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The role of the surface environment in healthcare-associated infections

Weber, David J.a,b; Anderson, Deverickc; Rutala, William A.a,b

Current Opinion in Infectious Diseases: August 2013 - Volume 26 - Issue 4 - p 338–344
doi: 10.1097/QCO.0b013e3283630f04

Purpose of review This article reviews the evidence demonstrating the importance of contamination of hospital surfaces in the transmission of healthcare-associated pathogens and interventions scientifically demonstrated to reduce the levels of microbial contamination and decrease healthcare-associated infections.

Recent findings The contaminated surface environment in hospitals plays an important role in the transmission of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), Clostridium difficile, Acinetobacter spp., and norovirus. Improved surface cleaning and disinfection can reduce transmission of these pathogens. ‘No-touch’ methods of room disinfection (i.e., devices which produce ultraviolet light or hydrogen peroxide) and ‘self-disinfecting’ surfaces (e.g., copper) also show promise to decrease contamination and reduce healthcare-associated infections.

Summary Hospital surfaces are frequently contaminated with important healthcare-associated pathogens. Contact with the contaminated environment by healthcare personnel is equally as likely as direct contact with a patient to lead to contamination of the healthcare provider's hands or gloves that may result in patient-to-patient transmission of nosocomial pathogens. Admission to a room previously occupied by a patient with MRSA, VRE, Acinetobacter, or C. difficile increases the risk for the subsequent patient admitted to the room to acquire the pathogen. Improved cleaning and disinfection of room surfaces decreases the risk of healthcare-associated infections.

aDepartment of Hospital Epidemiology, University of North Carolina Healthcare

bDivision of Infectious Diseases, UNC School of Medicine, Chapel Hill

cDepartment of Medicine, Duke University School of Medicine, Durham, North Carolina, USA

Correspondence to David J. Weber, MD, MPH, 2163 Bioinformatics, CB #7030, Chapel Hill, NC 27599-7030, USA. Tel: +1 919 966 2536; fax: +1 9190 966 1451; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.