Library Books: Antibiotic-Resistant Disease-Laden Loan

When most of think about catching a nasty bacterial infection, we think of public restrooms, communal showers, hospitals, emergency rooms, elevators, escalators, door knobs, or standing in a crowd of people. Most of us don't usually stop to think that we could acquire antibiotic-resistant bacteria from a library book. 

That's exactly what researchers at the University of Ibadan in Nigeria found, however, when they tested books at four public libraries for antibiotic-resistant strains of  Bacillus, Proteus, Micrococcus, Stapylococcus, Yersenia, , Klebsiella serratia, Erwinia, Pseudomonas and Providencia. Bacteria associated with infections ranging from MRSA to bubonic plague can be found on the pages of library books, and many of these bacteria are strains that cannot be easily treated with antibiotics.

Just how many library books are contaminated with disease-causing bacteria? The Nigerian researchers found that:

• 2.5 percent of books were contaminated with Erwinia. These bacteria won't make you sick, but they may kill your house plants or your garden.
• 2.5 percent of books were contaminated with Providencia. These are bacteria that can cause urinary tract infections. Just how these bacteria managed to migrate from someone's urinary tract to the pages of a library book we'll leave to your imagination.
• 22.5 percent of books were contaminated with Staphylococcus. These are the bacteria that can cause skin infections. Everyone has some staph bacteria on their skin, but they can easily infect cuts, burns, and abrasions.
• 27.5 percent of books were contaminated with Bacillus. There are only two species of Bacillus that cause medical problems, but one causes food poisoning and the other causes anthrax. The germs of this genus on library books probably got there from feces or spoiled food.

Obviously, lapses in personal hygiene can become important at a public library. That's especially true when one considers how hard it can be to treat the kinds of infections that can be transmitted on library books. In the Nigerian study:

• 17 percent of contaminated books contained bacteria that are resistant to treatment with Cipro (ciprofloxacin).
• 75 percent of contaminated books contained bacteria that are resistant to treatment with tetracycline.
• 100 percent of contaminated books contained bacteria that were resistant to at least one antibiotic.
• Every sample of Staphylococcus aureus was resistant to every antibiotic tested.
• 48 percent of contaminated books contained bacteria that were resistant to every antibiotic the researchers tested.

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Why does this make a difference? Bacteria are capable of passing genes for antibiotic resistance to their neighbors. This means that if you have an infection with some kind of bacteria that responds to antibiotics and you pick up one of these books that is festering with antibiotic-resistant bacteria, the bacteria on the book can make the bacteria already in your body resistant to the antibiotic that is holding them in check. Every worse, many contaminated books in this library contain bacteria that can transfer resistance to any antibiotic your doctor may be using to treat you.

You may not get an infection from the bacteria in an unsanitary book, but those bacteria can make it harder to treat any infection you may already have.

Other Unexpected Sources of Bacterial Infection from Food Poisoning to MRSA

It isn't just library books in Nigeria that can be contaminated with antibiotic-resistant bacteria. The researchers found up to 13,000 bacteria in every cubic centimeter of air in the building. Since the average adult takes in about 500 cubic centimeters (2 cups) of air with every breath, the implication is that every time adult patrons or employees of the library took a breath, they breathed in approximately 6.5 million bacteria. Every single staph bacterium they took in with every breath was potentially antibiotic resistant. Most of the other strains of bacteria they inhaled would also be very difficult to treat.

But this kind of bacteria infection is not a problem just in Nigeria. Gregory Repucci, a professor of food science safety at North Shore Community College in Danvers, Massachusetts, speculates that the same kind and degree of bacterial contamination can be found at the Boston Public Library. Over 20 years ago, American researchers found that half of books in one public library were contaminated with staph bacteria. Scientists at the University of São Paulo in Brazil also have found problematic infestations of fungi that cause allergies. About 20 percent of librarians in the Brazilian study had recurrent problems with hives due to constant exposure to fungus.

What other kinds of shared objects can transmit infections?

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• Academic studies have found bacteria on toys in nurseries and day care centers.
• Magazines at your doctor's office are almost certainly infected with bacteria, fungi, and viruses. Some of these microorganisms die off within 24 hours, so it might be safer to take a magazine on an obscure topic from the bottom of the stack, but the Bacillus bacteria that cause food poisoning form spores that can survive for months or even years.
• Soap dispensers in public restrooms accumulate fecal bacteria. It's important to hold your hands under running water for about 15 seconds to get rid of them.
• Restaurant menus harbor bacteria and viruses for up to 18 hours after contact. Never let a menu touch you plate or silverware, and wash your hands after holding it and before you eat.
• A study in the Journal of Environmental Health in 2007 found that 70 percent of lemon wedges, placed on the rims of glasses or in iced drinks, contained E. coli or other forms of fecal bacteria. It's better to have your drink without them.
• Restroom door handles tend to be germ-laden, since many people don't wash their hands after they use their facilities. Pick up a paper towel to turn the handle to open the door after you have washed your hands.
• A University of Arizona study found that two-thirds of shopping cart handles are contaminated with fecal bacteria. Use the disinfectant wipes provided by the grocery. And finally
• Disinfectant dispensers in public places tend to be contaminated by the people who use them. Don't use a disinfectant provided for you, especially at a doctor's office or in a hospital. Bring your own disinfectant from home.

Most of us who have healthy immune systems avoid coming down with illnesses from the trillions of bacteria we encounter in public places every day. If you are already sick, however, or if you are living with a compromised immune system, avoiding contaminated items in public places may keep you from getting sicker.