Source Of Hospital-acquired Infections Research Articles

Bad Habits that Stick: An Investigation into Adhesive Medical Tape Use Practices and Beliefs

Background: Medical tape is one of the most ubiquitous resources in the hospital. Although tape is advertised by manufacturers as a single patient-use item, half-used rolls are a common sight in hospitals. Tape is often manipulated by un-sanitized and ungloved hands and comes in close contact with patient skin. Medical tape has the potential to be a source of hospital-acquired infection as it has been documented to be colonized with pathogens ranging from MRSA to Rhizopus. Despite infection risk, currently the only clinical guidelines of tape use are outlined in the Centers for Medicare & Medicaid Services guidance for Hemodialysis patients issued in 2008 that requires “tape should be dedicated to a single patient and discarded after use” as hemodialysis patients are at higher risk of infection. However, there is a lack of standards in the practice of tape use across hospital systems. Methods: To understand the current practices and beliefs of tape use at our institution, we developed a standardized survey to query individuals from various roles (RN, Physician, Patient Care Technicians, respiratory therapists, phlebotomists) across all patient care areas at a 746-bed academic, tertiary care center. Results: 52 units were surveyed, including 225 employees. Qualitative analysis revealed a wide variety of uses for medical tape for patient care, with venipuncture, securing IVs, and wound dressings being the most common. Only 1.4% of individuals reported single use of tape rolls. 54% of individuals reported tape use behaviors that carry an elevated risk for inoculation of pathogens. 70% of individuals reported that tape was discarded after the patient was discharged from their respective area. These practices did not change across procedure-heavy areas such as the Emergency Department or the Operating Rooms, in fact only 22% of individuals surveyed reported single use of tape in these areas. Beliefs about tape use varied: 95% of individuals agreed that a roll of tape could be used multiple times on a single patient, and 52% of individuals agreed that a roll of tape could be used on multiple patients. Conclusions: Tape use practices varied across hospital units, indicating the need for standardized policies for tape use and storage. Beliefs about tape not being a single-use item were consistent across the hospital and suggest that education and culture change efforts are needed to decrease the risk for hospital-acquired infections from improper medical tape use.

Assessing the Dispersion Stability of Antimicrobial Fillers in Photosensitive Resin for Vat Polymerization 3D Printing.

Polymers are widely used in healthcare due to their biocompatibility and mechanical properties; however, the use of polymers in medical products can promote biofilm formation, which can be a source of hospital-acquired infections. Due to this, there is a rising demand for inherently antimicrobial polymers for devices in contact with patients. 3D printing as a manufacturing technology has increased exponentially in recent years. Surgical guides, orthotics, and prosthetics, among other medical devices, created by vat polymerization have been used in hospitals to treat patients. Biocompatible resins are available for these applications, but there is a lack of antimicrobial resins, which would further improve the technology for clinical use. The focus of this study was to assess settling of candidate antimicrobial metal and metal oxide fillers in vat polymerization resin to determine which fillers were compatible with the resin. Dispersion stability was assessed by measuring settling over the maximum print duration of the medium priced desktop 3D printers to evaluate printability of 17 potentially antimicrobial resins. Eight materials displayed settling behavior during the test period: molybdenum oxide, zirconium oxide nanopowder, scandium oxide, zirconium oxide, titanium oxide, tungsten oxide, lanthanum oxide, and magnesium oxide. No settling was observed for manganese oxide, magnesium oxide nanopowder, titanium oxide nanopowder, copper oxide, silver oxide, zinc oxide nanopowder, zinc oxide, silver nanopowder, and gold nanopowder during the test period. This method could be applied to assess settling of other fillers introduced into 3D printing resins before actual printing.

Microbial profile and antibiotic resistance pattern of water supply in a tertiary care hospital of Uttarakhand.

In healthcare settings, hospital water and water-related devices can act as a reservoir for waterborne infections. Potable water, sinks, faucet aerators, showers, tub immersion, toilets, dialysis water, water baths, eyewash stations, and dental-unit water stations have all been linked to nosocomial outbreaks. This study aimed to determine the microbial profile and pattern of antibiotic resistance in the water supply of a tertiary care hospital in Uttarakhand. This is a 1-year prospective study which was carried out by the Department of Microbiology and Immunology at Sri Mahant Indersh Hospital (SMIH), Dehradun. A total of 154 water samples were collected from the AC outlets, ventilators in the Intensive care unit (ICUs), Operation theatre (OTs), and High dependency unit (HDUs), scrub stations, pantry, and blood bank, patient's bathroom, private ward, septic ward, labour room, transplant unit, laboratory, scope rinse water, the dialysis unit and tank throughout the hospital, including tap water (pre and post flush [25%]), tap swabs (24%), drinking water (9%), AC outlets (13%), and other areas (3%). 30 of the 154 (19.5%) water samples tested were culture-positive. The most contaminated water samples were tap swabs (27%, n = 8/30). A total of nine organisms were isolated, of which the most predominant was Pseudomonas aeruginosa (40%; 12/30), followed by Legionella pneumophila (13%; 4/30), Acinetobacter baumanii (10%; 3/30), Klebsiella pneumoniae (10%; 3/30), Escherichia coli (7%; 2/30), Enterococcus faecalis (7%; 2/30), Aspergillus flavus (7%; 2/30), Stenotrophomonas (3%; 1/30), and Fusarium spp. (3%; 1/30). Gram-negative bacilli and non-lactose fermenting (GNB and NLF) showed a high rate of contamination, 53.3% (n = 16/30). P. aeruginosa showed resistance to gentamicin and amikacin (42%), imipenem (50%), levofloxacin (58%), and colistin (25%), while Acinetobacter baumanii showed resistance to gentamicin and amikacin (67%), minocycline (63%), and levofloxacin, imipenem and colistin (33%). The study's findings show that a variety of microorganisms are contaminating hospital water supplies and can be a source of hospital-acquired infections. A suitable and robust surveillance program for hospital water supplies, as well as strict adherence to infection control practices, is strongly advised.

Unusual sources of hospital-acquired infections in intensive care units and operating rooms at Tanta University Educational Hospital

Background Fomites can serve as a vehicle in transmission of health care-associated pathogens especially in intensive care units (ICUs) and operating rooms (ORs) where the patients are immunocompromised and at high risk of acquiring multidrug-resistant bacteria. Aim To assess bacterial contamination on inanimate surfaces and equipment in ICUs and ORs at Tanta University Educational Hospital to detect the potential reservoirs of hospital-acquired infections (HAIs) and to give appropriate recommendations for corrective actions. Materials and methods The samples were collected in sterile nutrient broth and incubated for 24 h. The isolation and identification of pathogenic bacteria were done through standard microbiological methods. Antibiotic susceptibility tests of the isolates were assessed by disc diffusion method. Results The contamination levels from group I (hospital samples) and group II (control samples) were 88.3% and 84%, respectively. In group I, Gram-negative bacilli were the most frequent isolates followed by Gram-positive cocci then Gram-positive bacilli, fungi, and lastly Gram-negative cocci that represented 35.7%, 34.4%, 25.9%, 3.2%, and 0.8%, respectively. In group II, all bacterial isolates were Gram-positive bacilli that represented 100%. Conclusion The presence of potential pathogenic-resistant bacteria on inanimate surfaces in hospital is of great health concern and these surfaces can serve as sources of HAIs.

Microbiological assessment of environmental surfaces in a healthcare facility

Hospital-acquired infections (HAIs) are infections occurring within 48 hours of hospital admission, 3 days of hospital discharge or 30 days after a surgical procedure. HAIs are a major cause of death and disability within the hospital. Inanimate surfaces can serve as sources of HAIs and can significantly contribute to the spread of pathogens within hospitals. Swab samples were obtained from 53 inanimate surfaces such as air, bed pan, ward doorknob, nurses’ glove, sink, sink tap, cistern lever, toilet seat and wheel chairs located in the various wards of the Accident and Emergency Unit as well as Plastic and Burn unit of, University of Port Harcourt Teaching Hospital (UPTH). The samples obtained were screened for the presence of pathogenic microorganisms and their susceptibility to frequently prescribed antibiotics using disc diffusion method. Our findings showed highest level of contamination was the cistern lever (15 %), and the least was from nurses’ gloves (6 %). Microbial identification revealed the presence of 161 microorganisms comprising Pseudomonas aeruginosa (27 %), Staphylococcus spp. (22 %), Salmonella spp. (16 %), Klebsiella spp. (13 %), and Candida spp. (21 %). Interestingly, 83 % of isolated staphylococci were resistant to cefoxitin, 57 % of Pseudomonas spp. was resistant to levofloxacin, and both Klebsiella spp. and Salmonella spp. were most resistant to ceftriaxone (81 % and 77 % respectively). The observed high prevalence of pathogenic and antibiotic resistant microorganisms calls for implementation of regular surveillance and effective infection control measures within the hospital.

Contamination of pulse oximeter probes before and after decontamination in two intensive care units.

The internal surfaces of pulse oximeter probes may be overlooked as hot spots for pathogenic microorganisms in an intensive care unit (ICU), thereby contributing to the high incidence of hospital-acquired infections. To determine the growth and identification of microorganisms on pulse oximeter probes in the multidisciplinary ICU (MICU) at Charlotte Maxeke Johannesburg Academic Hospital and the burns ICU (BICU) at Chris Hani Baragwanath Academic Hospital, before and after decontamination. This was a cross-sectional, comparative and contextual study, using purposive sampling. Data were collected from the internal surfaces of 34 pulse oximeter probes in a MICU and BICU. Each pulse oximeter probe was swabbed before and after decontamination. The endemic microorganism profile for the two ICUs was obtained from a laboratory database. Internal surfaces of 31 (91%; 95% confidence interval (CI) 0.76 - 0.98) pulse oximeter probes were contaminated with 9 different pathogenic microorganisms pre decontamination. Acinetobacter baumannii, Klebsiella pneumoniaei and Pseudomonas aeruginosa were endemic to both ICUs, and were the most-frequently isolated microorganisms. Staphylococcus aureus was the most common microorganism endemic to both ICUs, isolated on the internal surfaces of only 2 pulse oximeter probes. Of the internal surfaces of pulse oximeter probes, 6 (18%; 95% CI 0.07 - 0.35) remained contaminated post decontamination, with a microorganism growth reduction of 80% (p=0.0001). The internal surfaces of pulse oximeter probes may serve as hot spots for an array of pathogens with the potential to cause infection and outbreaks in ICUs. Decontamination of the internal surfaces of pulse oximeter probes should be emphasised. This study identifies internal surfaces of pulse oximeter probes as reservoirs for infection in intensive care units (ICUs), particularly in a burns ICU setting, pinpointing one of many sources of hospital-acquired infections within ICU cubicles.The study emphasises the need to clean the internal surfaces of pulse oximeter probes (whether visibly soiled or not) prior to disinfection.

Staphylococcus aureus colonization in Qazvin University hospitals healthcare workers

Background: Staphylococcus aureus (SA) colonization of hospital personnel is a source of hospital acquired infections. Objective: The aim of this study was to determine the prevalence of nasal carriage rate of SA and methicillin resistant Staphylococcus aureus (MRSA) among Health Care Workers (HCWs) at Qazvin university hospitals. Methods: A cross sectional study was conducted among 396 employees of five teaching hospitals from October 2016 to April 2017. After obtaining informed consent and completion of the questionnaire, a sample was taken from the anterior nasal cavity for microbiology. The isolation of SA and their antimicrobial sensitivity were carried out by standard bacteriological procedures (disk diffusion and E-Test method). MRSA were confirmed by cefoxitin disk diffusion test. Chi square and independent t test were used to analyze the collected data. Findings: From the 198 HCWs, 32 people (16.1%) carried SA that the most carriers were workers of intensive care units (20.3%). 3% of all HCWs were identified as MRSA carriers. Colonization with SA is significantly lower among nursing and higher education. All SA isolates were sensitive to vancomycin and rifampin. Conclusion: The rate of nasal SA (especially MRSA) carriage among HCWs of Qazvin university hospitals is low. Also, staff teaching appears to be a promising approach for reducing nasal carrier. Rifampin and mupirocin, for eradication of Staphylococcus colonization in health workers (even MRSA) are acceptable. Keywords: Methicillin resistant staphylococcus aureus, Healthcare workers, Nasal carriage, Antimicrobial sensitivity

The antimicrobial cathelicidin peptide hlF(1-11) attenuates alveolar macrophage pyroptosis induced by Acinetobacter baumannii in vivo

Acinetobacter baumannii is a Gram-negative coccobacillus found primarily in hospital settings that has recently emerged as a source of hospital-acquired infections, including bacterial pneumonia. The hLF(1-11) peptide comprising the first 11 N-terminal residues of human lactoferrin exerts antimicrobial activity in vivo and was highly effective against multidrug-resistant A. baumannii strains in vitro and in vivo. Pyroptosis is a caspase-1-dependent inflammatory cell death process and is induced by various microbial infections. In the present study, we investigated the molecular mechanisms that regulate pyroptosis induced by A. baumannii in macrophages. Our results revealed that A. baumannii induced pyroptosis through caspase-1 activation and IL-1β production. We also found that caspase-1 activation and IL-1β maturation in A. baumannii-triggered pyroptotic cell death were reduced by hLF(1-11) treatment. Moreover, hLF(1-11) inhibited the A. baumannii-induced caspase-1 activation and pyroptosis of pulmonary alveolar macrophages in vivo.

Structural Diversity in the Type IV Pili of Multidrug-resistant Acinetobacter

Acinetobacter baumannii is a Gram-negative coccobacillus found primarily in hospital settings that has recently emerged as a source of hospital-acquired infections. A. baumannii expresses a variety of virulence factors, including type IV pili, bacterial extracellular appendages often essential for attachment to host cells. Here, we report the high resolution structures of the major pilin subunit, PilA, from three Acinetobacter strains, demonstrating that A. baumannii subsets produce morphologically distinct type IV pilin glycoproteins. We examine the consequences of this heterogeneity for protein folding and assembly as well as host-cell adhesion by Acinetobacter Comparisons of genomic and structural data with pilin proteins from other species of soil gammaproteobacteria suggest that these structural differences stem from evolutionary pressure that has resulted in three distinct classes of type IVa pilins, each found in multiple species.

Monitoring of airborne bacteria and aerosols in different wards of hospitals - Particle counting usefulness in investigation of airborne bacteria.

The presence of airborne bacteria in hospital environments is of great concern because of their potential role as a source of hospital-acquired infections (HAI). The aim of this study was the determination and comparison of the concentration of airborne bacteria in different wards of four educational hospitals, and evaluation of whether particle counting could be predictive of airborne bacterial concentration in different wards of a hospital. The study was performed in an operating theatre (OT), intensive care unit (ICU), surgery ward (SW) and internal medicine (IM) ward of four educational hospitals in Isfahan, Iran. A total of 80 samples were analyzed for the presence of airborne bacteria and particle levels. The average level of bacteria ranged from 75-1194 CFU/m (3) . Mean particle levels were higher than class 100,000 cleanrooms in all wards. A significant correlation was observed between the numbers of 1-5 µm particles and levels of airborne bacteria in operating theatres and ICUs. The results showed that factors which may influence the airborne bacterial level in hospital environments should be properly managed to minimize the risk of HAIs especially in operating theaters. Microbial air contamination of hospital settings should be performed by the monitoring of airborne bacteria, but particle counting could be considered as a good operative method for the continuous monitoring of air quality in operating theaters and ICUs where higher risks of infection are suspected.

Wearable Sensors in Medical Education: Supporting Hand Hygiene Training with a Forearm EMG.

Lack of proper hand hygiene is a common source of hospital acquired infections. Training and evaluating efficiency in hand washing is therefore an important part of medical education. Here, we propose to use the Myo wearable armband to measure correctness of hand washing for mobile learning. Myo's sensors are designed in order to recognize the activity of the forearm, palm and fingers. Using signal processing and machine learning, the quality of the hand washing process can be estimated and used as evaluation in medical teaching. The project is in its initial phase, thus we present preliminary results and a vision of future development.

Audit of antibiotic prophylaxis at a district general hospital

This audit evaluates the adherence to the prophylactic surgical antibiotic policy at Kingston Hospital. With a greater understanding of the current use of prophylactic surgical antibiotics comes the ability to improve patient care while minimising the development of antibiotic resistance. Surgical site infections are a major source of hospital-acquired infections, causing significant morbidity and mortality. In appropriate cases, surgical antibiotic prophylaxis is essential in preventing such infections; however, this comes with increased risks of antibiotic resistance and antibiotic-associated diarrhoea. Consequently, this institution has extensive guidelines as to the cases in which antibiotic prophylaxis is required and what antibiotics should be administered. This audit examines the adherence to these guidelines. We audited against our local antibiotic prescribing policy, named the Blue Book guidelines.

Methicillin‐Resistant Staphylococcal Contamination of Clothing Worn by Personnel in a Veterinary Teaching Hospital

To determine the methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus pseudintermedius (MRSP) contamination rate of white coats (WC) and surgical scrubs (SS) worn by personnel at the Ontario Veterinary College Health Sciences Centre (OVCHSC) and to identify risk factors associated with clothing contamination. Cross-sectional study. Personnel including clinical faculty, house officers, technicians, and veterinary students working at the OVCHSC. Electrostatic cloths were used to sample WC and SS of hospital personnel. Samples were tested for MRSA and MRSP and isolates were typed. Participants completed a self-administered questionnaire and data was evaluated for risk factors. Of 114 specimens, MRS were isolated from 20 (17.5%), MRSA from 4 (3.5%), and MRSP from 16 (14.0%). Technicians were 9.5× (OR = 0.95, 95% CI: 1.2-∞, P = .03) more likely than students to have clothing contaminated with MRSA. No risk factors were identified for MRSP or for overall MRS contamination. Standard hospital clothing was found to have a high prevalence of MRS contamination in a veterinary teaching hospital and could be a source of hospital-acquired infections.

Nurses’ uniforms – The missing link in breaking the chain of hospital acquired infection?

Abstract Do nurses' uniforms contribute to the spread of hospital-acquired infections (HAI)? This possibility is explored through historical and contemporary literature utilising published scientific, social science and expert commentary. The literature describes nurses' uniforms link to HAI as contentious and controversial and the subject has caused debate in the House of Commons, England. The relevant themes from the literature include: historical development of nurses' uniforms; public perceptions of nurses' uniforms; bacteria and nurses' uniforms; and transfer of bacteria from nurses' uniforms to patients. Nurses' uniforms are in frequent close contactwith multiple patients and thus a likely source of HAI. The historical and social connection between nurses' uniforms and society, particularly in the UK, and public impact on uniform policy and guidelines are addressed.

Tourniquets and exsanguinators: a potential source of infection in the orthopedic operating theater?

Background and purpose Fomites are increasingly being recognised as a source of hospital-acquired infection. We have therefore assessed tourniquets and exsanguinators for the presence of bacterial pathogens in 1 elective and 2 trauma orthopedic hospitals.Material and methods Swabs were taken prior to and after decontaminating these devices with 1 of 3 different cleaning modalities. These were then assessed for colony counts and organisms identified.Results Bacteria commonly implicated in surgical site infections such as coagulase-negative staphylococci, Staphylococcus aureus and Proteus spp. were prevalent. We also found a resistant strain of Acinetobacter and Candida. Exsanguinators were the most heavily contaminated devices, and colony counts in the trauma hospitals were up to 400% higher than in the elective hospital. Alcohol- and non-alcohol-based sterile wipes were both highly effective in decontaminating the devices.Interpretation Infectious organisms reside on the tourniquets and exsanguinators presently used in the orthopedic theater. These fomites may possibly be a source of surgical site infection. We have demonstrated a simple and effective means of decontaminating these devices between cases.

Resin salve from the Norwegian spruce tree: a ‘novel’ method for the treatment of chronic wounds

Infected pressure ulcers are a common clinical problem in institutions and wards that care for older patients with chronic illnesses. These ulcers are difficult to treat and are a source of hospital-acquired infection. Modern treatment options, such as hydrogels, are frequently ineffective and expensive, and patient outcomes are often poor.

Infections nosocomiales à coronavirus humains chez le nouveau-né

Human coronaviruses, with two known serogroups named 229-E and OC-43, are enveloped positive-stranded RNA viruses. The large RNA is surrounded by a nucleoprotein (protein N). The envelop contains 2 or 3 glycoproteins: spike protein (or protein S), matrix protein (or protein M) and a hemagglutinin (or protein HE). Their pathogen role remains unclear because their isolation is difficult. Reliable and rapid methods as immunofluorescence with monoclonal antibodies and reverse transcription-polymerase chain reaction allow new researches on epidemiology. Human coronaviruses can survive for as long as 6 days in suspension and 3 hours after drying on surfaces, suggesting that they could be a source of hospital-acquired infections. Two prospective studies conducted in a neonatal and paediatric intensive care unit demonstrated a significant association of coronavirus-positive naso-pharyngal samples with respiratory illness in hospitalised preterm neonates. Positive samples from staff suggested either a patient-to-staff or a staff-to-patient transmission. No cross-infection were observed from community-acquired respiratory-syncitial virus or influenza-infected children to neonates. Universal precautions with hand washing and surface desinfection could be proposed to prevent coronavirus transmission.

Survival of human coronaviruses 229E and OC43 in suspension and after drying onsurfaces: a possible source ofhospital-acquired infections

Strains OC43 and 229E of human coronaviruses (HCoV) cause one-third of common colds and hospital-acquired upper respiratory tract HCoV infections have been reported in premature newborns. To evaluate possible sources of infection, virus survival was studied in aqueous suspensions and on absorptive and non-absorptive surfaces representative of a hospital environment. Virus susceptibility to chemical disinfection with standard products was also characterized. Virus survived in saline solution for as long as six days but less in culture medium, with or without added cells. After drying, HCoV-229E infectivity was still detectable after 3h on various surfaces (aluminum, sterile latex surgical gloves, sterile sponges) but HCoV-OC43 survived 1h or less. Of the various chemical disinfectants tested, Proviodine® reduced the virus infectious titre by at least 50%. This study suggests that surfaces and suspensions can be considered as possible sources of contamination that may lead to hospital-acquired infections with HCoV and should be appropriately disinfected.

Visitors to trauma hospitals as a possible source of hospital-acquired infection

The presence of visitors in trauma hospitals is to some extent natural and desirable: communication with relatives and acquaintances has a beneficial effect on the neuropsychiatric status of patients who have suffered trauma or are about to undergo surgical intervention, especially considering their prolonged inpatient treatment. In some cases, visitors are involved in the care of patients. However, visitors to trauma hospitals can be additional sources of infection, influencing the spread of nosocomial staphylococcal infection, which has so far received little attention.