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Abstract
Infection is one of the principal hazards to which patients in critical care centers are exposed. In addition to being more susceptible, they are exposed to great hazards of contamination and cross infection than most patients in ordinary wards. This is due to they receive much more nursing attention, handling and various forms of instrumentations in particular tracheostomy, mechanical ventilation, aspiration of bronchial secretion, catheterization of urinary tract, treatment of open wounds and prolonged intravenous infusion.
The commonest microorganisms causing disease in critical care units are gram negative bacilli and staphyylococci. Gram negative bacilli encountered in critical care units include : Enterobactericae (E-
f)
coli, klebsiella spp., proteus spp., enterobacter spp., and serratia spp.),
pseudomonas aeruginosa, hemophilus influenza and bacteroids fragilis. These organisms are known as opportunistic pathogens, they are normally harmless commensals, but they are able to multiply in tissues and cause diseases in immunocompromized patients.
The aim of this study is to put a strategy for infection control in the ICU in Benha University Hospital.
This study comprised collection of microbiological samples from environment, patients and working staff in intensive care unit in Benha University hospital.
.a.179.
Summar
The environmental samples include:
- 20 samples from air.
-20 samples from ventilator.
- 20 samples from air condition grill.
- 20 samples from laryngoscope.
-20 samples from beds. Workers samples : - 50 hand samples. - 50 nasal samples.
The patients samples include: - 50 nasal samples.
- 50 rectal samples.
All specimens were subjected to the following:
1.Isolation of the organisms by culturing on ordin bacteriological media (blood, chocolate and MacConkey agar and incubating aerobically at 37°C for 48 hours.
2.Gram stained smear for the isolated pathogen.
3.Biochemical reaction of the isolates.
4.Antimicrobial susceptibility test for the isolated pathogen.
5.The identified isolates were tested for the action o disinfectants by
.
microtitration method. u„,I for r 1 , 2e) \Iv k
a 180.a
Summa
Identification of gram negative bacilli was done as follow: Biochemical identification:
a)Oxidase test.
b)API 20 E.
Anti microbial susceptibility testing.
By conventional disc diffusion methods on Muller Hinton agar for detection of (ESBL).
Identification of Gram positive cocci was done as follow:
- Biochemical identification
a-Catalase test: to differentiate staplylococci (+ve) from streptococci (-ve).
b-Coagulase test : to identify staph aureus.
c-Dnase test : to identify staph aureus.
d-API staph.
- Antimicrobial susceptibility testing :
Conventional disc diffusion method on Muller Hinton agar for
detection of MRSA.
In this study, the results obtained from the air sampling, by the two methods, show the evidence of contamination of air.
In this study, samples were taken from laryngoscope, ventillators and air condition samples; the cidex, clorox, hydrocil, alkanol and Mada-
a.. 1814,
Summaq
cide I were effective on inhibition of growth of microorganisms, while polyseptol was not effective.
In Bed samples, all used disinfectants we e effective on the inhibition of growth of microorganisms.
In Staphylococci, cidex was the most poten 1/16, followed by clorox mada-cide 1 ’A, ployseptol ’A and lastly hydro it and alkanol I.
The most potent disinfectant working agai st gram-negative bacilli were cidex and clorox 1/8, followed by alkanol and mada-cide 1
hydrocil ’A and then polyseptol 1.
The most potent disinfectants working alga’ st candida were cidex and clorox 1/16 followed by alkalnol and h drocil 1/8, mada-cide 1 ’A and lastly polyseptol ’A.
In our study the effect of different disinfectant of mycobacterium tuberculosis were cidex ) wasK
Oa% - -11^14 /14 -one- while polysept
math not inhibit the growth of mycobacterium
-gross+.
In the present study, the commonest isolate froi was S.epidermidis (40%) followed by S.aurus (24%) (20%) and S.haemolyticus (16%).
ainst the growth ’ most effective
H
1 is-weakest-ene
re -(+004)
workers hands S.saprophyticus
ap 182.4~
Summar
In this study the percentage of MRSA from workers hands was 8.3 % of isolated S.aureus.
In this study the frequency of bacteria isolated from workers nose were 50% S.aureus and 50% S.epidermidis.
5
Out of this group of MRSA isolated from (40%) of s. aureus so isolation measures must be taken towards this group of workers.
In the present the isolated microorganisms from nasal samples of patients were (66%) gram-positive cocci, (40%) of them was S.aureus and 34% were gram-negative bacilli.
In this study, the percentage of MRSA in isolated S.aureus from nasal swabs from patients was (80%), 100% of MRSA were sensitive to vancomycin.
In this work, the most common isolate of rectal swabs from patients was E-coli.
In this work imipenem followed by aminoglycoside were the most effective antibiotic for gram-negative bacilli isolated from rectal swabs of patients.
gate, large number of gram-negative isolates from reval swab
W 6 0 ’’/
in our study were suspectedr confirmed ESBL producers, 6636 of
QV (82.,9•A) 3 907. 3 ’I ° bie
k.ornitholyticus, 68% of E-co 1, 4)% of K.oxytoca, 50% of P.mirabilis
2 e’ V. and 255% of C. koseri.