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Nosocomial infections, also known as hospital-acquired infections, are primarily spread through direct contact, particularly through the hands of healthcare staff. Hands serve as a major vector for transmitting pathogens from one patient to another, as well as from contaminated surfaces and medical equipment. The significance of hand hygiene in preventing the spread of infections in healthcare settings is well-documented. Regular handwashing and the use of hand sanitizers are critical measures in infection control protocols to mitigate this risk.

While other factors like dirty laundry, air-conditioning, and hospital food can contribute to infections, they are not the primary routes of transmission. For example, while contaminated laundry may harbor pathogens, it is not as immediate a concern as the contamination that may occur from healthcare workers' hands during patient care. Air-conditioning systems can circulate dust and contaminants but are less directly linked to person-to-person transmission. Hospital food, if improperly handled, can certainly pose risks, but it's not as significant a pathway for the widespread transmission of nosocomial infections compared to the hands of staff. Thus, the hands of healthcare staff represent the most common and critical route for the spread of nosocomial infections.