Reducing healthcare-associated infections incidence by a probiotic-based sanitation system: A multicentre, prospective, intervention study

• Published in: PloS one Vol. 13; no. 7; p. e0199616
• Main Authors: Caselli, Elisabetta, Brusaferro, Silvio, Coccagna, Maddalena, Arnoldo, Luca, Berloco, Filippo, Antonioli, Paola, Tarricone, Rosanna, Pelissero, Gabriele, Nola, Silvano, La Fauci, Vincenza, Conte, Alessandro, Tognon, Lorenzo, Villone, Giovanni, Trua, Nelso, Mazzacane, Sante
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 12.07.2018; Public Library of Science (PLoS)
• Subjects: Antibiotic resistance; Antibiotics; Bacillus; Biology and Life Sciences; Cleaning; Clinical trials; Contamination; Cross infection; Departments; Disinfection & disinfectants; Drug resistance; Environmental impact; Health aspects; Health care; Health surveillance; Hospitalization; Hospitals; Hygiene; Incidence; Infections; Intensive care; Intervention; Medical research; Medicine and Health Sciences; Microbiota; Microorganisms; Multidrug resistant organisms; Nosocomial infections; Pathogens; Patients; Prevention; Probiotics; Public health; Sanitation; Sanitation services; Sanitation systems; Sustainability; Systematic review; Urinary tract infections; Italy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0199616

Healthcare Associated Infections (HAI) are a global concern, further threatened by the increasing drug resistance of HAI-associated pathogens. On the other hand, persistent contamination of hospital surfaces contributes to HAI transmission, and it is not efficiently controlled by conventional cleaning, which does not prevent recontamination, has a high environmental impact and can favour selection of drug-resistant microbial strains. In the search for effective approaches, an eco-sustainable probiotic-based cleaning system (Probiotic Cleaning Hygiene System, PCHS) was recently shown to stably abate surface pathogens, without selecting antibiotic-resistant species. The aim of this study was to determine whether PCHS application could impact on HAI incidence. A multicentre, pre-post interventional study was performed for 18 months in the Internal Medicine wards of six Italian public hospitals (January 1st 2016-June 30th 2017). The intervention consisted of the substitution of conventional sanitation with PCHS, maintaining unaltered any other procedure influencing HAI control. HAI incidence in the pre and post-intervention period was the main outcome measure. Surface bioburden was also analyzed in parallel. Globally, 11,842 patients and 24,875 environmental samples were surveyed. PCHS was associated with a significant decrease of HAI cumulative incidence from a global 4.8% (284 patients with HAI over 5,930 total patients) to 2.3% (128 patients with HAI over 5,531 total patients) (OR = 0.44, CI 95% 0.35-0.54) (P<0.0001). Concurrently, PCHS was associated with a stable decrease of surface pathogens, compared to conventional sanitation (mean decrease 83%, range 70-96.3%), accompanied by a concurrent up to 2 Log drop of surface microbiota drug-resistance genes (P<0.0001; Pc = 0.008). Our study provides findings which support the impact of a sanitation procedure on HAI incidence, showing that the use of a probiotic-based environmental intervention can be associated with a significant decrease of the risk to contract a HAI during hospitalization. Once confirmed in larger experiences and other target populations, this eco-sustainable approach might be considered as a part of infection control and prevention (IPC) strategies. Trial registration-ISRCTN International Clinical Trials Registry, ISRCTN58986947.