title: Hard surface biocontrol in hospitals using microbial-based cleaning products.
abstract: BACKGROUND
  Healthcare-Associated Infections (HAIs) are one of the most frequent complications occurring in healthcare facilities. Contaminated environmental surfaces provide an important potential source for transmission of many healthcare-associated pathogens, thus indicating the need for new and sustainable strategies.
  
  
  OBJECTIVE
  This study aims to evaluate the effect of a novel cleaning procedure based on the mechanism of biocontrol, on the presence and survival of several microorganisms responsible for HAIs (i.e. coliforms, Staphyloccus aureus, Clostridium difficile, and Candida albicans) on hard surfaces in a hospital setting.
  
  
  METHODS
  The effect of microbial cleaning, containing spores of food grade Bacillus subtilis, Bacillus pumilus and Bacillus megaterium, in comparison with conventional cleaning protocols, was evaluated for 24 weeks in three independent hospitals (one in Belgium and two in Italy) and approximately 20000 microbial surface samples were collected.
  
  
  RESULTS
  Microbial cleaning, as part of the daily cleaning protocol, resulted in a reduction of HAI-related pathogens by 50 to 89%. This effect was achieved after 3-4 weeks and the reduction in the pathogen load was stable over time. Moreover, by using microbial or conventional cleaning alternatively, we found that this effect was directly related to the new procedure, as indicated by the raise in CFU/m2 when microbial cleaning was replaced by the conventional procedure. Although many questions remain regarding the actual mechanisms involved, this study demonstrates that microbial cleaning is a more effective and sustainable alternative to chemical cleaning and non-specific disinfection in healthcare facilities.
  
  
  CONCLUSIONS
  This study indicates microbial cleaning as an effective strategy in continuously lowering the number of HAI-related microorganisms on surfaces. The first indications on the actual level of HAIs in the trial hospitals monitored on a continuous basis are very promising, and may pave the way for a novel and cost-effective strategy to counteract or (bio)control healthcare-associated pathogens.
authors.affiliation: CIAS Laboratory, Centre for the Study of physical, chemical and microbiological Contamination of Highly Sterile Environments, Department of Architecture, University of Ferrara, Ferrara, Italy.
authors.forename: Alberta
authors.initials: A
authors.lastname: Vandini
authors.affiliation: Laboratory of Microbial Ecology and Technology, Ghent University, Ghent, Belgium; Chrisal R & D Department, Lommel, Belgium.
authors.forename: Robin
authors.initials: R
authors.lastname: Temmerman
authors.affiliation: CIAS Laboratory, Centre for the Study of physical, chemical and microbiological Contamination of Highly Sterile Environments, Department of Architecture, University of Ferrara, Ferrara, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Frabetti
authors.affiliation: Department of Medical Sciences, Microbiology Section, University of Ferrara, Ferrara, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Caselli
authors.affiliation: Department of Infection Prevention Control and Risk Management, Ferrara University Hospital, Ferrara, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Antonioli
authors.affiliation: Department of Medical Sciences, Microbiology Section, University of Ferrara, Ferrara, Italy.
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Balboni
authors.affiliation: Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Platano
authors.affiliation: Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Branchini
authors.affiliation: CIAS Laboratory, Centre for the Study of physical, chemical and microbiological Contamination of Highly Sterile Environments, Department of Architecture, University of Ferrara, Ferrara, Italy.
authors.forename: Sante
authors.initials: S
authors.lastname: Mazzacane
mesh_terms: D015169:Colony Count, Microbial; D003428:Cross Infection / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D006761:Hospitals