Bacterial Contamination of Antiseptics, Disinfectants and Hand Hygiene Products in Healthcare Facilities in High-Income Countries: A Scoping Review
, Anne-Sophie Heroes 2,3, Esenam Agbobli 4, Vera Kühne 2, Halidou Tinto 1, Dissou Affolabi 4 and Jan Jacobs 2,3
Round 1
Reviewer 1 Report
This is a very thorough scoping review on Bacterial contamination of antiseptics, disinfectants and hand hygiene products in healthcare facilities in high-income countries. Well organised and well written. Congratulations to the authors for such an exceptional work.
Just two minor points:
Line 54: (AS, DI and HH products). Please spell out AS, DI and HH when first mentioned.
Please put a list of Abbreviations at the end of the manuscript. Easier for the readers to check.
Author Response
We would first like to thank you for your time and efforts to review the manuscript originally entitled “Bacterial contamination of antiseptics, disinfectants and hand hygiene products in healthcare facilities in high-income countries: a scoping review”. We appreciate the critical reading, positive feedback and constructive remarks from the reviewer and welcome your relevant suggestions for improvement.
In this response letter, we address the comments of the reviewer. The points in the response letter address questions mentioned by the reviewer. Where appropriate, we refer to the changes made in the revised version of the manuscript, visible in its “track changes” version.
Response to Reviewer 1 Comments
Point 1: This is a very thorough scoping review on Bacterial contamination of antiseptics, disinfectants and hand hygiene products in healthcare facilities in high-income countries. Well organized and well written. Congratulations to the authors for such an exceptional work.
Response 1: We thank the reviewer for this encouraging comment
Point 2: Line 54: (AS, DI and HH products). Please spell out AS, DI and HH when first mentioned.
Response 2: We thank the reviewer for this suggestion, we have revised the section according to the reviewer’s suggestion for clarity. See revised version, Lines 53 – 54.
Point 3: Please put a list of Abbreviations at the end of the manuscript. Easier for the readers to check.
Response 3: We thank the reviewer for this valuable suggestion, we have added an abbreviation list at the end of the manuscript.
We would like to thank you for considering our remarks and changes.
On behalf of the co-authors,
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Dear Authors,
The manuscript (hygiene-227161) submitted for review is interesting but too long.
Authors, Please note and address the following comments:
It is recommended to refine of this manuscript and rewritten. In my opinion, it is not possible to publish it in this form.
What exactly was the purpose of this article? Chapter 2 - Objective, focus and scope of this review are review methods and are not to be the purpose of manuscript.
This manuscript would be good chapter of monography or book abot hospital hygiene, but as a review it is not well written.
Although Figure 1A, B, C is interesting is it needed?
The best chapter of this manuscript is chapter 4.5. (Factors associated with contamination).
References: References are not cited according to journal rules. Publications from MDPI provide information on how to properly cite. Authors may also find this information in the authors' guide.
I believe the manuscript addresses an important area of research in an international context, but the manuscript need improvement and reconsideration.
Reviewer
Author Response
We would first like to thank you for your time and efforts to review the manuscript originally entitled “Bacterial contamination of antiseptics, disinfectants and hand hygiene products in healthcare facilities in high-income countries: a scoping review”. We appreciate the critical reading, positive feedback and constructive remarks from the reviewer and welcome your relevant suggestions for improvement.
In attachment you can find the revised version with track of changes. In this response letter, we address the comments of the reviewer. The bullet points in the response letter address questions mentioned by the reviewer. Where appropriate, we refer to the changes made in the revised version of the manuscript, visible in its “track changes” version.
Reply to comments of Reviewer 2
Point 1: It is recommended to refine of this manuscript and rewritten. In my opinion, it is not possible to publish it in this form.
Response 1: We thank the reviewer for this reflection. We agree that the review is long, but it is comprehensive, complete and its structure (chapters and subheadings) allows the reader to navigate quickly to the content whereas the chapters are understandable on their own.
Further, unlike previous reviews (dating from > 15 years ago and predating the World Health Organization’s 2009 Hand Hygiene recommendations), we extended the scope towards products used for hand hygiene. In addition, we assessed key-features which were not systematically addressed in previous reviews (attributions, interventions and outstanding issues) and aggregated microbiological data using by updated bacterial nomenclature. Finally, we presented recent evolutions (e.g. large-scale impact by intrinsic contamination) and outstanding issues including antiseptic stewardship.
Point 2: What exactly was the purpose of this article? Chapter 2 -Objective, focus and scope of this review are review methods and are not to be the purpose of manuscript.
Response 2: We thank the reviewer for this comment. The original phrase at Chapter 2 of the manuscript read as follow “The present scoping review updates the frequency, burden, microbiological spectrum, and associated factors of bacterial contamination of antiseptics, disinfectants, and hand hygiene products (AS, DI and HH products) in healthcare facilities in high-income countries”. To meet the reviewer’s comment, we rephrased the sentence as: “In this scoping review we assess bacterial contamination of antiseptics, disinfectants, and hand hygiene products (AS, DI and HH products) in healthcare facilities in high-income countries in order to give an update on the frequency, burden and microbiological spectrum of contamination events. Moreover, we assess factors associated with contamination, attribution and transmission, interventions and formulate outstanding issues, research questions and recommendations.” – see revised version, Lines 52 - 57.
Point 3: This manuscript would be good chapter of monography or book about hospital hygiene, but as a review it is not well written.
Response 3: While we appreciate the critical appraisal of the reviewer, we do believe that the manuscript meets the requirements of a scoping review as we structured it according to Munn et al. BMC Medical Research Methodology 2018; 18: 143 https://doi.org/10.1186/s12874-018-0611-x. Above in this rebuttal letter, we justify the content of the manuscript and point to its accessibility and readability. Given the comprehensive nature of the review we also chose for Hygiene.
Point 4: Although Figure 1A, B, C is interesting is it needed?
Response 4: We thank the reviewer for this reflection. Figure 1 A-B-C is intended to illustrate terms regarding the type and functioning of antiseptics, disinfectants and hand hygiene products’ containers. There is a narrative description of the containers and dispensers in the text, but in our professional setting we noticed that most healthcare workers (and by extension most non-expert readers) are not familiar with the different types of dispensers and that the narrative description by itself was difficult to understand (“gravitational dispenser”, “rechargeable cartridge”, “wrist-operated pump” …). The detailed Figures of the containers further illustrate the vulnerability of the containers and dispensers to contamination (the high touch surfaces) and the difficulties of cleaning and reprocessing (e.g. pump system). Publishing this Figure in an open-access journal gives also the opportunity to use it for diffusion in training programs.
Point 5: The best chapter of this manuscript is chapter 4.5. (Factors associated with contamination).
Response 5: We thank the reviewer for this comment, as this is indeed one of the chapters that differentiate the present manuscript from previous reviews.
Point 6: References: References are not cited according to journal rules. Publications from MDPI provide information on how to properly cite. Authors may also find this information in the authors' guide.
Response 6: We thank the reviewer for the scrutinizing review and have updated the references in the manuscript with track changes according to the authors’ guidelines.
Point 7: I believe the manuscript addresses an important area of research in an international context, but the manuscript needs improvement and reconsideration.
Response 7: We thank the reviewer for his/her comment. With giving my respects to the reviewer, we would like to reassure that this scoping review was designed, written and structured accordingly to Scoping Review guidelines (Munn et al. BMC Medical Research Methodology 2018; 18: 143 https://doi.org/10.1186/s12874-018-0611-x). We refer to the above clarifications and justifications about content and structure of the review, as well as to considerations made by Reviewer 1. So, we make a plea to leave the review in its current content and structure but we will respect Editorial decision.
We would like to thank you for considering our remarks and changes.
On behalf of the co-authors,
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Dear Authors,
I recommended that this manuscript should be refined and rewritten, but the Authors only change purpose of this article and corrected the references.
As I wrote before, the manuscript is interesting, but it is rather a chapter in a book than an article. This manuscript has 52 pages, and is longer than previous one.
It is a pity that the authors did not try to shorten the text. In science, it is good to write synthetically.
If other Reviewers have recommended the manuscript for published I leave the decision to the Editors.
Reviewer
