title: Infection control in healthcare settings: perspectives for mfDNA analysis in monitoring sanitation procedures.
abstract: Appropriate sanitation procedures and monitoring of their actual efficacy represent critical points for improving hygiene and reducing the risk of healthcare-associated infections. Presently, surveillance is based on traditional protocols and classical microbiology. Innovation in monitoring is required not only to enhance safety or speed up controls but also to prevent cross infections due to novel or uncultivable pathogens. In order to improve surveillance monitoring, we propose that biological fluid microflora (mf) on reprocessed devices is a potential indicator of sanitation failure, when tested by an mfDNA-based approach. The survey focused on oral microflora traces in dental care settings.
  
  
  
  Experimental tests (n = 48) and an "in field" trial (n = 83) were performed on dental instruments. Conventional microbiology and amplification of bacterial genes by multiple real-time PCR were applied to detect traces of salivary microflora. Six different sanitation protocols were considered. A monitoring protocol was developed and performance of the mfDNA assay was evaluated by sensitivity and specificity.
  
  
  
  Contaminated samples resulted positive for saliva traces by the proposed approach (CT < 35). In accordance with guidelines, only fully sanitized samples were considered negative (100 %). Culture-based tests confirmed disinfectant efficacy, but failed in detecting incomplete sanitation. The method provided sensitivity and specificity over 95 %.
  
  
  
  The principle of detecting biological fluids by mfDNA analysis seems promising for monitoring the effectiveness of instrument reprocessing. The molecular approach is simple, fast and can provide a valid support for surveillance in dental care or other hospital settings.
authors: Unit of Public Health, University of Rome "Foro Italico", Piazza Lauro De Bosis, 6, 00135, Rome, Italy.
authors: Federica
authors: F
authors: Valeriani
authors: Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
authors: Carmela
authors: C
authors: Protano
authors: Unit of Public Health, University of Rome "Foro Italico", Piazza Lauro De Bosis, 6, 00135, Rome, Italy.
authors: Gianluca
authors: G
authors: Gianfranceschi
authors: Department of Public Health and Cellular Biology, University "Tor Vergata", Rome, Italy.
authors: Paola
authors: P
authors: Cozza
authors: Department of Public Health and Cellular Biology, University "Tor Vergata", Rome, Italy.
authors: Vincenzo
authors: V
authors: Campanella
authors: Hygiene and Epidemiology Chair, University "Parthenope", Naples, Italy.
authors: Giorgio
authors: G
authors: Liguori
authors: Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
authors: Matteo
authors: M
authors: Vitali
authors: Department of Public Health and Cellular Biology, University "Tor Vergata", Rome, Italy.
authors: Maurizio
authors: M
authors: Divizia
authors: Unit of Public Health, University of Rome "Foro Italico", Piazza Lauro De Bosis, 6, 00135, Rome, Italy. vincenzo.romanospica@uniroma4.it.
authors: Vincenzo
authors: V
authors: Romano Spica
mesh_terms: D001826:Body Fluids / Q000502:physiology; D003428:Cross Infection / Q000517:prevention & control*; D003695:Delivery of Health Care / Q000592:standards; D003748:Dental Equipment / Q000382:microbiology*; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D064307:Microbiota / Q000235:genetics* / Q000502:physiology; D009055:Mouth / Q000382:microbiology; D060888:Real-Time Polymerase Chain Reaction; D012463:Saliva / Q000382:microbiology*; D012499:Sanitation / Q000379:methods / Q000592:standards; D012680:Sensitivity and Specificity
keywords: Dental healthcare; Healthcare-associated infections; Real time PCR; Sanitation procedures; Surveillance; mfDNA