resistance promoted by exposure to disinfectants , as described in some studies , may not be clinically relevant because the test organism may not be a human pathogen , the altered level of antimicrobial susceptibility was within achievable serum levels for the antibiotic , or the antibiotic tested was not clinically used to treat the concerned pathogen . Although strains with reduced susceptibility to disinfectants have been reported outside laboratories , the concentration of disinfectants used in healthcare settings usually greatly exceeds the concentration required to kill strains with reduced susceptibility to disinfectants . Overall , from the current evidence , reports on disinfectant-promoted antibiotic resistance should not discourage the appropriate use of disinfectants , but more studies should be carried on the proposed linkage between disinfectant uses and antibiotic resistance , particularly in real-life scenarios outside laboratories and under community or environmentally relevant conditions . Meanwhile , one should also be aware that the actual scenarios of use can vary greatly , and many factors can contribute to the situation where the bacteria may be exposed to sub-lethal levels of biocides from the inappropriate uses of disinfectants . Apart from human errors and misuses , confounding factors such as the inappropriate dilution of disinfectants , co-existence of biocide-exhausting substances ( e . g ., due to inadequate cleaning prior to disinfection ), insufficient contact , and disturbance during the disinfection process are among the common issues encountered in disinfectant uses . Further , the methods of how disinfectants are applied in practice ( wipe , sprays , or gels ) and the characteristics of receiving surfaces or objects ( porous or having complex internal structures ) can also influence the efficacy of disinfection . Under these circumstances , bacteria can be , in theory , exposed to subinhibitory concentrations of biocides . Such risks may be aggravated in the current pandemic due to the widespread and non-discriminated use of disinfectants in non-conventional settings .”
Commenting on the capacity for resistance issues to be exacerbated by the pandemic , microbiologist Rodney Rohde says , “ Certainly , airborne and respiratory transmission is a great concern with SARS-CoV-2 . But we must not forget that most bacterial pathogens are transmitted via direct interaction with the environment ( medical devices , medical procedures , contact via person-to-person , etc .). Therefore , this pandemic may very well open the door for reversal on the gains we have made with AMR via education and practice . We have also seen data indicating that AMR has risen due to physician practices for COVID-19
Effectiveness of Cleaning During the COVID-19 Pandemic
The debate around cleaning and disinfection of the public sector naturally spills over into the healthcare arena from a community-acquired case perspective .
In a pre-print paper from MedRxiv , Lesho , et al . ( 2021 ) compared the effectiveness of standard and contingency-based cleaning in acute- and long-term care facilities amid COVID-19 related changes such as personnel shortages and surging case numbers .
In an acute-care hospital ( ACH ) – a 528-bed teaching hospital – and a long-term care facility ( LTCF ), 417 surfaces were tested for SARS-CoV-2 and adenosine triphosphate before and after various cleaning strategies , including ultraviolet light ( UV-C ), electrostatic spraying , and room fogging .
ACH surface contamination differed among outbreak and non-outbreak wards . RNA was detected on 66 percent of surfaces before cleaning and on 23 percent of those surfaces immediately after terminal cleaning , for a 65 percent post-cleaning reduction . UV-C resulted in an 87 percent reduction , while spraying with electrostatic bleach resulted in a 47 percent reduction . LTCF contamination rates differed between the dementia , rehabilitation , and the residential units ; 67 percent of surfaces had RNA after room fogging without terminal-style wiping . Fogging with wiping led to an 11 percent reduction in the proportion of positive surfaces .
Of importance , baseline contamination varied by type of unit and outbreak conditions , but not facility type . Removal of viral RNA varied according to strategy . Additionally , time spent cleaning was associated with cleaning thoroughness .
As Lesho , et al . ( 2021 ) observe , “ Healthcare associated ( HA ) transmission of SARS-CoV-2 results from a complex interplay of several factors , including patient census , nurse-to-patient ratio , adherence to isolation guidelines and policies for using personal protective equipment , patient acuity , and the prevalence of pre-symptomatic / asymptomatic carriers . However , we hypothesize that these factors may not fully account for large or prolonged nosocomial outbreaks . Environmental contamination could also be an overlooked contributor to HA-transmission . In addition , the shortage of environmental service ( EVS ) workers and their concerns regarding cleaning rooms of patients infected with SARS-CoV-2 further complicated cleaning and disinfection efforts . This forced some healthcare facilities to use contingency-based approaches such as professional remediation companies . Moreover , LTCFs have experienced inordinately high infection and mortality rates . The potential contribution of environmental contamination with SARS-CoV-2 to this is uncertain .”
Adding to the challenge of investigating the role of environmental SARS-CoV-2 , the researchers note , is that the majority of studies do not have the biosafety level necessary for the cultivation of live virus and must rely on viral RNA as a surrogate . Even though nucleic acid isolated from healthcare surfaces may not represent infectious or cultivable virus , and the infectious potential of environmental nucleic acid , including RNA , is not fully understood , we have shown that environmental nucleic acid from another common pathogen was correlated with nosocomial infections of that species .
Interestingly , the LTCF hired a commercial cleaning and remediation company as a contingency measure , as it could not adequately maintain cleaning standards and quality measures during a critical environmental service worker shortage .
Eight stationary surfaces sampled in rooms on the outbreak and