Silver-based Antibacterial Strategies for Healthcare-associated Infections: Processes, Challenges, and Regulations. An Integrated Review

Healthcare-associated infections (HCAIs) are a major cause of morbidity and mortality worldwide. One of the main routes of transmission is by contact with contaminated surfaces, where nosocomial pathogens form sessile communities called biofilms. When forming biofilms, these pathogens are extremely resistant to antibiotics and standard cleaning procedures. In this regard, in order to eliminate the extent of biofilm formation on these surfaces, intensive efforts have been deployed, particularly in recent years, to develop new antibacterial surfaces containing silver or silver compounds, which can be used to prevent the formation of biofilm. In this review, recent developments in the design and manufacturing of silver-based antibacterial surfaces are described in detail. Up-to-date toxicity and governmental regulations are then extensively presented. Finally, based on current research in this promising field, the main challenges and perspectives for their effective implementation are discussed.