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How Long do Nosocomial Pathogens Persist on Inanimate Surfaces? A Systematic Review

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Inanimate surfaces have often been described as the source for outbreaks of nosocomial infections. The aim of this review is to summarize data on the persistence of different nosocomial pathogens on inanimate surfaces. The literature was systematically reviewed in MedLine without language restrictions. In addition, cited articles in a report were assessed and standard textbooks on the topic were reviewed. All reports with experimental evidence on the duration of persistence of a nosocomial pathogen on any type of surface were included. Most gram-positive bacteria, such as Enterococcus spp. (including VRE), Staphylococcus aureus (including MRSA), or Streptococcus pyogenes, survive for months on dry surfaces. Many gram-negative species, such as Acinetobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Serratia marcescens, or Shigella spp., can also survive for months. A few others, such as Bordetella pertussis, Haemophilus influenzae, Proteus vulgaris, or Vibrio cholerae, however, persist only for days. Mycobacteria, including Mycobacterium tuberculosis, and spore-forming bacteria, including Clostridium difficile, can also survive for months on surfaces. Candida albicans as the most important nosocomial fungal pathogen can survive up to 4 months on surfaces. Persistence of other yeasts, such as Torulopsis glabrata, was described to be similar (5 months) or shorter (Candida parapsilosis, 14 days). Most viruses from the respiratory tract, such as corona, coxsackie, influenza, SARS or rhino virus, can persist on surfaces for a few days. Viruses from the gastrointestinal tract, such as astrovirus, HAV, polio- or rota virus, persist for approximately 2 months. Blood-borne viruses, such as HBV or HIV, can persist for more than one week. Herpes viruses, such as CMV or HSV type 1 and 2, have been shown to persist from only a few hours up to 7 days. The most common nosocomial pathogens may well survive or persist on surfaces for months and can thereby be a continuous source of transmission if no regular preventive surface disinfection is performed.
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BioMed Central
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BMC Infectious Diseases
Open Access
Research article
How long do nosocomial pathogens persist on inanimate surfaces?
A systematic review
Axel Kramer*
1
, Ingeborg Schwebke
2
and Günter Kampf
1,3
Address:
1
Institut für Hygiene und Umweltmedizin, Ernst-Moritz-Arndt Universität, Greifswald, Germany,
2
Robert-Koch Institut, Berlin, Germany
and
3
Bode Chemie GmbH & Co. KG, Scientific Affairs, Hamburg, Germany
Email: Axel Kramer* - kramer@uni-greifswald.de; Ingeborg Schwebke - schwebkei@rki.de; Günter Kampf - guenter.kampf@bode-chemie.de
* Corresponding author
Abstract
Background: Inanimate surfaces have often been described as the source for outbreaks of
nosocomial infections. The aim of this review is to summarize data on the persistence of different
nosocomial pathogens on inanimate surfaces.
Methods: The literature was systematically reviewed in MedLine without language restrictions. In
addition, cited articles in a report were assessed and standard textbooks on the topic were
reviewed. All reports with experimental evidence on the duration of persistence of a nosocomial
pathogen on any type of surface were included.
Results: Most gram-positive bacteria, such as Enterococcus spp. (including VRE), Staphylococcus
aureus (including MRSA), or Streptococcus pyogenes, survive for months on dry surfaces. Many gram-
negative species, such as Acinetobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa,
Serratia marcescens, or Shigella spp., can also survive for months. A few others, such as Bordetella
pertussis, Haemophilus influenzae, Proteus vulgaris, or Vibrio cholerae, however, persist only for days.
Mycobacteria, including Mycobacterium tuberculosis, and spore-forming bacteria, including Clostridium
difficile, can also survive for months on surfaces. Candida albicans as the most important nosocomial
fungal pathogen can survive up to 4 months on surfaces. Persistence of other yeasts, such as
Torulopsis glabrata, was described to be similar (5 months) or shorter (Candida parapsilosis, 14 days).
Most viruses from the respiratory tract, such as corona, coxsackie, influenza, SARS or rhino virus, can
persist on surfaces for a few days. Viruses from the gastrointestinal tract, such as astrovirus, HAV,
polio- or rota virus, persist for approximately 2 months. Blood-borne viruses, such as HBV or HIV,
can persist for more than one week. Herpes viruses, such as CMV or HSV type 1 and 2, have been
shown to persist from only a few hours up to 7 days.
Conclusion: The most common nosocomial pathogens may well survive or persist on surfaces for
months and can thereby be a continuous source of transmission if no regular preventive surface
disinfection is performed.
Published: 16 August 2006
BMC Infectious Diseases 2006, 6:130 doi:10.1186/1471-2334-6-130
Received: 26 April 2006
Accepted: 16 August 2006
This article is available from: http://www.biomedcentral.com/1471-2334/6/130
© 2006 Kramer et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0
),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Background
Within the global infection control community, there is
an ongoing controversy about the appropriate treatment
of inanimate surfaces in hospitals in order to prevent
transmission of nosocomial pathogens within an institu-
tion. Based on a lack of epidemiological data that would
provide evidence of a benefit for the patient from surface
disinfection (e.g., from a significant reduction of nosoco-
mial infection rates), some scientists postulate that clean-
ing of surfaces with non-antimicrobial detergents is
generally sufficient [1]. Others prefer cleaning of surfaces
with antimicrobial agents, based on data on the risk of
infection due to microbial contamination and potential
transmission of nosocomial pathogens, at least in the
immediate vicinity of patients [2-4].
New guidelines on treatment of surfaces in hospitals take
into account more parameters which are considered to be
relevant for preventing the transmission of nosocomial
pathogens, such as the type of ward or the expected fre-
quency of hand contact with a surface [5,6]. Irrespective of
the divergent opinions regarding the appropriate treat-
ment of surfaces, an important parameter for a fair scien-
tific assessment remains, that is, the persistence of
nosocomial pathogens on surfaces. The longer a nosoco-
mial pathogen persists on a surface, the longer it may be a
source of transmission and thus endanger a susceptible
patient or healthcare worker. The aim of this review was
therefore to collect and assess the data that have been pub-
lished in the last decades on persistence of all types of
nosocomial pathogens on surfaces, both in the context of
surface disinfection and the control of nosocomial out-
breaks.
Methods
Search strategy
The literature was systematically reviewed in MedLine on
the internet homepage of the National Library of Medi-
cine without language restrictions. The search was done
on 29 December 2005 and covered all years available in
MedLine. The following search terms were applied: per-
sistence, survival, surface, fomite, bacteria, virus, patho-
gen, transmission, and nosocomial. In addition, the
citations in each study found during the main search were
reviewed for potential relevance. Finally, standard text-
books on infection control, bacteriology and virology
were examined for information.
Selecting studies
All reports with experimental evidence on the duration of
persistence of a nosocomial pathogen on any type of inan-
imate surface were included. Information from textbooks
was also included, even if the chapter itself did not con-
tain experimental evidence. At least two of the investiga-
tors decided on the relevance of each report. Reports were
not blinded to the investigators so that they knew the
names of the authors of all studies.
Interpretation of studies
For a clinically relevant summary, all nosocomial patho-
gens were grouped according to their importance in caus-
ing hospital-acquired hand-transmitted infections [7] and
according to their mode of nosocomial transmission [8].
The range of the reported duration of persistence was used
as the principle outcome of the search for each nosoco-
mial pathogen. In addition, parameters with potential
influence on persistence were evaluated in all experimen-
tal studies.
Results
Persistence of bacteria
Most gram-positive bacteria, such as Enterococcus spp.
(including VRE), Staphylococcus aureus (including MRSA),
or Streptococcus pyogenes survive for months on dry sur-
faces (Table 1). In general, there was no obvious differ-
ence in survival between multiresistant and susceptible
strains of Staphylococcus aureus and Enterococcus spp. [9].
Only in one study was such a difference suggested, but the
susceptible strains revealed a very brief survival as such
[10]. Many gram-negative species, such as Acinetobacter
spp., Escherichia coli, Klebsiella spp., Pseudomonas aerugi-
nosa, Serratia marcescens, or Shigella spp. can survive on
inanimate surfaces even for months. These species are
found among the most frequent isolates from patients
with nosocomial infections [11]. A few others, such as
Bordetella pertussis, Haemophilus influenzae, Proteus vulgaris,
or Vibrio cholerae, however, persist only for days (Table 1).
Mycobacteria – including Mycobacterium tuberculosis and
spore-forming bacteria, including Clostridium difficile
can also survive for many months on surfaces (Table 1).
Overall, gram-negative bacteria have been described to
persist longer than gram-positive bacteria [12,13]. Humid
conditions improved persistence for most types of bacte-
ria, such as Chlamydia trachomatis [14], Listeria monocy-
togenes [15], Salmonella typhimurium [15], Pseudomonas
aeruginosa [16], Escherichia coli [17], or other relevant
pathogens [18,19]. Only Staphylococcus aureus was found
to persist longer at low humidity [16].
Low temperatures, e.g., 4°C or 6°C, also improved per-
sistence of most types of bacteria, such Listeria monocy-
togenes [15], Salmonella typhimurium [15], MRSA [20],
corynebacteria [21], Escherichia coli [17,22], Helicobacter
pylori [23], and Neisseria gonorrhoeae [24].
The type of test material does not reveal a consistent
result. Although some investigators report that the type of
material has no influence on the persistence [25,26],
other authors described a longer persistence on plastic
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[27,28], and others yet see a survival advantage on steel
[29].
Other factors were rarely investigated and hence provide
inconsistent results. Longer persistence has been
described with higher inocula [28], in the presence of pro-
tein [13], serum [13,24], sputum [30], or without dust
[10].
Persistence of fungi
Candida albicans as the most important nosocomial fungal
pathogen can survive up to 4 months on surfaces (Table
2). Persistence of other yeasts was described to be similar
(Torulopsis glabrata 5 months) or shorter (Candida parapsi-
losis 14 days).
The presence of serum or albumin, a low temperature, and
high humidity have been described as leading to longer
persistence [31].
Persistence of viruses
Most viruses from the respiratory tract such as corona-, cox-
sackie-, influenzavirus, SARS, or rhinovirus can persist on
surfaces for a few days. Viruses from the gastrointestinal
tract, such as astrovirus, HAV, polio- and rotavirus persist
for approximately 2 months. Blood-borne viruses, such as
HBV or HIV, can persist for more than one week. Herpes
viruses such as CMV or HSV type 1 and 2 have been shown
to persist from only a few hours up to 7 days.
The influence of humidity on persistence has been
described inconsistently. For entero- [32] and rhinovirus
[33], high humidity was associated with longer persist-
ence. HSV [34] and HAV [35] can persist longer at low
humidity. For adeno- [32,34], rota- [36,37], and poliovirus
[34,35], conflicting results were reported.
For most viruses, such as astro- [38], adeno- [34], poliovirus
[34], HSV [34], and HAV [35], low temperature is associ-
ated with a longer persistence.
Inconsistent results are also reported for the influence of
type of material. Some authors described that the type of
material did not affect the persistence of echo- [39], adeno-
[39-41], parainfluenza- [39], rotavirus [41], RSV [39], polio-
[41] or norovirus [42]. Other investigators found that per-
Table 1: Persistence of clinically relevant bacteria on dry inanimate surfaces.
Type of bacterium Duration of persistence (range) Reference(s)
Acinetobacter spp. 3 days to 5 months [18, 25, 28, 29, 87, 88]
Bordetella pertussis 3 – 5 days [89, 90]
Campylobacter jejuni up to 6 days [91]
Clostridium difficile (spores) 5 months [92–94]
Chlamydia pneumoniae, C. trachomatis 30 hours [14, 95]
Chlamydia psittaci 15 days [90]
Corynebacterium diphtheriae 7 days – 6 months [90, 96]
Corynebacterium pseudotuberculosis 1–8 days [21]
Escherichia coli 1.5 hours – 16 months [12, 16, 17, 22, 28, 52, 90, 97–99]
Enterococcus spp. including VRE and VSE 5 days – 4 months [9, 26, 28, 100, 101]
Haemophilus influenzae 12 days [90]
Helicobacter pylori 90 minutes [23]
Klebsiella spp. 2 hours to > 30 months [12, 16, 28, 52, 90]
Listeria spp. 1 day – months [15, 90, 102]
Mycobacterium bovis > 2 months [13, 90]
Mycobacterium tuberculosis 1 day – 4 months [30, 90]
Neisseria gonorrhoeae 1 – 3 days [24, 27, 90]
Proteus vulgaris 1 – 2 days [90]
Pseudomonas aeruginosa 6 hours – 16 months; on dry floor: 5 weeks [12, 16, 28, 52, 99, 103, 104]
Salmonella typhi 6 hours – 4 weeks [90]
Salmonella typhimurium 10 days – 4.2 years [15, 90, 105]
Salmonella spp. 1 day [52]
Serratia marcescens 3 days – 2 months; on dry floor: 5 weeks [12, 90]
Shigella spp. 2 days – 5 months [90, 106, 107]
Staphylococcus aureus, including MRSA 7 days – 7 months [9, 10, 16, 52, 99, 108]
Streptococcus pneumoniae 1 – 20 days [90]
Streptococcus pyogenes 3 days – 6.5 months [90]
Vibrio cholerae 1 – 7 days [90, 109]
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sistence was favored on non-porous surfaces for influenza-
virus [43], on formica and gloves for RSV [44], and on a
telephone receiver for FCV [45].
Other parameters for a longer persistence of viruses
include the presence of fecal suspension [38] and a higher
inoculum [46].
Persistence of other nosocomial pathogens
Cryptosporidium species have been reported to survive on
dry surfaces for only 2 hours [47].
Discussion
The most relevant nosocomial pathogens can persist on
dry inanimate surfaces for months. In addition to the
duration of persistence, some studies have also identified
factors influencing persistence. A low temperature, such as
4°C or 6°C, was associated with longer persistence for
most bacteria, fungi and viruses. High humidity (e.g., >
70%) was also associated with longer persistence for most
bacteria, fungi, and viruses, although for some viruses
conflicting results were reported. A few studies also sug-
gest that a higher inoculum is associated with longer per-
sistence. The type of surface material and the type of
suspension medium, however, reveal inconsistent data.
Overall, a high inoculum of the nosocomial pathogen in
a cold room with high relative humidity will have the best
chance for long persistence.
In most reports with experimental evidence, persistence
was studied on dry surfaces using artificial contamination
of a standardized type of surface in a laboratory. In most
studies, bacteria were prepared in broth, water or saline.
Viruses were usually prepared in a cell culture medium
[48]. The main advantage is that the environmental con-
ditions are consistent regarding temperature and air
humidity. In addition, the effect of temperature or relative
humidity can only be determined under controlled condi-
tions, which are much easier to ensure in the laboratory.
However, this may not always reflect the clinical situation,
in which surfaces can be simultaneously contaminated
with various nosocomial pathogens and different types of
body fluids, secretions etc. Yet the question remains: what
is the clinical evidence for the role of surfaces in nosoco-
mial infections?
In hospitals, surfaces with hand contact are often contam-
inated with nosocomial pathogens [49-51], and may serve
as vectors for cross transmission. A single hand contact
with a contaminated surface results in a variable degree of
pathogen transfer. Transmission to hands was most suc-
cessful with Escherichia coli, Salmonella spp., Staphylococcus
aureus (all 100%) [52], Candida albicans (90%) [53], rhino
virus (61%) [54], HAV (22% – 33%) [55], and rota virus
(16%) [56,57]. Contaminated hands can transfer viruses
Common modes of transmission from inanimate surfaces to susceptible patientsFigure 1
Common modes of transmission from inanimate surfaces to susceptible patients.
Contaminated
inanimate
surface
Susceptible
patient
direct transmission
Hands of
healthcare
worker
Compliance in
hand hygiene: ~ 50%
Table 2: Persistence of clinically relevant fungi on dry inanimate
surfaces.
Type of fungus Duration of persistence
(range)
Reference(s)
Candida albicans 1 – 120 days [31, 53, 99, 110]
Candida parapsilosis 14 days [110]
Torulopsis glabrata 102 – 150 days [31]
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to 5 more surfaces [58] or 14 other subjects [59]. Contam-
inated hands can also be the source of re-contaminating
the surface, as shown with HAV [55,58]. Compliance rates
of healthcare workers in hand hygiene are known to be
around 50% [7]. Due to the overwhelming evidence of
low compliance with hand hygiene, the risk from contam-
inated surfaces cannot be overlooked (Figure 1).
The main route of transmission is via the transiently con-
taminated hands of the healthcare worker [60-62]. An
outbreak of nosocomial infections due to Acinetobacter
baumannii in a neurosurgical intensive care unit may serve
as an example. A direct correlation was found between the
number of environmental isolates obtained during
screening and the number of patients who were colonized
or infected with the same strain during the same calender
month [63].
During outbreaks, the environment may play a significant
role for transmission of nosocomial pathogens, as sug-
gested by observational evidence. This has been described
for various types of microorganisms, such as Acinetobacter
baumannii [64-66], Clostridium difficile [67-69], MRSA
[65,70], Pseudomonas aeruginosa [4,65], VRE [65,71-77],
SARS [78,79], rota- [80,81], and norovirus [82]. However,
the evidence to support a role of environmental contami-
nation is not equally strong for all types of nosocomial
pathogens. For Clostridium difficile, MRSA, and VRE, data
are stronger than for other pathogens, such as Pseu-
domonas aeruginosa or Acinetobacter baumannii, of which
multiple types were detected in the environment, and
which did not always correlate with the acquired strain
[83].
The role of surface disinfection for the control of nosoco-
mial pathogens has been a contentious issue for some
time [3]. Routine treatment of clean floors with various
types of surface disinfectants (some of them had rather
poor bactericidal activity) has been described to have no
significant impact on the incidence of nosocomial infec-
tions [84]. Disinfection of surfaces in the immediate envi-
ronment of patients, however, has been described to
reduce acquisition of nosocomial pathogens such as VRE
[85] or Acinetobacter baumannii [86]. It is therefore advisa-
ble to control the spread of nosocomial pathogens at least
in the direct inanimate environment of the patient by rou-
tine surface disinfection.
Conclusion
Most nosocomial pathogens can persist on inanimate sur-
faces for weeks or even months. Our review supports cur-
rent guidelines which recommend a disinfection of
surfaces in specific patient-care areas in order to reduce
the risk of transmission of nosocomial pathogens from
inanimate surfaces to susceptible patients.
Competing interests
GK is a paid employee of Bode Chemie GmbH & Co. KG,
Hamburg, Germany.
Table 3: Persistence of clinically relevant viruses on dry inanimate surfaces.
Type of virus Duration of persistence (range) Source
Adenovirus 7 days – 3 months [32, 34, 38–41, 111]
Astrovirus 7 – 90 days [38]
Coronavirus 3 hours [112, 113]
SARS associated virus 72 – 96 hours [114]
Coxsackie virus > 2 weeks [34, 111]
Cytomegalovirus 8 hours [115]
Echovirus 7 days [39]
HAV 2 hours – 60 days [35, 38, 41]
HBV > 1 week [116]
HIV > 7 days [117–119]
Herpes simplex virus, type 1 and 2 4.5 hours – 8 weeks [34, 111, 118, 120]
Influenza virus 1 – 2 days [39, 43, 121, 122]
Norovirus and feline calici virus (FCV) 8 hours – 7 days [42, 45]
Papillomavirus 16 > 7 days [123]
Papovavirus 8 days [118]
Parvovirus > 1 year [118]
Poliovirus type 1 4 hours – < 8 days [35, 118]
Poliovirus type 2 1 day – 8 weeks [34, 38, 111]
Pseudorabies virus 7 days [124]
Respiratory syncytial virus up to 6 hours [44]
Rhinovirus 2 hours – 7 days [33, 125]
Rotavirus 6 – 60 days [36 – 38, 41]
Vacciniavirus 3 weeks – > 20 weeks [34, 126]
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Authors' contributions
All authors contributed to the conception, review of stud-
ies, and analysis of data. All authors were involved in
drafting and revising the manuscript. All authors
approved the final version of the manuscript.
Acknowledgements
The authors declare that they have no acknowledgements.
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... It is well documented that the SARS-CoV-2 virus is primarily spread by intimate personal contact and respiratory droplets, while airborne transmission during aerosol-generating medical procedures is conceivable in healthcare and nonclinical settings. Further, environmental surfaces are more likely contaminated with pathogenic viruses, bacteria, and fungi, which can pose significant public health and safety risks [18][19][20] . Despite ongoing efforts, AR/MDR amongst bacteria remains a major public health threat in the US and globally 21,22 . ...
... It is now evident that higher mortality among COVID-19 patients occurred due to secondary infection or co-infection of bacterial and/or fungal pathogens, which has received inadequate attention 23 . Bacteria have been found to survive on inanimate objects for varying periods 19,23,24 . ...
... The duration of bacteria survival on colonized items is directly related to the risk of transmission. The ability of bacteria to colonize and survive in a given object may be influenced by geographical and environmental factors such as temperature, humidity, presence of organic matter, the ability to form biofilms, and infection control measures used 19 and Acinetobacter spp., and are transmitted through contaminated surfaces 19,23,25-28 . In Nepal, robots were used for communication and serving food and medicine to COVID-19 patients 29 . ...
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Background: Twelve bacterial families were identified as global priority pathogens by the World Health Organization in 2017, recognizing the greatest threat they pose to human health and the declining antibiotic efficacy. Robotics has emerged as a swift and contactless tool for disinfecting bacterial surface contamination in healthcare facilities, however, head-to-head comparison of disinfection efficacy of robotic versus manual disinfections is limited. This study aimed at comparing how robotic disinfection performs over manual disinfection against the global priority pathogens in the healthcare setting. Methods: A spraying disinfection robot was developed, and its disinfection efficacy was compared against manual disinfection during July 2020-December 2020. Disinfections were performed on the clinical surfaces and inanimate objects at two hospitals in Nepal using robotic or manual application of a disinfectant (NaOCl). Swab samples from floor, bed, doorknob, and medical devices at both hospitals were collected before and after disinfection and examined for total heterotrophic plate count and bacterial pathogens were identified based on Gram’s staining and biochemical characteristics. Disinfection outcomes were reported as log reduction (log10 CFU/inch2) of heterotrophic count and presence or absence of target bacteria. A total of 76 samples were collected from two study sites including major pathogens: Staphylococcus aureus, Escherichia coli, Acinetobacter spp., and Klebsiella pneumoniae, among others. Results: Both robotic and manual disinfection significantly reduced microbial load (log 2.3 to log 5.8) in the hospitals. No pathogens were detected post-disinfection using the robot. The use of robotic disinfection was more effective, significantly reducing more bacterial load (log 5.8) compared to manual disinfection (log 3.95). Conclusions: Our results showed better efficacy of robotic disinfection compared to manual disinfection of hospital surfaces, and thus contactless robotic disinfection is recommended for disinfecting bacterial contamination of surfaces in the hospital and clinical settings as it favors patient safety against global priority pathogens.
... 29 Conversely, according to Weber et al., less than 15% of CRE found on immunized surfaces in patient rooms can survive for 24 hours and with low levels of contamination (5.1 cfu/120 cm 2 ). 30,31 However, more studies are needed to generalize the findings of the previous study to be able to conclude that the risk of the transmission of CRE from environmental surfaces is comparatively low. Additionally, the transmission of CRE from all types of surfaces should be considered in future studies. ...
... Asymptomatic colonisation is well documented and generally believed to be transient, although persistent colonisation with a single strain of S. marcescens for more than a year has been reported [6,7]. The bacteria tend to form biofilms and are capable of surviving on dry inanimate surfaces for weeks to months [5,8]. Persistence in hospital sinks for years has recently been described [1]. ...
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We report a national outbreak of Serratia marcescens complex type 755 (ct755) in Norway, with 74 cases identified between June 2021 and February 2023. Careful reviews of patient journals and interviews were performed, involving 33 hospitals throughout Norway. All available clinical isolates of S. marcescens collected between January 2021 and February 2023 (n = 455, including cases) from all involved hospitals were whole genome sequenced. Cases displayed a pattern of opportunistic infections, as usually observed with S. marcescens. No epidemiological links, common exposures or common risk factors were identified. The investigation pointed to an outbreak source present in the community. We suspect a nationally distributed product, possibly a food product, as the source. Phylogenetic analysis revealed a highly diverse bacterial population containing multiple distinct clusters. The outbreak cluster ct755 stands out as the largest and least diverse clone of a continuum, however a second cluster (ct281) also triggered a separate outbreak investigation. This report highlights challenges in the investigation of outbreaks caused by opportunistic pathogens and suggests that the presence of identical strains of S. marcescens in clinical samples is more common than previously recognised.
... [1][2][3] Because C. diff spores are difficult to kill and can persist in the environment for extended periods, they can contribute to in-hospital transmission. 2,4,5 Additionally, certain rooms or environmental features are more prone to harbor infectious organisms than others, thus further amplifying the risk. 6 For example, studies conducted by Ching et al 7 and Jou et al 8 suggested that the presence of curtains near the patient bed acts as a barrier for disease transmission, while rooms with larger square footage were associated with a greater risk of HO-CDI respectively. ...
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Objective Environmental features of a patient’s room depend on the patient’s level of acuity and their clinical manifestations upon admission and during their hospital stay. In this study, we wish to apply statistical methodology to explore the association between room features and hospital onset infections caused by Clostridioides difficile (HO-CDI) while accounting for room assignment. Method We conducted a nested case–control study using retrospective electronic health record (EHR) data of patients hospitalized at the Ohio State University Wexner Medical Center (OSUWMC) between January 2019 and April 2021. We collected clinical information and combined that with room-based information, collected as surveys. Data were analyzed to assess the association between room factors and HO-CDI. Results 2427 patients and 968 unique rooms were included in the study. Results indicated protective effects for rooms with cubical curtains near the patient (OR = 0.705, 95% CI = 0.549–0.906), rooms with separate shower units (OR = 0.674, 95% CI = 0.528–0.860), rooms with wall-mounted toilets (OR = 0.749, 95% CI = 0.592–0.950), rooms with sliding bathroom doors (OR = 0.593, 95% CI = 0.432–0.816), and sliding door knobs (OR = 0.593, 95% CI = 0.431-0.815). Rooms with manual paper towel dispensers had increased odds of HO-CDI (OR = 1.334, 95% CI = 1.053–1.691) compared to those with automatic towel dispensers. Conclusion Results suggest possible association between specific room features and HO-CDI, which could be further investigated with techniques like environmental sampling. Moreover, findings from the study offer valuable insights for targeted intervention measures.
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Surfaces contaminated with pathogens pose a significant risk of disease transmission and infection. Alcohol-based disinfectants are widely utilized to decontaminate high-touch areas across various settings. However, their limited antimicrobial activity and the emergence of alcohol-tolerant strains necessitate the development of highly efficient disinfectant formulations. In this work we test the broad-spectrum antimicrobial activities of the salt-incorporated alcohol solution disinfectant against enveloped and non-enveloped viruses, spore-forming and non-spore-forming bacteria, and mold and yeast fungi. Specifically, the disinfection capability of the isopropanol (IPA) and ethanol (EtOH) solutions containing NaCl salts was evaluated by measuring (1) antibacterial activity against Gram-positive bacteria (methicillin-resistant Staphylococcus aureus), Gram-negative bacteria (Pseudomonas aeruginosa, Escherichia coli), and an alcohol-tolerant strain of E. coli; (2) sporicidal activity against Clostridioides difficile; (3) the antiviral activity against enveloped A/PR8/34 H1N1 influenza virus and non-enveloped adenovirus VR-5; and (4) the antifungal efficacy against Aspergillus niger and Cryptococcus neoformans from the time-dependent viability assays. Additionally, the biocidal activity of the disinfectant formulation was tested by spraying it on the biocontaminated surfaces, including plastics, stainless steel, and glass. Overall, the inclusion of salt in alcohol solutions significantly enhanced their disinfection activities, positioning these solutions as promising candidates for long-term disinfection and maintenance of hygienic environments. This method, which employs mild salt instead of toxic materials, offers a simpler, more cost-effective, and safer alternative to conventional alcohol-based disinfectants. This research is expected to significantly impact on disease prevention and contribute greatly to public health and safety.
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The transfer of gram-positive bacteria, particularly multiresistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), among patients is a growing concern. One critical aspect of bacterial transfer is the ability of the microorganism to survive on various common hospital surfaces, The purpose of this study was to determine the survival of 22 gram-positive bacteria (vancomycin-sensitive and -resistant enterococci and methicillin-sensitive and -resistant staphylococci) on five common hospital materials: smooth 100% cotton (clothing), 100% cotton terry (towels), 60% cotton-40% polyester blend (scrub suits and lab coats), 100% polyester (privacy drapes), and 100% polypropylene plastic (splash aprons), Swatches were inoculated with 10(4) to 10(5) CFU of a microorganism, assayed daily be placing the swatches in nutritive media, and examining for growth after 48 h, All isolates survived for at least 1 day, and some survived for more than 90 days on the various materials. Smaller inocula (10(2)) survived for shorter times but still generally for days, Antibiotic sensitivity had no consistent effect on survival, The long survival of these bacteria, including MRSA and VRE, on commonly used hospital fabrics, such as scrub suits, lab coats, and hospital privacy drapes, underscores the need for meticulous contact control procedures and careful disinfection to limit the spread of these bacteria.
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Welche pathogenen Mikroorganismen gibt es? Welche Veränderungen lösen sie im Körper aus? Wie werden die Erreger diagnostiziert, und welche therapeutischen Maßnahmen sind einzuleiten? Diese Fragen muß jeder Mediziner und Arzt beantworten können. Denn trotz großer Fortschritte durch Schutzimpfungen, Antibiotikatherapie und Hygiene ist auch heute noch ein Großteil des klinischen Alltags der Verhütung, Diagnose und Therapie von Infektionskrankheiten gewidmet. Die klinisch relevanten Zusammenhänge stehen im Vordergrund dieser umfassenden Darstellung. Die ausgefeilte Didaktik dieses Lehrbuchs mit Erregersteckbriefen, strukturierten Zusammenfassungen und zahlreichen Farbphotos erleichtert den Einstieg in die komplexe Thematik und erhöht seinen Nutzen als Nachschlagewerk.
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This book is a collection of data on the tenacity in the environment of bacteria and some rickettsiae important in medicine and veterinary medicine. These data are of fundamental importance to physicians, veterinarians, epidemiologists and others when, in their practices, they are confronted with epidemics of contagious diseases or outbreaks of foodborne illnesses. At such times prompt answers are often needed to limit the problem, and thus to protect the public's health. Since data needed for such a purpose are widely distributed in the internatio­ nal scientific literature, the occasional desperate literature search is likely to miss some of the information that is available. This book seeks to fill that void. It lies in the nature of a compilation such as this is that it can never be totally complete. The compilation requires continual up-dating to include new information, and some currently acceptable information may have to be corrected as new data become available. However, most of the information in this compilation will never be out-of-date. The authors are always thankful for suggestions from others. Collection of the data in this book resulted from, first, several decades of studying the literature, and, second, literature searches made by the Institut fUr Dokumentationswesen in Frankfurt a. M. , the Biomedi­ zinische Datenbank of Hoechst A. G.
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Conscientious handwashing is often recommended as an important method for limiting transmission of cytomegalovirus (CMV) from infected individuals to health, education, and child care professionals. To assess the efficacy of handwashing, fingertips of radiation-sterilized latex gloves were inoculated with 0.2 mL of ten different CMV strains. Virus in each inoculum was quantitated by plaque assay. After five minutes, viral inocula were allowed to remain (control), or were washed away by dropwise application of 10 mL of distilled water (DI), 5 mL of 0.08% soap followed by 5 mL of DI, 5 mL of 0.01% Chlorhexidine gluconate followed by 5 mL of DI, or 5 mL of 0.025% povidone-iodine solution followed by 5 mL of DI. Separate glove fingertips were sampled 5, 15, 30, 60, 120 and 240 minutes after washing and cultured in duplicate for CMV. Similar studies were performed using human cadaver skin. Ordinary soap was as effective at preventing CMV recovery as other more expensive agents. For inocula with <5 log 10 pfu CMV/mL, washing with water alone was as effective as other agents. This was confirmed in similar studies with human hands using five CMV stains. Handwashing is probably an effective method for removing CMV from contaminated hands.
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Objective: To study the possible role of contaminated environmental surfaces as a reservoir of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals. Design: A prospective culture survey of inanimate objects in the rooms of patients with MRSA. Setting: A 200-bed university-affiliated teaching hospital. Patients: Thirty-eight consecutive patients colonized or infected with MRSA. Patients represented endemic MRSA cases. Results: Ninety-six (27%) of 350 surfaces sampled in the rooms of affected patients were contaminated with MRSA When patients had MRSA in a wound or urine, 36% of surfaces were contaminated. In contrast, when MRSA was isolated from other body sites, only 6% of surfaces were contaminated (odds ratio, 8.8; 95% confidence interval, 3.7-25.5; P
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