Efficient removal of hospital pathogens from hard surfaces by a combined use of bacteriophages and probiotics: potential as sanitizing agents.

Purpose: Many hospital-acquired infections (HAIs) can be transmitted by pathogens contaminating hospital surfaces, not efficiently controlled by conventional sanitation, which can indeed contribute to the selection of MDR strains. Bacteriophages have been suggested as decontaminating agents, based on their selective ability to kill specific bacteria. However, there are no data on their stability in detergents and their potential use in routine sanitation. On the other hand, a probiotic-based sanitation system (Probiotic Cleaning Hygiene System, PCHS) was recently shown to stably reduce pathogens on treated surfaces. However, its action is not specific and slow, being based on competitive antagonism. This work aimed to assess the effectiveness of a combined use of phages and PCHS in removing HAI-associated pathogens from different hard surfaces.

Materials and methods: The decontamination ability of phages in PCHS was tested in vitro and in situ, against drug-susceptible or resistant Staphylococcus aureus , Escherichia coli , and Pseudomonas aeruginosa strains, and using bacterial densities similar to those detected on hospital surfaces.

Results: Phages targeted efficiently all tested bacteria, maintaining their full activity when added to the PCHS detergent. Notably, the combined use of phages and PCHS not only resulted in a rapid reduction (up to >90%) of the targeted pathogens, but also, due to the stabilizing effect of probiotics, the pathogens were maintained at low levels (>99%) at later times too, when instead the effect of phages tends to diminish.

Conclusion: These results suggest that a combined biological system might be successfully used in hospital sanitation protocols, potentially leading to effective and safe elimination of MDR pathogens from the hospital environment.