{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:07:04Z","timestamp":1783901224878,"version":"3.55.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":58,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003848","name":"Industrial Technology Research Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003848","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100007632","name":"Changhua Christian Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007632","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Environmental surfaces contribute significantly to healthcare-associated infection (HAI) transmission. This study evaluated HyTAMO, a titanium dioxide-silver composite coating, in chronic respiratory care wards where patients require prolonged mechanical ventilation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Two 36-bed ventilator-dependent chronic care wards on different floors were compared from October 2024 to March 2025. Ward 2\u00a0F (experimental) received HyTAMO coating on high-touch surfaces; Ward 3\u00a0F (control) maintained standard cleaning. Environmental sampling (ATP, total viable counts and 16\u00a0S rRNA sequencing) was performed at baseline and weeks 0, 1, 2, 4, and 8. HAI rates were monitored for 5 months using CDC definitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics were generally comparable, except for patient age (80.0 vs. 75.6 years, favoring control group infection risk). Environmental bacterial counts showed no statistically significant Group \u00d7 Time interaction (F(5,20)\u2009=\u20093.012,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.076). However, HAI density in the experimental ward showed a progressive decline from 4.7 to 0.9 per 1000 patient-days over the 5-month post-intervention period, whereas the control ward exhibited an initial decrease followed by a rebound to pre-intervention levels (3.67\u21920.83\u21925.87\u2030). Poisson regression revealed a significant Group \u00d7 Time interaction (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.038), indicating divergent HAI trajectories between wards.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HyTAMO coating was associated with significantly divergent HAI trends compared with the control ward over a 5-month period, with the experimental ward showing progressive decline in HAI density despite non-significant differences in environmental bacterial counts. The disconnect between environmental and clinical outcomes warrants mechanistic investigation. The ultra-long patient stay duration (mean 3.2 years) provided ideal conditions for assessing long-term coating durability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Not applicable. The Institutional Review Board of Changhua Christian Hospital formally determined that this study does not constitute human subjects research (IRB Exemption Statement, May 17, 2024) accordingly, trial registration was not required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-026-13583-1","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T15:04:36Z","timestamp":1778943876000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term effectiveness of titanium dioxide-silver composite coating in reducing healthcare-associated infections in chronic respiratory care wards: a controlled trial"],"prefix":"10.1186","volume":"26","author":[{"given":"Yu-Kai","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Ching","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Hua","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Szu-Han","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan-Ying","family":"Chou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sen-Yung","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,16]]},"reference":[{"issue":"22","key":"13583_CR1","doi-asserted-by":"publisher","first-page":"2039","DOI":"10.1001\/jamainternmed.2013.9763","volume":"173","author":"E Zimlichman","year":"2013","unstructured":"Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173(22):2039\u201346.","journal-title":"JAMA Intern Med"},{"issue":"46","key":"13583_CR2","doi-asserted-by":"publisher","first-page":"1800516","DOI":"10.2807\/1560-7917.ES.2018.23.46.1800516","volume":"23","author":"C Suetens","year":"2018","unstructured":"Suetens C, Latour K, K\u00e4rki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities. Euro Surveill. 2018;23(46):1800516.","journal-title":"Euro Surveill"},{"issue":"4","key":"13583_CR3","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1128\/CMR.00020-14","volume":"27","author":"SJ Dancer","year":"2014","unstructured":"Dancer SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev. 2014;27(4):665\u201390.","journal-title":"Clin Microbiol Rev"},{"issue":"5","key":"13583_CR4","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1086\/670207","volume":"34","author":"CD Salgado","year":"2013","unstructured":"Salgado CD, Sepkowitz KA, John JF, Cantey JR, Attaway HH, Freeman KD, et al. Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Infect Control Hosp Epidemiol. 2013;34(5):479\u201386.","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"7","key":"13583_CR5","doi-asserted-by":"publisher","first-page":"2217","DOI":"10.1128\/JCM.01032-12","volume":"50","author":"MG Schmidt","year":"2012","unstructured":"Schmidt MG, Attaway HH, Sharpe PA, John J, Sepkowitz KA, Morgan A, et al. Sustained reduction of microbial burden on common hospital surfaces through introduction of copper. J Clin Microbiol. 2012;50(7):2217\u201323.","journal-title":"J Clin Microbiol"},{"issue":"10071","key":"13583_CR6","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1016\/S0140-6736(16)31588-4","volume":"389","author":"DJ Anderson","year":"2017","unstructured":"Anderson DJ, Chen LF, Weber DJ, Moehring RW, Lewis SS, Triplett PF, et al. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile. Lancet. 2017;389(10071):805\u201314.","journal-title":"Lancet"},{"issue":"33","key":"13583_CR7","doi-asserted-by":"publisher","first-page":"44638","DOI":"10.1007\/s11356-021-14996-y","volume":"28","author":"H Chakhtouna","year":"2021","unstructured":"Chakhtouna H, Benzeid H, Zari N, Qaiss AEK, Bouhfid R. Recent progress on Ag\/TiO2 photocatalysts: photocatalytic and bactericidal behaviors. Environ Sci Pollut Res Int. 2021;28(33):44638\u201366.","journal-title":"Environ Sci Pollut Res Int"},{"key":"13583_CR8","doi-asserted-by":"publisher","first-page":"2526","DOI":"10.1007\/s11051-014-2526-8","volume":"16","author":"XH Yang","year":"2014","unstructured":"Yang XH, Fu HT, Wang XC, Yang JL, Jiang XC, Yu AB. Synthesis of silver-titanium dioxide nanocomposites for antimicrobial applications. J Nanopart Res. 2014;16:2526.","journal-title":"J Nanopart Res"},{"key":"13583_CR9","doi-asserted-by":"publisher","first-page":"2203","DOI":"10.1007\/s11051-013-2203-3","volume":"16","author":"M Lungu","year":"2014","unstructured":"Lungu M, Gavriliu \u015e, Enescu E, Ion I, Br\u0103tulescu A, Mih\u0103escu G, et al. Silver-titanium dioxide nanocomposites as effective antimicrobial and antibiofilm agents. J Nanopart Res. 2014;16:2203.","journal-title":"J Nanopart Res"},{"key":"13583_CR10","doi-asserted-by":"publisher","first-page":"277","DOI":"10.3390\/diseases13090277","volume":"13","author":"L Drago","year":"2025","unstructured":"Drago L, Giarritiello F, Deflorio L, Uslenghi A, Minasi V, Covi M, et al. In vitro activity of silver-bound titanium dioxide (Tiab) against multidrug-resistant bacteria from dermatological infections. Diseases. 2025;13:277.","journal-title":"Diseases"},{"issue":"8","key":"13583_CR11","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.ajic.2010.02.011","volume":"38","author":"G Moore","year":"2010","unstructured":"Moore G, Smyth D, Singleton J, Wilson P. The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program. Am J Infect Control. 2010;38(8):617\u201322.","journal-title":"Am J Infect Control"},{"issue":"1","key":"13583_CR12","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.jhin.2015.09.008","volume":"92","author":"MP Muller","year":"2016","unstructured":"Muller MP, MacDougall C, Lim M, Armstrong I, Bialachowski A, Callery S, et al. Antimicrobial surfaces to prevent healthcare-associated infections: a systematic review. J Hosp Infect. 2016;92(1):7\u201313.","journal-title":"J Hosp Infect"},{"issue":"3","key":"13583_CR13","first-page":"309","volume":"99","author":"I Pineda","year":"2017","unstructured":"Pineda I, Hubbard R, Rodr\u00edguez F. The role of copper surfaces in reducing the incidence of healthcare-associated infections: a systematic review and meta-analysis. J Hosp Infect. 2017;99(3):309\u201311.","journal-title":"J Hosp Infect"},{"key":"13583_CR14","doi-asserted-by":"publisher","first-page":"103708","DOI":"10.1016\/j.redox.2025.103708","volume":"85","author":"X Liu","year":"2025","unstructured":"Liu X, Tao Y, Zhang L, Liu Y, Shi D, Wang J, et al. Caged-hypocrellin mediated photodynamic therapy induces chromatin remodeling and disrupts mitochondrial energy metabolism in multidrug-resistant Candida auris. Redox Biol. 2025;85:103708.","journal-title":"Redox Biol"},{"issue":"1","key":"13583_CR15","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.jaad.2025.08.040","volume":"94","author":"X Liu","year":"2026","unstructured":"Liu X, Guo S, Wang J, Zhang L, Lin Y, Liu Y, et al. Caged-hypocrellin-mediated antimicrobial photodynamic therapy as a dual-action strategy for fungal clearance and immune response regulation in drug-resistant Candida auris wound infections. J Am Acad Dermatol. 2026;94(1):73\u201380.","journal-title":"J Am Acad Dermatol"},{"issue":"2","key":"13583_CR16","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.ajic.2015.09.008","volume":"44","author":"MG Schmidt","year":"2016","unstructured":"Schmidt MG, von Dessauer B, Benavente C, Benadof D, Cifuentes P, Elgueta A, et al. Copper surfaces are associated with significantly lower concentrations of bacteria on selected surfaces within a pediatric intensive care unit. Am J Infect Control. 2016;44(2):203\u20139.","journal-title":"Am J Infect Control"},{"issue":"4","key":"13583_CR17","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1111\/j.1574-6976.2009.00200.x","volume":"34","author":"JD Oliver","year":"2010","unstructured":"Oliver JD. Recent findings on the viable but nonculturable state in pathogenic bacteria. FEMS Microbiol Rev. 2010;34(4):415\u201325.","journal-title":"FEMS Microbiol Rev"},{"issue":"2","key":"13583_CR18","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.mimet.2006.04.015","volume":"67","author":"A Nocker","year":"2006","unstructured":"Nocker A, Cheung CY, Camper AK. Comparison of propidium monoazide with ethidium monoazide for differentiation of live vs. dead bacteria by selective removal of DNA from dead cells. J Microbiol Methods. 2006;67(2):310\u201320.","journal-title":"J Microbiol Methods"},{"issue":"2","key":"13583_CR19","doi-asserted-by":"publisher","first-page":"277","DOI":"10.3201\/eid0702.010226","volume":"7","author":"RM Donlan","year":"2001","unstructured":"Donlan RM. Biofilms and device-associated infections. Emerg Infect Dis. 2001;7(2):277\u201381.","journal-title":"Emerg Infect Dis"},{"issue":"5 Suppl","key":"13583_CR20","doi-asserted-by":"publisher","first-page":"S6","DOI":"10.1016\/j.ajic.2012.12.004","volume":"41","author":"JA Otter","year":"2013","unstructured":"Otter JA, Yezli S, Salkeld JA, French GL. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. Am J Infect Control. 2013;41(5 Suppl):S6\u201311.","journal-title":"Am J Infect Control"},{"issue":"5","key":"13583_CR21","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1086\/670224","volume":"34","author":"MG Schmidt","year":"2013","unstructured":"Schmidt MG, Attaway HH, Fairey SE, Steed LL, Michels HT, Salgado CD. Copper continuously limits the concentration of bacteria resident on bed rails within the intensive care unit. Infect Control Hosp Epidemiol. 2013;34(5):530\u20133.","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"11","key":"13583_CR22","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1016\/S1473-3099(02)00437-1","volume":"2","author":"G Gavazzi","year":"2002","unstructured":"Gavazzi G, Krause KH. Ageing and infection. Lancet Infect Dis. 2002;2(11):659\u201366.","journal-title":"Lancet Infect Dis"},{"key":"13583_CR23","doi-asserted-by":"crossref","unstructured":"Qu J et al. Expert consensus on the prevention of secondary mucormycosis following respiratory viral infections. iFungi. 2026.","DOI":"10.26599\/iFungi.2026.9670007"},{"issue":"1","key":"13583_CR24","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1186\/s13756-021-00956-1","volume":"10","author":"AF Widmer","year":"2021","unstructured":"Widmer AF, Kuster S, Dangel M, J\u00e4ger S, Frei R. Long-term antimicrobial effectiveness of a silver-impregnated foil on high-touch hospital surfaces in patient rooms. Antimicrob Resist Infect Control. 2021;10(1):120.","journal-title":"Antimicrob Resist Infect Control"},{"issue":"9","key":"13583_CR25","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.3390\/antibiotics10091069","volume":"10","author":"AJ Cunliffe","year":"2021","unstructured":"Cunliffe AJ, Askew PD, Stephan I, Iredale G, Cosemans P, Simmons LM, et al. How do we determine the efficacy of an antibacterial surface? A review of standardised antibacterial material testing methods. Antibiotics. 2021;10(9):1069.","journal-title":"Antibiotics"},{"issue":"5","key":"13583_CR26","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1080\/1040841X.2021.1991271","volume":"48","author":"W B\u00e4umler","year":"2022","unstructured":"B\u00e4umler W, Eckl D, Holzmann T, Schneider-Brachert W. Antimicrobial coatings for environmental surfaces in hospitals: a potential new pillar for prevention strategies in hygiene. Crit Rev Microbiol. 2022;48(5):531\u201364.","journal-title":"Crit Rev Microbiol"},{"issue":"10","key":"13583_CR27","doi-asserted-by":"publisher","first-page":"2184","DOI":"10.1097\/01.CCM.0000181731.53912.D9","volume":"33","author":"N Safdar","year":"2005","unstructured":"Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33(10):2184\u201393.","journal-title":"Crit Care Med"},{"issue":"9","key":"13583_CR28","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.ajic.2005.04.246","volume":"33","author":"PW Stone","year":"2005","unstructured":"Stone PW, Braccia D, Larson E. Systematic review of economic analyses of health care-associated infections. Am J Infect Control. 2005;33(9):501\u20139.","journal-title":"Am J Infect Control"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-026-13583-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-13583-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-13583-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T23:11:13Z","timestamp":1783897873000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12879-026-13583-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,16]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["13583"],"URL":"https:\/\/doi.org\/10.1186\/s12879-026-13583-1","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,16]]},"assertion":[{"value":"13 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the Declaration of Helsinki. The Institutional Review Board (IRB) of Changhua Christian Hospital formally determined that this study was exempt from IRB review, as the research design was classified as non-human research (IRB Exemption Statement, Changhua Christian Hospital, May 17, 2024). The study involved an environmental surface intervention only, with no direct patient contact, no administration of any substance to patients, and no collection of personal data or biological samples from individual patients. Accordingly, individual informed consent to participate was not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"W.C. Sun is an employee of the Industrial Technology Research Institute, which developed HyTAMO coating technology. Other authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1295"}}