Smart surfaces to tackle infection and antimicrobial resistance

Topics: Antimicrobial surfaces, antimicrobial resistance, hospital aquired infection
Type: Briefing paper
Publication date: March 2020

Authors: Jonathan Otter, Kieran Brophy, Jonathan Palmer, Nicholas Harrison, Jason Riley, Daryl Williams, Gerald Larrouy-Maumus

Contaminated surfaces and medical devices contribute to the transmission of healthcare-associated infection (HCAI) and the spread of antimicrobial resistance (AMR).
Surface-attached biofilms (communities of microbial and non-microbial matter on surfaces) support microbial survival, persistence, and can protect microbes from attack by biocides and antibiotics.
Biofilms also play a role in several important infection pathways including infections related to medical devices (e.g. catheter-associated urinary tract infections), prosthesis-related infections (e.g. infected hip joints), and water-borne infections (e.g. Pseudomonasand Legionalla contamination of hospital water systems). These pathways are increasingly recognised in the transmission of pathogens that can cause HCAI and increase AMR.
A 2016 Public Health England survey of over 48,000 patient records found that 6.6% of patients acquired HCAI in hospitals.

Antimicrobial surfaces could disrupt the microbial habit by reducing microbial attachment and/or killing attached microbes.
The design, manufacture and testing of antimicrobial surface technologies must involve multidisciplinary teams from molecular science, engineering, medicine and business.
Potential application areas for antimicrobial surfaces include:

Improving the design of medical devices in order to reduce the risk of infection;
Reducing the risk of infection related to surgically implanted prosthesis (such as hip and knee joints);
Transforming the clinical environment to have touch surfaces with antimicrobial properties (e.g. coated bed rails) particularly for the prevention of infection in vulnerable patient groups such as adults and neonates in intensive care.
To make hospital water system less prone to contamination with bacteria such as Pseudomonas and Legionella.

In addition to applications in the hospital environment of developed countries, antimicrobial surfaces should be developed with low and middle-income (LMIC) settings in mind, where these surfaces could mitigate the impact of additional challenges related to LMIC settings (such as lack of power and clean water).
The spread of infection and antimicrobial resistance in the clinical environment cannot be tackled by antimicrobial surfaces alone, but be employed as part of a combined approach involving clinical and cleaning staff following protocols developed to prevent the spread of microbes, and the responsible distribution and use of antibiotics.

Imperial College London