الفهرس 
TitleOnly 14 pages are availabe for public view
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Abstract
The intensive care unit (ICU) is intended for the treatment of patients suffering from failure of one or more major vital organ systems. Many sophisticated and complex techniques have been developed for monitoring and support of body systems as respiratory and cardiocirculatory functions. Unfortunately, the success of these techniques is frequently defeated by the devastating occurrence of infections.
Hospital acquired infections have become especially prominent in ICUs; the
incidence is two to five times greater than in the general inpatient population. The causes of the increased risk in ICUs have been reported to include the growing complexity of ICUs, the impaired host defenses of patients, invasive procedures, exposure to multiple
antibiotics and colonization by resistant microorganisms. Environmental contamination poses an even greater challenge in the ICU, where patients are critically ill, with several risk factors. Ineffective cleaning procedures and infection control measures may be responsible for contamination of different equipment items and objects in the ICU environment.
The aim of this work was to assess cleaning and disinfection practices through measuring of the environmental surfaces and air BB in ICUs.
In this study, we evaluated bacterial contamination of 16 environmental inanimate surfaces and air in 2 ICUs of 2 hospitals in Alexandria governorate; A & B.
During 20 visits the following sampling methods were used:
a) RODAC plate method was used to sample 8 regular surfaces (commode, bed head, near patient devices, ventilator, curtains, counter, storage area and wheel chair) then the resultant aerobic colony count (ACC) was recorded and analyzed.
b) Wet swab method was used to sample 8 irregular surfaces(commode grasp, drip stand, bed rail, ventilator, trolley, suction jar wheel chair pushing handle and sink{hand tap}), cultured on blood and Macconkey agar then the isolated bacteria were identified by standard bacteriological procedures (microscopy and biochemical tests).
c) Settle plate method was used for assessment of air bacterial bioburden (BB).
This study revealed the following:
I Using RODAC plates:
1) No bacterial growth was detected in 10% (16) &13.8% (22) of the samples collected from the two ICUs A & B respectively that is to say 90% & 87.3% of samples collected yielded bacterial growth.
2) In both ICUs the most common isolated organisms were Bacillus spp., CoNS and S. aureus, the indicator organism (S. aureus) was isolated (≥1 CFU/cm2) from all touch sites except bed head in ICU B.
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3) Out of the 320 RODAC (160 from each ICU), ACC was > 2.5 CFU/cm2 in ventilator, curtains and wheel chair in addition to bed head in A and commode and near patient devices in B accounting for 5.6% (18 times {7,11 in A&B respectively}), in 55.6%(n=10) of them the indicator organisms was also recovered.
4) The wheel chair had the highest mean BB (43.7 and 65.6 CFU/plate), followed by ventilator touch sites (27.8 and 38.85 CFU/plate), then the commode (23.6 and 36.2 CFU/plate) in ICU A and B respectively. The bed head in ICU B and the counter in ICU A had the least mean BB (10.75, 10.9 CFU/plate) respectively. No statistically significant difference was found neither between BB of different touch sites and BB of the clinical and non-clinical areas in both ICUs p-values (<0.05) nor between BB of clinical area and non-clinical area within the same ICU (p-values 0.291&0.223 respectively).
5) The mean total BB of ICU B was higher than that of ICU A (297.80 and 270.5 CFU/plate, respectively) but this was not statistically significant (P=0.570). Additionally the percentage of reduction in total BB at sampled sites from baseline was higher in ICU B than that of ICU A (57.8 % &16.6% respectively).
II Using wet swabs:
1) Out of 160 samples in each ICU 70% (112) & 67.5 % (108) yielded bacterial growth in ICUs A & B respectively and the CoNS was the most frequently isolated bacteria from both ICUs {69.6% (78) & 83% (90) respectively.}
2) The indicator organism (MRSA, MSSA) and pathogenic Gram negative bacilli (Psuedomonas spp., Klebsiella spp., Acinetobacter spp.) were isolated from different sites.
3) The frequency of isolation of S. aureus was higher in ICU A (26 samples) than ICU B (10 samples). S. aureus was isolated from both clinical (commode, drip stand, bed rail and ventilator) and non-clinical areas (wheel chair pushing handle and sink{hand tap}) however, the difference in the frequency of isolation was only significant for bed rail (p=0.020).
4) Gram negative bacteria were more isolated from wet clinical and non-clinical areas (suction jar and sink {hand tap}) in both ICUs. In ICU A, 50% of Gram negative bacteria isolated were Pseudomonas spp. (6 times either alone or mixed) then Klebsiella spp. (33%) 4 times either alone or mixed and Acinetobacter (16.5%) 2 times either alone or mixed with Gram negative spp.), while in ICU B 37.5% of the Gram negative bacteria isolated were Pseudomonas spp. 3 times (either alone or mixed) and 62.5% were Klebsiella spp. (5 times either alone or mixed with Gram negative spp.)
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III Using both surface sampling methods:
MRSA/MSSA were isolated from regular and irregular of 4 sites (bed, commode, ventilator and chair) in both ICUs except the bed in ICU B while Gram negative bacilli (Pseudomonas ssp.) was isolated only from commode in ICU B.
IV Using settle plates for detection of air BB:
1) Out of the 20 air samples, 85% (18) &80% (16) yielded bacterial growth in ICUs A & B respectively. The air contaminants were only Gram positive (CoNS, Bacillus spp., S. aureus). S. aureus was isolated twice in ICU A but 4 times in B. Air BB ranged from (0.0 – 616.79 & 0.0 – 602.11 CFU/m3) with a mean (190.91&267.28 CFU/m3) in ICU A&B respectively. No statistically significant difference was found in air BB of the 2 ICU (P-value <0.335).
2) Using Spearman’s correlation to determine the relationship between surface and air BB, there was a weak positive monotonic correlation in A (rs = 0.237, P=0.314) while no correlation in B.