Fomite Transmission Among Respiratory Viruses and the Importance of Low-level Surface Disinfection

Background Many different respiratory viruses cause substantial morbidity and mortality worldwide. The impact of these viruses on human health is not well understood since diagnostic testing is uncommon, available tests have modest diagnostic accuracy, and therapies are rare. This leaves infection prevention our primary resource for reduction in morbidity and mortality due to these viruses. Main Body A practical approach to prevention of respiratory virus transmission is to institute protections to reduce the risk from all sources of potential transmission. This approach is called the “swiss cheese model” and is often considered the cornerstone of quality. Although mask use has been given a great deal of discussion for respiratory virus prevention, the role of surfaces and indirect contact transmission through fomites has been largely ignored despite a great deal of supporting evidence. Fomite transmission even more critical, as it is tightly interconnected with both droplet and airborne routes. Two major interventions for prevention of indirect contact from fomites include hand hygiene and surface disinfection. Given the difficulty in monitoring and ensuring compliance with hand hygiene, the importance of surface disinfection has been deemed more and more critical over the past decade. Nevertheless, a major bottleneck with surface disinfection as a transmission reduction intervention is that it is a “momentary event’, and microorganisms rapidly recontaminate the environment after traditional disinfection approaches. One improvement to these surface disinfection interventions may be to add continuously acting disinfectants or antimicrobial surface coatings to compatible surfaces. These are products that have bactericidal or bacteriostatic activity for an extended period of time. Several of these products exist, but only a few have shown effectiveness in interventional studies against a variety of pathogens. Conclusion During a time when SARS-CoV-2 is ravaging the world, when influenza viruses decimate populations annually, and countless other respiratory viruses cause significant morbidity, ensuring the most effective prevention interventions are both socially accepted and evidence-based is critical. Our approaches to respiratory virus transmission reduction must be all-encompassing if we wish to truly break the chain of transmission. This includes ensuring environmental hygiene through surface disinfection.