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Review
. 2024 Oct 8;13(1):119.
doi: 10.1186/s13756-024-01474-6.

Can probiotics trigger a paradigm shift for cleaning healthcare environments? A narrative review

Luisa A Denkel  1   2 , Andreas Voss  3 , Elisabetta Caselli  4 , Stephanie J Dancer  5 , Rasmus Leistner  6   7   8 , Petra Gastmeier  6   7 , Andreas F Widmer  9   10
Affiliations
Review

Can probiotics trigger a paradigm shift for cleaning healthcare environments? A narrative review

Luisa A Denkel et al. Antimicrob Resist Infect Control. .

Abstract

Background: The environment of healthcare institutions plays a major role in the transmission of multidrug resistant organisms (MDRO) and likely in subsequent healthcare-associated infections (HAIs). Probiotic cleaning products are a novel option for environmental cleaning. They represent a sustainable and biodegradable alternative to conventional chemical disinfectants for controlling microbial bioburden, and preventing pathogen transmission in hospital environments. High-quality studies including randomized clinical trials (RCT) triggered a summary with expert recommendations until further studies allow a critical review and meta-analysis of the data.

Methods: Infection control experts from five European countries summarized available data as of June 2023. Authors presented their published RCTs, reviewed the existing literature on probiotic cleaning, summarized the results and identified knowledge gaps and subsequent research needs.

Results: Probiotic cleaning was similarly effective for reducing HAI-related pathogens, enveloped viruses such as SARS-CoV-2 and MDRO in environmental samples compared to conventional chemical disinfectants. More importantly, probiotic cleaning was non-inferior to disinfectants in terms of preventing HAI in a large RCT. In addition, probiotic cleaning has also been shown to reduce antimicrobial resistance genes (ARG), costs and antimicrobial consumption in other hospital trials. They are biodegradable, do not require any protection for chemical hazards, and are compliant with occupational health. A paradigm shift, however, requires a very strong evidence to justify for such a change. In the past, this evidence was limited by the heterogeneity of study design, products, protocols, and few studies on clinical outcomes used in the trials. Furthermore, the regulatory, safety, and quality aspects of probiotic cleaning products are not, yet, completely defined and require clearing by authorities.

Conclusion: To date, probiotic cleaning is a breakthrough technology and a biological alternative for chemical disinfectant when treating hospital environment. It may also have a positive effect on MDRO transmission. However, the different compositions of probiotic products will require standardization, and more robust data should be generated to support these promising results on different compositions. This may trigger a paradigm shift in cleaning of healthcare institutions from chemical to biological control of the hospital environment.

Keywords: Antimicrobial resistance genes (ARG); Cleaning, healthcare-associated infections (HAI); Expert recommendations; Probiotics.

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Conflict of interest statement

Conflicts of interest to declare: This workshop was financially supported by Chrisal / Heiq. LAD and AW are members of the editorial board of the journal Antimicrobial Resistance & Infection Control. On behalf of all authors, the corresponding author states that there are no further conflicts of interest.

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