Role of hospital surfaces in the transmission of emerging health care-associated pathogens: Norovirus, Clostridium difficile, and Acinetobacter species
Section snippets
Microbiology and epidemiology
Caliciviruses are single-stranded RNA, nonenveloped, icosahedral viruses that are now recognized as common pathogens of humans and animals.16, 17Norovirus, a genus within the family Caliciviridae, is subdivided into 5 genotypes; genotypes GI, GII, and GIV include human pathogens. Understanding viral transmission and pathophysiology has been limited until recently by the lack of a cell culture system for growing norovirus and limited animal models (ie, gnotobiotic pig). Clinical findings
Microbiology and epidemiology
C difficile is an anaerobic, gram-positive, spore-forming, toxin-producing bacillus.35 It is part of the normal intestinal flora in humans and is carried by approximately 3% of healthy adults and 20% to 30% of hospitalized adults. C difficile exists in both vegetative and spore forms; in the colon, it exists as a vegetative cell, whereas, outside the colon, it survives in spore form. C difficile is the causative agent of antibiotic-associated colitis. Colonization of the intestinal tract occurs
Microbiology and epidemiology
Acinetobacter spp are strictly aerobic, gram-negative, nonfermentative, coccobacillary rods. In recent years, the frequency of multidrug-resistant (MDR) Acinetobacter spp has been increasing, and multiple outbreaks have been reported.51, 52, 53 Once established, outbreak strains may become endemic within an institution. The crude mortality rate for Acinetobacter infections has ranged up to 50%, whereas attributable mortality has ranged from 8% to 23% for hospitalized patients and from 10% to
Conclusion
The CDC/Hospital Infection Control Practices Advisory Committee guidelines for environmental infection control in health care facilities10 and sterilization and disinfection in health care facilities11 should form the basis for institutional policies regarding surface disinfection. The scientific evidence has strongly suggested that contamination of surfaces in hospital rooms plays an important role in the transmission of MRSA and VRE. Recent evidence also strongly suggests that contaminated
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STATEMENT OF CONFLICT OF INTEREST: Dr. Weber and Dr. Rutala have provided consultation for The Clorox Company and Johnson & Johnson. The remaining authors report no conflicts of interest.
Publication of this article was made possible by unrestricted educational grants from The Clorox Company, the American Society for Healthcare Engineering, and the Facility Guidelines Institute.