title: Surface-attached cells, biofilms and biocide susceptibility: implications for hospital cleaning and disinfection.
abstract: Microbes tend to attach to available surfaces and readily form biofilms, which is problematic in healthcare settings. Biofilms are traditionally associated with wet or damp surfaces such as indwelling medical devices and tubing on medical equipment. However, microbes can survive for extended periods in a desiccated state on dry hospital surfaces, and biofilms have recently been discovered on dry hospital surfaces. Microbes attached to surfaces and in biofilms are less susceptible to biocides, antibiotics and physical stress. Thus, surface attachment and/or biofilm formation may explain how vegetative bacteria can survive on surfaces for weeks to months (or more), interfere with attempts to recover microbes through environmental sampling, and provide a mixed bacterial population for the horizontal transfer of resistance genes. The capacity of existing detergent formulations and disinfectants to disrupt biofilms may have an important and previously unrecognized role in determining their effectiveness in the field, which should be reflected in testing standards. There is a need for further research to elucidate the nature and physiology of microbes on dry hospital surfaces, specifically the prevalence and composition of biofilms. This will inform new approaches to hospital cleaning and disinfection, including novel surfaces that reduce microbial attachment and improve microbial detachment, and methods to augment the activity of biocides against surface-attached microbes such as bacteriophages and antimicrobial peptides. Future strategies to address environmental contamination on hospital surfaces should consider the presence of microbes attached to surfaces, including biofilms.
authors.affiliation: Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St. Thomas' NHS Foundation Trust, London, UK; Bioquell (UK) Ltd., Andover, UK. Electronic address: jonathan.otter@kcl.ac.uk.
authors.forename: J A
authors.initials: JA
authors.lastname: Otter
authors.affiliation: Australian School of Advanced Medicine, Macquarie University, Nth Ryde, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Vickery
authors.affiliation: Public Health England MSD, Porton Down, Salisbury, UK.
authors.forename: J T
authors.initials: JT
authors.lastname: Walker
authors.affiliation: Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA.
authors.forename: E
authors.initials: E
authors.lastname: deLancey Pulcini
authors.affiliation: Departments of Microbial Infection and Immunity and Orthopedics, Ohio State University, Columbus, OH, USA; National Centre for Advanced Tribology, University of Southampton, Southampton, UK.
authors.forename: P
authors.initials: P
authors.lastname: Stoodley
authors.affiliation: Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: S D
authors.initials: SD
authors.lastname: Goldenberg
authors.affiliation: Bioquell (UK) Ltd., Andover, UK.
authors.forename: J A G
authors.initials: JA
authors.lastname: Salkeld
authors.affiliation: Bioquell (UK) Ltd., Andover, UK.
authors.forename: J
authors.initials: J
authors.lastname: Chewins
authors.affiliation: Bioquell (UK) Ltd., Andover, UK.
authors.forename: S
authors.initials: S
authors.lastname: Yezli
authors.affiliation: Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: J D
authors.initials: JD
authors.lastname: Edgeworth
mesh_terms: D001419:Bacteria / Q000187:drug effects*; D018407:Bacterial Physiological Phenomena; D018441:Biofilms / Q000187:drug effects*; D002448:Cell Adhesion; D004202:Disinfectants / Q000494:pharmacology*; D004203:Disinfection / Q000379:methods*; D005658:Fungi / Q000187:drug effects*; D006801:Humans; D008826:Microbial Sensitivity Tests
chemical_list: D004202:Disinfectants
keywords: Biocide susceptibility; Biofilms; Cleaning; Disinfection; Planktonic cells; Surface-attached cells