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J Hosp Infect. 2018 Nov;100(3):e123-e129. doi: 10.1016/j.jhin.2018.04.003. Epub 2018 Apr 9.

Is there an association between airborne and surface microbes in the critical care environment?

Author information

Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire Hospital, NHS Lanarkshire, UK.
Department of Critical Care, Hairmyres Hospital, NHS Lanarkshire Hospital, NHS Lanarkshire, UK.
Institute for Public Health and Environmental Engineering, School of Civil Engineering, University of Leeds, Leeds, UK.
Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK; Health Protection Scotland, Glasgow, UK; International Prevention Research Institute, Lyon, France.
Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire Hospital, NHS Lanarkshire, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK. Electronic address:



There are few data and no accepted standards for air quality in the intensive care unit (ICU). Any relationship between airborne pathogens and hospital-acquired infection (HAI) risk in the ICU remains unknown.


First, to correlate environmental contamination of air and surfaces in the ICU; second, to examine any association between environmental contamination and ICU-acquired staphylococcal infection.


Patients, air, and surfaces were screened on 10 sampling days in a mechanically ventilated 10-bed ICU for a 10-month period. Near-patient hand-touch sites (N = 500) and air (N = 80) were screened for total colony count and Staphylococcus aureus. Air counts were compared with surface counts according to proposed standards for air and surface bioburden. Patients were monitored for ICU-acquired staphylococcal infection throughout.


Overall, 235 of 500 (47%) surfaces failed the standard for aerobic counts (≤2.5 cfu/cm2). Half of passive air samples (20/40: 50%) failed the 'index of microbial air' contamination (2 cfu/9 cm plate/h), and 15/40 (37.5%) active air samples failed the clean air standard (<10 cfu/m3). Settle plate data were closer to the pass/fail proportion from surfaces and provided the best agreement between air parameters and surfaces when evaluating surface benchmark values of 0-20 cfu/cm2. The surface standard most likely to reflect hygiene pass/fail results compared with air was 5 cfu/cm2. Rates of ICU-acquired staphylococcal infection were associated with surface counts per bed during 72h encompassing sampling days (P = 0.012).


Passive air sampling provides quantitative data analogous to that obtained from surfaces. Settle plates could serve as a proxy for routine environmental screening to determine the infection risk in ICU.


Air; Bacterial transmission; Environmental contamination; Hospital environment; Hospital-acquired infection; MRSA; Staphylococcus aureus

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