Clinical Microbiology Procedures Handbook Air Cultures for Fungi

8/6/2019 Clinical Microbiology Procedures Handbook Air Cultures for Fungi

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11 ..8", Air Cultures for Fungi

A ir is tJ lu~m.o!! l l i t tm. ~ . i l l i : l l ! ~~[:3![ISr;lllrt:3 .fungi !Iro:m

WlIIrtts such al 5 soil. lDO][JsLl1lIJcl ion distur-

banccs. or r no td y o os pi 'l. al . ,eOll'ftUUlftiCliltS. p.14. 16)_AJtboogh breltbiing airborne f l ! l l E l g i I r . ' \ i

oommon 3 . 1 ] 1 1 .rOil I n l J l i S t m d i v i d i I J a ' 1 s results in

no effects, On b .e ru .I b. , hOO lJ 'i tc l. iz ed p< ll ie fll ts

with extreme im_IDli/.lmuppression are 5US-

~-ep~i.bie ~o iinfcctj(!lliliS wi:ll~ those a . i ' d I lO ! I i 'i E l I C

fliflP ~ . h a l ~aq grow <I ~ body t C n 1 ! p < : W : -d . l U [ C S . ( U ) .

Gcncrm]l!'" P<lf[i~liIro:;;,re mmtaio.ed ~iil.

cootro:ned f :1JI ' i! fWo.ruiI ! lelruls during~~iOOs of

seJi.l'en~:iJmrnulile suPf:re.s ..~io". Enliirorunc:ruta!] ,

ooIl~rQls: fOE fullgi",l spore 'OOIilla:oIlII'cnrti!latiml

(FsrCV) mc.1lldc in'DR~3SCIiI a U - ch< l!lDg,e s•. posi.

ti.....pFClSsllre lOOiIDiS. a nd h i" bi :) I fl lJ 1 .c ro dlai r

(1" '9 , 1 1 5 . , 19" '20 ) .. \vnell. ~l I s d elc rn liin oo th atsuch individuab; iI lI.avc cxpcrieaced a .0.000-

cnmial inICctWIl dl.l!.c to (jllpportlll i"l i is.tiC air-

bomefi'ameSJItlOUL~ fil!.lngj" an m'ileSl:i.g~Jtio!n is

l icq .u i il 'ed to d.ekli 'i lD i il e \1II 'hc l! .b.e~ttI,e o:mD:rolJl f id

el1'vi [O'Wli ie[lt . rmillt:d~li wbctln:cw t 'b.e[\e were

c(lb e~ b ~, m p:!i~dtx:d IP[oct ' .d.1 l . In: : .~.g,,"

tr~nspi)n of , rU J 1 ! J1E iim<LS. k e d lDati.e;ntouts:ide: th e

.cOIl l i : l ruUed, cnWlTOlmlcnt_ Famllgt o O ' detect dl~

lat tell1. t h e io s ti t u tO O : il l m ay e tc,d ' 1 . 0 ' l . ! I [ I I ! d e r t , a i i I r e

3m r $~p]ing to de~crnllil.e ';. !lethe. the 00.11-

trolled eD\'tto1im!.elillt is. \ l , ' o ' l ! ' i I k i l l l g effool.i\l"Ciy_

Aiir 5 3 1 l i 1 1 p l l i n g should not be :i!lil.itiated

H. Specnnen

~ i g : 1 m i l : l y . since the CO I l . d ) l l . c t and i ! i : 1 J t e ; r p r e t a t i o n

oJ ale culmres ~r)[' fungi are relatively corn-

plex, Uibiqtlitons. in all envirenmcnts, !ullgim ,controlled enviwllmeJttS mus t b e ' ,q ,u :ant, j .

,r.a:tOOailUf tli f,eIr .nwnbers compared with

those i« tiu: amhi.€'u air I I I con tiguous [mC'(ln~

trolled cUli'iromnents. These results will pro-

...de O J. basis for dictcunililing the ,efi'i.caq' of

the suspect eonuolled enviroamem, A J -

t lii .owgh envimnmental sam pl. i ]! l :g of f I( ! Ispih.l

, ai r lo r i !u liI gi i s [J o t ~C4;Om 'm c l1 id ic d.o n. a . rcatine

b i \ 8 1 s . , theee are '0 1 Dumbe.r of instances .in

wl l: ic !hsa rmp lmgmrny be j ,! ldged neces sary : ( i . )

wh en QQ5QCOn lia iin fe -c tio ~s a re d u,c to oo.m-

mOone t l.WO 'mn fi !J l.a iI ai rOO rn e b lf ig i ( 10 , 1 4 .

16). l E i ) dl.l!ring outdoor o: r mdoo'r construe-'l.1Q'I!n c lo se pro xim ity it o susceptible pa -tients, (m) prior to , initial occupancy of spe-

cial coutrolled envirenmcats, and (w), wheu

procedures necessary for the cleanest air

quan1y ;Me beln.g estalJ)l~s,li 'u;,dand 111llintai.lwd.

I n g en e,r nI I. microbl(lio-gic testing sl1.ould be

~imitod to - 'environ:m.ents assoessted with im~mUI3C i lCQmp rom is cd p -a ti ,c [l ts in transplant

pWloools. Laminar-Ilew rooms for other

hoop it at appL ic .a li ons '(::ro.mj'c~I ~Ilitl,:::;, phar-

maey, ete.) are tested w:iih a particle counter

and anemometer,

A. s.a.mph~ siiJI:e I O O t i ' I J I I D

CompajiSlilil sampLe:::; are e.o;.'Sei! ll;t i:a~ in order to det,e:rmi in,e t:be e f fec t i veness of

filtcalioll atDdp! 'm ' ide arank orocr coucestrarioa of fun,gi.• For example, the

level ( ) I f fuagiin a FSILV 'cDvil'oflment might b e ; compared with the levelsoutdoors ailldi!1il l .adjacoo~ areas ,Mthe hospital that are nO L controlled environ-

meees {S;.,9 } - . W'hellemul~wplc nesccomial infections have occurred, the looms of

these a!illect'C1il1 1lI1]!!)lilaloo be compared w~th the morns of those unaffected,

SOlilliIDIl.pleite selection mliWs~ tletaitOired to the goals. of th e u nd ertak in g;

undeTs~andi,"g the scerleas r o . I h . < l t . foUmli.i'wiU help in 'the design of the sanlp!ing

st rab::gy '_

U. Sample: "i'(llum,e

The volume of air sampled il s based on the expected number of fllngi in the:

environmene i ! 1 ! l ' q l i l e . < > l i i o l l i l and deLcliiiDined by the air volume per unittime of the

S,:lilT1pil;lf.The sample " ' joh. ! t i I ! l l~m~sJt be of sufficient size to provide quantitative

UJU.



1~8.2

infom1::l!tion at the lower limits or detectionwhen the air is relarively cleanand

~~ahe hi~,fuer limits of deteetkm whea the air is relatively dirty.

Terrrperaturc ufincuh~'lli.on n'f cultures i s . often adiusted to meet the

objectives oE the <:;;lillIdy (see below) aml w in affect the quantitation, During the

growing season, when crop'S. l a ' ! 1 I O f l I I s , 1 . ! . [ I d ,~1UdcIlS are not covered w i t h snow or

icc, em ideer aliI'g:cncra~~y cont ai ns s a pproxim a t c 1 y m ; O O O CFU/mC! ~1I.l lpperl. i .m]ts as

high as u r o " o o o CFU!nI i IJ]1 when CUm'l l l lUe; .s:r e j n( :' I! I. ba teda t r oom t empera tu re an d

only Ltu lUll! CFUbn:> ' ' 'W hen cultures are incubated at 37°c..lim ~nduu!liaieas with J I I 1~nmmum fililralion" fungal levels arc, generally about

o uc-lh iilid th e level, de tec ted oll!litsid,c ( 1 ¥ AID1e .assubjected tu h:igh-efficiency

flltr;,iaion can be expected to have <]IW the number 0 '£ fungi found in adjacent

indoor areas. U m.te!!. are Pl'opcrilly instajted and maintained (15), filtration

systems remove tbe maj()lrill~)' of fuf.l~, and ~ l T I t l l S it is necessary to collect

high-volume s<ilIm:plcs(>1 w"'; j.e., 3:5.3 f~j).However, when there is snow or icc

COVC:F(IUt(i(X:HS fOil e:idcfi ldcdpcfltlJld.S..1!)1l1IMJoor levels o f fUIIIg~may be drastically'reduced.

Rale

(hj,;::~lm)

W mpl l lc l .hm Qr.J I a : g . ' U

~lI;.!,leLow vo lume· iP fc : cl ll des sh,(J!"'t.·!;emilcotlc~:-

~iifjllll>th : l l i l might relate to specifle setivi-

IIies; 1!;:lXocliv~ [Of ~I~gJIcenceatra ti(ms of

spores.

:S~it i.mp<lcluf

{ : \ ; i l i I I L r i i f i J J g _ a ]

impacwli"

Wmpal! : l iou, 0 1 1 1 1

lioUliting agar platenJ,gh vQIlllllCaUows :lllIilJiHc,:nn collections

that miglllL relatespore aerosols to spe-

eiflc actl..-itiM; ei[ediyc for low conccn-

t rations of spores; q1..bOl!1~.iik<ltkm1J11~ybe

eomproeilsed at high levels I O f spores.

Ilililf~lr!:::trolillgill p n < : l . - ; ; ~ i c

:;~ri.~ ~tai :Iilll.g

at~1" mt::dia

(lal.ilH<lJliOfl difli; :; ' 'YI'I.,thus :ilm1ted 1Q, r e l < l . t . i 1 , ' C

determi Illations

~mpimlgciilClIll illUQ

~i~l!~dsl O V i . i - '\ " ' I ; _ ! l ! . ! m c sampling fales a n d t e n de n cy

to disnlnlm d :ump- s l im f ts app lkO l. ti lJ il to

i 110r ! ld in . iica l 5al I :npling .

filktl,ljem or ~ir

t l l l ! l i i t 1 lu g h O . 2 - lJ . I .m -

pore ...i".c fi Il!ers

][-1 {iili

1 4 , o _ . ] , .t O ONO! practicaljor vi<lhk microbes

Most s,]grl : i l " i .c: : l ' f1It s ;[ l'i rc s < li ro ;oo sm all and

l'I'un}'~.mto settle..L!~k of quantif r- ftll iull

seve [1eJy : lli m it .< ; ul.i~~~y.

~ F Oil al.ldlit.io.I"~ i nhm na !' in E l. s ee Id'l:!i"cnO(' :'I.

I'Amlci",;,_~mS ;)m p ilE i! ": > In c . .. . : ': 1'> · \ ··em.: ! ,~U0: . • ;".ll' l!.lIIl2l, G .. .. ] l}J .36_

rNt :w Ur un s. v, -i d S< . :i ft il il if I. cC ( l . • lac .• P .0 . B. : rn c :< lOOS ,U Ta lmad, [lC Rd.• Edison, N~ I 00 51 8, o r e as el. 1a J ...o nd (, n Lnl.,Re:r;cniHouse, n.il<l!J].I:li.. WaL. ~..o."'·JnKI ;t. D. '1JIli:;;:dK ill~' .

• , U i . .l < 1 i C ; " ;l[ li < lgn .o s i e s Co:rp.• 6 D an ~ 1 R d . . ~ ~I . h.iriklJ, Nil 1 ) 1 ' 0 - ; ) 6 .



Ai,- Cultures for Fungi U.S.3

C, .A..i:rsaeu (I~iDg de;v~cl!

Basic 'infonn:Iltion regardlag ~he 'I). ' . es of satnple:rn available and their [dative

~JwlJit< 'l lges aJJd dirsad\!~a.!J~iilg,CS i s . provided in T ab le 1. Many ai r samplers were

devised tt l) s<l!mplepa(lid.e:s rather U~aJil~u8gi.Thns, they arc rdativelyifleffe(>.

t ive [ 0 1 [ ' "sa.DlJI,E:ill lgair fo r . [ U f l J g i ! . Low·, , 'O~ul iRe sampk:rs operating at 1 n 3 ! m i n o r

~ess If'e{jurnllicsaMpling ~imes ·of 35 mi:1li, ( 1 ) : , [ more to ensure adequate . airsample¥'GhJ.Hte. The estended ,employee iliivolliYewent and the attendant noise of

samptiug ~ r l < ! i , y 'make tI~e,se 5ample,s r e l a t i v e l y useless, More-specific informa-

llon on Uit: '\;·3!~]liJlIIiS air saD ii lp l~ng dc \o i 'o c s i s provided in Appendix 1 to this

procedure.

S~nli.Iligpklltcs,have ofl(;ft bc>cn utilized r u n the past, bu t t h e y provide data of

btt'e rele"io'oo.re ..Siooic,e l l m : r i l o r n e palIiliiclcs s etr tl e a t dnfercllt rates 1 (6 )an d s in ce th o

smallest f 1 l 1 i l l g , a I D paruclcs are ()ncn C f u e p a th o g e ns of greatest concern" these

pathogenk. l t igenl ! ;s; l inay 00 missed. For ex:a:mpile,Aspergi ll rL<; f~tmi:gat ;us spores

are 2 to . 3. 5 I~l i l l I I dimlet~r. and tl lIDo]r aerodynamic buo ya nc e is enhanced by thepre se nce o f su rtae e Dcbiim .d:aJH(}1 :L5_Thes, eulyvolemetricmethods of sampling,pfo\,ide rel lmable data.

D_ Surfllice Sa1 . i i I l ! l i , l i i ! i l l g

Subseqeent sawplillillgof SiI!J~d, s"Lufaces m~y be useful if relatively large

f l 1 J l J m L 1 . b e r s o r suuiiar o [ g a m S " D ! l I 1 S an; fo uo d du ring a ir s am p lin g. S u ch sID ' . IpUng w a y

serve to linl. < I T : I I O t i v i , ( ] J 1 1 ! I ! S sonroe. sueh as 3! moldy sink" cebinet, or air duct to a

]Jm~'lcmwitb airborne f l ; 1 l ' l f § i . (n " UI. ill9).Sim;p]y :swabbing tile suspect areaand

plating the srw vO libD ~ . o , 1 I I I~ " e .d i a,are f .J ,er l :e f '~Uy su fficien t. for such foUi)w~upanalysis.

m, MedIaUse mbibitory mold ag,alrwi~liI!chiornJluphen-

1,001 ('One p~ak 'pe¥ sample], ~Otber S1!Ii(alble

:se'~c.c:6,,'e~ia,. · p a r t . ! i ; i I D ! a J . d . ) I ' tbo~ dlta:l pre-

'II1Qte diIlbcn1.ia~iolil of the fllllllg.ito ,!rodlll:cc

dislinguii;!hn~g roer.lJtili;ra~.iolii.c~;M:act~istics."may be :S~lbslilu'tcd_)'Co:mmU sOCIliollll1iiii o:l'lbris

handbook: ] '0:1' :specific guidance on identifica.-·

~io~ or fungi. AlItliough more flJ.ngj Inay be:

recovered on othcrmedlia such as rose ben-

gal ;agar (8). extensive subculturing maybe

i l"l.oa;S;. 'S3.T}'1:oacilh<lile identification.,

!b llIiIitiiilill p m : ' D i l ; : e s . ' S i l m I g

Wi, tb ~11I1{l6 'l aU:sru:npl,i:i ' ig devices, ~h c lUiIJll,oolia <Ire inoculatedin association with the

operation of d~es:[lillin~er..Spccik instructions fOf the use . o f the device ShOl,dd

be [o]]owed.

B, Incl!l,k'ltio Ill. E £ mp€:ifalhllll"e

L Room I"ennpcmlulieTIlle :sdcc~iuliiof the sempcratare of iaeubation is determined by the goals of

1 1 t H ' : : project. ltooliiiil temperatureincubation ~sselected to establish rank order

diiliferrer£e.s<lmlllng th,c areaa Scampkd. 'The cleanest environment rank order

sheuld be 5stahlislil:;:::d by using roem temperature incubation. This will allow

.im a l ! : i Ie(eml. i inat ! io i ' i of filltraliOH ,c>m.c~eJ1lJciesin va r i o us controlled environ-

ments in q _ u , I b : : > t : : o m but \7I;'.ill.o t gCiIlerany allow for identification of the fungi

suspected .iI~ paihogcns.

_. ~ -_ ..~~. - ;"""_-:-.-.- ---"- _.;:;:: .. .-,.-::::;---- -- - - - - -- - -- -



H.S.4

V. Q'Ua~ityControl

VI.

Identificationof Fungi

VIL Calculatiues

VITI. DatnIn ter])Jj"ct:,tion

2._ Incubat ion iili 3rC

[ncubation :ilil the more-elevated ternperarurewill provide a selective cnvi-

ronmcnt fO '1 " ~hc ~solati .ol l l . o r airborne fungi that tendtobe opportunistic

pmhngcll:S:." e.g., ASpt~zgi#us species (4·). In quantitative comparisons, f l . l ! l 1 , g i

that gn.l"")i," t " l J . 1 room [crnpcn,(lt~ !I(: ase generally to · ·fol d HlO rc numerou 8 . than

those s h . .d grm'li 3i1~ 37"'C,. I 1 ~ h w b j ' n i m i l ggrowth of t h e nonpathogenic f u n . g w by

incubarion at mhchi~,he,rh!Hl[lCahw:: will facilitato the detection and identi-fication i"lf the mo::;~ like]y pa'lilog,C[lS,

Periodicnll« calibrate 3Jir-s<lfll~:ilin~ equip-

ment for accurate qmHlJ1i."~{i'liu;measure 17) ..

Generally, a ]low I II l! ; ;( o !: 1 i 0 1 : " , c n b : c . , 1 J 1 orifice

may be cmpioyoed ~.IJ) cai ibf<!J ie lJ1C volume o~

O J . . i1sampled. Ca I u b . r< t . 1 ii O l I 1 o ~ [l'!!lm[P5, is a ls o a .

Ilect:-ssity ]01" re]i<lb~eda(!l ,imerpret31( ion. In-

When tests have beea 'l.'Ollduc~ed ' ~ l 1 i n i l,r(101[It cmpcn l1 t uH ': i .l1 I cl lI hO !. tn .on : sfm she pu rpo se o f

determining raak orders of fungal colony

counts, il t is sllIffl,c;ielllfto !!tU;iJi1'tW[~lC tl~lenum-

bcrs of colonies \lI'i1tbou"l. jdelill!i~yin:g the spe-

cics of fungi IfIH:SCIl~_ When the source I[lf .a

speci fi c ] "u l I1 gOJ ]nn rt !c~Ji on lIS w'l ! l lgM and lneu-

A. CCln,r'r:rsiOIJ factors

1. 1ft3 = 2l-3A l i lLem

2. l mj. - 35..3 fl.'3. I h 'l.m lm ll = ~102:S3m:i i /n1 in

dividuals se:c-ting calibration advice should

eontact tile man u lacturer of the sampling

device or censuh with an industrial hygienist

with experience iT O the use of the sam.pTing

device.

baJil.iO[lis a~37"C, cnkmie..,<;e..x.llibmug appro-

priatc gross morphology should be subjectedtu- microscopic examination and subcultured

[Or flllliiUllCIi identification only if required to

illlHIl 1.hemtcnt of the investigation. Sp~de.:>

idenll.ifl,calloI1l methods an: covered in :;ection

1 6 of this handbook,

H. I11trf'o:rm ii[l,g,c~fcula~li'linls

Divide tihe flll rmber of cotoaies of "UriCNo~a~sample by the vO~lJlme- of air sampled

to determine ~ & ~ C CFU pi!!roubic meter, When; calibration indic~:nes the

necessity, adjust air s3Jrnrde volumes by the appropriate Iactor,

The ubiquity Df h~] \ ig i i in the cnVliironlliliblilt

dictates ..h,nl. low levels of fungi 01, be Con-

siduc'd a l:3im:;c](![' 31urn; ~blls..H ' l 'l . ' . : 1 l b m : i ! ' s . that

detect ftm;gi,without qlll,<If!~if&Q~lKa.n' 1 l " u i l m ' l } c ' ! I j ! fnO use. MO,fCO\~l:, methocs, such as Si:Ui~6lIg

plales..l51<rl are ias I ! .! IJlI i,~ietnlb,-M:liIs~tive to de-

lt d f"tlgid T la~ h o g e :1 J i5p ro v i de I Ii lO 'lIIs.dlil in -

formatioo.

Rank orderil!g of JU ll g< l11 . ~ : e s ,.,rdihio the

( , :OJBlJiOUICG !; :1li " l iJ . I l, l iI iHl l. e .l i li l l areas i i i ! adj"cc~ll

ul"loontn)~II.!d areas, and u1.ud()l)i[s UBi:')! , < I , 10\1!i'

for a nliclerDlliIK'.li.~Jn to h.: made (;!iati\-"C' ~o it

mal fI.l1J1\~bl~II t T l f l iU(F<l i~ ion dicvucc".S.ll:: errup-

-__-- ----------------

tiOlilS in the positive pressure, leah; to the

outdoors, or point sources of funea!Rpor,cs,

S~K'I~.nterpretation must be made in the local

enviummcnt (If concern and must incorpo-rate O J ! knovilcag_e of the ,e:~feC:lof SHrlW CJOVl'.T

and temp era wire o rim:::u bst inn _ Gcne.r1lUy,

FSCV areas wil!.hhi~h.emc-i.enGy ilhratioll

should exhibit leve ls of f~lll,giapproxl1 iJa(.e : ly

a fun order of magnitude lower than tile

levels detected in 1.1madjacera outdoor envi-

ronmenr, hut this differential level cannot

he expected dmilllg long periods of SOlOW

U!!.JJ'l, 'l:[_



lUJ;.S

\,\lll};:nlest samples have been ililouJba~cd

at J7"C ~o $(Kciiica'ily dc~oot and id~emi(y a

fUIIgal ~l~.llu.:!lg-C:EJ. i ts p i- e. .~ e JT Io emay belp i:m-

plic;i\tea.lil e,IMI~Orulilc~ta' source. b!!l,t ~tsab-

l>CTLE:C does liIut lillie 'out,.lis f,emptJl~ry pres-

ence of &!ld~ a, souree during the actual,

perjod of patient expcsllre,. If O'n1yoae , 0 J I i -

nily ,of ~ iO '< l t hogcTI is recovered, I 'q~:a( s3Im-

pHll ig is j [l di ca~oo . M l !l lt i, pl e -! t Ji it p a th o gens on

culture f1'~<ltesMe of gn:a[cr OO'nt:lC!m t1L'iliilrhe

s in g le i is o llllt tO \ li l oI a. · · ' ,aI I ,dum,· · ,airioomi::

pdithogc,n.ic par t ic le . Repeat s®nmpl i i l i lg .s ' indi-

cated if wultiple ooliolll~1CSof a pOi tbogcn ~,e

recovre,rc..!l{rom lIU s i l im pl i :ng ii n Iilighly f ! l . tc : red

a r e a s , III < l l r e - . < ! ! s tliirt, I!lrfl)\"iu;;:; FSCV (:>95%

,c'f f icicnocy atrId ;> 10 a ][ c h <l! !li Ig c s pe r b], th e

l ot< Il l p - at !l o' g~n , ~. Ji~migtJ,.m$'. Aspergalus'

flavus. .r1sj1a;!5;#lus 1;1!1'Te',ILY". ,Rw-ari.ulR spp .•

or other 'PO,tel!l(iaUy'QPportuni;sticmllg)rL'i)

[e'f<'e~:hmdrl be IDaintarmedi ail <0.1 CFUJm3,.

IL 8aimtS" Jt. ~. edT. ~~. l'! ! l9 ,,, CbmJl!\)J! Q 1Wx;oco,[lf6a11 ~ i'lliil~ <L ~ by k 1J '1 in :a;'ililf~' i : s Q I I a : .

lion,f.1Imp. Infor1. 1,1!~$'l-':U_

Ll1iu~i:. n. ,C . ( td l. 1 <.1 9m . .Ciouitklill<":$ fur rJ;~ k&l"S.5 '·mclIi' 1 )1 ~ 1 . 1 1 1 the ~~ ~.

Conf.=ru::e 'L.i[ Go!nr!l :m~url mndusbUll.ffiWro~Gn!i:"ruililljL

3,. Cbad~.s.M'.~, J. , ~l!.,~. H.. A.. ~D~' •• &iI,

W. it.S i < l 1 Q ! m . O i I i . ]~g,. Sa!m:pfu:t,ai~ m i C l i O O l f -

~ ~ : i l 1 m ! ! l 3~l!>aller~l1Il '>. P'_ 1' l l9 '- ll ll1l ,i''i S. 11;.

Herillg It.iI.J.A£y~iF~Jor£~~ ..t i,p,; ,ofAumup;ffll:' ,C~;!i ' l ' I i i : I . : I \rmr:; ". 1n:fu,~. Con fe r -

enee o~ '~ll:mJl!l'!:iriI~l lmrl~I' il ll , ] ! i ) - " 6 e~" u~dlll~a1i.

4.• ~ ~. R.~9n. fIIf i · ssmr,l= [Of' iU1'lgi, ~~D

; :I I I:"! b,a","t lEria, I? ' Jl5!D-41L b: 'c. ~ ~c :4 • • • '\!l\etn.

r : : r d s iM M"'~"'.\fY~~. voL 4.~~"fe~. loc ..•~, 'lfod_,

:S _ 'GiTttR,~. V_ W, •. ! i i i , , , lI\~I~. 'R.. G· . , I% ; ad l. : ~ ._[j1(;,. S.~1lic-bll~hEg. ll962. M;qOO~.<!I 1O! lHl~ a:!ioo IiIfl I !o:&pi r~ ,m : i ! \! !t I J J w l i 1 t ;i : : S l l O O ' i < t : s. lip¢. . qwmI 'NQ! ' .!I.0::5(,1-51L

6. Cn:&~. F. iii•.19'j11,. jiM . ' I<tkrol!!!fw.lgll ' aj,rJu,. Al-

P l W S p l li u O ! '. , p . 1dI-1 . ' 15 . J l o lim~M "~C) ' , < § : . So.as, 1'1('[(:..

Me......rOil.

7" .Ii..eIlJI'i"r". J. 1R., rI'~.&. ~cl<r.IIll!!:,. ,J . II... ' ! l o f o r n i U : R s ,

V.1>. KII'UJ'. .. D . !;!iQ~. ~ Ii!! .• l i l i ' _ ~l,1tdll. ]~_

NI~iill ~P'lg,ilbs:iI!;, a MlJ>~n.~ 'I~'.iicw,

, " . I ' l l . .L l ''piJemWl. ~~6':~,3Q--.U1'.

S. Mornn.~ IL' _"''IF.G_Sw'~CSClfi>~mIM. D. Atlf •.Jji!!.

1'laJ_ S~m.p!iJ!l~fv r

;aimD~,,~, r u , 1 J :G 1 i " i: ~ l a l i S ! tr C l ! . 1

com-1"'li:WI!I l i ! ' r me<J l i l i l _ .<l[n._ 1m. ll '}-s. )hs"..;:., J. ~:!':i6...!.--tiM.

g. MJUI'TiII~.'iiV.A..Ji..j_ Stf1lirtllr. F.$_,(]l'~ ~,OO,F-S",

R ! h a o ' r .J > C . 1 9 8 5 . . , ' \" ;;Il<l ' l li l t iOO flK p r o : ! c : c t i o : J I l ! I c f i i:wml ll l C

,;(Jmpf(llfllistd Ij ! IJi l i l : ""IS~A\I;[; i_ SOC. U~jj1i1. il iefiv;;, AirC < > , w _ EJ: g . T r. 10 1 is . 'U:ll~~n'Jl.

m , Op(Al. S. ~m .,~...#1•}1.5l".I1I:. III•.'(Ja"!IL~dI,~.l'. L,Mont'",1:- l- )U!Ii1:;Ui, ~!liIII'. 1[;,., Ii Il !mr[Dq". 19Sii.Ek.aqr 0{

int~c~i@1I <n~lroi ":I I<:<lSIlIr t:~. - il ih.~laI ,00I>1el>t! li1l!>;-

1( hlilal. padIOg:Cn Jevels exceed LO CFU/m~

on. st:'ilcr.d OCCaS10rlS , t '! le air syste us or

!,l[ooedl:lul practice in the patient areas. re-

qu ires i li lt e[ Js i' l1 'C evaluation,

When. g r o 5~ ' ro ~C !i fl :YCOllJ~lt~ r a the r than

lu.n.g3l1pathcgens are dctermmed fo r the most

ilt~My ilUcn:.d ",'I iC'3.S, fil1'lga1l.e:v,tls sho1. i l ldnN

!f;';weed15 CFU!m3 fo~ cuttl.llle5incuilatcd at

room tl~IDpera:tll.l i1[: OF 2 CFlJlm:l Ior ~l,d~.un::;;

i l l i lQ l lbaled a, {3']"e. T he h em o g on eo ns OC:CU I . ' -

fenCC of , 31 no rg all ism ~ !J gi f; cs 1s , 01po, in! : source

from an mdoo ! ! " area (12}~i!i[ld! :such.pruiJlcnls

~e[le:rany arise f oom . s it :JJ I; ~ t' !O I :l Sthat inchu.k"

~ Il.OOnb"ollc.d humidity or w;Ite~ leakage, Re-

antly, r e f i t O V a ~ efficiencies of ' f i l t : r a t l . O I I ,were

c. .'5<tabi isbed [ 'Or l 'lmgi ' tha t gruw at 3'J"C 1 ( 1 3 ) ,

ali i .1i l there IDaly MC day be su :ff ie itn t da ta to

conduct rank order S U i : O I i r c " o ; < It tllls tempera-

ture,

, a i o : r n ~ J. Ir{"e:ct, i ) i . . o : : , 153:.614-6. )7.

lLP~~, !P . !K. . . . p. 'B, . iId_:&ih.VI!,. and 'N . K.Ralft~y.

1m. A . :~ive ! i 1 : u : d y oJ i i l : ii e c t . i . @ l L ~ ~ij~e~~

f o ' l l a w m , b!me m m m J o ' W " InJbsp.laLlI,,,til.JU; emergence

of iir~l'hu an d (:)I'toOll::l::aIovill!lS a s. I D~ m <ljo rCSIJ!SC.l ,O f mort1ltty _ J.;,fu;<l. eM/.ro! 4:&1-89 .

U. !a.~~> s, J ' • • ,i\,. J. Slrcil'd" Milt C. li:. MeJm'm.19'00. E]cv;JJud rOO~'itf;'l~io:~!i uf ,aht~ll~ ru l ' l , s , i i r u I

=idio=:lllilll. i l l l , < . B c-ffioe !!n" '~n)rune:i l1s .A lIt . l li ld • . H Y? ;

A . : r s . a c . 1_ 5bf l( f l. - -604_

n_ lth..~. 'F . 5..M.. M~.rcill_A, A" J. ,~61i1. nd, D.'V('~~'Ll£y.'990. E~liilliilllil ,af CfiruF~ciaI m liiitu:; far

'fimt"l s p o : . r e ~mmr~l o::fficieru::)I'.A : l iJ . sl J :o c l 3 I o :i In!,

(',.;t,oLNO~M :Inject.U. Rhl!~ iI.S " , . ,\ .. j.SmhfE:!, r,n,,~" !lwi! .l'.R

Mct;,llIi1lIt. iI .9(').'1. ~ ID liic . rir.k : £ " ' 1 : 1 : 0 1 : 5 . '~mBCII["Ii'lo!ilia,

iB , the p3rt~i11 at h~h .r i t5i: of i iJi l l let i&Ii . A . I f ¢ . J. M C I i .

7&,'1J2--Sl..

l ! : 5 . ~ D. 11 , 19'72. Me .( .b m: k: :.1 I. c on tr ol o f ho"'p;l"l" 'e al: ih .t io o lin d hpcrgjlt= !nk" ,1. iom: ; . Am. : lWv,R e : $ p - f . r : . D i . S ' . 1 : U 1 5 : 3 O ( 0 - $ 0 ' ) 1 .

16. Sarul~ Y. A•• 0:. II. Kopr. R ' I " o ' " " i l i « i l I . M. ]L

'Mrt:~ od 'II"{.;\, 1t~I!I. 1m.Incaeased ~CC(.i"'-

~1:}'O ( J h p ; ! ' l ' g i l l l I S ' flUvr:lS ' E r , O O l r ( l s p k , l i l o D r y ~P'ec: iml l : l l s

du£i ns b osp il .1 ! l ooilS:[rul~110l!l,.AUL R.;,·v, Re:sflit:, Dis . ,

115:33-38"nr . S I € ' I > ; ' 2 I r i .. ' W . n. 1 1 . '9 5 9 . . ; ' i t a J l f r p ! i n r , Mi'crol ;wl Acros;C!'k

MOD~uaph no, 00', J'~lbflK,Health Servke publlica·

1 ,1o :1 l fj,(J>. 6S6.US. [) .: :r 3Illr n: :r d ,o i Bdlth, [;dw.G"ll·

~iO"[]" am i W;;;lf;",I;'. U.S. GU' I I 'c : ! llm, -i l l l ' ri l ll ing, Of·fice, W il ii i h ing!Wl I , . D.c.

IS. SIRiikI".' \" J. ., 1'..r. :Sk\'~ms.lllIiil F. S . Ii lI la :l in e . , 1937.] 1 l - l ' l o s p i t 1 1 1 S4,"IlI.['re nf r u L o o l ' ! l e PC1J idJ@ff l 1 ; p a : : ; : : i < ' : . s

srm~,.1. Cfi I1 '_ " '1 icTCJIJ iQ~.2S: 1 , -4 .]9', s..treifcl. A- J I • • D' . V f 5 1 ! ! j " . , M1~f.S. n:Uli+~ 1 9 9 ( 1 .

(k~rencc : of 1I3flSiC:l1t ibi,g,b kv,.l s 'D[ airborne

runr ;a i ' : s : r - o r e s . Jl!! ly 19'-A'l'g'LI:il 3. J ' ~m . : : _ 5 1 f t ["t.

C~hJ Imioo.r A ir ~171 Clim~t'" 1;101-11~,2 0. S tr eif f,1 " A ... jl •., I~ . Y!:sicy, lo'. S. Rhil.lllt, ~111115.

lIt<urr-.1,.•• ~1.ilR9.(:O,ni'rol O l[ ~iroom~ fU ! lg~ ! ~ r ~ue5I n a

1.m:No1;l'S:ity hosprla!1. E . If 1 Ii nm. 1m . ]S:21l-221.



11..8.6

SI,IPP',lClIlellitaI

Reading

SU .'d("I" .~ J. I" '~,. A"!K"ry:;: ff i. , , , , and (),'1Q.<lrt!l=I,'~u. p.. ~.7d , . w a i N " .~,(,i.:mbial J 'vl . '" I""T'. OxJiu[ i1 i U:li'o'!::rsi{y

11M! ' 217 . ill K H . K~III,!I:>ID h -~ .I • .. .. . ',·'l!Ieo:: .[ f)i.·S';.,,~' l'rc"3.'!>.1\",.. ' )"<1, k

A. S i!i:l'C nmp3d(l"n;

1. (~'ll~.rald';5c-riPliinl1

Sieve imjXo.;llJl};.,Ii\;dflCicm all IIJuick

ellll'~I..;lorli ~2>5, (~jll~11 are ;olllmlClI:.i~lIy

lI!\'aDI~!bk ~ , . . ~ , , =rd'::EO;:J:lres <111111able [J.I~ ,\niklfS.r'IFI d 'l ., ,, ,· i . •e is fII~.most l:{lm.

mm,ly used " "{ l\U ' II Ic :U ! (: " s . :I .l U . iler, 'nl!;"

:;';UlTllp.lli1g I.i;:'l'ilcc I!I!!;>:=Sillcnia] irnjl'1.nkm

Gil ~h~ : : l J _ g , i l i ' .<;lyrf<iiCe 1 i 1 . 1 ' o i k " ' - I . viable par •.

l i.dlc.~. E<l. ,;h smag~ o - : I l Ul-e.:5i1mph:r ' m u : a , , , 2:4l)

or 4,00 Illo~~ th.mulgil l...]ichi ;bc rmli1it :ks

travel, arlilll U a~ liIoies t , , = = 1 smaRh:r as d:!.e

:>la,r;-<: JlJlIJUiJ 'l:1i dcsecnds, llBi:!;' ! f [ o vU .des ~hc

basis f(lr the dilifc.rcuti"tUQll or 1 ! , ' . a r i o l l l : ! >

p:utk'l-e sii2.e~.The sieve impallO:rs dlilJc[.-e,l ' Il8;JJt~ nCS]pimble (,<S'J!UlI-di<l1l eter] via-

b lc ll '" d rl id c . s ] i; O rn l J I! !( ml'c'>W'mllll'e (: > S 'IU'PI-

di.nncter] p.a.nidcs hen at lea 'Il ~\lI."O

sl ;;bg~::; 0] the s,3iillpllcr are MSC.d..n the~ " ' : l H 1 1 1 I l ~t: : rs . l<€Ii\: ii i]jl'acto r h as s t i J . l Sl3;g:C'S, the

] f 1 Q 1 J r i t i . c l b abi!l¥,r; ".(lIgl!: ] a r c oon5 .i d. e .r l5 li .l l

I1{JLlI"!.::i;P'~(<lb~c, while (he pil!ni".:'l~!> above

S~:lgC I) <Ire re sp·ird b.!c :.. B ec au se ~ ( th e

deS;ign and {lerod_Y1n<!.mk Iltlll.l!lrl!: cl air-

borne p;:utL'Cks. SI.<I[J> "3 reme- e . ' i p:lullides;

l im! are : ; .5 Il-lmi l l i l diameter, . .l Io 'l ', ing the

$mal.bl cm<ll if lliOl!g pmrlid(""s to become

iUljl<lC~cdiOr]]Slill&~ 6. 1k.ca~!SC0 I l i a :,tati.s-

ti.eOlI C"OTIT;ti:ion ~.nll1DJb, t h i s S:H1l :p ier ' < ! I _1Dl\\f5te~15mli3JliJ,k 3CCl!J1"<lJ;;Yn S ; 3 t m P . f u : I r . (If

areas WiDh l t u ig lh ! o;IlIlJC'(! n~Ji""liorL'l;of ais-

OO~e rlllrtllg:i. l1~e ,ltOilI"C'C[W-o it S < l i r l l D ~ i e ; ; _ B

wiucnc"llcII" »l~ !;'"Q~bnks; arc counted 0 . 1 1 1

t~ c s<lmp.le plnc_ mec(l!lse'llfthe r C i m p . ; o c : -

linn p<llielllilrilLl M inc -om ilD,G \ 'i ab lc p < t l m i : -

c t e s , a ~ . . h!<! [email protected] C Q i l l' l . i' e l F : > 4 C 9 : : - . is i1f'lr-allabk

(l).

2 .. I)i s~dk . ra f i l ; . ! !ges .

Th e S:lIJ!lpl.e~gcrIcHJly OIJCI;;llCS 31 ] ,Ill

n ~lm.illl.11l ;Irela I uvc!y ,eiealll cmil rflqmClll,

th e sa mp le lii'l''ilC"~o " d:-lcmlilTlill,~ 1LOCFilJ

of p 'al l] m"" :' I ,. ': : li I. s,~[ JII' ' I !. ·1 I I~1 .. jh ; ", ,( : l (1 ) be

t~"'Ii'i!";J~lGli lt~ ::-35 mUll ~ '1 o:,.:I!~T lu i:olh:<':l:;). 3 f. l '~ {('II " ] 1 i 1 I ~ ' ) o~ai:_Sic,,",: "ml[l;K"h]:r~

. ( ' :C!BH~r,: i Iy~mrk l ' a v ac 11.1"..iiUl iWmil 31ld ar e

a noise Jll.Jii~I[lC::: in an O o . . " C l I ! , p i o o ~PJlliClilt

fO!."I'i I I.. Fur ! , l l i l _ ; > , 8;a :lIpli I l _ g . l . i m c . " S , ' 2 1 1 i ( ! n I

loom vacuu IIIIW,llYbe ~\·:.bsl.illl[c~!by em-

f ! I 'LJyiJru~ . .n :aiirihl'''-f tll<l.1 i<~~lnc s Iilh~ crisl-

cal ori~ai'l1ll('n;!Lcdilu {he ,,'r S;I J1 i~ llc :r .

L GCm:r"~properties

TII~ $Iil im p::tclo r is :In (;.:md~llt particle

oolkatm ihat 1Itiliz cs In erti 3 .1 hiIce 10

impact viabk; paniclesonto the !>l!ff;H.:C of

IU1Cagar. These devices do not ditTerclIl: i .

~~eparticlc sizes (7). 111cr have a m~.'11~ \ . p ! :

disk (lin which a standard-sized 1 1 1 < 1 1 , (150

lb y 1 5 mm] llf < l~ r r n1: ti il lm ]S placed, The

11lJ~..tien of the plate ilJilder i!he s.bt~o:~mry

sl lil :a .1I0WJl. r o . I jl ood 'u c ti on o f aH)[[JprialC

~ii[m!-O.Jlu. ' f}ntmli{)n ·re!<lt!OTlship". Slit im· -

pactoss ilalve presCot sample volume rates

t.:Inglil;.'F,; [[OIm 30 [to 7 00 'litcFl>i'min; lhI,lS:.

v<loar.ion of sampie time will allo.v forquaEllit,.l.illlil. Since the sample volume

ranges a ..s high as 25 fl'~lmin. these collec-

I!OD:-i. t~ ke o nly m in utes. 1 . " b J l ! 5 , th e} ' m ;W

be used to di5li:ngl!l.ik~hchaDlf,cs ; nI conccn-

~.i!"a~"~o.nver brief periods, aD d such

cllai1gl:S mlght ' b - e rde:r(l~k 1 '0 Iocal activ-

il~C:,:.lh;ll im'lllloc them.

2 , . Di sadvan ' t(Q ,gc s

. t\ccurOl(.,"Y i : : ; lim](,!:d where there archigh

conecntrauens (If w'[lgal spores.

]. Gene]i";.!] propertles

The c en tr if ug al .imp actor I!l:!.ilizl'sthe same

princi p ! , e , . " ' i a: > 0[1I(;f impactors. A st ril]

oliJn~ainil1;g wells oJ ]l!W!j" rnwlmill i\'i phl.o~t1

3[f 'OI! l [ l ( l [the ! l ; i !TlJpi. iTIlg head. The compac t

rlmilab~ nature of 11~is.de....ce aad i ts q l li e t

o pcrau oa m ake it id.c.lI1 ~ L 1 r rh : - I c r n l s p i c ! J O I . l S

operation (3).

2. Disa~viln~agcs

Calibratios» j,s done at the factory, and

'qualillila(iu-l"I of ail" volume i~.thus (lot

posslolc except at theIactory.Thus, only

rclauve comparisons o r hHli;1i.11contami-

[!';J;~ion betweell (l.LJ[~;r~[ltareas tim be

~'"iI_;~dc.WLl.rkiTl~. with a welled :Slrip O il '~ndia

ma k es jd ca t i l i i c - . a : l i O l l dillic:u~Tand ~f:'I',rir(;sto"'.I':-I :tilJbC.lI[lllfd I.lg..

D. Frillratio'il

"[his fnelh()l.i is prilmarily used for lW;.Il~I"'lioll

uf airborne ilLilll(~r:;o!sand respirable dust (4)..

----. -_ .. - - ---------.- - - --



11.S.7

UOt:;]1IhSC or lhei!li s1ll1lalln,css 31nd klli""I.'\Ol~l1J;e F. l~ollo£i 'I<l;h

"aq~ pl~ r;il!e (~l !, c[ [lm i n) . fdH:.r (_"a~scllie.." ar e

no, P;';!!:~~.;:~IOF' SoaIffipling viaM!; mlcrobcs.

i F :. i li ip . i n g :e l :! ll lE l lU i t

~.c-dl!~ of lhc i [ ll)\ -woIu.lille s:l.lIDplIi i i lg rates

i!Il:d 1!. t : ;MeI l.cy tu d~"f1lpL 1Ii.. l&- 'p.&1tijA;ilc

dempS. the ~lllr't.._d'!Oil of (It.:...~ d~'II'j,oes i L < : ;

Ijmil~d 1(1 areas ~. 'fu.C[C hli ,gb 'CUl:OC-CIil ' If 'dl[~<;:

a r~ s lU iS JP 'C cl~ d. e • .g __ i ! . 1 . i J r ' k , c - y a m s .

I .• o\n.lkrs~n •.A. . . .. .. _]II'58. A ,,~ SlllIllpk. l'of Q[d!t:dtoo,

~i~in:g ,a~l I CIlI!1I1it' ! :;, r t i oo af 'o;\ahIe ai f l><J iLaI! p l ! I lt i cJb- ;: .

1 . Bf I JC; tc j7<J£. ': l~S1V:; ]S j.

2. ~!l!lIfg,.~Y. G •. (rtiilI,~. :l .9SR G~lin:.>~"lfx 'h.l' ~~.

meM ~)' Bi<J"e~ ~ f.ltc. Iimt:I_ &,,¥~.Conroe.r~!l<:e ;m f

'r........"I: in. I!1iI! I! .Qt i.00'lI.~ri;t~ .1i)'gjt;;O:iis'1!5~

C[nc:jnml!i"

3 .. C;i;'i~IlII. }~. W"""" •.~il.1l. dI I&.,Ji. 1~ .. 1 9 ' & ~ j . _The

y\w, Ilr ' ' ' ' 1 1 : : R('l]Jler ~iilnfug:ll air' :!i3mp1~TIr'-"l !he:, : : ~ n ; ; u I i l l ! i o D I O)fb~c~.ri~l ..iE O O ' I l n - l < ; [I] , o : I ! i J ii i a r e r m l im:spil:d

l . o c a 1 i ! l I l l . ' l : . 1 . . H Q I S p " I n ' f r - r . I C J I I ; 2 : 5 0 - - 2 ' 8 : 1 ' .

4 . . F i0 :4d s ,l " :_ G.•C,. s, fu .OOI"NW".lI . R. !!'\idw., udiC. ",,LU'crn""," 1 9 1 ' 1 . E....u1J:lI..inn or l ! 1 ! l o : r n b l i < ! : n e nl~~lr~IdI'l1'JOLIl!l[Sliil"r miil:Kll,ioI.i!tg~31 aU ;g1lllI'~g. .Ap¢. Mi-

This, ,t! l ,: .v;oc employs; i JD . lp ~ c lm . m O i l a st icky

.~ Iass $1Il[.f3C~ Ihc~Es rotated ill a rnb ie ru ou t-

dQl«If air. Rotorods are not practical for ~m.,.·

leeel i l K k r o o r s 2 I l 'l '. p li [ l; l! ', .. Geli~';i,lly employed

fo r ~ ~ an ! I 1 y s . i i s (J f ~ ~ p ' O D e s a nd p olle n 'it! ~lcr@,~'! > ' ! w d i e : s (7) . th .e ! lie.v iol~:mc.asl .l reS i1 l1mbeIS of

l i lOlWi:ab 'lc fl'Liticlcs.

('robid. l7:511-520I,S _ G I ft J ! iO C j '. .. .. B . ]'J"l'''. T h e Mjcro~!tl~ e rJ l J: I ' I ! tUm; t>-

s p 1 l' C: ~ . • p. llii-I<l5. J.ohn Wiley & . So!lL~,• Iuc., NewYor'k..

6. RhB!l!ie.'" s. , A...... S(Hlr~~ l.u. 1 K : t : r : s e : r . i !1 nd . ~ . B.

M~Gia~'II!.9M. E:mi..nsicrisk

r~Gi() [Sf'(Ir pm:ruI~~i)[;Iiil

I.ll 1m.. [,alien! !II h,~ Ili.!l;k d in:fl:'! :tioo . .A";'. J. . M . ...t;'6:42--5.'2.

t.Sl~d, ·W. E~. 19S9. Sa.mpl~IW MiCltl.t.~1Aero.rotJ · . ,

''''~[)liIG&~a.!?,ho. 00 , Pulblic H~hh Ser . .. i,o~ pub ll ca ;t i- rm ,!DQ. 6Sb.. "U.s. Dtpul'llient 'Il! H~ailn·rr...hlllooi(lil. :m d'Ii""c~.re, H ..S. OWer1l!1lhe.;ll'.iw!i~O«i!~, Washirkg'

iUlIi. n.c,

Documents

Clinical Microbiology Procedures Handbook Air Cultures for Fungi