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Hotel Rooms – Source of Community Associated Infections?

Keith Warriner
May 27, 2014

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I was waiting for a connection at Lisbon airport when an Assistant Producer from the Canadian Broadcast Company (CBC) called my mobile to gauge interest on undertaking a study to determine the sanitary status of hotel rooms. Of course there have been a number of studies performed over the years on hotel rooms but the majority were small and only designed to fill a 5 min feature on a slow news day. The CBC Marketplace people were more ambitious and planned to visit over 54 hotel rooms from six national chains in three major cities. The study encompassed looking at un-cleaned hotel surfaces using a black-light, followed by ATP swabs to get a general indication of microbial loading. Microbial testing included enumerating total aerobic counts, methicillin resistant bacteria (primarily MRSA), Clostridium difficile and the fecal indicators Escherichia coli/coliforms. Other studies had taken samples all over the room but our plan was to focus on frequent contact surfaces- TV remote controls, phones, alarm clock, bed covers, bathroom countertop and toilet seat.

 

With suitcase in hand we set off undercover and started sampling the hotel rooms. Early into the study it was evident that there were issues with the sanitary standards regardless if we were paying $100 per night or over $300. At the end of the sampling trials the low-lights we found were recycled bed sheets, chamber maids using their cleaning brushes for all surfaces regardless if this was a toilet or countertop. One could only imagine how the contamination went from one room to another on those famous cleaning brushes.

 
 
A CBC Marketplace Investigation Has Uncovered... by tvnportal 

 

Glasses in the bathroom were rinsed or given a dab of hand soap rather than replaced not to mention some interesting stains on beds etc. We also found visible mould on air conditioning units and ice machines. In terms of microbiological counts, high coliform levels were found on the comforter, TV remote, bathroom countertop, faucet and toilet seat. We also recovered antibiotic resistant strains from 19% of surfaces with 46% being confirmed as MRSA.  Toxigenic C difficile was also isolated from two hotel rooms. Twenty-four percent of the ice sampled contained high levels of coliforms with one testing positive for E coli.  

 

The media has a field day

 

To my surprise, the program attracted media interest when it was broadcasted across. I was happy that the study brought sanitation to the forefront as it is an important aspect of our lives.  As always there were a mixture of positive and negative comments. With respect to the latter, comments could be broadly classified on those relating to my acting abilities (or lack thereof) and qualifications to undertake such a study. Of the more constructive criticisms, the reoccurring comments were that our homes are equally as bad and that the risk of acquiring infections from contact surfaces was extremely low.  

 

So can infections be acquired from hotel rooms?

 

Attributing infections linked to hotels or domestic homes for that matter, is problematic given no surveys have been performed. From our own experiences, we know that if someone in our household suffers a cold or norovirus we can be sure that the rest of the residents will also acquire it. But what of hotels? Well, there was a study published by Cheesbrough & co-workers that illustrated the spread of norovirus within hotels with sequential guests acquiring infections. If we go back over 10 years ago to the SARS outbreak, there was the story of the infected Chinese Doctor who visited Hong Kong and booked into the Metropole hotel room 911. Unfortunately the Doctor died a few days later but not before sixteen hotel patrons contracted the virus and started spreading it across the globe.

 

What infections can be acquired from different sources with hotel rooms?

 

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Ice machines: An alarming feature of our study was the lack of sanitation of ice machines. With ice, the water used is dechlorinated to avoid flavor taints so there is nothing to stop bacteria multiplying. The carbon filters become a home for biofilms thereby potentially a breeding ground for all types of pathogens including Salmonella and Shiga Toxin Producing Escherichia coli, amongst others.  Therefore, if carbon filters are not changed every 4-6 months then ice machines can be a potential source of pathogens.

 

Air conditioning units: Airborne infections, especially moulds such as Aspergillus, are of concern given the spores can readily be breathed in thereby potentially causing aspergillious or more commonly named Farmer’s Lung.

 

470966571Bed sheets and contact surfaces: It is well documented that urinary tract infections can be acquired from bed linin and one would assume comforters. MRSA can also be transmitted through bed sheets if the user has an open cut or wound. With TV remotes plausible that MRSA present on the handheld device can transfer the pathogen by simply rubbing their eyes. Of course being exposed to MRSA is one aspect but the host also needs to be within a susceptible group such as elderly and other immune-compromised groups.

 

The bathroom: The bathroom can be considered one of the highest risk areas given that pathogens from infected persons can be shed in high numbers and then spread via aerosols when the toilet is flushed. The pathogen can become resident on the counter top, faucet and flush handle. Obviously, the cleaners brush going from the toilet to the sink is a more direct route. Once deposited then it is possible to transfer pathogens by oral routes via a tooth brush placed on the counter before using or indirectly via failing to wash hands then tucking into room service fare. Certainly one way to acquire C difficile infection .

 

What is the relative risk?

 

To conclude, I still standby my proposition that patrons can acquire infections from hotel rooms although suspect this is limited to those most susceptible in the population. For the rest, one could assume our immune-system provides adequate protection but this does not stop us acting as vehicles for pathogen transfer. In terms of relative risk of acquiring infection we simply don’t have enough data if we are exposed to more potential pathogens within hotel room’s relative the airplane, sub-way, taxi or elevator that brought us there. Still, I suspect most of us think that the sanitary standards within hotel rooms are higher than they actually are. Therefore, it may make sense to take a few precautions before jumping on the bed and using that remote.

  

Read more: Xu, C, Weese, SJ and Warriner, K (2014). Sanitary Status and Incidence of Methicillin Resistant Staphylococcus aureus and Clostridium difficile within Canadian
Hotel Rooms. Journal of Environmental Health (In Press).

 

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