Importance of Fomites in the Transmission of Infectious Disease Charles P. Gerba Department of Soil, Water and Environmental Science And Epidemiology and Biostatistics University of Arizona Tucson, AZ

 80% of all pathogens in the hospital and home environment are spread through hand contact

Most Diseases Spread Through Hand Contact  Every three minutes, a child brings his/ her hand to nose or mouth  Every 60 seconds, a working adult touches as many as 30 objects

Occurrence of fecal bacteria on the hand (United States) Preparing a meal Greatest Children after playing Doing the laundry Least Person exiting a toilet

Detection of Pathogens on Fomites  Hard surfaces Phones, tap handles, desk tops, door knobs, cutting boards, table tops Phones, tap handles, desk tops, door knobs, cutting boards, table tops E. coli, influenza, parainfluenza, norovirus E. coli, influenza, parainfluenza, norovirus  Clothing Laundry, towels, bed sheets Laundry, towels, bed sheets Salmonella, hepatitis A virus, norovirus, E. coli Salmonella, hepatitis A virus, norovirus, E. coli

Detection of Pathogens on Fomites  Bathroom Sinks, taps, bottom of the toilet seat Sinks, taps, bottom of the toilet seat Norovirus, Giardia, Cryptosporidium, Shigella Norovirus, Giardia, Cryptosporidium, Shigella  Kitchen Sponge, sink, cutting board Sponge, sink, cutting board Salmonella, Campylobacter, E. coli Salmonella, Campylobacter, E. coli  Schools Norovirus, rhinovirus, Salmonella, influenza Norovirus, rhinovirus, Salmonella, influenza

Sites by Coliform Bacterial Densities in the Home Bath Sink Kitchen Floor Bath Counter Bath Floor Toilet Seat Kitchen Sink Sponge Cutting Board

Environments Most Contaminated With Body Fluids

Fomite Cleaning is not enough to Prevent Exposure to Pathogens  % of norovirus detected on surfaces during outbreak at a college campus: 18% during outbreak at a college campus: 18% after cleaning with soap and water: 48% after cleaning with soap and water: 48%  % of surfaces on which E. coli detected: in restroom: 8% in restroom: 8% after cleaning with soap and water: 21% after cleaning with soap and water: 21%

Conclusions  Hand contact plays a significant role in transmission of common infections  Fomite contamination by pathogens is a common event in home and work environments  Washing fomite with soap and water is not enough to prevent the spread of pathogens

Overall Summary  Targeted hygiene is needed for “home” infection control  The benefit is prophylactic but real  Topical antiseptic wash products do not contribute to decreased antimicrobial susceptibility  Extensive data indicate environmental risks from individual active ingredients are unlikely  The data clearly support the current proposed labeling indication (i.e., “ to decrease bacteria on skin”)  The 1994 TFM log reductions after a single wash (i.e., 2 log 10 ) are appropriate, as long as standardized ASTM methods are employed