab’ situations with developing innovative and targeted AMCs, simulations and models that effectively measure infectious agents in the clinical ecosystem. They also want to understand whether using AMCs increases resistance and cross-resistance, or has adverse environmental consequences.

The process all starts with laboratory efficacy tests. Coatings that show good results in reducing microbial load, especially for infectious agents, and are non-toxic, durable and compliant with common healthcare cleaning methods, will feature in pilot ‘living lab’ studies or real-life situations. These studies will gather information on best practices, and will address ways in which practice must change to make the most of AMC interventions.

Any type of research on this issue must be in line with the HAI reporting mechanisms in place in the study country. Romania, for example, often makes headlines for its culture of underreporting HAIs; the country barely participates in ECDC-led-surveillance of HAIs. “There are many countries outside the US that just don’t have a very good robust surveillance system,” says Maureen Spencer, international consultant on infection prevention.

There are limitations to the COST research strategy, according to Kim Delahanty of the University of California San Diego Health System in the United States. “It does not take into consideration all the other proven measures to prevent HAIs,” she argues. “A risk assessment on how compliant these countries are to all the proven preventative measures should be assessed per facility, per country, due to different patient mix and risk factors. If every facility is compliant at 90% or better to all these measures, then looking outside to other adjuncts to care may be prudent. It is not a magic bullet and should be used judiciously.”

COST researchers plan to involve more patient rooms, wards and institutions in their studies. The hope is that this research will offer a true insight into the impact AMCs can have on HAI reduction.