Brief Report Evaluation of fungal contamination in operating rooms using a dusting cloth pad: Comparison among different sampling methods Daniela D’Alessandro MD, MPH, PhD a, *, Franco Cerquetani MD b , Maria Grazia Deriu ScD c , Maria Teresa Montagna ScD d , Ida Mura MD c , Christian Napoli MD d , Nicoletta Vescia MD, ScD e a Department of Civil Building and Environmental Engineering, “Sapienza” University of Rome, Rome, Italy b Medical Direction, “San Filippo Neri” Hospital, Rome, Italy c Department of Biomedical Sciences, University of Sassari, Sassari, Italy d Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy e Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy Key Words: Environmental surveillance Bio-contamination Controlled hospital environments To evaluate microbial contamination in hospitals environments, several methods are available, each one having its limitations. Therefore, the choice of system to use is open. This study compares the ability of a dusting cloth pad (DC pad) with 2 other methods (Rodac contact plate and air sampling) to detect contamination because of filamentous fungi in operating rooms, performing 110 sampling campaigns in hospitals of 3 Italian cities. Overall, 96% of the DC pad samples were positive compared with 51% of Rodac plates (P < .0001) and 35% of air samples (P < .0001). Authors conclude that the DC pad improves the ability to detect an environmental contamination of filamentous fungi. Copyright Ó 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. The health care facility environment is implicated in disease transmission, especially to immunocompromised patients, and the exposure of such patients to air molds spores can result in fatal infections. The incidence of these infections can be minimized by adherence to ventilation standards for specialized care environ- ments, appropriate maintenance, and careful cleaning. 1 Different strategies are required for the surveillance of fila- mentous fungi (FF) in hospital to prevent nosocomial invasive fungal infections among high-risk patients, and microbiologic environmental sampling is an unresolved issue. 2-4 The lack of standardized protocols and reference values for fungal environ- mental surveillance leave the choice to each hospital in terms of where, when, why, and how to detect them. 5 With the aim to simplify and to improve surface sampling, we developed a simple flat tampon (4.5 cm in diameter) by covering a circular cotton pad with a common dusting cloth (DC pad) selected among those in the market. Its efficiency to sample FF from surfaces, in comparison with other surface sampling systems (contact plates and cotton swabs), was already described in experimental conditions and in a field trial. 4,6 Nevertheless, with regard to envi- ronmental sampling in operating rooms (ORs), international stan- dards report not only surface samplings but also air sampling. Given this scientific background, the aim of this report is to compare DC pads to the most used systems for surface and air sampling (Rodac contact plates, Becton-Dickinson, Heidelberg, Germany and Surface Air System International PBI, Milan, Italy) in their ability to detect an environmental contamination due to FF in the ORs. METHODS The study refers to the results of 110 samplin’g campaigns carried out in the ORs of hospitals from 3 Italian cities: Bari, Rome, and Sassari, located in southern and central Italy, respectively. Samples were collected in the ORs before starting activity (at rest). Surface sampling with Rodac contact plates and DC pad followed the method described in a previous study. 4 In each OR, next to the surgical table, active sampling was performed using a surface air system (SAS) (International PBI, Milan, Italy), with a flow rate of 180 L/min and a suction volume of 500 L. 2,3,7 The sampler was placed in the operating theater approximately 1 m above the floor and approximately 1 m from the operating table. 7 The c 2 test was used to compare the overall proportions of samples found to be positive for FF. The McNemar test was used to * Address correspondence to Daniela D’Alessandro, MD, MPH, PhD, Department of Architecture and Planning for Engineering, Sapienza University of Rome, Via Eudossiana, 18, 00186 Rome, Italy. E-mail address: daniela.dalessandro@uniroma1.it (D. D’Alessandro). Conflicts of interest: None to report. Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2012.10.006 American Journal of Infection Control xxx (2013) 1-3