How Long Do Germs Live On Dead Animals

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• BMC Infect Dis
• v.half dozen; 2006
• PMC1564025

BMC Infect Dis. 2006; 6: 130.

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

Axel Kramer

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

Ingeborg Schwebke

²Robert-Koch Institut, Berlin, Germany

Günter Kampf

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

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

Received 2006 April 26; Accepted 2006 Aug 16.

Abstract

Background

Inanimate surfaces have often been described as the source for outbreaks of nosocomial infections. The aim of this review is to summarize data on the persistence of unlike nosocomial pathogens on inanimate surfaces.

Methods

The literature was systematically reviewed in MedLine without language restrictions. In addition, cited manufactures in a report were assessed and standard textbooks on the topic were reviewed. All reports with experimental evidence on the duration 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 equally Acinetobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Serratia marcescens, or Shigella spp., can also survive for months. A few others, such every bit Bordetella pertussis, Haemophilus influenzae, Proteus vulgaris, or Vibrio cholerae, notwithstanding, persist simply for days. Mycobacteria, including Mycobacterium tuberculosis, and spore-forming leaner, including Clostridium difficile, can too survive for months on surfaces. Candida albicans as the about of import nosocomial fungal pathogen can survive up to 4 months on surfaces. Persistence of other yeasts, such every bit Torulopsis glabrata, was described to be similar (five months) or shorter (Candida parapsilosis, fourteen days). Nearly viruses from the respiratory tract, such as corona, coxsackie, influenza, SARS or rhinoceros virus, can persist on surfaces for a few days. Viruses from the alimentary canal, such every bit astrovirus, HAV, polio- or rota virus, persist for approximately 2 months. Blood-borne viruses, such every bit HBV or HIV, tin persist for more than than 1 week. Herpes viruses, such as CMV or HSV type 1 and 2, have been shown to persist from only a few hours up to vii days.

Conclusion

The nigh common nosocomial pathogens may well survive or persist on surfaces for months and tin thereby exist a continuous source of manual if no regular preventive surface disinfection is performed.

Background

Inside the global infection control community, at that place is an ongoing controversy about the appropriate treatment of inanimate surfaces in hospitals in order to prevent transmission of nosocomial pathogens within an institution. Based on a lack of epidemiological data that would provide prove of a benefit for the patient from surface disinfection (eastward.g., from a significant reduction of nosocomial infection rates), some scientists postulate that cleaning of surfaces with non-antimicrobial detergents is generally sufficient [1]. Others prefer cleaning of surfaces with antimicrobial agents, based on data on the risk of infection due to microbial contamination and potential transmission of nosocomial pathogens, at least in the immediate vicinity of patients [2-four].

New guidelines on treatment of surfaces in hospitals take into business relationship more than 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 paw contact with a surface [5,6]. Irrespective of the divergent opinions regarding the advisable treatment of surfaces, an important parameter for a fair scientific cess 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 manual and thus endanger a susceptible patient or healthcare worker. The aim of this review was therefore to collect and assess the data 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 linguistic communication restrictions. The search was done on 29 December 2005 and covered all years bachelor in MedLine. The following search terms were practical: persistence, survival, surface, fomite, leaner, virus, pathogen, manual, and nosocomial. In add-on, the citations in each study found during the main search were reviewed for potential relevance. Finally, standard textbooks on infection control, bacteriology and virology were examined for data.

Selecting studies

All reports with experimental evidence on the duration of persistence of a nosocomial pathogen on any type of inanimate surface were included. Information from textbooks was also included, fifty-fifty if the chapter itself did not contain experimental evidence. At least two of the investigators decided on the relevance of each report. Reports were not blinded to the investigators so that they knew the names of the authors of all studies.

Estimation 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 mode of nosocomial transmission [8]. The range of the reported duration of persistence was used as the principle outcome 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

Most gram-positive bacteria, such as Enterococcus spp. (including VRE), Staphylococcus aureus (including MRSA), or Streptococcus pyogenes survive for months on dry surfaces (Table ​ 1). In general, there was no obvious difference in survival between multiresistant and susceptible strains of Staphylococcus aureus and Enterococcus spp. [9]. Only in one written report was such a difference suggested, but the susceptible strains revealed a very brief survival as such [x]. 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 plant among the almost frequent isolates from patients with nosocomial infections [11]. A few others, such every bit Bordetella pertussis, Haemophilus influenzae, Proteus vulgaris, or Vibrio cholerae, however, persist only for days (Table ​ ane). Mycobacteria – including Mycobacterium tuberculosis and spore-forming bacteria, including Clostridium difficile – can too survive for many months on surfaces (Tabular array ​ 1).

Table 1

Persistence of clinically relevant bacteria on dry inanimate surfaces.

Blazon of bacterium	Duration of persistence (range)	Reference(s)
Acinetobacter spp.	3 days to 5 months	[18, 25, 28, 29, 87, 88]
Bordetella pertussis	three – five days	[89, 90]
Campylobacter jejuni	upward to 6 days	[91]
Clostridium difficile (spores)	5 months	[92–94]
Chlamydia pneumoniae, C. trachomatis	≤ thirty hours	[14, 95]
Chlamydia psittaci	15 days	[90]
Corynebacterium diphtheriae	vii days – 6 months	[90, 96]
Corynebacterium pseudotuberculosis	1–viii days	[21]
Escherichia coli	1.5 hours – xvi months	[12, xvi, 17, 22, 28, 52, 90, 97–99]
Enterococcus spp. including VRE and VSE	5 days – 4 months	[9, 26, 28, 100, 101]
Haemophilus influenzae	12 days	[90]
Helicobacter pylori	≤ 90 minutes	[23]
Klebsiella spp.	2 hours to > thirty months	[12, 16, 28, 52, 90]
Listeria spp.	i solar day – months	[15, 90, 102]
Mycobacterium bovis	> two months	[thirteen, 90]
Mycobacterium tuberculosis	i day – iv months	[thirty, 90]
Neisseria gonorrhoeae	1 – iii days	[24, 27, ninety]
Proteus vulgaris	1 – 2 days	[90]
Pseudomonas aeruginosa	6 hours – xvi months; on dry floor: 5 weeks	[12, xvi, 28, 52, 99, 103, 104]
Salmonella typhi	half-dozen hours – 4 weeks	[90]
Salmonella typhimurium	x days – 4.2 years	[15, xc, 105]
Salmonella spp.	one day	[52]
Serratia marcescens	3 days – 2 months; on dry out floor: v weeks	[12, 90]
Shigella spp.	ii days – 5 months	[xc, 106, 107]
Staphylococcus aureus, including MRSA	7 days – vii months	[nine, 10, 16, 52, 99, 108]
Streptococcus pneumoniae	i – xx days	[90]
Streptococcus pyogenes	iii days – 6.v months	[90]
Vibrio cholerae	one – 7 days	[90, 109]

Overall, gram-negative bacteria have been described to persist longer than gram-positive bacteria [12,xiii]. Humid conditions improved persistence for nearly types of leaner, such equally Chlamydia trachomatis [14], Listeria monocytogenes [fifteen], Salmonella typhimurium [15], Pseudomonas aeruginosa [xvi], Escherichia coli [17], or other relevant pathogens [18,19]. Only Staphylococcus aureus was found to persist longer at low humidity [16].

Low temperatures, e.g., iv°C or 6°C, also improved persistence of most types of bacteria, such Listeria monocytogenes [15], Salmonella typhimurium [15], MRSA [20], corynebacteria [21], Escherichia coli [17,22], Helicobacter pylori [23], and Neisseria gonorrhoeae [24].

The blazon of test cloth does not reveal a consistent result. Although some investigators report that the blazon of material has no influence on the persistence [25,26], other authors described a longer persistence on plastic [27,28], and others yet see a survival reward 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 [xiii], serum [13,24], sputum [30], or without dust [10].

Persistence of fungi

Candida albicans equally the about important nosocomial fungal pathogen can survive up to 4 months on surfaces (Table ​ ii). Persistence of other yeasts was described to be similar (Torulopsis glabrata 5 months) or shorter (Candida parapsilosis 14 days).

Tabular array ii

Persistence of clinically relevant fungi on dry inanimate surfaces.

Type of mucus	Elapsing of persistence (range)	Reference(s)
Candida albicans	one – 120 days	[31, 53, 99, 110]
Candida parapsilosis	xiv days	[110]
Torulopsis glabrata	102 – 150 days	[31]

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

Persistence of viruses

Most viruses from the respiratory tract such as corona-, coxsackie-, influenzavirus, SARS, or rhinovirus tin persist on surfaces for a few days. Viruses from the gastrointestinal tract, such as astrovirus, HAV, polio- and rotavirus persist for approximately ii months. Claret-borne viruses, such as HBV or HIV, can persist for more than than 1 week. Herpes viruses such every bit CMV or HSV type 1 and ii have been shown to persist from merely a few hours upwards to 7 days.

The influence of humidity on persistence has been described inconsistently. For entero- [32] and rhinovirus [33], loftier humidity was associated with longer persistence. HSV [34] and HAV [35] can persist longer at depression humidity. For adeno- [32,34], rota- [36,37], and poliovirus [34,35], alien results were reported.

For nigh viruses, such as astro- [38], adeno- [34], poliovirus [34], HSV [34], and HAV [35], low 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 textile did not touch the persistence of echo- [39], adeno- [39-41], parainfluenza- [39], rotavirus [41], RSV [39], polio- [41] or norovirus [42]. Other investigators found that persistence was favored on non-porous surfaces for fluvirus [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 surfaces for simply 2 hours [47].

Discussion

The most relevant nosocomial pathogens can persist on dry inanimate surfaces for months. In addition to the elapsing of persistence, some studies have also identified factors influencing persistence. A low temperature, such equally 4°C or 6°C, was associated with longer persistence for most leaner, fungi and viruses. Loftier humidity (e.thou., > 70%) was also associated with longer persistence for almost bacteria, fungi, and viruses, although for some viruses conflicting results were reported. A few studies also suggest that a college inoculum is associated with longer persistence. The type of surface material and the type of pause medium, all the same, reveal inconsistent data. Overall, a high inoculum of the nosocomial pathogen in a common cold room with high relative humidity will take the best chance for long persistence.

In almost reports with experimental evidence, persistence was studied on dry surfaces using artificial contamination of a standardized blazon of surface in a laboratory. In most studies, bacteria were prepared in broth, water 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 add-on, the effect of temperature or relative humidity can only be adamant nether controlled conditions, which are much easier to ensure in the laboratory. Still, this may non always reverberate the clinical situation, in which surfaces tin be simultaneously contaminated with various nosocomial pathogens and different types of body fluids, secretions etc. Yet the question remains: what is the clinical evidence for the function of surfaces in nosocomial infections?

In hospitals, surfaces with hand contact are often contaminated with nosocomial pathogens [49-51], and may serve as vectors for cross transmission. A single hand contact with a contaminated surface results in a variable degree of pathogen transfer. Manual to hands was nearly successful with Escherichia coli, Salmonella spp., Staphylococcus aureus (all 100%) [52], Candida albicans (90%) [53], rhino virus (61%) [54], HAV (22% – 33%) [55], and rota virus (xvi%) [56,57]. Contaminated hands can transfer viruses to 5 more surfaces [58] or 14 other subjects [59]. Contaminated easily can also be the source of re-contaminating the surface, as shown with HAV [55,58]. Compliance rates of healthcare workers in manus hygiene are known to be around 50% [7]. Due to the overwhelming show of low compliance with hand hygiene, the chance from contaminated surfaces cannot be disregarded (Figure ​ one).

Mutual modes of transmission from inanimate surfaces to susceptible patients.

The primary route of transmission is via the transiently contaminated hands of the healthcare worker [sixty-62]. An outbreak of nosocomial infections due to Acinetobacter baumannii in a neurosurgical intensive care unit may serve as an example. A direct correlation was found between the number of environmental 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 significant role for transmission of nosocomial pathogens, as suggested by observational evidence. This has been described for various types of microorganisms, such every bit 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 show to back up a function of environmental contagion is non every bit 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 environment, and which did not always correlate with the caused strain [83].

The role of surface disinfection for the command of nosocomial pathogens has been a contentious issue for some time [3]. Routine treatment of clean floors with various types of surface disinfectants (some of them had rather poor bactericidal action) has been described to take no significant impact on the incidence of nosocomial infections [84]. Disinfection of surfaces in the firsthand environs of patients, nevertheless, has been described to reduce conquering of nosocomial pathogens such equally VRE [85] or Acinetobacter baumannii [86]. Information technology is therefore appropriate to control the spread of nosocomial pathogens at to the lowest degree in the direct inanimate environment of the patient past routine surface disinfection.

Determination

Most nosocomial pathogens can persist on inanimate surfaces for weeks or fifty-fifty months. Our review supports current guidelines which recommend a disinfection of surfaces in specific patient-care areas in order to reduce the take chances of manual of nosocomial pathogens from inanimate surfaces to susceptible patients.

Competing interests

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

Authors' contributions

All authors contributed to the formulation, review of studies, and analysis of data. All authors were involved in drafting and revising the manuscript. All authors approved the final version of the manuscript.

Tabular array 3

Persistence of clinically relevant viruses on dry inanimate surfaces.

Blazon of virus	Duration of persistence (range)	Source
Adenovirus	7 days – 3 months	[32, 34, 38–41, 111]
Astrovirus	7 – 90 days	[38]
Coronavirus	3 hours	[112, 113]
SARS associated virus	72 – 96 hours	[114]
Coxsackie virus	> 2 weeks	[34, 111]
Cytomegalovirus	8 hours	[115]
Echovirus	7 days	[39]
HAV	2 hours – lx days	[35, 38, 41]
HBV	> 1 week	[116]
HIV	> vii days	[117–119]
Herpes simplex virus, type i and 2	4.5 hours – 8 weeks	[34, 111, 118, 120]
Influenza virus	one – two days	[39, 43, 121, 122]
Norovirus and feline calici virus (FCV)	8 hours – 7 days	[42, 45]
Papillomavirus 16	> 7 days	[123]
Papovavirus	viii days	[118]
Parvovirus	> one twelvemonth	[118]
Poliovirus type i	4 hours – < 8 days	[35, 118]
Poliovirus type 2	1 twenty-four hour period – viii weeks	[34, 38, 111]
Pseudorabies virus	≥ seven days	[124]
Respiratory syncytial virus	up to 6 hours	[44]
Rhinovirus	two hours – 7 days	[33, 125]
Rotavirus	half-dozen – 60 days	[36 – 38, 41]
Vacciniavirus	3 weeks – > 20 weeks	[34, 126]

Acknowledgements

The authors declare that they have no acknowledgements.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564025/

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