Environmental Contamination PCR: Sources, Prevention, and Control

By Dr. Zubair Khalid, DVM, MS, PhD ·

Environmental Contamination PCR: Sources, Prevention, and Control

Introduction to Environmental Contamination in PCR

What is Environmental Contamination in PCR?

Environmental contamination in PCR refers to the introduction of extraneous nucleic acids—typically DNA—into a polymerase chain reaction that are not part of the intended template. These foreign DNA molecules can originate from the laboratory environment, reagents, equipment, or personnel. When present, they are amplified alongside or instead of the target sequence, producing false-positive results, ambiguous data, or complete reaction failure.

The polymerase chain reaction, as described in the foundational Polymerase Chain Reaction methodology, is an exponential amplification process. Each cycle doubles the number of target copies, meaning a single contaminating molecule can produce billions of copies within 30–40 cycles. This extraordinary sensitivity—theoretically capable of detecting a single DNA molecule—is both the technique's greatest strength and its most significant vulnerability. A single copy of contaminating DNA in a reaction tube can generate a strong positive signal indistinguishable from a genuine positive sample.

Environmental contamination is distinct from other PCR failure modes. It is not a problem with the polymerase enzyme, the primer design, or the thermal cycling parameters. Rather, it is an exogenous input problem: unwanted template molecules entering the reaction. Understanding this distinction is essential for troubleshooting, because the solutions differ fundamentally. Contamination requires source identification and elimination, whereas other failures require protocol optimization.

Why It Matters for Accurate Diagnostics and Research

The consequences of environmental contamination range from wasted reagents to catastrophic clinical misdiagnosis. In diagnostic settings, a false-positive PCR result for a pathogen such as Mycobacterium tuberculosis or SARS-CoV-2 can lead to unnecessary treatment, patient anxiety, and inappropriate public health measures. A false-negative result—which can occur if contaminating DNA competes for primers or polymerase—can delay critical treatment decisions.

In research, contamination undermines experimental validity. A study examining gene expression in tumor samples, for instance, could be invalidated if DNA from a previously amplified plasmid contaminates the reaction. The problem is particularly severe in fields like ancient DNA research, forensic science, and microbiome studies, where template quantities are low and the risk of environmental DNA swamping the genuine signal is high. Even in routine cloning and genotyping, contamination wastes time, money, and effort by forcing repeated experiments.

The issue is pervasive enough that dedicated protocols exist for detecting and eliminating contamination from cell culture systems, as discussed in Mycoplasma Contamination PCR and Cell Line Contamination. These protocols exist because contamination is not a rare event—it is a constant threat that requires systematic vigilance.

Common Sources of Contamination

Amplicon Contamination

Amplicon contamination is the most common and most dangerous source of PCR contamination. An amplicon is the DNA product generated by a previous PCR reaction. These products are typically short (100–1000 base pairs), stable, and present in extraordinarily high concentrations—a successful PCR can produce 10¹¹ to 10¹² copies of the target sequence per 50 µL reaction.

The danger of amplicons lies in their abundance and persistence. After thermal cycling, PCR tubes are opened to retrieve products for gel electrophoresis, sequencing, or cloning. Each tube opening releases a micro-aerosol containing millions of amplicon copies. These DNA fragments can remain viable on laboratory surfaces for weeks or months, surviving drying and resisting degradation. They are also resistant to many common decontamination methods because they are short, double-stranded, and often GC-rich.

Amplicon contamination is particularly insidious because it is self-propagating. A contaminated pipette or surface introduces amplicons into a new reaction; that reaction produces more amplicons; and the cycle continues. This is why laboratories that routinely perform PCR on the same target gene for extended periods eventually develop chronic contamination problems if they do not implement rigorous controls.

Reagent and Equipment Contamination

Reagents can become contaminated through multiple routes. The most common is the shared-use of stock solutions. A pipette tip that touches a contaminated surface and then enters a reagent tube introduces foreign DNA into the entire stock. Once contaminated, the reagent distributes the contaminant to every reaction that uses it.

Water is a frequently overlooked source. Molecular biology grade water is treated to remove nucleases, but it is not guaranteed to be DNA-free. If water used for PCR master mix preparation becomes contaminated, every reaction prepared with that water will show contamination. Similarly, buffer concentrates (e.g., 10× PCR buffer containing Tris-HCl, KCl, and MgCl₂) can become contaminated through repeated pipetting.

Equipment contamination affects pipettes, centrifuges, thermal cyclers, and gel electrophoresis apparatus. Pipettes are the highest-risk item because their shafts and internal mechanisms can retain aerosols. Centrifuges can spread contamination through rotor chambers when tubes leak or burst. Thermal cycler heating blocks can harbor DNA from tube exteriors, and gel tanks retain DNA from previous runs if not thoroughly rinsed.

Sample-to-Sample Cross-Contamination

Sample-to-sample cross-contamination occurs when DNA from one clinical or research sample enters another. This is distinct from amplicon contamination because the contaminating DNA is genomic or plasmid DNA from a biological specimen, not a PCR product.

Common routes include:

  • Using the same pipette tip for multiple samples
  • Splashing during sample lysis or DNA extraction
  • Opening tubes too close together, allowing droplets to transfer
  • Using contaminated tissue homogenizers or bead beaters
  • Carryover from DNA extraction columns or magnetic beads

Cross-contamination is particularly problematic in high-throughput settings where many samples are processed simultaneously. It produces false positives that are difficult to identify because the contaminating DNA may be present at low levels, producing weak but genuine amplification signals.

Mechanisms of Contamination Spread

Aerosolization and Droplet Formation

Aerosolization is the primary mechanism by which DNA spreads through a laboratory. When a liquid is disturbed—by pipetting, vortexing, opening a tube, or even walking past a bench—microscopic droplets are ejected into the air. These droplets, ranging from 0.1 to 100 µm in diameter, can remain suspended for hours and travel significant distances.

The physics of aerosol generation during pipetting is well characterized. When the plunger is released to aspirate liquid, a small droplet can form at the tip and be expelled with the air that exits the pipette. When the plunger is pressed to dispense, the rapid displacement of air can create a fine mist. This is why pipetting is the single highest-risk activity in a PCR laboratory.

Aerosolized DNA does not discriminate. It can settle on bench surfaces, enter open reagent tubes, contaminate pipette shafts, and even be inhaled by laboratory personnel (though inhalation is not a contamination risk for the worker—the DNA is not infectious—it does mean the worker can carry DNA on their breath and clothing). The small size of amplicons makes them particularly prone to aerosolization because they do not sediment quickly.

Pipetting Errors and Splashes

Pipetting errors extend beyond aerosol generation. Direct splashes occur when liquid is forcibly expelled from a tip, particularly when the tip is not properly seated or when the user presses the plunger too rapidly. A splash can deposit droplets on the bench, on gloves, or into adjacent tubes.

Carryover contamination occurs when the pipette shaft itself becomes contaminated. If the user aspirates a sample and then releases the plunger while the tip is still in the liquid, liquid can enter the shaft. Subsequent pipetting steps can then release this liquid into new tubes. This is why "pipetting with the tip touching the liquid surface" is discouraged—it creates a pathway for liquid to enter the pipette body.

Another common error is touching the pipette tip to a contaminated surface (such as a gloved hand or bench) before dispensing into a reaction tube. Even a nanoliter of contaminating liquid can contain thousands of DNA copies.

Workflow and Lab Practices

Workflow design has a profound impact on contamination spread. The most critical principle is that PCR involves two distinct phases: pre-amplification (reagent preparation and sample addition) and post-amplification (thermal cycling and product analysis). These phases must be physically separated.

In laboratories without separation, the same bench is used for setting up reactions and running gels. A researcher who loads a gel (opening tubes containing billions of amplicons) and then returns to the same bench to prepare new reactions will inevitably introduce contamination. Even with careful cleaning, the risk remains high because amplicons adhere to surfaces and resist removal.

Poor practices that contribute to contamination include:

  • Wearing the same gloves for pre- and post-amplification work
  • Writing on tubes with contaminated pens
  • Placing tubes in a shared rack that has contacted contaminated surfaces
  • Using the same centrifuge for pre- and post-PCR steps without decontamination
  • Failing to change pipette tips between samples

Detecting Contamination in PCR

Negative Controls and No-Template Controls

The no-template control (NTC) is the most fundamental contamination detection tool. An NTC is a reaction that contains all PCR components (master mix, primers, polymerase, water) but no template DNA. It is subjected to the same thermal cycling as test samples. If the NTC produces amplification, contamination is present.

The NTC serves multiple purposes. First, it detects contamination in the master mix or reagents. Second, it detects contamination introduced during reaction setup. Third, it validates that the amplification signal in test samples is genuinely from the template and not from environmental DNA.

A negative control can also be a sample known to be free of the target DNA (e.g., DNA from a different species for a species-specific assay). This is distinct from an NTC because it contains DNA, just not the target. Negative controls are useful for detecting cross-contamination during DNA extraction and sample processing.

The interpretation of NTC results requires nuance. A single NTC showing a faint band after 40 cycles may indicate low-level contamination or primer-dimer formation. Multiple NTCs showing strong bands indicate significant contamination. The threshold for action depends on the assay's purpose—diagnostic assays require zero contamination, while research assays may tolerate extremely low levels if properly controlled.

Use of Internal Amplification Controls

An internal amplification control (IAC) is a synthetic DNA sequence added to every reaction that is amplified by the same primers as the target but produces a distinguishable product (different size or different probe sequence). The IAC serves two purposes: it detects inhibition (failure of the reaction due to inhibitors in the sample) and it can detect contamination if the IAC is designed to be distinguishable from the target.

The IAC does not directly detect environmental contamination—it detects reaction failure. However, it is valuable for distinguishing contamination from inhibition. If the IAC amplifies but the target does not, the reaction worked and the target is genuinely absent. If neither amplifies, the reaction failed, and the result is invalid regardless of contamination status.

IACs are essential in diagnostic PCR where false negatives are as dangerous as false positives. They are less commonly used in research settings but are recommended for any assay where sample quality is uncertain.

Real-Time PCR and Melting Curve Analysis

Real-time PCR (qPCR) provides additional contamination detection capabilities through fluorescence monitoring and melting curve analysis. In qPCR, amplification is monitored in real time using fluorescent probes (e.g., TaqMan probes) or DNA-binding dyes (e.g., SYBR Green).

Melting curve analysis is particularly useful for detecting contamination. After amplification, the reaction is heated gradually, and fluorescence is monitored. The melting temperature (Tm) of a PCR product depends on its length and GC content. If a contaminating amplicon is present, it will produce a melting peak at a different temperature than the intended product. A well-designed assay should produce a single, sharp melting peak; multiple peaks indicate non-specific amplification or contamination.

Real-time PCR also allows quantification of contamination levels. The cycle threshold (Ct) value—the cycle at which fluorescence exceeds background—is inversely proportional to the starting template concentration. A contaminated NTC will show a Ct value; the lower the Ct, the higher the contamination level. This information helps identify the contamination source: very low Ct values (e.g., Ct < 20) suggest high-level contamination from a recent amplicon spill, while high Ct values (e.g., Ct > 35) suggest low-level environmental DNA.

Prevention Strategies: Laboratory Design and Workflow

Physical Separation of Pre- and Post-PCR Areas

The single most effective contamination prevention strategy is physical separation of pre-amplification and post-amplification activities. This requires at minimum three distinct areas:

  1. Reagent preparation area: Where master mixes are prepared. This area should be free of any DNA-containing samples and should never be used for post-PCR work.
  2. Sample processing area: Where DNA extraction and sample addition to PCR tubes occur. This area is separate from reagent preparation to prevent sample DNA from contaminating reagents.
  3. Post-PCR area: Where thermal cycling, gel electrophoresis, and product analysis occur. This area is the most contaminated and must be strictly isolated.

In an ideal laboratory, these areas are in separate rooms with controlled air flow (positive pressure in pre-PCR rooms, negative pressure in post-PCR rooms). In a teaching laboratory or small facility, this may not be feasible, but physical separation within a single room is still possible using dedicated benches, hoods, and equipment.

The rationale for separation is simple: post-PCR areas contain billions of amplicon copies. If any of these enter the pre-PCR area, they will contaminate reagents and produce false positives. Physical separation is the only way to guarantee that this does not happen.

Unidirectional Workflow

Unidirectional workflow means that samples and reagents move in one direction only: from clean areas to dirty areas, never the reverse. A researcher should proceed from reagent preparation → sample addition → thermal cycling → product analysis, without returning to earlier steps.

This principle applies to personnel movement as well. A researcher who has worked in the post-PCR area should not enter the pre-PCR area without changing gloves, lab coat, and ideally shoes. In high-security facilities, researchers shower and change clothing between areas.

Unidirectional workflow also applies to waste disposal. Used pipette tips, tubes, and gels from post-PCR work must be discarded in dedicated containers that are not opened in pre-PCR areas. Contaminated waste should be treated with bleach or autoclaved before disposal.

Use of Dedicated Equipment and Supplies

Each PCR area should have its own dedicated equipment: pipettes, tube racks, centrifuges, vortexers, and freezer boxes. Cross-use of equipment between areas is a major contamination route. A pipette used in the post-PCR area that is then used in the reagent preparation area will transfer amplicons directly into master mix.

Dedicated supplies include:

  • Pipette tips (ideally with aerosol filters)
  • Microcentrifuge tubes
  • Gloves
  • Lab coats
  • Benchtop absorbent pads
  • Tube racks

Reagents should also be dedicated to specific areas. A stock of PCR water kept in the reagent preparation area should never be taken to the post-PCR area. If it is, it must be discarded and replaced.

Chemical and Enzymatic Decontamination Methods

UV Irradiation

Ultraviolet (UV) irradiation at 254 nm damages DNA by inducing thymine dimer formation, which blocks polymerase extension. UV is commonly used to decontaminate PCR hoods, pipettes, and bench surfaces.

UV irradiation has significant limitations. First, it only affects surfaces directly exposed to the light—DNA in shadows, under equipment, or inside tubes is not affected. Second, UV damage is not complete; some DNA molecules survive, particularly short amplicons that have fewer thymine dimers. Third, UV does not penetrate liquids effectively, so contaminated solutions cannot be decontaminated by UV.

The standard protocol is to expose surfaces to UV for 10–30 minutes before use. However, UV is best used as a supplement to chemical decontamination, not a replacement. It is particularly useful for decontaminating PCR hoods between uses because it requires no liquid and leaves no residue.

Sodium Hypochlorite (Bleach) Treatment

Sodium hypochlorite (NaOCl) is the most effective chemical decontaminant for DNA. It works by oxidizing and degrading nucleic acids, breaking the phosphodiester backbone and modifying bases. A 10% (v/v) solution of household bleach (containing 5.25% sodium hypochlorite) is typically used, providing approximately 0.5% active chlorine.

Bleach treatment is effective against both amplicons and genomic DNA. It is also inexpensive and readily available. The protocol involves:

  1. Wiping surfaces with 10% bleach solution
  2. Allowing contact for 10–15 minutes
  3. Rinsing with water or 70% ethanol to remove residual bleach

Bleach is corrosive and can damage equipment over time. It should not be used on metal surfaces, electronic equipment, or pipette interiors. For these items, 70% ethanol or commercial DNA decontamination solutions (e.g., DNAZap) are preferred.

Enzymatic Digestion with UDG or DNase

Uracil-DNA glycosylase (UDG, also called uracil-N-glycosylase or UNG) is an enzyme that specifically recognizes uracil in DNA and removes the uracil base, creating an abasic site. This abasic site blocks polymerase extension, preventing amplification.

UDG is used in the dUTP/UDG system. In this system, dUTP is substituted for dTTP in the PCR master mix. During amplification, uracil is incorporated into all PCR products. Before setting up a new reaction, the master mix is treated with UDG, which degrades any contaminating uracil-containing amplicons from previous reactions. The UDG is then heat-inactivated during the initial denaturation step (typically 95°C for 10 minutes).

This system is highly effective against amplicon contamination because it specifically targets PCR products (which contain uracil) while leaving genomic DNA (which contains thymine) intact. It is widely used in diagnostic laboratories and is incorporated into many commercial master mixes.

DNase treatment is less commonly used because DNase degrades all DNA, including the template. It is used to decontaminate surfaces and reagents before adding template, but it must be completely inactivated before template addition. Heat inactivation (65°C for 10 minutes) is typically used, but residual DNase activity can degrade the template.

Best Practices for PCR Setup and Handling

Pipetting Techniques

Proper pipetting technique is the first line of defense against contamination. Key principles include:

  1. Use aerosol-resistant tips: These tips contain a filter that blocks aerosols from reaching the pipette shaft. They are essential for PCR work.
  2. Pipette slowly and smoothly: Rapid plunger movement creates aerosols. Aspirate and dispense at a controlled rate.
  3. Avoid touching the tip to contaminated surfaces: The tip should only contact the liquid being pipetted.
  4. Change tips between every sample: Never reuse a tip, even if it appears clean.
  5. Pipette into the center of the tube: Avoid touching the tube wall, which may be contaminated.
  6. Use positive displacement pipettes for viscous samples: These pipettes use a disposable piston and capillary, eliminating carryover.

A common error is "pipetting to the second stop" when dispensing. The second stop is designed to expel residual liquid from the tip, but it also creates a burst of air that can generate aerosols. For PCR, it is better to dispense to the first stop and accept the small residual volume.

Reagent Aliquoting and Storage

Aliquoting reagents into single-use portions prevents contamination of the entire stock. If a 1 mL tube of water is contaminated, only that tube is lost; if a 500 mL bottle is contaminated, the entire supply is compromised.

The protocol for aliquoting is:

  1. Prepare aliquots in a clean area (reagent preparation room)
  2. Use fresh, sterile tubes and pipette tips
  3. Label each aliquot with the reagent name, concentration, and date
  4. Store aliquots at the appropriate temperature (typically -20°C for primers and enzymes, 4°C for buffers)
  5. Discard any aliquot that has been opened or used

Primers are particularly important to aliquot because they are expensive and contamination of a primer stock will affect every reaction using that primer. Working stocks (e.g., 10 µM) should be prepared from concentrated stocks (e.g., 100 µM) and stored separately.

Use of PCR Hoods and Enclosures

PCR hoods (also called PCR workstations) provide a controlled environment for reaction setup. They come in two types:

  1. Laminar flow hoods: These provide a continuous flow of filtered air over the work surface, preventing airborne contaminants from settling. They are used for reagent preparation.
  2. UV hoods: These contain UV lamps that can be turned on between uses to decontaminate the interior. They are used for sample addition.

A PCR hood should be used exclusively for pre-amplification work. The hood should be cleaned before and after each use with 10% bleach followed by 70% ethanol. UV irradiation for 10–15 minutes before use is recommended.

The hood does not eliminate the need for good technique. It reduces the risk of airborne contamination but does not protect against contamination introduced through pipettes, gloves, or reagents.

Common Pitfalls and Troubleshooting

Ignoring Negative Controls

The most common mistake students make is ignoring the NTC. When the NTC shows amplification, the natural response is to assume it is an artifact and proceed with interpreting the experimental results. This is a serious error.

An amplified NTC means the experiment is invalid. Any positive result in test samples could be due to contamination rather than genuine template. The correct response is to:

  1. Stop the experiment
  2. Identify the contamination source
  3. Decontaminate the work area
  4. Repeat the experiment with fresh reagents and new NTCs

Running an experiment with a contaminated NTC and interpreting the results is worse than not running the experiment at all—it produces data that appear valid but are not.

Inadequate Cleaning Between Runs

Another common pitfall is inadequate cleaning between PCR runs. Cleaning with 70% ethanol alone is insufficient—ethanol precipitates DNA rather than degrading it. A visible smear on the bench after ethanol cleaning may still contain millions of DNA copies.

The correct cleaning protocol is:

  1. Wipe surfaces with 10% bleach
  2. Allow 10–15 minutes contact time
  3. Wipe with water to remove bleach residue
  4. Wipe with 70% ethanol to dry and remove any remaining residue

This protocol should be performed before and after each PCR setup session, not just when contamination is suspected.

Misinterpreting Contamination Signals

Students often misinterpret contamination signals. A faint band in the NTC after 40 cycles may be primer-dimer, not contamination. Primer-dimers are short products (typically 40–60 base pairs) formed when primers anneal to each other and extend. They appear as low molecular weight bands on gels and are more common with SYBR Green qPCR.

Distinguishing primer-dimers from contamination:

  • Primer-dimers appear at very low molecular weight (below the expected product)
  • Primer-dimers are more common with high primer concentrations or suboptimal annealing temperatures
  • Primer-dimers are usually reproducible across all reactions, including samples
  • Contamination bands appear at the expected product size

Another misinterpretation is confusing contamination with inhibition. If the NTC amplifies but the positive control does not, the problem may be inhibition (the positive control contains inhibitors) rather than contamination. The IAC is essential for making this distinction.

Summary and Key Takeaways

Environmental contamination is the most significant threat to PCR reliability. It arises from amplicons, reagents, equipment, and samples, and spreads through aerosols, pipetting errors, and poor workflow. Detection relies on negative controls, internal amplification controls, and real-time PCR analysis. Prevention requires physical separation of pre- and post-PCR areas, unidirectional workflow, dedicated equipment, and rigorous decontamination with bleach, UV, or enzymatic methods.

The key to contamination control is systematic vigilance. Every PCR experiment should include appropriate controls, and any sign of contamination should be investigated immediately. The cost of ignoring contamination—invalid results, wasted time, and potentially harmful diagnostic errors—far exceeds the cost of prevention.

Frequently Asked Questions

What is the most common source of contamination in PCR?

Amplicon contamination is the most common source. PCR products from previous reactions are present in extraordinarily high concentrations (10¹¹–10¹² copies per reaction) and are easily aerosolized when tubes are opened. These short DNA fragments persist on surfaces and resist degradation, making them the primary contamination threat in any laboratory that performs PCR regularly.

How can I prevent PCR contamination?

Prevention requires a multi-layered approach: physical separation of pre- and post-PCR areas, unidirectional workflow, dedicated equipment, aerosol-resistant pipette tips, reagent aliquoting, and regular decontamination with 10% bleach followed by 70% ethanol. Always include no-template controls in every experiment to detect contamination if it occurs.

What is a no-template control (NTC)?

An NTC is a PCR reaction that contains all components except template DNA. It is subjected to the same thermal cycling as test samples. If the NTC produces amplification, contamination is present, and the experiment is invalid. The NTC is the most fundamental contamination detection tool in PCR.

Does UV light eliminate all DNA contamination?

No. UV irradiation damages DNA by inducing thymine dimers, but it only affects surfaces directly exposed to the light. DNA in shadows, under equipment, or inside tubes is not affected. UV is useful for decontaminating PCR hoods between uses but should be combined with chemical decontamination (bleach) for reliable results.

Why do I see bands in my negative control?

Bands in the negative control indicate contamination or primer-dimers. If the band is at the expected product size, contamination is present. If the band is at very low molecular weight (below the expected product), it may be primer-dimers. In either case, the experiment is compromised and should be repeated after decontamination.

Can I use bleach to clean my PCR work area?

Yes. A 10% solution of household bleach (approximately 0.5% sodium hypochlorite) is the most effective chemical decontaminant for DNA. Apply it to surfaces, allow 10–15 minutes contact time, then rinse with water and wipe with 70% ethanol. Do not use bleach on metal surfaces, electronic equipment, or pipette interiors.

What is the difference between contamination and inhibition in PCR?

Contamination is the presence of unwanted DNA in the reaction, producing false-positive results. Inhibition is the presence of substances that block polymerase activity, producing false-negative results. Contamination causes amplification in negative controls; inhibition causes failure of amplification in positive controls. An internal amplification control can distinguish between them.

Key Takeaways

  • Environmental contamination in PCR is the introduction of extraneous DNA into reactions, causing false-positive results and invalidating experiments.
  • Amplicon contamination from previous PCR products is the most common and dangerous source, followed by reagent, equipment, and sample-to-sample cross-contamination.
  • Contamination spreads primarily through aerosols generated during pipetting, tube opening, and vortexing.
  • No-template controls are essential for detecting contamination; an amplified NTC invalidates the entire experiment.
  • Physical separation of pre- and post-PCR areas with unidirectional workflow is the most effective prevention strategy.
  • Decontamination requires 10% bleach (10–15 minutes contact) followed by 70% ethanol; UV irradiation is a useful supplement but not sufficient alone.
  • The dUTP/UDG system is a powerful enzymatic method for preventing amplicon carryover contamination in PCR.

Further Reading

  • Ye G et al. Environmental contamination of SARS-CoV-2 in healthcare premises. The Journal of infection. 2020. PubMed 32360881
  • Knapp J et al. Real time PCR to detect the environmental faecal contamination by Echinococcus multilocularis from red fox stools. Veterinary parasitology. 2014. PubMed 24484767
  • Ryu BH et al. Environmental contamination of SARS-CoV-2 during the COVID-19 outbreak in South Korea. American journal of infection control. 2020. PubMed 32485273
  • Shaughnessy MK et al. Environmental Contamination in Households of Patients with Recurrent Clostridium difficile Infection. Applied and environmental microbiology. 2016. PubMed 26921425
  • Ahn JY et al. Environmental contamination in the isolation rooms of COVID-19 patients with severe pneumonia requiring mechanical ventilation or high-flow oxygen therapy. The Journal of hospital infection. 2020. PubMed 32828864
  • Cheesbrough JS et al. Widespread environmental contamination with Norwalk-like viruses (NLV) detected in a prolonged hotel outbreak of gastroenteritis. Epidemiology and infection. 2000. PubMed 11057964

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