Emerging Biocide Resistance–Frequency, Drivers, Relevant Outcomes and Containment Strategies

A special issue of Hygiene (ISSN 2673-947X).

Deadline for manuscript submissions: closed (31 July 2024) | Viewed by 18953

Special Issue Editor


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Guest Editor
Institute for Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
Interests: hand hygiene; antiseptic stewardship; resistance and tolerance to biocidal agents; surface hygiene; antimicrobial efficacy testing

Special Issue Information

Dear Colleagues,

Biocidal products are relevant for the control of infections and should be used in a targeted way. During the pandemic, however, many hand and surface disinfectants were used in a general non-targeted way in public and private areas. Depending on the type of biocidal agents, exposure to subinhibitory concentration may cause an adaptive bacterial response resulting in a lower cellular susceptibility to the biocidal agent or to other biocidal agents, or even to antibiotics (cross-resistance).

Potential topics include but are not limited to:

  • Frequency and relevance of biocide resistance;
  • Mechanisms of tolerance;
  • Case reports (reduced cellular susceptibility, e.g., resulting in infection or food contamination);
  • Adaptive cellular effects of excessive disinfection measures in public places;
  • Evidence-based proposals for a targeted use of biocidal agents for the prevention of infectious disease;
  • Relevance of antimicrobial surface coating on bacterial tolerance;
  • Strategies for containment of biocide resistance;
  • Relevance of biofilms for biocide resistance;
  • Proposals for evidence-based definitions of biocidal tolerance and resistance.

Prof. Dr. Günter Kampf
Guest Editor

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Published Papers (2 papers)

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Review

40 pages, 1732 KiB  
Review
Bacterial Contamination of Antiseptics, Disinfectants and Hand Hygiene Products in Healthcare Facilities in High-Income Countries: A Scoping Review
by Palpouguini Lompo, Anne-Sophie Heroes, Esenam Agbobli, Vera Kühne, Halidou Tinto, Dissou Affolabi and Jan Jacobs
Hygiene 2023, 3(2), 136-175; https://doi.org/10.3390/hygiene3020012 - 19 Apr 2023
Cited by 5 | Viewed by 9697
Abstract
This scoping review addresses bacterial contamination of antiseptics, low-level disinfectants, and hand hygiene products in healthcare settings in high-income countries. Over 70 years, 114 articles were found: 68 outbreaks, 13 pseudo-outbreaks and 33 cross-sectional surveys. Outbreaks affected median 29 (1–151) patients, extended for [...] Read more.
This scoping review addresses bacterial contamination of antiseptics, low-level disinfectants, and hand hygiene products in healthcare settings in high-income countries. Over 70 years, 114 articles were found: 68 outbreaks, 13 pseudo-outbreaks and 33 cross-sectional surveys. Outbreaks affected median 29 (1–151) patients, extended for 26 (1–156) weeks and had a case fatality of 0.0% (0.0–60.0%). Most (72.8%) (pseudo-)outbreaks were caused by water-based chlorhexidine (CHG), quaternary ammonium compounds (QUAT) and the combination CHG–QUAT. Contaminating bacteria were nonfermentative Gram-negative rods (87.6% (pseudo-)outbreaks), mainly Burkholderia cepacia, Pseudomonas aeruginosa and Achromobacter spp.) and Enterobacterales (29.6%, 24/81), mostly Serratia spp.). Risk factors were at the level of the bacteria (natural resistance to CHG and QUAT), containers (design and functioning, presence of cork and cotton, biofilm formation), preparation (nonsterile water, overdilution) and practices (too long expiry dates, inappropriate container reprocessing, topping up of containers and deviation from procedures). Transmission occurred through direct contact (antiseptics), contact with semicritical items (disinfectants) and were handborne (soaps). During recent decades, reports of soap contaminated with Enterobacterales emerged and nationwide outbreaks of intrinsically contaminated CHG occurred. Outstanding issues comprise intrinsic contamination, implementation of antiseptic stewardship, the role of unit doses and sterile products, transmission studies, biofilm control and understanding healthcare providers’ perceptions. Full article
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32 pages, 1966 KiB  
Review
Bacterial Contamination of Antiseptics, Disinfectants, and Hand Hygiene Products Used in Healthcare Settings in Low- and Middle-Income Countries—A Systematic Review
by Palpouguini Lompo, Esenam Agbobli, Anne-Sophie Heroes, Bea Van den Poel, Vera Kühne, Cyprien M. Gutemberg Kpossou, Adama Zida, Halidou Tinto, Dissou Affolabi and Jan Jacobs
Hygiene 2023, 3(2), 93-124; https://doi.org/10.3390/hygiene3020010 - 13 Apr 2023
Cited by 8 | Viewed by 7844
Abstract
We conducted a systematic review of healthcare-associated outbreaks and cross-sectional surveys related to the contamination of antiseptics, disinfectants, and hand hygiene products in healthcare settings in low- and middle-income countries (PROSPERO CRD42021266271). Risk of bias was assessed by selected items of the ORION [...] Read more.
We conducted a systematic review of healthcare-associated outbreaks and cross-sectional surveys related to the contamination of antiseptics, disinfectants, and hand hygiene products in healthcare settings in low- and middle-income countries (PROSPERO CRD42021266271). Risk of bias was assessed by selected items of the ORION and MICRO checklists. From 1977 onwards, 13 outbreaks and 25 cross-sectional surveys were found: 20 from Asia and 13 from Africa. Products most associated with outbreaks were water-based chlorhexidine, chlorhexidine-quaternary ammonium compound combinations (7/13), and liquid soap products (4/13). Enterobacterales (including multidrug-resistant Enterobacter cloacae, Klebsiella pneumoniae, and Serratia marcescens) and non-fermentative Gram-negative rods were found in 5 and 7 outbreaks and in 34.1% and 42.6% of 164 isolates, respectively, from cross-sectional surveys. Risk factors included preparation (place, utensils, or tap water high and incorrect dilutions), containers (reused, recycled, or inadequate reprocessing), and practices (topping-up or too long use). Potential biases were microbiological methods (neutralizers) and incomplete description of products’ identity, selection, and denominators. External validity was compromised by low representativeness for remote rural settings and low-income countries in sub-Saharan Africa. Outstanding issues were water quality, biofilm control, field-adapted containers and reprocessing, in-country production, healthcare providers’ practices, and the role of bar soap. A list of “best practices” to mitigate product contamination was compiled. Full article
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