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The Role Played by Contaminated Surfaces in the Transmission of Nosocomial Pathogens

Published online by Cambridge University Press:  02 January 2015

Jonathan A. Otter
Directorate of Infection, St. Thomas' Hospital and King's College London, United Kingdom Bioquell UK Ltd, Andover, Hampshire, United Kingdom
Saber Yezli
Bioquell UK Ltd, Andover, Hampshire, United Kingdom
Gary L. French*
Directorate of Infection, St. Thomas' Hospital and King's College London, United Kingdom
Infection and Immunology Delivery Unit, 5th Floor, North Wing, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK (


Studies in the 1970s and 1980s suggested that environmental surface contamination played a negligible role in the endemic transmission of healthcare-associated infections. However, recent studies have demonstrated 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 Clostridium 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 played by surfaces in nosocomial transmission and to determine the effectiveness of different interventions in reducing associated infection rates.

Review Article
Copyright © The Society for Healthcare Epidemiology of America 2011

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