POLISH HYPERBARIC RESEARCH 1(62)2018
Journal of Polish Hyperbaric Medicine and Technology Society
Faculty of Mechanical and Electrical Engineering of the Polish Naval Academy
MICROBIAL CONTAMINATION OF A DIVING SUIT
Zbigniew Dąbrowiecki, Małgorzata Dąbrowiecka, Romuald Olszański, Piotr Siermontowski
Department of Maritime and Hyperbaric Medicine, Military Medical Institute
ABSTRACT
Pathogenic micro-organisms can easily transfer from the surface of a diver's skin onto the surfaces of a protective suit. A long-term stay in a hyperbaric
chamber during a saturation dive increases the risk of infection if in the chamber there is even a single carrier of disease-causing pathogens.
The conducted research has confirmed that the diving equipment located in Diving Centres is a place of many different bacteria and fungi, including
pathogenic ones. The vast majority of microbes found on the surfaces of wetsuits, etc. are commensals (with some being opportunistic organisms). This
fact allows us to realise that the surfaces of diving equipment are an excellent "transmission route" for various dermatoses and other diseases. In order to
reduce the risk of infection the diving equipment used by various people should be subject to the process of decontamination. The authors recommend
decontamination with the use of gaseous hydrogen peroxide which does not cause damage to equipment.
Keywords: diving, diving suit, contamination.
A R T I C L E I N F O
PolHypRes 201 Vol. 62 Issue 1 pp. 61 - 74
ISSN: 1734-7009 eISSN: 2084-0535
DOI: 10.2478/phr-2018-0005
Pages: 14, figures: 6, tables: 2
page www of the periodical: www.phr.net.pl
Publisher
Polish Hyperbaric Medicine and Technology Society
Rewiev article
Submission date: 05.01.2018
Acceptance for print: 15.03.2018
2018 Vol. 62 Issue 1
Journal of Polish Hyperbaric Medicine and Technology Society
Faculty of Mechanical and Electrical Engineering of the Polish Naval Academy
INTRODUCTION
In 2003, Wang et al. [1] reported a case of
infection with Methicillin-resistant Staphylococcus aureus
(MRSA) in 6 divers exposed to a 45-day exposure in
saturated conditions. The source of the infection was one
of the divers. The most probable transmission route of the
infection was a direct contact between the infected diver
and other participants of the exposure. The bacteria of the
Staphylococcus genus colonise the skin of every human
being, constituting its natural physiological bacterial flora,
however it should be remembered that in altered
conditions the same species may cause infections.
Staphylococcus aureus mainly colonises the nasal
vestibule and can be found in approximately 40% of
people. Its presence in humans is referred to as carrier
state.
Staphylococcus aureus may be the cause of local
infections, virtually affecting all tissues and organs, as
well as generalised, often life-threatening ones. The most
common are purulent inflammations of the skin and soft
tissues: furuncles, sties, impetigo, abscesses, purulent
fungi and bone marrow inflammation, septic arthritis,
endocarditis and pneumonia. The incubation period (time
from the contact with the pathogen to the first symptoms)
is between 4 and 10 days.
In the work of Hind et al. [2], the effect of an
increasing drug resistance of disease-causing pathogens
was
noted
in
relation
to
Staphylococcus
aureus,
Escherischia coli and salmonenella typhimirium in the
conditions of an increased pressure during saturation
diving (heliox, 36 and 71 bar).
Pathogenic micro-organisms can very easily
transfer from the surface of a fabric onto the body of
a worker using a protective suit.
In addition, there is a risk of transferring
pathogenic micro-organisms between people using the
same work clothes, particularly in the case of expensive,
specialist suits. Micro-organisms that can potentially
spread through clothing include intestinal bacteria such
as: Salmonella, Shigella, Campylobacter, E. coli (including
E. coli O157), C.difficile that cause infections of upper
respiratory tract and digestive tract (noraviruses,
rotaviruses, adeno and astroviruses).
The risk of infection also includes influenza
viruses,
herpesviruses,
and
pathogens
transmitted
through the skin, such as S. aureus (including MRSA),
yeast-like fungi (Candida albicans), strains of fungi that
cause Tinea pedis (foot tinea) and Tinea corporis (mycosis
of smooth skin) [3].
It is estimated that a person may emit
approximately one million dead skin cells per day, which
may contain fungi and bacteria, including S. aureus [4].
The survival of micro-organisms on different
surfaces depends on the type of fabric, humidity and
temperature,
as
well
as
the
initial
pathogen
concentration. Neeley and Maley studied the survival of
22 species of Gram-positive bacteria on such fabrics as:
100% cotton, 60% cotton + 40% polyester, 100%
polyester.
All
micro-organisms
survived
on
selected
materials for at least 1 day, and some of them for as many
as 90 days. In general, the survival rate of bacteria,
viruses and fungi on smooth hydrophobic surfaces is at
least 2-4 times higher as compared with such fabrics as
pure cotton (smooth, terry) or cotton / polyester (5,6,7).
Pathogenic micro-organisms can very easily
spread from the fabric surface onto the body of a worker
using protective clothing. In the work of Sattar et al., it
was demonstrated that one of the most important factors
determining the rate of transfer of pathogens from the
surface of the fabric onto the employee's hand is the
fabric’s humidity. Drying of the surface can reduce micro-
organism transfer by up to 10 times in relation to the
transfer from a wet surface onto moist skin [8].
RESEARCH OBJECTIVE
•
The research was aimed at determining the
degree of microbiological contamination of
diving equipment used during planned training.
•
The degree of microbiological contamination of
the equipment used has no impact on the course
of training but may be the cause of numerous
dermatoses found in the environment of divers
and individuals who have used the services of
centres offering such trainings, or diving
equipment rental facilities.
•
The
research
was
to
determine
the
microbiological quality of diving equipment and
demonstrate why it should be subjected to
a decontamination process.
RESEARCH COURSE
•
Collection of imprints from flat internal and
external surfaces of diving suits and wetsuits
onto media used for determining the total count
of microorganisms as well as those used to
indicate the presence of yeasts and fungi.
•
Collection of swabs from suits, wetsuits,
mouthpieces, masks, life jackets, etc.
•
Preparation of collected culture swabs on TSA
medium
(to
demonstrate
total
count
of
microorganisms), Chapman's medium (for the
presence of Staphylococcus aureus and other
Staphylococcus bacteria) and SA medium (for
the presence of yeasts, dermatophytes and other
fungi).
•
Evaluation of cultures.
The level of microbiological contamination of
surfaces of diving suits was tested using Orion's imprint
tests. Hygicult tests are designed to enable fast
monitoring
of
microbiological
hygiene
and/or
preliminary identification of micro-organisms (total
number of bacteria, yeasts, molds and enteric bacilli) on
various types of surfaces. The test can be carried out on
site or the slides can be used as convenient transport
media for cultured samples.
The Hygicult TPC slide is coated on both sides
with Total Plate Count agar, which facilitates rapid
growth of the most common micro-organisms. The test is
designed to detect an elevated total microbial count. The
Hygicult Y&F slide is coated on both sides with Malt agar,
which facilitates rapid growth of yeast and mold. The
growth of bacteria is inhibited. The test is designed to
detect an increased count of fungi on the tested surface.
With the use of Hygicult tests we are able to
obtain preliminary information regarding not only the
Polish Hyperbaric Research
state of microbiological purity, but also that related to the
type of micro-organism that causes contamination
(depending on the Hygicult test). The collected samples
were incubated for 24 hours in an incubator at 35-370C.
Using the attached model, the degree of contamination
was determined in cfu/cm2.
RESULTS
Tables 1 and 2 present the microbiological
contamination of selected fragments of suits and diving
equipment.
2018 Vol. 62 Issue 1
Journal of Polish Hyperbaric Medicine and Technology Society
Faculty of Mechanical and Electrical Engineering of the Polish Naval Academy
Tab. 1
Sample collection from diving equipment surfaces on October 6, 2017 (after dives).
No.
place of swab collection
Research results
•
small growth 1 – 20 cfu;
•
++ large growth 20 – 100 cfu;
•
+++ very large growth above 100 cfu;
Imprint
general microbial
count
TSA medium
general microbial
count
SA medium
presence of yeasts,
dermatophytes and
other fungi
Chapman medium
presence of
Staphylococcus sp.
presence of
Staphyolococcus
aureus
1
Diving suit no. 1– inside, armpits
+++
+++
++
+
-
2
Diving suit no. 1 – inside, neck area
++
++
++
++
+
3
No swabs collected
4
Diving suit no. 2 – inside, crotch
area
++
++
++
+
+
5
Diving suit no. 2 – outside
+++
+++
+++
++
+
6
Diving suit no. 3 – inside, hands
area
+++
+++
+++
++
++
7
Diving suit no. 3 – inside, armpit
+++
+++
+++
++
++
8
Wetsuit no. 1 – inside, neck area
++
++
++
++
+
9
Wetsuit no. 1 – inside, head
++
++
+
+
+
10
Wetsuit no. 1 – inside, torso
+++
++
++
++
+
Polish Hyperbaric Research
Tab. 1 cont,
Sample collection from diving equipment surfaces on October 6, 2017 (after dives).
No.
place of swab collection
Research results
•
small growth 1 – 20 cfu;
•
++ large growth 20 – 100 cfu;
•
+++ very large growth above 100 cfu;
Imprint
general microbial
count
TSA medium
general microbial
count
SA medium
presence of yeasts,
dermatophytes and
other fungi
Chapman medium
presence of
Staphylococcus sp.
presence of
Staphyolococcus
aureus
11
Wetsuit no. 2 – inside, sleeves
++
++
++
++
+
12
Wetsuit no. 2 – inside, legs
+++
+++
+++
+++
-
13
Wetsuit no. 2 – inside, crotch area
+++
+++
+++
+++
+++
14
Wetsuit no. 3 – inside, armpit
+++
++
+++
+
+
15
Wetsuit no. 3 – inside, legs
++
++
+++
+
+
16
Wetsuit no. 3 – outside, zip area
+++
++
++
+++
++
17
Wetsuit no. 4 – inside, head
++
++
++
++
+
18
Wetsuit no. 4 – inside, torso
+++
+++
+++
+++
+
19
Life-jacket – neck area
++
++
++
+++
++
20
Life-jacket – zip area
++
++
++
+++
-
2018 Vol. 62 Issue 1
Journal of Polish Hyperbaric Medicine and Technology Society
Faculty of Mechanical and Electrical Engineering of the Polish Naval Academy
Tab. 2
Sample collection from diving equipment surfaces on October 17, 2017 (before diving).
No.
place of swab collection
Research results
•
small growth 1 – 20 cfu;
•
++ large growth 20 – 100 cfu;
•
+++ very large growth above 100 cfu;
Imprint
general microbial
count
TSA medium
general microbial
count
SA medium
presence of yeasts,
dermatophytes and other
fungi
Chapman medium
presence of
Staphylococcus sp.
presence of
Staphyolococcus aureus
1
Diving suit no. 1 inside, head
+++
+++
+++
+++
+++
2
Diving suit no. 1 inside, neck area
++
++
++
++
+
3
Wetsuit boot no. 1 inside
++
++
+
-
-
4
Wetsuit boot no. 2 inside
++
++
++
+
-
5
Flipper inside
++
++
++
+
-
6
Goggles, nose area
++
+++
++
++
+
7
Diving suit no. 2 inside, head
++
+++
+++
++
+
8
Diving suit no. 2 inside, armpit
–
+
+
+
-
9
Mask, mouth and nose area
++
++
+
++
+
10
Diving suit no. 3 inside, neck area
+++
+++
++
+++
++
11
Sock inside
++
+++
+++
+++
+
12
Diving suit no. 4 inside, neck area
++
++
++
++
+
Polish Hyperbaric Research
Tab. 2 cont.
Sample collection from diving equipment surfaces on October 17, 2017 (before diving).
No.
place of swab collection
Research results
•
small growth 1 – 20 cfu;
•
++ large growth 20 – 100 cfu;
•
+++ very large growth above 100 cfu;
Imprint
general microbial
count
TSA medium
general microbial
count
SA medium
presence of yeasts,
dermatophytes and
other fungi
Chapman medium
presence of
Staphylococcus sp.
presence of
Staphyolococcus
aureus
13
Diving suit no. 4 inside, lower
sleeve part
++
+++
+++
+++
+++
14
Fleece undersuuit no. 1 inside,
crotch area
++
+++
++
++
+
15
Fleece undersuit no. 1 inside,
armpit
+
+
+
+
-
16
Fleece undersuit no. 2 inside, neck
area
+++
+++
+++
+++
+
17
Fleece undersuit no. 2 inside, leg
+++
+++
+++
+++
++
18
Orange life jacket, neck area
++
+++
++
++
+
19
Mouthpiece no. 1
Not collected
+++
+++
++
+
20
Mouthpiece no. 2
Not collected
+++
+++
-
-
2018 Vol. 62 Issue 1
Journal of Polish Hyperbaric Medicine and Technology Society
Faculty of Mechanical and Electrical Engineering of the Polish Naval Academy
DISCUSSION OF RESEARCH RESULTS
Fig. 1 Staphylococcus aureus.
•
Sample no. 13, the swab was taken from the
inside of a sleeve of a diving suit.
•
Sample No. 19, the swab was taken from the
inside of a mouthpiece.
•
Staphylococcus aureus bacteria were isolated
from Chapman medium.
•
The bacteria of the Staphylococcus genus
colonise the skin of every human being,
constituting a natural, physiological bacterial
flora, however it should be remembered that in
altered conditions the same species may cause
infections.
Staphylococcus
aureus
mainly
colonises the nasal vestibule and can be found in
approximately 40% of people. Its presence in
humans is referred to as carrier state.
•
Staphylococcus aureus may be the cause of local
infections, virtually affecting all tissues and
organs, as well as generalised infections, often of
a life-threatening character. The most common
are purulent inflammations of the skin and soft
tissues: furuncles, sties, impetigo, abscesses,
purulent fungi and bone marrow inflammation,
septic arthritis, endocarditis and pneumonia.
Fig. 2 Pseudomonas aeruginosa .
•
Sample No. 20, the swab was taken from the
inside of a mouthpiece; the Pseudomonas
aeruginosa bacillus was isolated
•
Pseudomonas aeruginosa causes, inter alia:
- infections of the lower respiratory tract, which
may take various courses, from asymptomatic
carrier state, through mild tracheitis and
bronchitis, to severe pneumonia;
- otitis externa, particularly in individuals
swimming in pools, known as "swimmer's ear";
- inflammation of hair follicles, mainly in people
with acne, especially after an exposure to water
contaminated with these bacilli, e.g. in the
swimming pool;
- pseudomonas aeruginosa bacilli are naturally
resistant to many antibiotics and easily acquire
resistance to subsequent ones, which makes it
very difficult to treat infections induced by these
bacteria.
Polish Hyperbaric Research
Fig. 3 Candida albicans.
•
Sample no. 2, the swab was taken from the
inside of a diving suit in the neck area.
•
Sample no. 16, the swab was taken from the
inside of a fleece undersuit in the neck area.
•
Yeasts of the genus Candida were isolated from
Saboraud medium.
•
The major representative and at the same time
the most frequently occurring pathogen is
Candida
albicans,
which
is
a
common
commensal of the human gastrointestinal tract,
however when it is present on the surface of the
skin it is an opportunistic micro-organism.
•
Candidiasis mainly affects the skin, mucous
membranes and nails.
•
The development of infection is favoured by
a long-lasting antibiotic therapy, skin micro-
injuries,
skin
maceration
associated
with
excessive sweating, obesity, diabetes, alcohol
abuse.
Fig. 4 Aspergillus Niger.
•
Sample no. 10, the swab was taken from the
inside of a wetsuit in the head area .
•
Aspergillus niger was isolated from Sabouraud
medium.
•
Fungi of the genus Aspergillus are responsible
for aspergillosis.
•
The infection can be located almost in almost
any tissue, however it mainly affects the
respiratory system.
Fig. 5 Trichophyton.
2018 Vol. 62 Issue 1
Journal of Polish Hyperbaric Medicine and Technology Society
Faculty of Mechanical and Electrical Engineering of the Polish Naval Academy
•
Sample no. 4, the swab was taken from the
inside of a wetsuit boot.
•
Sample no. 8, the swab was taken from the
inside of the wetsuit in the neck area.
•
Sabouraud agar culture allowed to isolate
dermatophytes from the Trichophyton genus,
which belong among disease-causing organisms.
•
The most common dermatophytoses caused by
this type of fungus affect the feet, nail plates,
scalp, hair, and chin (in men).
•
These conditions require long-term treatment
and strict adherence to the principles of
personal hygiene, as the infections are also
transmitted by a direct contact or through the
use of one’s personal items.
Fig. 6 Rhodotorula mucilaginosa.
•
Sample no. 9, the swab was taken from the
inside of a wetsuit in the head area.
•
Yeasts from the Rhodotorula genus were
isolated from the Sabouraud medium, i.e.
common
saprophytic
microorganisms
constituting a component of the physiological
flora of human skin.
•
However, recently numerous infections caused
by R.mucilaginosa, R.glutinis, R.minuta species
have been reported.
DISCUSSION OF RESEARCH RESULTS –
GENERAL CONCLUSIONS
•
None of the samples collected was sterile.
•
Staphylococcus aureus bacteria were isolated
from 80% of collected samples.
•
Pseudomonas aeruginosa bacteria were isolated
from samples taken from mouthpieces.
•
The overwhelming majority of swabs and
imprints resulted in a large or very large growth.
•
Microorganisms from the genera Candida,
Cryptococcus,
Rhodotorula,
Trichophyton,
Aspergillus and many others were isolated from
cultures on Sabouraud agar growth medium
used in the cultivation of yeasts, dermatophytes
and other fungi.
CONCLUSIONS
•
The
research
confirmed
that
the
diving
equipment located in Diving Centres is the home
of many different bacteria and fungi, including
pathogenic ones.
•
The vast majority of microbes found on the
surfaces of wetsuits, diving suits, etc. are
commensals
(with
some
of
them
being
opportunistic organisms). This fact allows us to
realise that the surfaces of diving equipment are
an excellent "transmission route" for various
dermatoses and other diseases.
•
In order to reduce the risk of infection the diving
equipment that is used by various people should
be subject to decontamination [9].
•
The authors recommend decontamination with
gaseous hydrogen peroxide which does not
cause damage to equipment.
REFERENCES
1.
Wang J, Barth S, Richardson M, Corson K, Madera J. An outbreak of methicillin-resistant Staphylococcus aureus cutaneous infection in
a saturation diving facility. Underaea Hyperb mad 2003 Winter,30 (4), 277-284;
2.
Hind J, Attwell RW, The effect of antybiotics on bacteria under hyperbaric conditions, J.Antimicrobial Chemotherapy, 1996 Feb, 37(2)253-263;
3.
International Scientific Forum on Home Hygiene 2011, The chain of infection transmission in the home and everyday life settings, and role of
higiene in reducing the risk of infection. Accessed at http://www.ifh-homehygiene.org;
4.
Noble WC. Dispersal of skin microorganisms. British Journal of Dermatology 1975;93:477-85;
5.
Neely AN, Maley MP. Survival of enterococci and staphylococci on hospital fabrics and plastic. Journal of Clinical Microbiology 2000;38:724-6;