Worldwide, millions of patients are affected annually by healthcare-associated infection (HCAI), impacting up to 80,000 patients in European Hospitals on any given day. This represents not only public health risk, but also an economic burden.
Through its Cooperation in Science and Technology programme (COST), the European Commission has recently funded a four-year initiative to establish a network of stakeholders involved in development, regulation and use of novel anti-microbial coatings for prevention of HCAI. The network (its acronym is AMiCI) currently comprises participants of more than sixty universities, knowledge institutes and companies across twenty-nine European countries and, to date, represents the most comprehensive grouping to target use of these emergent technologies in healthcare settings. By accessing the network’s website (www.amici-consortium.eu), there is an ongoing opportunity for those interested to engage with the programme.
Antimicrobial coatings hold promise based, in essence, on the application of materials and chemicals with persistent bactericidal or –static properties onto surfaces in healthcare environments.[2,3] However, an excellent systematic review of the topic was published recently in this journal in which the authors reported a scarcity of studies assessing non-copper antimicrobial surfaces in
the clinical environment, and a complete lack of published data regarding the successful implementation of materials other than copper on clinically significant outcomes (including HCAI).
The focus of considerable commercial investment and academic research energies, such antimicrobial coating-based approaches are widely believed to have potential to reduce microbial numbers on surfaces in clinical settings. This belief is despite limited definitive evidence for their efficacy in clinical settings; rather, it is based largely on positive findings from studies involving, for example, silver or gold ions, titanium or organosilane, under laboratory conditions. However, there are reports of successful delay and/or prevention of recontamination following conventional cleaning and disinfection by problematic microorganisms, including meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE).[7-10]
The European Commission funding of this network reflects the potential for antimicrobial innovations to positively impact on the 4 million patients reported by the European Centre for Disease Prevention and Control (ECDC) to be affected by HCAI annually. More specifically, the network participants will address knowledge gaps that persist due to due to lack of:
- systematic, international coordinated research on the effects (both positive and negative) of antimicrobial coatings in healthcare or other sectors;
- know-how regarding the availability and use of different materials mechanisms of action of (nano)-coatings and the desired use in different applications, procedures and products;
- information relating to the possible adverse effects of such materials, e.g. the potential induction of new resistance mechanisms in bacteria or emission of toxic agents into the environment;
- standard performance assessments for antimicrobial coatings, applicable in laboratory settings and, thereby, complicating direct comparison of different coatings from different producers;
- standard performance assessments to determine functionality of coatings in normal and extreme test conditions, field tests or benchmark methods to assess the efficacy in field conditions; and
- communication or publication of best practices by hospitals, other clinical facilities, regulators or product suppliers.
The project recognizes, and aims to address, the disparate perspectives of inventors and entrepreneurs; academic researchers; manufacturers; distributors; commercial, clinical, biocide and consumer affairs regulators; medicines agencies; clinical microbiologists; attending physicians; healthcare facility managers and procurement officers; environmental monitoring specialists and environmental protection agencies; hygiene companies; and, of course, patients and their carers. The AMiCI consortium is addressing this challenging these diversities of viewpoints through a series of consultation events and targeted transfer of personnel between industry and academic groups, strategically chosen to deal with the most pressing topics arising from those consultations, and development of coating capable of demonstrably reducing HCAI.
This article is based upon work from COST Action AMiCI (CA15114), supported by COST (European Cooperation in Science and Technology).
1. European Centre for Disease Prevention and Control, 2013. Summary: Point prevalence survey of healthcare-associated infections and antimicrobial use in European hospitals 2011–2012 [online] available:
http://ecdc.europa.eu/en/publications/_layouts/forms/Publication_DispForm.aspx?List=4f55ad51-4aed-4d32-b960-af70113dbb90&ID=865 [accessed 23 Jun2016].
2. Paige K, Wilson M, Parkin IP. Antimicrobial surfaces and their potential in reducing the role of the inanimate environment in th eincidence of hospitalacquired infections. J Material Chem 2009;19:3819-3831.
3. Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in th etransmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38:S25-S33.
4. Muller MP, MacDougall C, Lim M, et al. Antimicrobial surfaces to prevent healthcare-associated infections: a systematic review. J Hosp Infect 2016;92:7– 3.
5. Salgado CD, Sepkowitz KA, John JF, et al. Copper surfaces reduce the rate of healthcare-acquired infections in th eintersive care unit. Infect Control Hosp Epidemiol 2013;34:479-486.
6. Molling JW, Seezink JW, Teunissen BE, Muijrers-Chen I, Borm PJ. Comparative performance of a panel of commercially available antimicrobial nanocoatings in Europe. Nanotechnol Sci Appl 2014;7:97-104.
7. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:130.
8.Boyce JM, Havill NL, Otter JA, et al. Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting. Infect Control Hosp Epidemiol 2008; 29:723-729.
9. Morter S, Bennett G, Fish J, et al. Norovirus in the hospital setting: virus introduction and spread within the hospital environment. J Hosp Infect 2011;77:106-112.
10. Otter JA, Cummins M, Ahmad F, van Tonder C, Drabu YJ. Assessing the biological efficacy and rate of recontamination following hydrogen peroxide vapour decontamination. J Hosp Infect 2007;67:182-188.
Crijns F, Keinänen-Toivola M, Dunne C, Anti-microbial coating innovations to prevent healthcare-associated infection, Journal of Hospital Infection (2017), doi: 1
Crijns FRL1, Keinänen-Toivola MM2, Dunne CP3,*
1 Zuyd University of Applied Sciences, Nieuw Eyckholt 300, Heerlen, The Netherlands.
2 Satakunta University of Applied Sciences, Suojantie 2, FI-26100 Rauma, Finland.
3 Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
* Corresponding author:
Prof Colum Dunne, Graduate Entry Medical School, University of Limerick, Limerick, Ireland. Tel: +353 61 234703. Email: colum.dunne <at > ul.ie