Yasmin B Shaikh, Kevin M Gibas, Sara F Geffert, Leonard A Mermel
Although the findings should be interpreted with caution given the wide confidence interval and exploratory design of the analysis, they indicate that paper-towel dispensers may harbor bacterial contamination at the hand hygiene interface. These observations may guide future environmental hygiene policies and the development of targeted infection prevention interventions in healthcare settings.
BACKGROUND: /Purpose: Environmental surfaces that interface with hand hygiene may serve as underrecognized sites of microbial contamination. Paper-towel dispensers are frequently used but are often excluded from routine cleaning and surveillance. This study aimed to assess the prevalence and burden of bacterial contamination on paper-towel dispensers, compare contamination between manual and touch-free units, and characterize recovered organisms.
METHODS: We conducted a cross-sectional environmental surveillance study at a tertiary care hospital, sampling 40 paper-towel dispensers (30 manual, 10 touch-free) in public and staff bathrooms, hallway sinks, public kitchenette/nutrition station areas, and break areas. Dispenser apertures were swabbed using premoistened ESwabs. Samples were cultured on blood agar and assessed semi-quantitatively. Organisms were identified via MALDI-TOF. Contamination prevalence and CFU burden were compared between dispenser types using Fisher's exact and Mann-Whitney U tests.
RESULTS: Surveillance cultures identified bacterial contamination in 70% (28/40) of paper-towel dispensers. Contamination was more frequent among manual dispensers than touch-free dispensers (80% vs. 40%; relative risk 2.0, 95% confidence interval 0.92-4.36; Fisher's exact test, P=0.04). The most commonly recovered organisms were Bacillus spp. and Coagulase-negative staphylococci. Organisms of clinical or IPC concern were identified in 14% of dispensers, with most located in the emergency department. No multidrug-resistant organisms were detected.
CONCLUSION: Although the findings should be interpreted with caution given the wide confidence interval and exploratory design of the analysis, they indicate that paper-towel dispensers may harbor bacterial contamination at the hand hygiene interface. These observations may guide future environmental hygiene policies and the development of targeted infection prevention interventions in healthcare settings.