title: Lesser-known or hidden reservoirs of infection and implications for adequate prevention strategies: Where to look and what to look for.
abstract: In developing hygiene strategies, in recent years, the major focus has been on the hands as the key route of infection transmission. However, there is a multitude of lesser-known and underestimated reservoirs for microorganisms which are the triggering sources and vehicles for outbreaks or sporadic cases of infection. Among those are water reservoirs such as sink drains, fixtures, decorative water fountains and waste-water treatment plants, frequently touched textile surfaces such as private curtains in hospitals and laundry, but also transvaginal ultrasound probes, parenteral drug products, and disinfectant wipe dispensers. The review of outbreak reports also reveals Gram-negative and multiple-drug resistant microorganisms to have become an increasingly frequent and severe threat in medical settings. In some instances, the causative organisms are particularly difficult to identify because they are concealed in biofilms or in a state referred to as viable but nonculturable, which eludes conventional culture media-based detection methods. There is an enormous preventative potential in these insights, which has not been fully tapped. New and emerging pathogens, novel pathogen detection methods, and hidden reservoirs of infection should hence be given special consideration when designing the layout of buildings and medical devices, but also when defining the core competencies for medical staff, establishing programmes for patient empowerment and education of the general public, and when implementing protocols for the prevention and control of infections in medical, community and domestic settings.
authors.affiliation: London School of Hygiene and Tropical Medicine, International Scientific Forum on Home Hygiene, London, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Bloomfield
authors.affiliation: Institute of Hygiene and Public Health, Bonn University, Bonn, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Exner
authors.affiliation: Department of Chemistry, University of Duisburg-Essen, Essen, Germany.
authors.forename: Hans-Curt
authors.initials: HC
authors.lastname: Flemming
authors.affiliation: Schülke & Mayr GmbH, Norderstedt, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Goroncy-Bermes
authors.affiliation: Departement Environment et Santé Publique S.E.R.E.S., Faculté de Médicine, Nancy, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hartemann
authors.affiliation: Institute of Medical Microbiology and Hygiene, Tübingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Heeg
authors.affiliation: Institute of Hygiene and Public Health, Bonn University, Bonn, Germany.
authors.forename: Carola
authors.initials: C
authors.lastname: Ilschner
authors.affiliation: Pharmacy Department of Mainz University, Mainz, Germany.
authors.forename: Irene
authors.initials: I
authors.lastname: Krämer
authors.affiliation: Schülke & Mayr GmbH, Norderstedt, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Merkens
authors.affiliation: Schülke & Mayr GmbH, Norderstedt, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Oltmanns
authors.affiliation: Hygiene Institute of Vienna University, Vienna, Austria.
authors.forename: Manfred
authors.initials: M
authors.lastname: Rotter
authors.affiliation: UNC School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Rutala
authors.affiliation: Institute of Hygiene and Medical Microbiology, Heidelberg, Germany.
authors.forename: Hans-Günther
authors.initials: HG
authors.lastname: Sonntag
authors.affiliation: Department of Hospital Hygiene at Stuttgart Hospital, Stuttgart, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Trautmann
keywords: Infection reservoir; hygiene; outbreak; pathogen detection method; prevention strategy; viable but nonculturable status