title: Relationship between shared patient care items and healthcare-associated infections: a systematic review.
abstract: BACKGROUND
  Environmental surfaces may contribute to transmission of nosocomial pathogens. Noninvasive portable clinical items potentially shared among patients (NPIs) are part of the patient's immediate surroundings and may pose a threat of pathogen transmission.
  
  
  OBJECTIVE
  To assess the body of literature describing the range of microorganisms found on NPIs and evaluate the evidence regarding the potential for cross-transmission of microorganisms between NPIs and hospitalized patients in non-outbreak conditions.
  
  
  METHODS
  A comprehensive list of NPIs was developed, and a systematic review of these items combined with healthcare-associated infection related keywords was performed.
  
  
  METHODS
  PubMed, Scopus, and Cochrane Library.
  
  
  METHODS
  A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to identify and synthesize research reports published between January 1990 and July 2013 on studies regarding contamination of NPIs and association to infections in non-outbreak circumstances.
  
  
  RESULTS
  1498 records were scanned for eligibility. Thirteen studies met inclusion criteria. Overall, rates of NPI contamination ranged from 23% to 100%. Normal skin or environmental flora were found on almost all positive cultures. Potential pathogens, e.g., Staphylococcus aureus, were present on up to 86%, and Pseudomonas spp. and/or Enterobacteriaceae in 38% of positive cultures. Multi-drug resistant organisms were isolated from up to 25% of items. Three studies explored association between NPIs contamination and patient colonization and infection. One study reported 5 patients with healthcare-associated infections with pathogens found concurrently on NPIs, one found cross-transmission between patient skin bacteria and NPI contamination, and a third did not find any cross-transmission.
  
  
  CONCLUSIONS
  Potential pathogens and multiply resistant organisms present on NPIs in routine, non-outbreak conditions and in a variety of settings confirms the need to improve NPIs decontamination practices.
authors.affiliation: Department of Nursing, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel. Electronic address: Livshiz@exchange.bgu.ac.il.
authors.forename: Ilana
authors.initials: I
authors.lastname: Livshiz-Riven
authors.affiliation: Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Borer
authors.affiliation: Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Nativ
authors.affiliation: Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Seada
authors.initials: S
authors.lastname: Eskira
authors.affiliation: Center for Interdisciplinary Research to Prevent Infections, School of Nursing, Columbia University, New York, NY, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Larson
mesh_terms: D003428:Cross Infection / Q000209:etiology*; D006801:Humans; D005791:Patient Care
keywords: Colonization; Contamination; Cross-infection; Equipment and supplies; Hospital; Non-critical items