Microbial Load of Hand Sanitizer Dispensers—A University Hospital Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript investigates an important issue related to hospital hygiene, specifically the microbial contamination of hand sanitizer dispensers. However, its limitations should be addressed for it to make a meaningful contribution to the field. The study has a small sample size of 50, and it lacks depth in analyzing correlations between bacterial contamination and specific hospital settings or conditions. Furthermore, the paper would benefit from categorizing hand sanitizers based on their accessibility—whether they are available only to healthcare workers or to all patients and visitors. While the list of organisms found and their locations is useful, it provides limited actionable information in its current form.

Given these considerations, the manuscript has the potential to be impactful but requires significant revisions to address these limitations and offer more comprehensive insights.

 

Please check the comments below:

 

Line 52: Typical commercial specifications for hand sanitizers are -> Typical specifications for commercial hand sanitizers include

Line 127: sampling was contacted -> sampling was conducted

Line 128: sanitizer’s dispenser -> sanitizer dispenser

Line 131: spread onto to different -> spread onto different

Line 136-137: Combine these two lines as "Identification of the Isolates: After the aerobic 24h incubation..."

Line 139-140: Remove "into which colonies were developed," as it adds redundancy to the statement.

Line 144-145: "Five single colonies were directly taken from the nutrient agar plate." -> "Directly from the nutrient agar plate, five single colonies were taken."

Line 146: Isolated bacteria were analyzed -> The isolated bacteria were analyzed

Line 147-148: The Flexcontrol 3.4 software -> Flexcontrol 3.4 software

Please ensure the mentioned software, methods, and references are accurate and spelled correctly in the revised version. Also, ensure consistency in software naming (e.g., "Flexcontrol 3.4", "flexControl").

Line 151: Biotyper Log (score) -> Biotyper Log Score

Line 156: method in flexControl -> method in FlexControl

Line 170: that 55,5% -> ‘comprising 55.5%’ and replace comma with a period for the percentage.

Line 171-172: Combine lines to read “In the Neurosurgery ward, only Staphylococcus cohnii was identified, with a scoring value of 2.04, interpreted as a high-confidence identification.”

Line 174-175: In all maternity ward samples, the organisms identified are -> In all maternity ward samples, the identified organisms include

Line 177-178: Change ", and" to commas for consistency in listing.

Line 190: only one out the two -> only one of the two

Line 191: By neurological clinic -> In the neurological clinic

Line 192: no organism identification was possible. -> no organism was identified.

Line 193-195: At the university area, 4 bacterial strains were identified in 3 different sample stations. -> In the university area, three different sample stations yielded four identified bacterial strains.

Line 204-205: detected in both the hospital by the maternity ward and the university on dispensers by the cafeteria -> detected both in the maternity ward of the hospital and on dispensers at the university cafeteria.

Line 209: Among the organisms identified were -> Among the identified organisms are

Line 213: some of strains of these organisms -> some strains of these organisms

Line 216: and infect patients mainly -> and primarily infect patients

Line 223: leading to HAIs and community-acquired infections -> which can lead to HAIs and community-acquired infections

Line 226: Micrococcus luteus is a natural bacterial component of our human skin -> Micrococcus luteus is a natural component of human skin microbiota

Line 232: This bacteria has the capacity -> This bacterium has the ability

Line 237: an outbreak of S. haemolyticus at the Verona University Hospital Intensive Care Unit -> a S. haemolyticus outbreak at the Verona University Hospital's Intensive Care Unit

Line 248: However, is not considered -> However, it is not considered

Line 252: study about bacterial cross contamination -> study on bacterial cross-contamination

Line 253: All samples were received from -> All samples were taken from

Line 256: 8.1% of the species identified pertained -> 8.1% of the identified species pertained

Line 264: no HAI caused by mixta calida -> no HAIs caused by Mixta calida

Line 266: Pseudomonas luteola has been found and identified -> Pseudomonas luteola was found and identified

Line 275: has scored low-confidence value (<2.00) -> scored a low-confidence value (<2.00)

Line 278: Cytobacillus oceanisediminis detected on dispensers -> Cytobacillus oceanisediminis, detected on dispensers

Line 283: They found detected one or more bacteria -> They detected one or more bacteria

Line 288: According to the MALDI-TOF results -> Based on the MALDI-TOF results

Line 289-290: Other bacteria that were identified are the following; -> Other identified bacteria include:

Line 292: that also scored high-confidence identification value -> that also received a high-confidence identification score

Line 294: Systematic cleaning and correct use of manual dispenser’s areas -> Systematic cleaning and correct use of manual dispenser areas

Line 297: Undoubtfully, hand hygiene is an essential element -> Undoubtedly, hand hygiene is an essential element

Comments on the Quality of English Language

Moderate editing of English language required.

Author Response

Thank you for your valuable feedback that contributed to the manuscript's overall improvement.

Please see the attachment below that include extensively all comments and responses.

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

v    Strengths

The topic concerns a very relevant issue: hand hygiene and care-related infections.

Manuscript results are reproducible on the basis of the details provided in the methods section.  

Figure and table /pictures/diagrams are quite clear.

The laboratory techniques used are explained quite clearly and comprehensively.

Weaknesses

How come the article is listed as a communication and not as a scientific article?

The references cited are not very recent (most are more than 10 years old), being a topical subject anyway. Reference 30 data missing. The manuscript is not very clear.

Limitations of the study were not reported.

The limitation of this study is : 

 

Certainly as a precautionary principle if there was no contamination it would be better but in this case a finding of what is the hand contamination after gel use would perhaps be the most interesting thing. Since bacteria have been found on these dispensers, especially in the dispenser spout, wouldn't it be useful to know whether the bacteria found are resistant or sensitive to the gel in the dispenser itself? Because obviously one presses on the dispenser to get the gel, but in case these bacteria are sensitive, with careful use of the gel, at the end of the passage, these should not be found on the hands.

Abstract:

Line 20-21: which hospitals? in which cities? how many samples?

Introduction:

Are the WHO hand disinfection literature references the latest?

Line 50-51: please insert reference

Line 56-57: please insert reference

Line 67-68: please insert reference

Line 87-88: please insert reference

Line 105-107: please insert reference

Line 107-111: please insert reference

 

Materials and Methods:

The study design is missing.

Sample of 50 tests a bit small. How can they be sure that it is comprehensive?

Sampling procedure: which hospital? in which city? In which precise soils were the crops tested? In what period?

Identification of isolates: line 138, what techniques? Line 163: what were the threshold values? 

Were confounding aspects that might play a role in contamination (e.g. university versus non-university facilities) assessed?

Discussion:

 

Are all these bacteria sensitive or resistant to the contents of the dispensers? it would be useful for the purposes of the discussion to know this information

 

 

I would suggest to the author to include the article “Hand washing in operating room: A procedural comparison. Epidemiology, Biostatistics and Public Health. 13. 10.2427/11734” to improve the manuscript.

Author Response

Thank you for your valuable feedback that contributed to the manuscript's overall improvement.

Please see the attachment below that include extensively all comments and responses.

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

I read the manuscript titled "Microbial Load of Hand Sanitizer Dispensers: A University Hospital Study" with keen interest. The authors aimed to investigate the potential harboring of pathogenic microbes in hand sanitizers, their identification, and the potential emergence as multidrug-resistant microorganisms. The study's findings underscore the significance of practicing effective hand hygiene and regularly monitoring the microbial presence in hand sanitizing gels and dispenser equipment to mitigate the risk of cross-contamination and hospital outbreaks.

For further refinement of the manuscript, I would like to offer some questions and suggestions:

• Can you elaborate on how this study introduces novel insights or contributes new information to the existing body of knowledge?
• It would be beneficial to include information on the risks associated with hospital-acquired infections, providing a broader context for the importance of your study.
• Could you provide more details on how effective hand hygiene practices can specifically prevent the spread of bacteria in hospital settings?
• What is the potential role of manual hand sanitizer dispensers in the transmission of bacteria? Expanding on this aspect could enhance the practical implications of your research.
• Are there specific areas of manual hand sanitizer dispensers that exhibited higher microbial colonization? Including this information could highlight potential hotspots for attention.
• What infection control strategies do you recommend based on your findings to prevent cross-contamination and hospital outbreaks? Including specific recommendations can contribute to the practical application of your research.
• Could you provide additional data on the global recognition among physicians regarding the importance of adhering to hand hygiene practices and regularly monitoring microorganisms in hand sanitizing gels and dispenser equipment?

 

Incorporating responses to these questions and suggestions would further enhance the manuscript, providing a more comprehensive understanding of the study's significance and practical implications.

Comments on the Quality of English Language

Minor editing of English language required.

Author Response

Thank you for your valuable feedback that contributed to the manuscript's overall improvement.

Please see the attachment below that include extensively all comments and responses.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The acronyms for antimicrobials appear unconventional. Please either utilize the standard three-letter acronyms or provide a justification for the chosen names.

Line 28, 222, 238: b -> β or beta

Line 236: Please check the parenthesis '(', ')'.

Each isolate must be assigned a unique name or number. It's important to note that while they may belong to the same species, they are not the same strain. Additionally, incorporate a column in Table 2 to display the total count of isolates.

Please position Table 2 on a separate page in a landscape format to ensure it fits within a single page.

 

Table 3: 'Class of antibiotics' should be changed to 'Antibiotics', or you can add another column for the 'class' of the drug.

 

Comments on the Quality of English Language

Minor editing of English language required.

Author Response

Thank you for your valuable feedback that contributed to the manuscript's overall improvement.

Please see the attachment below that include extensively all comments and responses.

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

the suggestions made have been modified correctly and the manuscript is now clearer and more interesting.

Author Response

Dear Reviewer,

Thank you for your contribution to this work and for your commitment to the advancement of knowledge in our field. Your thoughtful comments and suggestions were instrumental in refining the content and structure of the manuscript.

Warm regards,

Authors' team