Infection control in healthcare settings: perspectives for mfDNA analysis in monitoring sanitation procedures.
BACKGROUND
Appropriate sanitation procedures and monitoring of their actual efficacy represent critical points for improving hygiene and reducing the risk of healthcare-associated infections. Presently, surveillance is based on traditional protocols and classical microbiology. Innovation in monitoring is required not only to enhance safety or speed up controls but also to prevent cross infections due to novel or uncultivable pathogens. In order to improve surveillance monitoring, we propose that biological fluid microflora (mf) on reprocessed devices is a potential indicator of sanitation failure, when tested by an mfDNA-based approach. The survey focused on oral microflora traces in dental care settings.


METHODS
Experimental tests (n = 48) and an "in field" trial (n = 83) were performed on dental instruments. Conventional microbiology and amplification of bacterial genes by multiple real-time PCR were applied to detect traces of salivary microflora. Six different sanitation protocols were considered. A monitoring protocol was developed and performance of the mfDNA assay was evaluated by sensitivity and specificity.


RESULTS
Contaminated samples resulted positive for saliva traces by the proposed approach (CT < 35). In accordance with guidelines, only fully sanitized samples were considered negative (100 %). Culture-based tests confirmed disinfectant efficacy, but failed in detecting incomplete sanitation. The method provided sensitivity and specificity over 95 %.


CONCLUSIONS
The principle of detecting biological fluids by mfDNA analysis seems promising for monitoring the effectiveness of instrument reprocessing. The molecular approach is simple, fast and can provide a valid support for surveillance in dental care or other hospital settings.
['Valeriani|Federica|F|', 'Protano|Carmela|C|', 'Gianfranceschi|Gianluca|G|', 'Cozza|Paola|P|', 'Campanella|Vincenzo|V|', 'Liguori|Giorgio|G|', 'Vitali|Matteo|M|', 'Divizia|Maurizio|M|', 'Romano Spica|Vincenzo|V|']
D001826:Body Fluids D003428:Cross Infection D003695:Delivery of Health Care D003748:Dental Equipment D006801:Humans D017053:Infection Control D064307:Microbiota D009055:Mouth D060888:Real-Time Polymerase Chain Reaction D012463:Saliva D012499:Sanitation D012680:Sensitivity and Specificity
mfDNA Sanitation procedures Healthcare-associated infections Surveillance Dental healthcare Real time PCR