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The microorganisms' growth results from the hands of the 25 anesthesiologists sampled at a ready-to-use operating room before patient contact showed that the overall mean number of total CFUs and CFU/cm2 were 407 (range: 2–2091) and 7 (range: 0–35) (Figure 2, Supplementary Table S1, available in www.besjournal.com), respectively. Five anesthesiologists’ hands (Providers 3, 7, 10, 23, and 25) (5/25, 20%) carried microorganisms more than 10 CFU/cm2 (Supplementary Table S1, Figure 2). Only one major pathogen Staphylococcus aureus was isolated, from 5/25 anesthesiologists (20%; Providers 1, 2, 3, 4, and 13) (Supplementary Table S1, Figure 2). Considering the possible impact of gender, we compared the microorganisms' growth between male and female anesthesiologists before uniform disinfection, and found no differences (Figure 2). Not surprisingly, after disinfection, the microorganism growth significantly decreased regardless of the total CFUs (P < 0.0001) or the number of species (P < 0.0001), but obvious divergences were determined between male and female providers, notably that female anesthesiologists performed hand hygiene better than male anesthesiologists, resulting in fewer CFUs (P = 0.0069) and fewer species (P = 0.0202) (Figure 2).
Name Gender Before Disinfection of Hands After Disinfection of Hands CFU/total CFU/cm2 Bacteria CFU/total CFU/cm2 Bacteria Provider 1 M 114 2 Brevibacillus parabrevis 1 0 Bacillus cereus Kocuria marina Staphylococcus aureus Staphylococcus epidermidis Staphylococcus hominis Provider 2 M 305 5 Staphylococcus epidermidis 3 0 Bacillus megaterium Bacillus cereus Staphylococcus capitis Moraxella osloensis Kocuria rhizophila Staphylococcus aureus Staphylococcus hominis Provider 3 M 950 16 Staphylococcus aureus 304 5 Micrococcus luteus Staphylococcus haemolyticus Kocuria palustris Micrococcus luteus Staphylococcus aureus Staphylococcus capitis Staphylococcus warneri Provider 4 M 28 0 Bacillus firmus 6 0 Lactobacillus plantarum Bacillus megaterium Staphylococcus capitis Enterobacter cloacae Staphylococcus epidermidis Staphylococcus aureus Staphylococcus capitis Staphylococcus epidermidis Provider 5 M 89 1 Bacterium* 2 0 Corynebacterium tuberculostearicum Neisseria mucosa Staphylococcus epidermidis Staphylococcus capitis Staphylococcus epidermidis Staphylococcus hominis Staphylococcus pettenkoferi Provider 6 M 330 6 Corynebacterium tuberculostearicum 3 0 Bacterium* Micrococcus antarcticus Micrococcus luteus Staphylococcus epidermidis Bacterium* Provider 7 M 2000 33 Staphylococcus capitis 7 0 Staphylococcus epidermidis Kocuria marina Provider 8 M 10 0 Bacillus cereus 8 0 Bacillus cereus Bacillus megaterium Staphylococcus capitis Moraxella osloensis Bacterium* Provider 9 M 2 0 Aerococcus viridans 0 0 Lactobacillus fermentum Provider 10 M 1352 23 Acinetobacter baumannii 15 0 Bacillus flexus Acinetobacter nosocomialis Brevibacterium linens Brevibacterium linens Sphingomonas aerolata Staphylococcus epidermidis Sphingomonas paucimobilis Provider 11 M 352 6 Bacillus cereus 13 0 Bacillus infantis Bacillus flexus Bacillus megaterium Bacillus infantis Bacillus simplex Bacillus megaterium Staphylococcus cohnii Dermacoccus nishinomiyaensis Provider 12 M 109 2 Bacillus megaterium 2 0 Micrococcus luteus Micrococcus luteus Neisseria meningitidis Serratia rubidaea Staphylococcus sp Provider 13 F 120 2 Micrococcus luteus 2 0 Bacillus horikoshii Moraxella sp Staphylococcus capitis Staphylococcus hominis Staphylococcus aureus Provider 14 F 67 1 Micrococcus luteus 2 0 Bacillus pseudofirmus Ralstonia syzygii Staphylococcus capitis Provider 15 F 77 1 Micrococcus luteus 0 0 Staphylococcus epidermidis Staphylococcus hominis Provider 16 F 15 0 Bacterium* 0 0 Kocuria marina Staphylococcus capitis Staphylococcus hominis Provider 17 F 202 3 Bacillus mojavensis 11 0 Brevibacillus borstelensis Kocuria rhizophila Brevibacterium linens Staphylococcus sciuri Bacterium* Staphylococcus epidermidis Provider 18 F 2 0 Bacillus subtilis 0 0 Staphylococcus capitis Provider 19 F 450 8 Brevibacterium linens 0 Bacterium* Provider 20 F 127 2 Acinetobacter pittii 2 0 Bacillus idriensis Brevundimonas vesicularis Micrococcus antarcticus Yeast* Micrococcus luteus Ralstonia syzygii Staphylococcus caprae Provider 21 F 103 2 Pasteurella dagmatis 0 0 Brachybacterium conglomeratum Bacterium* Brachybacterium conglomeratum Provider 22 F 60 1 Bacillus cereus 5 0 Neisseria perflava Staphylococcus cohnii Staphylococcus epidermidis Provider 23 F 1047 17 Bacillus cereus 0 0 Bacillus megaterium Staphylococcus cohnii Staphylococcus saprophyticus Provider 24 F 183 3 Bacillus cereus 0 0 Provider 25 F 2091 35 Bacillus sp 2 0 Bacillus circulans Brevibacterium casei Neisseria meningitidis Note. *Indicates identification scores of ≤ 60, considered “not reliable”. CFU, colony-forming units. Table S1. Bacterial growth on the hands of anesthesiologists before and after disinfection
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In this study, anesthesia environment samples were obtained from all nine operating rooms at the hospital. In each ready-to-use operating room we sampled the anesthesia cart, monitor screen, working table, and keyboard and mouse of the anesthesia machine (Figure 1). The microorganisms' growth results showed that the overall mean numbers of total CFUs found on the anesthesia cart, monitor screen, working table, and keyboard and mouse of the anesthesia machine were 376 (range: 36–1,114), 13 (range: 0–50), 223 (range: 13–684), and 469 (range: 38–2,000) (Supplementary Tables S2 and S3, available in www.besjournal.com), respectively. Based on CFU/cm2 results, five of the nine operating rooms (55.6%) carried microorganisms more than 5 CFU/cm2 on the anesthesia cart (Rooms 3 & 8), working table (Room 7), or the keyboard and mouse of anesthesia machine (Rooms 1 & 9) (Supplementary Tables S2 and S3). One major pathogen, Staphylococcus aureus, was isolated in three rooms (33.3%; Rooms 1, 3, and 7) (Supplementary Tables S2 and S3). Considering the importance of disinfection, we disinfected the working areas determined in this study with 5.5%–6.5% chlorine and then re-sampled after 30 minutes. Not surprisingly, after disinfection, microorganisms' growth significantly decreased regardless of the total CFUs (P < 0.05) or numbers of species (P < 0.05) (Figure 3). Furthermore, Figure 4 shows that the microorganisms' growth are very likely to be hand contact-related because the keyboard and mouse of the anesthesia machines, as the most frequently touched areas, carried the highest number of colonies, whereas the monitor screens carried the fewest colonies; these differences remained statistically significant even after disinfection. In this study, we also monitored the microorganisms' growth sampled from the working table of the anesthesia machines at different time points to determine how soon a repeat cleaning is needed. The results showed that microorganisms regrowth began 1 hour after disinfection, and increased gradually over time (Figure 5) until reaching an excessive amount (> 5 CFU/cm2) at 4 hours after disinfection (Supplementary Table S3).
Figure 5. Microorganisms’ growth on anesthesia machines (working tables) and the effectiveness of disinfection. CFU, colony-forming units.
No. of Operating Room Before disinfection
(Keyboard and Mouse)After disinfection
(Keyboard and Mouse)Before disinfection
(Medicative Cart)After disinfection
(Medicative Cart)Before disinfection
(Monitor)After disinfection
(Monitor)CFU/total; CFU/cm2 Bacteria CFU/total; CFU/cm2 Bacteria CFU/total; CFU/cm2 Bacteria CFU/total; CFU/cm2 Bacteria CFU/total; CFU/cm2 Bacteria CFU/total; CFU/cm2 Bacteria 1 2,000; 20 Micrococcus luteus 1; 0 Moraxella sp 129; 1 Bacillus firmus 0; 0 0; 0 0; 0 Staphylococcus epidermidis Bacillus licheniformis Staphylococcus pasteuri Kocuria rosea Bacterium* Bacterium* Staphylococcus hominis Staphylococcus pasteuri 2 106; 1 Bacterium* 2; 0 Bacillus sp 203; 2 Bacillus megaterium 8; 0 Micrococcus luteus 0; 0 0; 0 Bacillus simplex Staphylococcus epidermidis Kocuria rhizophila Staphylococcus capitis Nocardia higoensis Staphylococcus cohnii Staphylococcus epidermidis Bacterium* Staphylococcus epidermidis Staphylococcus cohnii Staphylococcus hominis Staphylococcus haemolyticus 3 548; 5 Corynebacterium aurimucosum 60; 1 Corynebacterium tuberculostearicum 637; 6 Arthrobacter aurescens 10; 0 Yeast* 31; 0 Micrococcus luteus 0; 0 Micrococcus luteus Staphylococcus capitis Kocuria palustris Micrococcus antarcticus Moraxella osloensis Kocuria marina Micrococcus antarcticus Bacterium* Staphylococcus hominis Staphylococcus hominis Moraxella osloensis Staphylococcus haemolyticus Staphylococcus warneri Staphylococcus cohnii Staphylococcus hominis 4 38; 0 Kocuria rhizophila 17; 0 Staphylococcus hominis 100; 1 Bacillus cereus 1; 0 Paenibacillus lautus 50; 1 Bacillus cereus 0; 0 Staphylococcus epidermidis Micrococcus luteus Kocuria rhizophila Staphylococcus pettenkoferi Staphylococcus epidermidis Staphylococcus epidermidis Staphylococcus haemolyticus Staphylococcus hominis Staphylococcus lugdunensis 5 91; 1 Bacterium* 1; 0 Paenibacillus glucanolyticus 208; 2 Corynebacterium aurimucosum 0; 0 6; 0 Moraxella osloensis 0; 0 Kocuria rosea Micrococcus antarcticus Staphylococcus warneri Staphylococcus epidermidis Staphylococcus warneri Staphylococcus hominis Bacterium* 6 416; 4 Micrococcus luteus 46; 0 Micrococcus luteus 488; 5 Acinetobacter lwoffii 0; 0 10; 0 Staphylococcus cohnii 0; 0 Staphylococcus epidermidis Pseudomonas luteola Micrococcus luteus Staphylococcus epidermidis Staphylococcus haemolyticus Staphylococcus saprophyticus Staphylococcus cohnii Staphylococcus hominis 7 202; 2 Escherichia coli 5; 0 Actinomyces funkei 36; 0 Bacillus cereus 6; 0 Bacillus licheniformis 15; 0 Bacillus subtilis 6; 0 Bacillus firmus Moraxella osloensis Micrococcus antarcticus Micrococcus luteus Staphylococcus capitis Bacillus licheniformis Staphylococcus aureus Staphylococcus epidermidis Moraxella osloensis Staphylococcus epidermidis Lactobacillus paracasei Staphylococcus hominis Staphylococcus haemolyticus Lysinibacillus sphaericus 8 197; 2 Dietzia maris 12; 0 Enterococcus pallens 1114; 11 Yeast* 2; 0 Micrococcus luteus 0; 0 0; 0 Kocuria rhizophila Micrococcus luteus Pandoraea pulmonicola Staphylococcus capitis Staphylococcus epidermidis Staphylococcus hominis Staphylococcus haemolyticus Staphylococcus saprophyticus 9 621; 6 Bacillus idriensis 11; 0 Micrococcus antarcticus 471; 5 Yeast* 5; 0 Kocuria rosea 5; 0 Bacterium* 0; 0 Bacterium* Micrococcus luteus Staphylococcus epidermidis Bacillus sp Staphylococcus hominis Staphylococcus cohnii Staphylococcus epidermidis Staphylococcus haemolyticus Staphylococcus epidermidis Staphylococcus warneri Note. *Indicates identification scores of ≤ 60, considered “not reliable”. CFU, colony-forming units. Table S2. Bacterial growth in the anesthesia environment before and after disinfection
No. of Operating Room Before Table Disinfection After Table Disinfection
(0 hours)After Table Disinfection
(1 hour)After Table Disinfection
(2 hours)After Table Disinfection
(3 hours)After Table Disinfection
(4 hours)CFU/total; CFU/cm2 Bacteria CFU/total; CFU/cm2 Bacteria CFU/total; CFU/cm2 Bacteria CFU/total; CFU/cm2 Bacteria CFU/total; CFU/cm2 Bacteria CFU/total; CFU/cm2 Bacteria 1 110; 1 Micrococcus antarcticus 2; 0 Staphylococcus hominis 19; 0 Bacillus mycoides 60; 1 Kocuria rosea 133; 1 Pseudomonas avellanae 252; 3 Micrococcus luteus Micrococcus luteus Staphylococcus epidermidis Paenibacillus apiarius Staphylococcus capitis Staphylococcus capitis Staphylococcus aureus Staphylococcus hominis Staphylococcus cohnii Staphylococcus haemolyticus Staphylococcus epidermidis Staphylococcus capitis Staphylococcus hominis Staphylococcus hominis Staphylococcus haemolyticus Staphylococcus cohnii Bacterium* Staphylococcus hominis 2 345; 3 Kocuria rosea 10; 0 Bacillus megaterium 43; 0 Bacillus megaterium 50; 1 Bacillus vallismortis 51; 1 Yeast* 54; 1 Bacillus subtilis Moraxella osloensis Bacillus sp Bacillus sp Kocuria rhizophila Kocuria rosea Bacterium* Staphylococcus capitis Kocuria rhizophila Bacterium* Neisseria perflava Staphylococcus capitis Moraxella osloensis Staphylococcus epidermidis Staphylococcus hominis Staphylococcus epidermidis Staphylococcus capitis Staphylococcus cohnii Staphylococcus epidermidis Staphylococcus haemolyticus Staphylococcus epidermidis Staphylococcus epidermidis Staphylococcus kloosii Staphylococcus pettenkoferi Bacterium* 3 445; 4 Bacillus pseudofirmus 6; 0 Staphylococcus epidermidis 47; 0 Micrococcus luteus 57; 0 Candida parapsilosis 72; 1 Bacterium* 115; 1 Moraxella osloensis Kocuria rhizophila Staphylococcus hominis Staphylococcus aureus Staphylococcus hominis Brachybacterium conglomeratum Yeast* Moraxella osloensis Staphylococcus haemolyticus Staphylococcus haemolyticus Staphylococcus epidermidis Staphylococcus aureus Staphylococcus sciuri Staphylococcus saprophyticus Staphylococcus capitis Staphylococcus epidermidis Staphylococcus hominis 4 30; 0 Kocuria marina 0; 0 3; 0 Bacterium* 25; 0 Bacterium* 175; 2 Yeast* 719; 7 Yeast* Paenibacillus chitinolyticus Staphylococcus capitis Enterobacter cloacae Micrococcus antarcticus Micrococcus luteus Bacterium* Staphylococcus epidermidis Micrococcus luteus Moraxella osloensis Staphylococcus hominis Staphylococcus capitis Staphylococcus capitis 5 684; 7 Bacterium* 1; 0 Bacterium* 6; 0 Staphylococcus capitis 18; 0 Bacillus cohnii 34; 0 Bacillus sp 264; 3 Bacterium* Neisseria subflava Yeast* Staphylococcus cohnii Staphylococcus warneri Staphylococcus hominis Staphylococcus lugdunensis Staphylococcus sciuri Bacterium* 6 115; 1 Bacillus cereus 1; 0 Staphylococcus hominis 3; 0 Bacterium* 3; 0 Brevibacterium iodinum 20; 0 Micrococcus luteus 24; 0 Bacillus megaterium Enterobacter cloacae Staphylococcus cohnii Bacterium* Paenibacillus massiliensis Moraxella sp Micrococcus antarcticus Staphylococcus epidermidis Kocuria marina Pseudomonas flavescens Staphylococcus cohnii Staphylococcus cohnii Staphylococcus epidermidis Staphylococcus hominis 7 74; 1 Kocuria marina 7; 0 Bacillus mannanilyticus 40; 0 Neisseria perflava 42; 0 Staphylococcus epidermidis 65; 1 Micrococcus luteus 201; 2 Bacillus megaterium Micrococcus antarcticus Lactobacillus paracasei Rothia mucilaginosa Staphylococcus haemolyticus Neisseria flavescens Neisseria flavescens Staphylococcus capitis Neisseria perflava Staphylococcus aureus Staphylococcus pettenkoferi Neisseria sicca Staphylococcus hominis Staphylococcus epidermidis Staphylococcus haemolyticus Staphylococcus hominis Rothia mucilaginosa Staphylococcus haemolyticus 8 13; 0 Kocuria rhizophila 0; 0 5; 0 Arcanobacterium phocae 8; 0 Bacillus cereus 11; 0 Staphylococcus epidermidis 105; 1 Alkalibacillus haloalkaliphilus Kocuria rosea Cardiobacterium sp Corynebacterium sp Staphylococcus haemolyticus Micrococcus luteus Moraxella osloensis Staphylococcus hominis Kocuria palustris Staphylococcus capitis Staphylococcus capitis Staphylococcus haemolyticus Staphylococcus epidermidis Staphylococcus hominis 9 187; 2 Bacillus simplex 0; 0 1; 0 Staphylococcus haemolyticus 3; 0 Bacillus smithii 6; 0 Micrococcus luteus 10; 0 Corynebacterium afermentans Staphylococcus epidermidis Micrococcus antarcticus Staphylococcus epidermidis Staphylococcus hominis Staphylococcus hominis Staphylococcus epidermidis Staphylococcus hominis Staphylococcus warneri Staphylococcus saprophyticus Note. *Indicates identification scores of ≤ 60, considered “not reliable”. CFU, colony-forming units. Table S3. Bacterial growth in the anesthesia environment (working table) before and after disinfection
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Baseline Microorganisms' Growth on Anesthesiologists' Hands
Baseline Microorganisms' Growth in Anesthesia Environments
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