Methods to assess antibacterial, antifungal and antiviral surfaces in relation to touch and droplet transfer: a review, gap-analysis and suggested approaches
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To help assess whether a potentially antimicrobial material, surface, or coating provides antimicrobial efficacy, a number of standardised test methods have been developed internationally. Ideally, these methods should generate data that supports the materials efficacy when deployed in the intended end-use application. These methods can be categorised based on their methodological approach such as suspension tests, agar plate/zone diffusion tests, surface inoculation tests, surface growth tests or surface adhesion tests. To support those interested in antimicrobial coating efficacy, this review brings together an exhaustive list of methods (for porous and non-porous materials), exploring the methodological and environmental parameters used to quantify antibacterial, antifungal, or antiviral activity. This analysis demonstrates that antimicrobial efficacy methods that test either fungi or viruses are generally lacking, whilst methods that test bacteria, fungi and viruses are not designed to simulate end-use/lack realistic conditions. As such, a number of applications for antimicrobial activity across medical touch screens, medical textiles and gloves and transport seat textiles are explored as example applications, providing guidance on modifications to existing methods that may better simulate the intended end-use of antimicrobial materials.
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Thank you for addressing all reviewer comments.
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The reviewers and I agree that this manuscript is well-written and an important contribution to existing literature. The reviewers have only minor comments that need to be addressed. Please particularly consider re-working the title for conciseness.
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Comments to Author
The review 'Methods to assess porous and non-porous antibacterial, antifungal and antiviral surfaces in relation to touch and droplet transfer in medical and transport applications: a gap analysis and suggested approaches' by Cunliffe etal is a largely systematic review of methods assessing the efficacy of antimicrobial surfaces, thereby largely focussing on standards. The review is well executed, presenting a clear overview. The review provides a highly needed insight into gap analyses and recommendations for further study for the development of standards. I have no major concerns for this review, it is generally well analysed with appropriate justifications. My minor concerns are provided here: Method/Presentation of broad results: 1. The review is largely systematic in nature. I therefore advise …
Comments to Author
The review 'Methods to assess porous and non-porous antibacterial, antifungal and antiviral surfaces in relation to touch and droplet transfer in medical and transport applications: a gap analysis and suggested approaches' by Cunliffe etal is a largely systematic review of methods assessing the efficacy of antimicrobial surfaces, thereby largely focussing on standards. The review is well executed, presenting a clear overview. The review provides a highly needed insight into gap analyses and recommendations for further study for the development of standards. I have no major concerns for this review, it is generally well analysed with appropriate justifications. My minor concerns are provided here: Method/Presentation of broad results: 1. The review is largely systematic in nature. I therefore advise to adopt the Systematic Review Approach and include reporting of accepted literature and standards via the PRISMA method. 2. Unclear which key words were used in literature/standards searching. Please insert key words. Results: 1. Three end-use scenarios are discussed, but their choice has not been justified. Can the authors please provide clarifications why these three scenarios (out of many) merit being discussed here over others? 2. New Results heading needed starting from L265 LL1-3: Title is very long and missing 'review': reword (and ideally shorten) to incorporate 'review' L16: 'potentially' should read 'potential' L23/L62 : edit 'paper' to 'review' LL22-26: Needs rephrasing (changing to 2 sentences?) to highlight that not the organisms are studied, but antimicrobial effects. The whole and very long sentence is difficult to follow. LL26-27: sentence needs rewording, as 'antimicrobial efficacy' or a similar phrasing is missing. LL51-53 Long sentence of which the meaning is unclear to me. Please restructure and clarify what it is meant to say. LL85 After table 2 insert the PRISMA flow diagram. L97 and many other instances: Write the full name of the species when first used. When used a 2nd or further time, only then use a clear abbreviation for the genus name. L289 edit 'analysis' to 'meta-analysis' - Refs 1-2 are duplicates, please remove one. - Table 1 has a different format to the other tables. Needs formatting to the same style - The species abbreviations throughout the text and tables need a bit of attention to make sure that not the same letter is re-used for a different genus. Eg currently S is both Staphylococcus and Serratia, C can be Candida or Cladosporium, P can be Pseudomonas or Penicillium. Please edit the 2nd genus to a different abbreviation. - Please remove all full stops from the table texts. - Table 9 contact times has unit missing - Figures 1-2 are both copyrighted by ISML. The legends do not indicate that permission has been given to reproduce. Or consider redrafting? - Figures 1-2 legends have citations missing.
Please rate the quality of the presentation and structure of the manuscript
Good
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
The manuscript by Cunliffe et al. assesses standardised test methods used to assess antimicrobial surfaces and materials. The authors find that there is inconsistency between the methods as well as similar/identical, redundant standardised test methods. There is also, importantly, a lack of standardised test methods that accurately simulate real-world use cases. The authors then suggest ways to improve the methods for testing a variety of antimicrobial materials that more accurately reflects intended use of the materials. The manuscript is well written and flows well. The conclusions are sound and backed up with good explanation, and the authors acknowledge that their suggestions for standardised methods are not exhaustive, but act as a guide for improving these tests. I only have some very minor …
Comments to Author
The manuscript by Cunliffe et al. assesses standardised test methods used to assess antimicrobial surfaces and materials. The authors find that there is inconsistency between the methods as well as similar/identical, redundant standardised test methods. There is also, importantly, a lack of standardised test methods that accurately simulate real-world use cases. The authors then suggest ways to improve the methods for testing a variety of antimicrobial materials that more accurately reflects intended use of the materials. The manuscript is well written and flows well. The conclusions are sound and backed up with good explanation, and the authors acknowledge that their suggestions for standardised methods are not exhaustive, but act as a guide for improving these tests. I only have some very minor comments: * Line 216 - says the contact time can be reduced to a maximum of 12 hours, but Table 8 says maximum of 8 hours * Table 9 is not referred to in the main text except line 197 - I think Table 9 should be referenced in the paragraph Lines 217-231 * Table 10 is not referred to in the main text at all - I think it should be referenced in the End-use scenario three section, perhaps in the paragraph Lines 257-264 * An additional subheading may be useful before Line 265, as this currently is in the same sub-section as end-use scenario three but is not related * Table 7 - P. aeruginosa is missing the full-stop after the P * Figure 1 - at the bottom section of the figure it says "… then Determine CFuUs". I am not sure if this is a typo of CFUs?
Please rate the quality of the presentation and structure of the manuscript
Good
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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