Patient Safety Related to Microbiological Contamination of the Environment of a Multi-Profile Clinical Hospital

Investigating Microbial Contamination of Indoor Air, Environmental Surfaces, and Medical Equipment in a Southwestern Ethiopia Hospital

Introduction

Healthcare-associated infections, primarily caused by microorganisms, are widespread in healthcare facilities. These infections pose a significant challenge, especially in low and middle-income countries, and have a detrimental impact on patient outcomes. It is crucial to assess the level of microbial load and associated factors to prevent the spread of these infections. The objective of this study was to assess the microbial load and identify the factors associated with it in various wards at Jimma Medical Center.

Method

A cross-sectional study conducted at Jimma Medical Center. Indoor air samples were collected using the settle plate method with a 1/1/1 scheme. Inanimate surfaces and medical equipment were sampled using Swabs from a 10 × 10 cm area. A total of 268 samples were collected from 10 rooms. Pertinent information regarding the associated factors was gathered using an observational checklist. A multiple linear regression model was used to identify any associations with the microbial load.

Result

Out of the total samples, 181 (67.5%) tested positive for culture, and 270 microbes were isolated. The average load of bacteria and fungi in the indoor air ranged from 124.4 to 1607 and 96 to 814.6 Colony-forming unit (CFU)/m3, respectively. The mean total aerobic colony counts of bacteria and fungi from all surfaces in the wards ranged from 5.25 to 43.3 CFU/cm2. Crowdedness [β = 2.748 (95% Confidence Interval (CI): 1.057-4.44)], the presence of waste material [β = 1.747 (95% CI: 0.213-3.282)], and an unclean room [β = 2.505 (95% CI: 0.990-4.019)] were significantly associated with the microbial load.

Conclusion

The microbial load detected in indoor air, inanimate surfaces and medical equipment was posing potential health risks. Consequently, it is recommended to implement regular microbial surveillance of the hospital environment and enhance the infection prevention program to mitigate these concerns.

Multisite Evaluation of Toothbrushes and Microbial Growth in the Hospital Setting

DESIGN

This observational, descriptive study was conducted to determine the prevalence of microbial growth on toothbrushes found in hospital patient rooms.

METHODS

Toothbrush sampling was conducted in 136 acute care hospitals and medical centers from November 2018 through February 2022. Inclusion criteria for the units and patient rooms sampled were as follows: general adult medical-surgical units or critical care units; rooms occupied by adults 18 years or older who were capable of (1) mobilizing to the bathroom; (2) using a standard manual, bristled toothbrush; and (3) room did not have signage indicating isolation procedures.

RESULTS

A total of 5340 patient rooms were surveyed. Of the rooms included, 46% (2455) of patients did not have a toothbrush available or had not used a toothbrush (still in package and/or toothpaste not opened). Of the used toothbrushes collected (n = 1817): 48% (872/1817) had at least 1 organism; 14% (251/1817) of the toothbrushes were positive for 3 or more organisms.

CONCLUSIONS

These results identify the lack of availability of toothbrushes for patients and support the need for hospitals to incorporate a rigorous, consistent, and comprehensive oral care program to address the evident risk of microbe exposure in the oral cavity.

Hedayati M. Indoor environment assessment of special wards of educational hospitals for the detection of fungal contamination sources: A multi-center study (2019-2021)

Background and Purpose

The hospital environment was reported as a real habitat for different microorganisms, especially mold fungi. On the other hand, these opportunistic fungi were considered hospital-acquired mold infections in patients with weak immune status. Therefore, this multi-center study aimed to evaluate 23 hospitals in 18 provinces of Iran for fungal contamination sources.

Materials and Methods

In total, 43 opened Petri plates and 213 surface samples were collected throughout different wards of 23 hospitals. All collected samples were inoculated into Sabouraud Dextrose Agar containing Chloramphenicol (SC), and the plates were then incubated at 27-30ºC for 7-14 days.

Results

A total of 210 fungal colonies from equipment (162, 77.1%) and air (48, 22.9%) were identified. The most predominant isolated genus was Aspergillus (47.5%), followed by Rhizopus (14.2%), Mucor (11.7%), and Cladosporium (9.2%). Aspergillus (39.5%), Cladosporium (16.6%), as well as Penicillium and Sterile hyphae (10.4% each), were the most isolates from the air samples. Moreover, intensive care units (38.5%) and operating rooms (21.9%) had the highest number of isolated fungal colonies. Out of 256 collected samples from equipment and air, 163 (63.7%) were positive for fungal growth. The rate of fungal contamination in instrument and air samples was 128/213 (60.1%) and 35/43 (81.2%), respectively. Among the isolated species of Aspergillus, A. flavus complex (38/96, 39.6%), A. niger complex (31/96, 32.3%), and A. fumigatus complex (15/96, 15.6%) were the commonest species.

Conclusion

According to our findings, in addition to air, equipment and instrument should be considered among the significant sources of fungal contamination in the indoor environment of hospitals.

Use of a door handle disinfection system to reduce the risks associated with microbial loads on fomites in a healthcare setting

Pathogenic organisms, including those that are multi-drug resistant, can survive for extended periods of time on surfaces. Numerous studies show that contaminated hand-touch sites, such as door handles, pose a serious risk for onward transfer to patients. Such surfaces, because of their frequent and common use, do not always receive sufficient cleaning attention. A proposed level of ≤2.5 colony forming units (Cfu's)/cm² on fomites, could result in fewer transmissions. A door handle disinfection system, utilising an atomising pump (non-aerosol), automatically delivers a pulse of disinfectant to a door handle each time the door is used. Microbial levels on the handles of frequently used door locations, in a busy Rehab unit of an Orthopaedic Hospital were monitored over a 16-week period, to compare microbial loads with and without a door handle disinfection system in place. A sample of two disinfectant types, Steri-7 (Broad spectrum disinfectant) and Dew (Hypochlorous acid), were used in the study. A level of ≤2.5 Cfu/cm² was recorded on 93% of samples collected where a door handle disinfection system was in use, with 66% of samples showing no microbes recovered. Where a level of >2.5 Cfu/cm² was recorded, the door handle disinfection system reduced this to a negligible level by the time the next sample was taken, compared with several days where no system was in place. Door handle disinfection systems offer an effective solution to reducing microbial levels on frequently and commonly touched door handles, as an automated solution with minimal additional costs to resources.

The State of Microbiological Cleanliness of Surfaces and Equipment of an Endoscopic Examination Laboratory-Data from a Reference Tertiary Clinical Endoscopy Center in Southern Poland

The increasing number of endoscopic procedures performed and their increasing invasiveness mean that endoscopy of the gastrointestinal tract is associated with the risk of transmitting pathogenic microorganisms through infected equipment or contact with other patients and medical staff. In order to ensure protection of the health of both patients and medical staff, endoscopy laboratories should meet high hygiene standards. The results of tests of the microbiological cleanliness of surfaces and equipment of an endoscopic examination laboratory performed in the period from January to December 2019 at the Provincial Clinical Hospital No. 2 in Rzeszow were assessed retrospectively. Samples for testing were collected by swabbing from places where microbiological contamination was the most likely and cleaning was the most difficult. In the analyzed period, a total of 86 samples were collected for microbiological tests, of which positive results accounted for 6.9%. Positive results were obtained mainly from swabs collected from wet surfaces (66.7%). Most of the isolated microorganisms were Gram-negative bacteria (66.7% of all positive tests) and they were: Acinetobacter junii, Ralstonia pickettii, and Achromobacter denitrificans. The condition of the microbiological cleanliness of the surfaces and equipment of the endoscopic examination laboratory was satisfactory. A very low level of microbiological contamination of the tested items indicates occasional shortcomings in the decontamination processes. Since microorganisms isolated from the collected samples may be the cause of infection in patients and medical personnel, it is necessary to verify the decontamination procedures applied and to continue periodic microbiological monitoring of their effectiveness.