Microbial Patient and Operating-Room Personnel Sampling and Culture Evaluation of Ambulatory Ophthalmology Unit: Novel Protocol
Narrative Responses:
Purpose
To evaluate an elaborative, novel protocol of personnel and patient nasal and conjunctival mucosa sampling as well as surface and air sampling of the several levels of sterility operating rooms in a modern ophthalmological ambulatory surgical center.
Methods
Operating room personnel (surgeons, nurses, technicians, assistants) and 122 consecutive patients were sampled with swab smears of nasal and conjunctival mucosa, prior to any ophthalmic drop administration and sterility. In eight rooms comprising the ambulatory surgical center, three levels of sterility were defined: 1: changing rooms, pre-op, and recovery area, 2: connecting hallways and sterilization room, 3: intraocular and refractive operating rooms. All rooms were sampled bi-weekly: wall and ceiling swab smears and air sampling with handheld air-sampler. The ventilation system air filters were removed, swabbed and cultured also. All cultures were analyzed and processed in a specialized microbiology laboratory.
Results
Surgeon cultures showed: Staphylococcus epidermidis, nurse and technician cultures showed showed Staphylococcus epidermidis and logdunensi, and patient cultures showed Staphylococcus epidmidis and Streptococcus pneumonia. Level 1 areas showed air samples: 200 CFU/m3 (microbial only colonies per cubic meter) wall and door swabs: 5 CFU of bacteria only (no fungus). Level 2 areas showed: air samples: 120 CFU/m3, wall, door and microscope swabs: 2 CFU, bacteria only no fungus. Level 3 areas showed: air samples: 88 CFU/m3 wall, door and microscope swabs: 3 CFU, bacteria only (no fungus). Almost all bacteria were Staphylococcus epidermidis with one CFU of Staphylococcus lugdunensis.
Conclusion
This novel elaborative microbial monitoring system of an ambulatory operating unit provided detailed data of the classification and population of microbes and the exact topographic location in the operating rooms. This information cautioned our ongoing disinfecting techniques and methods, and helped surgeons in planning appropriate antimicrobial prophylaxis for prospective patients.