Understanding antibiotic resistance
Understanding antibiotic resistance

Start this free course now. Just create an account and sign in. Enrol and complete the course for a free statement of participation or digital badge if available.

2.1.2 Indirect transmission of pathogens

Indirect transmission occurs when an infected person sheds bacteria into the air, water, food or onto other objects in the environment (known collectively as fomites), which can then infect someone else. Figure 4 summarises these indirect transmission routes.

Described image
Figure 4 Routes of indirect person-to-person transmission of infection.

Fomites are objects in the environment, such as door handles, cups and pens, that are routinely touched and can transmit infections. Healthcare-associated infections (HCAIs) can easily be indirectly transmitted to susceptible patients via fomites. A quarter of HCAIs are caused by antibiotic-resistant bacteria such as MRSA.

In the next activity, you will look at fomites that might transmit HCAIs.

Activity 2 Fomites and healthcare-associated infections

Timing: Allow about 5 minutes

Identify the fomites in this picture of hospital staff in 2001 that might transmit HCAIs.

A photo of a nurse talking to a group of three young doctors.
Figure 5 Hospital staff photographed in 2001.
To use this interactive functionality a free OU account is required. Sign in or register.
Interactive feature not available in single page view (see it in standard view).


Neck ties, stethoscopes, long-sleeved clothing, hospital badges worn at waist height and wrist watches could all brush against patients with infections and act as fomites, transmitting the infection to a susceptible individual. Consequently, in UK hospitals today, all staff must have their arms bare below the elbows and wrist watches and neck ties are banned.

Sanitation and hygiene both play an important role in preventing indirect transmission via the routes summarised in Figure 5. Next, you will look at how sanitation and hygiene prevent faecal–oral transmission and the effect that this could have on antibiotic use.

Take your learning further

Making the decision to study can be a big step, which is why you'll want a trusted University. The Open University has 50 years’ experience delivering flexible learning and 170,000 students are studying with us right now. Take a look at all Open University courses.

If you are new to University-level study, we offer two introductory routes to our qualifications. You could either choose to start with an Access module, or a module which allows you to count your previous learning towards an Open University qualification. Read our guide on Where to take your learning next for more information.

Not ready for formal University study? Then browse over 1000 free courses on OpenLearn and sign up to our newsletter to hear about new free courses as they are released.

Every year, thousands of students decide to study with The Open University. With over 120 qualifications, we’ve got the right course for you.

Request an Open University prospectus371