Is fumigation enough for air conditioning units in operation theatres and Intensive care units?
Keywords:Fumigation, AC, ICU, OT
Background:Strict asepsis is necessary in operating theatres (OT) and intensive care units (ICU) as the patients undergo invasive procedures. The filters of contaminated air conditioning (AC) units provide a niche for proliferation of fungi and production of fungal spores.
Methods: The routine procedure for maintenance of sterile atmosphere in our hospital, i.e. fumigation and mopping walls with disinfectants often fail to address these fungal spores of the AC filters. We therefore carried out a surveillance of the ACs in ICUs and OTs to find the level of contamination with fungal spores and also to improvise on intervention strategies to tackle the problem. Over 3 months period, 34 ACs from 7 OTs and 2 ICUs were screened by taking 2 swabs from each AC which were then tested for the presence of fungal spores as per standard methods.
Results: The contamination rate was 88.2% before fumigation and 76.9% after fumigation. The fungal spore contamination rate was reduced to 20% (1 out of 5 ACs) after servicing of the ACs was done. Aspergillus spp. was the most common fungal isolate.
Conclusion: Based on the observations, we recommend regular servicing of the ACs as well as wet mopping of the ducts with sporicidal solution at regular intervals.
Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA et al. Multistate point-prevalence survey of health care-associated infections. N Eng J Med. 2014;370:1198-208.
Javed I, Hafeez R, Zubair M, Anwar MS, Tayyib M, Husnain S. Microbiological surveillance of operation theatres and ICUs of a tertiary care hospital, Lahore. Biomedica. 2008;24:99-102.
Jaffal AA, Banat IM, El Mogheth AA, Nsanze H, Bener A, Ameen AS. Residential airborne microbial populations in the United Arab Emirates. Environ Intern. 1997;23(4):529-33.
Pasqualotto AC, Denning DW. Post-operative aspergillosis. Clin Microbiol Infect. 2006;12(11):1060-76.
Kelkar U, Kelkar S, Bal AM, Kulkarni S, Kulkarni S. Microbiological evaluation of various parameters in ophthalmic operating rooms. The need to establish guidelines. Indian J Ophthalmol. 2003;51:171-6.
Simmons RB, Price DL, Noble JA, Crow SA, Ahearn DG. Fungal colonization of air filters from hospitals. Am Ind Hyg Assoc J. 1997;58:900-4.
Kelkar U, Bal AM, Kulkarni S. Fungal contamination of air conditioning units in operating theatres in India. J Hosp Infect. 2005;60:81-4.
Sudharsanam S, Swaminathan S, Ramalingam A et al. Characterization of indoor bio aerosols from a hospital ward in a tropical setting. Afr Health Sci. 2012;12:217-25.
Vonberg RP, Gastmeier P. Nosocomial aspergillosis in outbreak settings. J Hosp Infect. 2006;63:246-54.
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(1):60-7.
Cruz GCP, Arguilar MJN, Helguera AOE. Fungal and bacterial contamination on indoor surfaces of a hospital in Mexico. Jundishapur J Microbiol. 2012;5(3):460-4.
Kelkar U, Kelkar S, Bal AM, Kulkarni S, Kulkarni S. Microbiological evaluation of various parameters in ophthalmic operating rooms. The need to establish guidelines. Indian J ophthalmol. 2002;51:171-76.
Patwardhan N, Kelkar U. Disinfection, sterilization and operation theater guidelines for dermatosurgical practitioners in India. Indian J Dermatol Venereol Leprol. 2011;77:83-93.
Bali R, Sharma P, Nagrath S, Gupta P. Microbial isolations from maxillofacial operation theatre and its correlation to fumigation in a teaching hospital in India J Maxillofac Oral Surg. 2014;13(2):128-32.
Koneman EW, Allen SD, Janda WM, Paul CS, Winn Jr. WC, eds. Diagnostic microbiology. 14th Edition. Philadelphia PA.Lippincott;1992:983-1069.
Overberger PA, Wadowsky RM, Schaper MM. Evaluation of air-borne particulates and fungi during hospital renovation. Am Ind Hyg Assoc J. 1995;56:706-12.
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.
Beezhold DH, Green BJ, Blachere FM, Schmechel D, Weissman DN, Velickoff D et al. Prevalence of allergic sensitization to indoor fungi in West Virginia. Allergy and Asthma Proceedings. 2008;29: 29-34.
Khan AAH, Karuppayil SM. Fungal pollution of indoor environments and its management. Saudi J of Biolog Sc. 2012;19:405-26.
Pokala HR, Leonard D, Cox J, Metcalf P, McClay J, Siegel J et al. Association of hospital construction with the development of healthcare & associated environmental mold infections (HAEMI) in pediatric patients with leukemia. Pediatr Blood Cancer. 2014;61:276-80.
Pini G, Faggi E, Donato R, Sacco C, Fanci R. Invasive pulmonary aspergillosis in neutropenic patients and the influence of hospital renovation. Mycoses 2008;51:117-22.
Dharan S, Pittet D. Environmental control in hospital theatres. J Hosp Inf. 2002;51:79-84.
Gniadek A, Macura AB. Air-conditioning vs. presence of pathogenic fungi in hospital operating theatre environment. Wiadomooeci Parazytologiczne. 2011;57(2):103-6.
Azab MM, Mohamed NAE, Gerges MA, Soliman MH. A qualitative and quantitative study monitoring indoor fungi in high risk patient’s units in a university hospital, Egypt. Internat J Curr Microbiol Applied Sc. 2014;3(8): 643-52.
Caggiano G, Napoli C, Coretti C, Lovero G, Scarafile G, DeGiglio O et al. Mold contamination in a controlled hospital environment: 3-year surveillance in southern Italy. BMC Inf Dis. 2014;14:595.
Dettenkofer M, Scherrer M, Hoch V, Glaser H, Schwarzer G, Zentner J et al. Shutting down operating theater ventilation when the theater is not in use: infection control and environmental aspects. Infect Control Hosp Epidemiol. 2003;24:596-600.
Kelkar U, Kulkarni S. Contaminated air conditioners as a potential source for contaminating operation theatre environment. Int J Infect Control. 2011;8:45-8.
Narang S, Gupta A, Gupta V, Dogra MR, Ram J, Pandav SS, Chakrabarti A. Fungal endophthalmitis following cataract surgery: clinical presentation, microbiological spectrum and outcome. Am J Ophthalmol. 2001;132:609-17.
Tarkkanen A, Raivio V, Anttila VJ, Tommila P, Ralli R, Merenmies L et al. Fungal endophthalmitis caused by Paecilomyces variotii following cataract surgery: A presumed operating room air- conditioning system contamination. Acta Ophthalmol Scand. 2004;82:232-5.
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;168:329-37.
Grossi PA, Gasperina DD, Barchiesi F, Biancofiore G, Carafiello G, De Gasperi A et al. Italian guidelines for diagnosis, prevention, and treatment of invasive fungal infections in solid organ transplant recipients. Transplant Proc. 2011;43:2463-71.
Occupational Health and Safety Administration. OSHA Fact Sheet: Formaldehyde: Occupational Safety and Health Administration, U.S. Department of Labor, 2002.
Rutala WA, Weber DJ. Draft guideline for disinfection and sterilization in healthcare facilities. CDC Healthcare Infection Control Practices Advisory committee. 2001.