Thursday, January 10, 2019

Cylinders, stethoscopes, yoga mats, aprons, notes, coins, prescription papers, curtains etc. all sources of healthcare-associated infections: Universal precautions needed




Oxygen cylinders act as a fomite for methicillin-resistant Staphylococcus aureus (MRSA), according to a new study in the Emergency Medicine Journal, December 1.

In the study, researchers tested the surface of nine oxygen cylinders and regulators located in ambulances at an emergency medical services (EMS) station in North Alabama, USA. Seventy offsite oxygen cylinders were also tested.

Of nine oxygen cylinders tested in the ambulances, nine had MRSA colonisation (100%). MRSA was also present on 67 of 70 oxygen cylinders (96%) tested at the offsite oxygen cylinder storage area.

Last year, a study reported in the September 2018 issue of American Journal of Infection Control found that patient privacy curtains surrounding patient beds in hospitals become progressively contaminated with bacteria, including MRSA. The increased MRSA positivity was observed between 10 and 14 days after being hung. By the 14th day, seven (87.5%) of the eight test curtains were positive for MRSA. This was the time to either change or clean the curtains, suggested the study.

A new study published online Dec. 12, 2018 in the Infection Control & Hospital Epidemiology reported stethoscopes as carriers of infection. On a set of 40 stethoscopes in use in an ICU, all 40 had a high abundance of Staphylococcus bacteria, with "definitive" S. aureus bacteria present on 24 of 40 stethoscopes tested.

The BMJ reported in 2015 that white coats worn by doctors harbor potential contaminants and contribute considerably to the burden of disease acquired in hospital by spreading infection

Research has also shown an association of yoga mats with fungal, bacterial and viral infections.

Equipment handles, clothes, carpets etc. are a source of bacteria. Computers, telephones, telephone mouthpieces, headsets, desks, ATMs, cash machines, elevator buttons have also been reported as potential sources for transmitting infectious microorganisms (Int J Environ Res Public Health. 2014;11(12):12544-61).

Notes and coins are also a source of infection. Banknotes recovered from hospitals may be highly contaminated by Staphylococcus aureus, while, Salmonella, Escherichia coli and S. aureus are commonly isolated from banknotes from food outlets. Influenza virus, Norovirus, Rhinovirus, hepatitis A virus and Rotavirus can be transmitted through hand contact (Future Microbiol. 2014;9(2):249-61).

This new study only adds to the growing list of evidences that for all practical purposes, everything used in healthcare can be considered to be contaminated and as a potential source of cross-contamination in hospitals.

While hand to hand transmission of microbes remains an important route of spread of infection, these studies highlight the role of contaminated environmental surfaces in the transmission of healthcare-associated infections.
  
Universal precautions needs to be taken. Every surface in healthcare settings needs to be taken as infected unless proved otherwise.  One should also not forget section 269 IPC act "Negligent act likely to spread infection of disease danger­ous to life.—Whoever unlawfully or negligently does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both."

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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