title: Elevator buttons as unrecognized sources of bacterial colonization in hospitals.
abstract: BACKGROUND
  Elevators are ubiquitous and active inside hospitals, potentially facilitating bacterial transmission. The objective of this study was to estimate the prevalence of bacterial colonization on elevator buttons in large urban teaching hospitals.
  
  
  METHODS
  A total of 120 elevator buttons and 96 toilet surfaces were swabbed over separate intervals at 3 tertiary care hospitals on weekdays and weekends in Toronto, Ontario. For the elevators, swabs were taken from 2 interior buttons (buttons for the ground floor and one randomly selected upper-level floor) and 2 exterior buttons (the "up" button from the ground floor and the "down" button from the upper-level floor). For the toilet surfaces, swabs were taken from the exterior and interior handles of the entry door, the privacy latch, and the toilet flusher. Samples were obtained using standard bacterial collection techniques, followed by plating, culture, and species identification by a technician blind to sample source.
  
  
  RESULTS
  The prevalence of colonization of elevator buttons was 61% (95% confidence interval 52%-70%). No significant differences in colonization prevalence were apparent in relation to location of the buttons, day of the week, or panel position within the elevator. Coagulase-negative staphylococci were the most common organisms cultured, whereas Enterococcus and Pseudomonas species were infrequent. Elevator buttons had a higher prevalence of colonization than toilet surfaces (61% v. 43%, p = 0.008).
  
  
  CONCLUSIONS
  Hospital elevator buttons were commonly colonized by bacteria, although most pathogens were not clinically relevant. The risk of pathogen transmission might be reduced by simple countermeasures.
authors.affiliation: Christopher E. Kandel, MD, is a resident in internal medicine at the University of Toronto, Toronto, Ontario.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Kandel
authors.affiliation: Andrew E. Simor, MD, FRCPC, is a Professor of Medicine and of Laboratory Medicine and Pathobiology at the University of Toronto, Head of the Department of Microbiology and the Division of Infectious Diseases at Sunnybrook Health Sciences Centre, and a Senior Scientist at the Sunnybrook Research Institute, Toronto, Ontario.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Simor
authors.affiliation: Donald A. Redelmeier, MD, FRCPC, MSHSR, FACP, is a Professor of Medicine at the University of Toronto, the Director of Evaluative Clinical Sciences at the Sunnybrook Research Institute, a Staff Physician in the Division of General Internal Medicine at Sunnybrook Health Sciences Centre, and a Senior Scientist at the Institute for Clinical Evaluative Sciences, Toronto, Ontario.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Redelmeier
mesh_terms: D001419:Bacteria / Q000302:isolation & purification*; D003428:Cross Infection / Q000209:etiology*; D018562:Disease Transmission, Infectious; D004607:Elevators and Escalators; D004866:Equipment Contamination / Q000706:statistics & numerical data; D006786:Hospitals, Urban; D006801:Humans; D009864:Ontario