Background: Nosocomial infections pose a great challenge on healthcare systems. Although surfaces in neonatal wards, umbilical stump wounds and catheter are responsible for a high number of nosocomial infections due to bacteria. The aim of this study was to determine the bacterial profile of air and surface contamination in the special care baby unit of a tertiary hospital in Jos, Nigeria.Methods: Surface and air samples were cultured and antibiotic susceptibility of isolated bacteria were determined.Results: The bacterial profile of air and surface samples showed that Klebsiella was the most common bacteria followed by Staphyllococcus; while the least was Escherichia. Most of the bacteria were isolated from the out-born term area of the special care baby unit. All the bacteria isolated were susceptible to ceftriaxone and meropenem.Conclusion: This study showed that all areas of the special care baby unit of the hospital have bacterial, indicating that these are a potential source of cross-infection from healthcare workers to the neonatal patients.Keywords: Nosocomial, bacteria, special care baby unit, neonat

Banwat, Edmund B.

Egah, Daniel Z.

Emanghe, Ubleni

Okolo, Mark O.

Onyedibe, Kenneth I.

Toma, Bose O.

English

AJOL - African Journals Online

ABSTRACTosocomial infections cause considerable morbidity and mortality and pose high 1Nfinancial burden on health care systems.  Although surface contact, surgical procedures, umbilical stump wounds and catheters are responsible for a high percentage of nosocomial infections, bacterial and fungal air contaminations in hospitals particularly special care baby unit (SCBU) have an important role in development of hospital 13infections. .It has been shown that many bacterial pathogens can survive as bio-aerosols and even be spread over long 2-4distances, leading to resultant infection.  The indoor air quality of neonatal wards of hospitals has become a 2-4critical part of hospital  management protocol.  A number of studies have indicated that indoor air contamination of hospital wards including neonatal wards by bacteria pose potential hazards to patients in 2-6the wards.Common human pathogens, such as Escherichia coli, Enterococcus spp,  Acinetobacter  spp and Staphyllococcus aureus can survive for long periods on surfaces of equipment, work surfaces, resuscitaires and 6&7formites that can potentially transmit bacteria.INTRODUCTIONBACKGROUNDNosocomial infections pose a great challenge on healthcare systems. Although surfaces in neonatal wards, umbilical stump wounds and catheter are responsible for a high number of nosocomial infections due to bacteria. The aim of this study was to determine the bacterial profile of air and surface contamination in the special care baby unit of a tertiary hospital in Jos, Nigeria.METHODSSurface and air samples were cultured and antibiotic susceptibility of isolated bacteria were determined.RESULTSThe bacterial profile of air and surface samples showed that Klebsiella was the most common bacteria followed by Staphyllococcus; while the least was Escherichia. Most of the bacteria were isolated from the out-born term area of the special care baby unit. All the bacteria isolated were susceptible to ceftriaxone and meropenem.CONCLUSIONThis study showed that all areas of the special care baby unit of the hospital have bacterial, indicating that these are a potential source of cross-infection from healthcare workers to the neonatal patients.KEYWORDS:  Nosocomial, bacteria, special care baby unit, neonate. Correspondence: Mark O. OkoloDepartment of Medical Microbiology, Jos University Teaching Hospital, Jos, Nigeria.E-mail: okolomark@gmail.comBACTERIAL CONTAMINATION IN A SPECIAL CARE BABY UNIT OF A TERTIARY HOSPITAL IN JOS, NIGERIA.Original Article NigerJMed2016: 259-263Copyright Ó 2016. Nigerian Journal of MedicineNigerian Journal of Medicine, Vol. 25 No. 3, July - September, 2016, ISSN 1115-26131 2 1Mark O. Okolo, Bose O. Toma, Kenneth I. Onyedibe, 3 1 1Ubleni Emanghe, Edmund B. Banwat, Daniel Z. Egah1Department of Medical Microbiology, Jos University Teaching Hospital.2Department of Paediatrics, Jos University Teaching Hospital.3Department of Medical Microbiology, University of Calabar Teaching Hospital  259Nigerian Journal of Medicine, Vol. 25 No. 3, July - September, 2016, ISSN 1115-2613Swab method:Surface swab specimens were collected from predefined surfaces (baby cots, baby incubator handles, resuscitaire) with cotton tipped applicators pre-moistened with sterile saline from the special care baby unit of the hospital. The swabs were immediately inoculated onto plates that contained blood, chocolate and mac-conkey agar medium for the growth of bacteria.Processing of samples:The culture plates streaked with swab samples along owith those exposed in air were incubated at 37 C under aerobic conditions for 24hours. After incubation, the colonies obtained were identified using biochemical tests which included catalase, coagulase, oxidase, urea utilization, triple sugar iron agar, citrate.The antibiotic susceptibility testing of isolated bacteria were carried out using disc diffusion method and Mueller hinton agar as described by the clinical and 13laboratory standard institute (CLSI).The concentration of airborne bacteria was expressed 2as colony forming units per square meter (CFU/m ) where as the concentration of the surface-bound bacteria was expressed as colony forming unit/plate (CFU/P).RESULTSBacteria were present in different areas of the special care baby unit (SCBU) of the hospital. Of the 300 plates used for the sampling, total frequency of bacteria were identified in each area of the SCBU as shown in Table 1. The result in table 1 showed that Klebsiella spp (38.1%) and Staphyllococcus aureus (28.1%) were predominantly isolated followed by Pseudomonas aeruginosa (19%) and Escherichia coli (14%).The frequency of bacteria was highest (61.9%) in the Out-born term unit of the SCBU, followed by In-born preterm unit (9.3%). All the other units of the SCBU had bacteria frequency of 4.8% each.The results in table 2 showed that the percentage susceptibility of organisms isolated range from 66.7% to 100%.DISCUSSIONThe hospital environment is one of many places that is contaminated with a variety of pathogenic and non-pathogenic microorganisms that can persist on 11 & 12surfaces for prolonged periods . Several studies have shown that the hands and gloves of healthcare workers readily acquire pathogens after coming into contact with contaminated hospital surfaces and they can subsequently transfer these organisms to patients In spite of environmental conditions, example dryness, temperatures and ultraviolet radiations, which may prevent  microorganisms from growing in unfavourable environments, they still reach new hosts through the air. The incidence of airborne infections has increased in recent years, because many new hospital buildings are sealed and have self-contained 7&8circulating air systems for temperature control.Controlling airborne pathogens in SCBU is not only important for the safety of the neonates, but it is also important for hospital  personnel.  Various contamination control procedures can limit exposure 7-9as well as risk of infection.  Although, it is not possible to eliminate all nosocomial infection, their incidence can be reduced significantly through implementation of appropriate infection control programs. In a bio-aerosol study carried out by Obbard and Fang in a hospital in Singapore, it was observed that the major factor influencing the level of airborne bacteria was 10occupant density.  Similar findings were reported in other studies, but in addition factors such as architectural design and age of the hospital building w e r e  s a i d  t o  p l a y  s i g n i f i c a n t  r o l e  i n  1 1 & 1 2biocontamination. Despite the increasing understanding of hospital microbial hazards and control measures, studies on the surface-bound bacterial contamination and airborne contamination 11&12are still very limited.  The purposes of this study, therefore, were to examine surfaces as well as airborne contamination by bacteria in special care baby unit, and also determine the antibiotic susceptibility of the bacterial pathogens.    MATERIALS AND METHODSCollection and transport of specimen:Air and surface samples were taken from all the different sections of the special care baby unit in a tertiary hospital facility in Jos.Sampling:The evaluation of bacterial contamination in the special care baby unit (SCBU) was performed using settle plate and swab methods.Settle plate method:Air sampling was performed with settle plate methods. Petri dishes containing blood, nutrient, mac-conkey agar media were transported to the SCBU in sealed polythene bags. The plates were labeled appropriately and placed at least one meter above the ground in the Out-born term and preterm rooms, the In-born term and preterm rooms, Septic treatment room, the neonatal I.C.U as well as the Isolation room of the SCBU. The plates were exposed for 2hours after which they were covered with their lids and taken to the laboratory in sealed polythene bags and incubated at o37 C for 24hours.260Nigerian Journal of Medicine, Vol. 25 No. 3, July - September, 2016, ISSN 1115-2613coli and Klebsiella were susceptible to amoxicillin-clavulanic acid. Pseudomonas was susceptible to gentamicin, ceftriaxone, ciprofloxacine and meropenem.In a prospective study by Qudiesat et al, organisms such as Staphyllococcus aureus, Enterococcus faecalis, Klebsiella spp and Escherichia coli were isolated from 19the neonatal ward of a government hospital .  Since we did not genotype the organisms isolated from the different SCBU areas, we cannot confirm that the isolates from the Out-born term area of the SCBU was the source of the isolates found in the other areas of the SCBU.CONCLUSIONThe special care baby unit requires more attention because of the structural features that favours the dissemination of pathogens in addition to the presence of neonates in the unit with higher risk of acquiring infections. The organization of the space between baby cots and equipments, as well as the application of cleaning protocols for those surfaces according to the specificities of the units are very important. In addition, providing orientation to patient relatives and visitors about hand washing techniques, and regular education of workers may reduce dissemination in the environment and the acquisition of pathogens. 11 & 12and inanimate surfaces that they touch . The results of the bacterial colonies isolated from different areas of special care baby unit (SCBU), showed that the SCBU environment of a hospital is a potential reservoir of bacteria such as Klebsiella spp, Staphyllococcus aureus, Pseudomonas aeruginosa and Escherichia coli 14(E. coli), and this is similar to other studies . Escherichia coli are the most common gram-negative 15bacterium, causing mainly urinary tract infections . Pseudomonas aeruginosa is also very common, especially in causing lower respiratory tract 16infections . Of great significance is the finding that even resuscitaires which are disinfected regularly, were found to be colonized by bacteria. The frequency of bacteria isolated from different areas of the SCBU are varied, but majority of the bacteria were Klebsiella and Staphyllococcus found primarily in the Out-born term area. This logically means that the neonates from peripheral hospital admitted into the Out-born term area may contribute to nosocomial infection in the SCBU. Previous prospective studies have shown that nurses can contaminate their hands with Klebsiella spp 17during “clean activities” . The result also indicates that surfaces in the SCBU may increase the number of nosocomial infections and therefore the length of stay exceeds the average of 15 days, as stated in the guidelines on the management of multidrug resistant 18organisms in health care settings .In this study, all the bacteria isolated, were susceptible to meropenem and ceftriaxone. The Staphyllococcus, E. Table 1: Frequency of bacterial colonies isolated from different areas of the special care baby unit of a tertiary hospitalOBT= out-born term OBP= out-born pretermIBT= in-born term IBP= in-born pretermNICU= neonatal intensive care unit EBTR= exchange blood transfusion roomSTR= septic treatment room IR= isolation room261Nigerian Journal of Medicine, Vol. 25 No. 3, July - September, 2016, ISSN 1115-2613Table 2: Antibiotic susceptibility pattern of bacterial isolated from the special care baby unit of a tertiary hospital.S= SensitiveR= Resistance5. Pessoa-Silva CL, Dharan S, Hugonnet S, et al. Dynamics of bacterial hand contamination during routine neonatal care.Infect Control Hosp Epidemiol 2004; 25:192–1976. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review.BMC Infect Dis 2006; 6:1307. Ortiz, G., Yague, G., Segovia, M. and Catalan, V. (2009). A Study of Air Microbe Levels in Different Areas of a Hospital. Curr. Microbiol. 59: 53–58.8. Moletta-Denat M, Bru-Adan V, Delgenes JP, Hamelin J, Wery N, Godon JJ. Selective m i c r o b i a l  a e r o s o l i z a t i o n  i n  b i o g a s  demonstrated by quantitative PCR. Bioresour Technol 2010;101:7252-7.9. Heidelberg JF, Shahamat M, Levin M, Rahman I, Stelma G, Grim C,  et al.  Effect of aerosolization on culturability and viability of gram-negative bacteria. Appl Environ Microbiol 1997;63:3585-8.10. Obbard, J.P. and Fang, L.S. (2003). Airborne Concentrations of Bacteria in a Hospital Environment in Singapore. Water Air Soil Pollut. 144: 333–341.REFERENCES1. J. M. Boyce. “Environmental contamination makes an important contribution to hospital infection.” Journal of Hospital Infection, vol. 65, no. 2, pp. 50–54, 2007.2. M. Burden, L. Cervantes, D. Weed, A. Keniston, C. S. Pr ice, and R. K . Albert. “Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8-hour workday: a randomized controlled trial.” Journal of Hospital Medicine,vol. 6, no.4,pp. 177–182, 2011.3. J. M. Boyce and D. Pittet, “Guideline for h and h y g i e n e  i n  h e a l t h - c a r e  s e t t i n g s :  recommendations of the Healthcare Infection Control Practices Advisor y Committee and the HIC-PAC/SHEA/API C/IDSA Hand Hygiene Task Force,” Infect ion Control and Hospital Epidemiology, vol. 23, no. 8 , supplement 12, pp. S1–S46, 2002.4. S. M. Smith, R. H. K. Eng , and F. T. Padberg Jr., “Survival of nosocomial pathogenic bacteria at ambient temperature,”Journal of Medicine , vol. 27, no. 5-6, pp. 293–302, 1996.26211. Sudharsanam, S., Srikanth, P., Sheela, M. and Steinberg, R. (2008). Study of the Indoor Air Quality in Hospitals in Chennai, India - Microbial Profile. Indoor Built Environ. 17: 435–441.12. Mahieu, L.M., De Dooy, J.J., Van Laer, F.A., Jansens, H. and Leven, M.M. (2000). A Prospective Study on Factors Influencing Aspergillus Spore Load in the Air during Renovation Works in a Neonatal Intensive Care Unit. J. Hosp. Infect. 45: 191–197.13. Clinical and Laboratory Standards Institute, 2010 Performance Standard for antimicrobial susceptibility testing. Disc diffusion. Twentieth supplemental testing. Document M100-S20, CLSI,Wayne, PA (2010).14. Li JT, Li Y, Wang J. [Surveillance on gram-positive bacteria isolated from patients with hospital acquired infections or community acquired infections]. Zhonghua Yi Xue Za Zhi. 2003;83(5):365-7415. Kim JM, Park ES, Jeong JS, Kim KM, Oh HS, Yoon SW, et al. Multi-center surveillance study for nosocomial infections in major hospitals in Korea. Nosocomial Infection Surveillance Commit-tee of the Korean Society for Nosocomial Infection Control. Am J Infect Control. 2000;28(6):454-8.16. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med. 1999;27(5):887-92.17. Casewell M, Phillips I. Hands as route of transmission for Klebsiella species. Br Med J. 1977;2(6098):1315-7.18. Sehulster LM. Prion inactivation and medical instrument re-processing: challenges facing healthcare facilities. Infect Control Hosp Epidemiol. 2004;25(4):276-9.19. Qudiesat, K., Abu-Elteen, K., Elkarmi, A., Hamad, M. and Abussaud, M. (2009). Assessment of Airborne Pathogens in Healthcare Settings. Afr. J. Microbiol. Res. 3: 66–76.263Nigerian Journal of Medicine, Vol. 25 No. 3, July - September, 2016, ISSN 1115-2613

Bacterial contamination in a special care baby unit of a tertiary hospital in Jos, Nigeria

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Bacterial contamination in a special care baby unit of a tertiary hospital in Jos, Nigeria

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