Implementation of Proper Hand Hygiene among Microbiological Laboratory Workers Respectively to WHO Guidelines

Background: Hand hygiene has a fundamental role in the prevention of one of the most challenging problems in the management of modern hospitals: nosocomial infections and occupational diseases. Aim: This survey presents the experience of laboratorians in the Microbiology Department in the Clinical Center in Skopje in promoting proper hand hygiene by participating in a training course and implementation of WHO guidelines among laboratory staff. Material and Methods: The group of 36 Health Care Workers (HCW) has been divided in to seven different groups, based on their specific work in the Institute of Microbiology. The investigation was conducted in two phases: phase-1 was before the training course and phase-2 immediately after taking the training course. During phase-2, hand samples were taken with the technique of the moist swab on the left hand and the fingertips touch method on the right hand. Results: It was found that 17% of the cultures from the left hand detected pathogenic bacteria and 39% on the samples taken from the right one (there is significant difference (p = 0.041). Conclusion: The Touch Method appears to be the more sensitive method than swabbing the critical areas of the palms. It is also evident (significant) that awareness of the problem of the staff, obtain some changes in their attitude and practice

Unusual appearance of Stenotrophomonas maltophilia in entubated patients hospitalized in Clinic for anestesiology, reanimation and intensive care) - KARIL Skopje

Stenotrophomonas maltophilia-associated infection is increasingly recognized as an nosocomial infection which occurs, in immunosuppressed individuals but not exclusively. Many strains of the bacterium manifest resistance to multiple antibiotics. It is considered an environmental bacterium, although little is known of the epidemiology of S. maltophilia, its sources and reservoirs. Even less is known of pathogenic mechanisms and virulence factors and this, reflects over difficulties in distinguishing colonization from true infection, which has fostered the view that the bacterium is essentially non-pathogenic.This study is generaly case report of unusual isolation of originated from medical devices (endotracheal tubes) used to support immunosuppressed surgical patients in KARIL and attempt to distinguish colonization from infection. During our continious monitoring procedure in KARIL, we have isolated 9 multi-drug resistant strains of Stenotrophomonas maltophilia (100% resistance to cefixime, ceftriaxone, cefuroxime, cefotaxime, coamoxiclav,imipenem). Automatic VITEK technique has been used for identification as well as for antibiotik susceptibility testing, to confirm traditional microbiological tecniques (morphology of colonies on blood agar plates and positive oxidase test,diskdifussion method and E-test).All patients suffered from traumatic haemoragical shock syndrome. Clinical significance has been confirmed in 2 cases with clinical signs for lower respiratory infection (high body temperatute 38.5oC, and Ro confirmation). These patients have been treated with clindamycin and ceftriaxone with recovering period in 4 days. Keywords:Stenotrophomonas maltophilia, ICU, clinical significance, endotracheal tub

Evaluation of Different Methods for Hygienic Microbiological Control from the Working Surfaces in the Microbiological Laboratories

Background: The role of the inter-hospital non-living environment in spreading of some infections is not universally accepted attitude, but still there is a proof that in some cases it is a risk factor for causing infections with some pathogenic microorganisms. Isolation of microorganisms from the non-living environment can significantly vary in reproducibility and sensitivity of different methods of collecting specimen and its cultivation. Aim: In aim to develop and assess hygienic control strategies with incorporating better monitoring and improved cleaning, we have undertaken this survey in microbiological labs to offer better approach in infection control procedures for sampling specimens from inanimate environment in health care facilities. Material and Methods: Three issues might have influence on isolation rates of the mircroorganisms:sampling technique, cultivation methods and professional behaviour of the staff regarding the recommendations and guidelines for hygiene of the workplace. Staphylococcus aureus was almost the only isolated opportunistic microorganism from the surfaces of the workplaces (five from ten), beside Enterococcus, and there was no obvious differentiation in isolation capability between both used swabs.Semi-quantitative method was used for cultivation of saprophytic bacteria. Average of cfu from all used nutrient media was used to estimate bio-mass. Results: Mann-Whitney U test has confirmed statistically significant differentiation between average of cfu (colony-forming unit) (p = 0.0215) sampled with Quanti swab in comparison with wet traditional cotton swab. Plating with swab on trypticase soy agar showed a statistically significant difference between the number of cfu after 24h and 48 h (Wilcoxon Matched Pairs Test: Z = 2.66; p = 0.0076). Plating with pouring on trypticase soy agar at 450C revealed a statistically significant difference between the number of cfu after 24h and 48 h (Wilcoxon Matched Pairs Test: Z = 2.52; p = 0.01171). Conclusion: This survey suggests that pour plate method is a more sensitive and appropriate cultivationmethod for hygienic control in healthcare facilities