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Choosing the Appropriate Surface Disinfectant antibiotics Review Back to Basics: Choosing the Appropriate Surface Disinfectant Angelica Artasensi , Sarah Mazzotta and Laura Fumagalli * Dipartimento di Scienze Farmaceutiche, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133 Milano, Italy; [email protected] (A.A.); [email protected] (S.M.) * Correspondence: [email protected]; Tel.: +39-0250319303 Abstract: From viruses to bacteria, our lives are filled with exposure to germs. In built environments, exposure to infectious microorganisms and their byproducts is clearly linked to human health. In the last year, public health emergency surrounding the COVID-19 pandemic stressed the importance of having good biosafety measures and practices. To prevent infection from spreading and to maintain the barrier, disinfection and hygiene habits are crucial, especially when the microorganism can persist and survive on surfaces. Contaminated surfaces are called fomites and on them, microorganisms can survive even for months. As a consequence, fomites serve as a second reservoir and transfer pathogens between hosts. The knowledge of microorganisms, type of surface, and antimicrobial agent is fundamental to develop the best approach to sanitize fomites and to obtain good disinfection levels. Hence, this review has the purpose to briefly describe the organisms, the kind of risk associated with them, and the main classes of antimicrobials for surfaces, to help choose the right approach to prevent exposure to pathogens. Keywords: antimicrobial; disinfectant; surface disinfection; fomite; surface contamination; microor- ganisms Citation: Artasensi, A.; Mazzotta, S.; Fumagalli, L. Back to Basics: Choosing the Appropriate Surface 1. Introduction Disinfectant. Antibiotics 2021, 10, 613. In built environment, especially considering an indoor lifestyle, touching objects https://doi.org/10.3390/ or surfaces which surround us is integral to everyday life. Such objects or surfaces if antibiotics10060613 contaminated are called fomites and, in the 21st century, their role in disease transfer is higher than ever in human history. Indeed, most microorganisms found in the indoor Academic Editor: Gregory Caputo environment are inactive, dormant, or dead and either show no impact on human health or are even beneficial. Nevertheless, fomites can become contaminated by pathogenic Received: 4 May 2021 organisms which have a variety of negative health consequences. In fact, microorganisms Accepted: 17 May 2021 can survive even for many months and multiply on surfaces or objects [1], leading to the Published: 21 May 2021 development of secondary reservoirs. As a consequence fomites can serve as a mechanism for transfer between hosts, just think to doorknobs, elevator buttons, handrails, phones, Publisher’s Note: MDPI stays neutral keyboards, writing implement, etc., that are touched by a person that afterward will handle with regard to jurisdictional claims in other objects (Figure1). published maps and institutional affil- iations. Furthermore, experimental data show that touching a fomite carries approximately the same risk for the acquisition of a lot of microorganisms (i.e., Methicillin-Resistant Staphylococcus aureus—MRSA, Vancomycin-Resistant Enterococcus—VRE, and Clostridium difficile) on hands as touching an infected patient [2–5]. Consequently, preventing trans- mission of pathogens with disinfection procedures must be carried out not only in the Copyright: © 2021 by the authors. high-risk sectors, like laboratories, operating rooms, intensive care units, or food-handling Licensee MDPI, Basel, Switzerland. settings but also for hygienic behavior in everyday life on floors and on all the surfaces This article is an open access article that frequently are touched with hands. distributed under the terms and conditions of the Creative Commons Therefore, environmental disinfection, hygiene habits, and the consequent mainte- Attribution (CC BY) license (https:// nance of barriers are crucial in preventing infection from spreading. To develop effective creativecommons.org/licenses/by/ policies and regulations to minimize the risk of transmission is strictly necessary to evalu- 4.0/). ate which organisms are present on the fomites. Furthermore, the choice of the effective Antibiotics 2021, 10, 613. https://doi.org/10.3390/antibiotics10060613 https://www.mdpi.com/journal/antibiotics Antibiotics 2021, 10, x FOR PEER REVIEW 2 of 32 to evaluate which organisms are present on the fomites. Furthermore, the choice of the effective antimicrobial agent is also based on the risk assessment of the microorganisms Antibiotics 2021, 10, 613 and the type of fomites 2 of 29 Public health emergency surrounding the COVID-19 pandemic, stressed the importance of having good biosafety measures and practices, as never before. On these bases, this review has the purpose to briefly describe the organisms, the kind of risk antimicrobial agent is also based on the risk assessment of the microorganisms and the associated with them, and the major characteristic of the main classes of antimicrobials for type of fomites surfaces to help in choosing the right approach to prevent exposure to pathogens. Figure 1. Generic transmission route. Figure 1. Generic transmission route. 2. MostPublic Common health Microorganisms emergency surrounding on Fomites the COVID-19and Associate pandemic,d Risks stressed the impor- tanceThe of havingprimary good goal biosafety of disinfecting measures procedures and practices, is the as inactivation never before. of On organisms these bases, on fomites.this review Generally has the, purposemicroorganisms to briefly belong describe to a thediverse organisms, group thesuch kind as bacteria, of risk associated viral, and withprotozoa them,n andspecies the major[6]. characteristicThese biological of the agents main classesare widely of antimicrobials found in for the surfaces natural to environmenthelp in choosing and the, as righta result approach, they can to be prevent found exposure either in many to pathogens. work sectors or household contexts. The majority of these microorganisms are harmless; however, some of them or their2. Most metabolites Common may Microorganisms cause disease ons. FomitesFor example and Associated, the transmission Risks of norovirus that causesThe nonbacterial primary goal ofgastroenteritis disinfecting procedures outbreaks is the is inactivation fomite-mediated of organisms as onwell fomites. as coccidioidomycosisGenerally, microorganisms. Furthermore belong, to some a diverse of the group greatest such asconcerns bacteria, regarding viral, and protozoanantibiotic- species [6]. These biological agents are widely found in the natural environment and, as a result, they can be found either in many work sectors or household contexts. The majority of these microorganisms are harmless; however, some of them or their metabolites may cause diseases. For example, the transmission of norovirus that causes nonbacterial gastroenteritis outbreaks is fomite-mediated as well as coccidioidomycosis. Furthermore, some of the greatest concerns regarding antibiotic-resistant bacteria transmission occur Antibiotics 2021, 10, x FOR PEER REVIEW 3 of 32 Antibiotics 2021, 10, 613 3 of 29 resistant bacteria transmission occur via fomite as reported by Julian et al. [7] for Staphylococcus pseudintermedius. Therefore, the knowledge of these organisms and their viasurvival fomite is as fundamental reported by Julianto choose et al. the [7] forrightStaphylococcus antimicrobial pseudintermedius agents and implementing. Therefore, theeffective knowledge tactics. of these organisms and their survival is fundamental to choose the right antimicrobial agents and implementing effective tactics. 2.1. Bacteria 2.1. BacteriaBacteria are single-celled organisms (0.3–1.5 µm) with independent life and replicationBacteria cycle. are single-celled Bacterial cells organisms are generally (0.3–1.5 µsurroundedm) with independent by two concentric life and replication protective cycle.layers: Bacterial an inner cells cell are membrane generally surroundedand an outer by cell two wall concentric [8]. The protective cytoplasmatic layers: membrane an inner cellshare membranes a similar and structure an outer to cell the walleukaryote’s [8]. The one, cytoplasmatic but there are membrane no sterols. shares Here, a similarproteins structureinvolved to in the the eukaryote’s energy production one, but can there be are found no sterols. like some Here, respiratory proteins involvedchain protein in the as energywell as production photosynthetic can beprotein found in like photosynthetic some respiratory bacteria chain that protein lack chloroplast. as well as photosyn-Among the theticproteins protein that inconstitute photosynthetic the cell wall bacteria, the thatmain lack one chloroplast.is peptidoglycan Among (PGN), the proteinsalso known that as constitutemurein, which the cell provides wall, the rigidity main one to isthe peptidoglycan structure and (PGN), counteracts also known the osmotic as murein, pressure which of providesthe cytoplasm. rigidity PGN to the isstructure characterized and counteracts by a glucidic the backbone osmotic pressureof altern ofating the units cytoplasm. of two PGNazotated is characterized carbohydrates, by a namely glucidic N backbone-acetylglucosamine of alternating (GlcNAc) units of and two N azotated-acetylmuramic carbo- hydrates,acid (MurNAc). namely Each N-acetylglucosamine MurNAc is cross- (GlcNAc)linked to a and short N-acetylmuramic amino acid chain, acid which
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