A Scoping Review of Fomites in Surgery Theaters and Intensive Care Units of Healthcare Facilities in Middle-Income Countries Open Access

Peng, Tzuhsuan (Spring 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/cz30pt96v?locale=en


Background: Health care-associated infections (HCAIs) pose a substantial burden to healthcare systems and patient safety worldwide. This burden is even more critical in low- and middle-income countries (LMICs). While surgical site infection remains the most common type of HCAIs, critically ill patients in the intensive care unit (ICU) are also subject to HCAIs. A higher HCAI rate in LMICs is attributed to inadequate infection prevention and control (IPC) at healthcare facilities. Fomites, or inanimate objects that can carry pathogens, are often overlooked in IPC and decontamination instruction. As a result, this thesis aims to search the scientific literature to identify potential fomites in surgery theaters and ICUs that may serve as sources of pathogens related to HCAIs in order to inform and improve the World Health Organization’s IPC guidelines.

Methods: A scoping review was conducted to search PubMed, Embase, and CINAHL databases for articles published before February 2021, written in English, and available for abstract. Four main keywords were used for the database search: HCAI, ICU or surgery theater, fomite, and names of middle-income countries. Abstract and title were screened first using inclusion criteria, and subsequently, full texts were evaluated for final inclusion based on exclusion criteria.

Results: The initial database search yielded 241 articles. Of the 45 articles that satisfied the inclusion criteria, eight and 37 studies were carried out in surgery theaters and ICUs, respectively. Multiple medical equipment and supplies (laryngoscopes, suction tips, trolleys, incubators, beds, etc.), environmental surfaces (floor, sinks, tables, operation lamps, etc.), and personal items (mobile phones, clothes, etc.) were found as potential fomites that may threaten HCAI prevention and control. The main transmission routes of pathogens from a fomite to a patient were direct contact and indirect contact through health workers' hands or gloves that touched the fomite.

Conclusions: Various fomites that may be involved in HCAIs were reported. Recommendations for the World Health Organization’s IPC guidelines include monitoring bacterial resistance to disinfectants; coming to a consensus regarding the reuse of single-use medical devices; developing protocols for regular cleaning of personal items; and developing a policy on restricting mobile phone usage in theatres and ICUs.

Table of Contents

Chapter 1: Introduction 1

Chapter 2: Literature Review 4

 Definitions and Types of Health Care-Associated Infections (HCAIs) 4

 Burden of HCAI 5

 HCAI and Fomites in the Surgery Theater 7

 HCAI and Fomites in the ICU 8

 HCAI Prevention and Control 10

 WHO Development of IPC guidelines 11

Chapter 3: Methodology 13

 Ethical Consideration 15

Chapter 4: Results 16

 Fomites in the Surgery Theater 18

  Fomites Related to Medical Equipment and Supplies in Surgery Rooms 18

  Fomites Related to Environmental Surfaces in Surgery Rooms 20

  Fomites Related to Personal Items in Surgery Rooms 21

 Fomites in the ICU 21

  Fomites Related to Medical Equipment and Supplies in ICUs 22

  Fomites Related to Environmental Surfaces in ICUs 24

  Fomites Related to Personal Items in ICUs 25

 Transmission Route from Fomite to Patient 27

Chapter 5: Discussion, Conclusion and Recommendations 28

 Discussion and Recommendations 28

  Medical Equipment and Supplies as a Fomite 29

  Environmental Surfaces as a Fomite 31

  Personal Items as a Fomite 31

 Limitations and Recommendations 32

 Conclusion 33

References 35

Appendices 58

 Appendix 1: Fomites and Associated Pathogens in the Surgery Theater 58

 Appendix 2: Fomites and Associated Pathogens in the ICU 61

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Last modified

Primary PDF

Supplemental Files