To the Editor:
We assessed the cleanliness of the illuminating glass surface (IGS) of overhead lights in operating rooms in our ambulatory surgical suite by obtaining bacterial and fungal culture swabs from these surfaces. Many studies have been done investigating disinfection in the operating room, but to date there are no reports regarding the cleanliness of the of overhead lights in operating rooms, and therefore no guidelines exist that pertain to cleaning these surfaces.
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Overhead lights have 3 parts: head, arm, and ceiling mount. The head has a dome with an IGS. This IGS overlies the sterile surgical field and is expected to be clean, if not sterile. All surfaces are usually cleaned before and after each and every procedure by a dedicated team of cleaners. Observation revealed that cleaning of IGS is at times missed in the ambulatory surgical suite because of high turnover and time constraints between cases.
After institutional review board approval, a pilot study was performed wherein 5 operating rooms (specifically Rooms 1, 2, 3, 4, and 7) in the ambulatory surgical suite at our hospital were selected on a random day where several surgeries were booked. Each operating room had 2 overhead, movable lights, from which culture swabs were taken twice in the same day from the IGS: once before the beginning of the first surgery and once after the end of the last surgery. Both cleaners and personnel involved in culturing the swabs were blinded. Bacterial cultures were grown for up to 1 week and fungal cultures were incubated for 2 weeks.
Cultures from 3 of 5 operating rooms had positive bacterial growth. One light in Room 1 showed no growth initially but grew Staphylococcus epidermidis after the last case. Similarly, 1 light in Room 2 grew S. epidermidis before the first case, but had no growth after the last case. In Room 7, 1 light grew S. epidermidis in the morning and Streptococcus viridans as well as S. epidermidis in the evening. The second light in Room 7 grew Neisseria mucosa in the morning and S. epidermidis in the evening. All strains of S. epidermidis were different and multi-drug resistant. The remaining swabs from the other operating rooms showed no bacterial growth. All 20 swabs for fungal cultures yielded negative results.
Growth of bacteria like Staphylococcus, Streptococcus, and Neisseria from the overhead lights makes the IGS a potential source of surgical site infections, thus possibly contributing to morbidity and mortality among patients having surgery because they have been shown to contribute to perioperative infections.
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All 3 bacteria strains have been shown to cause many infections, with endocarditis being the most significant.4
We believe cross-contamination may have a role in the growth of bacteria on these lights, especially if the lights are cleaned with the same wipe that was used to clean other surfaces in operating rooms and from soiled gloves worn by personnel, because once gloves are worn they are hardly ever changed within an operating room.Although these results cannot be generalized to other operating rooms or institutions, we believe that the practices of decontamination are similar, potentially leading to cross-contamination of the IGS of the overhead lights at other hospitals. Consequently, specific guidelines should be formulated, and personnel involved in the cleaning process should use a new pair of clean gloves and a new, clean antiseptic wipe while cleaning overhead lights to prevent cross-contamination, in turn preventing a bacterial shower onto the sterile surgical field, if any. Care should also be taken to ensure surfaces are thoroughly cleaned between cases, especially in ambulatory surgical suites with high rates of turnover.
We expect to implement these changes in our institution in the immediate future and a study will be performed to re-evaluate the cleanliness of these lights after these practices have been in place. Also, the possibility of a bacterial or fungal shower from IGS will be addressed.
References
- Chaos to comprehension: cleaning, sterilization, and disinfection.Urol Nurs. 2003; 23 (377): 329-332
- Disinfection, sterilization, and operation theater guidelines for dermatosurgical practitioners in India.Indian J Dermatol Venereol Leprol. 2011; 77: 83-93
- Evaluation of surface contamination with staphylococci in a veterinary hospital using a quantitative microbiological method.J Small Animal Pract. 2010; 51: 574-580
- Neisseria mucosa endocarditis.J Infect Dis. 1990; 162: 1199-1201
Article info
Publication history
Published online: October 15, 2012
Footnotes
Conflicts of interest: Funds for this project provided by Park Slope Anesthesia PC.
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© 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
