Source: https://nanoconcepts.net/elevator-buttons-as-unrecognized-sources-of-bacterial-colonization-in-hospitals/
Timestamp: 2019-04-20 20:44:38+00:00

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The following study published this month underscores the critical problem of cross contamination in hospital settings. According to the World Health Organization 80% of communicable disease is spread, not through personal contact but from cross contamination. Nano-Shield creates an invisible barrier which inhibits the growth of ALL microbes for 90 days or more.
An article published in Open Medicine, a peer-reviewed, independent, open-access journal.
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).
Conclusion: 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.
Christopher E. Kandel, MD, is a resident in internal medicine at the University of Toronto, Toronto, Ontario. 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. 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.
ensuring that questions related to any part of the work are appropriately investigated and resolved.
Funding: This project was supported by a Canada Research Chair in Medical Decision Sciences, the Canadian Institutes of Health Research, and the University of Toronto, Faculty of Medicine. The funding organizations had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript.
Disclaimer: The opinions stated in this commentary are those of the auth­ors and not of their institutions.
We hypothesized that buttons in hospital elevators may be an additional under-recognized site of microbial contamination. At a single university in a community setting, for example, about one-third of elevator buttons were colonized by bacteria.16 The corresponding frequency of colonization in hospitals has not been described. If present, such colonization creates the potential for pathogen transmission, given the ubiquity of elevators in large hospitals, the necessity of using the buttons to operate the elevator, and repeated contacts by diverse individuals. Pathogen transmission may occur if use of the buttons is associated with ineffective hand hygiene by individuals who interact with hospital inpatients. The objective of this study was to estimate the prevalence of bacterial colonization of elevator buttons in large teaching hospitals.
Study setting. We performed this study at 3 large urban teaching hospitals located in Toronto, Ontario. These hospitals represented a combined total of 1490 acute inpatient hospital beds (range 353 to 677 per hospital). Eligible elevators selected for inclusion had the following characteristics: connected to the majority of patient floors; opened to the main floor of the hospital (defined as street level); considered the most used (as judged by a service attendant at the hospital information desk); and available to patients, visitors, and health care professionals. The research ethics board of Sunnybrook Health Sciences Centre approved the study.
Each individual elevator button was swabbed in a standardized fashion with a sterile, single-use Transystem Culture Swab and Transport System (Copan Diagnostics, Inc., Murrieta, Calif.).19 The dry swab was removed from its sterile packaging by the individual collecting the samples, who immediately used it to swab the entire surface of one button for 3 seconds in a continuous motion while rotating the tip. For each elevator on each sampling day, a total of 4 buttons were swabbed: 2 exterior buttons and 2 interior buttons. Specifically, the exterior “up” button outside the elevator on the main floor, the exterior “down” button on a randomly selected upper-level floor, the interior “number” button to travel to the selected upper-level floor, and the interior “ground” button to return to the main floor were swabbed.
A random number generator (“Undecided,” Apple Computer Company iTunes App Store) that used the Lehmer algorithm was employed to determine the random upper-level floor destination at each hospital. To do so, the individual collecting the specimens activated the random number generator when approaching a hospital’s elevator bank to determine which destination floor to select at that hospital. Because each elevator had 2 interior button panels and each elevator bank had 2 exterior button panels, an additional randomization was undertaken to determine the panel to be swabbed by activating the same random number generator application. This randomized selection process was repeated every day during the study period, with no exceptions or anomalies.
Collection of control samples. We returned to the same hospitals a few months later to assess bacterial colonization of the public washrooms closest to the elevators, using the same sample collection techniques. Surfaces in the men’s washroom were swabbed (which may have introduced bias, although the difference in surface colonization between men’s and women’s washrooms is minimal20). Four toilet surfaces were swabbed over 8 separate days from 17 to 27 March 2013. Collections occurred daily from Sunday to Wednesday with the same time constraints for sample processing. From each public washroom, swabs were taken from the exterior and interior entry-door handles, the privacy latch, and the toilet flusher. When more than one toilet was available, randomization was performed to select the stall to be swabbed. If the designated washroom had automatic toilet-flushing mechanisms, we substituted the nearest manually operated toilet.
Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) using the polymerase chain reaction for the nuc and mec genes (for MRSA) and the vanA and vanB genes (for VRE).21,22 We did not perform advanced cultures because of a lack of personnel. All samples were cultured and characterized by the same trained laboratory technician, who was unaware of the study hypothesis or swab origin.
Statistical analysis. The primary outcome was the prevalence of bacteria on elevator buttons. We used a 2-tailed Χ2 test to assess for significant differences in colonization prevalence between the interior buttons and the exterior buttons as the primary comparison. Interior buttons are challenging to sterilize, are more likely to be touched by every passenger, and may be more likely to lead to pathogen transmission. In secondary analyses, we compared left and right elevator panels, days of the week, and individual hospitals. Analogous statistics were replicated for the control toilet surfaces, with a prespecified secondary analysis comparing the 4 surfaces (exterior and interior entry-door handles, individual privacy latch, toilet flusher). All p values were 2-tailed and were calculated using StatView version 5.0 (SAS Institute Inc., Cary, N.C.), with 0.05 defined as the threshold of statistical significance.
A total of 120 elevator buttons were swabbed over the study period, a completion rate of 100%, with 108 (90%) of the samples collected on weekdays. Specimen collection was evenly distributed by hospital and date. The most common randomized elevator destinations were the ninth floor at hospital 1, the ninth floor at hospital 2, and the third and fourth floors at hospital 3. About half of the swabbed elevator buttons were located on the left-hand panel (exterior and interior). No adverse events or service disruptions occurred during the study.
A total of 73 samples from the 120 cultures showed microbiological growth, equivalent to a colonization prevalence of 61% (95% confidence interval 52%–70%). The most common organisms cultured were coagulase-negative staphylococci, followed by Streptococcus spp. (Table 1). The distribution of coagulase-negative staphylococci was relatively even across the buttons, whereas Streptococcus spp. and coliform bacteria were predominately isolated from the interior elevator buttons. One sample grew Pseudomonas sp., 2 samples grew Enterococcus spp., and another grew a fungal species. No specimens were positive for Staphylococcus aureus, MRSA, or VRE.
We found no statistically significant difference in the prevalence of colonization between the interior and exterior elevator buttons (60% v. 62%, p = 0.85). Findings were also consistent by day of the week (weekend 60% v. 58% weekday, p = 0.85), button panel side (left 58% v. right 65%, p = 0.46), and selected floor (street level 57% v. upper level 65%, p = 0.35). Among the interior and exterior buttons, we found similar colonization prevalence between the main floor and the random upper floor (Figure 1). Colonization prevalence varied somewhat among the 3 hospitals (range 45% to 73%, p = 0.034).
than elevator buttons (61% v. 43%, p = 0.008). The colonization prevalence varied marginally among the 4 surfaces (range 29% to 54%, p = 0.47). We observed no significant variation by day of the week (weekend 38% v. weekday 44%, p = 0.55). There was modest variability among the 3 hospitals (range 25% to 53%, p = 0.063). Coagulase-negative staphylococci were the most frequently cultured organisms, and the distribution of bacterial species was approximately even across the toilet surfaces. Four surfaces grew a fungus and one grew Pseudomonas sp.
The majority of colonizing bacteria had low pathogenicity. This pattern is reassuring and in keeping with the extremely low rates of hospital-acquired MRSA and VRE at the participating hospitals.24 Absence of pathogenic organisms on elevator buttons is a testament to the prevailing cleaning services combined with widespread hand hygiene. Although the prevalence of colonization of elevator buttons in our study was lower than that for computer keyboards6 and ultrasound transducers11 in previous studies, patients remain at potential risk of cross-contamination because of the frequent use of these buttons by diverse individuals. In addition, a visitor is more likely to come into contact with an elevator button or a toilet than with inanimate hospital equipment and may transmit organisms if interacting with inpatients.
microorganisms may not have been detected because broth enhancement techniques were not used.17 Together, these limitations may have led to underestimation of colonization prevalence, yielding an unduly reassuring assessment.

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