Risks associated with pathogenic fungi isolated from surgical centers, intensive care units, and materials sterilization center in hospitals. Risks associated with pathogenic fungi isolated from critical hospital areas.

The hospital environment requires special attention to air quality, since it needs to be healthy for the protection of patients and health professionals in order to prevent them against hospital infections. The objective of this study was to isolate, identify and evaluate the susceptibility profile of isolated fungi from two hospitals. For air sampling the impaction (Spin Air, IUL®) and passive sedimentation methods were used. For the isolation of fungi from surfaces, contact plates (RODAC®) were used. The identification of the fungi was performed by observing the macroscopic and microscopic aspects of the colonies, whereas for better visualization of fruiting structures, the microculture technique was performed on slides. To evaluate the susceptibility profile, the broth microdilution test recommended by CLSI was performed. Thirty-five isolates were identified: Aspergillus flavus (12), Aspergillus fumigatus (11), Aspergillus niger (1), Aspergillus terreus (2), Penicillium spp. (7), and Fusarium spp. (2) in the hospitals evaluated. All isolates had a minimum inhibitory concentration (MIC) more than 128 µg/ml for fluconazole; 0.5 to 4.0 µg/ml for amphotericin B (hospital 1), and all isolates from haospital 2 had MIC ≥2.0 µg/ml. In hospital 1, MIC for posaconazole ranged from 0.25 µg/ml to ≥32 µg/ml, and hospital 2 ranged from 0.5 to 1.0 µg/ml. The monitoring and evaluation of air quality and surfaces are essential measures for prevention and control of hospital infections, as these microorganisms are becoming increasingly resistant to antimicrobial agents, thus making treatment difficult, especially in immunocompromised individuals.

Healthcare-associated infections: bacteriological characterization of the hospital surfaces in the University Hospital of Abomey-Calavi/so-ava in South Benin (West Africa).

BACKGROUND: Healthcare-associated infections have become a public health problem, creating a new burden on medical care in hospitals. The emergence of multidrug-resistant bacteria poses a difficult task for physicians, who have limited therapeutic options. The dissemination of pathogens depends on "reservoirs", the different transmission pathways of the infectious agents and the factors favouring them. Contaminated environmental surfaces are an important potential reservoir for the transmission of many healthcare-associated pathogens. Pathogens can survive or persist in the environment for months and be a source of infection transmission when appropriate hygiene and disinfection procedures are inefficient. The aim of this study was to identify bacterial species from hospital surfaces in order to effectively prevent healthcare-associated infections. METHODS: Samples were taken from surfaces at the University Hospital of Abomey-Calavi/So-Ava in South Benin (West Africa). To achieve the objective of this study, 160 swab samples of hospital surfaces were taken as recommended by the International Organization for Standardization (ISO 14698-1). These samples were analysed in the bacteriology section of the National Laboratory for Biomedical Analysis. All statistical analyses were performed using SPSS Statistics 21 software. A Chi Square Test was used to test the association between the Results of culture samples and different care units. RESULTS: Of the 160 surface samples, 65% were positive for bacteria. The frequency of isolation was predominant in Paediatrics (87.5%). The positive samples were 64.2% Gram-positive bacteria and 35.8% of Gram-negative bacteria. Staphylococcus aureus predominated (27.3%), followed by Bacillus spp. (23.3%). The proportion of other microorganisms was negligible. S. aureus and Staphylococcus spp. were present in all care units. There was a statistically significant association between the Results of culture samples and different care units (χ2 = 12.732; p = 0.048). CONCLUSION: The bacteria found on the surfaces of the University Hospital of Abomey-Calavi/So-Ava's care environment suggest a risk of healthcare-associated infections. Adequate hospital hygiene measures are required. Patient safety in this environment must become a training priority for all caregivers.

Ultraviolet-C light as a means of disinfecting anesthesia workstations.

BACKGROUND: Anesthesia workstations (AWs) are a reservoir for pathogenic organisms potentially associated with surgical site infections. This study examined the effectiveness of the Tru-D SmartUVC device (Tru-D LLC, Nashville, TN) on bioburden reduction (BR) on AWs. METHODS: Strips of tissue inoculated with a known concentration of either Staphylococcus aureus, Enterococcus faecalis, or Acinetobacter sp were placed on 22 high-touch surfaces of an AW. Half of the AW surfaces received direct ultraviolet (UV) light exposure and half received indirect exposure. Two inoculated strips, in sterile tubes outside of the room, represented the control. Trials were conducted on AWs in an operating room and a small room. Strips were placed in a saline solution, vortexed, and plated on blood agar to assess BR by the number of colony forming units. RESULTS: All experimental trials, compared with controls, exhibited a BR >99%. There was a significantly greater reduction of E faecalis colony forming units in the operating room AW under direct exposure (P = .019) compared with indirect exposure. There was no significant difference in reduction when comparing AWs between rooms. CONCLUSION: Regardless of room size and exposure type, automated UV-C treatment greatly influences BR on AW high-touch surfaces. Hospitals instituting an automated UV-C system as an infection prevention adjunct should consider utilizing it in operating rooms for BR as part of a horizontal infection prevention surgical site infection-reduction strategy.

Quantifying the rambunctious journey of the anesthesia provider's hands during simulated, routine care.

BACKGROUND: The role of anesthesia providers in dispersing potentially pathogenic material from one patient to another during intraoperative care needs further study. In this study we aimed (1) to quantify the dispersion of a surrogate pathogen from a simulated patient's mouth to the anesthesia workstation during routine anesthetic induction, (2) to test the hypothesis that there would be fewer contamination sites by providers who used a double-gloving technique, and (3) to examine the effectiveness of between-case anesthesia apparatus disinfection. METHODS: Twenty subjects were randomized to a single pair of gloves group (group 1) or a double-gloved group (group 2) and completed a simulated general anesthesia induction, completing a standardized set of interventions. Dispersion of a surrogate pathogen dye placed in the oral cavity of the simulated patient was tracked by a blinded observer and photography. Standard cleaning of the workstation was performed, and residual dye was quantified. Group performance was plotted using regression analysis and rate of contamination compared using parametric statistics. RESULTS: Group 1 contaminated an average of 16.0 (SEM = 0.89) sites compared with group 2, who contaminated an average of 7.6 (SEM = 0.85). The cart drawers, gas flow dials, medication vials, and ventilator controls were significantly contaminated by group 1, but not by group 2 (P < .05 in all cases). There were similar rates of contamination in both groups for the airway equipment, breathing system, intravenous access ports, and the roll of tape used to secure the endotracheal tube. Once the airway management phase of the induction ended, new site contamination continued at a high rate in group 1 but not group 2. CONCLUSIONS: A double-gloving technique was associated with less spread of an oral inoculum to the workstation but was not uniformly protective. Between-case cleaning was ineffective in removing the contaminant, indicating that biologic material from one patient may be present when subsequent patients are cared for. This suggests risks for the current patient (eg, skin or oral site transfer to an intravenous site) and also may place future patients at risk. Importantly, using models that simulate actual clinical events can inform clinical practice and decipher challenging areas of ergonomics.

Cleanliness of disposable vs nondisposable electrocardiography lead wires in children.

BACKGROUND: Mediastinitis costs hospitals thousands of dollars a year and increases the incidence of patient morbidity and mortality. No studies have been done to evaluate adenosine triphosphate (ATP) counts on disposable and nondisposable electrocardiography (ECG) lead wires in pediatric patients. OBJECTIVE: To compare the cleanliness of disposable and nondisposable ECG lead wires in postoperative pediatric cardiac surgery patients by measuring the quantity of ATP (in relative luminescence units [RLUs]). ATP levels correlate with microbial cell counts and are used by institutions to assess hospital equipment and cleanliness. METHODS: A prospective, randomized trial was initiated with approval from the institutional review board. Verbal consent was obtained from the parents/guardians for each patient. Trained nurses performed ATP swabs on the right and left upper ECG cables on postoperative days 1, 2, and 3. RESULTS: This study enrolled 51 patients. The disposable ECG lead wire ATP count on postoperative day 1 (median, 157 RLUs) was significantly lower (P < .001) than the count for nondisposable ATP lead wires (median, 610 RLUs). On postoperative day 2, the ATP count for the disposable ECG lead wires (median, 200 RLUs) was also lower (P = .06) than the count for the nondisposable ECG lead wires (median, 453 RLUs). CONCLUSION: Results of this study support the use of disposable ECG lead wires in postoperative pediatric cardiac surgery patients for at least the first 48 hours as a direct strategy to reduce the ATP counts on ECG lead wires.

Otitis externa following aural irrigation linked to instruments contaminated with Pseudomonas aeruginosa.

BACKGROUND: The incidence of acute otitis externa, an infection of the external auditory canal, in general practitioners' (GP) practices in The Netherlands is about 14 per 1000 patients per year. In early 2010, one of the authors noted that some of the otitis externa patients in his GP practice had undergone cerumen removal by ear syringing a few weeks earlier. Bacterial cultures of samples taken from the instruments used showed contamination of an ear syringe by Pseudomonas aeruginosa. From then on, P. aeruginosa isolates from patients' ears were stored in the laboratory. AIM: It was assessed whether cross-contamination with P. aeruginosa between patients in the same GP practice could occur through the use of contaminated ear lavage instruments. METHODS: From 17 GP practices, the otolaryngology Outpatient Department and the Out-of-Hours GP Service, instruments used for examining and cleaning the outer ear were swabbed. Strains of P. aeruginosa cultured from the instruments were genotyped together with isolates of patients registered in the same practice. FINDINGS: In four practices where contaminated instruments were found, genotyping showed similarity between P. aeruginosa strains isolated from a patient and the ear syringe, and/or between strains of different patients in the same practice. CONCLUSIONS: Transmission of P. aeruginosa from ear lavage instruments to patients appears to occur with otitis externa as a result. Together with the Infection Control Unit of our hospital we have formulated recommendations for the appropriate cleaning, disinfection and storage of re-usable ear lavage instruments for the GP practices to implement.

Cleanliness of portable medical equipment disinfected by nursing staff.

Increased attention has been focused on disinfection by housekeepers, but few data are available on disinfection of equipment by nurses. We used adenosine triphosphate bioluminescence assays and aerobic cultures to assess the cleanliness of portable medical equipment disinfected by nurses between each patient use. We found that the equipment was not being disinfected as per protocol and that education and feedback to nursing are warranted to improve disinfection of medical equipment.

Cleaned, ready-to-use, reusable electrocardiographic lead wires as a source of pathogenic microorganisms.

BACKGROUND: Cleaned electrocardiographic lead wires are a potential source of microorganisms capable of causing nosocomial infection. OBJECTIVES: To examine fungal and bacterial growth on cleaned reusable lead wires, determine if microbial growth is associated with hospital site or work environment, determine the prevalence of antibiotic-resistant bacteria, and learn if antibiotic-resistant bacteria are associated with hospital site and work environment. METHODS: Cleaned lead wires (N = 320) from critical care and telemetry units, emergency departments, and operating rooms of 4 hospitals were swabbed and the specimens cultured for microbial growth. Bacterial species were grouped by their risk for human infection: at risk (n = 9), potential risk (n = 5), and no risk (n = 10). Work environments were compared by using pairwise contrasts from a generalized estimating equation model. RESULTS: Fungi were rare (0.6%). Of 226 cultures from 201 wires (62.8%) with bacterial growth, 121 were of at- or potential-risk bacteria (37.8%). Urban hospitals had less growth (P ≤ .001) and fewer bacterial species per wire (P ≤ .001) than did community hospitals. Presence of any bacteria (P = .02) and number of bacterial species per wire (P = .002) were lowest in operating rooms; emergency departments and telemetry units had more growth than did critical care units. Among specimens of staphylococci and enterococci, 6 each were sensitive to antibiotics; of 4 resistant staphylococcal species, 1 was not a human opportunistic pathogen and 3 were potential-risk species. CONCLUSIONS: Bacteria are common on reusable, cleaned lead wires and differ by hospital and clinical area.

Microbial contamination of suction tubes attached to suction instruments and preventive methods.

We investigated the microbial contamination of suction tubes attached to wall-type suction instruments. Microbial contamination of suction tubes used for endoscopy or sputum suction in hospital wards was examined before and after their disinfection. In addition, disinfection and washing methods for suction tubes were evaluated. Suction tubes (n=33) before disinfection were contaminated with 10(2)-10(8) colony-forming units (cfu)/tube. The main contaminants were Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia. The suction tubes were disinfected with sodium hypochlorite (n=11) or hot water (n=11), or by an automatic tube cleaner (n=11). After 2-h immersion in 0.1% (1,000 ppm) sodium hypochlorite, 10(3)-10(7) cfu/tube of bacteria were detected in all 11 tubes examined. After washing in hot running water (65 degrees C), 10(3)-10(7) cfu/tube were detected in 3 of the 11 examined tubes. The bacteria detected in the suction tubes after disinfection with sodium hypochlorite or hot water were P. aeruginosa, A. baumannii, and S. maltophilia. On the other hand, after washing with warm water (40 degrees C) using the automatic tube cleaner, contamination was found to be <20 cfu/tube (lower detection limit, 20 cfu/tube) in all 11 tubes examined. These results suggest the usefulness of washing with automatic tube cleaners.

The antimicrobial effect of Octenidine-dihydrochloride coated polymer tracheotomy tubes on Staphylococcus aureus and Pseudomonas aeruginosa colonisation.

BACKGROUND: The surface of polymeric tracheotomy tubes is a favourable environment for biofilm formation and therefore represents a potential risk factor for the development of pneumonia after tracheotomy. The aim of this in-vitro study was to develop octenidine-dihydrochloride (OCT) coated polymer tracheotomy tubes and investigate any effects on Staphylococcus (S.) aureus and Pseudomonas (P.) aeruginosa colonization. Additionally the resistance of the OCT coating was tested using reprocessing procedures like brushing, rinsing and disinfection with glutaraldehyde RESULTS: Contamination with S. aureus: Before any reprocessing, OCT coated tracheotomy tubes were colonized with 103 cfu/ml and uncoated tracheotomy tubes with 105 cfu/ml (P = 0.045). After reprocessing, no differences in bacterial concentration between modified and conventional tubes were observed.Contamination with P. aeruginosa: Before reprocessing, OCT coated tubes were colonized with 106 cfu/ml and uncoated tubes with 107 cfu/ml (P = 0.006). After reprocessing, no significant differences were observed. CONCLUSION: OCT coating initially inhibits S. aureus and P. aeruginosa colonisation on tracheotomy tubes. This effect, however, vanishes quickly after reprocessing of the tubes due to poor adhesive properties of the antimicrobial compound. Despite the known antimicrobial effect of OCT, its use for antimicrobial coating of tracheotomy tubes is limited unless methods are developed to allow sustained attachment to the tube.

Evaluation of disinfectants on military NATO and DECON litters.

OBJECTIVE: This study evaluated the effectiveness of five disinfectants: A33, 10% bleach, 1% bleach, SPOROX, and 3% H2O2, on military NATO and DECON litters. DESIGN: Suspensions of Acinetobacter baumannii, Staphylococcus aureus, and spore-enhanced Bacillus subtilis, with five percent albumin, were inoculated onto litters and dried overnight. The litters were saturated with disinfectant solutions and sampled after 10 minutes. The Log10 reduction in the number of bacteria recovered was calculated. SETTING: 59th Medical Wing, 59th Clinical Research Division, Lackland AFB TX. MAIN OUTCOME MEASURES: A reduction of > or =3 Log10 in the number of bacteria recovered from the test squares compared to the control squares was considered effective disinfection. RESULTS: On the NATO litter 10% bleach and SPOROX were effective against vegetative cells. On the DECON litter A33, 10% bleach, and SPOROX were effective against vegetative cells. After the 10 minute exposure none of the disinfectants evaluated were effective against spore-enhanced B. subtilis. CONCLUSION: When contaminated with vegetative cells military NATO and DECON litters can be effectively disinfected with a 10 minute exposure to some disinfectants. Further research is needed to find an effective disinfectant for spore contamination.

[Adherence of Candida albicans is inhibited by yeast mannan].

The adherence of Candida albicans strain NIH A207 to plastic plates was inhibited by the addition of mannan, and plates coated with mannan also inhibited the adherence of C. albicans strains TIMM1768, TIMM2640, and JCM2076. Mannan coated the plastic plates under neutral and acidic conditions, but not under alkaline conditions. These results indicate that C. albicans cannot attach to mannan. Thus mannan-coated medical equipment might be useful to prevent C. albicans adherence.

Preventing infection from reusable medical equipment: a systematic review.

BACKGROUND: In 2000, the World Health Organization (WHO) had eight sets of conflicting recommendations for decontaminating medical equipment. We conducted a systematic review of observational studies to assist WHO in reconciling the various guidelines. This paper summarises the methods developed and illustrates the results for three procedures--alcohol, bleach and povidone iodine. METHODS: We developed a Medline search strategy and applied inclusion criteria specifying the decontamination procedures of interest and an outcome of microbial destruction for a set of marker organisms. We developed protocols to assess the quality of studies and categorised them according to the reliability of the methods used. Through an iterative process we identified best practice for the decontamination methods and key additional factors required to ensure their effectiveness. We identified 88 published papers for inclusion, describing 135 separate studies of decontamination. RESULTS: For disinfection with alcohol, best practice was identified from 23 studies as an exposure to 70-80% ethanol or isopropanol for at least 5 minutes. Bleach was effective for sterilization at a concentration of 5000 ppm for 5 minutes and for disinfection at 1000 ppm for 10 minutes (33 studies). Povidone iodine was only partially effective for disinfection at a concentration of 1% for 15 minutes (15 studies). CONCLUSIONS: Our findings provide an evidence base for WHO guidelines on decontaminating medical equipment. The results support the recommended use of bleach and show that alcohol could be used more widely than current guidelines suggest, provided best practice is followed. The effectiveness of povidone iodine is uncertain.

Monte Carlo studies for irradiation process planning at the Portuguese gamma irradiation facility.

The paper describes a Monte Carlo study for planning the irradiation of test samples for microbiological validation of distinct products in the Portuguese Gamma Irradiation Facility. Three different irradiation geometries have been used. Simulated and experimental results are compared and good agreement is observed. It is shown that Monte Carlo simulation improves process understanding, predicts absorbed dose distributions and calculates dose uniformity in different products. Based on these results, irradiation planning of the product can be performed.