Probiotic-Based Sanitation Reduces Hospital Infections Better Than Chlorine

JULY 18, 2018
Brandon May
Elisabetta Caselli, PhDElisabetta Caselli, PhD
The Probiotic Cleaning Hygiene System (PCHS), a microbial-based decontamination strategy which is comprised of detergents that contain spores of Bacillus probiotics, is an effective and safe system for controlling contamination in the hospital setting and effectively reducing the risk of healthcare-associated infections (HAIs), according to a multicenter study published in PLoS One.

Additionally, the probiotic-based cleansing system demonstrated little to no impact on worsening the risk of antibiotic resistance, which is a common issue associated with chemical-based cleansers.

“HAI is a global concern, further worsened by the growing antibiotic-resistance of the associated microbes,” lead study author Elisabetta Caselli, PhD, of the University of Ferrara, told MD Magazine®. “The persistent contamination of the hospital environment contributes to such infections, and sanitation procedures used so far are not effective in controlling it and can further increase AMR (antimicrobial resistance). The studies on human microbiota have evidenced that, rather than eliminating all the microbes, it can be more advantageous and effective to replace ‘bad’ microbes with ‘good’ ones to preserve health and even to cure a disease.”

The investigators enrolled a total of 6 Italian hospitals with Internal Medicine departments that replaced a chlorine-based cleansing protocol with a PCHS sanitation program. Cleaning staff were trained on PCHS application standards. Patients, data extractors, and healthcare personnel were blinded to the cleansing system change.

Two study phases were included in the study: 1) a 6-month pre-PCHS period, and 2) a 6-month post-PCHS period. At minimum, a 2-month interval was allowed between the phases. The investigators compared the 2 phases in regard to the association of the PCHS strategy on HAI reduction in a total of 11,842 surveyed patients.

Additionally, the researchers assessed both quantitative and qualitative characterization of hospital surface ‘bioburden’ in each surveyed area. Quantification of Staphylococcus spp., Enterobacteriaceae spp., Acinetobacter spp., Mycetes, Pseudomonas spp., Clostridium difficile, and total bacteria was performed. Floors, bed footboards, and sinks from randomized rooms were sampled for hospital surface microbiota each month, with a total of 24,875 environmental samples included in the final analysis.

A significant global reduction in HAI cumulative incidence was observed from pre- to post-PCHS implementation (4.8% vs 2.3%, respectively; odds ratio 0.44; 95% CI 0.35-0.54; P <.0001). Additionally, the use of a PCHS cleansing program in the 5 intervention hospitals resulted in a mean decrease of 83% (range 70—96.3%) in surface pathogens compared with the use of a conventional, chemical-based cleaning strategy (22,737 CFU/m2 to 4,632 CFU/m2; range 842-12,632 CFU/m2; P <.0001). By contrast, no differences were observed at the control hospital between the observation periods.

Researchers collected data on HAIs that occurred during the pre-PCHS and PCHS phases. The study reported a 66.6% decrease in C. difficile from 9 samples to just 3 samples in the PCHS phase.

Considering only median-risk Internal Medicine wards were included in this analysis, the findings may hold limited generalizability across other ward types or other health structures. An additional limitation of the study, according to Dr. Caselli, was related to the time required to obtain the stable abatement of environmental contamination “as the mechanism is based on competitive antagonism, and we are currently studying a biological approach to overcome this point.”

“The main clinical implications associated with our findings are related to the halved incidence of HAI observed in the hospitals when they were sanitized with the studied biological approach, such as PCHS and the probiotic cleaning hygiene system,” Dr. Caselli explained. “Since HAI are directly responsible for thousands of deaths every year, we think that this approach might be considered as a part of infection prevention strategies.”

The study, “Reducing healthcare-associated infections incidence by a probiotic-based sanitation system: A multicentre, prospective, intervention study,” was published in PloS One.

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