Abstract
Background: MDR bacteria pose serious threat to patient safety worldwide.HCW is an important source of dissemination and transmission of these organisms to patients. Although many studies have been carried out in India which have determined the prevalence of one or two MDR bacteria colonizing the HCW, but no study so far has determined the prevalence and common risk factors for acquisition of the most prevalent type of MDR. Methods: Hand swabs from 198 HCW were obtained, processed and isolates identified by automated method using Vitek II (Biomerieux, Durham,NC).Risk factor assessment was done based on a questionnaire using Fischer’s exact /Chi square test. Result : A total of 24 HCWs (12.1%) were found positive for MDR bacteria.MDR Acinetobacter baumanii 10(5.1%), MDR Pseudomonas aeruginosa 7(3.4%) MRSA were 5(3.2%), and Vancomycin Resistant Enterococcus 2(0.6%).Majority of MDR (16.1%) was isolated from hands of doctors. Male sex, presence of chronic /open wound and close contact with patients were factors found significantly associated with colonization of hands of HCW. Conclusion: HCAI in the vulnerable ICU patient population can be linked to the MDR bacterial flora of the HCWs. The contamination of healthcare workers’ hands during patient care with multidrug- resistant organisms is most frequent with A. baumannii. Compliance with contact precautions and more aggressive environmental cleaning may decrease transmission. DOI:10.21276/APALM.1485
Highlights
Multi drug resistant (MDR) bacteria pose serious threat to patient safety worldwide adversely affecting their mortality and morbidity despite antimicrobial therapy and advances in supportive care [1,2] This is especially true for patients admitted in Intensive Care Units (ICU) who are more likely to be immunocompromised and suffering from serious underlying diseases[3,4]
Health Care Associated Infections in the vulnerable intensive care units (ICU) patient population can be linked to the MDR bacterial flora of the Health care workers (HCW)
Time spent in ICU health care, Occpation(aOR 1.912; 95%confidence intervals (CIs) 0.959–3.812),Contact with animals, Use of antibiotics in last six months, Hospital admission in last 1 year(aOR 2.610;95%CI 1.339 – 5.088), Chronic skin disease, Dibetes mellitus, were factors not found to be significantly associated with colonization of hands of HCW with MDR bacteria (p > 0.05)
Summary
Multi drug resistant (MDR) bacteria pose serious threat to patient safety worldwide adversely affecting their mortality and morbidity despite antimicrobial therapy and advances in supportive care [1,2] This is especially true for patients admitted in Intensive Care Units (ICU) who are more likely to be immunocompromised and suffering from serious underlying diseases[3,4]. Studies have shown that 10 to 70% of nosocomial infections are preventable depending on setting, study design, baseline infection rate and type of infection [1] Understanding the factors that lead to contamination of HCW hands in a particular setting is likely to help develop strategies unique to each institution to prevent transmission of MDR bacteria from HCW to patients and vice versa It would help curb the menace of prescribing inadequate empirical antibiotic therapy to patients leading to increased morbidity and mortality, development of antimicrobial resistance and leading to unnecessary hospitalization. Health Care Workers are an important source of dissemination and transmission of these organisms to patients especially in intensive care units (ICU). many studies have been carried out in India which have determined the prevalence of either gram positive or gram negative MDR bacteria colonizing the HCW separately, no study so far has determined the prevalence and risk factors for acquisition of MRSA, VRE, MDR Acinetobacter baumanii & Pseudomonas aeruginosa simultaneously in the same HCW population
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