Indoor Air Bacterial Load and Antibiotic Susceptibility Pattern of Isolates in Operating Rooms and Surgical Wards at Jimma University Specialized Hospital, Southwest Ethiopia

BACKGROUND: Surgical site infection is the second most common health care associated infection. One of the risk factors for such infection is bacterial contamination of operating rooms’ and surgical wards’ indoor air. In view of that, the microbiological quality of air can be considered as a mirror of the hygienic condition of these rooms. Thus, the objective of this study was to determine the bacterial load and antibiotic susceptibility pattern of isolates in operating rooms’ and surgical wards’ indoor air of Jimma University Specialized Hospital. METHODS: A cross sectional study was conducted to measure indoor air microbial quality of operating rooms and surgical wards from October to January 2009/2010 on 108 indoor air samples collected in twelve rounds using purposive sampling technique by Settle Plate Method (Passive Air Sampling following 1/1/1 Schedule). Sample processing and antimicrobial susceptibility testing were done following standard bacteriological techniques. The data was analyzed using SPSS version 16 and interpreted according to scientifically determined baseline values initially suggested by Fisher. RESULTS: The mean aerobic colony counts obtained in OR-1(46cfu/hr) and OR-2(28cfu/hr) was far beyond the set 5-8cfu/hr acceptable standards for passive room. Similarly the highest mean aerobic colony counts of 465cfu/hr and 461cfu/hr were observed in Female room-1 and room-2 respectively when compared to the acceptable range of 250-450cfu/hr. In this study only 3 isolates of S. pyogenes and 48 isolates of S. aureus were identified. Over 66% of S. aureus was identified in Critical Zone of Operating rooms. All isolates of S .aureus showed 100% and 82.8% resistance to methicillin and ampicillin respectively. CONCLUSION: Higher degree of aerobic bacterial load was measured from operating rooms’ and surgical wards’ indoor air. Reducing foot trafficking, improving the ventilation system and routine cleaning has to be made to maintain the aerobic bacteria load with in optimal level.   KEYWORDS: Indoor air, hospital environment, surgical site infection, Southwest Ethiopi

Postoperative Nosocomial Infections and Antimicrobial Resistance Pattern of Bacteria Isolates among Patients Admitted at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia

Background: Nosocomial infection constitutes a major public health problem worldwide. Increasing antibiotic resistance of pathogens associated with nosocomial infections also becomes a major therapeutic challenge for physicians. Thus, the aim of this study was to identify post operative bacterial infections and determine their current antimicrobial resistance to commonly prescribed drugs.Methods: A cross sectional study was conducted on patients under gone operation from October 2010 to January 2011 and followed for development of clinical signs and symptoms of surgical site and blood stream infection until the time of discharge. Structured questionnaire was used to collect socio demographic characteristics. Wound swab and venous blood samples were collected and processed for bacterial isolation and antimicrobial susceptibility testing following standard bacteriological techniques.Results: Out of 294 patients who had clean and clean-contaminated operation, 10.9% were confirmed of bacterial nosocomial infections. The rate of nosocomial infections among clean and clean-contaminated operations was 3.3% and 12.8% respectively. Nosocomial surgical site and blood stream infection rate was 10.2% and 2.4% correspondingly. A total of 42 bacterial pathogens were identified of which S. aureus was the leading isolates accounting 26.2% followed by E. coli and Coagulase negative Staphylococcus species each 21.4%. Nearly 100% of Gram positive and 95.5% of Gram negative bacterial isolates showed resistance against two or more antimicrobial drugs.Conclusions: Multiple drug resistance of isolates to antimicrobials was alarmingly high so that any empirical prophylaxis and treatment needs careful selection of effective drugs. To minimize such infections, adherence of strict aseptic surgical procedures and proper management of wounds is required

Risk factors for postoperative nosocomial infections among patients seen at Felege Hiwot referral hospital, Bahirdar, Ethiopia

Background: Nosocomial infections are the most challenging problem in all health care systems. In developing countries many people are dying daily due to inadequate health care services of which postoperative infections constitute a large proportion of this burden. Factors underlying postoperative nosocomial infections are multiple and these include the type of surgical procedure, the skills of the surgeon, the duration of surgery and the underlying disease of the host.Objectives: The aim of this study was to identify possible risk factors for post operative nosocomial infections among operated patients at Felege Hiwot Referral Hospital.Methods: A cross-sectional study was conducted on patients who under gone operations from October 2010 to January 2011. A predesigned structured questionnaire was used for collection of data on socio-demographic characteristics and associated risk factors. The clinical diagnosis was made by respective surgeons and gynaecologists. Bacterial culture confirmation was done for all patients who developed clinical signs and symptoms of surgical site and/or bloodstream infection starting from the second day of admission until the time of discharge using standard bacteriological techniques. The data was checked for completeness, coded and fed into SPSS version16 and P-value <0.05 was considered statistically significant for association between variables.Results: A total of 294 patients were included in the study of which 32.7% were males and 67.3% were females making male to female ratio 1:2.1 with mean age of 32.2 years. The rate of postoperative culture confirmed nosocomial infection was 10.9%. The infection rate was higher in females (11.6%) than males (9.4%) (P=0.564, OR=1.270, 95%CI=0.564- 2.863). Patients age of >51 years old were likely to develop post operative nosocomial infection (P=0.033, OR=6.375, 95%CI=1.156-35.14) by taking 11-20 years age group as a reference category during bivariate analysis. The logistic rigration analysis showed that patient with underlying diseases (P =0.010, OR=2.725, 95%CI=1.269-5.853) and patients who undergone appendectomy (P=0.03, OR=3.1, 95%CI=1.1-8.3) were more likely developed post operative nosocomial infections. Operation duration of 91-150 minutes (P=0.006, OR=11.00, 95%CI=1.989-60.83), and postoperative hospital stay of greater than 15 days (P=0.001, OR=82.00, 95% CI=5.738- 1.172) were also likely to be risk factor for infection.Conclusion: This study confirmed that advanced age, underlying disease, extended preoperative and postoperative hospital stay, longer duration of surgery and appendectomy as potential risk factors for post operative infections. Hence, more attention is required in management of such cases through the use of effective antibiotics as a prophylaxis and adherence of strict aseptic operating procedures.Keywords: Post operative nosocomial infection, risk factors, clean-operation, clean-contaminated operation