onto Columbia blood agar plates (Becton Dickinson,
Heidelberg, Germany), incubated at 36
1°C for 24 hours,
and plate counted. Samples were stored, while protectedfrom direct sunlight and contamination, under standard
room conditions (23
5% relative air humidity).
They were then sampled and plate counted after 48, 72,96, 144, and 168 hours, to test for bacterial growth.Tests for bacterial growthwere repeated three times.
Test of bacterial transmissibility.
To test the trans-missibility of bacteria from one hand to paper and backto another hand, we adapted the classic finger-padmethod developed by Ansari and Sattar and specified inthe American Society for Testing and Materials (ASTM)Standards E-1838-96 and E-1838-02 for testing viru-cidal activity of hand antiseptics.
strain NCTC 10538 (from the NationalCollection of Type Cultures [NCTC], a part of theHealth Protection Agency of the United Kingdom)was used as the test organism. Volunteers washed theirhands in tap water without soap, dried them with single-use papertowels, and waited 10 minutes to ensure thatthey were dry.
The tip of each volunteer’s index fingerwas inoculated with 25 microliters of test suspension(10
CFU/mL) and air-dried.After drying, volunteers pressed the inoculated finger-tips on paper swatches for 30 seconds. The index finger-tips of another group of volunteers were then irrigatedwith sterile 0.9% saline (to simulate the common badhabit of licking the finger before turning pages or goingthrough files) and pressed on the contaminated swatchesfor 30 seconds to simulate cross-contamination. A ster-ile Eppendorf tube filled with 1 mL of saline solutionwas then pressed to the fingertip of each of the second
volunteers and shaken for one minute; volumes of 0.1 mL
of this undiluted sampling solution were plated ontoColumbia blood agar and incubated as described above.Tests were repeated six times.
Survival of test organisms on paper over time.
Alltest strains survived on the inoculated paper. Figure 1shows the changes in recoverable organisms for eachindividual organism. There were notable differences inthe survival of different pathogens over time.
was reduced by almost 5 log
in 24 hours (a reduction
Paper is omnipresent on hospital units, butfewstudies have examined the possible role of paper in thespread of nosocomial pathogens.
To determine by laboratory investigationhow long bacterial pathogens can survive on office paperand whether bacteria can be transferred from hands to pa-per and back to hands in a “worst-case scenario.”
Samples of four bacterial pathogens (
Esch- erichia coli
) were prepared according to stan-dard laboratory procedures. Sterile swatches of office paperwere inoculated with the pathogens and bacterial survivalwas tested over seven days. To test the transmission of bac-teria from one person’s hands to paper and back to anotherperson’s hands, the fingertips of volunteers were inoculatedwith a nonpathogenic strain of
; these volunteers thenpressed the inoculum onto sterile paper swatches. Anothergroup of volunteers whose hands had been moistened pressedtheir fingertips onto the contaminated paper swatches. Bac-teria transferred to the moistened fingertips were cultivatedaccording to standard laboratory procedures.
The four tested organisms showed differencesin length of survival depending on environmental room con-ditions, but were stable on paper for up to 72 hours and stillcultivable after seven days. Test organisms were transferredto paper, survived on it, and were retransferred back tohands.
Paper can serve as a vehicle for cross-contamination of bacterial pathogens in medical settings ifcurrent recommendations on hand hygiene aren’t meticu-lously followed.
cross-contamination, disinfection, finger padmethod, hand antisepsis, hand hygiene, hospital-acquiredinfection, infection control, nosocomial infection, spread ofpathogens, survival on inanimate surfaces
Vol. 111, No. 12
Bacteria can be transferred to paper,survive on it, and subsequentlycontaminate hands.