The role of the environment in the spread of emerging pathogens in at-risk hospital wards

Infections in hospital high-risk environments due to emerging pathogens as Pseudomonas aeruginosa, Burkholderia cepacia, Stenotrophomonas maltophilia or heterogeneous glycopeptide-intermediate Staphylococcus aureus are responsible for a high mortality rate. The severity of these infections is due to bacterial virulence factors, their resistance to multiple antibiotics and the associated difficulty in treating infections. Although resistance to a single antimicrobial agent or class is troublesome, of greater concern is the development of resistance to multiple agents or classes, which severely limits treatment options. This is a major public health problem and a cause of substantial morbidity and mortality among hospitalized patients, especially in at-risk wards. The hospital environment can act as a reservoir of these microorganisms. The main reservoirs identified in hospital settings are water, medical devices that are not thoroughly cleaned/disinfected or dried, contaminated solutions, hands, colonized or infected patients, air and surfaces. To better prevent nosocomial infections related to emerging pathogens, the control of the hospital environment, the strict application of hand disinfection and other recommended procedures, and the investigation of potential cross-transmission in the hospital setting are needed.