Antimicrobial Agent – Triclosan
Triclosan is a diphenyl ether (5-chloro-2-[2,4-dichlorophenoxyl] phenol) and like other chlorine-based chemicals, it acts as a cell wall penetrant. It disrupts the microbial cell wall, disturbing the metabolic process, leading to the death of the organism. Although McMurray et al. (1998) suggest that some organisms may be insensitive to triclosan and could result in the development of resistant strains of organisms, considerable counter evidence and scientific argument dispels this position (FDA 1997, CSMA 1998, Jones 1999). The latter references indicate that currently used antimicrobial agents like triclosan, have very different action mechanisms than antibiotics. Additional studies also indicate that there is no existing clinical evidence to suggest that these agents, as used in ‘real world’ applications, are either mutagenic or prone to create resistive strains of organisms (Russell 2002, McBain et. al. 2002, Fraise 2002). An extensive review of the literature on bacterial resistance to topical antimicrobial products by Jones (1999), clearly indicates that there is no scientific evidence that triclosan has an influence on the development of resistive strains of organisms. Indeed, Jones et al. (2000) verifies that triclosan was clinically effective in reducing MRSA isolates from surgical wounds as well as reducing the percentage of ciprofloxacin-resistant MRSA strains.
It is worthy to note that triclosoan can be incorporated into the voids of any polymeric structure (Medlin 1997), as well as being suspended in certain liquid compounds. Such potential use of an antimicrobial agent makes it attractive for sustained treatment. This was one of the underlying motivations for using it in the present study. The concept was to have all construction materials, fixtures, medical instruments, and contents within the healthcare delivery areas, either surface treated or constructed with an antimicrobial agent as an integral part of the product. A limited number of polymer products containing triclosan were available for this study. The goal was to test these and where necessary, to develop others. These included surface sprays and coating liquids.
Over a period of three years, the authors used various triclosan-treated products and applied them to different problem areas throughout the main campus. These included concrete floor surfaces in the decontamination and food services areas; carpet underlay in maternity areas where spills created obnoxious odors and in shower areas where dampness led to continuous growth of microorganisms and degradation of carpet backing; in bathrooms on toilet seats, sanitary napkin dispensers, sinks and faucets and waste baskets; on counters, floors and isolettes in the Neonatal Intensive Care Unit; and on floor drain covers and mortar joints on bathroom floors and walls. In every application studied, the use of triclosan-treated items resulted in a reduction of surface bioburden.
With the success of these preliminary ‘real world’ tests, the authors began planning for a larger application of the treatment. During this planning period, management decided to construct a new outpatient facility, consisting of two floors, each containing 25,000 square feet (2315 m2) of floor space. This building provided an excellent site for the expanded project. It was scheduled to open in January 1998, at which time this study began.