Epidemiology of bacterial contamination of inert hospital surfaces and equipment in critical and non-critical care units: a Brazilian multicenter study

Abstract

27The hospital environment is an important reservoir of microorganisms, including 28 multidrug-resistant pathogens, which can cause in-patient contamination and healthcare-29 related infections. The objective of this study was to analyze the epidemiology of bacterial 30 contamination (contaminated sites, pathogen species and their antimicrobial 31 susceptibility, and tracking of multidrug-resistant microorganisms -MDR) of inert 32 hospital surfaces and medical equipment in two public hospitals in Northern Brazil. 33 This was a cross-sectional study with 243 samples (n = 208, from Hospital A; and n = 35, 34 from Hospital B) collected by friction with swabs moistened in Brain Heart Infusion from 35 inert surfaces and equipment. The samples were cultivated and bacterial species were 36identified by the classical approach and tested for their susceptibility through agar 37 diffusion assay according to the Clinical and Laboratory Standards Institute (CLSI). 38Most inert surfaces and equipment analyzed presented bacterial contamination (95.5%). 39Staphylococcus aureus was the main pathogen of clinical significance detected both in 40 Hospital A (61.8%) and B (68.6%). Hospital A showed higher rates of isolated MDR 41 bacteria than Hospital B, especially in the Adult Intensive Care Unit, which included 42 methicillin-resistant Staphylococcus aureus (MRSA) (52.7%), Enterobacteria resistant to 43 4 th generation cephalosporins (19.4%), and multidrug-resistant Pseudomonas aeruginosa 44 (2.78%). The failures in the prevention and control of infections in the two hospitals 45 analyzed reinforce the need for a revised protocol for cleaning and disinfection of inert 46 surfaces and medical equipment, and for regulation of antibiotic dispensing, mainly in the 47 AICU of Hospital A, which was found to be a reservoir of MDR pathogens. This study is 48 innovative because it is the pioneer in Western Bahia that describes the epidemiology of 49 contamination of hospital surfaces, opportuning futures studies in this field. 50 Introduction 51Healthcare-associated infections (HAI) are a major public health concern 52 commonly associated with extended length of hospital stay. HAI account for high hospital 53 costs and contribute to increased morbidity and mortality of infected patients [1]. 54HAI are usually caused by pathogenic bacteria that may emerge from the patient's 55 endogenous microflora during antibiotic therapy in approximately 70% of the cases [2,3]. 56HAI may also be acquired from the exogenous environment (30% of the cases) in that the 57 hospital setting plays a significant role in contagion and transmission outbreaks [3,4]. 58In the hospital setting, patients, staff and visitors represent the main reservoir of 59 microorganisms, whereas secondary reservoirs include all environments where nutrients, 60 moisture, and temperature are suitable for microbial survival, such as air humidifiers and 61 nebulizers [5,6]. In addition, dry and inanimate surfaces can also serve as a reservoir of 62 pathogens [3,5,7-9], as in mattre...

Bacterial Pathogens and Their Antimicrobial Resistance Patterns of Inanimate Surfaces and Equipment in Ethiopia: A Systematic Review and Meta-analysis

“…The hospital environment is the potential reservoir for many pathogens responsible for nosocomial infections provided that hospital-acquired infection has remained one of the serious public health problems worldwide [14]. Bacterial contamination of inanimate surfaces and equipment poses a great threat to the cross-transmission of healthcareassociated infections [51].…”

“…Medical equipment is any device including a sphygmomanometer, stethoscope, and thermometer used for the diagnosis and therapeutic purposes for hospitalized patients in pediatrics, ICU, neonatal intensive care unit (NICU), and surgical, medical, gynecology, and orthopaedic wards/units [5,14]. Nonmedical devices that harbour microbes also include computers and HCW's cell phones as well as other equipment found in the hospital environment that has contact with HCW.…”

“…A highly virulent pathogen such as Staphylococcus aureus (Methicillin-resistant Staphylococcus aureus or MRSA), Coagulase-negative Staphylococci (CoNS), Enterococcus species (vancomycin-resistant Enterococci), Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Clostridium difficile, and Acinetobacter baumannii are capable of harbouring on contaminated inanimate surfaces and medical apparatus [5]. Contributing factors for the transfer of microorganisms from one surface to another may depend on the type of organisms, source of surfaces, surface humidity level, size of inoculum, medical personnel hand hygiene compliance, ward design (overbending), number of colonized patients, and antibiotic stewardship practices [13,14].…”

“…Based on this, it should be decontaminated before and after the patient contact as well as exposure to the environment to mitigate the horizontal transfer of microorganisms from infected patients [14,17,18].…”

“…The importance of nosocomial infections has grown into the epidemiology and determinants of healthcare-related microbial contamination to implement measures against the rapidly evolving colonization and dissemination of MDR pathogens [3,14,19]. This is mainly due to microbial contamination being common among ICU, operating room (OR), adult medical wards, pediatric wards, neonatal intensive care unit, and gynecologic wards [14]. Lack of regular cleaning and disinfection practices is believed as the main factor for the spread of HAIs.…”