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Original Research: Survival of Bacterial Pathogens on Paper and Bacterial Retrieval from Paper to Hands: Preliminary Results

Hübner, Nils-Olaf MD; Hübner, Claudia PhD; Kramer, Axel MD, PhD; Assadian, Ojan MD, DTMH

AJN The American Journal of Nursing: December 2011 - Volume 111 - Issue 12 - p 30-34
doi: 10.1097/01.NAJ.0000408181.37017.82
Feature Articles

Background Paper is omnipresent on hospital units, but few studies have examined the possible role of paper in the spread of nosocomial pathogens.

Objective To determine by laboratory investigation how long bacterial pathogens can survive on office paper and whether bacteria can be transferred from hands to paper and back to hands in a "worst-case scenario."

Methods Samples of four bacterial pathogens (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus hirae) were prepared according to standard laboratory procedures. Sterile swatches of office paper were inoculated with the pathogens and bacterial survival was tested over seven days. To test the transmission of bacteria from one person's hands to paper and back to another person's hands, the fingertips of volunteers were inoculated with a nonpathogenic strain of E. coli; these volunteers then pressed the inoculum onto sterile paper swatches. Another group of volunteers whose hands had been moistened pressed their fingertips onto the contaminated paper swatches. Bacteria transferred to the moistened fingertips were cultivated according to standard laboratory procedures.

Results The four tested organisms showed differences in length of survival depending on environmental room conditions, but were stable on paper for up to 72 hours and still cultivable after seven days. Test organisms were transferred to paper, survived on it, and were retransferred back to hands.

Conclusion Paper can serve as a vehicle for cross-contamination of bacterial pathogens in medical settings if current recommendations on hand hygiene aren't meticulously followed.

Keywords cross-contamination, disinfection, finger pad method, hand antisepsis, hand hygiene, hospital-acquired infection, infection control, nosocomial infection, spread of pathogens, survival on inanimate surfaces

This study investigated how long bacterial pathogens can survive on regular office paper—a potentially im portant vehicle for cross-contamination and infection in clinical settings.

Nils-Olaf Hübner is consultant, infection control, Claudia Hübner is clinical staff member, and Axel Kramer is director, all at the Institute for Hygiene and Environmental Medicine of the Ernst Moritz Arndt University of Greifswald, Greifswald, Germany. Ojan Assadian is consultant, clinical microbiology, and consultant, infectious diseases and tropical medicine, at the Clinical Institute for Hospital Hygiene of the Medical University of Vienna, Vienna, Austria. Contact author: Nils-Olaf Hübner, nhuebner@uni-greifswald.de. The authors have disclosed no potential conflicts of interest, financial or otherwise.

© 2011 Lippincott Williams & Wilkins, Inc.