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

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How long do nosocomial pathogens persist on inanimate surfaces? A systematic review

BMC Infectious Diseases volume 6, Article number:130 (2006) Cite this article

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Abstract

Background

Inanimate surfaces take frequently been described as the source for outbreaks of nosocomial infections. The aim of this review is to summarize information 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 study were assessed and standard textbooks on the topic were reviewed. All reports with experimental testify on the elapsing of persistence of a nosocomial pathogen on any type of surface were included.

Results

Most gram-positive leaner, such as Enterococcus spp. (including VRE), Staphylococcus aureus (including MRSA), or Streptococcus pyogenes, survive for months on dry surfaces. Many gram-negative species, such every bit Acinetobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Serratia marcescens, or Shigella spp., can too survive for months. A few others, such as Bordetella pertussis, Haemophilus influenzae, Proteus vulgaris, or Vibrio cholerae, withal, persist only for days. Mycobacteria, including Mycobacterium tuberculosis, and spore-forming leaner, including Clostridium difficile, can also survive for months on surfaces. Candida albicans as the most important nosocomial fungal pathogen tin 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, xiv days). Virtually 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 ii months. Claret-borne viruses, such equally HBV or HIV, tin persist for more than one week. Herpes viruses, such equally CMV or HSV type 1 and two, have been shown to persist from just a few hours up to 7 days.

Conclusion

The nearly mutual nosocomial pathogens may well survive or persist on surfaces for months and can thereby be a continuous source of manual if no regular preventive surface disinfection is performed.

Peer Review reports

Groundwork

Within the global infection control community, there is an ongoing controversy most the appropriate handling of inanimate surfaces in hospitals in gild to forestall transmission of nosocomial pathogens inside an institution. Based on a lack of epidemiological data that would provide evidence of a benefit for the patient from surface disinfection (e.thousand., from a significant reduction of nosocomial infection rates), some scientists postulate that cleaning of surfaces with non-antimicrobial detergents is mostly sufficient [1]. Others prefer cleaning of surfaces with antimicrobial agents, based on data on the take chances of infection due to microbial contamination and potential transmission of nosocomial pathogens, at least in the immediate vicinity of patients [2–iv].

New guidelines on treatment of surfaces in hospitals accept into account more parameters which are considered to be relevant for preventing the transmission of nosocomial pathogens, such as the blazon of ward or the expected frequency of mitt contact with a surface [five, 6]. Irrespective of the divergent opinions regarding the appropriate treatment of surfaces, an important parameter for a fair scientific assessment remains, that is, the persistence of nosocomial pathogens on surfaces. The longer a nosocomial pathogen persists on a surface, the longer it may exist 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 information that take been published 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 outbreaks.

Methods

Search strategy

The literature was systematically reviewed in MedLine on the internet homepage of the National Library of Medicine without language restrictions. The search was washed on 29 December 2005 and covered all years available in MedLine. The following search terms were applied: persistence, survival, surface, fomite, bacteria, virus, pathogen, transmission, and nosocomial. In improver, the citations in each study institute during the master search were reviewed for potential relevance. Finally, standard textbooks on infection control, bacteriology and virology were examined for information.

Selecting studies

All reports with experimental evidence on the elapsing of persistence of a nosocomial pathogen on any type of inanimate surface were included. Information from textbooks was likewise included, even if the chapter itself did non contain experimental evidence. At to the lowest degree two of the investigators decided on the relevance of each report. Reports were not blinded to the investigators then that they knew the names of the authors of all studies.

Interpretation of studies

For a clinically relevant summary, all nosocomial pathogens were grouped according to their importance in causing infirmary-acquired hand-transmitted infections [7] and according to their manner of nosocomial transmission [eight]. The range of the reported elapsing of persistence was used as the principle upshot of the search for each nosocomial pathogen. In addition, parameters with potential influence on persistence were evaluated in all experimental studies.

Results

Persistence of bacteria

About gram-positive bacteria, such every bit Enterococcus spp. (including VRE), Staphylococcus aureus (including MRSA), or Streptococcus pyogenes survive for months on dry surfaces (Tabular array 1). In full general, at that place was no obvious difference in survival between multiresistant and susceptible strains of Staphylococcus aureus and Enterococcus spp. [9]. Only in one study was such a divergence 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 aeruginosa, 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, still, persist merely for days (Table 1). Mycobacteria – including Mycobacterium tuberculosis and spore-forming bacteria, including Clostridium difficile – tin can also survive for many months on surfaces (Table 1).

Table i Persistence of clinically relevant bacteria on dry inanimate surfaces.

Total size table

Overall, gram-negative bacteria have been described to persist longer than gram-positive bacteria [12, 13]. Humid conditions improved persistence for almost types of bacteria, such as Chlamydia trachomatis [14], Listeria monocytogenes [15], Salmonella typhimurium [15], Pseudomonas aeruginosa [16], Escherichia coli [17], or other relevant pathogens [eighteen, nineteen]. Only Staphylococcus aureus was found to persist longer at low humidity [sixteen].

Low temperatures, e.g., 4°C or half dozen°C, also improved persistence of most types of leaner, such Listeria monocytogenes [15], Salmonella typhimurium [fifteen], MRSA [twenty], corynebacteria [21], Escherichia coli [17, 22], Helicobacter pylori [23], and Neisseria gonorrhoeae [24].

The type of examination material does not reveal a consistent event. Although some investigators report that the type of textile has no influence on the persistence [25, 26], other authors described a longer persistence on plastic [27, 28], and others still 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 poly peptide [13], serum [13, 24], sputum [30], or without grit [ten].

Persistence of fungi

Candida albicans as the nigh important nosocomial fungal pathogen can survive up to 4 months on surfaces (Table two). Persistence of other yeasts was described to be like (Torulopsis glabrata v months) or shorter (Candida parapsilosis 14 days).

Table two Persistence of clinically relevant fungi on dry inanimate surfaces.

Full size table

The presence of serum or albumin, a low temperature, and high humidity have been described as leading to longer persistence [31].

Persistence of viruses

Nearly viruses from the respiratory tract such equally corona-, coxsackie-, fluvirus, SARS, or rhinocerosvirus tin persist on surfaces for a few days. Viruses from the alimentary canal, such equally astrovirus, HAV, polio- and rotavirus persist for approximately 2 months. Claret-borne viruses, such equally HBV or HIV, can persist for more than one week. Herpes viruses such as CMV or HSV blazon 1 and 2 have been shown to persist from merely 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 persistence. HSV [34] and HAV [35] can persist longer at low humidity. For adeno- [32, 34], rota- [36, 37], and poliovirus [34, 35], alien results were reported.

For nearly viruses, such as astro- [38], adeno- [34], poliovirus [34], HSV [34], and HAV [35], depression temperature is associated 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 bear on the persistence of echo- [39], adeno- [39–41], parainfluenza- [39], rotavirus [41], RSV [39], polio- [41] or norovirus [42]. Other investigators institute that persistence was favored on non-porous surfaces for influenzavirus [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 out surfaces for only 2 hours [47].

Discussion

The nearly relevant nosocomial pathogens can persist on dry out inanimate surfaces for months. In addition to the duration of persistence, some studies have also identified factors influencing persistence. A low temperature, such as four°C or 6°C, was associated with longer persistence for nigh bacteria, fungi and viruses. High humidity (east.g., > 70%) was likewise associated with longer persistence for virtually leaner, fungi, and viruses, although for some viruses alien results were reported. A few studies also propose that a higher inoculum is associated with longer persistence. The blazon of surface material and the type of suspension medium, even so, reveal inconsistent data. Overall, a loftier inoculum of the nosocomial pathogen in a cold room with loftier relative humidity volition accept the best chance for long persistence.

In nigh reports with experimental show, persistence was studied on dry out surfaces using artificial contamination of a standardized blazon of surface in a laboratory. In near studies, bacteria were prepared in broth, h2o or saline. Viruses were usually prepared in a cell culture medium [48]. The main advantage is that the environmental conditions are consistent regarding temperature and air humidity. In addition, the effect of temperature or relative humidity can only be determined under controlled conditions, which are much easier to ensure in the laboratory. Even so, this may non always reflect the clinical situation, in which surfaces tin can exist simultaneously contaminated with various nosocomial pathogens and different types of body fluids, secretions etc. Still the question remains: what is the clinical evidence for the function of surfaces in nosocomial infections?

In hospitals, surfaces with paw contact are ofttimes contaminated with nosocomial pathogens [49–51], and may serve equally vectors for cross manual. A unmarried hand contact with a contaminated surface results in a variable degree of pathogen transfer. Transmission to hands was most successful with Escherichia coli, Salmonella spp., Staphylococcus aureus (all 100%) [52], Candida albicans (ninety%) [53], rhino virus (61%) [54], HAV (22% – 33%) [55], and rota virus (16%) [56, 57]. Contaminated hands can transfer viruses to v more surfaces [58] or 14 other subjects [59]. Contaminated hands can as well 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% [vii]. Due to the overwhelming bear witness of low compliance with hand hygiene, the hazard from contaminated surfaces cannot be disregarded (Figure 1).

Figure 1
figure 1

Common modes of transmission from inanimate surfaces to susceptible patients.

Total size prototype

Table 3 Persistence of clinically relevant viruses on dry inanimate surfaces.

Full size table

The main road of transmission is via the transiently contaminated hands of the healthcare worker [60–62]. An outbreak of nosocomial infections due to Acinetobacter baumannii in a neurosurgical intensive intendance unit may serve equally an example. A straight correlation was found betwixt the number of ecology 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 pregnant role for transmission of nosocomial pathogens, as suggested by observational testify. 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 testify to support a role of environmental contamination 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 Pseudomonas aeruginosa or Acinetobacter baumannii, of which multiple types were detected in the environs, and which did non always correlate with the caused strain [83].

The role of surface disinfection for the control of nosocomial pathogens has been a contentious issue for some fourth dimension [3]. Routine treatment of clean floors with diverse 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 infections [84]. Disinfection of surfaces in the immediate environment of patients, nevertheless, has been described to reduce acquisition of nosocomial pathogens such as VRE [85] or Acinetobacter baumannii [86]. It is therefore appropriate to control the spread of nosocomial pathogens at least in the straight inanimate environment of the patient past routine surface disinfection.

Conclusion

Near nosocomial pathogens can persist on inanimate surfaces for weeks or even months. Our review supports current guidelines which recommend a disinfection of surfaces in specific patient-care areas in lodge to reduce the risk of transmission of nosocomial pathogens from inanimate surfaces to susceptible patients.

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  1. Institut für Hygiene und Umweltmedizin, Ernst-Moritz-Arndt Universität, Greifswald, Germany

    Axel Kramer & Günter Kampf

  2. Robert-Koch Institut, Berlin, Germany

    Ingeborg Schwebke

  3. Bode Chemie GmbH & Co. KG, Scientific Affairs, Hamburg, Germany

    Günter Kampf

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Correspondence to Axel Kramer.

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GK is a paid employee of Bode Chemie GmbH & Co. KG, Hamburg, Germany.

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Kramer, A., Schwebke, I. & Kampf, Yard. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 6, 130 (2006). https://doi.org/x.1186/1471-2334-vi-130

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Keywords

  • Rota Virus
  • Nosocomial Infection
  • Hand Hygiene
  • Clostridium Difficile
  • Serratia Marcescens

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