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

Fomites & Money in the Spread of Nosocomial Infections

It is believed that the main route of transmission of most pathogens is via the transiently contaminated hands of the healthcare worker.[34] A single contact of a hand with a contaminated surface can result in a variable degree of pathogen transfer.[8] In hospitals, surfaces, such as beds and keyboards, that come into contact with hands serve as reservoirs of nosocomial pathogens and vectors for cross-transmission.[35,36] Banknotes and coins can also serve as pathogen reservoirs.[17] Moreover, various inanimate objects in the operating room theatre that are directly or indirectly associated with surgical procedures were found to be variously contaminated with known bacterial and fungal pathogens (Box 1).

Banknotes can serve as a potential source of pathogens and, in a study from India, the greatest number of S. aureus isolates was found on paper currency that was recovered from hospitals.[17] In addition, it was found that epidemic nosocomial and community-acquired MRSA can easily survive on coins when soil (pus and blood) was also present.[2] Over half of the surface samples from hospitals in the USA and Ireland were found to be contaminated with MRSA, including those taken from beds and mattresses, and the strains were similar to those isolated from patients.[37,38] Cell phones could also be a source of pathogens, and in Saudi Arabia, coagulase-negative staphylococci and antibiotic-resistant Micrococcus spp. were isolated from cell phones.[26] Contamination of the faucet handles of the single sink used for hand washing by technologists in the work area was responsible for an outbreak of Shigella sonnei in the Rhode Island Hospital.[39] Moreover, hospital personnel may transmit C. difficile to susceptible patients by transient carriage on their hands. The same strain of C. difficile was isolated from the hands of children and teachers in a diarrheal outbreak in a day-care setting.[40] In summary, evidence from healthcare studies and outbreaks has revealed that fomites, including money and coins, can serve as reservoirs of nosocomial pathogens.