Paper Money and Coins as Potential Vectors of Transmissible Disease

Emmanouil Angelakis; Esam I Azhar; Fehmida Bibi; Muhammad Yasir; Ahmed K Al-Ghamdi; Ahmad M Ashshi; Adel G Elshemi; Didier Raoult


Future Microbiol. 2014;9(2):249-261. 

In This Article


Healthcare-associated infections are one of the most serious patient safety issues in healthcare today.[1] Most pathogens are able to survive on surfaces and these surfaces can act as sources of pathogen transmission if no disinfection is performed. In addition, the survival of nosocomial pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), in the environment is of great interest to infection control professionals.[2] Moreover, food workers have been implicated in several outbreaks of food-borne diseases and human occupational activities could introduce the risk of food contamination.[3] Pathogens that can infect food workers have multiple sources and contaminated workers in turn become potential sources of contamination in food processing and preparation facilities.[4]

Fomites are inanimate objects capable of absorbing, harboring and transmitting infectious microorganisms.[5,6] Banknotes and coins are handled by persons of vary­ing health and hygienic standards, and are stored under varying environmental and personal hygienic conditions. Paper currency is widely exchanged for goods and services. Both paper banknotes and coins offer ample surface area to harbor bacteria and microorganisms, and the hygienic status of currency has been a scourge to some for over a century.[5] Several authors have raised the concern that banknotes and coins could serve as vectors for the transmission of disease-causing microorganisms.[5,6] Microbial contaminants may be transmitted directly, through hand-to-hand contact, or indirectly, via food or other inanimate objects. As a result, hand hygiene is considered critical for preventing food outbreaks and healthcare-associated infections.[1] However, only few data are available about the types of patient care activities that are able to transmit the patient flora to healthcare workers' hands. In addition, it remains unclear how long bacteria can survive on paper or how many organisms may be transferred in a full hand-to-paper-to-hand transmission cycle.[1] Although little has been written concerning the potential of banknotes, coins and fomites to become reservoirs and vehicles for the transmission of pathogens, the data have been quietly accumulating. Here, we review the infectious potential of coins, currency notes and fomites.