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09 October 2020 | Story Leonie Bolleurs | Photo Supplied
Disinfectants
Once they have an understanding of the development of disinfectant resistance, the Veterinary Biotechnology group will be able to make recommendations to hospitals and the agricultural industry on how to prevent the development of these resistant microorganisms.

SARS-CoV-2, an enveloped coronavirus, is susceptible to most disinfectants. Therefore, the majority of disinfectants, including those containing 70% ethanol, should be able to kill the virus fairly quickly.

Nevertheless, it was found that some bacteria are highly resistant to several commercially available disinfectants. These bacteria are currently still quite rare, and the work of the Veterinary Biotechnology group at the University of the Free State (UFS) aims to prevent the development of more highly resistant bacteria.

The research group in the Department of Microbial, Biochemical and Food Biotechnology is working on disinfectant resistance. They recently published an article, ‘Molecular basis of bacterial disinfectant resistance’.

Group members include: Prof Robert Bragg, professor in the department; Dr Charlotte Boucher, research associate; Samantha Mc Carlie, master’s student and laboratory manager; master’s students, Twyne Skein and Gunther Staats; honours students, Carlo Visser, Bernadette Belter, Boudine van der Walt, Jacky Huang, and Mart-Louise van Zyl; and an NRF intern, Gloria Kankam.

According to Mc Carlie, the work being done on disinfectant resistance is largely attributable to the major issues currently experienced with antibiotic resistance.

“Antibiotic resistance is becoming one of the biggest life-threatening challenges of our time – even overshadowing the current COVID-19 pandemic – as multidrug-resistant infections are becoming increasingly difficult to treat. Bacterial infections that are present in hospitals and agriculture are becoming unresponsive to many of the antibiotics currently in use, marking the start of a post-antibiotic era.”

It is predicted that by 2050, antimicrobial resistance could lead to as many deaths as cancer causes today and could account for between 10 million and 50 million deaths per year.

Lack of proper biosecurity

Mc Carlie says the resistance to antibiotics is spreading rapidly due to a lack of proper biosecurity measures in the food and agricultural industry as well as in the hospital environment, even if the COVID-19 pandemic has gone a long way towards increasing the awareness of hospital staff to the importance of good biosecurity. Millions of rands are lost every year due to multidrug-resistant infections in the dairy and poultry industries of South Africa, and superbugs are present in almost every major hospital in the country.

“Currently, the best viable protection we have against bacteria is biosecurity and disinfectants. Biosecurity relies heavily on the use of disinfectants to control bacterial growth. This makes it only more troubling that disinfectant resistance is emerging at an alarming rate.”

She believes it is important to understand the mechanisms of resistance in order to combat resistance to disinfectants. “Once the mechanisms are identified, possible solutions can be investigated.”

The research group is currently monitoring disinfectant resistance, looking at which microorganisms are resistant to which disinfectants. They take environmental samples and test the levels of disinfectant resistance to observe the development and spread thereof.

Once they have an understanding of the development of disinfectant resistance, the Veterinary Biotechnology group will be able to make recommendations to hospitals and the agricultural industry on how to prevent the development of these resistant microorganisms.

“As we learn more about these highly resistant isolates, it will direct day-to-day treatment of multidrug-resistant infections and hopefully aid in the fight against antibiotic and disinfectant resistance,” says Mc Carlie.

The dangers of over-prescribing

“Resistance to antimicrobials such as antibiotics and disinfectants is a natural occurrence. We did not invent antibiotics, we discovered them, and so bacterial resistance has been around for as long as antibiotics have – as a survival strategy.”

“However, the widespread use of antimicrobials creates selective pressure for those microorganisms that are resistant to the antimicrobial being used. Over-prescribing and improper use of antibiotics has led to widespread antibiotic resistance. We expect the same trend to be seen with disinfectant resistance in the near future,” says Mc Carlie.

She urges the public to take note that disease-causing microorganisms can become resistant to antibiotics and disinfectants if they are not used correctly. A course of antibiotics should always be taken at the correct time and until the last dose. In the same way, disinfectants should be used at the recommended level and not diluted below that level.

These resistant organisms are causing major issues in the agricultural and medical industries, but this effect has not been seen in households yet. As long as disinfectants are used correctly, most will be able to kill the novel coronavirus.

There is, however, a need to establish tests on the efficacy of the massive number of ‘hand sanitisers’ that are now suddenly available.

According to Prof Bragg, existing disinfectants and hand sanitisers have been specifically tested against SARS-CoV-2 and have been found to be effective. He says the undergraduate students in the department will be evaluating a wide range of different hand sanitisers as part of their practical training.

Mc Carlie adds that the excessive use of poor-quality disinfectants as hand sanitisers can result in bacteria developing resistance to these disinfectants. “It is therefore very important that reliable high-quality disinfectants are used as hand sanitisers during this COVID-19 crisis, otherwise we will be replacing one crisis with a potentially even bigger crisis.”

Mc Carlie believes there is a need to start looking at alternatives to control bacterial growth. “Disinfectants are currently the only viable option, and if these microorganisms become resistant to disinfectants as well, we will have nowhere else to turn,” she says.

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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