Hostname: page-component-6898cfcb55-zkb6p Total loading time: 0 Render date: 2026-11-11T09:49:43.566Z Has data issue: false hasContentIssue false
  • English
  • Français

Contamination of portable equipment with healthcare-associated pathogens: a point-prevalence culture survey in 31 American hospitals

Published online by Cambridge University Press:  23 September 2026

Jennifer L. Cadnum,
Claire E. Kaple,
Rebecca Crapanzano-SigafoosOpen the ORCID record for Rebecca Crapanzano-Sigafoos[Opens in a new window] and
Curtis DonskeyOpen the ORCID record for Curtis Donskey[Opens in a new window]
Jennifer L. Cadnum
Affiliation:
Research Service, VA Northeast Ohio Healthcare System, USA
Claire E. Kaple
Affiliation:
Department of Molecular Biology and Microbiology, Case Western Reserve University, USA
Rebecca Crapanzano-Sigafoos
Affiliation:
Association for Professionals in Infection Control and Epidemiology, USA
Curtis Donskey*
Affiliation:
Infectious Diseases Section, Louis Stokes Cleveland VA Medical Center , Cleveland, USA
*
Corresponding author: Curtis Donskey; Email: curtis.donskey@va.gov

Abstract

We conducted a point-prevalence culture survey in 31 hospitals to assess contamination of portable medical equipment. Of 308 devices cultured, 52 (16.9%) were contaminated with 1 or more pathogens. The percentages of contamination with Candida species, vancomycin-resistant enterococci, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus were 6.8%, 6.2%, 5.2%, 2.9%, respectively.

Information

Type
Concise Communication
Information
Antimicrobial Stewardship & Healthcare Epidemiology , Volume 6 , Issue 1 , 2026, e291
Creative Commons
Creative Common License - CCCreative Common License - BY
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© US Department of Veterans Affairs, 2026

Contaminated portable medical equipment is a potential vector for transmission of healthcare-associated pathogens. Reference Donskey1 Although many devices make direct contact with patients (eg, vital signs equipment), indirect interactions are also common (ie, hands of personnel move between equipment and patients). Reference Donskey1 Whole genome sequencing in conjunction with contact tracing has provided evidence supporting transmission of pathogens such as Candidozyma auris and vancomycin-resistant enterococci (VRE) from contaminated equipment to patients. Reference Lee, White, Monahan, Jensen, Chan and van Hal2,Reference Eyre, Sheppard and Madder3 Moreover, in a recent cluster-randomized trial, manual once-daily cleaning and disinfection of shared equipment by dedicated staff resulted in improved cleaning and a significant reduction in healthcare-associated infections. Reference Browne, White and Russo4 These results suggest that improved low-level disinfection of portable equipment may reduce healthcare-associated infections.

Although it is recommended that shared equipment be cleaned and disinfected between patients, practices in real-world settings are often suboptimal. Reference Donskey1,Reference Havill, Havill, Mangione, Dumigan and Boyce5 Havill et al. Reference Havill, Havill, Mangione, Dumigan and Boyce5 reported that equipment was not being disinfected per protocol and recommended that staff receive regular education and feedback. Suwantarat et al. Reference Suwantarat, Supple, Cadnum, Sankar and Donskey6 demonstrated that portable equipment was often contaminated with pathogens. Given evidence that daily disinfection of equipment can be beneficial, Reference Browne, White and Russo4 studies are needed to evaluate current equipment cleaning and disinfection practices and levels of contamination in multiple hospitals. Here, we report findings from a culture survey of portable equipment in 31 hospitals.

Methods

The study protocol was approved by the Cleveland VA Medical Center’s institutional review board. In conjunction with a culture survey assessing Clostridioides difficile contamination after postdischarge room cleaning and disinfection, Reference Cadnum, Plumlee and Hailes7 hospitals also collected cultures from a convenience sample of shared portable devices. The study was conducted in collaboration with the Association for Professionals in Infection Control (APIC).

The 31 participating hospitals provided information on bed size and on the types of cleaning and disinfection products recommended for use on portable equipment. The sites were provided with supplies and instructions on culture collection and mailing including the types of devices to be sampled. Infection prevention personnel used Sponge Sticks with neutralizing buffer (3M, St. Paul, MN) to sample up to 10 portable devices in clinical areas that were ready for use without regard to whether it had been cleaned. For larger devices, standardized 20 × 20-cm surface areas were sampled; for smaller devices, the entire surface area was wiped with the sponges. Environmental services and clinical personnel were not made aware of the study.

The sponges were refrigerated after collection and mailed on ice to the Cleveland VA Medical Center within 1 week. Cleveland VA Medical Center personnel were blinded to the identity of the facilities. The sponges were processed for recovery of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Candida species, and toxigenic C. difficile. Reference Cadnum, Pearlmutter and Jencson8 Microbes recovered from selective media were identified and subjected to susceptibility testing in accordance with Clinical Laboratory Standards Institute guidelines. 9 Broth enrichment cultures were processed for toxigenic C. difficile. Reference Cadnum, Plumlee and Hailes7 Fisher’s exact test was used to compare proportions of contamination among groups.

Results

Characteristics of the hospitals

The geographic location of the study hospitals is shown in the supplemental material. The average bed size was 513 (median, 350; range, 59 to 2,300 beds). Of the 31 hospitals, 23 (74.2%) reported using ready-to-use (RTU) quaternary ammonium or quaternary ammonium alcohol disinfectant wipes alone or in combination with another product for cleaning and disinfection of equipment (Supplemental material). The remaining hospitals reported primarily using dilutable quaternary ammonium products (N = 3), RTU sodium hypochlorite wipes (N = 2), dilutable peracetic acid-based products (N = 2), or RTU hydrogen peroxide wipes (N = 1).

Contamination of portable equipment

Of the 308 devices cultured, 52 (16.9%) were contaminated with 1 or more pathogens (Figure 1). Two pathogens were recovered from 10 devices and 3 were recovered from 2 devices. Candida species, including Candida albicans (N = 8) and Candida parapsilosis (N = 13), were recovered from devices in 12 hospitals and were the most common pathogens recovered (21 of 308 devices, 6.8%). VRE and toxigenic C. difficile were recovered from 19 (6.2%) and 16 (5.2%) portable devices, respectively. The supplemental material provides detailed information on the disinfectant products used and the percentages of positive cultures for the 31 individual hospitals. For the 31 hospitals, the median number of devices with contamination with 1 or more pathogens was 1 (range 0 [0%] to 7 [70%]). The percentage of contamination did not differ for hospitals using RTU wipe products versus dilutable products (45/258, 17.4% vs 7/50, 14.0%; P = .68). The percentage of C. difficile contamination did not differ for hospitals using sporicidal (N = 6) versus non-sporicidal (N = 25) disinfectants for equipment (4/60, 6.7% vs 9/248, 3.6%; P = .29).

Figure 1.

Percentage of portable devices (N = 308) contaminated with 1 or more pathogens. MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant enterococci.

A bar graph showing the percentage of portable devices contaminated with various pathogens.

Figure 2 shows the percent contamination with 1 or more pathogens for different types of devices and the total numbers of each device cultured. The devices with the highest percentage of contamination included scales, isolation carts with personal protective equipment, and workstations-on-wheels.

Figure 2.

Percentage of contamination with 1 or more pathogens for different types of devices and the total numbers of each device sampled.

A bar graph showing the percentage of contamination for different types of devices.

Discussion

In the current study, we conducted a point-prevalence culture survey to assess contamination of in-use portable equipment in 31 hospitals. Overall, 16.9% of devices were contaminated with 1 or more pathogens. For individual hospitals, the percentage of contamination varied from 0% to 70%. Our results suggest that efforts are needed to improve cleaning and disinfection of shared portable equipment.

VRE and C. difficile were the most common bacterial pathogens recovered. Contaminated portable equipment has been implicated as a source of VRE transmission, including between different intensive care unit areas. Reference Lee, White, Monahan, Jensen, Chan and van Hal2 Most of the study hospitals reported use of non-sporicidal disinfectants for shared portable equipment. In settings with high rates of healthcare-associated CDI, use of sporicidal disinfectants for shared portable equipment and/or use of disposable equipment may be considered. Reference Cadnum, Plumlee and Hailes7 However, it is notable that the percentage of C. difficile contamination did not differ significantly for hospitals reporting use of sporicidal versus non-sporicidal disinfectants for equipment (6.7% vs 3.6%, respectively).

Contaminated surfaces have not traditionally been considered an important source for transmission of Candida spp. However, C. auris has frequently been recovered from environmental surfaces in rooms of colonized or infected patients, and an outbreak of C. auris in an intensive care unit was linked to shared temperature probes. Reference Eyre, Sheppard and Madder3 Some studies have implicated environmental surfaces, including portable equipment, as a source for acquisition of other Candida spp. For example, Sanchez et al. Reference Sanchez, Vazquez, Barth-Jones, Dembry, Sobel and Zervos10 reported recovery of a Candida parapsilosis strain from inanimate surfaces in a new intensive care unit before patients were admitted with subsequent infections due to the same strain. The ability of Candida species to survive for prolonged periods on dry and moist surfaces may increase the likelihood of transmission from the environment. Reference Eyre, Sheppard and Madder3

Our study has several limitations. The cultures were processed for only a limited number of pathogenic microbes, and therefore our results may underestimate the total burden of contamination. We did not collect information on equipment cleaning practices, and no observations or objective assessments (eg, fluorescent marker monitoring) were obtained to assess whether the devices that were cultured had been cleaned. A limited number of devices were sampled at each hospital and there is a potential selection bias because a convenience sample of devices was cultured. The study hospitals may not be representative the median bed size was 350 beds. Finally, the sampling method differed for large and small devices.

In conclusion, we found that portable medical equipment in 31 United States hospitals was frequently contaminated with healthcare-associated pathogens. Additional studies are needed to evaluate practices for cleaning and disinfection of shared equipment.

Supplementary material

The supplementary material for this article can be found at https://doi.org/10.1017/ash.2026.10816.

Acknowledgments

We thank the infection prevention personnel at the hospitals participating in the culture survey.

Financial support

This work was supported by the Clorox Company and by the US Department of Veterans Affairs Office of Research and Development as part of funding for VASeqCURE, which in turn received funding from the American Rescue Plan Act funds. Clorox Company personnel provided input on study design but did contribute to data analysis or writing, editing, or approval of the manuscript.

Competing interests

C.J.D. has received research funding from Clorox, Ushio America, GOJO, and Blueprint Biosecurity. All other authors report no conflicts of interest.

References

Donskey, CJ. Beyond high-touch surfaces: portable equipment and floors as potential sources of transmission of health care-associated pathogens. Am J Infect Control 2019;47S:A90–A95.10.1016/j.ajic.2019.03.017CrossRefGoogle ScholarPubMed
Lee, AS, White, E, Monahan, LG, Jensen, SO, Chan, R, van Hal, SJ. Defining the role of the environment in the emergence and persistence of vanA vancomycin-resistant Enterococcus (VRE) in an intensive care unit: a molecular epidemiological study. Infect Control Hosp Epidemiol 2018;39:668–675.10.1017/ice.2018.29CrossRefGoogle Scholar
Eyre, DW, Sheppard, AE, Madder, H, et al. A Candida auris outbreak and its control in an intensive care setting. N Engl J Med 2018;379:1322–1331.10.1056/NEJMoa1714373CrossRefGoogle Scholar
Browne, K, White, NM, Russo, PL, et al. Investigating the effect of enhanced cleaning and disinfection of shared medical equipment on health-care-associated infections in Australia (CLEEN): a stepped-wedge, cluster randomised, controlled trial. Lancet Infect Dis 2024;24:1347–1356.10.1016/S1473-3099(24)00399-2CrossRefGoogle ScholarPubMed
Havill, NL, Havill, HL, Mangione, E, Dumigan, DG, Boyce, JM. Cleanliness of portable medical equipment disinfected by nursing staff. Am J Infect Control 2011;39:602–604.10.1016/j.ajic.2010.10.030CrossRefGoogle ScholarPubMed
Suwantarat, N, Supple, LA, Cadnum, JL, Sankar, T, Donskey, CJ. Quantitative assessment of interactions between hospitalized patients and portable medical equipment and other fomites. Am J Infect Control 2017;45:1276–1278.10.1016/j.ajic.2017.05.003CrossRefGoogle ScholarPubMed
Cadnum, JL, Plumlee, S, Hailes, JM, et al. Does routine use of sporicidal disinfectants for all postdischarge hospital rooms reduce environmental contamination with Clostridioides difficile spores? Am J Infect Control 2025;53:652–655.10.1016/j.ajic.2025.01.010CrossRefGoogle ScholarPubMed
Cadnum, JL, Pearlmutter, BS, Jencson, AL, et al. Microbial bioburden of inpatient and outpatient areas beyond patient hospital rooms. Infect Control Hosp Epidemiol 2022;43:1017–1021.10.1017/ice.2021.309CrossRefGoogle ScholarPubMed
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, 26th edition. CLSI document M100. Wayne, PA: Clinical and Laboratory Standards Institute. 2016.Google Scholar
Sanchez, V, Vazquez, JA, Barth-Jones, D, Dembry, L, Sobel, JD, Zervos, MJ. Nosocomial acquisition of Candida parapsilosis: an epidemiologic study. Am J Med 1993;94:577–582.10.1016/0002-9343(93)90207-6CrossRefGoogle ScholarPubMed
Figure 0

Figure 1.Percentage of portable devices (N = 308) contaminated with 1 or more pathogens. MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant enterococci.

Figure 1

Figure 2.Percentage of contamination with 1 or more pathogens for different types of devices and the total numbers of each device sampled.

Supplementary material: File

Cadnum et al. supplementary material

Cadnum et al. supplementary material
Download Cadnum et al. supplementary material(File)
File 207.1 KB