Why AMG™
AMG™ : COMPLEMENTS EXISTING INFECTION CONTROL PROTOCOLS
Hand hygiene practice is widely recognised as one of the important infection control measures to prevent the transmission of microbes that cause healthcare-associated infections (HAIs). However, hand hygiene campaigns alone are not sufficient, and multiple infection prevention strategies are warranted in efforts to reduce HAIs.1 AMG™ antimicrobial glove can complement existing infection control protocols without the complications of changing current practice or requiring specialised training. The wearing of AMG™ antimicrobial glove does not differ from ordinary medical glove, but with added microbe-killing property.
CLINICAL AND ECONOMIC IMPACT OF HAIs
Every year HAIs cause unnecessary suffering and higher medical costs for hundreds of millions of patients and their families around the world. These infections prolong hospital stay, increase the risk of post-operative complications and disabilities, increase resistance to antimicrobials, and even result in unnecessary deaths and massive financial losses to the healthcare system.
AMG™ : NEW PARADIGM IN MANAGING HAIs
In healthcare settings, microbes can be transmitted via several ways—physical contact (touching), sprays and splashes, inhalation, and sharps injuries, i.e., when a needle, scalpel or other medical instruments penetrate the skin. Among all these routes, physical contact is the main mode of transmission.2
Frequently touched objects within the hospital environment, such as bed rails, IV poles and tray tables, are heavily burdened by microbes, and they serve as significant reservoirs for the spread of pathogenic microbes. These objects’ surfaces have microbial burden that far exceed the benign level of <250 colony forming units (CFU) /100 cm
2. This increases the likelihood of microbial transmission from the surfaces to healthcare workers and/or patients.
3
Figure 1
Figure 2
AMG™ antimicrobial glove can kill microbes on the outer glove surface via its photodestructive action and reduce the microbial load during and after glove use. With this unique feature, it can minimise the chances of microbial transmission, thereby help to mitigate the spread of HAIs.
AMG™ is now proven with virucidal efficacy against Human Coronavirus (COVID-19 Virus 3,4,5) and Modified Vaccinia Virus (Monkeypox Virus 6,7)
The COVID-19 pandemic had caused the loss of millions of lives worldwide1 and caused additional billions of dollars being spent in healthcare costs.2 Besides, Monkeypox is a disease of global public health importance as it not only affects countries in west and central Africa, but the rest of the world. Studies are currently underway to further understand the epidemiology, sources of infection and transmission patterns8. Monkeypox virus is transmitted from one person to another by close contact with rashes, scabs, body fluids, respiratory droplets, and contaminated materials such as clothing, bedding, or towels 8. The proportion of patients who has died has varied between 0 and 11% in documented cases and has been higher among young children 8. Anyone can get or pass on viruses. Hartalega, uses our strength to empower, show our love to protect others.
References
World Health Organization (WHO) Coronavirus (COVID-19) Dashboard Data. Accessed 12-05-2022.
- JAMA Network, The Financial Effects and Consequences of COVID-19_ A Gathering Storm.
- Determination of the Virucidal Activity (ASTM D7907-14) of NB-AB-AMPF-030-SE-VBLU-EN6N Antimicrobial Nitrile Powderfree Examination Gloves (Blue), Test Report No.: VX-TR-22-0152.
- Australian Government Department of Health, Therapeutic Goods Administration (TGA), Surrogate Viruses for Use in Disinfectant Efficacy Tests to Justify Claims Against COVID-19.
- United States Environmental Protection Agency (EPA), Instructions for Review of Pesticide Registration Improvement Act (PRIA) Submissions for Products Eligible for Inclusion on List N:
Submission Information for Registrants.
- Determination of the Virucidal Efficacy (ASTM D7907-14) of NB-AB-AMPF-030-SE-VBLU-EN6N ANTIMICROBIAL NITRILE POWDERFREE EXAMINATION GLOVES (BLUE), Test Report No.: TR-22-0338
- Australian Government Department of Health, Therapeutic Goods Administration (TGA), Surrogate Viruses for Use in Disinfectant Efficacy Tests to Justify Claims Against Monkeypox.
- World Health Organization (WHO) Monkeypox Fact Sheets dated 19 May 2022. Accessed 05-08-2022
Efficacy
AMG™ IS EFFECTIVE AGAINST A WIDE RANGE OF MICROBES AND KILL MICROBES RAPIDLY
Based on ASTM D7907 Standard Test Methods for Determination of Bactericidal Efficacy on the Surface of Medical Examination Gloves, the AMG™ antimicrobial glove is effective in killing superbugs like MRSA and VRE. Test data has shown that AMG™ antimicrobial gloves can kill up to 99.999% of selected microbes, such as Staphylococcus aureus, in just 5 minutes.
Further testing was conducted on Staphylococcus aureus at a shorter contact time. Bacteria kill rate (%) results recorded: 99.989% (1 min) & 99.998% (2 mins).
| Microbe |
Type |
Average % of Bacteria Killed |
| 5 mins |
10 mins |
15 mins |
20 mins
|
| Enterococcus faecalis (VRE) |
Gram-positive |
99.982 |
99.996 |
- |
99.968 |
| Enterococcus faecium |
Gram-positive |
99.991 |
99.991 |
99.996 |
- |
| MRSA |
Gram-positive |
99.988 |
99.998 |
99.999 |
99.997 |
| Staphylococcus aureus* |
Gram-positive |
99.999 |
99.993 |
- |
99.994 |
| Streptococcus pyogenes |
Gram-positive |
99.946 |
99.970 |
99.988 |
99.996 |
| Escherichia coli |
Gram-negative |
- |
- |
99.030 |
- |
| Klebsiella pneumoniae |
Gram-negative |
- |
96.471 |
- |
97.747 |
Table 1. AMG™ Antimicrobial Glove Test Results for Bacteria Kill Rate.
AMG™ is now proven with virucidal efficacy against Human Coronavirus (COVID-19 Virus 4,5,6) and tested to have virucidal efficacy against Modified Vaccinia Virus (Monkeypox Virus 7,8)
Hartalega AMG™ Antimicrobial Gloves is now proven with virucidal efficacy against Human Coronavirus (Strain 229E), ATCC VR-7404.
Lab result shows that AMG™ is able to kill up to 99.696% of Human Coronavirus (Strain 229E)
4. The report based on test strain modified from ASTM D7907-14 Standard Test Methods for determination of virucidal efficacy on the surface of AMG™ Antimicrobial nitrile powder free medical examination gloves. By referring to the published information online from Therapeutic Goods Administration, Australia
5 & United States Environmental Protection Agency
6, surrogate viruses, such as Human Coronavirus(Strain 229E), can be used to justify a COVID-19 efficacy claim.
| Virucidal Reduction Efficacy against Human Coronavirus, % |
Contact Time
(minutes) |
5 mins |
10 mins |
20 mins |
30 mins |
| RT |
99.259% |
99.043% |
99.696% |
99.637% |
RT, Reduction from Challenge Inoculum (CI), RT = (CI-TS) x 100%/CI
Hartalega AMG™ Antimicrobial Gloves has been proven to have virucidal efficacy against Modified Vaccinia Virus, Strain Ankara, ATCC VR-15087 .
Lab result shows that AMG™ is able to kill up to 99.000% of Modified Vaccinia Virus
7. The report based on test strain modified from ASTM D7907-14 Standard Test Methods for determination of virucidal efficacy on the surface of AMG™ Antimicrobial nitrile powder free medical examination gloves
7. By referring to the published information online from Therapeutic Goods Administration, Australia
8, surrogate viruses, such as Vaccinia virus, can be used to justify a Monkeypox efficacy claim.
| Virucidal Reduction Efficacy against Modified Vaccinia Virus, % |
Contact Time
(minutes) |
5 mins |
10 mins |
20 mins |
30 mins |
| RT |
91.459% |
93.387% |
96.135% |
99.000% |
RT, Reduction from Challenge Inoculum (CI), RT = (CI-TS) x 100%/CI
The Unique Benefits of AMG™ Antimicrobial Gloves
Non-leach technology
AMG antimicrobial glove is the world’s first non-leaching antimicrobial examination glove.
The photosensitiser has been tested for nonmigration with the following medium:
- Hot water (50°C for up to 72 hours)*
- Sweat
- Saliva
- Ethanol
All extracts were analysed at Intertek using validated analytical techniques to detect the presence of the photosensitiser. Results concluded that the photosensitiser could not be detected in any of the extracts from neither the inner nor the outer glove surface.
Although the photosensitiser is proven safe to use, AMG antimicrobial glove has been designed to ensure further that it does not leach and transfer onto patients.
* Conducted according to ISO 10993-12 standard
Uncompromised glove properties
Apart from medical settings, AMG antimicrobial glove has been proven safe for use in different applications and industries. Its safety and effectiveness are proven to ensure it befits its intended use.
i. Medical
Tested for impermeability and glove strength, AMG antimicrobial glove is effective in preventing contamination between patient and healthcare practitioner, as well as for handling various chemotherapy drugs. All tests conducted are in accordance with recognised international standards such as ASTM D6319, EN 455 and ISO 11193 part 1.
ii. Personal Protective Equipment (PPE)
The glove has been tested to protect users from substances and mixtures that are hazardous to health, and harmful biological agents that may cause very serious consequences or damage to health.
iii. Food Contact
The glove has been tested safe for food contact according to the standards of U.S. FDA 21 CFR 177.2600, BfR XXI German Recommendation and Japan Food Sanitation on various types of simulants representing different types of food that are acidic, alcoholic and fatty in content. Some countries may require further registration with biocidal agencies such as the European Chemicals Agency (ECHA) and the Environmental Protection Agency (EPA).
Low risk of developing microbial resistance
Singlet oxygen technology has been assessed as low risk in regards to developing microbial resistance. This is attributed to the non-specific nature of the glove’s microbe-killing mechanism. Generally, oxidative antimicrobials, such as singlet oxygen used in AMG technology, has been viewed as having a low potential for microbes developing resistance by the EU Scientific Committee.
Biocompatible
AMG antimicrobial glove is suitable for different applications as it has been tested safe for use against various contacts such as skin and oral. Some of these tests confirm that the AMG antimicrobial glove is:
FAQ
These are the questions we hear a lot, and you'll find the answers below. But if you have others, please don't hesitate to contact us — we're here to help You
GENERAL
1. What is AMG antimicrobial glove?
AMG antimicrobial glove is the world’s first non-leaching antimicrobial glove, designed to kill microbes on the outer glove surface rapidly upon contact.
2. What is the purpose of AMG antimicrobial glove?
Though conventional glove provides a barrier between the healthcare worker and patient, it does not tackle the problem of transient transmission, where microbes get transmitted from one surface to another. AMG antimicrobial glove is designed to help reduce the spread of HAI, as it is proven to kill up to 99.999% of selected microbes.
3. How does AMG antimicrobial glove help in the fight against HAIs?
The use of medical gloves is intended to prevent crosscontamination between the patient, the user and its environment. However, conventional gloves can only provide passive protection as contaminated gloves caused by improper storage, inappropriate use and techniques for donning and removing may, in turn, become a vehicle for transmission of microbes. Conversely, gloves with AMG technology provide a novel approach in HAIs prevention as the gloves can continuously and effectively reduce or inhibit microbial colonisation on the glove surface within a short amount of time, thus further reducing the risk of cross-contamination.
4. Does AMG antimicrobial glove replace the need for hand hygiene?
Although AMG antimicrobial glove has been found effective against a wide range of microbes, it does not replace the need for hand hygiene. Instead, AMG antimicrobial glove complements hand hygiene practice and serves as an extra precaution or tool to help mitigate the spread of HAIs.
5. What does it mean by non-leaching? Is it safe?
We designed the antimicrobial gloves to be non-leaching to ensure the catalytic dye, which is a photosensitiser, does not transfer to the patient. To further ensure the safety of the final glove, the gloves were tested for leaching extractables as per below.
- Tested at Intertek UK, the gloves were extracted using water, artificial saliva, artificial sweat and alcohol at room and body temperature. The extracts were analysed by validated analytical techniques to detect the presence of the photosensitiser. None of the photosensitiser could be detected from the gloves’ inner or outer surface.
- ISO 10993 biocompatibility testing has been conducted on the inside and external surface of the gloves. Results confirm that the gloves are non-sensitising, non-irritating, non-toxic (oral) and non-cytotoxic.
- The Modified Draize-95 test was also conducted where both the inner and outer surfaces of the gloves were tested on human skin. The gloves provided no clinical evidence of inducing allergic reactions. With this test result, the U.S. FDA allows a “Low Dermatitis Potential” claim for the gloves.
6. What materials are in contact with my skin when using AMG™ Antimicrobial gloves?
The AMG™ technology is introduced on the external side of the glove. The glove user is exposed to the donning side of the glove, which is similar to a standard examination glove. The skin of the glove user is not exposed to this technology.
7. How does singlet oxygen work?
The AMG™ technology uses a special dye that absorbs visible light which raises it from a ground state to an excited quantum state, causing an elevation in energy to take place. The energy then transfers to a proximal oxygen molecule found in the air, causing the oxygen molecule to also rise to an excited quantum state. The ground state of oxygen present in air is a triplet electronic configuration, written as 3O2 . Upon sensitisation by the dye molecule, the electronic configuration changes and enters the singlet state, 1O2. This singlet oxygen state is reactive and more oxidative compared to ground state oxygen and therefore, is able to kill microbes such as bacteria by oxidising the cells’ protein and lipid. Using the dye as a catalyst, singlet oxygen can be generated continuously as it absorbs light and air.
8. What are the advantages of using a singlet oxygen antimicrobial system?
Singlet Oxygen is a non-selective system that can react rapidly against many microbial components. There is no single protection mechanism that bacteria can use to protect themselves from singlet oxygen.11 This is in contrast to antibiotics, which needs a very specific mechanism to kill the bacteria. As singlet oxygen is transient, it does not lead to the release of persistent biocides into the environment. AMG™ technology will as such transform the standard examination glove from a passive medical device to a medical device that will reduce or inhibit microbial colonisation.
9. Has singlet oxygen technology been used before commercially?
Whilst it has not received as much attention as traditional biocides, singlet oxygen has been researched for a wide range of uses for many years and a number of important commercial applications are known.12,13,14,15,16
10. Is there literature to show any potential of resistance using singlet oxygen antimicrobial system?
Experimental studies have been done and reported in scientific literature about singlet oxygen efficacy and microbial resistance.17,18 These have shown that bacteria were killed to a high extent with singlet oxygen, typically 99.9% or 99.99%, leaving only the most robust bacteria. These bacteria were then re-cultivated and re-exposed to singlet oxygen. This cycle was repeated 10 or 20 times, with the efficacy of kill measured. In all cases, it was found that there was no decrease in efficacy and no development in resistance.
Many of the mechanisms bacteria use to confer resistance involve processes internal to the cell. In AMG™ system, however, the singlet oxygen is generated purely exogenously to the cell – the dye is separate from the bacteria, does not leach, and cannot enter the cell. Other authors in the literature have noted 21,17 that this makes the development of resistance especially difficult because singlet oxygen is short lived and with a short length of diffusion – nothing the bacterial cell does internally will affect the process of oxidation by singlet oxygen.
Furthermore, a review of the potential for resistance to biocidal materials was done by the EU expert scientific committee. The report puts biocidal materials into three categories: low risk of resistance developing, medium risk and high risk. Oxidative systems were categorised as low risk, some traditional biocide materials such as chlorhexidine and PHMB as medium risk, and silver as high risk.10
11. What is the amount of light needed to activate AMG™ technology?
Testing of AMG™ glove has been conducted at general lighting conditions at hospitals of 1000 lux and 500 lux. Results show that there was no significant difference in bactericidal efficacy. Further testing at lower light levels are underway.
12. Would differences in lighting type affect the efficacy of AMG™ Antimicrobial gloves (for example – LED, fluorescent, incandescent light bulbs)?
No. The AMG™ technology is activated by any white light source. It is specifically activated by light in the 600 - 700 nm region but all white light sources contain this, otherwise, they would be coloured.
13. Will the dye be depleted if the AMG™ Antimicrobial Gloves are continually exposed to light?
No. Singlet oxygen will be generated continuously as long as there are light and air. Heat aged AMG™ gloves (accelerated ageing equivalent to 3 years shelf life) did not show any significant difference in bactericidal efficacy compared to fresh AMG™ gloves.
AMG™ gloves were also exposed to “light” (equivalent to 30 days in an open box environment). Again, there was no significant difference in bactericidal efficacy compared to fresh AMG™ gloves.
14. What are the different classifications of bacteria?
Bacteria are classified into Gram-positive or Gram-negative. This classification came from a staining property observed by Hans Gram in 1884. It was observed that some bacteria could be stained with a dye, and others could not. It was later found that bacteria have different cell wall structures. Gram-positive bacteria allow substances to cross the cell wall more easily. The cell wall of Gram-negative bacteria is multi-layered and so it is harder for substances to cross the cell wall.
15. What are some examples of Gram-negative bacteria?
Gram-negative bacteria include Esherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii among others.
16. What are some examples of Gram-positive bacteria?
Gram-positive bacteria include MRSA, Staphylococcus aureus, Enterococcus faecium, Streptococcus pyogenes, Enterococcus faecalis (VRE) among many others.
17. What type of bacteria survive longer on surfaces, which allows for the possibility of infection transfer?
Based on a study conducted by Hirai,22 which measures the survival of different types of bacteria on cotton lint, the results showed that Gram-positive bacteria have longer lifetimes on surfaces, which may have implications that these bacteria are available for transfer to cause HAIs. Gram-negative bacteria are known to die more quickly on surfaces, especially if the surface is dry.
18. How about in a clinical environment? Is there a survival difference between Gram-positive and Gramnegative bacteria?
The pattern of lower survival of Gram-negative bacteria is also seen in the clinical environment. In Wilson et al study,23 Grampositive bacteria such as Staph a. were found in numerous locations in the hospital environment, but Gram-negative bacteria such as E. Coli were not found on any surfaces sampled, despite having a number of patients in the ward with E. Coli infections.
19. Do biocides kill Gram-positive or Gram-negative bacteria easily?
All bacteria respond to biocides differently, requiring different contact times and concentrations for inactivation. In general, Gram-negative bacteria are harder to kill with biocides.24
20. How is the bactericidal efficacy of AMG™ Antimicrobial gloves measured?
AMG™ Antimicrobial Glove will start generating singlet oxygen and start killing bacteria immediately upon exposure to light and oxygen. Based on the requirements of ASTM D7907-14, the contact time in which the bacteria have been exposed the external surface of the glove containing antimicrobial agent needs to be measured at intervals of 5 mins, 10 mins, 20 mins and 30 mins. At the end of each contact time, the glove is transferred into a validated neutraliser to stop the bactericidal activity. This will stop the singlet oxygen killing activity on the microbes which will, in turn, allow the calculation of bacteria kill.
Additional testing has been conducted at shorter contact times of 1 min and 2 mins on Staphylococcus aureus with bacteria kill rates of 99.898% and 99.998% respectively.
21. Does AMG™ technology have any effect on viruses?
We believe AMG™ technology can kill viruses as well as bacteria. This is why we chose to name it Antimicrobial instead of Antibacterial. However, all our tests are based on ASTM D7907 Standard Test Methods for Determination of Bactericidal Efficacy on the Surface of Medical Examination Gloves. This test method specified the glove had to be tested against 11 specific bacteria. As AMG™ technology is a new invention, there is no other standard that we can use to test for viral efficacy. Nevertheless, we are working on adapting D7907 to test for viruses. This work will take a longer time to complete. One of the challenges is that viruses only replicate inside living cells; once exposed to the environment they will be destroyed quickly, therefore making it difficult to test.
We have decided to launch AMG™ glove with the D7907 test data as we believe most HAIs attributable to hand-surface contamination are bacteria. Viruses like Hepatitis and HIV are spread through the faecal-oral route or transmission through contaminated syringes, needles, sharps, or infected blood transfusions. The more common flu virus is mainly spread to others by droplets made when people with flu, cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might get flu by touching a surface or object that has flu virus on it and then touch their own mouth, nose, or possibly eyes.25
22. What is the medical device classification for AMG™ Antimicrobial Gloves in MDD93/42/EEC?
European Union MDD 93/42/EEC Annex IX:
Class I (Rule 5) includes "All invasive devices with respect to body orifices, other than surgically invasive devices and which are not
intended for connection to an active medical device…".
As such, the Antimicrobial Nitrile Powder Free Examination gloves are an invasive device intended for short transient use (I. Definitions, 1.1) for examinations on intact skin and also involve body orifices (I. Definitions, 1.2). All other parts of rule 5 do not apply. Based on rule 5 (III. Classification, section 2, 2.1), the Antimicrobial Nitrile Powder Free Examination Gloves are classified as a medical device class I.
23. What is the intended use and indication for AMG™ Antimicrobial Gloves in the technical file?
The Antimicrobial Nitrile Powder Free Examination Gloves are intended to be used in the framework of medical examinations and diagnostic and therapeutic procedures conducted under non-sterile conditions. Furthermore, the use of the device is intended to help prevent cross-contamination.
Its indication is stated as "Any medical condition requiring an examination, a diagnostic or therapeutic procedure on the intact skin or mucosa under non-sterile conditions".
24. Does AMG™ Antimicrobial Gloves require registration by EU Biocidal Regulation?
The Biocides Regulation (EU) No. 528/2012 is not applicable for medical devices unless they are intended to be used for other purposes not covered by the medical device directive, in which case the Biocides Regulation shall also apply to that product insofar as those purposes are not addressed by those instruments. Based on our understanding, this would mean that the biocides regulation is only applicable if the gloves are intended for other non-medical purposes or the antibacterial feature would not be within the original purpose of the medical device. As the gloves’ medical purpose is to prevent infection of the patient and the antimicrobial feature supports this purpose, we believe that the biocides regulation is not applicable.26
References
- McLaws, M.L. (2015). The relationship between hand hygiene and health care-associated infection: it’s complicated. Infection and Drug Resistance, 8, 7-18.
- Collins, A. (2008). Preventing Health Care–Associated Infections. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2683/
- Schmidt, M. G., Attaway, H. H., Sharpe, P. A., John, J., Sepkowitz, K. A., Morgan, A., … Salgado, C. D. (2012). Sustained reduction of microbial den on common hospital surfaces through introduction of copper. Journal of Clinical Microbiology, 50(7), 2217-2223
- Determination of the Virucidal Activity (ASTM D7907-14) of NB-AB-AMPF-030-SE-VBLU-EN6N Antimicrobial Nitrile Powderfree Examination Gloves (Blue), Test Report No.: VX-TR-22-0152
- Australian Government Department of Health, Therapeutic Goods Administration (TGA), Surrogate Viruses for Use in Disinfectant Efficacy Tests to Justify Claims Against COVID-19.
- United States Environmental Protection Agency (EPA), Instructions for Review of Pesticide Registration Improvement Act (PRIA) Submissions for Products Eligible for Inclusion on List N: Submission Information for Registrants.
- Determination of the Virucidal Efficacy (ASTM D7907-14) of NB-AB-AMPF-030-SE-VBLU-EN6N ANTIMICROBIAL NITRILE POWDERFREE EXAMINATION GLOVES (BLUE), Test Report No.: TR-22-0338
- Australian Government Department of Health, Therapeutic Goods Administration (TGA), Surrogate Viruses for Use in Disinfectant Efficacy Tests to Justify Claims Against Monkeypox.
- World Health Organization (WHO) Monkeypox Fact Sheets dated 19 May 2022. Accessed 05-08-2022
- SCENIHR (Scientific Committee on Emerging and Newly Identified Health Risks). (2009). Assessment of the Antibiotic Resistance Effects of Biocides, p. 57
- Maisch, T. (2015). Resistance in antimicrobial photodynamic inactivation of bacteria. Photochemical & Photobiological Sciences, 14(8), 1518-1526.
- DeRosa, M. (2002). Photosensitized singlet oxygen and its applications. Coordination Chemistry Reviews, 233-234, 351-371.
- Wainwright, M. (2004). Photoantimicrobials - a PACT against resistance and infection. Drugs Of The Future, 29(1), 85-93.
- Babilas, P., Schreml, S., Landthaler, M., & Szeimies, R. (2018). Photodynamic therapy in dermatology: state-of-the-art.
- Juarranz, Á., Jaén, P., Sanz-Rodríguez, F., Cuevas, J., & González, S. (2008). Photodynamic therapy of cancer. Basic principles and applications. Clinical And Translational Oncology, 10(3), 148-154.
- Khan, A. (1991). The discovery of the chemical evolution of singlet oxygen. Some current chemical, photochemical, and biological applications. International Journal Of Quantum Chemistry, 39(3), 251-267
- Giuliani, F., Martinelli, M., Cocchi, A., Arbia, D., Fantetti, L., & Roncucci, G. (2009). In Vitro Resistance Selection Studies of RLP068/Cl, a New
- Zn(II) Phthalocyanine Suitable for Antimicrobial Photodynamic Therapy. Antimicrobial Agents And Chemotherapy, 54(2), 637-642.
- 11. Tavares, A., Carvalho, C., Faustino, M., Neves, M., Tomé, J., & Tomé, A. et al. (2010). Antimicrobial Photodynamic Therapy: Study of Bacterial
- Recovery Viability and Potential Development of Resistance after Treatment. Marine Drugs, 8(1), 91-105.
- World Health Organization. (n.d.). Health Care-Associated Infections [Fact Sheet]. Retrieved from http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
- Hirai, Y. (1991). Survival of bacteria under dry conditions; from a viewpoint of nosocomial infection. Journal Of Hospital Infection, 19(3), 191-200
- Moore, G., Muzslay, M., & Wilson, A. (2013). The Type, Level, and Distribution of Microorganisms within the Ward Environment: A Zonal Analysis of an Intensive Care Unit and a Gastrointestinal Surgical Ward. Infection Control & Hospital Epidemiology, 34(05), 500-506.
- McDonnell, G., & Russell, A. D. (1999). Antiseptics and Disinfectants: Activity, Action, and Resistance. Clinical Microbiology Reviews, 12(1), 147–179
- Centers for Disease Control and Prevention. (2018). How Flu Spreads. Retrieved from https://www.cdc.gov/flu/about/disease/spread.htm
- MDSS Consulting, EU Authorized Representative
