Antimicrobial surface coating in the emergency department as protective technology for infection control (ASEPTIC): a pilot randomized controlled trial.

Study objective: We examined the effectiveness of an antimicrobial surface coating for continual disinfection of high touch-frequency surfaces in the emergency department (ED).

Methods: Following a preliminary observation identifying stretcher rails as the surface with highest touch-frequency in the ED, we conducted a pilot randomized controlled trial involving 96 stretcher rails. The stretchers were randomized to receive an antimicrobial surface coating or placebo coating. Routine cleaning of stretchers subsequently continued as per hospital protocol in both arms. Sampling for total aerobic, gram-positive halophilic, gram-negative and methicillin-resistant Staphylococcus aureus bacteria was performed pre- and post-treatment at 24 h, 7 days and 180 days. Individuals who applied the coating and outcome assessors were blinded to the allocated arms. The primary outcome is contamination of antimicrobial versus placebo rails measured as colony forming units per cm²(CFU/cm²).

Results: Baseline total aerobic bacteria was comparable between placebo and intervention arms (0.84 versus 1.32 CFU/cm², P = 0.235). Total aerobic bacteria contamination was significantly lower on antimicrobial versus placebo rails at 24 h (0.61 versus 1.01 CFU/cm², median difference 0.40 CFU/cm², 95% confidence interval [CI] 0.01 to 1.01 CFU/cm²). There was a non-statistically significant tendency for contamination to be lower on antimicrobial versus placebo rails at 7 days (1.15 versus 1.50 CFU/cm², median difference 0.35 CFU/cm², 95% CI -0.64 to 1.28 CFU/cm²), but higher at 180 days (2.06 versus 1.84 CFU/cm², median difference - 0.22 CFU/cm², 95% CI -1.19 to 0.78 CFU/cm²).

Conclusion: This is the first double-blinded, placebo-controlled, randomized trial to evaluate an antimicrobial surface coating on high touch-frequency surfaces in the emergency department. Total aerobic bacteria found on antimicrobial-coated patient transport stretcher rails was significantly lower than placebo rails at 24 h.