Integrative Biomedical Sciences Hospital Acquired Infections with Multiresistant Microorganisms: UN Interagency Coordination
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ISSN: 2469-4096 Research Article Integrative Biomedical Sciences Hospital Acquired Infections With Multiresistant Microorganisms: UN Interagency Coordination Group on Antimicrobial Resistance Demands Immediate, Ambitious and Innovative Action S.Guggenbichler 1*, Fey T2 and Guggenbichler JP3 1Division für Gefäßchirurgie und endovaskuläre Chirurgie der Universitätsklinik für Herzchirurgie, Gefäßchirurgie und endovaskuläre Chirurgie, LKH, Müllner Hauptstraße 48, A-5020 Salzburg 2Department of Material Science and Engineering, Institute of Glass and Ceramics, Martensstr. 5, 91058 Erlangen, Germany 3Department or Pediatrics, University of Erlangen, Germany, AmiSTec GMbH und Co KG, Kössen, Austria Rec date: Nov 25, 2019 Acc date: Feb 27, 2020 Pub date: Mar 6, 2020 *Correspondance: Peter Guggenbichler J, Erlangen, Department or Pediatrics, AmiSTecGMbH und Co KG, Kössen, Austria, E-mail: [email protected] Summary The present review is mostly focused on decontamination of solid air interfaces in health-care units, such as hospital furniture, door-handles, computer keyboards, textiles etc., although solid liquid surfaces are also of great concern in hospitals such as faucets, showers, pipes and drains, where biofilms occur frequently. New methods, in addition to or as an alternative to appropriate use of disinfectants and antibiotics are required to reduce microbial associated infections and to reverse the dramatic increase in antimicrobial resistance. The requirements for such surfaces mandatory for prevention of hospital acquired infections and the emergence of multi-resistant microorganisms however are high. Many different chemical strategies and technologies for coatings intended to eradicate microorganisms from surfaces are described in the literature. None of these technologies meets the expectations for prevention of hospital acquired infections by formation of self-sanitizing surfaces except the in situ generated biocides on the basis of transition metal oxides embedded into surfaces. Surfaces decorated with metal oxide Lewis acids such as MoO3, WO3 and Zinc Molybdate show a broad-band and strong antimicrobial activity resulting in a reduction of the number of colony forming units by 6 – 7 log 10 within 1-3 hours. Their mechanism of action is based on the in-situ generation of + H3O ions through the reaction with moisture from the air, inspired by the body’s own defense mechanism imitating + e.g. the acid coating of the skin. The resulting acidified surfaces have a pH of 4.5 and the H3O ions are able to diffuse through the cell membrane of microorganisms where they can distort the pH-equilibrium and transport systems of the cell. In addition by these mechanism also free radicals e.g. oxygen radicals and hydroxyl radicals are formed which result in a synergistic mode of action including a positive zeta potential. This is reflected by an extraordinary fast eradication of microorganisms i.e. a reduction of 5 log 10 within 10 minutes. Present Recommendations more importantly, claiming at least 800,000 lives per year in Europe — that’s 2200 lives each day. To combat Health care-associated infections, which are widely the alarming 5% of all hospital admissions that result in seen as preventable and often caused by unsatisfactory readmission due to conditions acquired in health care hospital conditions or human error, are costing health facilities, all staff and contractors should be well educated care facilities more than $30 billion annually and are, on how to minimize the spread of fatal infections [1-3]. Integ Biomed Sci, 6(1): 84-104 (2020) 84 One problem remains the definition of “resistance” and antibiotic susceptibility, fungi, legionella, Aspergillus spp., how to measure resistance to a biocide [4]. This has yet virus documented by the RODAC plate method. to be addressed globally, although the measurement • Fast eradication of microorganisms i.e., minimum of resistance is becoming more relevant, with regulators 5 log 10 reduction within 1 hour: “self-sanitizing” both in Europe and in the United States demanding surfaces must actively eradicate microorganisms that manufacturers provide evidence that their biocidal on a surface within a reasonably short period of products will not impact on bacterial resistance. Alongside time. This should occur within less than 3 hours. in vitro evidence of potential antimicrobial cross-resistance • Reduction of adherence, blockage of proliferation following biocide exposure, our understanding of the and biofilm formation is an additional important mechanisms of bacterial resistance and, more recently, feature – however as a single feature it is in no way our understanding of the effect of biocides to induce sufficient. mechanism(s) of resistance in bacteria has improved. • Activity against a high inoculum size of 109 CFU on an area of 3 cm². In order to block the spread of multi-resistant • No induction of resistance. This is of crucial microorganisms in the hospital, cutting off the importance transmission route is a particularly important strategy • Nontoxic, skin and soft tissue compatibility, no along with actively treating the infective source based on allergenicity, sbD (safe by design) the sensitivity of the particular strain, which is determined • Long lasting/permanent antimicrobial activity by characterising the strain for drug resistance. As we • water-, acid-, alkaline-, alcohol insoluble, UV Light cannot rely on adequate eradication of microorganisms stabile by disinfectants any highest emphasis is now put on • Activity in spite of soiling, cleanable with detergents adequate hand hygiene measures [5]. This however would • Uncomplicated technical processability, heat require 50 - 80 times hand washing and disinfection. Over stabile up to 400°C, non-corrosive recent years, researchers have noted a steady rise in the • Physical stability, activity irrespective of sweat, number of serious infections caused by ethanol tolerant grease, blood, pus strains which appear to result in large part from adaptive • Authorisation by the European commission on and evolutionary changes in cell membrane composition biocidal products. no nanoparticles [6]. The development of alcohol-tolerant strains has the • Favourable cost/benefit analysis potential to undermine the effectiveness of alcohol- based disinfectant standard precautions. A number of technologies have been proposed: Active drug eluting agents (e.g. ions or nanoparticles Considering the above information we have to reassess of silver, copper, zinc, or antibiotics, chloride, iodine, preventive measures for hospital acquired infections disinfectants). Active eluting agents must be incorporated and to curb the dramatic increasing rate of emerging into the metabolism of microorganisms and are eluted resistant microorganisms. It is obvious that we need a from the polymer of the surface: This shows crucial new, innovative approach to combat this problem which disadvantages: is jeopardising our clinical medicine. The activity is limited to a short period of time. For Technologies for “self-sanitizing surfaces” silver this means duration of activity of 3 weeks [7]. The formation of self-sanitizing surfaces - the correct Copper endowment of a surface has been investigated term for surface which eradicates microorganisms from and preliminary results show a substantial reduction in a surface without disinfectants - seems to be a promising the number of HAI which establishes the proof of concept. technology providing a broad spectrum of activity, long However adverse events have been observed [8]. Besides lasting to permanent antimicrobial activity without copper has a induction of resistance. • Poor antimicrobial activity. This activity is somewhat The requirements for self-sanitizing surfaces improved by alloys e.g. combination with zinc or are high tin but still does not meet the requirements. • Copper is cytotoxic in use for implantable Broad antimicrobial activity, against Gram-positive, biomaterials. Gram-negative microorganisms, irrespective of their • The surfaces are rapidly oxidizing and require ISSN: 2469-4096 Short Communication Integrative Biomedical Sciences Integ Biomed Sci, 6(1): 84-104Nursing Students’ Perceptions of Biomedical (2020) Education with Augmented Reality Ma CW* School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong SAR, PR China 85 *Correspondence: Dr. Chun-Wai Ma, School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, PR China, E-mail: [email protected] Received date: April 30, 2019; Accepted date: June 10, 2019; Published date: June 17, 2019 Introduction The University of Hong Kong. A typical educational AR application “Brain AR App” (Harmony Studios Ltd., UK) Innovative techniques provide a teaching strategy to was used to assist teaching and learning during five improve education in biomedical sciences for nursing lectures whose topics are relevant to the content of students [1]. With augmented reality (AR) technology, the AR application. The teacher explained biomedical elements in the physical environment can be enriched concepts by manipulating the digital content projected or supplemented by computer-generated sensory inputs onto the screen to facilitate interactions with nursing such as text, images, 3-dimensional (3D) graphics, and students. The teacher also provided guidance on audio. AR has been paradigmatically applied worldwide installing and using the AR software