Efficacy of novel antimicrobial gloves impregnated with antiseptic dyes in preventing the adherence of multidrug-resistant nosocomial pathogens

Activity of antimicrobial examination gloves under realistic conditions: challenge not fulfilled

BACKGROUND

Antimicrobial materials or surfaces are advertised as part of infection prevention bundles. However, the efficacy of such antimicrobial surfaces has not been sufficiently investigated in hospitals. In this study, the antimicrobial activity of examination gloves with light-activated antimicrobial properties against Gram-positive microorganisms was investigated modelling real live conditions.

METHOD

In a standardized experimental set-up with dry and realistic contamination, the antimicrobial properties of gloves claiming light dependent antimicrobial activity against Gram-positive organisms were tested in comparison with conventional examination gloves. All gloves were contaminated through a standardized activity of the test persons for construction with contaminated building blocks. For contamination suspensions of Enterococcus faecium ATCC 6057, Acinetobacter baumannii (outbreak strain), methicillin resistant Staphylococcus aureus ATCC 43300 or E. faecium (VRE) patient isolate were dried on the surfaces. After the standardized activity, the gloves were held for 10 min in the light present in the room (bright conditions) and the grade of contamination was determined subsequently by quantitative culture. In one experimental series gloves were held in a dark box after contamination as a control (dark conditions).

RESULTS

The light intensity in all experiments under bright conditions was significantly above the limit value specified by the manufacturer for the activation of antimicrobial properties (> 500 lx). The mean values for experiments with antimicrobial active and non-active gloves were 955 and 935 lx, respectively. As claimed by the manufacture, the gloves showed no sufficient efficacy against A. baumannii under bright conditions. Against Gram-positive microorganisms such as E. faecium, E. faecium (VRE) and methicillin resistant S. aureus the gloves showed only very low antimicrobial activity with a reduction factor < 1 log10 even after 10 min in bright conditions. Interestingly, comparable results for experiments with A. baumannii and E. faecium were shown under dark conditions.

CONCLUSION

The lack of activity of the active principle against Gram-negative microorganisms could be confirmed. The reduction factors of > 4 log10 within 5 min for Gram-positive microorganisms claimed for the product using a standard test procedure (ASTM D7907) could not be confirmed in a realistic experimental test set-up even after 10 min of light exposure. The effectiveness against Gram-positive microorganisms should be further investigated under realistic (dry) conditions, including patient care. At this stage, the use of supposedly antimicrobial gloves should not be recommended, as the belief in their efficacy may encourage the misuse of gloves.

Performance-Enhancing Materials in Medical Gloves

Medical gloves, along with masks and gowns, serve as the initial line of defense against potentially infectious microorganisms and hazardous substances in the health sector. During the COVID-19 pandemic, medical gloves played a significant role, as they were widely utilized throughout society in daily activities as a preventive measure. These products demonstrated their value as important personal protection equipment (PPE) and reaffirmed their relevance as infection prevention tools. This review describes the evolution of medical gloves since the discovery of vulcanization by Charles Goodyear in 1839, which fostered the development of this industry. Regarding the current market, a comparison of the main properties, benefits, and drawbacks of the most widespread types of sanitary gloves is presented. The most common gloves are produced from natural rubber (NR), polyisoprene (IR), acrylonitrile butadiene rubber (NBR), polychloroprene (CR), polyethylene (PE), and poly(vinyl chloride) (PVC). Furthermore, the environmental impacts of the conventional natural rubber glove manufacturing process and mitigation strategies, such as bioremediation and rubber recycling, are addressed. In order to create new medical gloves with improved properties, several biopolymers (e.g., poly(vinyl alcohol) and starch) and additives such as biodegradable fillers (e.g., cellulose and chitin), reinforcing fillers (e.g., silica and cellulose nanocrystals), and antimicrobial agents (e.g., biguanides and quaternary ammonium salts) have been evaluated. This paper covers these performance-enhancing materials and describes different innovative prototypes of gloves and coatings designed with them.

Prevention of nosocomial transmission and biofilm formation on novel biocompatible antimicrobial gloves impregnated with biosynthesized silver nanoparticles synthesized using Eucalyptus citriodora leaf extract

Failure in the prevention of cross-transmission from contaminated gloves has been recognized as an important factor that contributes to the spread of several healthcare-associated infections. Ex situ coating process with silver nanoparticles (AgNPs) using Eucalyptus citriodora ethanolic leaf extract as reducing and capping agents to coat glove surfaces has been developed to prevent this mode of transmission. Elemental analysis of coated gloves showed 24.8 Wt% silver densely adhere on the surface. The coated gloves fully eradicated important hospital-acquired pathogens including Gram-positive bacteria, Gram-negative bacteria, and yeasts within 1 h. The coated gloves showed significant reduction, an average of five logs when tested against all standard strains and most clinical isolates (p < 0.01). Following prolonged exposure, the coating significantly reduced the numbers of most adhered pathogenic species, compared with uncoated gloves (p < 0.0001). AgNPs-coated gloves reduced microbial adhesion of mixed-species biofilms. A series of contamination and transmission assays demonstrated no transmission of viable organisms. Biocompatibility analysis confirmed high viability of HaCaT and L929 cells at all concentrations of AgNPs tested. The coated gloves were non-toxic with direct contact with L929 cells. The highly efficacious AgNPs-coated gloves potentially provide additional protection against transmission of healthcare-associated infections.

ANTIMICROBIAL AGENTS AND ANTI-ADHESION MATERIALS FOR MEDICAL AND SURGICAL GLOVES

Healthcare-associated infections (HAIs) can be common in healthcare settings, such as the intensive care unit and surgical sites, if proper precautions are not followed. Although traditional techniques are encouraged, such as educating the public and healthcare workers to practice proper handwashing or to double glove, they have not been fully effective in combating HAIs. The use of surface-modified antimicrobial gloves may be an alternative approach to prevent the transmission of pathogens between healthcare workers and patients. This paper gives a comprehensive review of strategies to produce antimicrobial gloves. The chemistry of some potential chemically synthesized antimicrobial agents and nature-inspired superhydrophobic surfaces are discussed. The principles of killing microbes must be understood to effectively select these materials and to design and fabricate surfaces for the reduction of bacterial adhesion. Also, current company trends and technologies are presented for gloves proven to effectively kill bacteria. Such glove use, when coupled with in-depth research on diverse surgical procedures and medical examinations, could ease the burden of HAIs.

Enhanced antibacterial activity of a novel biocompatible triarylmethane based ionic liquid-graphene oxide nanocomposite

Biofilm formation on medical implants and devices has been a severe concern that results in their impaired performance and life-threatening complications. Thus, development of novel functional coatings for infection prone surfaces with biofilm inhibiting characteristics is of prime significance considering the rapid emergence of multidrug resistant bacteria. Herein we present a novel nanocomposite derived from Graphene Oxide (GO) and a newly developed functional Ionic liquid (IL) obtained through a metathesis reaction between a triarylmethane dye hexamethyl pararosaniline chloride or crystal violet (CV) and sodium dodeceyl sulfate (SDS) to yield [CV][DS] (hexamethyl pararosaniline dodecyl sulfate). This highly biocompatible [CV][DS]-GO nanocomposite exhibit more than four times improved antibacterial activity in comparison to bare GO against both gram negative Escherichia coli (E. coli) and gram positive Staphylococcus aureus (S. aureus). As suggested by XRD, FTIR and UV absorption and SEM results improved activity of [CV][DS]-GO nanocomposite is ascribed to the synergistic effect of reduced nanocomposite sheet thickness, enhanced amphiphilicity imparted by dodecylsulfate (DS), exposed active ArN⁺ groups of CV and some inherent functionalities of GO. This is also complemented by the ruptured and diffused S. aureus cell walls as observed in bacterial SEM result. In contrast, the nanocomposites of the precursors with GO do not demonstrate any significant antibacterial effect. Coatings developed using GO upon infestation with E. coli revealed significant biofilm formation after 48 and 72 h of incubation while [CV][DS]-GO coated surface demonstrated no colony growth under similar circumstances. Thus, [CV][DS]-GO nanocomposite coatings exhibit excellent resistance to bacterial growth even up to 72 h incubation signifying its bactericidal effect. Therefore, the developed nanocomposite may be considered as one of the improved antibacterial wash resistant coating material for biomedical devices and surfaces susceptible to to biofilm formation.

Study on the In Vitro Activity of Five Disinfectants against Nosocomial Bacteria

Nosocomial infections cause significant morbidity and mortality worldwide, and the pathogenic organisms responsible for such infections can develop resistance to antimicrobial agents. Understanding the activity of disinfectants against clinical and environmental bacterial isolates is therefore crucial. We analysed the in vitro activity of five antimicrobial products (phenolic compounds, didecyldimethylammonium chloride (DDAC), sodium hypochlorite, isopropanol + ammonium compounds (IACs), hydrogen peroxide) against 187 bacterial strains comprising clinical isolates, as well as 30 environmental isolates of Pseudomonas aeruginosa from hospital water samples. Disk diffusion assays were employed to assess antimicrobial activity. Hydrogen peroxide was significantly more active (p < 0.0001) than the other disinfectants against all P. aeruginosa, Klebsiella pneumoniae, Enterococcus faecalis and Staphylococcus aureus strains. It was also the only disinfectant with activity against both clinical and environmental strains of P. aeruginosa. DDAC and IAC-based disinfectants were ineffective against Gram-negative strains, but showed significant activity (particularly IACs, p < 0.0001) against the Gram-positive strains. Compared with IACs, DDAC was significantly more active on E. faecalis and less active on S. aureus (p < 0.0001). Sodium hypochlorite and phenol compounds, by contrast, were inactive against all bacterial strains. The development of disinfection procedures that are effective against all microorganisms is essential for limiting the spread of nosocomial infections.

PROGRESS ON ANTIMICROBIAL SURGICAL GLOVES: A REVIEW

Surgical gloves provide a protective blockade for patients and members of the surgical team. Glove integrity is critical in an era of blood-borne pathogens. Therefore, the need for improved means for prevention and also gloving and appropriate hand hygiene in a hospital setting is ostensible. This perspective highlights the progress on antimicrobial surgical gloves in deducting the microbial passage after a glove puncture in a model of wound contamination. Moreover, traditional methods to avoid microbes in the hospital and various antimicrobial agents, such as metal ions and antiseptic dyes, are reviewed.

Gloves, gowns and masks for reducing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in the hospital setting

BACKGROUND

Meticillin-resistant Staphylococcus aureus (MRSA; also known as methicillin-resistant S aureus) is a common hospital-acquired pathogen that increases morbidity, mortality, and healthcare costs. Its control continues to be an unresolved issue in many hospitals worldwide. The evidence base for the effects of the use of gloves, gowns or masks as control measures for MRSA is unclear.

OBJECTIVES

To assess the effectiveness of wearing gloves, a gown or a mask when contact is anticipated with a hospitalised patient colonised or infected with MRSA, or with the patient's immediate environment.

SEARCH METHODS

We searched the Specialised Registers of three Cochrane Groups (Wounds Group on 5 June 2015; Effective Practice and Organisation of Care (EPOC) Group on 9 July 2013; and Infectious Diseases Group on 5 January 2009); CENTRAL (The Cochrane Library 2015, Issue 6); DARE, HTA, NHS EED, and the Methodology Register (The Cochrane Library 2015, Issue 6); MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations (1946 to June week 1 2015); EMBASE (1974 to 4 June 2015); Web of Science (WOS) Core Collection (from inception to 7 June 2015); CINAHL (1982 to 5 June 2015); British Nursing Index (1985 to 6 July 2010); and ProQuest Dissertations & Theses Database (1639 to 11 June 2015). We also searched three trials registers (on 6 June 2015), references list of articles, and conference proceedings. We finally contacted relevant individuals for additional studies.

SELECTION CRITERIA

Studies assessing the effects on MRSA transmission of the use of gloves, gowns or masks by any person in the hospital setting when contact is anticipated with a hospitalised patient colonised or infected with MRSA, or with the patient's immediate environment. We did not assess adverse effects or economic issues associated with these interventions.We considered any comparator to be eligible. With regard to study design, only randomised controlled trials (clustered or not) and the following non-randomised experimental studies were eligible: quasi-randomised controlled trials (clustered or not), non-randomised controlled trials (clustered or not), controlled before-and-after studies, controlled cohort before-after studies, interrupted time series studies (controlled or not), and repeated measures studies. We did not exclude any study on the basis of language or date of publication.

DATA COLLECTION AND ANALYSIS

Two review authors independently decided on eligibility of the studies. Had any study having been included, two review authors would have extracted data (at least for outcome data) and assessed the risk of bias independently. We would have followed the standard methodological procedures suggested by Cochrane and the Cochrane EPOC Group for assessing risk of bias and analysing the data.

MAIN RESULTS

We identified no eligible studies for this review, either completed or ongoing.

AUTHORS' CONCLUSIONS

We found no studies assessing the effects of wearing gloves, gowns or masks for contact with MRSA hospitalised patients, or with their immediate environment, on the transmission of MRSA to patients, hospital staff, patients' caregivers or visitors. This absence of evidence should not be interpreted as evidence of no effect for these interventions. The effects of gloves, gowns and masks in these circumstances have yet to be determined by rigorous experimental studies, such as cluster-randomised trials involving multiple wards or hospitals, or interrupted time series studies.

Infection control and prevention considerations

Due to the nature of their underlying illness and treatment regimens, cancer patients are at increased risk of infection. Though the advent and widespread use of anti-infective agents has allowed for the application of ever-greater immune-suppressing therapies with successful treatment of infectious complications, prevention of infection remains the primary goal. The evolutionary changes of microorganisms, whereby resistance to anti-infective therapy is increasingly common, have facilitated a paradigm shift in the field of healthcare epidemiology. No longer is the focus on "control" of infection once established in a healthcare environment. Rather, the emphasis is on prevention of infection before it occurs. The most basic tenet of infection prevention, and the cornerstone of all well-designed infection prevention and control programs, is hand hygiene. The hands of healthcare workers provide a common potential source for transmission of infectious agents, and effective decontamination of the hands reduces the risk of transmission of infectious material to other patients. Once infection is suspected or established; however, implementation of effective control strategies is important to limit the spread of infection within a healthcare environment. This chapter outlines the basic tenets of infection prevention, principles of isolation precautions and control measures, and elements for a successful infection control and prevention program.

Disposable gendine antimicrobial gloves for preventing transmission of pathogens in health care settings

BACKGROUND

Transmission of organisms by contact of gloves with surfaces following contact with a pathogen source has been recognized as an important vector for pathogenesis of health care-associated infections. In these cases, the gloves protect the wearer from contact with the pathogenic organisms; however, this personal protection can facilitate the wearer unwittingly becoming a carrier of the pathogens from one location to another. A novel gendine (combination of chlorhexidine and gentian violet) antiseptic coating for the external surface of the glove was developed as a potential intervention to prevent this mode of transmission.

METHODS

We characterized the ability of the coating to rapidly kill bacterial and fungal pathogens within 1 minute of contact with the glove surface. The International Organization of Standardization 22196 concentrated inoculum contact testing methodology was followed.

RESULTS

The gendine-coated gloves were able to fully eradicate multidrug-resistant organisms included methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterocci, multidrug-resistant Pseudomonas aeruginosa, and Klebsiella pneumoniae carbapenemase producing. In addition, Candida albicans, Candida glabarata, and 2 pathogenic Escherichia coli strains commonly associated with invasive gastroenteritis were also fully eradicated within 1 minute of contact. The gendine coating did not adversely impact the finish or integrity of the disposable gloves.

CONCLUSION

The highly efficacious gendine-coated antimicrobial gloves potentially provide an additional means of protection against horizontal transmission of common pathogens in a hospital setting.

In-vitro experimental evaluation of skin-to-surface recovery of four bacterial species by antibacterial and non-antibacterial medical examination gloves

Background

The number of bacteria recovered from a stainless steel coupon after touching a pigskin substrate with an examination glove coated on its outside with polyhexanide (PHMB), as compared to the number of bacteria recovered in the same manner with non-coated control gloves was evaluated.

Methods

Suspensions containing 1 × 10⁹ colony-forming units of 4 clinically relevant bacterial species (Enterococcus faecium ATCC #51559; Escherichia coli ATCC #25922; Klebsiella pneumoniae ATCC #4352; and Staphylococcus aureus ATCC #33591) were used to contaminate Gamma-irradiated pigskin substrates. Bacterial recoveries from the pigskin substrate, stainless steel coupons, and each glove swatch were performed. A difference in the bacterial recovery from the stainless steel coupons after touching with coated and uncoated control gloves was measured.

Results

For E. faecium, the coated glove showed a reduction of 4.63 log₁₀ cfu recovery, when compared to control gloves. For E. coli, the coated glove showed 5.48 log₁₀ cfu, for K. pneumoniae 5.03 log₁₀ cfu, and for S. aureus 5.72 log₁₀ cfu recovery, when compared to the non-coated control glove.

Conclusion

An in-vitro experiment designed to mimic cross-contamination of clinically relevant bacteria in a simulated healthcare setting following glove contact with a contaminated biological surface and cross-transfer to a stainless steel surface has demonstrated that an examination glove coated on its outside surface with PHMB was able to reduce bacterial recovery from a contaminated surface by > 4 log₁₀ cfu, compared to a control non-coated examination glove. These elaborated results may encourage further clinical investigation on the clinical impact of an antibacterial examination glove.

Triphenylmethane dye activation of beta-arrestin

β-Arrestins regulate G protein-coupled receptor signaling as competitive inhibitors and protein adaptors. Low molecular weight biased ligands that bind receptors and discriminate between the G protein dependent arm and β-arrestin, clathrin-associated arm of receptor signaling are considered therapeutically valuable as a result of this distinctive pharmacological behavior. Other than receptor agonists, compounds that activate β-arrestins are not available. We show that within minutes of exposure to the cationic triphenylmethane dyes malachite green and brilliant green, tissue culture cells recruit β-arrestins to clathrin scaffolds in a receptor-activation independent manner. In the presence of these compounds, G protein signaling is inhibited, ERK and GSK3β signaling are preserved, and the recruitment of the beta2-adaptin, AP2 adaptor complex to clathrin as well as transferrin internalization is reduced. Moreover, malachite green binds β-arrestin2-GFP coated immunotrap beads relative to GFP only coated beads. Triphenylmethane dyes are FDA approved for topical use on newborns as components of triple-dye preparations and are not approved but used effectively as aqueous antibiotics in fish husbandry. As possible carcinogens, their chronic ingestion in food preparations, particularly through farmed fish, is discouraged in the U.S. and Europe. Our results indicate triphenylmethane dyes as a result of novel pharmacology may have additional roles as β-arrestin/clathrin pathway signaling modulators in both pharmacology research and clinical therapy.

The prevention of biofilm colonization by multidrug-resistant pathogens that cause ventilator-associated pneumonia with antimicrobial-coated endotracheal tubes

Ventilator-associated pneumonia (VAP) continues to be the nosocomial infection associated with the highest mortality in critically ill patients. Since silver-coated endotracheal tubes (ETT) was shown in a multicenter prospective randomized trials to decrease the risk of VAP, we compared the efficacy of two antiseptic agents such as gardine- and gendine-coated ETTs with that of silver-coated ETTs in preventing biofilm. The ETTs were tested for their ability to prevent the biofilm formation of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Enterobacter cloacae, and Candida albicans. Scanning electron microscopy studies revealed a heavy biofilm on uncoated and silver-coated ETT but not on the gardine-coated ETT. The gardine and gendine ETTs completely inhibited the formation of biofilms by all organisms tested and were more effective in preventing biofilm growth than the silver ETTs (p < 0.001). The gardine- and gendine-coated ETTs were more durable against MRSA than either the silver-coated or uncoated ETTs for up to 2 weeks (p < 0.0001). We have therefore shown that gardine- and gendine-coated ETTs are superior to silver-coated ETTs in preventing biofilm. Future animal and clinical studies are warranted to determine whether the gardine- and gendine-coated ETTs can significantly reduce the risk of VAP.