Nosocomial infections are frequently caused by bacteria that are resistant to various antibiotics, resulting in the mortality or delayed recovery of hospitalized patients. Several studies have investigated the efficiency of ozone (O3) gas for the disinfection of surfaces to eliminate different nosocomial pathogens. In this study, the efficacy of O3 gas in a heavily contaminated healthcare facility was investigated using a low concentration of FDA-approved and human-safe O3. The total microbial loads on the air conditioning (AC) duct, wall, and tables after 1 month of O3 application were 0 CFU/100 cm2, 1 CFU/ 100 cm2, and 1 CFU/100 cm2, respectively. Moreover, the total microbial loads on the AC duct, wall, and tables 2 months after O3 application were 0 CFU/m2, 14 CFU/m2, and 1 CFU/m2, respectively. Finally, after the third month following O3 application, the microbial loads were 0 CFU/100 cm2 on the AC duct, 7 CFU/100 cm2 on the walls, and 54 CFU/100 cm2on the tables. Overall results show that O3 gas controlled fungal growth, as it was decreased to minimal levels on some swabbed surfaces or even eliminated on most swabbed medical devices and work surfaces. Moreover, O3 is capable of eradicating nosocomial pathogens present in hidden areas even at low concentrations that match the levels approved by the FDA for human exposure. The study concluded that gaseous O3 can serve as an effective, safe, and cheap disinfectant. O3 could effectively work to eliminate both nosocomial bacteria and mould pathogens.
1. Magill SS, O’Leary E, Janelle SJ, Thompson DL, Dumyati G, Nadle J, et al. Changes in prevalence of health care–associated infections in US hospitals. N Engl J Med. 2018;379(18):1732-44.
2. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46):1800516.
3. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019;19(1):56-66.
4. Hanawi SA, Saat NZ, Zulkafly M, Hazlenah H, Taibukahn NH, Yoganathan D, et al. Impact of a healthy lifestyle on the psychological well-being of university students. Int J Pharm Res Allied Sci. 2020;9(2):1-7.
5. Alsulami SA, Alqarni AM, Felemban DF, Alshawaf YY, Alsulami SK, Belal SH, et al. An overview of urinary tract infection diagnosis and management approach in primary health care centers: literature review. Pharmacophore. 2020;11(6):104-7.
6. Plachouras D, Kärki T, Hansen S, Hopkins S, Lyytikäinen O, Moro ML, et al. Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill. 2018;23(46):1800393.
7. Ramasethu J. Prevention and treatment of neonatal nosocomial infections. Matern Health Neonatol Perinatol. 2017;3(1):1-11.
8. Cipolla D, Giuffrè M, Mammina C, Corsello G. Prevention of nosocomial infections and surveillance of emerging resistances in NICU. J Matern Fetal Neonatal Med. 2011;24(sup1):23-6.
9. Ki V, Rotstein C. Bacterial skin and soft tissue infections in adults: a review of their epidemiology, pathogenesis, diagnosis, treatment and site of care. Can J Infect Dis Med Microbiol. 2008;19(2):173-84.
10. Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pac J Trop Biomed. 2017;7(5):478-82.
11. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med. 2014;370(13):1198-208.
12. Li Y, Ren L, Zou J. Risk factors and prevention strategies of nosocomial infection in geriatric patients. Can J Infect Dis Med Microbiol. 2019;2019.
13. Sserwadda I, Lukenge M, Mwambi B, Mboowa G, Walusimbi A, Segujja F. Microbial contaminants isolated from items and work surfaces in the post-operative ward at Kawolo general hospital, Uganda. BMC Infect Dis. 2018;18(1):1-6.
14. Su LX, Wang XT, Pan P, Chai WZ, Liu DW. Infection management strategy based on prevention and control of nosocomial infections in intensive care units. Chin Med J. 2019;132(1):115-9.
15. López‐García M, King MF, Noakes CJ. A multicompartment SIS stochastic model with zonal ventilation for the spread of nosocomial infections: Detection, outbreak management, and infection control. Risk Anal. 2019;39(8):1825-42.
16. Singh AA, Fatima A, Mishra AK, Chaudhary N, Mukherjee A, Agrawal M, et al. Assessment of ozone toxicity among 14 Indian wheat cultivars under field conditions: growth and productivity. Environ Monit Assess. 2018;190(4):1-4.
17. Zeng L, Fan GJ, Lyu X, Guo H, Wang JL, Yao D. Atmospheric fate of peroxyacetyl nitrate in suburban Hong Kong and its impact on local ozone pollution. Environ Pollut. 2019;252:1910-9.
18. Mohan S, Saranya P. Assessment of tropospheric ozone at an industrial site of Chennai megacity. J Air Waste Manage Assoc. 2019;69(9):1079-95.
19. Burgassi S, Zanardi I, Travagli V, Montomoli E, Bocci V. How much ozone bactericidal activity is compromised by plasma components? J Appl Microbiol. 2009;106(5):1715-21.
20. Sohail M, Latif Z. Molecular analysis, biofilm formation, and susceptibility of methicillin-resistant Staphylococcus aureus strains causing community-and health care-associated infections in central venous catheters. Rev Soc Bras Med Trop. 2018;51(5):603-9.
21. Haque M, Sartelli M, McKimm J, Bakar MA. Health care-associated infections–an overview. Infect Drug Resist. 2018;11:2321-33.
22. Climo M, Diekema D, Warren DK, Herwaldt LA, Perl TM, Peterson L, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol. 2003;24(12):942-5.
23. Bell T, O’Grady NP. Prevention of central line–associated bloodstream infections. Infect Dis Clin. 2017;31(3):551-9.
24. Cookson B, Mackenzie D, Kafatos G, Jans B, Latour K, Moro ML, et al. Development and assessment of national performance indicators for infection prevention and control and antimicrobial stewardship in European long-term care facilities. J Hosp Infect. 2013;85(1):45-53.
25. Huis A, Schouten J, Lescure D, Krein S, Ratz D, Saint S, et al. Infection prevention practices in the Netherlands: results from a National Survey. Antimicrob Resist Infect Control. 2020;9(1):1-7.
26. Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva CL, Donaldson L, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis. 2006;6(10):641-52.
27. Kudo D, Sasaki J, Ikeda H, Shiino Y, Shime N, Mochizuki T, et al. A survey on infection control in emergency departments in Japan. Acute Med Surg. 2018;5(4):374-9.
28. Viboud C, Simonsen L. Global mortality of 2009 pandemic influenza A H1N1. Lancet Infect Dis. 2012;12(9):651-3.
29. Mitchell BG, Gardner A, Stone PW, Hall L, Pogorzelska-Maziarz M. Hospital staffing and health care–associated infections: a systematic review of the literature. Jt Comm J Qual Patient Saf. 2018;44(10):613-22.
30. Russo PL, Cheng AC, Mitchell BG, Hall L. Healthcare-associated infections in Australia: tackling the ‘known unknowns’. Aust Health Rev. 2017;42(2):178-80.
31. Russo A, Gavaruzzi F, Ceccarelli G, Borrazzo C, Oliva A, Alessandri F, et al. Multidrug-resistant Acinetobacter baumannii infections in COVID-19 patients hospitalized in intensive care unit. Infection. 2021:1-10. doi:10.1007/s15010-021-01643-4
32. Vasudevan RS, Mojaver S, Chang KW, Maisel AS, Peacock WF, Chowdhury P. Observation of stethoscope sanitation practices in an emergency department setting. Am J Infect Control. 2019;47(3):234-7.
33. Brown KL, Ramaiah R, Fenton M, Wood TL, Scott K, Carter K, et al. Adverse family social circumstances and outcome in pediatric cardiac transplant recipients at a UK center. J Heart Lung Transplant. 2009;28(12):1267-72.
34. Abubakar I, Moore J, Drobniewski F, Kruijshaar M, Brown T, Yates M, et al. Extensively drug-resistant tuberculosis in the UK: 1995 to 2007. Thorax. 2009;64(6):512-5.
35. Hayden MK, Bonten MJ, Blom DW, Lyle EA, van de Vijver DA, Weinstein RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis. 2006;42(11):1552-60.
36. Mi E, Li J, McClane BA. NanR regulates sporulation and enterotoxin production by Clostridium perfringens type F strain F4969. Infect Immun. 2018;86(10):e00416-18.
37. Eckstein BC, Adams DA, Eckstein EC, Rao A, Sethi AK, Yadavalli GK, et al. Reduction of Clostridium difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis. 2007;7(1):1-6.
38. Hu WS, Woo DU, Kang YJ, Koo OK. Biofilm and Spore Formation of Clostridium perfringens and Its Resistance to Disinfectant and Oxidative Stress. Antibiotics. 2021;10(4):396.
39. Alfa MJ, Dueck C, Olson N, DeGagne P, Papetti S, Wald A, et al. UV-visible marker confirms that environmental persistence of Clostridium difficile spores in toilets of patients with C. difficile-associated diarrhea is associated with lack of compliance with cleaning protocol. BMC Infect Dis. 2008;8(1):1-7.
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