Hand Colonization with Gram-Negative Organisms of Healthcare Workers Accessing the Cardiac Intensive Care Unit: A Cross-Sectional Study at the Uganda Heart Institute

Abstract

Background Hands of healthcare workers (HCWs) are vehicles for pathogens responsible for healthcare-associated infections (HAIs). Following the identification of Gram-negative organisms (GNOs) in all cases of HAIs in the cardiac intensive care unit (ICU), we sought to determine the burden of hand colonization with GNOs among healthcare workers who access the cardiac ICU. Methods We retrospectively reviewed results from surveillance cultures of fingertip imprints of HCWs who access the cardiac ICU at the Uganda Heart Institute. We collected data on staff category, isolates, and susceptibility to antibiotics. We analyzed the data using Microsoft Excel, and the results are summarized in proportions and percentages and presented in charts and tables. Results Fifty-six healthcare workers participated in the surveillance. 21 were ICU clinicians, 21 non-ICU clinicians, and 14 nonclinicians. GNOs were cultured in 19 (33.9%) HCWs, in which 8/19 (42.1%) were non-ICU clinicians, 6/19 (31.2%) ICU clinicians, and 5/19 (26.3%) nonclinicians. 32 isolates were identified, of which 47%, 28%, and 25% were cultured from non-ICU clinicians, nonclinicians, and ICU clinicians, respectively. Predominant isolates were Acinetobacter (34%), Citrobacter (21.9%), and Pseudomonas (21.9%). Antimicrobial resistance ranged from 4% to 90%. 9/28 (32.1%) isolates, predominantly Acinetobacter species (spp), were carbapenem resistant. 8/28 (28.6%) isolates, predominantly Citrobacter spp, were multidrug resistant. Resistance to ciprofloxacin and cefepime was low at 3.6% and 4.4%, respectively. Conclusion Gram-negative organisms, predominantly Acinetobacter, Citrobacter, and Pseudomonas spp, were prevalent on the hands of HCWs who access the cardiac ICU irrespective of the staff category. Antimicrobial resistance was high, with multidrug resistance and carbapenem resistance common among Citrobacter spp and Acinetobacter spp, respectively. Resistance to cefepime and ciprofloxacin was low.

Identification of human-dependent routes of pathogen’s transmission in a tertiary care hospital

“…A total of 60.6% of students were carriers of S. aureus, 3% Pseudomonas aeruginosa, 3% Enterobacter, and 18.1% Candida spp. [27] Ssemogerere et al [27] The differences we found concerned the quantity or quality of microorganisms that belong to the normal microflora of the hand skin (mostly coagulase-negative Staphylococci) and the probable environmental contaminant of the genus Bacillus. Our results confirmed the research hypotheses.…”

“…A total of 60.6% of students were carriers of S. aureus, 3% Pseudomonas aeruginosa, 3% Enterobacter , and 18.1% Candida spp. [ 27 ]…”

“…Ssemogerere et al[ 27 ] cultured fingertip imprints of ICU physicians, non-ICU physicians and nonclinicians, and isolated: Acinetobacter spp. from 34.4% samples, Citrobacter spp.…”

Gastrointestinal Tract Colonization Rate of Extended-Spectrum Beta-Lactamase-Producing Gram-Negative Bacteria and Associated Factors Among Orthopaedic Patients in a Tertiary Hospital in Tanzania: Implications for Infection Prevention

“…ESBL hand contamination among health-care workers in the orthopaedic wards was lower (8.3%), and similar to 10.7% among health-care workers in a cardiac intensive care unit in Kampala, Uganda. 28 …”

“…ESBL hand contamination among health-care workers in the orthopaedic wards was lower (8.3%), and similar to 10.7% among health-care workers in a cardiac intensive care unit in Kampala, Uganda. 28 The predominance of ESBL-producing E. coli and Klebsiella spp. among orthopaedic patients, non-medical caregivers, and health-care workers in this study is in agreement with two systematic reviews and meta-analyses among patients with various infections in East African hospitals, animals, and non-hospital environments, 6,11 and another study among general and orthopaedic patients in Denmark.…”