What surfaces are contaminated in the hospital environment?

As discussed in my previous posts, bacterial and fungal pathogens can remain viable on inanimate surfaces from days to months and in some cases even years. These organisms can also survive over a wide range of temperatures, humidity, and exposure to sunlight. (1)

In the current post I want to briefly review what the literature shows us are the most pathogen contaminated surfaces found in the hospital environment.

contaminated-surfaces Surfaces that are frequently touched and/or in close proximity to the patient are often the most colonized with nosocomial pathogens, (2) and are termed “high-touch surfaces”. (3, 4)

Examples of the most contaminated high touch surfaces are bedlinens and patient pyjamas which have been reported to harbor nosocomial pathogens, including antibiotic resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA). (5)

From an analysis of several studies that reported contamination of inanimate surfaces, it was found that the bed linens, patients’ gown, and the overbed table were the commonest sites for MRSA contamination (approximately a mean of 40% of the sites). (6) The next most contaminated sites were the floor and the bedrails which comprised 34.5% and 27% of the contaminated sites respectively. (6)

In some cases, the most contaminated high touch surface was the fabric privacy curtains that surround the patients’ beds. (7) In a culture survey of privacy curtains, the pathogens identified included antibiotic resistant bacteria and known pathogens including vancomycin-resistant enterococci (VRE) (42% of samples), MRSA (22% of samples), and Clostridium difficile (4% of samples). In addition other bacteria including Micrococcus species (sp.), Bacillus sp., Escherichia coli, coagulase-negative Staphylococcus, and Staphylococcus aureus were found.(7, 8) The highest contamination of privacy curtains was was found in privacy curtains of isolation rooms. In a recent outbreak of Group A Streptococcus (GAS) infection in the UK, 10 out of 34 bedside curtains were found to be heavily contaminated with GAS. (9)

A wide range of objects have been identified as having pathogen contamination including healthcare worker uniforms, computer keyboards, blood pressure cuﬀs, door handles, tourniquets, infusion pump bottoms, television sets, stethoscopes, telephones, and other furniture in the patient room.(10-13)

High touch surfaces have also been reported to be contaminated with a wide range of bacterial nosocomial pathogens, including MRSA, C. difficile as mentioned above and also Acinetobacter baumannii, extended spectrum beta-lactamase (ESBL) producing enterobacteriaceae and carbapenem-resistant enterobacteriaceae (CRE).[9-13] Viral and fungal contamination of high touch surfaces has also been reported.(14, 15)

References cited

1) JC. Environmental aspects of staphylococcal infections acquired in hospitals. Am J Public Health 1960; 50: 468–73.

2) Bhalla A, Pultz NJ, Gries DM, et al. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalised patients. Infect Control Hosp Epidemiol 2004;25:164–167.

3) Huslage K, Rutala WA, Sickbert-Bennett E, Weber DJ. A quantitative approach to defining “high-touch” surfaces in hospitals. Infect Control Hosp Epidemiol 2010;31:850-853;

4) Sehulster L, Chinn RY. CDC HICPAC. 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;52:1–42.

5) Malnick S, Bardenstein R, Huszar M, Gabbay J, Borkow G. Pyjamas and sheets as a potential source of nosocomial pathogens. J Hosp Infect 2008;70(1):89-92.

6) Dancer SJ. Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 2008;8(2):101-13.

7) Das I, Lambert P, Hill D, et al. Carbapenem-resistantAcinetobacterand role of curtains in an outbreak in intensive care units. J Hosp Infect 2002;50:110–114.

8) Trillis F, 3rd, Eckstein EC, Budavich R, Pultz MJ, Donskey CJ. Contamination of hospital curtains with healthcare-associated pathogens. Infect Control Hosp Epidemiol 2008;29:1074–1076.

9) Mahida N, Beal A, Trigg D, Vaughan N, Boswell T. Outbreak of invasive group A Streptococcus infection: Contaminated patient curtains and cross-infection on an ear, nose and throat ward. J Hosp Infect 2014;87:141–144.

10) 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;

11) Bonten MJ, Hayden MK, Nathan C et al. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet 1996;348:1615-1619;