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Surface modifications for antimicrobial effects in the healthcare setting: a critical overview
C Adlhart1, J Verran2, N F Azevedo3
1Institute of Chemistry and Biotechnology, Zurich University of Applied Sciences ZHAW, Wädenswil, Switzerland.
Abstract:
The spread of infections in healthcare environments is a persistent and growing problem in most countries, aggravated by the development of microbial resistance to antibiotics and disinfectants. In addition to indwelling medical devices (e.g. implants, catheters), such infections may also result from adhesion of microbes either to external solid-water interfaces such as shower caps, taps, drains, etc., or to external solid-gas interfaces such as door handles, clothes, curtains, computer keyboards, etc. The latter are the main focus of the present work, where an overview of antimicrobial coatings for such applications is presented. This review addresses well-established and novel methodologies, including chemical and physical functional modification of surfaces to reduce microbial contamination, as well as the potential risks associated with the implementation of such anticontamination measures. Different chemistry-based approaches are discussed, for instance anti-adhesive surfaces (e.g. superhydrophobic, zwitterions), contact-killing surfaces (e.g. polymer brushes, phages), and biocide-releasing surfaces (e.g. triggered release, quorum sensing-based systems). The review also assesses the impact of topographical modifications at distinct dimensions (micrometre and nanometre orders of magnitude) and the importance of applying safe-by-design criteria (e.g. toxicity, contribution for unwanted acquisition of antimicrobial resistance, long-term stability) when developing and implementing antimicrobial surfaces.
Insights
This review explores antimicrobial coatings for surfaces like door handles and keyboards to combat healthcare-associated infections. It covers various methods and emphasizes safe-by-design principles for effective contamination control.
Area of Science:
- Materials Science
- Microbiology
- Public Health
Background:
- Healthcare-associated infections (HAIs) are a growing global concern, exacerbated by antimicrobial resistance.
- Microbial contamination on external surfaces (solid-gas interfaces) contributes significantly to infection spread.
- Existing medical device coatings do not address broader environmental surface contamination.
Purpose of the Study:
- To provide an overview of antimicrobial coatings for external surfaces in healthcare settings.
- To review established and novel surface modification techniques for reducing microbial contamination.
- To assess the risks and safe-by-design considerations for implementing these antimicrobial surfaces.
Main Methods:
- Review of chemical surface modifications: anti-adhesive (superhydrophobic, zwitterions) and contact-killing (polymer brushes, phages) surfaces.
- Discussion of biocide-releasing systems (triggered release, quorum sensing-based).
- Assessment of topographical modifications (micro- and nano-scale) and safe-by-design criteria (toxicity, resistance development, stability).
Main Results:
- Various chemical and physical surface modification strategies can reduce microbial adhesion and proliferation.
- Topographical features at micro- and nano-scales influence antimicrobial efficacy.
- Potential risks include toxicity and the promotion of antimicrobial resistance, necessitating careful design.
Conclusions:
- Antimicrobial coatings offer promising solutions for controlling microbial contamination on external healthcare surfaces.
- A safe-by-design approach is crucial to mitigate risks associated with these technologies.
- Further research is needed to optimize long-term stability and minimize unintended consequences.
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