The Role of Contaminated Surfaces in the Transmission of Nosocomial Pathogens

Studies in the 1970s and 1980s suggested that environmental surface contamination had a negligible role in the endemic transmission of healthcare-associated infections. However, recent studies demonstrate that several major nosocomial pathogens are shed by patients and contaminate hospital surfaces at concentrations sufficient for transmission, survive for extended periods, persist despite attempts to disinfect or remove them and can be transferred to the hands of healthcare workers. Evidence is accumulating that contaminated surfaces make an important contribution to the epidemic and endemic transmission of C. difficile, vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, Pseudomonas aeruginosa and norovirus and that improved environmental decontamination contributes to the control of outbreaks. Efforts to improve environmental hygiene should include enhancing the efficacy of cleaning and disinfection and reducing the shedding of pathogens. Further high quality studies are needed to clarify the role of surfaces in nosocomial transmission and determine the effectiveness of different interventions in reducing associated infection rates.