Investigation of the Antimicrobial Activity of Hospital Furniture Coated with Melamine Resin Endowed with Catalysts as In Situ Generated Biocides

For people in the 21st century, it is hard to imagine the world before antibiotics. At the beginning of the 20th century, as many as nine women out of every 1,000 who gave birth died, 40 percent from sepsis. In some cities as many as 30 percent of children died before their first birthday. One of every nine people who developed a serious skin infection died, even from something as simple as a scrape or an insect bite. Pneumonia killed 30 percent of those who contracted it; bacterial meningitis was almost universally fatal. Ear infections caused deafness; sore throats were not infrequently followed by rheumatic fever and heart failure. Surgical procedures were associated with high morbidity and mortality due to infection. This picture changed dramatically with three major developments: improvements in public health, vaccines, and antibiotics. Over the course of the 20th century, deaths from infectious diseases declined markedly and contributed to a substantial increase in life expectancy.


Introduction
For people in the 21st century, it is hard to imagine the world before antibiotics. At the beginning of the 20th century, as many as nine women out of every 1,000 who gave birth died, 40 percent from sepsis. In some cities as many as 30 percent of children died before their first birthday. One of every nine people who developed a serious skin infection died, even from something as simple as a scrape or an insect bite. Pneumonia killed 30 percent of those who contracted it; bacterial meningitis was almost universally fatal. Ear infections caused deafness; sore throats were not infrequently followed by rheumatic fever and heart failure. Surgical procedures were associated with high morbidity and mortality due to infection.
This picture changed dramatically with three major developments: improvements in public health, vaccines, and antibiotics. Over the course of the 20th century, deaths from infectious diseases declined markedly and contributed to a substantial increase in life expectancy.
Antibiotics have saved millions of lives. But the world is now at dire risk of losing this progress. Bacteria and other microbes evolve in response to their environment and inevitably develop mechanisms to resist being killed by antibiotics but Increasing tolerance of hospital Enterococcus faecium to handwash alcohols [1,2]. For many decades, the problem was manageable as the growth of resistance was slow and the pharmaceutical industry continued to create new antibiotics. Over the past decade, however, this brewing problem has become a crisis. The evolution of antibiotic resistance is now occurring at an alarming rate and is outpacing the development of new countermeasures capable of thwarting infections in humans [3][4][5][6][7]. This situation threatens patient care, economic growth, public health, agriculture, economic security, and national security. The UN Interagency Coordination Group on Antimicrobial Resistance demands therefore immediate, coordinate and ambitious measures to combat this problem [8].

The Problem
Intensive care unit (ICU)-acquired infections are a challenging health problem worldwide, especially when caused by multidrugresistant (MDR) pathogens and a daily challenge for the clinician dealing with critically ill patients. Contamination of inanimate surfaces in ICU has been identified in outbreaks and crosstransmission of pathogens among critically ill patients. In ICUs, inanimate surfaces and equipment (e.g., bedrails, stethoscopes, medical charts, ultrasound machine) are frequently contaminated by bacteria, including MDR isolates [9]. Contamination may occur either by transfer of microorganisms contaminating healthcare workers' hands or direct patient shedding of microorganisms in the immediate environment of a patient's bed. Multi drug resistant (MDR) bacteria have been reported as contaminating microorganisms of surfaces, commonly used medical equipment and high-contact communal surfaces (e.g., telephones, keyboard, medical charts) in ICU [8]. It has been reported that both Grampositive and Gram-negative bacteria are able to survive up to months on dry inanimate surfaces, with even longer persistence under humid and lower-temperature conditions [10]. Environmental contamination by fungi and viral pathogens including coronavirus has been also described not only in ICU. Factors that may affect the transfer of microorganisms from one surface to another and crosscontamination rates are type of organisms, source and destination surfaces, humidity level, and size of inoculum [11][12][13].
Cross-transmission of microorganisms from inanimate surfaces may have a significant role for ICU-acquired colonization and infections. A higher environmental contamination has been reported around infected patients than around patients who are only colonized, in this last group, a correlation has been observed between frequency of environmental contamination and culturepositive body sites. Admission to a room previously occupied by a patient with MRSA, VRE, Acinetobacter, or C. difficile increases the risk for the subsequent patient admitted to the room to acquire the pathogen [14]. Healthcare workers not only contaminate their hands after direct patient contact but also after touching inanimate surfaces and equipment in the patient zone (Beste Übersetzung von " Patientennahen Oberflächen") [15,16]. Quartile distribution of health care acquired infections stratified by microbial burden were measured in the intensive care unit rooms during patients stay. A significant association between burden and HAI risk with an 89% risk occurring in a room when 100cm² surfaces were contaminated by more than 10 5 CFU [17].
Contamination of inanimate surfaces in ICU has been identified in outbreaks and cross-transmission of pathogens among critically ill patients. Contamination may occur either by transfer of microorganisms contaminating healthcare workers' hands or direct patient shedding of microorganisms in the immediate environment of a patient's bed. Multi drug resistant (MDR) bacteria have been reported as contaminating microorganisms of surfaces, commonly used medical equipment and high-contact communal surfaces (e.g., telephones, keyboard, medical charts) in ICU [18,19]. Factors that may affect the transfer of microorganisms from one surface to another and cross-contamination rates are type of organisms, source and destination surfaces, humidity level, and size of inoculum [20]. However, other factors playing a role in contamination and cross-transmission rate in the ICU may include hand hygiene compliance, nurse-staffing levels, frequency/ number of colonized or infected patients, ICU structural features (e.g., single-bed or multi-bed ICU rooms) and adoption of antibiotic stewardship programs. The issue of environmental contamination may pose an even greater challenge in the ICU, where patients are critically ill, with several risk factors for nosocomial infections [21] and the highest standard measures for infection prevention cannot always be addressed due to impelling, life-threatening conditions. Moreover, the nearby environment of ICU beds is crowded by equipment for monitoring and support, with many hand-touch sites, requiring sophisticated and specific cleaning procedures. There is a law by nature that all substances with antimicrobial activity which require the incorporation of the agent into the metabolism of microorganisms induce resistance [18]. This is well known for antibiotics but also disinfectants. Therefore, it is required that a technology be developed which is not incorporated to the bacterial metabolism but attacks microorganisms from the outside i.e., acid water molecules, free radicals and most important a positive zeta potential i.e., a positive electrostatic charge at the surface which ruptures the phospholipid bilayer of microorganisms upon contact within minutes. Geneva -The tone of the debate over antibiotic resistance is intensifying, with a United Nations Interagency Coordination Group on Antimicrobial Resistance now speaking of a "potentially catastrophic drug resistance crisis" and calling for "immediate, coordinated and ambitious action" upon the release of a new report [8].
Selection of the optimal additive as an in situ generated biocide is of crucial importance. The use of a catalyst is considered a suitable technology as it meets all the basic requirements for the prevention of hospital acquired infections [24].

Samples for Hospital Furniture have Been Produced by Different Techniques
An absorbent paper has been impregnated with 2% liquid Zinc Molybdate in melamine resin and applied to particle boards. It has been found that submicron particles (0.25 µm particle size) added to liquid melamine resin stay in solution for a substantially longer time and does not disintegrate from the surface before the resin is dried. Larger particles (5 -8µm particle size) are separating form the surfaces faster. Therefore, a decreased antimicrobial activity has been detected with particles sizes 5 -8µm [35]. Oxidation to format catalysed by glutathione-dependent and -independent dehydrogenases in nasal tissues is a major route of detoxication and generally precedes incorporation. The possibility that inhaled formaldehyde might induce various forms of distantsite toxicity has been proposed, but no convincing evidence for such toxicity has been obtained in experimental studies [36,37].
Formaldehyde also evaporates within a matter of 3 weeks.
Soyad adhesive technology is a bio-based, formaldehyde-              is effective also against microorganisms in a biofilm as it is not incorporated into the bacterial metabolism. This has a consequence that in situ generated biocides do not induce resistances. These additives can easily apply to virtually every surface [40][41][42][43][44].