Toothbrushes are commonly used in hospital settings and may harbor potentially harmful microorganisms. A peer-reviewed literature review was conducted to evaluate the cumulative state of knowledge related to toothbrush contamination and its possible role in disease transmission. A systematic review was conducted on adult human subjects through three distinct searches. The review resulted in seven experimental and three descriptive studies which identified multiple concepts related to toothbrush contamination to include contamination, methods for decontamination, storage, design, and environmental factors. The selected studies found that toothbrushes of healthy and oral diseased adults become contaminated with pathogenic bacteria from the dental plaque, design, environment, or a combination of factors. There are no studies that specifically examine toothbrush contamination and the role of environmental factors, toothbrush contamination, and vulnerable populations in the hospital setting (e.g., critically ill adults) and toothbrush use in nursing clinical practice. 1. Introduction Toothbrushes play an essential role in oral hygiene and are commonly found in both community and hospital settings. Toothbrushes may play a significant role in disease transmission and increase the risk of infection since they can serve as a reservoir for microorganisms in healthy, oral-diseased and medically ill adults [1]. Contamination is the retention and survival of infectious organisms that occur on animate or inanimate objects. In healthy adults, contamination of toothbrushes occurs early after initial use and increases with repeated use [2, 3]. Toothbrushes can become contaminated from the oral cavity, environment, hands, aerosol contamination, and storage containers. Bacteria which attach to, accumulate, and survive on toothbrushes may be transmitted to the individual causing disease [4, 5]. In the hospital setting, toothbrushes are commonly used for oral care by nurses. There is a need for standardized nursing guidelines to prevent toothbrush contamination, which may increase the risk of infections from potentially pathogenic microorganisms and is clinically relevant for assessing the risks and benefits of oral care and informing nursing practice. This review of peer-reviewed literature was conducted to evaluate the cumulative state of knowledge related to toothbrush contamination, its possible role in disease transmission, and in preparation for a research study related to toothbrush contamination in critically ill adults. 2. Methods A systematic review of the
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