Abstract
BackgroundEnvironmental 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.MethodsSampling 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.ResultsSixty-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%).ConclusionsOur 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0595-z) contains supplementary material, which is available to authorized users.
Highlights
Environmental monitoring of airborne filamentous fungi is necessary to reduce fungal concentrations in operating theaters and in controlled environments, and to prevent infections
Air sampling According to International Standard Organization (ISO 14698–1) [23] microbial standard procedures, air contamination was evaluated by active sampling (SAS, Aquaria Microflow, Milan, Italy) with a flow rate of 180 L/min
Filamentous fungi were isolated from air samples of two operating theaters and three controlled environments (Table 1)
Summary
Environmental monitoring of airborne filamentous fungi is necessary to reduce fungal concentrations in operating theaters and in controlled environments, and to prevent infections. Pathogenic or opportunist microorganisms in hospital environments may be a source of infection in susceptible hosts [1,2] This is worrying in controlled environments with immunocompromised patients [3,4,5] and in operating theaters where numerous risk factors may exist, including inefficient ventilation systems and failure to follow infection control behaviors in healthcare workers [6,7]. The most common infection in fatal complications is aspergillosis in patients with hematological malignancies [15] and mucormycosis in patients with uncontrolled diabetes mellitus [16,17]. Rare mold diseases, such as fusariosis and scedosporiosis, have been described [18,19,20]. Filamentous fungal infections (FFIs) are serious postoperative complications in transplant recipients [21,22], requiring particular attention by the clinician and surgeon
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