Detection of potential pathogenic and drug resistant bacteria isolated from inanimate hospital environments in Operation Theaters and Intensive Care Units of Tikur Anbessa Specialized Hospital and ALERT Hospital in Addis Ababa, Ethiopia
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Date
2020-02
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Addis Ababa University
Abstract
Background: The role of hospital environments especially those of the operation theaters (OTs) and intensive care units (ICUs) in the transmission of hospital associated pathogens and multidrug resistant (MDR) bacterial strains like Extended-Spectrum β-Lactamases (ESBLs), Methicillin-resistant S. aureus (MRSA) and Vancomycin resistant Enterococci (VRE) dissemination are critical and an essential element in the control of Health care associated infections
(HAIs) and emergence of resistance genes.
Objectives: The current study aimed to detect potential pathogenic and drug resistant bacteria from inanimate hospital environments in OTs and ICUs of the selected hospitals.
Methodology: A cross-sectional study was conducted on 280 hospital environmental samples in two different hospitals from June to September, 2018 G.C: Tikur Anbessa Specialized Hospital (TASH) (n=187) and All Africa Leprosy Rehabilitation and Training Hospital (ALERT) (n=93). Settle plate’s method (Passive air sampling following 1/1/1 schedule) was used for air sample collection while swab method was used to collect samples from inanimate surfaces in the OTs and ICUs of the selected hospitals. A total of 257 environmental swabs and 23 air samples were collected from different sites of ICUs and OTs. All isolates/samples were identified by using routine bacterial culture, Gram staining and a panel of biochemical tests. For each identified bacteria antibiogram profiles were determined by the Kirby Bauer
disk diffusion method based on the Clinical and Laboratory Standards Institute (CLSI) guidelines. Double disk synergy test was used to confirm ESBL production while Modified Hodge test (MHT) was used to screen carba pen emases production. On the other hand, Cefoxitin /oxacillin discs were used to screen MRSA.
Results: Out of 280 swabs and settle plates, 227(81%) of samples were positive for bacterial contamination. A total of 282 bacteria were identified. Of these, the predominant bacteria identified from the environmental samples from OTs and ICUs were S. aureus (27.5% vs 9.6%), Coagulase negative Staphylococcus (CONS) (16% vs 2.8%) and Acinetobacter spp(2.5% vs 14.5%) respectively. The bacterial load on air was found beyond the standard limits. The most common bacterial contaminated sites were bed linens 37(13.1%), followed by environmental surfaces including (wall, floor, corridor and door knob) 35(12.4%) and beds 33(11.7%). Out of the280environmental samples 76(27.1%), 25(8.9%) and 7(2.5%) were MRSA, ESBL and Carbapenemase producer bacteria respectively. Most the identified bacteria showed considerable resistance to antibacterial agents. Of the total 282 identified bacteria, 158(56%) of the isolates were resistant to at least 3 antibiotics and 58 multi-drug resistance phenotypes were exhibited by the MDR isolates.
Conclusion: Hospital environment especially those of the operation theaters and intensive care units are highly contaminated with potential pathogenic bacteria. Bacterial isolates were highly resistant to commonly used antibiotics with high multi-drug resistance percentage. Therefore, well-designed infection prevention and control strategies should be in place for combating health care-associated infections and the consequences.
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Keywords
Extended-Spectrum β-Lactamases (ESBLs), Hospital acquired infection, Inanimate Hospital environments, Methicillin-resistant S. aureus (MRSA), Vancomycin resistant Enterococci (VRE).