Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit.
OBJECTIVE
We postulate that computer keyboards and faucet handles are significant reservoirs of nosocomial pathogens in the intensive care unit (ICU) setting.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Bures
S
S
Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859-5000, USA.
Fishbain
J T
JT
Uyehara
C F
CF
Parker
J M
JM
Berg
B W
BW
D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission*; D004197:Disease Reservoirs / Q000706:statistics & numerical data; D016521:Electrophoresis, Gel, Pulsed-Field; D004756:Enterobacteriaceae Infections / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission*; D016983:Enterococcus; D004784:Environmental Monitoring / Q000379:methods; D062665:Epidemiological Monitoring; D004866:Equipment Contamination / Q000517:prevention & control / Q000706:statistics & numerical data; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission*; D006254:Hawaii / Q000453:epidemiology; D006772:Hospitals, Military; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D016106:Methicillin Resistance; D008838:Microcomputers; D015995:Prevalence; D012307:Risk Factors; D012498:Sanitary Engineering / Q000295:instrumentation; D012703:Serotyping; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission*; D013211:Staphylococcus aureus