Avoiding hospital-acquired infections will be posible with FLEXPOL.

During our lifetime it’s inevitable for us to make use of healthcare centres, like hospitals or other healthcare facilities. Although progress has been made in hospital care and public health, there’s still a serious problem that risks patient’s lives: nosocomial infections.

Staphylococcus aureus, responsible of several nosocomial infections. Source: National Health Institute (NIH).

Nosocomial infections, also known as hospital-acquired infections, are contracted by patients in a hospital or other healthcare facility. Of every hundred hospitalized patients, seven in developed and then in developing countries acquire a healthcare-associated infection. Nosocomial infections not only add to functional disability and emotional stress of the patient but also can lead to a permanent reduction of their quality of life and are one of the leading causes of death. The most susceptible patients are those admitted to intensive care unit, with a proportion of infected patients that can be as high as 51% in Europe. Other high-risk populations are burn and transplant patients, and neonates. Nevertheless, the price is not only human: it’s estimated that nosocomial infections annually cost 7 billion euros in direct costs.

Nowadays, to prevent these infections, prevention and control programs are focused in hygiene, cleanliness and disinfection of healthcare centres. Infected patients are treated with antibiotics, but there is a greater number of resistant bacteria and the future perspective seems complicated. Although bacteriophages could be a solution for the treatment issue, we need still to solve the prevention problem.

What if we could cover every surface where the pathogen may attach, so the structure of the new surface would prevent the adhesion and besides to supply an antiseptic substance that would eliminate the pathogen or inhibit their growth?

 

Prevalence of health care-associated infection in high-income coutries, 1995-2010. Source: World Health Organization (WHO).
Prevalence of health care-associated infection in low- and middle-income coutries, 1995-2010. Source: World Health Organization (WHO).

FLEXPOL, a project agains nosocomial infections.

FLEXPOL film developed at University of Alicante. Source: University of Alicante.

Concern about this difficulty has catalyzed the creation of the European project FLEXPOL (Anitmicrobial FLEXibal Polymers), sustained by European Commission, with the aim to develop a pilot line to produce an antimicrobial adhesive film for its use in hospitals. The consortium is made up of research and industry staff from Italy, Spain, Portugal, United Kingdom and Germany, such as the enterprise Naturality and the University of Alicante, who jointly work on the encapsulation of essential oils used by this technology. These oils are extracted from local natural plants, such as rosemary or thyme, with strong antifungal and antimicrobial properties, able to fight more than 250 pathogens, such as: Bacillus cereus, Staphylococcus aureus, Staphylococcus epidermis, Listeria monocytogenes, Enterococcus faecalis. Streptococcus oralis, Propionobacterium acnes, Clostridium sporogenes, Shigella boydii, Escherichia coli, Salmonella typhimurium, Klebsiella oxytoca. Pseudomonas aeruginosa, Yersinia enterocolitica Bacteroides fragilis, Campylobacter jejuni, etc.

This product is based on specifically developed nanostructures and the use of polymers that contain antimicrobial oil blends. The combination of material and surface structure can kill various germs and inhibit bacterial growth with an efficacy of 99%, ensuring the health protection of both patients and medical staff and reducing expenditures for detergents and sanitizers. The idea of the project is to apply these films to walls, floors, doors, knobs, etc., minimizing contamination with microbes.

 

Structure of FLEXPOL project. Source: FLEXPOL.

 

The project in detail

FLEXPOL is a 36-month (3 years, starting in 2017) innovation project divided into eight work packages, aimed at technical and scientific development (1-5), and general purpose (6-8). It’s expected to conclude in December 2019.

 

FLEXPOL workflow. Source: FLEXPOL.

 

Work package 1 is aimed to perform the selection of the adequate systems for encapsulation of essential oils, where the Italian company Celanese Softer S.p.A plays a role by developing suitable, scalable, cost-effective methods to extract high-value chemicals from essential oils and introduce them in a suitable matrix with encapsulating performance. At this point are also involved the Spanish company Naturality S.L. and the University of Alicante.

The main objective of work package 2 is to elaborate strategies to create antimicrobial and partially fungicidal behaviour based on topography. This is achieved by means of superhydrophobic surfaces inhibiting the bacteria adhesion and providing water scarcity, as well as structures with nanospikes. The structures will provide inhibition to attach as well as the death of those bacteria able to bind. These goals are handled by the Spanish research institute IK4-Tekniker and the Catalan Institute of Nanoscience and Nanotechnology (ICN2).

The third work package, in the charge of the 3B’s research laboratories of the University of Minho in Portugal,  tries to establish scientific evidence of safety, efficacy and quality of FLEXPOL films during the product development phase. To accomplish this, antimicrobial activity, cytotoxicity, development of antimicrobial resistance and cleaning will be investigated.

Within the work package 4, developed by Propagroup S.p.A, the FLEXPOL pilot production is scaled up for prove of industrial competitiveness regarding materials and production equipment. Films are made with 100 µm thickness and nanofeatures are imprinted onto the films with encapsulated essential oils by thermal nano-imprint lithography.

The fifth work package, carried out at University Hospital of Donostia,  will give results in the real setting of a hospital environment about the capability of FLEXPOL to reduce microorganism load on surfaces as well as its durability under standard cleaning procedures.

The objective of work package 6 is to compile technical documentation like design requirements and specifications, verification and validation activities, risk assessment and other documentation needed, which will be managed by Granta Design Ltd (United Kingdom).

The target of work package 7 is to coordinate the dissemination of project results to targeted audiences during the project development time. It’s also meant to secure the intellectual property rights.

The last work package carried out by German Fraunhofer Institute for Production Technology IPT oversees the coordination of efforts of the consortium, ensuring the progress of the project and covering administrative, legal, financial and ethic issues. An important task is to report to the European Commission.

Here’s available to you all the information about each of the components of this consortium, and the tasks they will handle:

These new developments, if introduced in the hospital environment where it’s fundamental to take care of the fragilest patients, could extend their commercial application to every spheres that make up a metropolis, from cinemas, parks and shopping centers to our own homes.This way, we would create a totally aseptic living space, but what kind of effect could this have on our immune system? To what extent does our development depend on our relationship with microorganisms?

We will find the answer, but by the moment we are sure that Howard Hughes, the billionaire genius depicted in the film The Aviator (Martin Scorsese, 2004) and one of the first magnates of international airline business , would not have lost a moment in founding companies for the massive commercialization of surface treatments such as FLEXPOL, due to his OCD (Obsessive-Compulsive Disorder) that made him develop a fixation about germs and infections.

 

Howard Hughes “standing in front of his new Boeing Army Pursuit Plane” (Boeing 100A) in Inglewood, California in the 1940s. Source: Wikipedia, public domain.

 

 

References:

Swamy, M. K., Akhtar, M. S., & Sinniah, U. R. (2016). Antimicrobial Properties of Plant Essential Oils against Human Pathogens and Their Mode of Action: An Updated Review. Evidence-Based Complementary and Alternative Medicine : eCAM2016, 3012462. http://doi.org/10.1155/2016/3012462 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206475/pdf/ECAM2016-3012462.pdf

Khan, H., Baig, F. and Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7(5), pp.478-482.

WHO(2018). WHO | Prevention of hospital-acquired infections: A practical guide. 2nd edition. [online] Available at: http://www.who.int/csr/resources/publications/drugresist/WHO_CDS_CSR_EPH_2002_12/en/

WHO (2018). Report on the burden of endemic health care-associated infection worldwide. [online] Apps.who.int. Available at: http://apps.who.int/iris/handle/10665/80135.

Wikipedia (2018). Hospital-acquired infection. [online] Available at: https://en.wikipedia.org/wiki/Hospital-acquired_infection.

Flexpol (2018). FLEXPOL – Antimicrobial FLEXibal POLymers for its use in hospital environments. [online] Available at: https://www.flexpol.eu/.

University of Alicante (2018). Innovative antimicrobial adhesive films to reduce infection risk in hospitals. University News. [online] Available at: https://web.ua.es/en/actualidad-universitaria/2018/febrero18/1-11/innovative-antimicrobial-adhesive-films-to-reduce-infection-risk-in-hospitals.html.

Irene Perez Diez

Irene Pérez Díez, Graduated in Biochemistry and Biomedical Sciences by Valencia University and post-graduated in biomedicine, currently student of bioinformatics master by Valencia University. Has done interships in labs of Spain and Fracnce, and today she is doing practices in the Príncipe Felipe Research Center (CIPF). Contact by: equipoinspira@inspirabiotech.com

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