The role of medical personnel and the environment in the transmission of healthcare-associated infections in the paediatric unit of a University Teaching Hospital

Abstract

Medical personnel, the environment and devices in paediatric wards at the Lagos University Teaching Hospital (LUTH) were screened to identify possible reservoirs/routes of spread of infections and to evaluatethe effectiveness of decontamination processes. Between April and June 1995, nasal, throat and hand swabs as well as urine, stool and swabs of staff uniforms were collected from 126 personnel. Equipment, surfaces, soap, disinfectants, sterile instruments, dressings and the air were also sampled. Further, a questionnaire was administered to assess the general healthcare situation as viewed by staff. All specimens were processedaccording to standard techniques. Staphylococcus aureus isolated from nasal swabs was tested to Methicillin by Oxacillin E test. Only 74 (59%) hand swabs were sterile, whereas 52 (41%) had pure and/or mixed growthof staphylococci, enterococci, Bacillus and gram-negative bacteria. Sixty-six (52%) staff were nasal carriers of Staphylococcus aureus, 25 (38%) of which were methicillin- resistant (MIC 8->32ìg/ ml). Six (5%) staffharboured Streptococcus pyogenes in throat swabs, 2 (8%) Escherichia coli in faecal specimens and 9 (11%) had significant bacteriuria. Most frequently used equipment/materials were recontaminated within the 12 hours of sampling. Some disinfectants were contaminated by gram- negative bacteria. Understaffing, overcrowding and insufficient equipment reportedly militated against adequate patient care. These findings highlight the necessity for hospitals to ensure thorough personal, environmental and professional asepsis through implementation of appropriate guidelines or measures suggested herein.