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PLoS One. 2018 Jul 12;13(7):e0199616. doi: 10.1371/journal.pone.0199616. eCollection 2018.

Reducing healthcare-associated infections incidence by a probiotic-based sanitation system: A multicentre, prospective, intervention study.

Author information

Section of Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
CIAS Interdepartmental Research Centre, Departments of Medical Sciences and Architecture, University of Ferrara, Ferrara, Italy.
Department of Medicine, University of Udine, Udine, Italy.
Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy.
Department of Infection Prevention Control and Risk Management, S. Anna University Hospital, Ferrara, Italy.
Centre for Research on Health and Social Care Management (CERGAS), Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy.
Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
Azienda USL di Ferrara, Ferrara, Italy.
Department of Biomedical Sciences and Dental and Functional Images, University of Messina, Messina, Italy.
Ospedale di Santa Maria del Prato, Feltre (Belluno), Italy.
Azienda Ospedaliera Universitaria Ospedali Riuniti di Foggia, Foggia, Italy.
Ospedale Sant'Antonio Abate, Tolmezzo (Udine), Italy.


Healthcare Associated Infections (HAI) are a global concern, further threatened by the increasing drug resistance of HAI-associated pathogens. On the other hand, persistent contamination of hospital surfaces contributes to HAI transmission, and it is not efficiently controlled by conventional cleaning, which does not prevent recontamination, has a high environmental impact and can favour selection of drug-resistant microbial strains. In the search for effective approaches, an eco-sustainable probiotic-based cleaning system (Probiotic Cleaning Hygiene System, PCHS) was recently shown to stably abate surface pathogens, without selecting antibiotic-resistant species. The aim of this study was to determine whether PCHS application could impact on HAI incidence. A multicentre, pre-post interventional study was performed for 18 months in the Internal Medicine wards of six Italian public hospitals (January 1st 2016-June 30th 2017). The intervention consisted of the substitution of conventional sanitation with PCHS, maintaining unaltered any other procedure influencing HAI control. HAI incidence in the pre and post-intervention period was the main outcome measure. Surface bioburden was also analyzed in parallel. Globally, 11,842 patients and 24,875 environmental samples were surveyed. PCHS was associated with a significant decrease of HAI cumulative incidence from a global 4.8% (284 patients with HAI over 5,930 total patients) to 2.3% (128 patients with HAI over 5,531 total patients) (OR = 0.44, CI 95% 0.35-0.54) (P<0.0001). Concurrently, PCHS was associated with a stable decrease of surface pathogens, compared to conventional sanitation (mean decrease 83%, range 70-96.3%), accompanied by a concurrent up to 2 Log drop of surface microbiota drug-resistance genes (P<0.0001; Pc = 0.008). Our study provides findings which support the impact of a sanitation procedure on HAI incidence, showing that the use of a probiotic-based environmental intervention can be associated with a significant decrease of the risk to contract a HAI during hospitalization. Once confirmed in larger experiences and other target populations, this eco-sustainable approach might be considered as a part of infection control and prevention (IPC) strategies. Trial registration-ISRCTN International Clinical Trials Registry, ISRCTN58986947.

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Conflict of interest statement

The authors declare that they received unrestricted funds by Copma scrl (Ferrara, Italy), but the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

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