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In one hospital, almost 50% of hand cultures from staff were positive at the end of their working shift (113).Factors such as debilitating clinical condition, lengthy ward-stay and frequent exposure to medical interventions, most likely act by necessitating increased frequency and intensity of direct contact with staff hands (111).Results from a recent surveillance programme in the US and Europe, indicate that spp., accounts for an average of 6.5% of all Gram negative infection in Intensive Care Units (ranked 5th amongst Gram negative organisms in ICU) and an average of 3.5% in non-ICU patients (91).Currently is the seventh most common cause of pneumonia with an incidence of 4.1% in the US, 3.2% in Europe and 2.4% in Latin America (51), and the tenth most common cause of bloodstream infection with an incidence of 2.0% amongst hospitalized patients (2).

Many diverse environmental sources such as air conditioning units (82), urine-collecting basins (122), bed-pan macerators (42), liquid soap dispensers (104) and even tap water (46) have also been implicated.

Once established, carriage is persistent and patients are likely to carry the organism at multiple sites, with the throat and nose identified as common sites in 59% and 31% of colonized patients, respectively (11).

Regardless of the source or reservoir, the predominant mode of spread of from hand cultures of hospital staff has been reported consistently in epidemiologic studies (39, 49).

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