Reservoirs of Pathogens Causing Health Care-Associated Infections in the 21st Century: Is Renewed Attention to Inanimate Surfaces Warranted?

Controversy over the relative importance of pathogens recovered from the hospital environment as a significant source of nosocomial infection has existed for decades. Attention to this particular aspect of infection prevention and control has been low of late, but the emergence of more virulent strains of pathogens, such as Clostridium difficile, and the persistence of familiar ones, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, have prompted a return to concerns about environmental infection control. This article reviews the accumulated evidence and highlights newer approaches for prevention that include renewed investigation of disinfectant fogging, methods to enhance environmental hygiene, selection of surface materials, and even application of antimicrobials to surfaces in the patient care setting. All new ideas, however, require an appreciation and use of both evidence-based and critical appraisal using epidemiologic principles to verify those that are the most effective strategies.