జర్నల్ ఆఫ్ ప్రివెన్షన్ అండ్ ఇన్ఫెక్షన్ కంట్రోల్ అందరికి ప్రవేశం

నైరూప్య

Infection Control Transmission at Mary Johnston Hospital: A descriptive randomized sampling of Medical Chart Cases as a potential carriers of hospital acquired infection, Isolation and identification of opportunistic and pathogenic organisms from different hospital ward units and a randomized controlled triple-blind trial of identifying a readily available and cost effective disinfecting agent for infection control

James Belgira Tamayo*, Ronald Allan Payumo  

Background: Health care associated infection (HAI) is a vital and a critical concern for clinicians, hospitalists, infectious control committee (IFC) and healthcare institutions in the Philippines. In a cross sectional prevalence study conducted by Godfera et al. In tertiary care hospitals of 224 patients surveyed 28% had HAI. Immune compromised patients, pediatrics, elderly and post op patients are at risk for acquiring HAI. Patient’s medical chart cases in hospitals are potentially contaminated by pathogenic bacteria and might serve as reservoirs and vehicles for transmission of nosocomial infections.

Objective: To microbiologically analyze and identify the presence of bacterial con- termination in hospital chart cases and compare the distribution of contributory pathogenic species from different ward and special units of Mary Johnston Hospital. This study was also conducted to determine a readily available and cost effective disinfecting agent that can be recommended to the Infection Control Committee (ICC), hospitals and other allied healthcare facilities to reduce the risk of Hospital Acquired infections contamination from chart cases surface to hands of Health care workers (HCW) to patient contact.

Methodology: Descriptive, randomized sampling randomized controlled triple-blind trial. Sample composed medical chart cases in direct contact with doctors, nurses and allied health care workers. Data were collected and analyzed using the SPSS statistical software package (Version 16.0, SPSS Inc, and Chicago, IL, USA). The statistics used in this study will included descriptive statistics, the chi-square (X²) test, the Fisher’s exact test (for expected numbers <5) and the t test to compare differences in the characteristics and the results of identified and isolated bacteria retrieved from medical chart cases and effectively of disinfecting agent used against them.

Results: For general wards and special units, the overall sampling rates were 71.4 % (50/70) medical chart cases of currently active hospital beds out of 120 bed capacity of Mary Johnston Hospital. The randomized chart cases were comprised of 27% (10/37) Pedia, 33% (8/24) Obgyn, 31% (7/22) Medicine, 21% (5/21) Surgery, 100% (4/4) Covid 19 Clean ER, 100% (6/6) Covid 19 tent ER, 71% (10/14) Covid Ward. 100% Isolation and 11 bacteria were identified from culture positive chart cases, 45% were gram negative and 55% were gram positive.

Most common bacteria isolated was Bacillus spp. 78% followed by Coagulase- negative Staphylococcus aureus 24%, Acinetobacter spp. 18%, Pseudomonas aeruginosa 16%, Diptheroids spp. 12%, Enterococcus 8%, Stenotrophomonas spp. 6%, Staphylococcus aureus 4%, Morganella morganii 4%, Regression analysis revealed the incidence of contamination and risk of contact transmission was 2 to 4 fold high on active units such as the Covid Tent ER and Pedia Ward. Burkoholderia spp. 2% and Streptococcus spp. 2% which were only found on Pedia Ward. Hospital acquired infection (HAI) on post op patients at surgery ward are low risk.

Zonrox Bleach Original was able to kill most of the identified isolated bacteria with a high disinfecting percentage of almost 100% to all species, followed by Green Cross 70% ethyl alcohol that has shown to kill a wide range of isolated organisms 72% (8/11) but not adequate enough to eradicate some of the isolated Bacillus spp. and Coagulase-negative Staphylococcus aureus. Lysol is effective against Pseudomonas aeruginosa, Acinetobacter species, Coagulase-negative Staphylococcus aureus and Diptheroids species but not Bacillus spp, while Domex Ultra Bleach is effective against Coagulase-negative Staphylococci and Stenotrophomonas but not against Pseudomonas aeruginosa, Bacillus spp. and Acinetobacter spp

Conclusion: Fomites, such as medical chart cases can serve as a reservoir for opportunistic and pathogenic bacteria than can predispose healthcare workers to become a vector in causing hospital acquired infections (HAI) to patients through close contact. Cross transmission is possible acquiring bacterial contamination through our hands by touching medical chart cases during our shifts and hospital staffs during their tour of duty. Most of the time medical chart cases regardless of the ward or unit they belong should always be considered to be harboring opportunistic infection that can cause HAI, disinfection and sanitation of medical equipment and work surfaces is highly advised as frequent as possible and during every shifts. Zonrox Bleach is effective against wide array of gram (+), gram (-) bacteria and pathogenic species that can highly contribute to Hospital acquired infections. It has shown 100 percentages no growth on culture and high bactericidal activity with an 84% disinfection rate. Green Cross 70% Ethyl alcohol though is not the recommended alcohol content for disinfection (80% -90% as recommended on journals and CDC guidelines) still showed to have a high bactericidal activity with an 80% disinfection rate.