BMC Infectious Diseases | |
Mold contamination in a controlled hospital environment: a 3-year surveillance in southern Italy | |
Maria Teresa Montagna1  Osvalda De Giglio1  Giancarlo Scarafile1  Grazia Lovero1  Caterina Coretti1  Christian Napoli1  Giuseppina Caggiano1  | |
[1] Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, Bari, Italy | |
关键词: Environment; Surfaces; Air; Hospital; Fungi; Contamination; | |
Others : 1122033 DOI : 10.1186/s12879-014-0595-z |
|
received in 2014-02-25, accepted in 2014-10-29, 发布年份 2014 | |
【 摘 要 】
Background
Environmental monitoring of airborne filamentous fungi is necessary to reduce fungal concentrations in operating theaters and in controlled environments, and to prevent infections. The present study reports results of a surveillance of filamentous fungi carried out on samples from air and surfaces in operating theaters and controlled environments in an Italian university hospital.
Methods
Sampling was performed between January 2010 and December 2012 in 32 operating theaters and five departments with high-risk patients. Indoor air specimens were sampled using a microbiological air sampler; Rodac contact plates were used for surface sampling. Fungal isolates were identified at the level of genera and species.
Results
Sixty-one samples (61/465; 13.1%) were positive for molds, with 18 from controlled environments (18/81; 22.2%) and 43 (43/384; 11.2%) from operating theaters. The highest air fungal load (AFL, colony-forming units per cubic meter [CFU/m3]) was recorded in the ophthalmology operating theater, while the pediatric onco-hematology ward had the highest AFL among the wards (47 CFU/m3). The most common fungi identified from culture of air specimens were Aspergillus spp. (91.8%), Penicillium spp., (6%) and Paecilomyces spp. (1.5%). During the study period, a statistically significant increase in CFU over time was recorded in air-controlled environments (p = 0.043), while the increase in AFL in operating theaters was not statistically significant (p = 0.145). Molds were found in 29.1% of samples obtained from surfaces. Aspergillus fumigatus was the most commonly isolated (68.5%).
Conclusions
Our findings will form the basis for action aimed at improving the air and surface quality of these special wards. The lack of any genetic analysis prevented any correlation of fungal environmental contamination with onset of fungal infection, an analysis that will be undertaken in a prospective study in patients admitted to the same hospital.
【 授权许可】
2014 Caggiano et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20150213021625274.pdf | 190KB | download |
【 参考文献 】
- [1]Sehulster L, Chinn RY: Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 2003, 52:1-42.
- [2]Safe Surgery Saves Lives. World Health Organization, Geneva; 2009.
- [3]Hao ZF, Ao JH, Hao F, Yanf RY, Zhu H, Zhang J: Environment surveillance of filamentous fungi in two tertiary care hospitals in China. Chin Med J 2011, 124:1970-1975.
- [4]Azie N, Neofytos D, Pfaller M, Meier-Kriesche HU, Quan SP, Horn D: The PATH (Prospective Antifungal Therapy) Alliance® registry and invasive fungal infections: update 2012. Diagn Microbiol Infect Dis 2012, 73:293-300.
- [5]Montagna MT, Lovero G, Coretti C, Martinelli D, Delia M, De Giglio O, Caira M, Puntillo F, D’Antonio D, Venditti M, Sambri V, Di Bernardo F, Barbui A, Lo Cascio G, Concia E, Mikulska M, Viscoli C, Maximova N, Candoni A, Oliveri S, Lombardi G, Pitzurra L, Sanguinetti M, Masciari R, Santantonio T, Andreoni S, Barchiesi F, Pecile P, Farina C, Viale P, et al.: SIMIFF study: Italian fungal registry of mold infections in hematological and non-hematological patients. Infection 2014, 42:141-151.
- [6]Napoli C, Tafuri S, Montenegro L, Cassano M, Notarnicola A, Lattarulo S, Montagna MT, Moretti B: Air sampling methods to evaluate microbial contamination in operating theatres: results of a comparative study in an orthopaedics department. J Hosp Infect 2012, 80:128-132.
- [7]Slekovec C, Faivre B, Humbert P, Bertrand X, Hocquet D, Pazart L, Talon D: Chronic wound care leads to the bacterial contamination of the environment. Ann Dermatol Venereol 2012, 139:798-802.
- [8]Knobben BA, van Horn JR, van der Mei HC, Busscher HJ: Evaluation of measures to decrease intra-operative bacterial contamination in orthopaedic implant surgery. J Hosp Infect 2006, 62:174-180.
- [9]Galvin S, Dolan A, Cahill O, Daniels S, Humphreys H: Microbial monitoring of the hospital environment: why and how? J Hosp Infect 2012, 82:143-151.
- [10]Tang CS, Wan GH: Air quality monitoring of the post-operative recovery room and locations surrounding operating theatres in a medical center in Taiwan. PLoS One 2013, 8(4):e610934.
- [11]Pini G, Donato R, Faggi E, Fanci R: Two years of a fungal aerobiocontamination survey in a Florentine haematology ward. Eur J Epidemiol 2004, 19:693-698.
- [12]Montagna MT, De Giglio O, Napoli C, Lovero G, Caggiano G, Delia M, Pastore D, Santoro N, Specchia G: Invasive fungal infections in patients with hematologic malignancies (Aurora Project): lights and shadows during 18-months surveillance. Int J Mol Sci 2012, 13:774-787.
- [13]Morace G, Borghi E: Fungal infections in ICU patients: epidemiology and the role of diagnostics. Minerva Anestesiol 2010, 76:950-956.
- [14]Pokala HR, Leonard D, Cox J, Metcalf P, McClay J, Siegel J, Winick N: Association of hospital construction with the development of healthcare associated environmental mold infections (HAEMI) in pediatric patients with leukemia. Pediatr Blood Cancer 2014, 61:276-280.
- [15]Nosari AM, Caira M, Pioltelli ML, Fanci R, Bonini A, Cattaneo C, Castagnola C, Capalbo SF, De Fabritiis P, Mettivier V, Morselli M, Pastore D, Aversa F, Rossi G, Pagano L: Hema e-chart registry of invasive fungal infections in haematological patients: improved outcome in recent years in mould infections. Clin Microbiol Infect 2013, 19:757-762.
- [16]Giglio M, Caggiano G, De Blasi R, Brienza N, Bucaria V, Ladisa P, Ceci G, Dalfino L, Montagna MT, Bruno F, Puntillo F: A fatal rhino-cerebral zygomycosis in a young woman with latent diabetes mellitus and cerebral blood vessel agenesis. Med Mycol 2010, 48:394-397.
- [17]Skiada A, Pagano L, Groll A, Zimmerli S, Dupont B, Lagrou K, Lass-Florl C, Bouza E, Klimko N, Gaustad P, Richardson M, Hamal P, Akova M, Meis JF, Rodriguez-Tudela JL, Roilides E, Mitrousia-Ziouva A, Petrikkos G: Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect 2011, 17:1859-1867.
- [18]Caggiano G, Cantisani P, Rolli M, Gianfreda CD, Pizzolante M, Montagna MT: The importance of a proper aetiological diagnosis in the management of patients with invasive mycoses: a case report of a brain abscess by Scedosporium apiospermum. Mycopathologia 2011, 172:317-322.
- [19]Miceli MH, Lee SA: Emerging moulds: epidemiological trends and antifungal resistance. Mycoses 2011, 54:666-678.
- [20]Muhammed M, Anagnostou T, Desalermos A, Kourkoumpetis TK, Carneiro HA, Glavis-Bloom J, Coleman JJ, Mylonakis E: Fusarium infection: report of 26 cases and review of 97 cases from the literature. Med (Baltimore) 2013, 92:305-316.
- [21]Partridge-Hinckley K, Liddell GM, Almyroudis NG, Segal BH: Infection control measures to prevent invasive mould diseases in hematopoietic stem cell transplant recipients. Mycopathologia 2009, 168:329-337.
- [22]Grossi PA, Gasperina DD, Barchiesi F, Biancofiore G, Carafiello G, De Gasperi A, Sganga G, Menichetti F, Montagna MT, Pea F, Venditti M, Viale P, Viscoli C, Nanni Costa A: Italian guidelines for diagnosis, prevention, and treatment of invasive fungal infections in solid organ transplant recipients. Transplant Proc 2011, 43:2463-2471.
- [23]Cleanrooms and associated controlled environments: biocontamination control. Part 1: general principles and methods. Document ISO 14698‐1:2003. ISO, ᅟ; 2014.
- [24]Linee guida per la definizione degli standard di sicurezza e di igiene ambientale dei reparti operatori. ᅟ.
- [25]Pasquarella C, Veronesi L, Castiglia P, Liguori G, Montagna MT, Napoli C, Rizzetto R, Torre I, Masia MD, Di Onofrio V, Colucci ME, Tinteri C, Tanzi M: SItI working group “Hygiene in Dentistry”: Italian multicentre study on microbial environmental contamination in dental clinics: a pilot study. Sci Total Environ 2010, 408:4045-4051.
- [26]Napoli C, Marcotrigiano V, Montagna MT: Air sampling procedures to evaluate microbial contamination: a comparison between active and passive methods in operating theatres. BMC Public Health 2012, 12:594. BioMed Central Full Text
- [27]De Hoog GS, Guarro J, Gené J, Figueras MJ: Atlas of Clinical Fungi. Centraalbureau voor Schimmelcultures (CBS), The Netherlands; 2009.
- [28]De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, Denning DW, Patterson TF, Maschmeyer G, Bille J, Dismukes WE, Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ, Marr KA, Muñoz P, Odds FC, Perfect JR, Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell TC, Viscoli C, Wingard JR, et al.: European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group; National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group: Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008, 46:1813-1821.
- [29]Augustowska M, Dutkiewicz J: Variability of airborne mikroflora in a hospital ward within a period of one year. Ann Agric Environ Med 2006, 13:99-106.
- [30]Singh N, Paterson DL: Aspergillus infections in transplant recipients. Clin Microbiol Rev 2005, 18:44-69.
- [31]Panagopoulou P, Filioti J, Farmaki E, Maloukou A, Roilides E: Filamentous fungi in a tertiary care hospital: environmental surveillance and susceptibility to antifungal drugs. Infect Control Hosp Epidemiol 2007, 28:60-67.
- [32]Awosika S, Olajubu F, Amusa N: Microbiological assessment of indoor air of a teaching hospital in Nigeria. Asian Pac J Trop Biomed 2012, 2:465-468.
- [33]Pini G, Faggi E, Donato R, Sacco C, Fanci R: Invasive pulmonary aspergillosis in neutropenic patients and the influence of hospital renovation. Mycoses 2008, 51:117-122.