Are room decontamination units needed to prevent transmission of environmental pathogens?

Healthcare-associated infections remain an important source of morbidity and mortality, with an estimated 1.7 million infections and 99,000 deaths annually. The major source of nosocomial pathogens is thought to be patients' endogenous flora, but an estimated 20%-40% of healthcare-associated infections have been attributed to cross infection via the hands of healthcare personnel. Contamination of the hands of healthcare personnel could in turn result directly from patient contact or indirectly from touching contaminated environmental surfaces. There is excellent evidence in the scientific literature that environmental contamination plays an important role in the transmission of several key healthcare-associated pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Acinetobacter, norovirus, and Clostridium difficile.' All of these pathogens have been demonstrated to persist in the environment for hours to days (and in some cases months), to frequently contaminate the environmental surfaces in rooms of colonized or infected patients, to transiently colonize the hands of healthcare personnel, to be transmitted by healthcare personnel, and to cause outbreaks in which environmental transmission was deemed to play a role. Furthermore, admission to a room in which the previous patient had been colonized or infected with MRSA, VRE, or C. difficile has been shown to be a risk factor for the newly admitted patient to develop colonization or infection.