ISSN 1115-7976 X-RAY Contents lists vilble t Journl of Assocition of Rdiogrphers of Nigeri Journl homepge: www.jrn-xry.org Vol. 26 X-ry Equipments nd Accessories s possible Vectors of Nosocomil Bcteri in Anmbr Stte, Nigeri. JC Eze 1, EU Ekpo 2 CC Nzott 1, NC Asogw 1 NO Egbe* 2 1 Deprtment of Rdiogrphy/Rdiologicl Science, Nnmdi Azikiwe University, Nnewi cmpus. 2 Deprtment of Rdiogrphy & Rdiologicl Sciences, University of Clbr, Clbr. *Correspondence to: nneoyiegbe@unicl.edu.ng ARTICLE INFO Article history Received July 26, 2012; Revised August 30, 2012; Accepted September 6, 2012; Avilble online, 2012 Keywords: Nosocomil, Bcteri, infection, X-ry equipment, Culture ABSTRACT Bckground of Study: Nosocomil infections hve become mjor chllenge in helth institutions, s they ffect the qulity of helth cre delivered. The rdiology deprtment is one of the minstys of modern medicine. It is therefore necessry to ssess its role in the spred of nosocomil infections. Aim: To ssess the presence nd specie of nosocomil bcteri on x-ry equipments nd ccessories s well s their prevlence in public nd privte hospitls in Anmbr stte. Method: Sterile swb sticks were used dily to swb the surfces of selected x-ry equipments nd ccessories, t the close of work in public nd privte hospitls in Anmbr Stte. McConkey nd Blood gr medi were used to prepre the culture medi. The prepred medi were put in petri dishes nd swb smples were inoculted onto the culture pltes. Culture pltes were then incubted for 24 hours, t temperture of 37 o c. Bcteril identifiction ws done microscopiclly under bright light bsed on their colonil chrcteristics. Results: Bcteri were isolted in 43/50 (86%) smples collected. Bcteri isolted were; Stphylococcus ureus (36.1%), Pseudomons eruginos (22.7%), Proteus spp (7. 2%), Streptococcus (13. 4%), nd Coliform spp. (20.6%). X -ry cssettes hd the highest bcteril lod followed by X-ry tube hndles nd couch. Conclusion: Rdiology equipment nd ccessories in Anmbr Stte hve high bcteril lod nd therefore re potentil sources of nosocomil infection. copyright@2012 jrn-xry
INTRODUCTION Nosocomil infections re those cquired in the hospitl by ptient who ws dmitted for reson other thn tht infection 1. It my lso be seen s n infection occurring in ptient, in hospitl, or other helth cre fcility; in whom the infection ws not present or incubting t the time of dmission. This includes infections cquired in the hospitl but ppering fter dischrge; nd lso occuptionl infections mong stff of the fcility 2. Nosocomil infections re incresingly becoming of gret concern to helth cre providers nd institutions, s they ffect the qulity of helth cre delivery 3-5. Approximtely bout two million nosocomil infections occur nnully in the United Sttes of Americ 6. This hs resulted in considerble mortlity, morbidity nd cost in the popultion 7-8. A helthcre environment increses the risk of infection for two primry resons. First, it is likely tht normlly sterile body sites will become exposed, llowing pthogens to cuse infections through contct with mucous membrnes, non-intct skin nd internl body res. Secondly, the likelihood of susceptible host is high becuse of the vulnerble helth sttus of ptients. The risk of nosocomil infection is therefore n unvoidble prt of dily ptient cre 9. The rdiology deprtment is considered one of the centrl res for spred of nosocomil infections due to n pprecible number of ptients who visit the deprtment for vrious exmintions 10-13. The orgnisms cusing most nosocomil infections my come from the ptient, contminted instrument nd the environment. In the rdiology deprtment, they re likely to be trnsmitted through contct with stff, equipment nd ccessories during positioning nd hnds on pproch s well s droplet. Some of the infective orgnisms re irborne nd others itrogenic 14-15. Stphylococcus nd coliform colonies hve been observed on x-ry couches nd erect buck, cssettes, nd intensifying screens 11,16. Grm positive bcteri nd fungi hve lso been isolted from ntomicl mrkers 17. Colonies of K. Pneumoni, E. coli, micrococcus species, E. feclis, S. Epidermidis, Stphylococcus species, nd Streptococcus species, Klebsiell spp hve lso been isolted from cssettes, brium preprtion sites, led rubber sheet nd prons, portble trys, 18 wheel chirs nd stretchers -19. Surfces touched by rdiogrphers re lso reported to be infected by Klebsiell spp. 10. Hospitl-cquired infections dd to functionl disbility nd emotionl stress of the ptient nd in some cses, led to disbling conditions tht reduce the qulity of life. Nosocomil infections re lso one of the leding cuses of deth nd their economic costs re considerble 7. To prevent further infections, improve lifestyle nd reduce cost, it is necessry to study possible sources of nosocomil infections in the X-ry deprtment. This study sought to ssess the presence nd specie of nosocomil bcteri on x- ry equipments nd ccessories s well s their prevlence in public nd privte hospitls in Anmbr stte, Nigeri. 19
RESEARCH METHODOLOGY About 50 swb smples were collected from X-ry deprtments of public nd privte hospitls in Anmbr stte of Nigeri (25 Public, 25 privte) fter close of work. Swb smples were collected from hed nd til ends of X- ry couches, middle re of erect bucky nd chest stnds, X-ry tube hed hndles, exposure knobs, top surfce of control consoles, middle re of X-ry cssettes, nd inside surfce of ntomicl mrkers [Figure 1]. Swb smples were lbelled nd sent to microbiology lbortory for culture nd nlysis. Culture medi (McConkey nd Blood gr) were prepred ccording to mnufcturer s instruction. McConkey gr preprtion ws done by putting weighted quntity of gr powder in conicl flsk, dding pproprite quntity of distilled wter nd stirring until homogeneity ws chieved. The conicl flsk ws covered with cotton wool nd put in to the utoclve. It ws then heted for 15 minutes t temperture of 121 0 c to sterilize the medium. The medi ws fterwrd poured into petri dishes fter cooling to 47 0 C. Culture pltes were covered nd llowed to set for inocultion of the smples. A similr procedure ws lso used for blood gr preprtion. Aseptic procedure ws then observed in inocultion of the swb smples. Culture pltes were then incubted for 24 hours t temperture of 37 0 c. The pltes were lter exmined microscopiclly under bright light nd orgnisms identified nd isolted bsed on colonil chrcteristics. Dt ws nlysed using simple frequency distribution. Figure 1 Procedure for dt collection with swbs on cssette (left), exposure button (middle) nd ntomicl mrker (right) 20
Tble 1: Overll Number of Smples Collected nd the Number of Growth Recorded. Smples. Public Hospitls Privte Hospitls Totl (Percentge) Totl Number of 25 smples 25 smples 50 smples (100%) Smples Number of Smples with Growth 24 smples (48%) 19 smples (38%) 43 smples (86%) Number of Smples without Growth 1 smple (2%) 6 smples (12%) smples (14%) RESULTS Results show n 86% (48%, public nd 38%, privte) bcteril growth for ll hospitls studied. About 24/25 (96%) smples hd bcteril growth in public hospitls nd 19/25 (76%) in privte hospitls [Tble1]. Bcteri isolted were Stphylococcus ureus 36.1%, P. eruginos 22.7%, Coliform 20.6%, Streptococcus 13.4% nd Proteus 7.2% [Figure 5]. B c t e r i l l o d Public Hospitls Privte Hospitls. Equipment nd ccessories Figure 2: Distribution of bcteril lods on equipment nd ccessories 21
A higher percentge of P. Aeruginos (68.2%) ws found in public thn privte hospitls (31.8%) while higher percentge of Coliform (55%) ws observed in privte bove tht in public hospitls (45%) [Figure 3]. Bcteril lod ws more on X-ry cssettes followed by the X-ry couch with S. Aureus forming bulk of it. This ws closely followed by P. eruginos nd coliform. No Proteus spp nd P. eruginos were found on the control console [Figure 4]. F r e q u e n c y Public Hospitls Privte Hospitls Bcteril Species isolted Figure 3: Distribution of isolted bcteri species in public nd privte hospitls. 22
B c t e r i l l o d S.ureus P.eruginos Proteus spp. Streptococcus Coliform spp. Bcteril spcies on equipment nd ccessories Figure 4: Distribution of bcteril species lod on the vrious X-ry equipment nd ccessories. DISCUSSION Ptients presenting for rdiologicl exmintion re often ill or require certin X-ry exmintion to exmine their helth sttus. Such ptients my either trnsmit or contrct infections from the rdiology deprtment through contct with rdiologicl equipment nd ccessories, droplets nd irborne routes 14-15. Most ptients contrct these infections becuse their immune system is down 2. Medicl sepsis is therefore required before, during nd fter rdiologicl investigtions. 23
Figure 5: Percentge distribution of bcteril specie in study popultion. Our findings show tht x-ry equipment nd ccessories used in the medicl imging deprtments of hospitls in Anmbr stte hrbour nosocomil pthogens, especilly bcteri [Tble 1]. Stphylococcus ureus, Pseudomons eruginos, Proteus spp., Streptococcus nd Coliform spp. were the common bcteri isolted in our study [Figure 5]. Stphylococcus ureus ws however the most predominnt bcteri (68.2%) in public hospitls nd 36.1% overll nd coliform spp (55%) in privte hospitls [Figure 3]. Fox nd Hrvey 11 reported stph ureus s the most common bcteri isolted from X-ry cssettes, couches, bucky nd stretchers. This is becuse stph ureus re cutneous bcteri tht colonize the skin nd nose nd therefore cn esily be trnsmitted through contct with stff, equipment nd ccessories s well s inhltion by visitors/ptients nd re resistnt to ntibiotics 2. Pseudomons eruginos (22.6%) nd coliform spp (20.6%) were lso found to be the second nd third most prevlent bcteri [Figure 5]. These microorgnisms were isolted more from ll equipment nd ccessories studied except the control console with no growth of P eruginos [Figure 4]. P eruginos is often isolted in wter nd dmp res. They my colonize the digestive trct of hospitlized ptients 2. This my be the reson why there ws no growth of it on the control console which is usully fr from ptients exmined. 24
10, 11, 16 hve Some studies reported the presence of these bcteri on x-ry equipment nd ccessories. Streptococcus (13.4%) nd Proteus spp. (7.2%) were the lest bcteri isolted in our study [Figure 5]. Streptococcus hs been identified s one of the microorgnisms colonizing x-ry cssettes, x-ry tbles, chest bords, Frnklin hed units nd wheel chirs in the imging deprtment 20,21. Proteus spp. were more on the couch nd exposure button. They re usully more effective when the host defences re compromised, nd cn cuse serious infections like; surgicl site infections, bcteremi nd lung infections 2. X-ry cssettes hd the highest bcteril lod in ll hospitls studied [Figure 3]. There re reports 10,13 tht x-ry cssettes re the most frequently contminted ccessories. Surfces touched by rdiogrpher nd ptients such s the X- ry tube hed hndle, exposure button nd control console x-ry couches s well s chest stnds/erect buckies ll recorded bcteril growth [Figure 4]. Microorgnisms re therefore spred by the rdiogrphers ttending to ptients nd ptients presenting for exmintion. Bcteril contmintions of surfces touched by rdiogrphers nd ptients hve lso been reported 10,17. Infections cquired in the helthcre setting rise gret risk for ptients. Therefore mesures to prevent detect, monitor nd protect ptients nd stffs re essentil nd will reduce mortlity, morbidity nd cost resulting from such infections. This is comprehensive nd requires collbortive effort by ll stkeholders in the helth sector. CONCLUSION The X-ry deprtment is source of nosocomil bcteri. All equipment nd ccessories studied recorded significnt mount of bcteril growth. The common species of bcteri contrcted from the rdiology deprtment re Stphylococcus ureus, Psuedomons eruginos, Proteus spp., Streptococcus, nd Coliform spp. X-ry cssettes re the most potent reservoir of bcteri followed by the X-ry couch nd surfces touched by the rdiogrpher. Overll bcteril lod is more in public hospitls thn privte hospitls. Stph ureus lod is higher in public hospitls nd coliform spp in privte hospitls in Anmbr Stte of Nigeri. Observtion of medicl septic technique before, during nd fter rdiogrphic exmintions will help reduce the spred of nosocomil infections. Acknowledgement: We pprecite the co-opertion of ll stff nd personnel of the surveyed hospitls especilly the Rdiogrphers. The Lbortory Scientists who ssisted us in the culture of smples is hereby cknowledged. Thnk you. REFERENCES 1. WHO 2002 Prevention of Hospitlcquired Infections: A prcticl guide. 2nd Ed. World Helth Orgniztion Deprtment of 25
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