A Laboratory Study on Pathogenic Fungi Carried by Flowers in an Infectious Disease Ward

This article addressed the pathogenic fungus distributions on the flowers which were placed in the infectious disease ward. 10 strains of flowers were randomly chosen from the visitors from 30th November 2009 to 6th January 2010. Samples were collected from different parts of the flowers on day 1 and day 8 from the collection. 76 samples were divided into 2 groups (38 samples each group) which were collected on Day 1 and Day 8. 66 of 76 (86.8%) were pathogenic fungus positive. Monilia (24.5%), demalaceous fungi (14.5%) and Rhodothece sp (13.2%) were the top 3 pathogenic fungus in the 318 positive colonies. In the 33 comparing samples (day 1 and day 8), 6 samples were consistent and 23 were inconsistent (P<0.01). The rest 4 samples were pending. It is not recommended for visitor to bring flowers in the ID ward as there were high risk of pathogenic fungus in the flowers, especially for those patients who were suffering immunosuppressed in the ward.


Introduction
Flowers have ever been shown in studies to bring about a positive mood. It also brightened the room and served as a constant reminder of how much you care. Visitors always brought flowers when they visited patients in the hospital.
The flowers were placed to improve the environment in the hospital [1]. However, Tormo Molina insisted pathogens were found in the vase of flowers which was placed in the ward in the 1970s. The flowers may be contaminated with variety of pathogenic and non-pathogenic microorganisms during the time of growing and transporting [2][3][4][5]. When the flowers were placed in the ward, they may be contaminated by the air pollution surface of the tables or beds [6]. In some studies, the concentrations of Aspergillus and Penicillium spore were much higher in the ward than outside. To examine if any pathogens can be found on the flowers in the ward, fungus cultures were taken from the different parts of flowers.

Materials
From 30th Nov 2009 to 6th Jan 2010, 10 strains of flower were randomly chosen from the visitors who brought the flowers to visit the patients in ID ward. The patients stayed in the ID ward from one week to three months. These patients were major diagnosed with unknown fever and central nervous system infection. There were 4 patients located in each room. The flowers were placed in the rooms and the windows were kept open 1 hour twice per day (AM and PM). The room temperature maintained at 18-22 °C with humidity of 35-45%.

Sampling
Each bunch of flower was taken picture. Samples were collected by sterile scissors from different parts of the flowers, such as petals, floral leaf, stems, flower roots (or mud, root nutrient solution). The sampling process was sterilized to avoid any contamination. The samples were sent to mycology laboratory with half an hour of collection. The 2 nd samples were collected from the same bunch of flower which was placed at a designated area in the ward on Day 8. Total 76 samples were collected in this study (Table 1)

Statistical analysis
The data analysis was done by SPSS 13.0 software. Enumeration data were compared using chi square test or Fisher's exact test and significance was inferred for P<0.05.

Discussion
There were limited studies and research regarding at pathogens which were carried by flowers placed in the ward in the world. This study aimed to investigate pathogenic fungi on different parts of flowers in the ward. This article could contribute for infection control especially for those suffering immunosuppressed patient group in the hospital.
In this study, 66 of 76 (86.8%) were pathogenic fungus positive. The major fungus was Candida (24.5%), dematiaceous fungi and red yeast [7,8]. In the 10 negative culture samples, 7 were from flower cores. It indicated that the pathogens suspended indoor air and drooped down on the surface of flowers. The predominant microorganisms including fungi and bacteria, such as staphylococcus aureus, Bacillus cereus and Acinetobacter could be detected in the indoor air in the ward such as staphylococcus aureus, Bacillus cereus and Acinetobacter could be detected in the indoor air in the wards [9]. Segvić et al found that Cladosporium, penicillium and Alternaria were common fungus which can detected in the air [10]. In addition, Lugauskas et al monitored the concentrations and distributions of fungus species and suggested that aspergillus, Cladosporium, Alternaria and Aureobasidium pullulans could be used as air pollution assessment standard [11]. The flower core was in the deep center of the flowers and it was considered as the most "clean" part of the flowers. While the samples from the stems, roots and nutrient solutions were fungus positive 100%, it indicated fungus were easyto grow in the high nutritive substances.
There were similar constituent fungus between on Day 1 and Day 8. However, the results of the paired samples showed that 23 of 33 (69.7%) fungus colonies changed when the samples at different time. It indicated the time may impact the pathogenic fungus species. It recommended the impact of the fungus species carried by flowers need further investigations.

Conclusions
The patients who received broad-spectrum antibiotics, deep venous catheterization or immunosuppressive treatment were at high risk of fungus infections in the ID ward. It is important to identify the infection sources for infection control and protect the patients from nosocomial infections [12]. It is not recommended for the vistors bring the flowers to visit the patients based on this study.