Books as Fomites: How Much 'Culture' Can One Good Book Provide?

1. Books as Fomites: how much ‘culture’ can one good book provide? Jay Watson Dara Wegman-Geedey, PhD Year of the Book presentation 16 April 2008

2. First things first…. • WHAT is a fomite? • Current usage: a fomite is any inanimate object that transfers pathogens from one host to another or from a natural reservoir to a susceptible host • Origins: The word fomite is a back-formation from the plural fomites, which was originally the Latin plural of the singular, fomes, literally meaning “touchwood” or “tinder.” In classical Latin, fomites was pronounced like a concatenation of English "foe" + "me" + "tays"; but "foe" + "mites" has now become a common pronunciation, and "fomite" (also pronounced with a long 'i') is the singular form in English. (http://en.wikipedia.org/wiki/Fomites)

3. Properties of “good” fomites… • Varies for bacteria, but in general: • non-porous surfaces • moderate humidity (approx 45-65%) • must also consider cell walls, endospores, possible VNC status • Varies widely for viruses, but in general: • non-porous surfaces • moderate humidity (approx 45-50%) • presence of microbes

4. A brief history of books as fomites…. • Mostly anecdotal from late 1800s/early 1900s – no definite study data • Diphtheria in US: 2 children handling books at a farmhouse where diphtheria had been present years prior • Smallpox in US: 1 person borrowing books from a library in neighboring town where a smallpox outbreak had occurred • Scarlet fever in US: 1 person from book in which “a young sufferer had used pieces of his peeling skin as bookmarks” • streptococci/pneumococci in France: lab isolations from books handled by infected patients • Ringworm from XIVth century parchment, Yucel & Kantarcioglu, 1998

5. Books/paper as fomites in popular culture • Microban folders, local Staples, 2007 • Microbeguard’s Food Touch  paper liners, AP release Jan 2007 • Seinfeld episode: “The Bookstore,” April 1998 • Paper currency, Pope et al., 2002 • England/Wales Public Health (Control of Disease) Act, 1984, Atensteadt, 2006 • Paper towel litter, Harrison, et al., 2003

6. Our questions… • Would the environmental conditions of the library support growth of pathogens? • Would the conditions in special collections differ in support of pathogen growth compared to the standard library stacks? • Would the physical make-up of a book (e.g., cloth vs paper) affect the survival of pathogens? • Would survival of pathogens differ on various types of information storage materials? • books, periodicals, microfilm. microfiche

7. Effect of Library Environment on Pathogen Growth • Environment of each floor and Special Collections was evaluated from at least 10 positions to find average temperature, humidity, light • Representative incubation sites chosen: 2nd floor stacks, special collections, control in lab incubator • Staphylococcus aureus, S. epidermidis and Escherichia coli stock cultures were grown overnight in tryptic soy broth • Diluted samples of S. aureus, S. epidermidis and E. coli were spread plated separately on tryptic soy agar plates • Replicates made for placement in each incubation area • TSA plates were evaluated daily for three days • Colonies counted by visual examination of the plates

8. Library Environs Results, Control

9. Library Environs Results, part 2

10. Library Environs Results, part 3

11. Library Environment Conclusions • Library and special collections environmental conditions support growth of a Gram negative organism (E. coli) but fail to support growth of Gram positive bacteria (Staphylococcus sp.) • But these conditions don’t kill the Gram positive organisms either. Returning them to optimal conditions resulted in maximum expected growth.

12. Effect of Materials on Pathogen Survival • Store-bought spray bottles were evaluated and calibrated for delivery of appropriate “spritz” size • S. aureus and E. coli cultures were grown overnight in TSB • Books, periodicals, microfilm and microfiche (substrates) “retired” from the library were inoculated with either diluted spritzes of S. aureus or E. coli • Substrates were immediately sampled using PetriFilm direct contact method to determine survival of model pathogens • Sampling repeated at one week intervals for a one month period

13. Materials Effect on Survival Results

14. Materials Effect on Survival Conclusions (in progress) • Survival on non-porous surfaces appears better than on non-porous for both model organisms • Survival of Gram positive S. aureus appears better on all surfaces than the Gram negative E. coli

15. The take-home message…. • WASH your hands after handling potential fomites • use liquid handsoap that does not contain Triclosan or other antimicrobials • don’t need to select for the strong ones, just need to remove bacteria from your hands • 30 seconds: “Happy Birthday” twice • all surfaces, under nails • Alcohol-based hand sanitizers okay – but only if no running water available

16. Acknowledgements • Student researchers: • Rihana Al-Ghalayini ‘09 • Christine Bridge ’08 • Jay Watson ’08 • Special thanks: • to the library staff for donating “retired” books, journals, microfilm and microfiche from the Tredway Library collection. • and to Alyssa Tillary ‘10 who helped plate cultures for the environmental conditions study in the library. • and to 3M for the first 200 PetriFilms: donated as part of the 3M Microbiology University Program.