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432

Letters to the Editor

Hospital curtains: An
undermined source of
nosocomial infections
Sir,
Contact hygiene is often a neglected subject in most
hospital settings, particularly with regards to contact
with the patient environment in a hospital setting.
The purpose of this letter is to emphasize the role of
patient bedside curtains in the transmission of microbial
pathogens. Various diseaseassociated bacteria are
transferred from person to person via hospital equipment
including bedside curtains, which are categorized as
high touch surfaces by the Center for Disease Control
and Prevention.[1] Various outbreaks of hospitalacquired
pathogens and their transmission have been reported
in clinics, inpatient wards, and Intensive Care Units
(ICUs). Bedside, curtains are frequently directly touched
by patients hands, as well as the nursing staff and
the visitors. This, in particular, makes all healthcare
workers, patients, and visitors vulnerable of transmitting
diseasecausing pathogens among each other.
Numerous human pathogens have been identified
in hospital and clinic curtains. These include
Micrococcus species (sp.), Bacillus sp., Escherichia coli,
coagulasenegative Staphylococcus, and Staphylococcus
aureus. Some of these bacteria may still persist even
after laundry of curtains and become potential causes of
infectious diseases, particularly in hospitalized patients
with attenuated immune systems. In a survey where
curtains were cleaned every 4 months reported, 42%
vancomycinresistant enterococci (VRE), 22% methicillin
resistant S. aureus (MRSA), and 4% Clostridium difficile
using contact plates and swabbing technique. Most
contamination was found in privacy curtains of isolation
rooms. Ninetytwo percent of the privacy curtains in
the hospital wards and ICUs to be contaminated with
bacteria as determined by culture swabs.[2] Most of
the hospital curtains were harboring MRSA and VRE,
posing a potential pathogenic threat to the patient and
their house staff.

were replaced. If this trend of pathogenic transmission

continues, there is a potential danger that newer,
drugresistant bacteria may evolve, providing a
challenge to healthcare providers to limit the spread
of nosocomial infections. There was an epidemic of
Acinetobacter baumannii in ICU settings of a tertiary
care hospital in Birmingham (United Kingdom) in 2002,
where bedside curtains were identified as the primary
source of carbapenemaseproducing Acinetobacter
species, which were resistant to meropenem.[3] Similarly,
in a recent outbreak of Group A Streptococcus (GAS)
infection in ENT ward in Nottingham (UK), 10 out of
34 bedside curtains identified as reservoirs of GAS.[4]
These data highlight the importance of recognizing
hospital curtains as a potential reservoir of microbial
pathogens. It is imperative for healthcare facilities
to set an appropriate frequency of changing bedside
curtains and promote contact hygiene to minimize
a risk of bacteria transmission. This should be based
on patient discharge and the institutional prevalence
of microbial pathogens such as MRSA. It is crucial to
adapt decontamination protocols to ensure effective
elimination of microbes from hospital curtains. Besides
contact hygiene before and after a patient interaction,
one intervention suggested to spray 3% hydrogen
peroxide to reduce curtain contamination. This technique
is able to decontaminate bedside curtains after 2 h.[5]
It is understandable that several factors contribute to
the hurdles in achieving high disinfect rates; sustained
efforts should be implemented to identify and control
the spread of infectious agents that are transferred by
contacting hospital curtains.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.

Despite proper laundry, patient side curtains were

reported to be contaminated within a week after they

Usman Ghani, Salman Assad,

Touqeer Sulehria, Immad Arif

Department of Critical Care Medicine,

Shifa Tameer-e-Millat University, Islamabad, Pakistan

Correspondence:
Dr. Salman Assad,
Department of Critical Care Medicine,
Shifa Tameer-e-Millat University, Islamabad, Pakistan.
Email: salmanassad91@gmail.com

2016 Indian Journal of Critical Care Medicine | Published by Wolters Kluwer -Medknow
Page no. 56

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Indian Journal of Critical Care Medicine July 2016 Vol 20 Issue 7

433

References
1.

2.
3.
4.

5.

Sehulster L, Chinn RY; CDC; HICPAC. Guidelines for environmental

infection control in healthcare facilities. Recommendations of CDC
and the healthcare infection control practices advisory committee
(HICPAC). MMWR Recomm Rep 2003;52:142.
Trillis F 3rd, Eckstein EC, Budavich R, Pultz MJ, Donskey CJ.
Contamination of hospital curtains with healthcareassociated
pathogens. Infect Control Hosp Epidemiol 2008;29:10746.
Das I, Lambert P, Hill D, Noy M, Bion J, Elliott T. Carbapenemresistant
Acinetobacter and role of curtains in an outbreak in intensive care units.
J Hosp Infect 2002;50:1104.
Mahida N, Beal A, Trigg D, Vaughan N, Boswell T. Outbreak of
invasive group A Streptococcus infection: Contaminated patient curtains
and crossinfection on an ear, nose and throat ward. J Hosp Infect
2014;87:1414.
Neely AN, Maley MP. The 1999 Lindberg award 3% hydrogen peroxide
for the grampositive disinfection of fabrics. J Burn Care Rehabil
1999;20:4717.

Dealing with the

neglected public health
issue of drowning in
lowresource settings

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DOI: 10.4103/0972-5229.186263

How to cite this article: Ghani U, Assad S, Sulehria T, Arif I. Hospital curtains: An
undermined source of nosocomial infections. Indian J Crit Care Med 2016;20:432-3.

or ships poorly maintained or manned by unexperienced

drivers, flood disasters, infants left unsupervised near
water, tourists unaware of prevalent risks, and lack of
barriers limiting exposure to water bodies are some of
the known potential risk factors.[14]

Sir,
Globally, drowning has been acknowledged as one of
the leading causes of deaths attributed to unintentional
injury and accounts for almost 9% of all injuryrelated
fatalities.[1] The current estimates suggest that every
year almost 0.37 million people die due to drowning,
of which more than 90% of the victims are from
low and middleincome nations.[1] Further, the worst
affected regions in terms of incidence are Western Pacific
and Southeast Asia, while the African region has reported
maximum mortality.[1,2] Not only that the available
estimates do not reflect the precise picture as many cases
often go unreported, especially nonfatal events, and
even drowning deaths resulting because of suicide or
homicide or disasters are excluded.[2,3] Moreover, it also
contributes a significant financial burden on the families
and on the health system.[2]
The epidemiological assessment of the global trends
revealed that children in the agegroup of 14 years
have the highest incidence of drowning, while in excess
of 50% of victims are <25 years.[1] Moreover, the overall
death rates have been twice more common in males
than females owing to highrisk behaviors.[1] In addition,
factors such as poor swimming skills, easy access to open
water sources either because of occupation or due to
proximity to house, frequent traveling on water in boats

It is extremely important to understand that once an

individual begins to drown, the result is usually fatal and
is eventually determined based on the promptness of
rescuing the individual from the water, and speed with
which appropriate resuscitation is executed.[2,5] Thus,
prevention is extremely crucial, and interventions such as
creating barriers to restrict access to open water sources;
building safe places for underfive children away from
water sources; and teaching basic swimming, water
safety, and safe rescuerelated skills in schools will have a
sizeable impact on the overall burden of the problem.[24]
Further, measures such as training observers regarding
safe rescue and resuscitation, creating awareness
about the condition and susceptibility among children,
establishing and enforcing safe boating regulations,
ensuring preparedness to adequately respond to flood
disasters, encouraging intersectoral coordination, and
promoting welldesigned studies to ascertain the high
risk factors and impact of corrective strategies will also
eventually reduce the incidence of drowning and its
associated consequences.[25]
Acknowledging the public health importance and the
fact that the condition has been neglected till date, the
World Health Organization has appealed to the national
governments to prioritize the concern of drowning
prevention, generate reliable date on drowning estimates,
integrate it with other public health agendas, formulate a
water safety plan at the national level, and even advocate
for the involvement of all concerned stakeholders.[1,2]

Page no. 57