Source Of Nosocomial Infections Research Articles

Infections nosocomiales à entérovirus en néonatologie : du diagnostic à la preuve, à propos d’une observation d’infection neuroméningée

Although enteroviruses generally cause asymptomatic or mild disease, neonates are at higher risk for severe illnesses, among which systemic disease characterized by multiorgan involvement is a potentially fatal condition. Enterovirus neonatal infections may be the source of nosocomial infections in neonatology or in pediatric intensive care units. We report central nervous system infections due to Echovirus 11 in two neonates and the molecular evidence of nosocomial transmission of this strain in a neonatal unit by enterovirus genotyping and phylogenetic analysis. This report illustrates the importance of including enterovirus genome detection in the sepsis screening concomitantly with bacteriological investigations performed at admission of a neonate. Rapid diagnosis and subsequent genotyping could have a beneficial impact on clinical practices at the individual level (reducing the length of antibiotic therapy) and public health policy at the collective level by reinforcing hygiene measures to prevent nosocomial infections, with nurseries and neonatal units being at greater risks.

Vermeidung katheterassoziierter Infektionen

Bloodstream infections due to intravascular catheterization, peritoneal catheters for dialysis, suprapubic or transurethral catheters, are one of the major sources of nosocomial infections. Therefore, the prevention of catheter-associated infections is an important issue for physicians and nursing staff working in hospitals or in outpatient settings. The risk can be minimized by diligent checking of the indications, hygienic measures, using the right materials, thorough follow-up and education of the medical and nursing staff. Thus it is possible to avoid individual suffering of patients and to reduce costs in the healthcare system.

Mycobacterium mucogenicum and other non-tuberculous mycobacteria in potable water of a trauma hospital: a potential source for human infection

This study examined the frequency of occurrence of non-tuberculous mycobacteria (NTM) in potable water samples from a main trauma hospital in Mexico City. Sixty-nine potable water samples were collected, 23 from each source: cistern, kitchen tap and bathroom showers. Of the 69 samples, 36 harboured NTM species. Twenty-nine of the 36 isolates were Mycobacterium mucogenicum, two Mycobacterium rhodesiae, one Mycobacterium peregrinum, one Mycobacterium fortuitum and three were Mycobacterium spp. Hospital potable water harbouring NTM represents a potential source for nosocomial infections, therefore we suggest that hospital potable water microbiological guidelines should include testing for NTM species.

Nursing and physician attire as possible source of nosocomial infections

Uniforms worn by medical and nursing staff are not usually considered important in the transmission of microorganisms. We investigated the rate of potentially pathogenic bacteria present on uniforms worn by hospital staff, as well as the bacterial load of these microorganisms. Cultures were obtained from uniforms of nurses and physicians by pressing standard blood agar plates at the abdominal zone, sleeve ends, and pockets. Each participant completed a questionnaire. A total of 238 samples were collected from 135 personnel, including 75 nurses (55%) and 60 physicians (45%). Of these, 79 (58%) claimed to change their uniform every day, and 104 (77%) defined the level of hygiene of their attire as fair to excellent. Potentially pathogenic bacteria were isolated from at least one site of the uniforms of 85 participants (63%) and were isolated from 119 samples (50%); 21 (14%) of the samples from nurses' gowns and 6 (6%) of the samples from physicians' gowns (P = NS) included of antibiotic-resistant bacteria. Up to 60% of hospital staff's uniforms are colonized with potentially pathogenic bacteria, including drug-resistant organisms. It remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection.

The Difference in Effectiveness of 70% and 0.5% Chlorine to ReduceThe Germ Number on Stethoscope’s Membrane Experimental research at stethoscope in Baitul Izah Ward of Sultan Agung Islamic Hospital Semarang

Background: Recently, nosocomial infection (hospital- acquired infections) is estimated to affects more than 1.4 million of in patients in all over the world. Stethoscope is one source of nosocomial infection caused by the continuous contact from one patient to another. 70% alcohol and 0.5% chlorine can be used for disinfection. The purpose of the research is to find out the difference in the effectiveness of 70% alcohol and 0.5% chlorine to reduce the amount of germ on the stethoscope’s membrane.Design and Methods: This was an experimental research with the Post Test Only Control Group Design using 18 stethoscopes divided into 3 groups randomly. Group A was the control group (aquabidest), group B were treated with 70% alcohol treatment, and group C was treated with 0.5% chlorine. The research samples were the stethoscopes used to treat patient in Baitul Izah ward of Islamic Hospital of Sultan Agung Semarang. The data on the germ amount was analyzed using Kruskal-Wallis test. Results: There was a significant difference between aquabidest group and 70% alcohol group (p<0.05) and between aquabidest control group and chlorine group(p>0.05), nevertheless, there was no significant difference between the 70% alcohol group and 0.5% chlorine group ( 0.652). Conclusion: There was no difference in the effectiveness between 70% alcohol and 0.5% chlorine to reduce the number of germ on the stethoscope’s membrane (Sains Medika, 3(1):63-68).

Penlight: a source of nosocomial infection?

Introduction: Within an oral and maxillofacial ward various items come into intimate contact with patients’ oral and nasal cavities, surgical sites and skin. The penlight constitutes one of the many items used, however its potential to harbour or transmit pathogens is unknown.

MRSA prevalence in european healthcare settings: a review

BackgroundDuring the past two decades, methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly common as a source of nosocomial infections. Most studies of MRSA surveillance were performed during outbreaks, so that results are not applicable to settings in which MRSA is endemic. This paper gives an overview of MRSA prevalence in hospitals and other healthcare institutions in non-outbreak situations in Western Europe.MethodsA keyword search was conducted in the Medline database (2000 through June 2010). Titles and abstracts were screened to identify studies on MRSA prevalence in patients in non-outbreak situations in European healthcare facilities. Each study was assessed using seven quality criteria (outcome definition, time unit, target population, participants, observer bias, screening procedure, swabbing sites) and categorized as 'good', 'fair', or 'poor'.Results31 observational studies were included in the review. Four of the studies were of good quality. Surveillance screening of MRSA was performed in long-term care (11 studies) and acute care (20 studies). Prevalence rates varied over a wide range, from less than 1% to greater than 20%. Prevalence in the acute care and long-term care settings was comparable. The prevalence of MRSA was expressed in various ways - the percentage of MRSA among patients (range between 1% and 24%), the percentage of MRSA among S. aureus isolates (range between 5% and 54%), and as the prevalence density (range between 0.4 and 4 MRSA cases per 1,000 patient days). The screening policy differed with respect to time points (on admission or during hospital stay), selection criteria (all admissions or patients at high risk for MRSA) and anatomical sampling sites.ConclusionsThis review underlines the methodological differences between studies of MRSA surveillance. For comparisons between different healthcare settings, surveillance methods and outcome calculations should be standardized.

Rotavirus Nosocomial Infection in Children under 5 years of age: A Preliminary study in Nepal

Introduction: Rotavirus is one of the most common causes of acute gastroenteritis among infants and young children. The spread of rotavirus infection in pediatric wards can cause acute diarrhoea during hospitalization, and in turn, prolong hospitalization or need, rehospitalization. The aim of the study was to determine the prevalence of nosocomial infection due to rotavirus and other causal organisms among children less than 5 years of age. Methodology: A cross-sectional study between November 2009 and May 2010 was conducted among 96 pediatric patients in children hospital, Nepal. Stool samples were collected during hospitalization and up to 3 days after discharge from the hospital. Rotavirus antigens were detected by EIA and standard microbiological procedure were applied for other enteric pathogens. Results: The prevalence of nosocomial infection due to rotavirus was 30.2% (29/96). Of them, 16 (55.17%) of the 29 children with nosocomial infection during hospitalization and/or up to 72 hours after discharge developed diarrhoea. The prevalence of symptomatic cases of nosocomial infection was 55.17% (16/29), which involved 16.7% (16/96) of the study subjects, showing a prevalence of 44.82% (13/29) for asymptomatic nosocomial infection consisted of 13.54% (13/96) of the total subjects. Eleven of the 16 symptomatic subjects of nosocomial infection were affected by diarrhoea during hospitalization and five subjects after discharge. Bacteria (8.3%) and protozoa (5.2%) agents were also causing nosocomial infection in children. Conclusions: Children attending hospital may asymptomatically carry enteric pathogens and potentially act as source of nosocomial infection. Due to the relatively high frequency of nosocomial infection in the Children Hospital of Nepal, it is necessary to follow strictly hygienic rules such as isolation of patients with diarrhoea and hand-washing before and after the examination of each patient and cleaning the examination instruments after use in each patient. Key words: Diarrhoea; children; Rotavirus infection; Cross-sectional study; Nepal DOI: 10.3126/jnps.v31i1.3540J Nep Paedtr Soc 2010;31(1):30-34

Emerging pathogenAspergillus calidoustuscolonizes water distribution systems

Recent studies have changed the taxonomy of Aspergillus section Usti, and a novel species, Aspergillus calidoustus, has been erected. It was also demonstrated that clinical isolates previously identified as A. ustus actually belong to the emerging pathogen A. calidoustus. Aspergillus ustus were frequently isolated from Norwegian water systems, and due to the taxonomical progress, these waterborne strains could be identified more precisely. A MLST study including ITS, calmodulin, β-tubulin and actin sequences was conducted on 32 strains previously identified as A. ustus. All strains were identified as A. calidoustus, which was verified by physiological, biochemical and phylogenetic analyses. This is the first report of that A. calidoustus is able to colonize water distribution systems. In respect to the potential role of water systems as a source of nosocomial infections in patients with immunodeficiency, attention should be given to water systems in hospitals and other healthcare units, especially the heated-water installations.

Bacterial contamination of the hands of doctors: A study in the medicine and dermatology wards

Doctors' hands are a common source of bacterial contamination. Often, these organisms are found to be virulent species with multidrug-resistance patterns. These are the sources of nosocomial infections in many patients. The present study was undertaken to find out the prevalence of bacterial contamination in the hands of doctors in the Medicine and Dermatology wards of a tertiary care hospital. The hands of 44 doctors were swabbed and cultured at entry to ward and at exit. Then, tap water and alcohol swab wash techniques were used and further swabs were done at each step. Thus, each doctor was sampled four-times for the study. The antibiotic-sensitivity pattern of the organisms was determined by the disc-diffusion method. There was a significant contamination of the doctors' hands at entry (59.1%) and at exit (90.9%). Overall, Staphylococcus was the predominant organism (59% at entry and 85% at exit); coagulase-negative ones were more prevalent at entry (32%) and coagulase-positive ones were more prevalent at exit (54%). There was no difference in the hand contamination rates of junior and senior doctors. Also, the contamination rates were similar in the Medicine and Dermatology wards. Among the gram negative organisms, Escherichia coli (4.5%), Pseudomonas (4.5%), Enterococci (13.6%) and Klebsiella (9%) were the main ones isolated. Gram negative organisms were significantly more prevalent at exit (P = 0.009) compared with their numbers at entry. Hand washing techniques reduced the contamination rates significantly, 76% with tap water wash and further 16.5% with alcohol swab. The removal rate for both groups of organisms was similar. Also, coagulase-positive and -negative Staphylococci showed equal rates of removal with hand washing (P = 0.9793). The organisms were found to be resistant to most of the commonly used antibiotics; the beta-lactam group was especially largely resistant both for gram positive and gram negative bacteria. Both cheaper ones like cloxacillin (50-100%) and very costly ones like cefepime (100%) were equally vulnerable to resistance. Even newer antibiotics like linezolid and vancomycin showed a significant resistance to Staphylococcus. In gram negative organisms, drugs like ceftazidime and gentamicin showed 100% resistance. This study shows the high level of contamination of doctors' hands. It emphasizes the need for proper hygienic measures in day to day practice in hospitals to reduce the level of nosocomial infections. Also, it shows that most of the commonly used antibiotics will be ineffective in nosocomial infections.

Epidemiology of Hospital Infections: from the Hospital Environment

Hospital environments are the most important source of nosocomial infections. The concept of the hospital environment that includes the hospital\\\'s air, water and environment, medical equipments, the patient\\\'s food, drinks and articles. Air and water are the most important in terms of infection within them. There are interactions with each other host, microbial and environmental factors in the development of these infections. The microorganisms live or inanimate resources can be transmitted from different ways to the individuals in the hospital environment. The hospital environment contains many components. Therefore, infections with the war are difficult and complex.

Antimicrobial susceptibility, plasmid profiles, and RAPD-PCR typing of Acinetobacter bacteria

Abstract Background: Multiple-drug resistant Acinetobacter have widely spread in the last decades imposing a serious nosocomial source of infection. Nevertheless, little knowledge was gaimed on tracing the development of antibiotic resistance in Acinetobacter species. Objectives: Explore Acinetobacter spp. via antimicrobial susceptibility, plasmid profiles, and random amplified polymorphism DNA polymerase chain reaction (RAPD-PCR) typing. Methods: One hundred twelve Acinetobacter isolates (including 66 A. baumannii and 46 non-Acinetobacter baumannii strains) were obtained from three university hospitals. The source of infection of these isolates included blood, urine, wound, and respiratory tract. Their susceptibilities to 17 antibiotics were tested and then all Acinetobacter isolates were typed by plasmid analysis and RAPD-PCR method. Results: A. baumannii isolates revealed nine different patterns of antibiotic resistance. Of those, non- A. baumannii, were associated with plasmid and RAPD-PCR typings (p <0.05). A. baumannii was more resistant to multiple antibiotics than non-A. baumannii (p <0.05). Seven different plasmid profiles were observed among 112 Acinetobacter isolates. Plasmids were found in 107 (95.5%) of the 112 isolates. Unlike in RAPD-PCR typing, there was no difference between the type of Acinetobacter, A. or non-A. baumannii strains and plasmid profiles (p >0.05). By RAPD-PCR, six profiles were found for each A. and non-A. baumannii strains. The pattern 6 was the most common pattern among the isolates. Both plasmid and RAPD-PCR typing showed no association between plasmid profiling and site of infection (p >0.05). Conclusion: There is a wide spread of multi-drug resistant Acinetobacter spp., particularly A. baumannii, in the Middle East region that can be traced efficiently by plasmid and genotyping typing of Acinetobacter. More care should be taken for tracing the development of antimicrobial resistance of Acinetobacter using precise molecular typing techniques.

Preventing Pathogens Proliferation and Reducing Potential Sources of Nosocomial Infections with Biocidal Textiles in Developing Countries

Nosocomial infections, especially those caused by antibiotic resistant bacteria, are increasing at an alarming rate over the globe. Unfortunately, standard infection control practices, such as pre-emptive isolation of high-risk patients, wide and targeted surveillance cultures, and proper ventilation systems are lacking in developing countries mainly due to insufficient resources. Patients shed bacteria and contaminate their pyjamas and sheets. The temperature and humidity between the patients and the bed are appropriate conditions allowing for effective bacterial proliferation. Bed making releases large quantities of micro-organisms into the air, which contaminate the immediate and non-immediate surroundings. Personnel in contact with contaminated textiles can also cross-contaminate other surfaces or patients. Thus textiles in hospitals can be an important source of microbes contributing to endogenous, indirect-contact, and aerosol transmission of nosocomial related pathogens. The use of safe wide-spectrum antimicrobial textiles, especially in those textiles that are in close contact with the patients, may significantly reduce bioburden in clinical settings and consequently reduce the risk of nosocomial infections. This is of special significance in resource poor developing countries, where wards are overcrowded and population infection burdens are very high. The use of biocidal textiles is a simple, cost-affordable and feasible measure that may be especially important in developing countries where essential infection control measures are not implemented.

Preventing Pathogens Proliferation and Reducing Potential Sources of Nosocomial Infections with Biocidal Textiles in Developing Countries~!2009-09-29~!2009-12-17~!2010-09-06~!

Preventing Pathogens Proliferation and Reducing Potential Sources of Nosocomial Infections with Biocidal Textiles in Developing Countries~!2009-09-29~!2009-12-17~!2010-09-06~!

Detection of potentially pathogenic bacteria in the drinking water distribution system of a hospital in Hungary

The drinking water distribution system of a hospital was investigated using standard cultivation techniques, taxon-specific PCRs targeting pathogenic bacteria, denaturing gradient gel electrophoresis, cloning and sequencing. The results obtained verify the higher sensitivity of PCR compared to cultivation for detecting Legionella and Pseudomonas aeruginosa. Moreover, several other opportunistic pathogenic bacteria, such as Escherichia albertii, Acinetobacter lwoffi and Corynebacterium tuberculostrearicum, were detected, emphasizing that drinking water systems, especially those with stagnant water sections, could be the source of nosocomial infections.

Nosocomial Contamination of Laryngoscope Handles: Challenging Current Guidelines

Laryngoscope blades are often cleaned between cases according to well-defined protocols. However, despite evidence that laryngoscope handles could be a source of nosocomial infection, neither our institution nor the American Society of Anesthesiologists has any specific guidelines for handle disinfection. We hypothesized that laryngoscope handles may be sufficiently contaminated with bacteria and viruses to justify the implementation of new handle-cleaning protocols. Sixty laryngoscope handles from the adult operating rooms were sampled with premoistened sterile swabs. Collection was performed between cases, in operating rooms hosting a broad variety of subspecialty procedures, after the room and equipment had been thoroughly cleaned for the subsequent case. Samples from 40 handles were sent for aerobic bacterial culture, and antimicrobial susceptibility testing was performed for significant isolates. Samples from 20 handles were examined for viral contamination using a polymerase chain reaction assay that detects 17 respiratory viruses. Of the 40 samples sent for culture, 30 (75%) were positive for bacterial contamination. Of these positive cultures, 25 (62.5%) yielded coagulase-negative staphylococci, seven (17.5%) Bacillusspp. not anthracis, three (7.5%) alpha-hemolytic Streptococcusspp., and one each (2.5%) of Enterococcusspp., Staphylococcus aureus(S. aureus), and Corynebacteriumspp. No vancomycin-resistant enterococci, methicillin-resistant S. aureus, or Gram-negative rods were detected. All viral tests were negative. We found a high incidence of bacterial contamination of laryngoscope handles despite low-level disinfection. However, no vancomycin-resistant enterococci, methicillin-resistant S. aureus, Gram-negative rods, or respiratory viruses were detected. Our results support adoption of guidelines that include, at a minimum, mandatory low-level disinfection of laryngoscope handles after each patient use.

Prevalence and Clinical Characteristics of Norovirus Gastroenteritis Among Hospitalized Children in Spain

The importance of norovirus as a cause of gastroenteritis outbreaks is well documented, but the role of norovirus in sporadic acute severe gastroenteritis is not so well established. The aim of this study was to determine the prevalence and clinical characteristics of norovirus gastroenteritis among hospitalized children. A prospective study was conducted in children less than 5 years old, admitted with acute gastroenteritis between January 2005 and January 2008 to the Pediatrics Department of the Universitary Hospital, Albacete, Spain. Demographic and clinical data were collected. A stool sample from each child was screened for enteropathogenic bacteria and tested by reverse transcription polymerase chain reaction for rotavirus, astrovirus, norovirus, and sapovirus and by immunochromatographic method for enteric adenoviruses. Norovirus was the second most frequent pathogen after rotavirus, being detected in 61 (17.3%) of the 352 children enrolled, in 29 of them (8.2%) as single agent. Mixed infections involving other viruses or bacteria were present in 52.4% of norovirus positive samples, a nosocomial source of infection was demonstrated in 17.2%. Norovirus infection was more prevalent in winter and affected mainly children less than 2 years of age. Vomiting was present in 68% and fever in 48.3% of cases, 3 children had nonfebrile seizures. Compared with rotavirus enteritis, norovirus infection was slightly less severe (in terms of severity score and need of intravenous rehydration) and fever was less frequent. Norovirus was a frequent cause of acute severe sporadic gastroenteritis in children representing the second etiologic agent after rotavirus.

Commentary: Ulger F et al. (2009). Are we aware how contaminated our mobile phones with nosocomial pathogens?

AbstractBackground: The objective of this study was to determine the contamination rate of the health care workers’ (HCWs) mobile phones and hands in operating room and intensive care unit (ICU). Micro‐organisms from HCWs hands could be transferred to the surfaces of the mobile phones during their use.Methods: Two hundred HCWs were screened; samples from the hands of 200 participants and 200 mobile phones were cultured.Results: In total, 94·5% of phones demonstrated evidence of bacterial contamination with different types of bacteria. The Gram‐negative strains isolated from mobile phones were 31·3%, and the ceftazidime‐resistant strains from the hands were 39·5%. Staphylococcus aureus strains isolated from mobile phones of 52% and those strains isolated from hands of 37·7% were methicillin resistant. Distributions of the isolated micro‐organisms from mobile phones were similar to those from hands isolates. Some mobile phones were contaminated with nosocomial important pathogens.Conclusion: These results showed that HCWs hands and their mobile phones were contaminated with various types of micro‐organisms. Mobile phones used by HCWs in daily practice may be a source of nosocomial infections in hospitals. Abstract reprinted from Annals of Clinical Microbiology and Antimicrobials, volume 8, Ulger F et al., ‘Are we aware how contaminated our mobile phones with nosocomial pathogens?’, doi:10.1186/1476‐0711‐8‐7. © 2009, reproduced with permission from BioMed Central Ltd.

Are we aware how contaminated our mobile phones with nosocomial pathogens?

BackgroundThe objective of this study was to determine the contamination rate of the healthcare workers' (HCWs') mobile phones and hands in operating room and ICU. Microorganisms from HCWs' hands could be transferred to the surfaces of the mobile phones during their use.Methods200 HCWs were screened; samples from the hands of 200 participants and 200 mobile phones were cultured.ResultsIn total, 94.5% of phones demonstrated evidence of bacterial contamination with different types of bacteria. The gram negative strains were isolated from mobile phones of 31.3% and the ceftazidime resistant strains from the hands were 39.5%. S. aureus strains isolated from mobile phones of 52% and those strains isolated from hands of 37.7% were methicillin resistant. Distributions of the isolated microorganisms from mobile phones were similar to hands isolates. Some mobile phones were contaminated with nosocomial important pathogens.ConclusionThese results showed that HCWs' hands and their mobile phones were contaminated with various types of microorganisms. Mobile phones used by HCWs in daily practice may be a source of nosocomial infections in hospitals.

Staphylococcus aureus on computer mice and keyboards in intensive care units of the Universitas Academic Hospital, Bloemfontein, and ICU staff’s knowledge of its hazards and cleaning practices

Nosocomial infections result in severe health and financial difficulties for patients and healthcare facilities. The objective of the study was to determine the presence of Staphylococcus aureus on computer mice and keyboards in the intensive care units (ICUs) of Universitas Academic Hospital, Bloemfontein, and ICU staff's knowledge regarding cleaning of computer mice and keyboards and their potential hazard as reservoirs for pathogens. Swab specimens from computer mice and keyboards (14 each) were investigated for S. aureus. Swabbing was repeated six months later. Standard microbiology laboratory methods were used to culture and identify organisms. An anonymous questionnaire completed by the ICU staff determined their awareness of computer mice and keyboards as potential sources of nosocomial infections. In addition to various environmental microorganisms and normal human flora, S. aureus was initially isolated from one computer mouse, and from two keyboards and five mice six months later. The questionnaire response rate was 85.6%. Seventy-one percent of respondents stated that they regarded keyboards and mice as an important source of nosocomial infections. Nevertheless, 62% of doctors and 40.3% of nurses indicated that they never washed their hands before or after using the computer. Ninety-seven percent of respondents were not aware of an official cleaning policy for computer equipment. In order to prevent nosocomial infections resulting from microbial transmission between equipment, staff and patients, proper cleaning policies should be implemented.