Relationships in anesthesia work areas between contamination measured as colony-forming units, Staphylococcus aureus detection, and S. aureus transmission

Arnav Bhushan; Franklin Dexter; Carmen Brindeiro; Randy W. Loftus; Unyime Ituk

doi:10.1007/s44254-026-00169-y

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Relationships in anesthesia work areas between contamination measured as colony-forming units, Staphylococcus aureus detection, and S. aureus transmission

Journal article

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Relationships in anesthesia work areas between contamination measured as colony-forming units, Staphylococcus aureus detection, and S. aureus transmission

Arnav Bhushan, Franklin Dexter, Carmen Brindeiro, Randy W. Loftus and Unyime Ituk

Anesthesiology and perioperative science, Vol.4(1), 22

12/01/2026

DOI: 10.1007/s44254-026-00169-y

PMCID: PMC13056790

PMID: 41959886

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Abstract

Purpose: Earlier, patients developed surgical site infection for 2.0% of cases without Staphylococcus aureus transmission through anesthesia work areas, 11% with S. aureus transmitted susceptible to prophylactic antibiotic, and 18% with transmission of antibiotic-resistant isolates. A randomized trial and an effectiveness study both found that anesthesiologists who used basic preventive measures (e.g., alcohol releasing intravenous caps) and received feedback on colony-forming units per surface area sampled (CFU) had reduced S. aureus transmission and postoperative healthcare-associated infections. We used prospectively collected data to evaluate whether CFU would be a reliable criterion for hospitals to assess anesthesiologists' contributions to postoperative infections. Methods: During the summer of 2025, reservoirs (e.g., anesthetist's hands at case start/end) were sampled during 81 cesarean delivery cases performed in the same operating room. There were ≤ 15 reservoirs sampled per case. Results: 52/1016 reservoir samples had S. aureus detected, more often with greater CFU (P = 0.0063). The 159/1016 samples with < 100 CFU had no S. aureus. Total CFU of all reservoirs for each case to total S. aureus isolates was 2.50 × 109 per S. aureus (standard error 0.53 × 109, N = 81 cases). CFU and S. aureus transmission were uncorrelated (all 15 reservoirs' unadjusted P ≥ 0.12, Holm-Bonferroni P > 0.99). Conclusions: With substantive contamination (≥ 100 CFU), so few isolates are S. aureus that surrogate measures of insufficient disinfection (e.g., ATP bioluminescence) are inaccurate markers both of S. aureus isolation and transmission. The lack of association between contamination and transmission shows that feedback on CFU provides information on the effectiveness of disinfection, not on S. aureus transmission.

Anesthesiology

Surgery

Critical Care Medicine

Intensive

Medicine

Medicine & Public Health

Neurosciences

Original Research

Pharmacology/Toxicology

Details

Title: Subtitle: Relationships in anesthesia work areas between contamination measured as colony-forming units, Staphylococcus aureus detection, and S. aureus transmission
Creators: Arnav Bhushan - University of Iowa
Franklin Dexter - University of Iowa
Carmen Brindeiro
Randy W. Loftus - Mayo Clinic
Unyime Ituk - University of Iowa
Resource Type: Journal article
Publication Details: Anesthesiology and perioperative science, Vol.4(1), 22
DOI: 10.1007/s44254-026-00169-y
PMID: 41959886
PMCID: PMC13056790
NLM abbreviation: Anesthesiol Perioper Sci
eISSN: 2731-8389
Publisher: Springer Nature Singapore
Grant note: T32AI007343 / National Institute of Allergy and Infectious Diseases (http://dx.doi.org/10.13039/100000060)
Language: English
Date published: 12/01/2026
Academic Unit: Anesthesia
Record Identifier: 9985151632402771

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