Fostering Collaboration Between Infection Prevention and Environmental Services

Persistence of pathogenic organisms is a related concern. Kramer et al. (2006) observe, “The most common nosocomial pathogens may well survive or persist on surfaces for months and can thereby be a continuous source of transmission if no regular preventive surface disinfection is performed.” The researchers’ review of the literature revealed that most Gram-positive bacteria, such as Enterococcus spp. (including VRE), Staphylococcus aureus (including MRSA), and Streptococcus pyogenes, survive for months on dry surfaces, while many Gram-negative species, such as Acinetobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Serratia marcescens, or Shigella spp., can also survive for weeks to months. Candida albicans, a significant nosocomial fungal pathogen, can survive up to four months on surfaces.

Inanimate surfaces come into play as HCWs’ hands easily become colonized by pathogenic microorganisms from handling contaminated equipment or touching inanimate surfaces in patients’ immediate surroundings. Crnich et al. (2005) observe, “A variety of nosocomial pathogens can be recovered from surfaces of the inanimate hospital environment. The capacity of these organisms to persist for weeks to months on surfaces such as tabletops, bed railings and linens raises concern about indirect horizontal transmission of pathogenic microorganisms. Many Gram-positive organisms, especially enterococci and S. aureus, retain viability for periods in excess of three months when incorporated in dried organic materials commonly found on hospital surfaces.

In contrast, Gram-negative organisms subsist for much shorter periods, in the order of hours, with the exception of Klebsiella species, Acinetobacter species, and Enterobacter species, which can retain viability for several days. The capacity of surface organisms to secondarily contaminate HCWs’ hands and clothes without any direct patient contact provides support for the role of hospital surfaces in the horizontal spread of hospital pathogens.”