Fig. 1

Approach for the Assessment of ESKAPE+C Pathogen Transmission for Direct and Indirect Transmission Events. a For the direct contact scenario, the primary VITRO-SKIN coupon is inoculated with a mix of pathogen and background bacteria, representing a contaminated patient hand (step 1). The inoculated VITRO-SKIN is either washed (step 2a) or not washed (step 2b) and then touched to a new, secondary VITRO-SKIN with only background microorganisms (step 3), simulating the touch transfer of bacteria from a sick patient to a clean healthcare worker. The secondary VITRO-SKIN with any transferred bacteria (step 4), representing the contaminated healthcare worker, is then harvested for downstream analysis (step 5). b For the indirect contact scenario, the primary VITRO-SKIN coupon is inoculated with a mix of pathogen and background bacteria, representing a contaminated patient hand. The inoculated VITRO-SKIN is touched to a surface (nitrile, stainless steel, or cotton), simulating bacterial transfer to the fomite (step 1). The fomite then either undergoes a surface-appropriate wash (step 2a) or does not (2b). A new, secondary VITRO-SKIN with only background microorganisms, representing a clean health worker hand, touches the fomite (step 3) where bacteria on the surface may transfer to the secondary VITRO-SKIN (step 4). The secondary VITRO-SKIN with any transferred bacteria is then harvested for downstream analysis (step 5)