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Bacteriological Monitoring and Evaluation of Cleaning-disinfection of Computer-related Equipment in an Obstetric and Gynecology Hospital

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It is already known that computer keyboards and mouses in hospitals are contaminated with different kinds of bacteria. However, the mouse pad has been neglected with regard to both research and regular cleaning and disinfection in hospitals. In our study, we monitored and evaluated the bacteriology degrees of 74 computers' keyboards, mouses and mouse pads from six departments. The results showed that before cleaning-disinfection, the contamination rate of the mouse pad ranked second following the keyboards. Enterococcus Faecium was cultured from the mouse pads. The computer-related equipment in the wards and outpatient rooms were much more contaminated than that in the operating rooms. Acinetobacter spp. was only isolated from the doctor's computers. After cleaning-disinfection, 4 strains of MRSA were isolated from the keyboards and the mouses, one and 3 were cultured at day 3 and day 5 after cleaning-disinfection, respectively. One strain of Pseudomonas Aeruginosa was isolated from the mouses at day 3 after cleaning-disinfection.These demonstrated that the bacterial contamination of the mouse pads must be as emphasized as that of the keyboards and mouses. Furthermore, It is better to clean and disinfect the computer-related equipment(keyboards, mouses, mouse pads) at least once a day.
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1
1Bacteriological Monitoring and Evaluation of Cleaning-disinfection of
2Computer-related Equipment in an Obstetric and Gynecology Hospital
3Meiling Li1*, Tingyan Lu2, Hongwei Zhang3, Shufang Chen1*, Xueying Mao4, Li Shen2,
4Yan Lu5 and Shufang Leng1
51 Department of hospital infection management, The International Peace Maternity & Child
6Health Hospital of China welfare institute attached to Shanghai Jiao Tong university school
7of medicine, Shanghai, China
82 Department of Clinical laboratory, The International Peace Maternity & Child Health
9Hospital of China welfare institute attached to Shanghai Jiao Tong university school of
10 medicine, Shanghai, China
11 3 Department of Epidemiology, Secondary Military Medical University, Shanghai, China.
12 4 Centre for Molecular Oncology, Barts Cancer Institute, Barts and the London School of
13 Medicine and Dentistry, Queen Mary University of London, London, UK
14 5 Department of Internal medicine, The International Peace Maternity & Child Health
15 Hospital of China welfare institute attached to Shanghai Jiao Tong university school of
16 medicine, Shanghai, China
17 Corresponding author: Meiling Li1*: E-mail address: limeilinghua@163.com; Shufang
18 Chen1*:E-mail address: 18017316228@163.com
19
20 Abstract
21 It is already known that computer keyboards and mouses in hospitals are contaminated with
22 different kinds of bacteria. However, the mouse pad has been neglected with regard to both research
23 and regular cleaning and disinfection in hospitals. In our study, we monitored and evaluated the
24 bacteriology degrees of 74 computers’ keyboards, mouses and mouse pads from six
25 departments. The results showed that before cleaning-disinfection, the contamination rate of the
26 mouse pad ranked second following the keyboards. Enterococcus Faecium was cultured from
27 the mouse pads. The computer-related equipment in the wards and outpatient rooms were
28 much more contaminated than that in the operating rooms. Acinetobacter spp. was only
29 isolated from the doctor’s computers. After cleaning-disinfection, 4 strains of MRSA were
30 isolated from the keyboards and the mouses, one and 3 were cultured at day 3 and day 5
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31 after cleaning-disinfection, respectively. One strain of Pseudomonas Aeruginosa was
32 isolated from the mouses at day 3 after cleaning-disinfection.These demonstrated that the
33 bacterial contamination of the mouse pads must be as emphasized as that of the keyboards and
34 mouses. Furthermore, It is better to clean and disinfect the computer-related
35 equipment(keyboards, mouses, mouse pads) at least once a day.
36 Keywards: Contamination; Computer-related equipment; Cleaning-disinfection;
37
38 Introduction
39 On a global scale, hospital-acquired infections (HAIs) have become one of the most
40 important causes of morbidity and mortality in medical institutions[1-5] and also threaten
41 the safety of health-care providers[6]. According to a survey from the World Health
42 Organization, there are approximately 1.7 million and 4.5 million HAI patients in USA and
43 Europe, respectively, accounting for 37,000 and 100,000 deaths each year. Many pathogens,
44 such as MRSA, VRE, Acinetobacter, Klebsiella, Listeria, Escherichia coli, Mycobacterium
45 tuberculosis, Pseudomonas aeruginosa and the Noel virus, can survive on a dry object
46 surface for several months or even a year [7-9]. Therefore, cleaning and disinfecting the
47 high-touch object surfaces is an important measure for controlling HAIs [10].
48 There have been many studies emphasizing the importance of cleaning and disinfecting
49 the computer keyboard and mouse in healthcare settings, representing an important type of
50 high-touch object surface. One study demonstrated that 95% of keyboards in a teaching
51 hospital had growth of one or more microorganisms, and 5% were positive for pathogens
52 known to be associated with HAI transmission, such as Staphylococcus aureus and
53 Enterococci [11]. Some studies showed that the keyboard or mouse was one of the most
54 likely bacterial vehicles in the ICU and that the degree of contamination cannot be
55 neglected [12-14]. A survey of two acute district general hospitals indicated that MRSA
56 had been identified on computer terminals (24%), and five of the MRSA-positive terminals
57 were from hospital A, which had a significantly higher rate of MRSA transmission than
58 hospital B [15]. However, the mouse pads have been neglected in both research and the
59 regular cleaning-disinfection in hospitals.
60 In our research, we aimed to address four issues: 1) The bacteriological characteristics
61 of computer-related equipment, especially the mouse pad; 2) The bacteriological
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62 characteristics of computer-related equipment in different clinical departments; 3) The
63 bacteriological characteristics of doctor’s and nurse’s computer-related equipment in the
64 wards; 4) How often we should clean and disinfect computer-related equipment.
65
66 Materials and methods
67 Study Object Selection
68 chosen between October 2014 and December 2015 (Supplementary Table 1). In the
69 wards, 1 nurse’s station computer, 1 doctor’s office computer and 1 doctor’s mobile
70 computer from each obstetric and gynecology ward were selected randomly for testing.
71 Five samples were collected from every surface, including before cleaning-disinfection,
72 immediately after cleaning-disinfection and day 1, day 3 and day 5 after
73 cleaning-disinfection.
74 Sample Method
75 Samples were collected from the keyboard (including the Number keys, Character keys,
76 Enter key, Shift key, and Space bar), the mouse (except the underside) and the mouse pad
77 (area≥100cm2). Sterile swabs dipped with sterile saline solution or neutralizing agent were
78 smeared and rolled evenly back and forth five times on the surfaces. The hand-contacted
79 part of the swabs was cut off, and the rest was put into a sampling tube containing 10 ml of
80 sterile saline solution or neutralizing agent. All samples (947 samples) were sent to the
81 clinical laboratory immediately.
82 Bacteriology Identification
83 In a biological safety cabinet, the sampling tubes were shaken for 30s on an oscillator,
84 100µl of each sample was transferred to blood-agar culture medium plates, and the plates
85 were cultured for 48 hours at 35°C in an incubator. Colonies were counted and identified
86 by Gram stain, catalase test, oxidase test, plasma coagulase test, biochemical tube test or
87 using a VITEK-2 instrument for bacterial identification. Drug-sensitive testing was only
88 used for detecting MRSA.
89 Statistical analysis
90 SPSS 17.0 software was used for statistical analysis and used the following parameters:
91 α= 0.05, which may be calibrated according to the specific statistical data:
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92 , in which R was the number of sample rates that had to be compared
 
]1[2' RR
93 in pairs. The contamination rate (%) was the proportion of samples with bacterial colonies
94 >10 cfu/cm2.
95
96 Results
97 Bacteriological Analysis before Cleaning-disinfection
98 The bacterial contamination of keyboards, mouses and mouse pads
99 As shown in Table 1, there were significant differences in the contamination rate
100 between the keyboard group and the mouse group, as well as between the mouse group and
101 mouse pad group, from high to low was keyboards, mouse pads and mice, respectively. The
102 potentially pathogenic bacteria cultured from the computer-related equipment was as
103 shown in Supplementary Table 2, One isolate of Enterococcus Faecium was cultured from
104 the mouse pad. Klebsiella. Pneumoniae, Pseudomonas, and Enterobacter cloacae were
105 isolated from the keyboard. Acinetobacter lwoffii were mainly cultured from the mouse pad
106 and keyboard.
107 Table 1 The contamination rates of keyboard, mouse and mouse pad.
N
Contamination Rate (%)
Median
IQR
P-value1
Keyboard
74
39.1
9.0
1.8-18.3
0.0002
Mouse
74
12.2
2.5
1.0-6.0
0.0043
Mouse pad
47
34.0
5.0
2.0-16.0
0.5684
108 1 P-value was calculated for the contamination rate, α’ = 0.017
109 2 P-value was calculated between the Keyboard group and Mouse group
110 3 P-value was calculated between the Mouse group and Mouse pad group
111 4 P-value was calculated between the Keyboard group and Mouse pad group
112
113
114 The bacterial contamination of the computer-related equipment in different
115 departments
116 As shown in Table 2, the computer-related equipment in the wards and outpatient
117 rooms were much more contaminated than that in the other departments. In total, 8 isolates
118 of Staphylococcus aureus were cultured, 5, 1, 1, and 1 from the wards, outpatient rooms,
119 neonatal dept., and delivery room, respectively. Enterobacter cloacae, and Pseudomonas
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120 were cultured from the wards. Enterococcus Faecium was from the neonatal dept.
121 Klebsiella. Pneumoniae was isolated from the operating rooms (Supplementary Table 3).
122 Table 2 The contamination rate of computer-related equipment in different departments before
123 cleaning-disinfection
N
1 Contamination Rate
(%)
Median
IQR
P-value
Wards
72
38.9
8.5
3.0-17.5
0.000
Outpatient Room
42
33.3
5.5
2.0-14.5
0.001
Delivery Room
14
28.6
4.0
1.0-15.3
0.036
Medical Dept.
10
30.0
3.0
2.0-15.0
0.051
Neonatal Dept.
20
15.0
0.0
0.0-5.8
0.325
Operating Room2
39
5.1
1.0
0.0-4.0
124 1 Contamination rate is the subject of P-value calculation, α’ = 0.005
125 2 Operating Room as the control group
126
127
128 The bacterial contamination of the doctor’s and nurse’s computer-related equipment
129 in the obstetric and gynecology wards
130 There was no significant difference in the contamination rate between the doctor’s
131 office/mobile computer-related equipment and the nurse’s computer-related equipment in
132 the obstetric and gynecology wards (Table 3). The species of potentially pathogenic
133 bacteria from the doctor’s computers was more than that from the nurse’s computers,
134 Acinetobacter lwoffii and Acinetobacter ursingii were isolated from the doctor’s computers.
135 One strain of Enterobacter cloacae was from the nurse’s computers in the gynecology
136 wards, 2 isolated of Pseudomonas were cultured from the obstetric wards (Supplementary
137 Table 4-5).
138 Table 3 The contamination rate of computer-related equipment in obstetric and gynecology wards before
139 cleaning-disinfection
N
Contamination Rate
(%)
Median
IQR
P-value 1
Obstetric wards
40
42.5
9.0
5.0-17.5
Doctor’s office computers
14
50.0
11.5
4.5-19.3
0.310
Doctor’s mobile computers
13
46.2
10.0
5.5-50.0
0.420
Nurse’s station computers 2
13
30.8
7.0
2.0-12.5
Gynecology wards
27
40.7
6.0
2.0-22.0
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Doctor’s office computers
10
70.0
20.5
5.5-32.3
0.070
Doctor’s mobile computers
8
25.0
2.5
2.0-11.8
1.000
Nurse’s station computers 2
9
22.2
5.0
2.0-12.0
140 1 calculated for the contamination rate, α= 0.05
141 2 control group
142
143
144 Bacteriological Analysis after Cleaning-disinfection
145 As shown in Table 4, at day 1 and day 3 after cleaning-disinfection, the
146 contamination rates of the computer-related equipment gradually increased, and the
147 contamination rate of mouse pads ranked the second following the keyboards. 4 strains of
148 MRSA were isolated from the keyboards and the mouses, one and 3 were cultured at day 3
149 and day 5 after cleaning-disinfection, respectively. Furthermore, the strain of
150 Staphylococcus aureus gradually increased (7, 8 and 10 strains).11, 7, and 7 were isolated
151 from the keyboards, and mouses and mouse pads, respectively. One strain of Pseudomonas
152 Aeruginosa was isolated from the mouses at day 3 after cleaning-disinfection
153 (Supplementary Table 6).
154 Table 4 The contamination rate of computer-related equipment after cleaning-disinfection.
155 1 BCD: Before Cleaning-disinfection
156 2 ACD: After Cleaning-disinfection
157
158
159 Discussion
160 Cleaning and disinfecting object in the hospital is significantly important for
161 controlling hospital associated infections [16-19]. In this study, we found that the
162 contamination rate of mouse pads ranked second following the keyboards (34.0% vs
163 39.1%). The mouse pad is one of the high-touch objects so that it can be a container” for
164 pathogens. In another study was the contamination rate of the mouse pad researched, and
N
Cleaning-
disinfection
Rate
Contamination
Rate (%)
1BCD
Contamination
Rate (%)
2ACD Day 1
Contamination
Rate (%)
2ACD Day 3
Contamination Rate
(%)
2ACD Day 5
Keyboard
74
98.5
39.1
46.6
54.8
54.7
Mouse
74
97.9
12.2
17.8
20.6
18.8
Mouse pad
47
99.3
34.0
36.2
37.2
27.9
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165 the results were as same as in our study [20]. The mouse pads have been relatively
166 disregarded in the medical settings. Furthermore, the contamination rates of
167 computer-related equipment in the wards and outpatient rooms were significantly higher
168 than that in the operating rooms. In the gynecology wards, the contamination rate of the
169 doctor’s computer-related equipment was higher than that of nurse’s computer-related
170 equipment.
171 The most common bacteria cultured from the computer-related equipment was
172 Coagulase-negative staphylococcus, This finding was similar to the results of William's
173 study[21]. In total, 60 isolates of Acinetobacter were detected including 41 isolates of
174 Acinetobacter lwoffii, 16 isolates of Acinetobacter ursingii, and 3 isolates of Acinetobacter
175 baumannii. As an opportunistic pathogen, A.baumannii is one of the most clinically
176 significant multidrug-resistant bacteria, which can cause of the nosocomial infections,
177 especially in intensive care units [22-24]. It can persist and form biofilms on various abiotic
178 materials in the hospital environment [24]. Contamination of ambient air with
179 Acinetobacter baumannii was also a transmission way in Luis A study [25]. Despite
180 Acinetobacter spp. ( A. lwoffii, A. ursingii ) other than A. baumannii were often considered
181 relatively avirulent bacteria, they were able to be the opportunists in the presence of
182 indwelling medical devices and caused invasive diseases [26]. A former research found that
183 indwelling catheter-related with A. lwoffii bacteremia in immunocompromised hosts
184 appeared to be associated with a low risk of mortality [27]. A bacteremia caused by A.
185 ursingii in a patient with a pulmonary adenocarcinoma confirmed that it was an
186 opportunistic human pathogen for the first time [28]. 33 strains of Staphylococcus aureus
187 were detected, including 4 strains of MRSA. MRSA was previously detected from
188 healthcare personnel computers [15, 29]. The other importantly isolated bacteria included
189 Enterococcus Faecalis, Enterococcus Faecium, Klebsiella. Pneumoniae, Enterobacter
190 cloacae, and Pseudomonas Aeruginosa.
191 The above isolated potentially pathogenic bacteria were also cultured from the samples
192 of the HAI patients in our hospital, their detection rates were as shown in Table 5. the most
193 common pathogens from HAI patients were Enterococcus Faecalis. this may be associated
194 with the characteristic of maternity hospitals,with the large number of samples taken from
195 the genital tract. Staphylococcus aureus and Coagulase-negative staphylococcus were also
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196 the main pathogens from HAI patients. The majority of Staphylococcus aureus were
197 cultured from surgical incisions, and 12 cases were MRSA positive. In the process of
198 patient-object-patient” pathogens transmission, hand carriage plays an important role.
Table 5 The strain and percentage of the associated pathogenic bacteria from HAI patients in 2014-2016
 
Strain (%)
Enterococcus Faecalis
113 (14.9)
Staphylococcus aureus
38 (5.0)
MRSA
12 (1.6)
Coagulase-negative staphylococcus
31 (4.1)
Klebsiella. pneumoniae
26 (3.4)
Enterococcus Faecium
25 (3.3)
Enterobacter cloacae
9 (1.2)
Pseudomonas Aeruginosa
9 (1.2)
Acinetobacter baumannii
3 (0.4)
Acinetobacter lwoffii
1 (0.1)
Micrococcus
1 (0.1)
199
200
201 A limitation of the study was the absence of bacteria homology detection among
202 different computer equipment or between the computer equipment and HAI patients who
203 were infected with the same bacteria. It will be further explored in the future study.
204
205 Conclusions
206 In summary, we found that the cleaning and disinfection of mouse pads must be
207 brought to attention in the hospitals. Furthermore, it was better to clean and disinfect the
208 computer-related equipment at least 1 time/day. At the same time, health-care workers
209 should stick to good hand hygiene.
210
211 Acknowledgements
212 Not applicable
213
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284 Authors' contributions
285 Meiling Li designed the study, finished all experimental tests, collected and analyzed
286 the data and wrote the manuscript. Shufang Chen made a contribution to design the study,
287 analyze data and wrote the manuscript.Tingyan Lu guided the bacteria test and data
288 analysis. Hongwei Zhang contributed to guide the data analysis and modify the manuscript.
289 Xueying Mao done a great job to revise and polish the manuscript in English. Li Shen took
290 part in doing the experimental test. Yan Lu took part in the design of this study. Shufang
291 Leng took part in collect the data. All authors read and approved the final manuscript.
292
293 Additional information
294 Competing interests: The authors declared no conflict of interest in the manuscript.
295 Funding:This research was funded by the hospital funding(GFY5508)
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