A Multi-level Antimicrobial Surface Coating for a Healthier Environment
Condition: Hospital Acquired Infections
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      This project aimed to study the use of the multi-level antimicrobial coating in a working
      hospital environment. Patient privacy curtains from a public sector hospital were coated and
      installed in rehabilitation ward in comparison of normally washed curtains in the same
      setting and compared the mean reduction on both control and treatment end to assess the
      effectiveness of coating against hospital acquired infections including multidrug resistant
      organisms (MDROs).
    

Detailed description: 
      1. A multi-level antimicrobial coating was produced in the Hong Kong University of Science
           and Technology (HKUST) laboratory using the newly developed staged flow micromixing to
           prepare contact-killing and anti-adhesion coating made of US-FDA approved polymeric
           materials. The process was optimized to scale-up the production to 5 liters per hour.
           300 liters of the multi-level antimicrobial coating was prepared for the study for a
           total of 24 weeks as three liters of the coating was needed for one patient privacy
           curtain.

        2. The study was conducted in the rehabilitation ward of the Kowloon Hospital including
           both male and female cubicles. It was carried out in three stages with each stage
           consisting of survey and a four weeks' observation period, separated by three weeks'
           washout period. In the rehabilitation ward of Kowloon Hospital, a set of male and female
           cubicle was recruited for the study after getting maximum number of bacterial
           contamination on patient privacy curtains in pilot study of 8 weeks. Each cubicle had 12
           curtains besides admitted patients where all the samples are collected.

        3. Environmental sampling was carried out using sponge swab on the surfaces of the patient
           privacy curtains. The total bacteria count and quantitative isolation of MRSA was done
           using established protocols. The total bacteria count provides a quantitative measure of
           surface cleanliness, while the methicillin-resistant Staphylococcus aureus (MRSA) count
           was indicative of the risk of contact transmission from contaminated surfaces. 2-4 weeks
           survey provided control data on the cleanliness of patients privacy curtains in terms of
           total bacteria and MRSA counts.

           During the study period, the Kowloon Hospital/Queen Elizabeth Hospital infection control
           team monitored MDROs regularly as part of their routine operation. The procedure and
           schedule was followed strictly the infection control protocol. All infection control
           measures implemented after isolation of MDROs were followed according to the hospital's
           usual practice as advised by the infection control team. In the study, the
           identification of the organisms in patients more than 48 hours after admission without
           prior isolation of the organisms in clinical or screening specimens was defined as
           nosocomial.

        4. The investigators demonstrated a cross-over intervention study. In the first stage of
           study, half of the patient privacy curtains were considered as treatment (antimicrobial
           coated) and the other half of the curtains as control in the same setting in a cubicle.
           As the study was double blind, so coding was done to identify the treatment as control
           curtains.

        5. Sample were taken from eight highly touched areas of 50x50 cm² on weekly bases for three
           consecutive weeks on 7th day of first installation. On each period/phase 480, 576 and
           786 samples were collected accordingly using the developed sample protocol. In total,
           the investigators collected 1824 samples from 76 patient privacy curtains in which 912
           (50%) were control curtain and 912 (50%) are antimicrobial coated curtains.

        6. Healthcare workers from the participating wards were assessed for their acceptance of
           the multilevel antimicrobial disinfectant coating by way of a questionnaire. Additional
           reformulation may be necessary to increase the acceptability of the coating technology
           to the healthcare workers.

        7. For the bacteria count, duplicate plates of tryptic soy agar (TSA) for total bacteria
           count and Chromagar MRSA (selective agar for MRSA detection) were used for enumeration.
           CFU/m² is calculated after 48 hours incubation at 37°C. Data was analyzed using
           Statistical Package for the Social Sciences (SPSS) V.25 to assess the effectiveness of
           the coating in reducing the contamination level of the surface. The total bacteria count
           on the patient privacy curtains was compared between the control and treatment group
           using Mann-Whitney test and T-test. ANOVA analysis allowed the comparison of different
           periods of study of phase wise as well as week wise. The significance of the statistical
           test is defined to have a P value <0.05.
    

Intervention name(s): Regular Patient privacy curtain; Antimicrobial Coated curtains
Intervention type(s): Combination Product; Combination Product
Intervention description(s): Laundered curtains, used in the hospital, coming from the hospital inventory.; Antimicrobial coating consist of active polymers that are approved by USFDA and USEPA.
Intervention MeSH terms: Anti-Infective Agents; Anti-Bacterial Agents
Allocation: Non-Randomized
Intervention model: Crossover Assignment
Intervention model description: Phase 1, even numbers in coding are treatment and odd coded curtains are control (Blind) Phase 2, odd numbers in coding are treatment and even coded curtains are control (Blind) Phase 3, even numbers in coding are treatment and odd coded curtains are control (Blind)
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Antimicrobial coating, MDRO, MRSA, Patient Privacy Curtains