Study on viruses on neoprene Polish Hyperbaric Research

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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;

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