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Staphylococcus aureus on computer mice and keyboards in intensive care units of the Universitas Academic Hospital, Bloemfontein, and ICU staff’s knowledge of its hazards and cleaning practices

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Nosocomial infections result in severe health and fnancial diffculties for patients and healthcare facilities. The objective of the study was to determine the presence of Staphylococcus aureus on computer mice and keyboards in the intensive care units (ICUs) of Universitas Academic Hospital, Bloemfontein, and ICU staff’s knowledge regarding cleaning of computer mice and keyboards and their potential hazard as reservoirs for pathogens. Swab specimens from computer mice and keyboards (14 each) were investigated for S. aureus. Swabbing was repeated six months later. Standard microbiology laboratory methods were used to culture and identify organisms. An anonymous questionnaire completed by the ICU staff determined their awareness of computer mice and keyboards as potential sources of nosocomial infections. In addition to various environmental microorganisms and normal human fora, S. aureus was initially isolated from one computer mouse, and from two keyboards and fve mice six months later. The questionnaire response rate was 85.6%. Seventy-one percent of respondents stated that they regarded keyboards and mice as an important source of nosocomial infections. Nevertheless, 62% of doctors and 40.3% of nurses indicated that they never washed their hands before or after using the computer. Ninety-seven percent of respondents were not aware of an offcial cleaning policy for computer equipment. In order to prevent nosocomial infections resulting from microbial transmission between equipment, staff and patients, proper cleaning policies should be implemented.
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Southern African Journal of Epidemiology and Infection
ISSN: 1015-8782 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/ojid19
Staphylococcus aureus on computer mice
and keyboards in intensive care units of the
Universitas Academic Hospital, Bloemfontein, and
ICU staff’s knowledge of its hazards and cleaning
practices
P Anastasiades , T L Pratt , L H Rousseau , W H Steinberg & G Joubert
To cite this article: P Anastasiades , T L Pratt , L H Rousseau , W H Steinberg & G Joubert
(2009) Staphylococcus aureus on computer mice and keyboards in intensive care units of the
Universitas Academic Hospital, Bloemfontein, and ICU staff’s knowledge of its hazards and
cleaning practices, Southern African Journal of Epidemiology and Infection, 24:2, 22-26, DOI:
10.1080/10158782.2009.11441345
To link to this article: https://doi.org/10.1080/10158782.2009.11441345
© Federation of Infectious Disease Societies
of South Africa
Published online: 15 Jul 2015.
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22 2009;24(2)South Afr J Epidemiol Infect
Original Research:
Staphylococcus aureus on computer mice and keyboards in intensive care units
Peter Anastasiades, Tiffany L Pratt, Lydia H Rousseau, MBChB students, School of Medicine,
Wilhelm J Steinberg, Department of Family Medicine,
Gina Joubert, Department of Biostatistics
Faculty of Health Sciences, University of the Free State, Bloemfontein.
Correspondence to: Dr. WJ Steinberg, Dept of Family Medicine (G19), University of the Free State, PO Box 339, Bloemfontein, 9300 South Africa
E-mail: gnogwjs.md@ufs.ac.za
Staphylococcus aureus
on computer mice and keyboards in intensive
care units of the Universitas Academic Hospital, Bloemfontein,
and ICU staff's knowledge of its hazards and cleaning practices
P Anastasiades, TL Pratt, LH Rousseau, WH Steinberg, G Joubert
Introduction
Apart from posing serious implications to patients’ health,
nosocomial infections have a considerable financial impact not
only for the individual, but also for the health system. In Brazil,
nosocomial infections cause an estimated 45,000 deaths per year
at an indirect cost of $4.8 billion.1 More than two million patients
acquire nosocomial infections in the United States each year, at a
cost exceeding $4.5 billion and resulting in 90,000 deaths.2 In South
Africa, approximately one in seven patients admitted to hospital are
at risk of developing a nosocomial infection.3 It is estimated that the
worldwide prevalence of nosocomial infections is about 10%, with
an incidence of about 5% of all hospital admissions.4
Healthcare workers are a potential source of hospital-acquired
infections. Pathogens are transmitted by carriage on hands from
inanimate objects present in the hospital setting, including computer
keyboards and mice.5
Staphylococcus aureus causes the majority of all hospital-acquired
infections. It is the most common cause of surgical wound
infections and pneumonia, and the second most common cause
of bacteraemia. Other infections caused by this pathogen include
endocarditis, septicaemia, osteomyelitis, meningitis, various types of
skin infections, gastroenteritis, and toxic shock syndrome.5,6
S. aureus is carried by 20-40% of healthy individuals at any given
time. Carriage occurs mostly on the skin and the organism is found
in large quantities on the mucous membranes of the anterior nares
and vagina. Carriers serve as a source of infection to themselves and
others via direct contact or contamination of fomites.6
Multidrug-resistant strains of S. aureus, particularly methicillin-
resistant S. aureus (MRSA), pose a major clinical and epidemiological
problem in hospitals, as they are easily transferred among hospital
staff and patients, especially in intensive care units (ICUs).7 In a study
conducted in ICUs in the United Kingdom, Hails et al8 found that at
least 16% of patients were colonised with MRSA. A significant factor
contributing to the transmission of microorganisms is their ability to
survive on environmental surfaces. Although microbial contamination
of environmental surfaces in the hospital setting is not unique to
computer equipment, computer keyboards and mice represent a
high contact area for hospital staff, and may contribute to the spread
of potential pathogens without direct patient contact.
Coagulase-negative staphylococci were cultured from all keyboards
investigated in different studies conducted in the USA.9,10 In another
study which focused on the isolation of MRSA, 65% of nurses
who had contact with MRSA-infected patients, contaminated their
uniforms as well as the keyboards and mice in the wards in which
they worked. These results confirmed that inanimate objects could
serve as reservoirs for bacteria.11
Hartmann et al 5 also found that keyboards and mice might serve
as a source for the transmission of microorganisms. Qualitative
bacteriological sampling was used to show that the colonisation rate
for keyboards and mice with potentially pathogenic bacteria was
greater than that of other surfaces in the ICU.5
Nosocomial infections result in severe health and financial difficulties for patients and healthcare facilities. The objective of the study was
to determine the presence of Staphylococcus aureus on computer mice and keyboards in the intensive care units (ICUs) of Universitas
Academic Hospital, Bloemfontein, and ICU staff's knowledge regarding cleaning of computer mice and keyboards and their potential hazard
as reservoirs for pathogens. Swab specimens from computer mice and keyboards (14 each) were investigated for S. aureus. Swabbing
was repeated six months later. Standard microbiology laboratory methods were used to culture and identify organisms. An anonymous
questionnaire completed by the ICU staff determined their awareness of computer mice and keyboards as potential sources of nosocomial
infections. In addition to various environmental microorganisms and normal human flora, S. aureus was initially isolated from one computer
mouse, and from two keyboards and five mice six months later. The questionnaire response rate was 85.6%. Seventy-one percent of
respondents stated that they regarded keyboards and mice as an important source of nosocomial infections. Nevertheless, 62% of doctors
and 40.3% of nurses indicated that they never washed their hands before or after using the computer. Ninety-seven percent of respondents
were not aware of an official cleaning policy for computer equipment. In order to prevent nosocomial infections resulting from microbial
transmission between equipment, staff and patients, proper cleaning policies should be implemented.
South Afr J Epidemiol Infect 2009;24(2):22-26
23 2009;24(2)South Afr J Epidemiol Infect
Original Research:
Staphylococcus aureus on computer mice and keyboards in intensive care units
In a study investigating the presence of both Gram-positive and
Gram-negative bacteria on computer keyboards, coagulase-negative
staphylococci and S. aureus were isolated from 100% and 4% of
keyboards, respectively. It was suggested that plastic keyboard covers
with regular cleaning policies could reduce contamination. It was
found, however, that covers did not provide secure protection against
bacterial transmission due to frequent use. It was then recommended
that the same infection prevention measures employed during direct
contact with patients (i.e. hand washing and use of gloves), should
be enforced when handling computer hardware.10
Universitas Academic Hospital in Bloemfontein does not have a
cleaning protocol for computer keyboards and mice.12 Cleaning
companies usually do not accept responsibility for the cleaning of
technological equipment due to the possible damage and consequent
replacement costs. Cleaning protocols for computer keyboards and
mice were not found in the housekeeping services’ contract.
In view of these circumstances, the aim of this study was to detect
S. aureus on keyboards and mice in the ICUs of Universitas Academic
Hospital. The knowledge of ICU staff with regard to cleaning of
keyboards and mice and the potential hazard posed by these fomites
as reservoirs for pathogenic microorganisms, was also investigated.
Methods
A descriptive study was conducted. Firstly, the presence of S. aureus
on the keyboards and mice in the ICUs was investigated. Secondly,
the knowledge and awareness of ICU staff members regarding
keyboard and mouse contamination, its potential hazard in the
hospital setting, and cleaning policies were determined by means
of a questionnaire.
The study was divided into two categories, namely computer
keyboards and mice in the eight ICUs in Universitas Academic
Hospital, and questionnaire responses. The multi-disciplinary,
surgical, neurosurgical, neonatal, coronary and cardiothoracic
ICUs each had two computers, while the paediatric cardiology and
paediatric ICUs each had one, giving a total of 14 keyboards and 14
computer mice included in the investigation. Personal and secretarial
computers were excluded.
Computer keyboards and mice were swabbed with sterile swabs
moistened in an isotonic saline solution. Swabbing was performed
as shown in Figure 1. Due to the fact that the initial investigation
yielded an unexpectedly low isolation rate of S. aureus, a second
round of the investigation was performed six months later. The
student researchers were trained in the technique of swabbing.
Two researchers were allocated to swab the computer mice
and keyboards, respectively, which was performed by the same
individuals in both rounds of the investigation.
All swabs were streaked out onto mannitol salt agar (MSA) plates and
incubated for 72 hours at 37°C.6,13,14 The student researchers were
trained by an experienced medical technologist to identify microbial
colonies on basic morphological characteristics. Consequently,
estimated colony counts could be obtained for coagulase-negative
staphylococci, Gram-positive bacilli, micrococci, fungi and S. aureus.
The student researchers’ findings were double-checked by the
medical technologist. This technique could, however, be regarded as
a limitation of the study, as a standardised method was not employed
to obtain exact colony counts of each type of organism isolated from
computer mice and keyboards.
In order to isolate and identify S. aureus, Gram stains as well as
catalase and coagulase tests were performed on all colonies turning
MSA plates from pink to yellow. These tests are routinely used in
the local diagnostic microbiology laboratories, and therefore no
additional biochemical investigations were performed to confirm the
identification of S. aureus.
A self-administered questionnaire was used to determine the level
of awareness amongst ICU staff members about keyboards and
mice as reservoirs for potential pathogenic bacteria. Questionnaires
were distributed among staff members (n=160) who were present
at the time of the study. Cleaning staff, nurses, doctors and any other
persons who regularly used the computers in the ICUs were included.
Questionnaires were personally handed out by the researchers
and collected again within two days, ensuring a good response
rate. Participation was voluntary and anonymous, and consent
was obtained from all respondents. In addition to an information
leaflet, the questionnaire was accompanied by pictures of computer
mice and keyboards to clarify any potential misinterpretation by
respondents.
Afrikaans and English questionnaires were distributed, which could
be regarded as a limitation of the study as it was not available in any
of the other nine official languages. However, since the questionnaires
were handed out in person, assistance could be offered should any
problems have occurred.
Approval to perform the investigation was granted by the Ethics
Committee of the Faculty of Health Sciences, University of the
Free State. Permission was also obtained from the Head: Clinical
Services, of the Universitas Academic Hospital, as well as the head of
Department of Medical Microbiology. After a pilot study, conducted in
the Universitas Referrals Department and exactly modeling the main
study, minor changes were made to the questionnaire to ensure
language and technical clarity.
Results
Microbiology results
A contaminated ICU was defined as an ICU with either the computer
mouse or keyboard yielding the isolation of S. aureus. Out of the
Figure 1: Method of swabbing computer mice15 and keyboards16
24 2009;24(2)South Afr J Epidemiol Infect
Original Research:
Staphylococcus aureus on computer mice and keyboards in intensive care units
eight ICUs, only one (12.5%) was contaminated in the first round of
investigation, and five (62.5%) in the second round.
S. aureus was isolated from only one computer mouse and no
keyboards in the first round of investigation. In the second round,
two keyboards (14.3%) and five mice (35.7%) were contaminated.
S. aureus was found on both the computer mouse and keyboard in only
one ICU. The estimated number of colonies grown from the second
round of investigation was less per item than in the first round.
Table 1 summarises the estimated colony counts of the different
types of microorganisms isolated from all the computer mice
and keyboards examined during the first and second rounds of
investigation. From 28 swabs (taken from 14 computer mice and 14
keyboards) obtained in each of these rounds, a total of 806 microbial
colonies were isolated in round one, of which 17 (2.1%) were
identified as S. aureus. In the second round of swabbing,however,
31 (6.6%) S. aureus colonies were isolated.
Coagulase-negative staphylococci (CNS) substantiated the bulk of
the colony count in both rounds of investigation (first round: n=559,
69.4%; second round: n=281, 59.8%) and were isolated from all
the computer mice and keyboards. In round two of the investigation,
performed six months later, 92.8% (n=13) of the keyboards and
78.5% (n=11) of the computer mice were contaminated with CNS.
The Gram-positive bacilli, micrococci and fungi that were isolated
were not identified to species level due to time constraints, and also
because these organisms are commonly regarded as contaminants
of environmental origin. As a result, potential pathogenic species
belonging to each of these groups were not identified, which was
beyond the scope of this investigation. Fungi were only found on
the keyboards and not on the computer mice in both rounds of
swabbing.
When comparing the estimated colony counts obtained during the
first and second rounds of the investigation, results from the second
round showed a lesser degree of contamination (Table 1). With regard
to S. aureus, however, the number of colonies isolated increased
from 17 in the first round to 31 in the second round of investigation.
All 17 colonies of S. aureus cultured during the first round were
obtained from computer mice, while nine colonies of S. aureus were
isolated from keyboards and 22 colonies from computer mice in the
second round of swabbing.
Questionnaire results
From a total of 160 questionnaires distributed to ICU staff members,
137 (85.6%) were returned. The majority of respondents (n=85; 62%)
were nurses, while 31 (22.6%) were doctors and 20 (14.6%) were
cleaning staff. One respondent (0.7%) was a medical technologist.
In the case of cleaning staff, respondents were instructed not to
complete two questionnaire items pertaining to direct contact with
patients, and these specific items from their questionnaires were
excluded from the analysis.
According to questionnaire results as shown in Figure 2, 59% of
doctors indicated that they washed their hands both before and after
contact with a patient, as opposed to 75% of nurses who applied this
practice. Thirty-five percent of doctors and 12% of nurses indicated
that they washed their hands only after contact with a patient.
Figure 3 shows participants' responses with regard to the washing of
hands in relation to the use of computer mice and keyboards. Sixty-
two percent of doctors and 40.3% of nurses indicated that they did
not wash their hands at all (i.e. neither before nor after) when using
computers. The feedback also showed that only 3% of doctors and
16.9% of nurses practiced washing of hands both before and after
the use of computer mice and keyboards.
In response to the questionnaire item investigating participants’
perception regarding the frequency of cleaning of computer mice
and keyboards, contrasting results were obtained. Responses
varied from ‘once a day’ to ‘never’, selected by 37% and 28% of
respondents, respectively. Two percent of respondents believed
Table 1: Comparison of estimated colony counts obtained with first and second
round swabbing of computer mice and keyboards.
Type of organisms
isolated
Estimated colony counts
First round Second round
Keyboards Mice Total Keyboards Mice Total
Coagulase-negative
staphylococci 345 214 559 173 108 281
Gram-positive bacilli 193 28 221 123 24 147
Micrococcus 2 3 5 3 0 3
Fungi 14 0 14 8 0 8
Staphylococcus
aureus 0 17 17 9 22 31
Total 554 262 816 316 154 470
Figure 2: Participants’ response to the questionnaire item pertaining to the
washing of hands and patient contact
100
90
80
70
60
50
40
30
20
10
0
Doctors (n=29)
% of positive responses
Nurses (n=84)
59
75
3
59
34
10 12
Before contact with the patient
Before and after contact with the patient
After contact with the patient
Sometimes
Figure 3: Participants’ response to the questionnaire item pertaining to the
washing of hands and use of computer mice and keyboards
Other
35.2
Before use
35.2
100
90
80
70
60
50
40
30
20
10
0
% of positive responses
Doctors (n=29) Nurses (n=77)
After use
14 11.7
Before and
after use
3
16.9
Before use
62
40.3
Do not use
computer
14
20.8
25 2009;24(2)South Afr J Epidemiol Infect
Original Research:
Staphylococcus aureus on computer mice and keyboards in intensive care units
computer mice and keyboards were cleaned once a year, 4% once a
month and 5% once a week.
When respondents were asked to indicate who they thought was
assigned the responsibility of cleaning computer mice and keyboards,
12% indicated a member of the nursing staff, while 39% said it was
done by the cleaning staff and 40% said that no-one was doing it.
The most commonly suggested cleaning method as perceived by the
participants, was using a wet or damp cloth to wipe the computer
mice and keyboards, with 22% and 23% of respondents suggesting
this method for mice and keyboards, respectively. Other agents
suggested for cleaning of mice and keyboards included Biocide
D solution (14%), Hibitane solution (11%) and alcohol, which was
suggested by only 9% of respondents as a cleaning agent for
computer mice.
In response to the questionnaire item indicating that computer
mice and keyboards played an important role in the transmission
of nosocomial infections, 71% of respondents said yes, 5% said no,
and 24% were not sure. The feedback from different occupational
groups with regard to computer equipment as a potential source of
nosocomial infections is demonstrated in Figure 4.
Hundred percent of doctors, 97% of nurses and 88% of cleaners
indicated that they were not aware of the existence of any cleaning
policy for computer mice and keyboards.
Discussion
The rate of contaminated ICUs (12.5% in the first round and 62.5%
in the second round of the investigation) was consistent with results
reported in the literature, ranging from zero to 38%.1-4,7-11
Although the total microbiological burden on computer mice
and keyboards was higher in the first round of the investigation,
S. aureus was isolated in greater numbers during the second round.
However, no valid scientific explanation could be put forward for this
observation. It would be purely speculative to propose that either
the level of contamination had been diminished, colonisation with
S. aureus had increased, or the level of environmental cleaning and
disinfection had improved.
More computer mice were contaminated with S. aureus as compared
to keyboards. A possible explanation for this finding might be that an
individual's hand is in direct contact with the upper surface of the
computer mouse. In addition, one’s palm is usually moist to a varying
degree due to perspiration, which contains sodium chloride that will
sustain the growth of halophilic bacteria such as S. aureus.4,6
Although CNS are found in large numbers in the environment and
are present on the human body as a member of the commensal
flora, these organisms can cause serious opportunistic infections
in an immunocompromised individual,17 ranging from urinary tract
infections to osteomyelitis and valvular endocarditis. Therefore, the
high isolation rate of CNS from computer mice and keyboards in the
ICUs was a cause of concern.
Aerobic Gram-positive bacilli are frequently isolated from a wide
variety of environmental sources and are usually not of medical
importance. Micrococci are also found in the environment and are
members of the normal flora in humans. Micrococcus luteus, however,
can cause endocarditis and pneumonia in immunocompromised
patients.17,18
Fungi are very common and widely distributed environmental
organisms. It should be noted, however, that even non-
pathogenic fungi can cause serious morbidity and mortality in
immunocompromised persons such as HIV/AIDS patients, patients
undergoing treatment for various malignancies, and those suffering
from diabetes mellitus,5,6,17,18
The antibiotic susceptibility profiles of the S. aureus strains isolated
from computer mice and keyboards in the ICUs were not determined
in this study, and therefore warrant further investigation.
The response rate of 85.6% to the questionnaire was sufficient to
regard it as representative of the total ICU medical, nursing and
cleaning staff of Universitas Academic Hospital. The questionnaire
provided information regarding important issues, such as washing
of hands in relation to contact with patients and computer mice
and keyboard use, and the awareness of cleaning policies and
procedures.
Despite the fact that 60% of doctors and 81% of nurses believed
that computer mice and keyboards played an important role in the
transmission of nosocomial infections, 62% of doctors and 40.3%
of nurses indicated that they never washed their hands when using
computers. This discrepant finding gave the impression that although
an awareness existed among medical and nursing staff regarding the
potential health hazard of computer mice and keyboards, the majority
of them did not consider washing of hands as a preventive measure
to break the potential cycle of microbial transmission between
computer equipment, staff and patients. The importance of applying
hand hygiene, not only when contact with patients is involved, needs
to be addressed. It is furthermore essential that emphasis is focused
on the actual implementation of and compliance to these protocols,
rather than merely increasing awareness.3,7-9
The cleaners were generally perceived to be responsible for cleaning
the keyboards and mice. However, the external cleaning company
hired by Universitas Academic Hospital has no such contractual
obligation. The absence of an official cleaning protocol for computer
mice and keyboards was highlighted by the perception of 37% of
respondents that computers were cleaned once a day, and 28% of
respondents who believed that it was not done at all. This conflicting
feedback was supported by the fact that the vast majority of ICU staff
Figure 4: Comparison of different occupational groups’ feedback with
regard to computer mice and keyboards as playing an important role in the
transmission of nosocomial infections
100
90
80
70
60
50
40
30
20
10
0
Doctors (n=30)
% of positive responses
No
60
10
30
Doctors (n=30)
81
2
17
Doctors (n=30)
44
12
44
Not sureYes
26 2009;24(2)South Afr J Epidemiol Infect
Original Research:
Staphylococcus aureus on computer mice and keyboards in intensive care units
members (≥88%) were not aware of any cleaning policy regarding
computer mice and keyboards.
Only 9% of respondents were of the opinion that alcohol was a suitable
cleaning agent for computer mice, which is in actual fact the most
appropriate disinfectant to use on the type of material computer mice
and keyboards are made of. The frequency of cleaning of computer
mice and keyboards, and proper training of the person appointed
to take responsibility for this matter, should be elucidated with the
Infection Control Division of the hospital, the person in charge of
each ICU, and the manager of the cleaning staff.
According to guidelines proposed by the Centers for Disease Control
and Prevention (CDC) in the USA, difficult-to-clean hospital equipment
(eg. computer keyboards) should be protected from potential
contamination by means of special protective covers.19,20 However,
despite the use of keyboard covers on bedside computers, Neely
et al21 reported an increase in Acinetobacter baumannii colonisation of
patients in a paediatric burn unit. The keyboard covers were identified
as the primary source of this organism, which was transferred
from the covers to staff's hands and subsequently to patients. The
problem could only be reversed after daily cleaning and disinfection
of the covers were instated as a supplementary control measure,21
thus emphasising regular cleaning and disinfection procedures as
the key solution to keyboard contamination in hospitals.
Neely et al7 further recommended the use of immersible computer
keyboards in high-risk areas in hospitals, such as patients’ rooms.
The use of washable computer equipment, especially keyboards
and mice, have been found to reduce the spread of pathogenic
microorganisms considerably.22 The UK-based inventor and
manufacturer of washable computer equipment, Unotron Ltd,
predicted in 2006 that their fully-immersible computer mouse
had the potential to be “one of the most significant preventative
measures since the introduction of hand washing”.23 Due to financial
constraints currently experienced in the South African Department
of Health, the cost of these highly developed technological devices
might be a deterring factor in the acquisition of this type of equipment
for large-scale use in hospitals.
Failure of staff to adhere to facility procedures with regard to cleaning
and disinfection of surfaces and equipment in the hospital setting
is regarded as one of the most common reasons for environmental
contamination with microorganisms.24 In conclusion, it should
therefore be recommended to the management as well as the
housekeeping and infection control divisions of the hospital, that a
protocol should be established with specific reference to computer
mice and keyboards, especially in the ICUs. The person(s) responsible
for this task should be identified, and also the frequency and method
of cleaning, with ethanol being proposed as the most effective in
terms of reducing microorganisms as well as cost. Furthermore, a
specific protocol on the washing of hands before and after using
computer mice and keyboards is strongly advocated.
Acknowledgements
The authors thank the ICU staff members of the Universitas Academic
Hospital who participated in the study; Dr Nic van Zyl, Head: Clinical
Services of Universitas Academic Hospital who granted permission
for this investigation to be undertaken and published; Department of
Medical Microbiology, Faculty of Health Sciences, University of the
Free State, for permission to use laboratory facilities and equipment,
and Elzette Sonnekus and Mthethelei Kesa, for assistance with the
isolation and identification of microorganisms; Daleen Struwig,
medical writer, Faculty of Health Sciences, for technical and editorial
preparation of the manuscript for publication.
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... Computers are ubiquitous in the health care centers and have been shown to be contaminated with potentially pathogenic microorganisms [3,4]. ...
... The increased availability of multiple user computers in the university setting means that these items or equipment are handed by numerous users on a daily basis given that computers are not routinely disinfected , the opportunity for the transmission of contaminating microorganisms potentially great [3,5,6]. ...
... Soiling is on important factor in preserving viability of bacteria on hand surfaces thus dirty surfaces would harbor more bacteria than clean ones. This makes the process of dusting and removal of soil and distby simple cleaning procedures of paramount influence on the reduction of surface contamination [3,4,10]. ...
Article
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A study was carried out to isolate and identify microorganism associated with computer keyboards and mice. A total of (250) samples were collected from two different objects (150) samples from the keyboards and (100) samples from the mice. Samples were collected from different Computer centers places some computer laboratories (multiple-user) in college of medicine, Al-Batol Teaching Hospital, Al-Jamhory Teaching Hospital in Mosul City and Laptops of Single-user (staff rooms).The collected samples were inoculated on Nutrient agar,, Salmonella-Shighella agar, Blood agar, Chogulate agar ,Maconkey agar ,Brucella agar and Minnitol Salt agar .The isolates obtained were examined and identified by colonial morphology; biochemical characteristics and Gram stain, 99.2% of total samples collected were contaminated with mixed bacterial growth. The bacteria that have been isolates includes, Gram positive bacilli,Gram negative bacilli, Staphylococcus aureus , Staphylococcus epidermis ,Enterococcus, Escherichia coli, Streptococcus.The study indicated that the number of microorganisms present on multiple-user computer keyboard and mice were greater than the single user computer keyboards and mice. The presence of pathogenic and commercial bacteria on the computer keyboards and mice indicates that they might acts as environmental vehicles for the transmission of potentially pathogenic bacteria. Our data recommended that regular cleaning and disinfection of the different parts of computers must be used to reduce the microbial load especially for multiple user work station. Aims of the study This study aims to identify the types of bacteria which could be the source of contamination from computer keyboards and mouse to the users. 2
... Computers are ubiquitous in the health care centers and have been shown to be contaminated with potentially pathogenic microorganisms [3,4]. ...
... The increased availability of multiple user computers in the university setting means that these items or equipment are handed by numerous users on a daily basis given that computers are not routinely disinfected , the opportunity for the transmission of contaminating microorganisms potentially great [3,5,6]. ...
... Soiling is on important factor in preserving viability of bacteria on hand surfaces thus dirty surfaces would harbor more bacteria than clean ones. This makes the process of dusting and removal of soil and distby simple cleaning procedures of paramount influence on the reduction of surface contamination [3,4,10]. ...
Article
Full-text available
This study concerned with the effect of trichomonas vaginalis parasute on the histology of mice testis The parasite was taken from the vaginal swap of female albatooo hospital and inoculated of the parasite in the mice after 15days the testis was taken showed many histological changes while there was no changes in the testis of control group
... Nous obtenons 109 réponses, soit un taux de participation global de 31 %. Selon la catégorie professionnelle, ce taux est de 34 % pour les praticiens et sages-femmes (66 réponses [2][3][4][5][6][7]. En raison du recours de plus en plus intensif à « l'informatisation », les ordinateurs sont aujourd'hui omniprésents à l'hôpital, de plus en plus proches des patients et accessibles à tous. ...
... La question à réponse libre reflète l'intérêt que portent les soignants sur la contamination de leur environnement puisqu'elle totalise 48 commentaires (44 %) dont la majorité témoigne de l'implication et de la volonté d'amélioration des pratiques des participants. AnAstAsiAdes et al. ont également utilisé un questionnaire pour évaluer les connaissances du personnel hospitalier sur la contamination bactérienne des claviers dont une majorité d'infirmières et seulement vingt médecins[7]. Dans leur étude, AnAstAsiAdes et al.Tableau III -Pratiques et fréquences de nettoyage des claviers selon la fonction au sein de l'établissement. ...
... De plus, tout change-puisque la compliance générale à l'HdM des professionnels de santé est évaluée à 40 %[19]. AnAstAsiAdes et al. montrent que 62 % et 40,3 % des médecins et infirmières ne pratiquent aucune HdM lors de l'utilisation d'ordinateurs[7].Notre étude montre que les consignes données par l'EOH sont méconnues pour la majorité des prescripteurs et pharmaciens (69 %) ainsi que pour la moitié des internes, elles seraient en revanche connues des autres professionnels de santé (80 % des cadres). Ces consignes envoyées par l'EOH à l'ensemble des cadres de santé et disponibles sous forme d'affiche (« SHA (solution hydroalcoolique) avant utilisation du clavier en attendant l'acquisition progressive de matériel facile à nettoyer ») avaient été données en juin 2009 mais très peu d'affiches sont encore visibles. ...
Article
Contexte. Les claviers des ordinateurs, omniprésents à l’hôpital et très difficiles à nettoyer, abritent des bactéries potentiellement pathogènes. Il nous a semblé nécessaire d’interroger les professionnels de santé à propos de leur perception d’un risque éventuel lié à l’utilisation de ces dispositifs. Matériel et méthode. Un questionnaire anonyme de dix questions est créé en ligne et communiqué par mail à certains professionnels de santé pour évaluer leurs connaissances, opinions et attentes sur la contamination bactérienne des claviers et les mesures d’hygiène associées. Résultats. Cent neuf personnes ont répondu dont une majorité de praticiens. Leurs opinions sont convergentes pour la quasi-totalité des sujets abordés ; plus de 90% des participants estiment que les claviers abritent des germes potentiellement pathogènes transférables aux mains de l’utilisateur. L’hygiène des mains doit être réalisée avant et après utilisation des claviers et leur nettoyage doit être quotidien selon plus de 70% des participants. Des dispositifs facilitant l’entretien des claviers sont souhaités. Discussion et conclusion. Les réponses à l’enquête nous fournissent une base de réflexion pour mettre en place de nouvelles barrières d’hygiène souhaitées par la majorité des professionnels de santé.
... However, S. aureus has been implicated to cause a number of infections in humans (Hartman et al., 2004;Kanayama et al., 2017). S. epidermidis occasionally assumes an opportunistic pathogenic role in causing human infection such as endocarditis (Anastasiades et al., 2009;Muhammad et al., 2016). But it is important to note that the increased virulence of S. epidermidis resulting from the acquisition of methicillin-resistance has been recognized in isolates from keyboards (Ben-Saida et al., 2006). ...
... But it is important to note that the increased virulence of S. epidermidis resulting from the acquisition of methicillin-resistance has been recognized in isolates from keyboards (Ben-Saida et al., 2006). This may reinforce the assertion of the role of computer keyboards as aetiologic agents for infectious pathogens (Nwankiti et al., 2012) especially as this traditional skin flora can occasionally assume an opportunistic role in causing human infection such as endocarditis (Anastasiades et al., 2009). This finding is similar to those of Hartmann et al. (2004), who isolated S. epidermidis from computer keyboards in the Intensive Care Units on multiple user computers. ...
... The occurrence of bacterial and fungal analyzed in this study may be due to handling methods as well as environment factors. This study is also in conformity with Anastasiades et al. (2009) who reported that Staphylococcus aureus is prevalent. S. aureus is of health significance as it can cause food poisoning. ...
Article
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Automated Teller Machines (ATMs) services are considered one of the most essential services offered by the banking industry globally. These services are provided within certain locations, both within and outside the area of the bank branches. Like all surfaces, microbial colonization of these metallic keypads is eminent. On this premise, microbial examination of ATMs (monitors and keyboards) in selected locations (Ozoro, Abraka, Obiaruku and Ughelli) of Delta State were examined for pathogenic bacteria isolates (Escherichia coli, Enterobacter sp, Citrobacter sp, Staphylococcus aureus, Bacillus sp and Klebsiella sp) and fungal isolates (Aspergillus niger, Botrytis sp, Mucor sp and Penicillum sp) using swab culture method. The percentage prevalence of bacterial isolates from the samples were Escherichia coli (13.33%), Enterobacter sp (10.00%), Citrobacter sp (13.33%), Staphylococcus aureus (13.33%), Bacillus sp (26.66%) and Klebsiella sp (20.02%). Fungal isolates recorded were Aspergillus niger (26.66%), Botrytis sp (13.34%), Mucor sp (40.00%) and Penicillum sp (20.00%). It was also observed that values of total viable count on the keyboard across the samples were higher than the monitor except that of Abraka. Findings from this study revealed that ATMs might be potential areas for pathogen accumulation and transmission, prompting the need for adequate personal hygiene by both the users and custodians of such machines for effective public health management.
... A similar study in Ebonyi State by [11] revealed S. aureus to be the most abundant (28.57%) bacterial isolate followed by E. coli (21.43%). The study is also in conformity with [12] who reported that Staphylococcus aureus was prevalent. ...
Article
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Money is an essential commodity in the life of humans and it is required to meet daily needs; as such, there is always a consistent usage of automated teller machines (ATM) to withdraw money to meet these needs. In this process, however, there is exchange of pathogenic and non-pathogenic microbes resulting from direct contact from the numerous users of these piece of equipment, especially with hands which are even known to be a 'house' of microorganisms. The study was carried out to evaluate the antibiotic susceptibility patterns of bacteria present on Automated Teller Machines (ATM) in Calabar Communities in Calabar, Cross River State, Nigeria. One hundred and fifty (150) samples were collected and analysed using standard microbiological procedures. Isolates were identified by microscopic, biochemical and carbohydrate fermentation characterizations. The susceptibility of the isolates to antibiotics was determined by the modified Kirby-Bauer disc diffusion method. Results revealed that all ATMs harbored seven different species of bacteria namely Escherichia coli, Staphylococcus aureus, Bacillus subtilis, Pseudomonas aeruginosa, Salmonella typhimurium, Klebsiella spp., and Shigella spp. However, Staphylococcus aureus was the most frequently occurring bacterial isolate (28.3%) followed by Escherichia coli (18.6%), Bacillus spp. (17.7%), Pseudomonas aeruginosa (14.2%), Salmonella typhimurium. (9.7%), Klebsiella spp. (6.2%) and Shigella spp. (5.2%) respectively. Antibiotic susceptibility results showed a zone of inhibition ranging from 8mm to 45mm. The widest zone of inhibition (45mm) was recorded with Augmentin for Salmonella typhimurium while the least zone of inhibition (8mm) was recorded in Ampicillin for Pseudomonas aeruginosa. All bacterial isolates showed a high level of resistance (6mm) to Nalidixic acid except Klebsiella spp. (10mm) and Salmonella typhimurium. Overall, Ceproflox and Quinolone showed the highest efficacy against the bacteria isolates followed by Augmentin and Tarivid. Heavy bacterial presence on ATM surfaces is evident from this study. Frequent disinfection of ATMs surfaces and their accessories along with periodic microbiological surveillance is thereby recommended.
... The point of contact is the customer's hands to the surfaces of keypad and/or screen of these devices. Anastasiades et al [9] reported that ATM's located in hospitals were most contaminated (100%) while those in fast food centres were least contaminated (50%). The levels of contamination could be linked to several factors ranging from frequency of machine use, hygiene status of users and the surrounding environment. ...
Article
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Background: Automated Teller Machines (ATMs) represent a good transient environment for development of pathogenic microbes. Investigation on the level of bacterial contaminants on keypads of ATMs was carried out in Akure, Nigeria. Methods: A total of sixty ATMs keypads were sampled in two major locations (main market and Federal University of Technology, campus) in Akure. Samples were collected from key-pad and screen parts of the ATM devices with sterile swab sticks and was cultured immediately on Nutrient agar, Manitol salt agar, and MacConkey agar mediums for Microbial examination. Standard bacteriological methods were employed in the analysis of the sample. Presumptive identification of bacterial isolates was by cellular morphology, Gram staining reaction, motility, catalase, coagulase test, oxidase strip test and MICROBACT Biochemical Identification system was used to identify the species of the oxidase negative Gram negative bacteria. Results: Out of 30 ATMs keypads examined in the two locations, 28 and 22 yeilded bacteria growth in Akure main Market and FUTA Campus respectively. The organisms isolated were Staphylococcus aureus, Klebsiella species, Escherichia coli, Pseudomonas and Bacillus species. All the bacterial isolates showed high resistance to Ampicillin but low resistance to Ciprofloxacin. Conclusion: The study confirmed the presence of pathogenic bacteria species on ATM key-pads with possible health implications in Akure, Nigeria. Daily and regular cleaning regimen of the key-pads with sanitizers, and public enlightenment on the hygienic usage of the keypads is necessary to reduce health risks to the users.
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Objetivo – As infecções relacionadas à assistência à saúde são um problema mundial. A contaminação de pacientes através de mãos e objetos constitui-se na principal causa de infecção. O objetivo deste foi avaliar a contaminação bacteriana de terminais de computadores utilizados em diferentes setores do Hospital de Clínicas de Passo Fundo-RS (HCPF), analisando o possível papel dos mesmos como fômites de infecção hospitalar. Métodos – Ao todo foram coletadas amostras de 221 terminais de computadores situados em setores críticos, semicríticos e não críticos. A coleta foi realizada com swab umedecido em solução salina, por fricção, sendo o material semeado em placas de Petri contendo ágar sangue e ágar MacConkey. As placas foram incubadas a 35-37ºC por 24 horas e as colônias presentes nos meios de cultura foram identificadas por técnicas convencionais. Resultados – Em 87,5% das amostras houve crescimento de micro-organismos, sendo identificados 11 tipos de bactérias. Cocos Gram-positivos foram os mais frequentes, com predominância de Staphylococcus coagulase-negativos (44,3%). As bactérias Gram-negativas foram responsáveis por apenas 4,2% dos casos. Não houve diferença significativa entre os três setores, embora Staphylococcus aureus tenha ocorrido com maior frequência nos setores críticos. Conclusão – Elevados níveis de contaminação foram observados nos terminais de computadores dos três setores, reforçando a importância da higienização desses equipamentos para evitar a transmissão cruzada de micro-organismos para os pacientes. Descritores: Bactéria; Computador; Contaminação; Hospital
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Background: Using of Automated Teller Machines (ATMs) and Point of Sale (POS) devices can be one of the agents transmit various microbial and fungal infections in public. In addition because of its usage and the simplification for transporting money and the other utilizations such as providing a well accessibility to personal account for shopping and other activities which are related and required to displacing different amount of money, these devices are being preferred to use increasingly. Thus it is obvious that the severe usage of these devices by public with different level of health, can be lead to diffusion of such microbial microorganisms and play an important role in spreading a lot of illnesses, such as: skin diseases, allergies and etc. which may have many economic and health consequences to those people. Aim: To determine the pathogens which have essential roles in imperiling the social health and recognize the factors of related contamination and illnesses, they involve thereinafter. Study design: Descriptive cross-sectional Methods: In this survey, a total of 6360 samples including 2610 ATMs and 3750 POS devices were randomly sampled from their keyboards and cultured on different culture medias by using principal scientific sources and standard microbial methods. Result: The highest rate of microbial contamination from ATM devices was due to Staphylococcus epidermidis (17,36%) and its lowest rate was Pseudomonas Spp (3,22%). In case of POS devices, the highest rate was Staphylococcus epidermidis (18,53%)and the lowest rate was Pseudomonas (2,99%). According to the results obtained in this study, the microbes which can be transmitted by ATMs and POS devices to different people, can be harmful to social health and increasing the rate of related illnesses among people; thus by right informing and warning people of bad consequences which comes afterward by disregarding and inobservance to personal and social health as well as using correct cleaning methods for these devices, can be useful for decreasing the transmission of infections properly.
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The early detection of colonization with methicillin-resistant Staphylococcus aureus (MRSA) of patients in intensive-care units is an essential step in the strategy for preventing MRSA epidemics. In this study, tubes containing soft salt-mannitol agar with cloxacillin (6 μg/ml) (SSMAC) were prepared for inoculation of clinical samples at patients’ bedsides by personnel of an intensive-care unit. A total of 1,914 swabs from different sample sites of 81 patients were dipped into SSMAC tubes, and after 24 h of incubation (in an incubator located near the intensive-care unit), an evident color change was considered by the intensive-care-unit personnel to be an MRSA alarm. Sixty-three (3.3%) SSMAC tubes were considered positive for MRSA, 1,827 (95.4%) were considered negative, and 24 (1.2%) were considered intermediate. Compared with values for parallel conventional surveillance cultures for MRSA, excluding tubes with intermediate results, the SSMAC test had a sensitivity of 72.7%, a specificity of 99.2%, a positive predictive value of 76.2%, and a negative predictive value of 99.0%. When intermediate tubes were considered positive, the corresponding values were 75.3, 98.2, 63.2, and 99.0%, respectively. The sensitivity and specificity values of the test to identify MRSA-colonized patients were 89.4 and 100%, respectively. Oropharyngeal and naris specimens were the most reliable samples for MRSA detection. False-negative results were frequent in bronchial aspirates with low (<103 to 106 CFU/ml) MRSA counts. False-positive results were mainly due to methicillin-resistant Staphylococcus haemolyticus. The SSMAC tube is a useful, rapid, and inexpensive tool for the early identification of MRSA-colonized patients and, consequently, for the implementation of measures to prevent the spread of MRSA.
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The stethoscope is a universal tool in the hospital that is in direct contact with many patients and can therefore be a vector in the dissemination of bacterial infections. To research the presence of bacteria, fungi and yeast on the stethoscope diaphragm and the resistance of bacteria to antimicrobial drugs. Descriptive, prospective, non-controlled. A tertiary care hospital. Samples were taken randomly from 300 stethoscopes employed by medical staff (medical residents, medical students, nurses and nursing school students) and other sectors of the hospital. Three hundred stethoscope diaphragms used in several sectors of the hospital facilities by medical doctors (63 samples), medical residents (54 samples), medical students (106 samples), nursing school students (33 samples) and specific sectors (36 samples) were analyzed. Material was collected randomly. It was collected with the aid of a sterile swab moistened in physiological solution, inoculated into Brain Heart Infusion media and incubated in an oven for 24 to 48 hours. After this period, the samples were inoculated into blood agar, MacConkey agar and Sabouraud media and identified by Gram staining and biochemical assays. An assay to test bacteria sensitivity to antibiotics was also carried out by the Kirby-Bauer method. Eighty-seven percent of the analyzed stethoscopes were contaminated. Gram-positive cocci, yeasts, fungi and Gram-positive and negative bacilli were isolated. There was no significant association between the most predominant microorganisms and professional category. Staphylococcus aureus, Staphylococcus negative coagulase and Bacillus were significantly more frequent in relation to the presence of more than one microorganism on the stethoscope diaphragm. Stethoscopes presented a high rate of contamination and their use without precautions can spread nosocomial infections.
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Objective: User interfaces of patient data management systems (PDMS) in intensive care units (ICU), like computer keyboard and mouse, may serve as reservoirs for the transmission of microorganisms. Pathogens may be transferred via the hands of personnel to the patient causing nosocomial infections. The purpose of this study was to examine the microbial contamination of computer user interfaces with potentially pathogenic microorganisms, compared with other fomites in a surgical intensive care unit of a tertiary teaching hospital. Methods: Sterile swab samples were received from patient's bedside computer keyboard and mouse, and three other sites (infusion pumps, ventilator, ward round trolley) in the patient's room in a 14 bed surgical intensive care unit at a university hospital. At the central ward samples from keyboard and mouse of the physician's workstation, and control buttons of the ward's intercom and telephone receiver were obtained. Quantitative and qualitative bacteriological sampling occurred during two periods of three months each on eight nonconsecutive days. Results: In all 14 patients' rooms we collected a total of 1118 samples: 222 samples from keyboards and mice, 214 from infusion pumps and 174 from the ward's trolley. From the central ward 16 samples per formites were obtained (computer keyboard and mouse at the physician's workstation and the ward's intercom and telephone receiver). Microbacterial analysis from samples in patients' rooms yielded 26 contaminated samples from keyboard and mouse (5.9%) compared with 18 positive results from other fomites within patients' rooms (3.0%; p < 0.02). At the physician's computer terminal two samples obtained from the mouse (6.3%) showed positive microbial testing whereas the ward's intercom and telephone receiver were not contaminated (p = 0.15). Conclusions: The colonization rate for computer keyboard and mouse of a PDMS with potentially pathogenic microorganisms is greater than that of other user interfaces in a surgical ICU. These fomites may be additional reservoirs for the transmision of microorganisms and become vectors for cross-transmission of nosocomial infections in the ICU setting.
Article
ISSUE: The introduction of computer equipment and devices (CE) into patient care settings has greatly increased in recent years. The potential for this equipment to serve as a reservoir for infectious organisms was identified by the infection control working group (ICWG) and the outcomes management department of our multihospital system. A computer disinfection taskforce (TF) was established to provide guidelines for cleaning and disinfection of this equipment for use by each hospital. PROJECT: The TF consisted of infection control professionals (ICPs) throughout the system, representatives of major service lines, and administrative and information technology professionals. Meetings were conducted via conference calls and supplemented by e-mail communications. A literature review was done of computer contamination in medical settings. In addition, all ICPs in the system were asked for any written policies related to cleaning/disinfection of CE. From this the TF determined that recognition of the problem was highly variable throughout the system. The taskforce also discussed criteria development, specifically that recommendations would need to be consistent with recognized authorities and flexible to fit the needs of the many hospitals in the system. Different types of CE likely to be in contact with patients were reviewed and equipment specifications were examined to determine what types of cleaning solutions might be used. RESULTS: Four recommendations were made related to CE and included: 1) When cleaning/disinfecting computer hardware, use the same type of cleaner/disinfectant and the same frequency of cleaning as would normally be used for other devices in that area. 2) The use of plastic keyboard covers or immersible keyboards should be considered for direct patient care areas. 3) When purchasing computer hardware, consider the design and purchase equipment with as many smooth surfaces as possible to reduce the risk of microbial contamination. 4) Ensure that use of CE is included in policies for handwashing. The final recommendations were reviewed by the ICWG and the director of medical affairs prior to distribution. LESSONS LEARNED: Development of a guideline for use in a multihospital system should have representation from all involved disciplines as well as a representative sample of hospitals within the system. This will ensure that the guidelines take into account the variety of clinical settings encountered within the system.
Article
We postulate that computer keyboards and faucet handles are significant reservoirs of nosocomial pathogens in the intensive care unit (ICU) setting. Sterile swab samples were obtained from 10 keyboards and 8 pairs of faucet handles in the medical ICU at Tripler Army Medical Center during a period of 2 months. Methicillin-resistant Staphylococcus aureus (MRSA) obtained from the environmental and patient specimens were sent for DNA identification by using pulsed-field gel electrophoresis. A total of 144 samples were obtained (80 keyboards and 64 faucet handles), yielding 33 isolates. The colonization rate for keyboards was 24% for all rooms and 26% in occupied rooms. Rates for faucet handles in all rooms and occupied rooms were 11% and 15%, respectively. The environmental isolates annd their prevalence were: MRS, 49%; Enterococcus, 18%; Enterobacter, 12%; and all other gram-negative rods, 21%. Fourteen individual patient isolates were recorded: MRSA, 43%; Enterobacter, 21%; other gram-negative rods, 36%; and Enterococcus, 0%. By using pulsed-field gel electrophoresis, an indistinguishable strain of MRSA was identified in two patients, the keyboards and faucet handles in their respective rooms, and on other keyboards throughout the ICU, including the doctors' station. The colonization rate for keyboards and faucet handles, novel and unrecognized fomites, is greater than that of other well-studied ICU surfaces in rooms with patients positive for MRSA. Our findings suggest an associated pattern of environmental contamination and patient infection, not limited to the patient's room. Pulsed-field gel electrophoresis results have documented an indistinguishable strain of MRSA present as an environmental contaminant on these two fomites and in two patients with clinical infections patients during the same period. We believe these findings add evidence to support the hypothesis that these particular surfaces may serve as reservoirs of nosocomial pathogens and vectors for cross-transmission in the ICU setting. New infection control policies and engineering plans were initiated on the basis of our results.
Article
Methicillin-resistant Staphylococcus aureus (MRSA) is a major problem in intensive care units in most countries. Despite recommendations for screening and isolation of patients with MRSA our perception has been that there is little uniformity in approach in ICUs besides adherence to basic infection control procedures. We thus sought to identify MRSA prevalence and the variation of infection control policy across intensive care units in England. Postal questionnaire with telephone follow-up in English intensive care units. Responses were obtained from 217 (96%) ICUs. Marked variation in practice was noted in terms of patient screening, staff screening, infection control procedures, isolation or cohorting of colonised/infected patients, and ward discharge policy. Point prevalence data showed that 16.2% of ICU patients were known to be colonised or infected with MRSA. There was a regional bias, but no difference was noted between high and low prevalence regions in terms of unit demographics or infection control policies. This study highlights the lack of consistent policy across English ICUs regarding isolation, screening and discharge practices for MRSA. Prospective studies are urgently needed to determine best practice.
Article
We tested 100 keyboards in 29 clinical areas for bacterial contamination. Ninety five were positive for microorganisms. Streptococcus, Clostridium perfringens, Enterococcus (including one vancomycin-resistant Enterococcus), Staphylococcus aureus, fungi, and gram-negative organisms were isolated. Computer equipment must be kept clean so it does not become another vehicle for transmission of pathogens to patients.