Bures S, Fishbain J T, Uyehara C F, Parker J M, Berg B W
Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859-5000, USA.
Am J Infect Control. 2000 Dec;28(6):465-71. doi: 10.1067/mic.2000.107267.
We postulate that computer keyboards and faucet handles are significant reservoirs of nosocomial pathogens in the intensive care unit (ICU) setting.
Sterile swab samples were obtained from 10 keyboards and 8 pairs of faucet handles in the medical ICU at Tripler Army Medical Center during a period of 2 months. Methicillin-resistant Staphylococcus aureus (MRSA) obtained from the environmental and patient specimens were sent for DNA identification by using pulsed-field gel electrophoresis.
A total of 144 samples were obtained (80 keyboards and 64 faucet handles), yielding 33 isolates. The colonization rate for keyboards was 24% for all rooms and 26% in occupied rooms. Rates for faucet handles in all rooms and occupied rooms were 11% and 15%, respectively. The environmental isolates annd their prevalence were: MRS, 49%; Enterococcus, 18%; Enterobacter, 12%; and all other gram-negative rods, 21%. Fourteen individual patient isolates were recorded: MRSA, 43%; Enterobacter, 21%; other gram-negative rods, 36%; and Enterococcus, 0%. By using pulsed-field gel electrophoresis, an indistinguishable strain of MRSA was identified in two patients, the keyboards and faucet handles in their respective rooms, and on other keyboards throughout the ICU, including the doctors' station.
The colonization rate for keyboards and faucet handles, novel and unrecognized fomites, is greater than that of other well-studied ICU surfaces in rooms with patients positive for MRSA. Our findings suggest an associated pattern of environmental contamination and patient infection, not limited to the patient's room. Pulsed-field gel electrophoresis results have documented an indistinguishable strain of MRSA present as an environmental contaminant on these two fomites and in two patients with clinical infections patients during the same period. We believe these findings add evidence to support the hypothesis that these particular surfaces may serve as reservoirs of nosocomial pathogens and vectors for cross-transmission in the ICU setting. New infection control policies and engineering plans were initiated on the basis of our results.
我们推测在重症监护病房（ICU）环境中，电脑键盘和水龙头把手是医院病原体的重要储存源。
在两个月的时间里，从特里普勒陆军医疗中心的医疗重症监护病房的10个键盘和8对水龙头把手上采集无菌拭子样本。从环境和患者样本中分离出的耐甲氧西林金黄色葡萄球菌（MRSA）通过脉冲场凝胶电泳送去进行DNA鉴定。
共采集了144个样本（80个键盘和64个水龙头把手），分离出33株菌株。所有病房键盘的定植率为24%，有患者的病房为26%。所有病房和有患者病房水龙头把手的定植率分别为11%和15%。环境分离株及其流行率为：耐甲氧西林金黄色葡萄球菌（MRS），49%；肠球菌，18%；肠杆菌，12%；以及所有其他革兰氏阴性杆菌，21%。记录到14株个体患者分离株：MRSA，43%；肠杆菌，21%；其他革兰氏阴性杆菌，36%；肠球菌，0%。通过脉冲场凝胶电泳，在两名患者、他们各自病房的键盘和水龙头把手以及整个重症监护病房包括医生工作站的其他键盘上鉴定出了一株无法区分的MRSA菌株。
对于MRSA呈阳性的病房，作为新的且未被认识的污染物的键盘和水龙头把手的定植率高于其他经过充分研究的重症监护病房表面。我们的研究结果表明存在一种环境污染与患者感染的关联模式，且不限于患者病房。脉冲场凝胶电泳结果证明，在同一时期，这两种污染物表面以及两名临床感染患者体内存在一株无法区分的MRSA菌株作为环境污染物。我们认为这些发现为支持以下假设增添了证据，即这些特定表面可能是医院病原体的储存源以及重症监护病房环境中交叉传播的媒介。基于我们的研究结果，启动了新的感染控制政策和工程计划。
