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Major article| Volume 42, ISSUE 11, P1165-1172, November 2014

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Application of quantitative microbial risk assessment for selection of microbial reduction targets for hard surface disinfectants

Published:September 18, 2014DOI:https://doi.org/10.1016/j.ajic.2014.07.024

      Background

      This quantitative microbial risk assessment (QMRA) included problem formulation for fomites and hazard identification for 7 microorganisms, including pathogenic Escherichia coli and E coli 0157:H7, Listeria monocytogenes, norovirus, Pseudomonas spp, Salmonella spp, and Staphylococcus aureus. The goal was to address a risk-based process for choosing the log10 reduction recommendations, in contrast to the current US Environmental Protection Agency requirements.

      Method

      For each microbe evaluated, the QMRA model included specific dose-response models, occurrence determination of aerobic bacteria and specific organisms on fomites, exposure assessment, risk characterization, and risk reduction. Risk estimates were determined for a simple scenario using a single touch of a contaminated surface and self-inoculation. A comparative analysis of log10 reductions, as suggested by the US Environmental Protection Agency, and the risks based on this QMRA approach was also undertaken.

      Results

      The literature review and meta-analysis showed that aerobic bacteria were the most commonly studied on fomites, averaging 100 colony-forming units (CFU)/cm2. Pseudomonas aeruginosa was found at a level of 3.3 × 10−1 CFU/cm2; methicillin-resistant S aureus (MRSA), at 6.4 × 10−1 CFU/cm2. Risk estimates per contact event ranged from a high of 10−3 for norovirus to a low of 10−9 for S aureus.

      Conclusion

      This QMRA analysis suggests that a reduction in bacterial numbers on a fomite by 99% (2 logs) most often will reduce the risk of infection from a single contact to less than 1 in 1 million.

      Key Words

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      References

        • Regli S.
        • Rose J.B.
        • Haas C.N.
        • Gerba C.P.
        Modeling the risk from Giardia and viruses in drinking water.
        J Am Water Works Assoc. 1991; 83: 76-84
        • Rose J.B.
        • Haas C.N.
        • Gerba C.P.
        Linking microbiological criteria for foods with quantitative risk assessment.
        J Food Saf. 1995; 15: 121-132
        • Hong T.
        • Gurian P.L.
        • Huang Y.
        • Haas C.N.
        Prioritizing risks and uncertainties from intentional release of selected category A pathogens.
        PLoS ONE. 2012; 7: e32732
        • Hong T.
        • Gurian P.L.
        • Ward N.F.
        Setting risk-informed environmental standards for Bacillus anthracis spores.
        Risk Anal. 2010; 30: 1602-1622
        • Barker J.
        • Stevens D.
        • Bloomfield S.F.
        Spread and prevention of some common viral infections in community facilities and domestic homes.
        J Appl Microbiol. 2001; 91: 7-21
        • Bellamy K.
        • Laban K.L.
        • Barrett K.E.
        • Talbot D.C.
        Detection of viruses and body fluids which may contain viruses in the domestic environment.
        Epidemiol Infect. 1998; 121: 673-680
        • Sattar S.A.
        • Lloyd-Evans N.
        • Springthorpe V.S.
        • Nair R.C.
        Institutional outbreaks of rotavirus diarrhoea: potential role of fomites and environmental surfaces as vehicles for virus transmission.
        J Hyg (Lond). 1986; 96: 277-289
        • England B.L.
        Detection of viruses on fomites.
        in: Gerba Goyal Methods in environmental virology. Marcel Dekker, New York [NY]1982: 179-220
        • Ekanem E.E.
        • Dupont H.L.
        • Pickering L.K.
        • Selwyn B.J.
        • Hawkins C.M.
        Transmission dynamics of enteric bacteria in day care centers.
        Am J Epidemiol. 1983; 118: 562-572
        • Goldmann D.A.
        Transmission of viral respiratory infections in the home.
        Pediatr Infect Dis J. 2000; 19: S97-102
        • Hall C.B.
        • Douglas Jr., R.G.
        • Geiman J.M.
        Possible transmission by fomites of respiratory syncytial virus.
        J Infect Dis. 1980; 141: 98-102
        • Manning M.L.
        • Archibald L.K.
        • Bell L.M.
        • Banerjee S.N.
        • Jarvis W.R.
        Serratia marcescens transmission in a pediatric intensive care unit: a multifactorial occurrence.
        Am J Infect Control. 2001; 29: 115-119
        • Reed S.E.
        An investigation of the possible transmission of Rhinovirus colds through indirect contact.
        J Hyg (Lond). 1975; 75: 249-258
        • Reynolds K.A.
        • Watt P.M.
        • Boone S.A.
        • Gerba C.P.
        Occurrence of bacteria and biochemical markers on public surfaces.
        Int J Environ Health Res. 2005; 15: 225-234
        • Barker J.
        • Vipond I.B.
        • Bloomfield S.F.
        Effects of cleaning and disinfection in reducing the spread of Norovirus contamination via environmental surfaces.
        J Hosp Infect. 2004; 58: 42-49
        • Morens D.M.
        • Rash V.M.
        Lessons from a nursing home outbreak of influenza A.
        Infect Control Hosp Epidemiol. 1995; 16: 275-280
        • Boone S.A.
        • Gerba C.P.
        The occurrence of influenza A virus on household and day care center fomites.
        J Infect. 2005; 51: 103-109
        • Butz A.M.
        • Fosarelli P.
        • Dick J.
        • Cusack T.
        • Yolken R.
        Prevalence of rotavirus on high-risk fomites in day-care facilities.
        Pediatrics. 1993; 92: 202-205
        • Aitken C.
        • Jeffries D.J.
        Nosocomial spread of viral disease.
        Clin Microbiol Rev. 2001; 14: 528-546
        • Bures S.
        • Fishbain J.T.
        • Uyehara C.F.
        • Parker J.M.
        • Berg B.W.
        Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit.
        Am J Infect Control. 2000; 28: 465-471
        • Muniesa M.
        • Jofre J.
        • Garcia-Aljaro C.
        • Blanch A.R.
        Occurrence of Escherichia coli O157:H7 and other enterohemorrhagic Escherichia coli in the environment.
        Environ Sci Technol. 2006; 40: 7141-7149
        • Ludwig K.
        • Sarkim V.
        • Bitzan M.
        • Karmali M.A.
        • Bobrowski C.
        • Ruder H.
        • et al.
        Shiga toxin-producing Escherichia coli infection and antibodies against Stx2 and Stx1 in household contacts of children with enteropathic hemolytic-uremic syndrome.
        J Clin Microbiol. 2002; 40: 1773-1782
        • Fitzpatrick M.
        Haemolytic uraemic syndrome and E coli O157.
        Br Med J. 1999; 318: 684-685
      1. Centers for Disease Control and Prevention. Investigation update: multistate outbreak of listeriosis linked to whole cantaloupes from Jensen Farms, Colorado. Available from: http://www.cdc.gov/listeria/outbreaks/cantaloupes-jensen-farms/index.html. Accessed June 28, 2013.

      2. Centers for Disease Control and Prevention. Norovirus. Available from: http://www.cdc.gov/norovirus/. Accessed June 28, 2013.

        • Hall A.J.
        • Lopman B.A.
        • Payne D.C.
        • Patel M.M.
        • Gastanaduy P.A.
        • Vinje J.
        • et al.
        Norovirus disease in the United States.
        Emerg Infect Dis. 2013; 19: 1198-1205
      3. CAMRAwiki. Case study: norovirus in drinking water. Available from: http://qmrawiki.msu.edu/index.php?title=Case_Study%3A_Norovirus_in_Drinking_Water. Accessed June 14, 2013.

        • Stapleton F.
        • Carnt N.
        Contact lens–related microbial keratitis: how have epidemiology and genetics helped us with pathogenesis and prophylaxis?.
        Eye (London). 2012; 26: 185-193
        • Stapleton F.
        Contact lens–related microbial keratitis: what can epidemiologic studies tell us?.
        Eye Contact Lens. 2003; 29: S85-S89
        • Centers for Disease Control and Prevention
        Vital signs: incidence and trends of infection with pathogens transmitted commonly through food—Foodborne Diseases Active Surveillance Network, 10 US sites, 1996–2010.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 749-755
      4. Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus (MRSA) infections. Available from: http://www.cdc.gov/mrsa/. Accessed June 28, 2013.

        • Klevens R.M.
        • Morrison M.A.
        • Nadle J.
        • Petit S.
        • Gershman K.
        • Ray S.
        • et al.
        Invasive methicillin-resistant Staphylococcus aureus infections in the United States.
        JAMA. 2007; 298: 1763-1771
        • Scott E.
        • Bloomfield S.F.
        • Barlow C.G.
        An investigation of microbial contamination in the home.
        J Hyg (Lond). 1982; 89: 279-293
        • Rusin P.
        • Maxwell S.
        • Gerba C.
        Comparative surface-to-hand and fingertip-to-mouth transfer efficiency of gram-positive bacteria, gram-negative bacteria, and phage.
        J Appl Microbiol. 2002; 93: 585-592
        • Enriquez C.E.
        • Enriquez-Gordillo R.
        • Kennedy D.I.
        • Gerbo C.P.
        Bacteriological survey of used cellulose sponges and cotton dishclothes from domestic kitchens.
        Dairy Food Environ Sanit. 1997; 17: 20-24
        • Yepiz-Gomez M.S.
        • Bright K.R.
        • Gerba C.P.
        Identity and numbers of bacteria present on tabletops and in dishcloths used to wipe down tabletops in public restaurants and bars.
        Food Prot Trends. 2006; 26: 3
        • Scott E.
        • Duty S.
        • McCue K.
        A critical evaluation of methicillin-resistant Staphylococcus aureus and other bacteria of medical interest on commonly touched household surfaces in relation to household demographics.
        Am J Infect Control. 2009; 37: 447-453
        • Nicas M.
        • Best D.
        A study quantifying the hand-to-face contact rate and its potential application to predicting respiratory tract infection.
        J Occup Environ Hyg. 2008; 5: 347-352
        • Teunis P.
        • Takumi K.
        • Shinagawa K.
        Dose response for infection by Escherichia coli O157:H7 from outbreak data.
        Risk Anal. 2004; 24: 401-407
        • Rose J.B.
        • Haas C.N.
        A risk assessment framework for the evaluation of skin infections and the potential impact of antibacterial soap washing.
        Am J Infect Control. 1999; 27: S26-33
        • Beumer R.R.
        • te Giffel M.C.
        • Spoorenberg E.
        • Rombouts F.M.
        Listeria species in domestic environments.
        Epidemiol Infect. 1996; 117: 437-442
        • Wagner M.
        • Auer B.
        • Trittremmel C.
        • Hein I.
        • Schoder D.
        Survey on the Listeria contamination of ready-to-eat food products and household environments in Vienna, Austria.
        Zoonoses Public Health. 2007; 54: 16-22
        • Blanch A.R.
        • Garcia-Aljaro C.
        • Muniesa M.
        • Jofre J.
        Detection, enumeration and isolation of strains carrying the stx2 gene from urban sewage.
        Water Sci Technol. 2003; 47: 109-116
        • Scott E.
        • Bloomfield S.F.
        The survival and transfer of microbial contamination via cloths, hands and utensils.
        J Appl Bacteriol. 1990; 68: 271-278
        • Plotkin K.R.
        • Reynolds K.A.
        • Gerba C.P.
        • Sifuentes L.
        • Koeing D.W.
        • Beamer P.I.
        Risk modeling of human viruses on fomites and the impact of a healthy workplace intervention.
        In preparation for Appl Environ Microbiol. 2013;