The role of the intensive care unit environment and health-care workers in the transmission of bacteria associated with hospital acquired infections

Abstract

The goal of this study was to attempt to determine the rate of contamination of health-care workers' (HCWs) hands and environmental surfaces in intensive care units (ICU) by the main bacteria associated with hospital acquired infections (HAIs) in Tehran, Iran. A total of 605 and 762 swab samples were obtained from six ICU environments and HCWs' hands. Identification of the bacterial isolates was performed according to standard biochemical methods, and their antimicrobial susceptibility was determined based on the guidelines recommended by clinical and laboratory standards institute (CLSI). The homology of the resistance patterns was assessed by the NTSYSsp software. The most frequent bacteria on the HCWs' hands and in the environmental samples were Acinetobacter baumannii (1.4% and 16.5%, respectively), Staphylococcus aureus (5.9% and 8.1%, respectively), S. epidermidis (20.9% and 18.7%, respectively), and Enterococcus spp. (1% and 1.3%, respectively). Patients' oxygen masks, ventilators, and bed linens were the most contaminated sites. Nurses' aides and housekeepers were the most contaminated staff. Imipenem resistant A. baumannii (94% and 54.5%), methicillin-resistant S. aureus (MRSAs, 59.6% and 67.3%), and vancomycin resistant Enterococci (VREs, 0% and 25%) were detected on the hands of ICU staff and the environmental samples, respectively. Different isolates of S. aureus and Enterococcus spp. showed significant homology in these samples. These results showed contamination of the ICU environments and HCWs with important bacterial pathogens that are the main risk factors for HAIs in the studied hospitals.

Perfil dos microrganismos associados à colonização e infecção em Terapia Intensiva

“…No Brasil, a RDC nº 44/2010 que estabelece o controle para todos os antimicrobianos sob prescrição constituiu um relevante passo para prevenção da resistência bacteriana. 20,21 A identificação do perfil de sensibilidade dos microrganismos aos antimicrobianos utilizados no tratamento das IRAS em UTI traz evidências para a prática clínica, tomada de decisões, adequação dos protocolos de acordo com cada realidade visando, além do uso racional dos antimicrobianos, despertar a atenção para as possíveis fontes ambientais dos MR. 4,16,22 Apesar da constatação do perfil dos microrganismos associados às IRAS observa-se que um período maior e amplificação da amostra podem favorecer a análise específica para cada microrganismo e tendências temporais. Dentre as limitações do estudo está o fato deste ter sido realizado em uma única instituição hospitalar.…”

“…1,2 Nas instituições hospitalares, as Unidades de Terapia Intensiva (UTI) são consideradas o epicentro da resistência bacteriana devido à maior ocorrência de surtos por bactérias multirresistentes. [3][4][5] Nas UTIs as taxas de infecções são estimadas entre 18 e 54%, sendo responsável por 5 a 35% de todas as IRAS e por, aproximadamente, 90% de todos os surtos hospitalares. [6][7][8] Em tais unidades os pacientes colonizados e/ou infectados representam a principal fonte de patógenos pois, na colonização apesar de não haver sintomas clíni-cos e imunológicos de infecção, os microrganismos estão presentes nas superfícies cutâneas e mucosas do hospedeiro.…”

Adherence and factors related to acceptance of alcohol for antiseptic hand rubbing among nursing professionals

“…In these scenarios HH are essential to assure patient safety (9) . In ICU nursing professionals are those who keep direct contact with patients, being responsible for the greatest majority of health care (10) .…”

Do bacteria isolated from ICU patients ‘ESKAPE’ antibiotic treatment? In vitro susceptibility of the Enterobacteriaceae family to tigecycline

“…Patients admitted for treatment in the ICU are in a serious condition, immunosuppressed, usually with several underlying conditions, previously treated in other departments, and they undergo emergency intra-abdominal surgery. The patient's condition influences the length of the ICU stay and the type and number of procedures to which the patient is subjected (intubation, mechanical ventilation, vascular access, parenteral nutrition and other invasive procedures) [10,12,13]. An important link in the interaction between the patient and the ICU environment is the bacterial flora present in the unit, which has a high resistance to antibiotics (MDR strains) and its ability to quickly colonize the patient, environment, and staff [11,13,14].…”

“…The patient's condition influences the length of the ICU stay and the type and number of procedures to which the patient is subjected (intubation, mechanical ventilation, vascular access, parenteral nutrition and other invasive procedures) [10,12,13]. An important link in the interaction between the patient and the ICU environment is the bacterial flora present in the unit, which has a high resistance to antibiotics (MDR strains) and its ability to quickly colonize the patient, environment, and staff [11,13,14]. After Rutkowska et al [11] observed that after aproximately a week from the start of hospitalization in ICU, 96% of patients demonstrated a change in their microbiota, which demonstrated a change in their microbiota, which was replaced by pathogens characteristic of a given hospital department.…”