Skip to main content Accessibility help

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

  • Jonathan A. Otter (a1) (a2), Saber Yezli (a2) and Gary L. French (a1)


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.


Corresponding author

Infection and Immunology Delivery Unit, 5th Floor, North Wing, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK (


Hide All
1.Villegas, MV, Hartstein, AI. Acinetobacter outbreaks, 1977–2000. Infect Control Hosp Epidemiol 2003;24:284295.
2.Dancer, SJ. The role of environmental cleaning in the control of hospital-acquired infection. J Hosp Infect 2009;73:378385.
3.Williams, REO, Blowers, B, Garrod, LP, Shooter, RA. Hospital Infections: Causes and Prevention. 2nd ed. London: Lloyd-Luke, 1966.
4.Weber, DO, Gooch, JJ, Wood, WR, Britt, EM, Kraft, RO. Influence of operating room surface contamination on surgical wounds: a prospective study. Arch Surg 1976;111:484488.
5.Maki, DG, Alvarado, CJ, Hassemer, CA, Zilz, MA. Relation of the inanimate hospital environment to endemic nosocomial infection. N Engl J Med 1982;307:15621566.
6.Mallison, GF, Haley, RW. Microbiologic sampling of the inanimate environment in U.S. hospitals, 1976–1977. Am J Med 1981;70:941946.
7.McGowan, JE Jr. Environmental factors in nosocomial infection: a selective focus. Rev Infect Dis 1981;3:760769.
8.Sehulster, L, Chinn, RY. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 2003;52:142.
9.Weber, DJ, Rutala, WA, Miller, MB, Huslage, K, Sickbert-Bennett, E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38(suppl):S25S33.
10.Vanden Bergh, MF, Verweij, PE, Voss, A. Epidemiology of nosocomial fungal infections: invasive aspergillosis and the environment. Diagn Microbiol Infect Dis 1999;34:221227.
11.Hayden, MK, Blom, DW, Lyle, EA, Moore, CG, Weinstein, RA. Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant enterococcus or the colonized patients' environment. Infect Control Hosp Epidemiol 2008;29:149154.
12.Huslage, K, Rutala, WA, Sickbert-Bennett, E, Weber, DJ. A quantitative approach to defining “high-touch” surfaces in hospitals. Infect Control Hosp Epidemiol 2010;31:850853.
13.Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18:622627.
14.Duckro, AN, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165:302307.
15.Sexton, T, Clarke, P, O'Neill, E, Dillane, T, Humphreys, H. Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene. J Hosp Infect 2006;62:187194.
16.Eckstein, BC, Adams, DA, Eckstein, EC, et al. Reduction of Clostridium difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis 2007;7:61.
17.French, GL, Otter, JA, Shannon, KP, Adams, NM, Watling, D, Parks, MJ. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect 2004;57:3137.
18.Rohr, U, Kaminski, A, Wilhelm, M, Jurzik, L, Gatermann, S, Muhr, G. Colonization of patients and contamination of the patients' environment by MRSA under conditions of single-room isolation. Int J Hyg Environ Health 2009;212:209215.
19.Bonten, MJ, Hayden, MK, Nathan, C, et al. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet 1996;348:16151619.
20.Boyce, JM, Havill, NL, Otter, JA, Adams, NM. Widespread environmental contamination associated with patients with diarrhea and methicillin-resistant Staphylococcus aureus colonization of the gastrointestinal tract. Infect Control Hosp Epidemiol 2007;28:11421147.
21.Boyce, JM, Opal, SM, Chow, JW, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:11481153.
22.Dubberke, ER, Reske, KA, Noble-Wang, J, et al. Prevalence of Clostridium difficile environmental contamination and strain variability in multiple health care facilities. Am J Infect Control 2007;35:315318.
23.Dumford, DM III, Nerandzic, MM, Eckstein, BC, Donskey, CJ. What is on that keyboard? detecting hidden environmental reservoirs of Clostridium difficile during an outbreak associated with North American pulsed-field gel electrophoresis type 1 strains. Am J Infect Control 2009;37:1519.
24.Trick, WE, Temple, RS, Chen, D, Wright, MO, Solomon, SL, Peterson, LR. Patient colonization and environmental contamination by vancomycin-resistant enterococci in a rehabilitation facility. Arch Rhys Med Rehab 2002;83:899902.
25.Hardy, KJ, Oppenheim, BA, Gossain, S, Gao, F, Hawkey, PM. A study of the relationship between environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) and patients' acquisition of MRSA. Infect Control Hosp Epidemiol 2006;27:127132.
26.Drees, M, Snydman, D, Schmid, C, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2008;46:678685.
27.Davidson, MM, Sood, VP, Ho-Yen, DO. Small round virus excretion in long-stay geriatric patients. J Med Virol 1993;41:256259.
28.Riggs, MM, Sethi, AK, Zabarsky, TF, Eckstein, EC, Jump, RL, Donskey, CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007;45:992998.
29.Getchell-White, SI, Donowitz, LG, Groschel, DH. The inanimate environment of an intensive care unit as a potential source of nosocomial bacteria: evidence for long survival of Acinetobacter calcoaceticus. Infect Control Hosp Epidemiol 1989;10:402407.
30.Lemmen, SW, Hafner, H, Zolldann, D, Stanzel, S, Lutticken, R. Distribution of multi-resistant gram-negative versus gram-positive bacteria in the hospital inanimate environment. J Hosp Infect 2004;56:191197.
31.Gallimore, CI, Taylor, C, Gennery, AR, et al. Contamination of the hospital environment with gastroenteric viruses: comparison of two pediatric wards over a winter season. J Clin Microbiol 2008;46:31123115.
32.Wu, HM, Fornek, M, Schwab, KJ, et al. A norovirus outbreak at a long-term-care facility: the role of environmental surface contamination. Infect Control Hosp Epidemiol 2005;26:802810.
33.Denton, M, Wilcox, MH, Parnell, P, et al. Role of environmental cleaning in controlling an outbreak of Acinetobacter baumannii on a neurosurgical intensive care unit. J Hosp Infect 2004;56:106110.
34.Jeanes, A, Rao, G, Osman, M, Merrick, P. Eradication of persistent environmental MRSA. J Hosp Infect 2005;61:8586.
35.Kaatz, GW, Gitlin, SD, Schaberg, DR, et al. Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol 1988;127:12891294.
36.Gehanno, J, Louvel, A, Nouvellon, M, Caillard, JF, Pestel-Caron, M. Aerial dispersal of meticillin-resistant Staphylococcus aureus in hospital rooms by infected or colonised patients. J Hosp Infect 2009;71:256262.
37.Best, EL, Fawley, WN, Parnell, P, Wilcox, MH. The potential for airborne dispersal of Clostridium difficile from symptomatic patients. Clin Infect Dis 2010;50:14501457.
38.Vernon, MO, Hayden, MK, Trick, WE, et al. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166:306312.
39.Mayer, RA, Geha, RC, Helfand, MS, Hoyen, CK, Salata, RA, Donskey, CJ. Role of fecal incontinence in contamination of the environment with vancomycin-resistant enterococci. Am J Infect Control 2003;31:221225.
40.Al-Nassir, WN, Sethi, AK, Nerandzic, MM, Bobulsky, GS, Jump, RL, Donskey, CJ. Comparison of clinical and microbiological response to treatment of Clostridium difficile-associated disease with metronidazole and vancomycin. Clin Infect Dis 2008;47:5662.
41.Atmar, RL, Opekun, AR, Gilger, MA, et al. Norwalk virus shedding after experimental human infection. Emerg Infect Dis 2008;14:15531557.
42.Caul, EO. Small round structured viruses: airborne transmission and hospital control. Lancet 1994;343:12401242.
43.Boyce, JM, Havill, NL, Otter, JA, et al. Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting. Infect Control Hosp Epidemiol 2008;29:723729.
44.Rutala, WA, Katz, EB, Sherertz, RJ, Sarubbi, FA Jr. Environmental study of a methicillin-resistant Staphylococcus aureus epidemic in a burn unit. J Clin Microbiol 1983;18:683688.
45.Cooper, RA, Griffith, CJ, Malik, RE, Obee, P, Looker, N. Monitoring the effectiveness of cleaning in four British hospitals. Am J Infect Control 2007;35:338341.
46.Foster, WD, Hutt, MS. Experimental staphylococcal infections in man. Lancet 1960;2:13731376.
47.Lawley, TD, Clare, S, Deakin, LJ, et al. Use of purified Clostridium difficile spores to facilitate evaluation of health care disinfection regimens. Appl Environ Microbiol 2010;76:68956900.
48.Teunis, PF, Moe, CL, Liu, P, et al. Norwalk virus: how infectious is it? J Med Virol 2008;80:14681476.
49.Dancer, SJ. How do we assess hospital cleaning? a proposal for microbiological standards for surface hygiene in hospitals. J Hosp Infect 2004;56:1015.
50.Kramer, A, Schwebke, I, Kampf, G. How long do nosocomial pathogens persist on inanimate surfaces? a systematic review. BMC Infect Dis 2006;6:130.
51.McDonnell, G, Russell, AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999;12:147179.
52.Barker, J, Vipond, IB, Bloomfield, SF. Effects of cleaning and disinfection in reducing the spread of norovirus contamination via environmental surfaces. J Hosp Infect 2004;58:4249.
53.Dettenkofer, M, Block, C. Hospital disinfection: efficacy and safety issues. Curr Opin Infect Dis 2005;18:320325.
54.Rutala, WA, Weber, DJ. The benefits of surface disinfection. Am J Infect Control 2005;33:434435.
55.Byers, KE, Durbin, LJ, Simonton, BM, Anglim, AM, Adal, KA, Farr, BM. Disinfection of hospital rooms contaminated with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1998;19:261264.
56.Corbella, X, Pujol, M, Argerich, MJ, et al. Environmental sampling of Acinetobacter baumannii: moistened swabs versus moistened sterile gauze pads. Infect Control Hosp Epidemiol 1999;20:458460.
57.Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de, Vijver, Weinstein, RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:15521560.
58.Oelberg, DG, Joyner, SE, Jiang, X, Laborde, D, Islam, MP, Pickering, LK. Detection of pathogen transmission in neonatal nurseries using DNA markers as surrogate indicators. Pediatrics 2000;105:311315.
59.Jiang, X, Dai, X, Goldblatt, S, et al. Pathogen transmission in child care settings studied by using a cauliflower virus DNA as a surrogate marker. J Infect Dis 1998;177:881888.
60.Rusin, P, Maxwell, S, Gerba, C. Comparative surface-to-hand and fingertip-to-mouth transfer efficiency of gram-positive bacteria, gram-negative bacteria, and phage. J Appl Microbiol 2002;93:585592.
61.Rheinbaben, F, Schunemann, S, Gross, T, Wolff, MH. Transmission of viruses via contact in a household setting: experiments using bacteriophage straight phiX174 as a model virus. J Hosp Infect 2000;46:6166.
62.Ray, AJ, Hoyen, CK, Taub, TF, Eckstein, EC, Donskey, CJ. Nosocomial transmission of vancomycin-resistant enterococci from surfaces. JAMA 2002;287:14001401.
63.Bhalla, A, Pultz, NJ, Gries, DM, et al. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164167.
64.Randle, J, Arthur, A, Vaughan, N. Twenty-four-hour observational study of hospital hand hygiene compliance. J Hosp Infect 2010;76:252255.
65.Martinez, JA, Ruthazer, R, Hansjosten, K, Barefoot, L, Snydman, DR. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med 2003;163:19051912.
66.Huang, SS, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:19451951.
67.Shaughnessy, MK, Micielli, R, DePestel, DD, et al. Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol 2011;32:201206.
68.Nseir, S, Blazejewski, C, Lubret, R, Wallet, F, Courcol, R, Durocher, A. Risk of acquiring multidrug-resistant gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect doi:10.1111/j.l469-0691.2010.03420.x. Published December 13, 2010.
69.Samore, MH, Venkataraman, L, DeGirolami, PC, Arbeit, RD, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:3240.
70.Mayfield, JL, Leet, T, Miller, J, Mundy, LM. Environmental control to reduce transmission of Clostridium difficile. Clin Infect Dis 2000;31:9951000.
71.Wilcox, MH, Fawley, WN, Wigglesworth, N, Parnell, P, Verity, P, Freeman, J. Comparison of the effect of detergent versus hypochlorite cleaning on environmental contamination and incidence of Clostridium difficile infection. J Hosp Infect 2003;54:109114.
72.Manian, FA, Griesenauer, S, Senkel, D. Impact of an intensive terminal cleaning and disinfection (C/D) protocol involving selected hospital rooms on endemic nosocomial infection (NI) rates of common pathogens at a tertiary care medical center. Paper presented at: 5th Decennial Meeting of the Society for Healthcare Epidemiology of America (SHEA), March 18–22, 2010, Atlanta. Abstract LB6.
73.Passaretti, CL, Otter, JA, Lipsett, P, et al. Adherence to hydrogen peroxide vapor (HPV) decontamination reduces VRE acquisition in high-risk units. Paper presented at: 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and the Infectious Diseases Society of America (IDSA), October 25–28, 2008, Washington, DC. Abstract K-4124b.
74.Dancer, SJ. Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 2008;8:101113.
75.Mahamat, A, MacKenzie, FM, Brooker, K, Monnet, DL, Daures, JP, Gould, IM. Impact of infection control interventions and antibiotic use on hospital MRSA: a multivariate interrupted time-series analysis. Int J Antimicrob Agents 2007;30:169176.
76.Dancer, SJ, White, LF, Lamb, J, Girvan, EK, Robertson, C. Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study. BMC Med 2009;7:28.
77.Maragakis, LL, Cosgrove, SE, Song, X, et al. An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment. JAMA 2004;292:30063011.
78.Zanetti, G, Blanc, DS, Federli, I, et al. Importation of Acinetobacter baumannii into a burn unit: a recurrent outbreak of infection associated with widespread environmental contamination. Infect Control Hosp Epidemiol 2007;28:723725.
79.Scott, P, Deye, G, Srinivasan, A, et al. An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq. Clin Infect Dis 2007;44:15771584.
80.Kumarasamy, KK, Toleman, MA, Walsh, TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis 2010;10:597602.
81.Peleg, AY, Hooper, DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 2010;362:18041813.
82.Jones, EL, Kramer, A, Gaither, M, Gerba, CP. Role of fomite contamination during an outbreak of norovirus on houseboats. Int J Environ Health Res 2007;17:123131.
83.Isakbaeva, ET, Widdowson, MA, Beard, RS, et al. Norovirus transmission on cruise ship. Emerg Infect Dis 2005;11:154158.
84.Gunn, RA, Terranova, WA, Greenberg, HB, et al. Norwalk virus gastroenteritis aboard a cruise ship: an outbreak on five consecutive cruises. Am J Epidemiol 1980;112:820827.
85.Centers for Disease Control and Prevention. Norovirus outbreak in an elementary school—District of Columbia, February 2007. MMWR Morb Mortal Wkly Rep 2008;56:13401343.
86.Patterson, W, Haswell, P, Fryers, PT, Green, J. Outbreak of small round structured virus gastroenteritis arose after kitchen assistant vomited. Commun Dis Rep CDR Rev 1997;7:R101R103.
87.Evans, MR, Meldrum, R, Lane, W, et al. An outbreak of viral gastroenteritis following environmental contamination at a concert hall. Epidemiol Infect 2002;129:355360.
88.Cheesbrough, JS, Barkess-Jones, L, Brown, DW. Possible prolonged environmental survival of small round structured viruses. J Hosp Infect 1997;35:325326.
89.Cheesbrough, JS, Green, J, Gallimore, CI, Wright, PA, Brown, DW. Widespread environmental contamination with Norwalk-like viruses (NLV) detected in a prolonged hotel outbreak of gastroenteritis. Epidemiol Infect 2000;125:9398.
90.Goodman, ER, Platt, R, Bass, R, Onderdonk, AB, Yokoe, DS, Huang, SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29:593599.
91.Hota, B, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Interventional evaluation of environmental contamination by vancomycin-resistant enterococci: failure of personnel, product, or procedure? J Hosp Infect 2009;71:123131.
92.Carling, PC, Briggs, JL, Perkins, J, Highlander, D. Improved cleaning of patient rooms using a new targeting method. Clin Infect Dis 2006;42:385388.
93.Carling, PC, Parry, MM, Rupp, ME, Po, JL, Dick, B, Von Beheren, S. Improving cleaning of the environment surrounding patients in 36 acute care hospitals. Infect Control Hosp Epidemiol 2008;29:10351041.
94.Dharan, S, Pittet, D. Environmental controls in operating theatres. J Hosp Infect 2002;51:7984.
95.Moore, G, Griffith, C. A laboratory evaluation of the decontamination properties of microfibre cloths. J Hosp Infect 2006;64:379385.
96.Wilson, AP, Ostro, P, Magnussen, M, Cooper, B. Laboratory and in-use assessment of methicillin-resistant Staphylococcus aureus contamination of ergonomic computer keyboards for ward use. Am J Infect Control 2008;36:e19e25.
97.Andersen, BM, Rasch, M, Hochlin, K, Jensen, FH, Wismar, P, Fredriksen, JE. Decontamination of rooms, medical equipment and ambulances using an aerosol of hydrogen peroxide disinfectant. J Hosp Infect 2006;62:149155.
98.Rutala, WA, Gergen, MF, Weber, DJ. Room decontamination with UV radiation. Infect Control Hosp Epidemiol 2010;31:10251029.
99.Boyce, JM. New approaches to decontamination of rooms after patients are discharged. Infect Control Hosp Epidemiol 2009;30:515517.
100.Hardy, K, Price, C, Szczepura, A, et al. Reduction in the rate of methicillin-resistant Staphylococcus aureus acquisition in surgical wards by rapid screening for colonization: a prospective, cross-over study. Clin Microbiol Infect 2010;16:333339.
101.Lankford, MG, Collins, S, Youngberg, L, Rooney, DM, Warren, JR, Noskin, GA. Assessment of materials commonly utilized in health care: implications for bacterial survival and transmission. Am J Infect Control 2006;34:258263.
102.Noyce, JO, Michels, H, Keevil, CW. Potential use of copper surfaces to reduce survival of epidemic meticillin-resistant Staphylococcus aureus in the healthcare environment. J Hosp Infect 2006;63:289297.
103.Stone, SP, Cooper, BS, Kibbler, CC, et al. The ORION statement: guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection. Lancet Infect Dis 2007;7:282288.
104.Ghenghesh, KS, Nashnoush, H, Shaker, A, Enaami, H, Zorgani, A. Isolation of methicillin-resistant Staphylococcus aureus (MRSA) from rented DVDs. Am J Infect Control 2009;37:612.
105.Coronado, F, Nicholas, JA, Wallace, BJ, et al. Community-associated methicillin-resistant Staphylococcus aureus skin infections in a religious community. Epidemiol Infect 2007;135:492501.
106.Johnston, CP, Cooper, L, Ruby, W, Carroll, KC, Cosgrove, SE, Perl, TM. Epidemiology of community-acquired methicillin-resistant Staphylococcus aureus skin infections among healthcare workers in an outpatient clinic. Infect Control Hosp Epidemiol 2006;27:11331136.
107.Sethi, AK, Al-Nassir, WN, Nerandzic, MM, Donskey, CJ. Skin and environmental contamination with vancomycin-resistant enterococci in patients receiving oral metronidazole or oral vancomycin treatment for Clostridium difficile–associated disease. Infect Control Hosp Epidemiol 2009;30:1317.
108.McBryde, ES, Bradley, LC, Whitby, M, McElwain, DL. An investigation of contact transmission of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2004;58:104108.
109.Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 2002;23(suppl):S3S40.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed