• Nils-Olaf Hübner, Claudia Hübner, Axel Kramer, and Ojan Assadian.
• Institute for Hygiene and Environmental Medicine, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany. nhuebner@uni-greifswald.de
• Am J Nurs. 2011 Dec 1;111(12):30-4; quiz 35-6.

BackgroundPaper is omnipresent on hospital units, but few studies have examined the possible role of paper in the spread of nosocomial pathogens.ObjectiveTo determine by laboratory investigation how long bacterial pathogens can survive on office paper and whether bacteria can be transferred from hands to paper and back to hands in a "worst-case scenario."MethodsSamples of four bacterial pathogens (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus hirae) were prepared according to standard laboratory procedures. Sterile swatches of office paper were inoculated with the pathogens and bacterial survival was tested over seven days. To test the transmission of bacteria from one person's hands to paper and back to another person's hands, the fingertips of volunteers were inoculated with a nonpathogenic strain of E. coli; these volunteers then pressed the inoculum onto sterile paper swatches. Another group of volunteers whose hands had been moistened pressed their fingertips onto the contaminated paper swatches. Bacteria transferred to the moistened fingertips were cultivated according to standard laboratory procedures.ResultsThe four tested organisms showed differences in length of survival depending on environmental room conditions, but were stable on paper for up to 72 hours and still cultivable after seven days. Test organisms were transferred to paper, survived on it, and were retransferred back to hands.ConclusionPaper can serve as a vehicle for cross-contamination of bacterial pathogens in medical settings if current recommendations on hand hygiene aren't meticulously followed.

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