Hand Colonization with Gram-Negative Organisms of Healthcare Workers Accessing the Cardiac Intensive Care Unit: A Cross-Sectional Study at the Uganda Heart Institute.

Lameck Ssemogerere,Martin W Dünser,Cornelius Sendagire,Peter Lwabi,Cephas Mijumbi,Yvonne Namungoma,Arthur Kwizera,Moses Othin,Ceaser Mbabazi,John Paul Magala,Michael Oketcho,Christine Florence Najjuka,Anna Noland Oketayot,Ritah Nkwine,Judith Namuyonga

doi:10.1155/2019/6081954

Abstract

Background Hands of healthcare workers (HCWs) are vehicles for pathogens responsible for healthcare-associated infections (HAIs). Following the identification of Gram-negative organisms (GNOs) in all cases of HAIs in the cardiac intensive care unit (ICU), we sought to determine the burden of hand colonization with GNOs among healthcare workers who access the cardiac ICU. Methods We retrospectively reviewed results from surveillance cultures of fingertip imprints of HCWs who access the cardiac ICU at the Uganda Heart Institute. We collected data on staff category, isolates, and susceptibility to antibiotics. We analyzed the data using Microsoft Excel, and the results are summarized in proportions and percentages and presented in charts and tables. Results Fifty-six healthcare workers participated in the surveillance. 21 were ICU clinicians, 21 non-ICU clinicians, and 14 nonclinicians. GNOs were cultured in 19 (33.9%) HCWs, in which 8/19 (42.1%) were non-ICU clinicians, 6/19 (31.2%) ICU clinicians, and 5/19 (26.3%) nonclinicians. 32 isolates were identified, of which 47%, 28%, and 25% were cultured from non-ICU clinicians, nonclinicians, and ICU clinicians, respectively. Predominant isolates were Acinetobacter (34%), Citrobacter (21.9%), and Pseudomonas (21.9%). Antimicrobial resistance ranged from 4% to 90%. 9/28 (32.1%) isolates, predominantly Acinetobacter species (spp), were carbapenem resistant. 8/28 (28.6%) isolates, predominantly Citrobacter spp, were multidrug resistant. Resistance to ciprofloxacin and cefepime was low at 3.6% and 4.4%, respectively. Conclusion Gram-negative organisms, predominantly Acinetobacter, Citrobacter, and Pseudomonas spp, were prevalent on the hands of HCWs who access the cardiac ICU irrespective of the staff category. Antimicrobial resistance was high, with multidrug resistance and carbapenem resistance common among Citrobacter spp and Acinetobacter spp, respectively. Resistance to cefepime and ciprofloxacin was low.

Highlights

Hands of healthcare workers (HCWs) are vehicles for pathogens responsible for healthcare-associated infections (HAIs)
Fifty-six healthcare workers participated in the surveillance. 42/56 (75%) were clinicians and 14/56 (25%) were nonclinicians (NC). 50% (21/42) of the clinicians were intensive care unit (ICU) clinicians (ICU-C)
Doctors were more than 50% in both ICU-C and non-ICU clinicians (nICU-C) categories (Figure 1)

Summary

Introduction

Hands of healthcare workers (HCWs) are vehicles for pathogens responsible for healthcare-associated infections (HAIs). 32 isolates were identified, of which 47%, 28%, and 25% were cultured from non-ICU clinicians, nonclinicians, and ICU clinicians, respectively. Gram-negative organisms, predominantly Acinetobacter, Citrobacter, and Pseudomonas spp, were prevalent on the hands of HCWs who access the cardiac ICU irrespective of the staff category. HAIs in the ICU have worse outcomes compared to non-ICU-acquired infections [5] Transmission of these infections to patients is mainly via the hands of healthcare workers (HCWs). Pathogenic Gram-negative organisms (GNOs) are commonly identified in patients with HAIs. ey colonize patients, HCWs, and hospital environments during routine patient care and are common residents in the ICUs and other hospital wards [4, 6, 8, 11, 12]. 21% of the infections were caused by GNOs found on personnel hands, and the predominant hand colonizers were found to be Acinetobacter (45%) and Klebsiella (39%) [9, 18]

Methods

Results

Conclusion