Bacterial contamination, bacterial profile and antimicrobial susceptibility pattern of isolates from stethoscopes at Jimma University Specialized Hospital

Colonisation of hospital surfaces from low- and middle-income countries by extended spectrum β-lactamase- and carbapenemase-producing bacteria

Hospital surfaces can harbour bacterial pathogens, which may disseminate and cause nosocomial infections, contributing towards mortality in low- and middle-income countries (LMICs). During the BARNARDS study, hospital surfaces from neonatal wards were sampled to assess the degree of environmental surface and patient care equipment colonisation by Gram-negative bacteria (GNB) carrying antibiotic resistance genes (ARGs). Here, we perform PCR screening for extended-spectrum β-lactamases (blaCTX-M-15) and carbapenemases (blaNDM, blaOXA-48-like and blaKPC), MALDI-TOF MS identification of GNB carrying ARGs, and further analysis by whole genome sequencing of bacterial isolates. We determine presence of consistently dominant clones and their relatedness to strains causing neonatal sepsis. Higher prevalence of carbapenemases is observed in Pakistan, Bangladesh, and Ethiopia, compared to other countries, and are mostly found in surfaces near the sink drain. Klebsiella pneumoniae, Enterobacter hormaechei, Acinetobacter baumannii, Serratia marcescens and Leclercia adecarboxylata are dominant; ST15 K. pneumoniae is identified from the same ward on multiple occasions suggesting clonal persistence within the same environment, and is found to be identical to isolates causing neonatal sepsis in Pakistan over similar time periods. Our data suggests persistence of dominant clones across multiple time points, highlighting the need for assessment of Infection Prevention and Control guidelines.

Bacterial Profile and Their Antimicrobial Susceptibility Pattern of Isolates Recovered from Intensive Care Unit Environments at Wachemo University Nigist Ellen Mohammed Memorial Comprehensive Specialized Hospital, Southern Ethiopia

Background

Bacterial contamination of indoor hospitals, especially in intensive care units is a serious health hazard in the world with a high morbidity and mortality rates. Particularly, multidrug-resistant bacteria can cross-contaminate medical devices, inanimate surfaces, health care providers, and patients in the intensive care unit. This study was aimed to assess the bacterial profile and their antimicrobial susceptibility patterns of bacterial isolates from intensive care unit at WUNEMMCSH (Wachemo University Nigest Ellen Mohammed Memorial Compressive Specialized Hospital), Southern Ethiopia.

Methods

A hospital-based cross sectional study was conducted on 180 intensive care unit environmental samples at WUNEMMCSH from August 1, 2022, to October 30, 2022. In this study, a total of 180 swab samples were collected from medical devices, inanimate surfaces, patients, and health care providers from the intensive care unit by using sterile cotton-tipped swabs moistened with normal saline. Then, bacterial isolates were identified using the standard culture method, Gram stain, and biochemical tests. Antimicrobial susceptibility tests for bacterial isolates were performed by using the Kirby Bauer disk diffusion method. Data were entered into EpiData Version 4.6 cleanup and exported to SPSS V25 for analysis.

Results

A total of 180 swab samples were processed from intensive care unit environments, and 143 (79.4%) were found to have been contaminated by at least one potential pathogenic bacterial isolate. A total of two hundred and thirty-eight bacteria were isolated. Of these, the predominant bacteria were coagulase-negative Staphylococci 72 (30.3%), S. aureus 61 (25.6%), E. coli 41 (17.2%), and K. pneumoniae 30 (12.6%). Seventy (49%) out of all swabbed samples were contaminated with mixed isolates. In the antimicrobial susceptibility tests, 19 (86%) Gram-positive bacteria and 25 (76%) Gram-negative bacterial isolates were susceptible to nitrofurantoin, respectively. Vancomycin was sensitive to 83% of Gram-positive isolates. Gram-positive and Gram-negative isolates from irrespective sources showed multidrug resistance in 56.4% and 76.2%, respectively.

Conclusion

The inanimate hospital environments, medical device, health care providers, and patients in ICU rooms of WUNEMMCSH (Wachemo University Nigest Ellen Mohammed Memorial Comprehensive Specialized Hospital) were colonized with 143 (79.4%) of potential pathogenic bacterial isolate, which can cause nosocomial infections with high rates of morbidity and mortality among patients. The frequencies of multidrug-resistant 159 (66.8%) bacterial pathogens were alarmingly high. Therefore, to reduce the risk of bacterial contamination and MDR, strict adherence to hospital infection prevention and control measures should be enforced. These measures include regularly performing hand hygiene, periodic disinfection, and sterilization of medical equipment.

A Microbiological Assessment of Stethoscopes Used by Clinicians in a Tertiary Hospital in Benin City, Nigeria

Background

The hospital environment serves as a niche for pathogenic microorganisms, so efforts are constantly being made to identify the potential mode of microbial pathogen transmission causing clinical infections.

Objective

The aim of this study was to microbiologically examine the stethoscopes used by clinicians at the University of Benin Teaching Hospital (UBTH) in Benin, Nigeria.

Methods

A total of 106 clinicians' stethoscopes were cleaned using cotton-tipped swabs dampened with normal saline. This included both earpieces along with the diaphragm (three samples per stethoscope). The samples were then sent to the Medical Microbiology Laboratory of UBTH and processed immediately as per the standard guidelines. The emergent colonies were subsequently identified, and antimicrobial susceptibility tests were performed.

Results

A total of 114 (35.8%) bacterial isolates were recovered, including Staphylococcus aureus (S. aureus) (33.3%), coagulase-negative staphylococci (CoNS) (33.3%), Bacillus spp. (22.8%), Acinetobacter spp. (5.3%), Escherichia coli (E. coli) (1.8%) and Klebsiella spp. (3.5%). Diaphragms had the highest yield of methicillin-resistant S. aureus (MRSA) (46.2%) and CoNS (17.9%). Age (P = 0.0387) and cadre of clinician (P = 0.0043) were risk factors for contamination, whereas clinicians who never cleaned their stethoscopes (P = 0.0044) or cleaned only the earpieces (P = 0.0001) had more contaminated stethoscopes.

Conclusion

The contamination rate of stethoscopes used by clinicians in Benin City was 56.6%. There is a need to establish proper stethoscope cleaning practices for all cadres of personnel in clinical practice to minimise health risks to patients and healthcare workers (HCW).

Bacterial Assessment of Stethoscopes Used by Healthcare Workers at a Tertiary Care Government Hospital in Bharatpur, Nepal

The transmission of healthcare-associated infections (HCAIs) in healthcare settings is a serious challenge in the medical fraternity. Medical devices, such as stethoscopes used by healthcare workers (HCWs), are likely to harbor a considerable number of pathogenic microbes, which may result in the transmission of HCAIs. This study sought to investigate bacterial contamination of stethoscopes used by HCWs at Bharatpur Hospital, Nepal. During the study period of 3 months from December 2019 to February 2020, a total of 87 stethoscopes were examined; bacterial pathogens were isolated and identified by culture and biochemical tests, and their susceptibilities against different antibiotics were determined using standard protocols of the Clinical and Laboratory Standards Institute (CLSI). The disc diffusion method was used primarily to screen for extended-spectrum beta-lactamase (ESBL)- and metallo-beta-lactamase (MBL)-producing isolates, followed by their confirmation using cephalosporin/clavulanate combination discs and the disc potentiation methods, respectively. In addition, molecular detection of blaCTX-M and blaVIM genes was performed using conventional polymerase chain reaction (PCR). Of the 87 stethoscopes examined, more than a quarter (28.7%) were colonized with different pathogenic bacteria. Bacterial contamination of stethoscopes was found to be significantly associated with various factors, such as disinfecting routine, method of disinfection, and department of the hospital (p < 0.05). A higher rate of bacterial contamination was observed on the diaphragm of the stethoscope (12.64%) and among HCWs who overlooked hand hygiene practices (45.45%). The prevalence of methicillin-resistant S. aureus (MRSA) was 44.44%, and approximately half of the Gram-negative isolates (47%) were multidrug resistant (MDR). Imipenem (81.25%) and chloramphenicol (83.33%) were found to be the most effective antibiotics for Gram-negative and Gram-positive bacteria, respectively. Phenotypic screening showed that 43.75% of isolates were ESBL producers, and 18.75% were MBL producers, but blaCTX-M and blaVIM genes were detected in only 31.25% and 6.25% of isolates, respectively. The results of the study call for effective stethoscope disinfection practices along with the judicious use of antibiotics by HCWs in order to minimize cross-contamination, emergence of resistance, and spread of nosocomial infections in clinical settings.

An Omniphobic Spray Coating Created from Hierarchical Structures Prevents the Contamination of High-Touch Surfaces with Pathogens

Engineered surfaces that repel pathogens are of great interest due to their role in mitigating the spread of infectious diseases. A robust, universal, and scalable omniphobic spray coating with excellent repellency against water, oil, and pathogens is presented. The coating is substrate-independent and relies on hierarchically structured polydimethylsiloxane (PDMS) microparticles, decorated with gold nanoparticles (AuNPs). Wettability studies reveal the relationship between surface texturing of micro- and/or nano-hierarchical structures and the omniphobicity of the coating. Studies of pathogen transfer with bacteria and viruses reveal that an uncoated contaminated glove transfers pathogens to >50 subsequent surfaces, while a coated glove picks up 10⁴ (over 99.99%) less pathogens upon first contact and transfers zero pathogens after the second touch. The developed coating also provides excellent stability under harsh conditions. The remarkable anti-pathogen properties of this surface combined with its ease of implementation, substantiate its use for the prevention of surface-mediated transmission of pathogens.

A Self-Forming Hydrogel from a Bactericidal Copolymer: Synthesis, Characterization, Biological Evaluations and Perspective Applications

Objects touched by patients and healthcare workers in hospitals may harbor pathogens, including multi-drug resistant (MDR) staphylococci, enterococci (VRE), Escherichia coli, Acinetobacter, and Pseudomonas species. Medical devices contaminated by these pathogens may also act as a source of severe and difficult-to-treat human infections, thus becoming a critical public health concern requiring urgent resolutions. To this end, we recently reported the bactericidal effects of a cationic copolymer (CP1). Here, aiming at developing a bactericidal formulation possibly to be used either for surfaces disinfection or to treat skin infections, CP1 was formulated as a hydrogel (CP1_1.1-Hgel). Importantly, even if not cross-linked, CP1 formed the gel upon simple dispersion in water, without requiring gelling agents or other additives which could be skin-incompatible or interfere with CP1 bactericidal effects in possible future topical applications. CP1_1.1-Hgel was characterized by attenuated-total-reflectance Fourier transform infrared (ATR-FTIR) and UV-Vis spectroscopy, as well as optic and scanning electron microscopy (OM and SEM) to investigate its chemical structure and morphology. Its stability was assessed by monitoring its inversion properties over time at room temperature, while its mechanical characteristics were assessed by rheological experiments. Dose-dependent cytotoxicity studies performed on human fibroblasts for 24 h with gel samples obtained by diluting CP_1.1-Hgel at properly selected concentrations established that the 3D network formation did not significantly affect the cytotoxic profile of CP1. Also, microbiologic investigations carried out on two-fold serial dilutions of CP1-gel confirmed the minimum inhibitory concentrations (MICs) previously reported for the not formulated CP1.Selectivity indices values up to 12 were estimated by the values of LD₅₀ and MICs determined here on gel samples.

Bacterial Contamination of Surgical Instruments Used at the Surgery Department of a Major Teaching Hospital in a Resource-Limited Country: An Observational Study

Surgical instruments, be they disposable or reusable, are essential in any surgical procedure. Reusable surgical instruments should be properly sterilized or disinfected before use. However, the protocols are not always followed accordingly. This results in sterilization and disinfection failures, leading to a possible increase in the incidence of surgical site infections. This observational study report on bacterial contaminants identified instruments used for surgical procedures in a major teaching hospital in a resource-limited country. In total, 207 pre-sterilized surgical instruments and instrument parts used at three units—the general surgical theater, and the gastrointestinal (GI) endoscopy and urology endoscopy (uro-endoscopy) units—within the surgical department were randomly sampled and examined for bacterial contamination. Bacteria isolates were identified, and their antimicrobial susceptibility patterns were determined. Bacteria isolates that were identified included Citrobacter spp., Citrobacter freundii, Bacillus cereus, Staphylococcus hominis, and Staphylococcus aureus. Bacillus cereus was the most predominant bacteria isolated (30/61, 49.1%), and Staphylococcus hominis the least (1/61, 1.6%). In terms of the number of isolates from the three units examined, the uro-endoscopy unit recorded the highest followed by the general surgical theater and the GI endoscopy. However, there was no association between the various units and bacteria isolated, and no significant difference between the number of isolates among the various units (p = 0.9467, χ2 = 0.1095). In this study, even though CFU per device or device part counted was less than 20, bacteria isolated from the instruments used for a surgical procedure is of great concern considering that the setting of the study is a major teaching hospital. Multi-drug resistance was observed in almost all the isolated bacteria. Sterilization processes should be strictly adhered to, taking into consideration the length and temperature in order to reduce the risk of using contaminated instruments in these environments. It is therefore recommended that similar studies should be carried out in surgical departments at different levels of hospitals to ascertain the extent of this problem.

Microbiological Impacts of Decontamination of Stethoscopes and Assessment of Disinfecting Practices among Physicians in Pakistan: A Quality Improvement Survey

The study was conducted to determine bacterial contamination of stethoscopes used by doctors before and after disinfecting with isopropyl alcohol and analyze their practices of disinfecting stethoscopes. Samples from stethoscopes were taken before and after disinfecting with 70% isopropyl alcohol swab with the help of a sterile swab. All swabs were inoculated on Blood and MacConkey agar plates and were examined for growth. Stethoscopes of 78 doctors were sampled which included 45 (58%) males and 33 (42%) females. Before decontamination of diaphragms with isopropyl alcohol, 27 (34.6%) diaphragms had "growth" while 51 (65.4%) had "no growth." After decontamination with isopropyl alcohol, 5 (6.4%) had "growth" while 73 (93.6%) had "no growth." The most common microorganism isolated from stethoscopes' diaphragms was methicillin-resistant Staphylococcus epidermidis (MRSE), that is, 14 out of 78 (17.9%). The survey also evaluated factors associated with contamination of stethoscopes. Most doctors 71(91%) believe that stethoscopes can be a source of infection and 55.1% (N = 43) responded that both diaphragm and bell of stethoscopes can transmit infections. Many doctors (41%, N = 32) reported that "forgetfulness/laziness" was the barrier which they faced regarding stethoscope hygiene followed by "lack of time" (21.8%, N = 17). The contamination rate (66.6%) is highest in those doctors who are using their stethoscopes for 3-5 years. Of them, 30 doctors (38.5%) never decontaminated their stethoscopes among which 17 had growth in their stethoscopes before cleaning with isopropyl alcohol, while three had growth even after decontamination. Most doctors used sanitizer (29.5%) and isopropyl alcohol (25.6%) as cleaning agents.

Assessment of Bacterial Profiles and Antimicrobial Susceptibility Pattern of Isolates Among Patients Diagnosed with Surgical Site Infections at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia: A Prospective Observational Cohort Study

Background

Although emergency health-care services, particularly clinical and surgical care, are an important part of the provision of high quality health care in Ethiopia, infections related with surgical care are still the most well-known medical services-related diseases. This study aimed to assess the bacterial profiles and antimicrobial susceptibility pattern of isolates among patients diagnosed with surgical site infections at Mizan-Tepi university teaching hospital, southwest Ethiopia.

Methodology

A prospective observational cohort study was conducted from June to September 2021. Patient data were collected using a structured questionnaire. Follow-up of patients who had undergone a surgical procedure was conducted for at least 30 days. Wound swabs were collected from patients suspected to have surgical site infections (SSIs) and cultured onto appropriate culture media. The antimicrobial susceptibility testing was done using the disk diffusion technique. Data were analyzed using SPSS software version 25.0. Frequencies and cross-tabulation were used to summarize descriptive statistics.

Results

In this study, the postoperative SSIs rate was 12.6%. All patients with SSIs were culture positive, and a total of 41 bacterial isolates were detected. Of these, 73.2% were Gram-negative, 26.8% were Gram-positive and 24.2% were a mixture of two bacterial growths. Escherichia coli accounted for 29.3%, followed by Staphylococcus aureus (19.5%), Proteus species (14.6%) and Pseudomonas aeruginosa (12.2%). With the exceptions of amikacin and meropenem, which exhibited very high sensitivity, ranging from 33.3–100.0% isolates was resistant against all other tested antibiotics. The resistance rate to three or more classes of antibiotics was 100.0%.

Conclusion

In this study, the most isolated bacteria causing SSIs were Gram-negative and multidrug-resistant strains. This event highlights that surveillance of the bacterial profile and antibiotic susceptibility pattern coupled with the implementation of the strict protocol for antibiotic use and operative room regulations is important to minimize the burden of SSIs.

Data on antibiotic resistance among indoor microbiome at Meerut, India

Microbial dynamics of the domestic environment and their antibiotic-resistant properties have been poorly characterized. We surveyed the microbial community and their antibiotic profiling located in the rural and urban areas of Meerut city, Uttar Pradesh, India. Results show that bacterial community load across all samples had more than 100-fold higher than fungal community (all p<0.05.). Based on population load, the kitchen of both rural (Fungal: 4.16±1.81 vs Bacteria: 160.5±27.13) and urban areas (Fungal: 6.2±1.02 vs Bacteria: 205.46±30.9) were more contaminated than living rooms (rural area-Fungal: 2.13±0.74 vs Bacteria: 62.17±20.68 and urban area- Fungal: 4.75±1.68 vs Bacteria: 74.88±7.53). Six bacteria, namely Pseudomonas sps; Citrobacter sps; Bacillus Subtilis; Brevundimonas diminuta; Bacillus megaterium; and Klebsiella pneumonia, showed dominance on all other bacterial and fungal sp hence, only these six bacteria were subjected to antibiotic sensitivity test (AST). In AST, Klebsiella pneumoniae, Bacillus Subtilis, Bacillus megaterium, were resistant to more than three antibiotics. The most sensitive strain for Ciprofloxacin, Streptomycin was Citrobacter sp. However, Pseudomonas sp was found sensitive only to Amoxillin. Brevundimonas diminuta is found most sensitive to all antibiotics. Plasmid profiling of selected bacteria suggests that antibiotic resistance properties arose from plasmids, not genomic ones. These findings give new insights into the local-scale distribution of MDR bacteria in a household environment.

Bacterial contamination rates and drug susceptibility patterns of bacteria recovered from medical equipment, inanimate surfaces, and indoor air of a neonatal intensive care unit and pediatric ward at Hawassa University Comprehensive Specialized Hospital, Ethiopia

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Bacterial contamination rates for medical equipment, inanimate surfaces, and indoor air in an Ethiopian hospital were found to be high.

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Most isolated bacterial species were known causes of human disease.

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Most of the isolated bacteria were antibiotic resistant.

Introduction: Bacterial contamination of medical equipment, inanimate surfaces, and indoor air of the hospital environment is the main source of hospital-acquired infection in developing countries.

Objective: The aim of this study was to determine the bacterial contamination rates for medical equipment, inanimate surfaces, and indoor air, and the drug susceptibility profiles of bacteria, in the neonatal intensive care unit and pediatric ward of Hawassa University Comprehensive Specialized Hospital (HUCSH).

Methods: A hospital-based cross-sectional study was carried out from October 20 to December 30, 2020. Samples were collected from medical equipment, inanimate surfaces, and indoor air of the neonatal intensive care unit and pediatric ward, and processed using standard microbiological methods. Data entry and analysis were carried out using SPSS software version 25.0.

Results: Of the total samples collected, 171 (74.7%; 95% CI 68.4‒83.5) were culture positive. These comprised 33 (58.9%) of samples taken from medical equipment, 26 (42.6%) from inanimate surfaces, and 112 (100%) from indoor air . Micrococcus species (41.3%), Acinetobacter species (13.7%), and Klebsiella pneumoniae (10.2%) were the most commonly isolated bacteria.

Conclusions: High bacterial contamination rates of medical equipment, inanimate surfaces, and indoor air of the neonatal intensive care unit and pediatric ward were found. Most of the bacterial species isolated were known causative agents of hospital-acquired infection. Around one-quarter of the bacteria were multidrug resistant.

Bacterial Pathogens and Their Antimicrobial Resistance Patterns of Inanimate Surfaces and Equipment in Ethiopia: A Systematic Review and Meta-analysis

Background

Hospital-acquired infections have remained a serious cause of mortality, morbidity, and extended hospitalization. Bacterial contamination of inanimate surfaces of the hospital environment and equipment is considered a major contributing factor to the development of several nosocomial infections worldwide. The hospital environment and many devices are an important reservoir of many clinically important bacterial agents including multidrug-resistant pathogens. Therefore, this systematic review and meta-analysis are aimed at investigating bacterial pathogens and their antimicrobial resistance patterns of inanimate surfaces and equipment in Ethiopia.

Methods

An exhaustive literature search was carried out using the major electronic databases including PubMed, Web of Science, MEDLINE, EMBASE, CINAHL, Google Scholar, Cochrane Library, Scopus, and Wiley online library to identify potentially relevant studies without date restriction. Original articles which address the research question were identified, screened, and included using the PRISMA flow diagram. Data extraction was prepared in Microsoft Excel, and data quality was assessed by using 9-point Joanna Briggs Institute critical appraisal tools. Then, data were exported to STATA 16.0 software for analyses of pooled estimation of outcome measures. Estimation of outcome measures at a 95% confidence interval was performed using DerSimonian-Laird's random-effects model. Finally, results were presented via text, figures, and tables.

Results

A total of 18 studies with 3058 bacterial isolates recovered from 3423 swab specimens were included for systematic review and meta-analysis. The pooled prevalence of bacterial contamination of inanimate surfaces and equipment was found 70% (95% CI: 59, 82). Among the Gram-negative bacterial species, the prevalence of ampicillin-resistant K. pneumoniae was the highest 80% (95% CI: 78, 92) followed by Citrobacter species 78% (95% CI: 57, 83).

Conclusion

This study has shown a high prevalence of bacterial contamination of inanimate surfaces and equipment in Ethiopia.

Magnitude, Diversity, and Antibiograms of Bacteria Isolated from Patient-Care Equipment and Inanimate Objects of Selected Wards in Arba Minch General Hospital, Southern Ethiopia

Intoduction

Patient-care equipment and inanimate objects contaminated with bacteria are a persistent problem in countries like Ethiopia, and remain overlooked. This study aimed to elucidate the magnitude of contaminations, diversity, and antimicrobial-susceptibility patterns of bacterial isolates from selected wards of Arba Minch General Hospital, Ethiopia.

Methods

Samples were inoculated into bacteriological media and identified by biochemical characterization, followed by antimicrobial-susceptibility tests.

Results

Of the 99 inanimate objects and items of patient-care equipment examined, 71 (71.7%) showed contamination: 26 (76.4%) from the surgical ward and 22 (66.6%) and 23 (71.8%), respectively, from the pediatric ward and neonatal intensive care unit. In the case of Gram-positive bacteria, coagulase-negative staphylococci (CoNS; 52.2%) were predominant, followed by Staphylococcus aureus (47.7%), whereas common Gram-negative counterparts were Acinetobacter spp. (28.5%) and Klebsiella spp. (23.8%). Antibiograms of S. aureus and CoNS showed 100% and 78% resistance, respectively, against penicillin. Isolates of Acinetobacter spp. showed 100% resistance to ceftriaxone and ampicillin, whereas those of Klebsiella spp. displayed complete resistance against ampicillin and trimethoprim–sulfamethoxazole. All isolates of Citrobacter spp., Enterobacter spp., Salmonella spp., Escherichia coli, and Serratia spp. exhibited 100% resistance to amoxicillin, ampicillin, and trimethoprim–sulfamethoxazole. Overall prevalence of multidrug-resistant bacteria was 57.7%.

Conclusion

A stringent infection-vigilance program comprising routine sampling from equipment and inanimate objects combined with antimicrobial-resistance surveillance and decontamination efforts must be instituted promptly.

The critical role of infection prevention overlooked in Ethiopia, only one-half of health-care workers had safe practice: A systematic review and meta-analysis

Background

Effective infection prevention and control measures, such as proper hand hygiene, the use of personal protective equipment, instrument processing, and safe injection practicein the healthcare facilitiesare essential elements of patient safety and lead to optimal patient outcomes. In Ethiopia, findings regarding infection prevention practices among healthcare workers have been highly variable and uncertain. This systematic review and meta-analysis estimates the pooled prevalence of safe infection prevention practices and summarizesthe associated factors among healthcare workers in Ethiopia.

Methods

PubMed, Science Direct, Google Scholar, and the Cochran library were systematically searched. We included all observational studies reporting the prevalence of safe infection prevention practices among healthcare workers in Ethiopia. Two authors independently extracted all necessary data using a standardized data extraction format. Qualitative and quantitative analyseswere employed. The Cochran Q test statistics and I² tests were used to assess the heterogeneity of the studies. A random-effects meta-analysis model was used to estimate the pooled prevalence of safe infection prevention practice.

Results

Of the 187 articles identified through our search, 10 studies fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of safe infection prevention practice in Ethiopia was 52.2% (95%CI: 40.9–63.4). The highest prevalence of safe practice was observed in Addis Ababa (capital city) 66.2% (95%CI: 60.6–71.8), followed by Amhara region 54.6% (95%CI: 51.1–58.1), and then Oromia region 48.5% (95%CI: 24.2–72.8), and the least safe practices were reported from South Nation Nationalities and People (SNNP) and Tigray regions with a pooled prevalence of 39.4% (95%CI: 13.9–64.8). In our qualitative syntheses, the odds of safe infection prevention practice were higher among healthcare workers who had good knowledge and a positive attitude towards infection prevention. Also, healthcare workers working in facilities with continuous running water supply, having infection prevention guideline, and those received training were significantly associated withhigher odds of safe infection prevention practice.

Conclusions

Infection prevention practices in Ethiopia was poor, with only half of the healthcare workers reporting safe practices. Further, the study found out that there were regional and professional variations in the prevalence of safe infection prevention practices. Therefore, the need to step-up efforts to intensify the current national infection prevention and patient safety initiative as key policy direction is strongly recommended, along with more attempts to increase healthcare worker’s adherence towards infection prevention guidelines.

Comparison of Effectiveness of 70%-isopropanol, 65%-ethanol and 1%-chlorhexidine for Stethoscope Decontamination

Stethoscopes are potential vector for health care associated infections worldwide. Ethyl alcohol (EA), isopropyl alcohol (IPA) and chlorhexidine (CH) are widely used for disinfecting stethoscope, however, comparative analysis of these disinfectants are scarce. Hence this paper aims to compare the reduction in bioburden with respect to stethoscope decontamination. A randomized, double-blind study was undertaken from various categories of health care workers (HCW) working in various departments. Each participant was asked to fill a questionnaire and diaphragms of their stethoscopes were imprinted on blood agar and sabourauds dextrose agar before and after disinfection with either 65%-EA, 70%-IPA or 1%-CH. The culture plates were incubated aerobically and the growth was further identified. 384 HCW participated in the study. 168 participants never cleaned their stethoscope, out of which 147 respondents (91.6%) comprised of students. EA (47%) and IPA (23%) were the two major types of alcohols used as disinfecting agents. 280 samples showed growth among which 51.8% were potent pathogens. Before disinfection, Staphylococcus aureus (27%) was the predominant pathogen, followed by Klebsiella (6.8%), Enterococcus and Candida respectively. Among the disinfectants used, maximum antimicrobial activity was exhibited by IPA (92.5%) compared to EA (82.5%) and CH (77.8%). Huge lacunae regarding knowledge, attitude and practice of stethoscope maintenance was found among student community. The microbial growth varies at various department. Disinfecting stethoscope with 70%-IPA for just 30 seconds is equally efficient compared to 1 minute and IPA was superior to EA and CH for decontaminating stethoscope. Stethoscopes are potential vector for health care associated infections worldwide. Ethyl alcohol (EA), isopropyl alcohol (IPA) and chlorhexidine (CH) are widely used for disinfecting stethoscope, however, comparative analysis of these disinfectants are scarce. Hence this paper aims to compare the reduction in bioburden with respect to stethoscope decontamination. A randomized, double-blind study was undertaken from various categories of health care workers (HCW) working in various departments. Each participant was asked to fill a questionnaire and diaphragms of their stethoscopes were imprinted on blood agar and sabourauds dextrose agar before and after disinfection with either 65%-EA, 70%-IPA or 1%-CH. The culture plates were incubated aerobically and the growth was further identified. 384 HCW participated in the study. 168 participants never cleaned their stethoscope, out of which 147 respondents (91.6%) comprised of students. EA (47%) and IPA (23%) were the two major types of alcohols used as disinfecting agents. 280 samples showed growth among which 51.8% were potent pathogens. Before disinfection, Staphylococcus aureus (27%) was the predominant pathogen, followed by Klebsiella (6.8%), Enterococcus and Candida respectively. Among the disinfectants used, maximum antimicrobial activity was exhibited by IPA (92.5%) compared to EA (82.5%) and CH (77.8%). Huge lacunae regarding knowledge, attitude and practice of stethoscope maintenance was found among student community. The microbial growth varies at various department. Disinfecting stethoscope with 70%-IPA for just 30 seconds is equally efficient compared to 1 minute and IPA was superior to EA and CH for decontaminating stethoscope.

Bacteriological Study of Electronic Devices Used by Healthcare Workers at Ruhengeri Referral Hospital

Electronic devices have become one of the most essential accessories being used in hospitals. Those devices increase the communication and contact making healthcare delivery more efficient and quality service oriented. The study was designed to collect reliable information about the spreading of pathogens through electronic devices especially in sensitive departments. The objectives of this study were to evaluate the bacterial colonization of electronic devices and determine the effectiveness of disinfection with alcohol 70% (w/v) to reduce the bacterial colonization of electronic devices. It was a cross-sectional study where samples were collected by means of moistened swabs in sterile saline solution from 30 electronic devices used by healthcare workers at Ruhengeri Referral Hospital within four different units: maternity, neonathology, intensive care, and theater room. To evaluate the effects of disinfection using 70% isopropyl alcohol, the second sample collection was carried out after decontamination with 70% isopropyl alcohol. Samples were analyzed in the microbiology lab of INES-Ruhengeri. The result showed that Staphylococcus aureus was the most predominant with 22.5%. Lactobacillus and Citrobacter spp. were 12.5%; Pseudomonas aeruginosa, coagulase-negative Staphylococci, and Serratia marcescens were 10%; Escherichia coli was 7.5%; Klebsiella spp. and Providencia spp. were at 5%. The lowest prevalence was 2.5% of Enterobacter spp. and Salmonella spp. The threat of dissemination of isolated microorganisms is valid, since all devices evaluated in this study showed bacterial contamination of species associated to hospital-acquired infections. Special care should be taken when using electronic devices in healthcare settings in addition to disinfection to reduce the risk of transmission of bacterial agents. Further studies should evaluate the antibiotic susceptibility for better conclusive results since all isolated bacteria in this study were subjected to high resistance and were associated with nosocomial infections.

Bacterial contamination and antimicrobial susceptibility patterns of intensive care units medical equipment and inanimate surfaces at Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia

Objective

To determine bacterial contaminants and their antimicrobial susceptibility patterns from medical equipment and inanimate surfaces.

Results

Of 130 swabs, 115 (88.5%) swabs were culture positive, of which contaminated medical equipment and inanimate surfaces account 70 (83.3%) and 45 (97.8%), respectively. All the swabs collected from sphygmomanometer, bedside table, computer and computer standing tables were 100% contaminated with bacteria. From the culture-positive swabs, a total of 171 bacterial isolates were identified, out of which 117 (68.4%) and 54 (31.6%) isolates were gram-positive and gram-negative, respectively. Most isolates (82%) were resistant to ampicillin and 13%, 8.6%, and 14% was observed in ciprofloxacin, gentamicin, and tetracycline respectively. Multi-drug resistant was observed in Escherichia coli (72.7%) and Staphylococcus aureus (58.7%).

Decontamination of patient equipment: nurses' self-reported decontamination practice in hospitals of southeast Ethiopia

OBJECTIVE

Failure to adequately decontaminate patient equipment will increase the risk of transmission of infection between patients and may contribute to the development of hospital-acquired infections. In effect, full obedience towards the acceptable decontamination process by healthcare workers is required. The aim of this study was to assess decontamination practice and associated factors among nurses in hospitals of the southeast, Ethiopia.

RESULTS

A total of 273 nurses participated in the study with a response rate of 98.9%. Of these respondents, the acceptable decontamination practice was found to be 49.1% [95% CI 43.2-54.9%]. Nurses who have reported good infection prevention practice were 7.313 times more likely to had acceptable decontamination practice than there counterpart [AOR = 7.313; 95% CI: 4.030, 13.272, p value = 0.000]. Nurses who were working in the department having instructive posters or guideline target on instrument processing were 2.675 times more likely to had acceptable decontamination practice [AOR = 2.675; 95% CI: 1.376, 5.200, p-value = 0.004]. This low decontamination practice among nurses is a concern and might make hospitalized patients prone to different pathogenic microorganisms, which in turn can increase the risk of healthcare-associated infections. Therefore, enhancing the current nurses' decontamination practice through considering those identified factors is crucial.

Stethoscope disinfection is rarely done in Ethiopia: What are the associated factors?

Introduction

The stethoscope, which is non-critical medical devices and a symbol of healthcare, is likely to be contaminated by pathogenic microorganisms and can play a contributory role in the transmission of hospital-acquired infection. And regular cleaning of the diaphragm of the stethoscope with a suitable disinfectant is decisive. However, in the resource-constrained setting like many healthcare facilities in Ethiopia healthcare provider’s stethoscope disinfection practice and its associated factors have not been well studied so far. Therefore, this study sought to determine stethoscope disinfection practice and associated factors among the healthcare providers in Addis Ababa, Ethiopia.

Methods

A facility-based cross-sectional study was carried out between April and May 2016. For this study, 576 healthcare providers (physicians, health officers, nurses, midwives, and anesthesiologist) were included from 21 healthcare facilities in Addis Ababa. A pre-tested structured questionnaire was used for data collection. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were used to identify factors that were significantly associated with stethoscope disinfection after every use.

Results

A total of 546 healthcare providers participated in this study, for a response rate of 94.7%. Two-fifths, 39.7% (95%CI: 35.9, 44.0%) of healthcare providers disinfecting their stethoscope after every use. And a significant number of participants 34.6% (95%CI: 30.8, 38.5%) never disinfect their stethoscope. Three out of four (76.0%) healthcare providers believe that stethoscope contamination can contribute to the transmission of infections. Safe infection prevention practice (AOR = 3.79, 95%CI: 2.45–5.84), awareness on infection prevention guideline (AOR = 1.93; 95%CI: 1.31, 2.82), and favorable attitude towards infection prevention (AOR = 1.73, 95%CI: 1.02, 2.93) were significantly associated with stethoscope disinfection after every use. The study also found that the odds of stethoscope disinfection were likely to be reduced by 79% among physicians than nurses (AOR = 0.21; 95%CI: 0.09, 0.49).

Conclusions

Only a small proportion of healthcare providers disinfect their stethoscopes after every use. Factors such as safe infection prevention practice, awareness on infection prevention guidelines, and favorable attitude towards infection prevention were the independent predictors of stethoscopes disinfection after every use. Hence, promotion of stethoscope hygiene along with an educational program to enhance disinfection compliance in healthcare facilities may have a positive effect.

Non-critical healthcare tools as a potential source of healthcare-acquired bacterial infections in eastern Ethiopia: A hospital-based cross-sectional study

Background:

Outbreaks of healthcare-acquired infections have been linked to contaminated medical devices such as electronic thermometers, sphygmomanometers, stethoscopes, latex gloves, masks, neckties, white coats and other.

Objective:

The aim of this study was to assess non-critical healthcare tools as a potential source of healthcare-acquired bacterial infections and associated factors in public health hospitals of Harar, eastern Ethiopia from March 2016 to February 2017.

Methods:

A hospital-based cross-sectional study was conducted on 212 non-critical healthcare tools owned by different health professionals. The data were collected from each owner using self-administered questionnaire. Swab specimens were collected from 187 stethoscopes and 25 sphygmomanometers using sterile cotton tips. Bacterial investigation and antimicrobial susceptibility tests were performed using standard culture tests. The data were double entered into EPI-Data version 3.1 and exported into the Statistical Package for Social Sciences version 16 for analysis.

Result:

The overall prevalence of non-critical healthcare tool contamination was 53.8%. A total of 137 bacterial strains were isolated. Staphylococcus aureus was the most frequent isolate (35%). Resistance to two or more different classes of antimicrobial was found to be 19.3%. The proportion of stethoscopes or sphygmomanometers contamination owned by the health professionals who were not cleaned regularly before and after examining each patient was found to be high (77%). The majority of non-critical healthcare tools used by health professionals working in the intensive care unit were contaminated (75%) followed by medical wards (73.5%).

Conclusion:

This study confirmed that the majority of the stethoscopes and sphygmomanometers were contaminated with pathogenic bacteria known to be associated with healthcare-acquired infections. Most of the healthcare workers did not practice stethoscope and sphygmomanometers disinfection. Strict and careful decontamination of stethoscopes and sphygmomanometers need to be in place before use.

To assess the stethoscope cleaning practices, microbial load and efficacy of cleaning stethoscopes with alcohol-based disinfectant in a tertiary care hospital

Background

The objectives of our study were to study the stethoscope cleaning practices of medical personnel and to assess the microbial load on stethoscopes and efficacy of cleaning stethoscopes with alcohol-based disinfectant.

Methodology

A questionnaire-based cross-sectional study was conducted among medical personnel at a tertiary care hospital in India to assess their knowledge and cleaning practices regarding stethoscope disinfection. Samples from the stethoscopes were collected before and after cleaning with alcohol-based disinfectant.

Results

Out of 62 participants, 53.22% individuals had never cleaned their stethoscope. All the initial swab samples showed bacterial growth. There was mixed growth in the samples taken from 35 stethoscope bells and 31 diaphragms. Bacteria included coagulase negative staphylococci, bacillus species, diptheroids, S. aureus, Acinetobacter and Klebsiella pneumoniae. After cleaning with an alcohol-based disinfectant, there was a significant decrease in the average number of bacterial colony-forming units.

Conclusions

Regular cleaning practices should be followed to prevent growth and transmission of potentially pathogenic organisms.

Bacterial contamination of frequently touched objects in a tertiary care hospital of Pokhara, Nepal: how safe are our hands?

Background

Objects frequently touched by patients and healthcare workers in hospitals harbor potential pathogens and may act as source of infectious agents. This study aimed to determine the bacterial contamination of common hospital objects frequently touched by patients, visitors and healthcare workers.

Methods

A total of 232 samples were collected from various sites like surface of biometric attendance devices, elevator buttons, door handles, staircase railings, telephone sets and water taps. Isolation, identification and antibiotic susceptibility testing of the isolates was performed by standard microbiological techniques. Biofilm forming ability of the S. aureus isolates was tested by a microtitre plate method.

Results

A total of 232 samples were collected and 219 bacterial isolates were recovered from 181 samples. Staphylococcus aureus was the most common bacterial isolate (44/219). Majority of S. aureus isolates were recovered from elevator buttons, biometric attendance devices and door handles. Among the S. aureus isolates, 36.3% (16/44) were methicillin resistant Staphylococcus aureus (MRSA) while remaining were methicillin sensitive Staphylococcus aureus (MSSA). Out of 44 S. aureus isolates, 12 (29.5%) were multidrug resistant and 14 (31.8%) were biofilm producers. The majority of MRSA isolates 62.5% (10/16) were biofilm producers. Acinetobacter was the most common Gram negative isolate followed by E coli and Pseudomonas species.

Conclusions

High bacterial contamination of frequently touched objects with variety of potential pathogens and normal flora was detected. S. aureus was the most common bacterial isolate. Biofilm forming ability offers additional survival advantage to the organisms on these objects. Present study highlights the need of improved hand hygiene among healthcare workers and regular cleaning/disinfection of sites of frequent public contact.

Bacterial Profile and Antimicrobial Susceptibility Pattern of the Isolates from Stethoscope, Thermometer, and Inanimate Surfaces of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia

Background

Nosocomial infections occur among patients during their stay in hospitals. The severity of infection depends on the characteristics of microorganisms with a high risk of being acquired when the environment is contaminated. Antibiotic-resistant bacteria are emerging rapidly around the globe creating a serious threat.

Methods

A cross-sectional study was conducted from December 2016–February 2017 at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia. Samples were collected from the equipment and hospital surfaces. The isolated bacteria were checked for susceptibility by the Kirby–Bauer disc diffusion method following the standards of CLSI 2014. Health professionals and sanitary team members were included in the study which assessed the disinfection practice of objects from which samples were taken. Data were analyzed using SPSS version 20.0.

Results

A total of 201 swab samples were taken, and most bacteria were recovered from thermometer and floor consisting of 21.6% S. aureus, 19.3% CoNS, 15.9% E. coli, 14.8% Klebsiella species, 11.4% P. aeruginosa, 10.2% Proteus species, and 6.8% Serratia species. The most multidrug resistant organisms were S. aureus (79%), Klebsiella species (53.8%), CoNS (47%), and Proteus species (44.4%). Only 6.45% of health professionals disinfect their stethoscope consistently.

Conclusion

S. aureus, CoNS, and E. coli were the predominant isolates. Most isolates showed highest susceptibility to ciprofloxacin and least to ampicillin and penicillin. There is no regular sanitation and disinfection of hospital equipment and surfaces.

Microbial contaminants isolated from items and work surfaces in the post- operative ward at Kawolo general hospital, Uganda

BACKGROUND

Nosocomial infections are a major setback in the healthcare delivery system especially in developing countries due to the limited resources. The roles played by medical care equipment and work surfaces in the transmission of such organisms have inevitably contributed to the elevated mortality, morbidity and antibiotic resistances.

METHODS

A total 138 samples were collected during the study from Kawolo general hospital. Swab samples were collected from various work surfaces and fomites which consisted of; beds, sink taps, infusion stands, switches, work tables and scissors. Cultures were done and the susceptibility patterns of the isolates were determined using Kirby Bauer disc diffusion method. Data was analyzed using Stata 13 and Microsoft Excel 2013 packages.

RESULTS

A total of 44.2% (61/138) of the collected swab specimens represented the overall bacterial contamination of the sampled articles. Staphylococcus aureus and Klebsiella pneumoniae accounted for the highest bacterial contaminants constituting of 75.4% (46/61) and 11.5% (7/61) respectively. Infusion stands and patient beds were found to have the highest bacterial contamination levels both constituting 19.67% (12/61). The highest degree of transmission of organisms to patients was found to be statistically significant for patient beds with OR: 20.1 and P-value 8X10^- 4. Vancomycin, ceftriaxone and ciprofloxacin were the most effective antibiotics with 100%, 80% and 80% sensitivity patterns among the isolates respectively. Multi-drug resistant (MDR) Staphylococcus aureus accounted for 52% (24/46) with 4% (1/24) classified as a possible extensively drug resistant (XDR) whereas Gram negative isolates had 27% (4/15) MDR strains out of which 50%(2/4) were classified as possible pan-drug resistant (PDR).

CONCLUSION

The high prevalence of bacterial contaminants in the hospital work environment is an indicator of poor or ineffective decontamination. The study findings reiterate the necessity to formulate drug usage policies and re-examine effectiveness of decontamination and sterilization practices within Kawolo general hospital. We also recommend installation of a sound Microbiology unit at the hospital to take on susceptibility testing to check on the empirical use of antibiotics as a way of reducing the rampant elevations in drug resistances.

Paramedical staffs knowledge and attitudes towards antimicrobial resistance in Dire Dawa, Ethiopia: a cross sectional study

Background

The continuing emergence, development and spread of pathogenic organisms that are resistant to antimicrobials are a cause of increasing concern. The control of antimicrobial resistance requires knowledge of factors causing antimicrobial resistance, good attitudes towards the intervention strategies as well as changes in antibiotic prescribing behavior of health workers. Hence, this study was aimed to assess paramedical staffs’ knowledge and attitudes towards antimicrobial resistance and their antibiotics prescription practices in Dire Dawa, Ethiopia.

Methods

A cross-sectional survey was conducted among paramedical staffs working in hospitals and health centers. A total of 218 paramedical staffs were participated and a self-administered questionnaire was used to collect data. Data was analyzed using SPSS version 20. Chi square/Fisher’s exact tests were used for comparison of data and a p value of less than 0.05 was considered statistically significant.

Results

Out of the total, 137 (62.8%) of paramedical staffs had good knowledge on the factors causing antimicrobial resistance. The most common causes of antimicrobial resistance reported were patients’ poor adherence (96.5%), self prescription (95%), and empiric choice of antibiotics (94.5%). In general, more than 80% of the respondents had positive attitudes towards the antimicrobials resistance intervention strategies. Relatively less proportion of participants recognized that antimicrobial resistance as a problem in their local institutions. The most perceived driving forces for unnecessary antibiotics prescriptions were treatment failure (67.7%) and patient push (53.3%). The majority, 76.9% of the prescribers mentioned that standard treatment guidelines were available in their institutions though only 15.7% of them reported referring the guidelines on the daily basis. Among the prescribers, 85.8% never attended formal trainings on antibiotics prescriptions.

Conclusions

As this study generated important information on knowledge and attitudes of paramedical staffs about antimicrobial resistance, it identified areas of misconceptions and specific groups to be targeted for educational interventions regarding antimicrobial resistance. It is, therefore, suggested that a well-planned, organized and structured training programs should be undertaken to improve the appropriate use of antibiotics.

Use of 90% ethanol to decontaminate stethoscopes in resource limited settings

Background

In developing countries like Nepal, 90% ethanol is cheap and is available in most hospitals. The unavailability of isopropyl alcohol (IPA) in these settings led us to compare the efficacy between 90% ethanol and isopropyl alcohol pads in reducing the bacterial contamination of diaphragm of stethoscope.

Methods

A randomized blinded experimental study was carried out to determine the difference between cleaning stethoscopes with 90% ethanol and IPA. Cultures of diaphragm were taken before and after cleaning with one of the cleaning agent. Colony forming units (CFU) count and organism identification was done by a blinded investigator. CFU before and after cleaning were compared using Wilcoxon signed–rank test. Mann Whitney U test was used to compare the decrease in CFU count between the cleaning agents.

Results

About 30% of the stethoscopes harbored potential pathogens. Significant reduction in CFU was observed with both IPA (Wilcoxon signed–rank test, P value <0.001) and 90% ethanol (Wilcoxon signed–rank test, P value <0.001). Comparing median decrease in CFU between cleaning with IPA and with 90% ethanol, no significant difference was found (Mann Whitney U test; U = 1357, P value >0.05).

Conclusions

Both 90% ethanol and IPA are equally effective in decontaminating the diaphragm of stethoscope. Selection of agent should be done on the basis of cost and availability.

Antibiotic resistant airborne bacteria and their multidrug resistance pattern at University teaching referral Hospital in South Ethiopia

BACKGROUND

Hospitals provide a reservoir of microorganisms, many of which are multi-resistant to antibiotics. Emergence of multi-drug resistant strains in a hospital environment, particularly in developing countries is an increasing problem to infection treatment. This study aims at assessing antibiotic resistant airborne bacterial isolates.

METHODS

A cross-sectional study was conducted at Wolaita Sodo university teaching and referral Hospital. Indoor air samples were collected by using passive air sampling method. Sample processing and antimicrobial susceptibility testing were done following standard bacteriological techniques. The data was analyzed using SPSS version 20.

RESULTS

Medically important bacterial pathogens, Coagulase negative staphylococci (29.6%), Staphylococcus aureus (26.3%), Enterococci species, Enterococcus faecalis and Enterococcus faecium (16.5%), Acinetobacter species (9.5%), Escherichia coli (5.8%) and Pseudomonas aeruginosa (5.3%) were isolated. Antibiotic resistance rate ranging from 7.5 to 87.5% was detected for all isolates. Acinetobacter species showed a high rate of resistance for trimethoprim-sulfamethoxazole, gentamicin (78.2%) and ciprofloxacin (82.6%), 28 (38.9%) of S. aureus isolates were meticillin resistant, and 7.5% Enterococci isolates of were vancomycin resistant. 75.3% of all bacterial pathogen were multi-drug resistant. Among them, 74.6% were gram positive and 84% were gram negative. Multi-drug resistance were observed among 84.6% of P. aeruginosa, of 82.5% Enterococcii, E. coli 78.6%, S. aureus 76.6%, and Coagulase negative staphylococci of 73.6%.

CONCLUSIONS

Indoor environment of the hospital was contaminated with airborne microbiotas, which are common cause of post-surgical site infection in the study area. Bacterial isolates were highly resistant to commonly used antibiotics with high multi-drug resistance percentage. So air quality of hospital environment, in restricted settings deserves attention, and requires long-term surveillance to protect both patients and healthcare workers.

A meta-analysis of the rates of Staphylococcus aureus and methicillin-resistant S aureus contamination on the surfaces of environmental objects that health care workers frequently touch

BACKGROUND

Health care workers may potentially spread Staphylococcus aureus and methicillin-resistant S aureus (MRSA) to patients by contaminated high-touch items. We aimed to determine the pooled rates of S aureus and MRSA contamination and influencing factors.

METHODS

A literature search of the PubMed, ScienceDirect, Embase, Ovid, and Scopus databases was performed. Pooled contamination rates were determined using random effect models. Subgroup and meta-regression analyses were conducted to identify factors potentially influencing the rates of S aureus and MRSA contamination. Sensitivity and publication bias analyses were performed.

RESULTS

Thirty-eight studies were included in the meta-analysis. The pooled contamination rates were 15.0% (95% confidence interval [CI], 9.8%-21.1%) for S aureus and 5.0% (95% CI, 2.7%-7.7%) for MRSA. The subgroup analyses indicated that the pooled rate of S aureus contamination was significantly higher for studies conducted in South America, in developing countries, and during 2010-2015. The pooled rate of MRSA contamination was significantly higher for studies conducted in Africa. The meta-regression analysis suggested that the pooled rate of S aureus contamination was lower for studies conducted in developed countries (odds ratio, 0.664; 95% CI, 0.509-0.867; P = .004). No bias was found in the publication of the rates of S aureus and MRSA contamination.

CONCLUSIONS

S aureus and MRSA contamination statuses of high-touch items are worrisome and should be paid greater attention. Developing country status was a risk factor for S aureus contamination.

Intense pre-admission carriage and further acquisition of ESBL-producing Enterobacteriaceae among patients and their caregivers in a tertiary hospital in Rwanda

OBJECTIVES

To assess the presence and risk factors of intestinal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among patients admitted to the University Teaching Hospital of Butare and among their attending caregivers, and to analyse the acquisition of ESBL-PE carriage during hospital stay and associated factors.

METHODS

We screened 392 patients and their attending caregivers at admission and discharge for ESBL-PE carriage. Bacterial species were determined using the API-20E system, and antimicrobial susceptibility testing was performed by agar disc diffusion. Data on socio-economic status, diet, behaviour, household assets, livestock and hospital procedures were collected.

RESULTS

At admission, 50% of the patients showed intestinal ESBL-PE carriage (Escherichia coli, 51%; Klebsiella pneumoniae, 39%; Enterobacter cloacae, 19%) as did 37% of their caregivers. Co-resistance was common but no carbapenem resistance was detected. At discharge, the proportion of ESBL-PE-colonised patients increased to 65% (caregivers, 47%) with almost complete carriage in paediatric patients (93%). The acquisition rate among initially non-colonised patients was 55% (or, 71/1000 patient days). Independent predictors of admission carriage included a colonised caregiver, prior antibiotic intake, egg consumption and neglecting to boil drinking water, whereas being a paediatric patient, undergoing surgery and male gender predicted acquisition during hospitalisation.

CONCLUSIONS

Abundant admission carriage of ESBL-PE and a high acquisition rate in a Rwandan university hospital point to potential intrahospital transmission and community dissemination. Caregivers are an additional source of possible spread. Risk factors of colonisation such as diet and water source need to be tackled to prevent the further emergence and spread of ESBL-PE.

Evaluation of the Levels and Quality of Microbial Contamination in Medical Emergency Departments in Comparison to Other Workplaces

Work in Hospital Emergency Departments (HEDs) exposes both the emergency ward staff and patients to infectious and in other way harmful biological agents. The results of this study shows the presence of pathogenic bacteria isolated by three different methods. It revealed 9.8% of pathogens detected by imprint method, 10.5% of pathogens by swabbing method, 17.6% and 22% in HEDs corridors and rooms, respectively, by air sampling method. In control workplaces (offices) pathogenic bacteria reached the level of 6.5% and 14.7% by imprint method and swabbing, respectively. The relatively low level of contamination by bacteria in HEDs may depend on the effectiveness of Standard Protective Precautions in the studied hospitals.

Utilizing Moist or Dry Swabs for the Sampling of Nasal MRSA Carriers? An In Vivo and In Vitro Study

This study investigates the quantitative bacterial recovery of Methicillin-resistant Staphylococcus aureus (MRSA) in nasal screenings by utilizing dry or moistened swabs within an in vivo and an in vitro experimental setting. 135 nasal MRSA carriers were each swabbed in one nostril with a dry and in the other one with a moistened rayon swab. Quantitative bacterial recovery was measured by standard viable count techniques. Furthermore, an anatomically correct artificial nose model was inoculated with a numerically defined suspension of MRSA and swabbed with dry and moistened rayon, polyurethane-foam and nylon-flocked swabs to test these different settings and swab-materials under identical laboratory conditions. In vivo, quantities of MRSA per nostril in carriers varied between <10¹ and >10⁷ colony forming units, with a median of 2.15x10⁴ CFU. However, no statistically significant differences could be detected for the recovery of MRSA quantities when swabbing nasal carriers with moist or dry rayon swabs. In vitro testing confirmed the in vivo data for swabs with rayon, polyurethane and nylon-flocked tips, since pre-moistening of swabs did not significantly affect the quantities of retrieved bacteria. Therefore, pre-moistening of swabs prior to nasal MRSA sampling provides no advantage in terms of recovering greater bacterial quantities and therefore can be omitted. In addition, this situation can be mimicked in an in vitro model, thereby providing a useful basis for future in vitro testings of new swab types or target organisms for screening approaches.

Healthcare Personnel Attire and Devices as Fomites: A Systematic Review

BACKGROUND Transmission of pathogens within the hospital environment remains a hazard for hospitalized patients. Healthcare personnel clothing and devices carried by them may harbor pathogens and contribute to the risk of pathogen transmission. OBJECTIVE To examine bacterial contamination of healthcare personnel attire and commonly used devices. METHODS Systematic review. RESULTS Of 1,175 studies screened, 72 individual studies assessed contamination of a variety of items, including white coats, neckties, stethoscopes, and mobile electronic devices, with varied pathogens including Staphylococcus aureus, including methicillin-resistant S. aureus, gram-negative rods, and enterococci. Contamination rates varied significantly across studies and by device but in general ranged from 0 to 32% for methicillin-resistant S. aureus and gram-negative rods. Enterococcus was a less common contaminant. Few studies explicitly evaluated for the presence of Clostridium difficile. Sampling and microbiologic techniques varied significantly across studies. Four studies evaluated for possible connection between healthcare personnel contaminants and clinical isolates with no unequivocally direct link identified. CONCLUSIONS Further studies to explore the relationship between healthcare personnel attire and devices and clinical infection are needed. Infect Control Hosp Epidemiol 2016;1-7.

Stethoscope Hygiene: Practice and Attitude of Medical Students

OBJECTIVE

The purpose of this study was to evaluate the frequency and attitude of medical students towards cleaning their stethoscopes.

SUBJECTS AND METHODS

A cross-sectional study was carried out in the first week of December 2013. The study included 771 students (397 in their fourth and 374 in their sixth year) from the Faculty of Medicine, University of Belgrade, Serbia. An anonymous questionnaire was distributed to students before the start of compulsory lessons in classrooms.

RESULTS

317 of the 397 fourth-year students (79.8%) and 306 of the 374 sixth-year students (81.9%) cleaned their stethoscope. The stethoscope diaphragm was most commonly cleaned, while the flexible tubing was the least commonly cleaned area, mainly using ethyl alcohol-based agents. The strongest positive attitude was observed for the statement 'It is important that my stethoscope is clean' (4.3 out of 5.0). A positive correlation (Spearman's x03C1; = 0.105) was observed between a higher frequency of cleaning and the stronger positive notion that a stethoscope should be cleaned.

CONCLUSION

A considerably high proportion of the students studied had ever cleaned their stethoscopes. Based on the students' responses, it would be useful to implement instructions on stethoscope hygiene in the regular practical curriculum with the aim of applying stethoscope disinfection in daily work.