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ORIGINAL RESEARCH PAPER PREVALENCE OF MULTIDRUG RESISTANT BUGS

OVER HIGH TOUCH SURFACES AT CRITICAL AREAS IN A TERTIARY CARE
CANCER INSTITUTE

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 ORIGINAL RESEARCH PAPER Volume - 13 | Issue - 07 | July - 2024 | PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

PREVALENCE OF MULTIDRUG RESISTANT BUGS OVER HIGH TOUCH SURFACES

AT CRITICAL AREAS IN A TERTIARY CARE CANCER INSTITUTE

Healthcare
MD, DNB Microbiology, Assistant Professor, Department of Microbiology, Homi
Dr. Ankita Bhabha Cancer Hospital & Mahamana Pandit Madan Mohan Malviya Cancer Centre,
Chaurasia Varanasi , Uttar Pradesh.
MD, DNB Microbiology, Associate Professor, Department of Microbiology, Homi
Dr. Sujit Bharti Bhabha Cancer Hospital & Mahamana Pandit Madan Mohan Malviya Cancer Centre,
Varanasi , Uttar Pradesh.
PhD in Nursing, FACEN Assistant Nursing, Superintendent Department of Nursing,
Dr Rajni Sharma Homi Bhabha Cancer Hospital & Mahamana Pandit Madan Mohan Malviya Cancer
Centre, Varanasi, Uttar Pradesh.
MD, DNB Microbiology, Associate Professor, Department of Microbiology, Homi
Dr. Rahul Sarode* Bhabha Cancer Hospital & Mahamana Pandit Madan Mohan Malviya Cancer Centre,
Varanasi, Uttar Pradesh. *Corresponding Author
M.Sc. Microbiology, Scientic Assistant B, Department of Microbiology, Homi Bhabha
Ranjeet Singh Cancer Hospital & Mahamana Pandit Madan Mohan Malviya Cancer Centre, Varanasi,
Uttar Pradesh.
Nurse (A), ICN, B.Sc Nursing, MBA (Hospital Administration), Department of Nursing,
Avinash Kumar Homi Bhabha Cancer Hospital & Mahamana Pandit Madan Mohan Malviya Cancer
Sharma Centre, Varanasi, Uttar Pradesh.
MD, DNB Microbiology, Associate Professor, Department of Microbiology, Homi
Dr. Vijeta Bajpai Bhabha Cancer Hospital & Mahamana Pandit Madan Mohan Malviya Cancer Centre
Varanasi, Uttar Pradesh.
MD, DNB Microbiology, Assistant Professor, Department of Microbiology, Homi
Dr. Anwita Mishra Bhabha Cancer Hospital& Mahamana Pandit Madan Mohan Malviya Cancer Centre,
Varanasi, Uttar Pradesh.
ABSTRACT
Background: Hospital acquired infections (HAIs) is the most common cause of morbidity and mortality among hospitalised patients. Inanimate
hospital objects are the main exogenous source for HAIs. Methodology: This is a prospective study conducted in a tertiary care hospital for 6
months. The study was conducted in the intensive care unit (ICU), Hematolymphoid (HL) ward and paediatric ward. The high touch surface areas
were identied and their surveillance swabs were collected. In the Microbiology laboratory these collected surveillance samples were processed on
Blood agar plate for culture identication by aerobic culture method and Gram positive and Gram-negative organisms were further evaluated.
Results: In this study a total of 519 samples were collected from various high touch surface areas in ICU, HL ward and Paediatric ward. Among
these 23.89% (n=124) were culture positive. In this study high bacterial growth was from Paediatric ward 9.25% (n=48), followed by ICU 7.71%
(n=40) and HL ward 6.93% (n=36). Coagulase negative staphylococcus (CONS) were most commonly isolated from all 3 locations followed by
Pseudomonas species and Acinetobacter species. Among the total MDR organisms 26.61% (33/124), the common site contaminated with MDR
organisms were bed railings 21.21% (7/33) followed by door handles 9.0% (3/33). Conclusion: Environmental surveillance allows for the early
detection of pathogens, including MDROs, on high-touch surfaces. Identifying contamination promptly enables healthcare facilities to implement
targeted interventions to prevent the spread of pathogens and reduce the risk of HAIs.
KEYWORDS

INTRODUCTION surfaces is required on a daily basis to minimise spread of these

Hospital acquired infections (HAIs) is the most common cause of infections (8).
morbidity and mortality among hospitalised patients, contributing to
MATERIALS AND METHODS
prolonged hospital stays and increasing healthcare costs (1,2).
This is a prospective study conducted in a tertiary care hospital for 6
Inanimate hospital objects are the main exogenous source for HAIs months. The study was conducted in the intensive care unit (ICU),
(3). Most common sources to contaminate inanimate objects and hematolymphoid (HL) ward and paediatric ward. The high touch surface
patients' surroundings is the patient's own microbiota and hands of areas were identied and their surveillance swabs were collected. Cotton
health care workers (HCWs) (4). Environment contains dust particles, swabs were used for collection of samples. They were soaked in normal
which serves as a medium for transporting of microbes and plays an saline and rubbed over the surface and then placed in sterile culture
important role in transmission of threatening organisms like tubes. In the Microbiology laboratory these collected surveillance
antimicrobial resistant organisms like Methicillin resistant samples were processed on Blood agar plate for culture identication by
Staphylococcus aureus (MRSA), Vancomycin resistant enterococci aerobic culture method and Gram positive and Gram-negative organisms
(VRE), Carbapenem resistant organisms (CROs), Clostridium difcile were further evaluated for Methicillin resistance and Multi – Drug
etc., also prolonged patients harbouring multidrug resistant organisms Resistance (MDR) respectively. MDR status of Gram-negative
(MDROs) (5) (6). Presence of such organisms on high touch areas like organisms were evaluated on the basis of susceptibility patterns of the
patient's bedside, bed railings, ventilator monitor, bedside table, bacterial strain towards Piperacillin-Tazobactum, Ceftazidime,
Healthcare associated equipment and on patients leads to transmission Imipenem, Amikacin and Cotrimoxazole. Antibiotic susceptibility
of MDROs from one patient to another if proper hand hygiene is not testing was performed by Kirby Bauer Disk Diffusion Method and its
followed (7). MDROs presence on high touch surface areas serve as results were interpreted according to the Clinical Laboratory Standards
potential sources for HAIs hence cleaning and disinfection of these Institute (CLSI) 2021 criteria (9).
International Journal of Scientific Research 71
Volume - 13 | Issue - 07 | July - 2024 PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr

Statistical Analysis was done using SPSS software. To compare all the Bed Railings showed maximum growth in all three areas followed by
organisms between high touch surface areas of ICU, HL ward, and door handles and cardiac tables. Coagulase negative staphylococcus
paediatric ward Chi-square goodness of t test was performed. (CONS) were most commonly isolated from all 3 locations followed
by Pseudomonas species and Acinetobacter species as shown in Table
RESULTS 1. Among the bacterial isolates, maximum MDROs were isolated from
In this study a total of 519 samples were collected from various high ICU (n=12) and Paediatric ward (n=12) followed by HL ward (n=9).
touch surface areas in ICU, HL ward and Paediatric ward. Among these
23.89% (n=124) were culture positive. In this study high bacterial Overall most common Gram positive MDR bug was MRCONS
growth was from Paediatric ward 9.25% (n=48), followed by ICU 75.76% (25/33) and Gram negative MDR bug was Klebsiella
7.71% (n=40) and HL ward 6.93% (n=36). Distribution of various pneumoniae 9.10% (03/33) followed by P. aeruginosa 6.10% (02/33).
organisms isolated from different locations and sites is shown in Table Among the total MDR organisms 26.61% (33/124), the common site
1 and 2. The most common site with bacterial contamination was bed contaminated with MDR organisms were bed railings 21.21% (7/33)
railings 23.39% (29/124) followed by door handles 13.71% (17/124) . followed by door handles 9.0% (3/33).
Table 1: Organisms Isolated From High Touch Surface Areas Of ICU, HL Ward And Paediatric Ward.
Organism ICU n=40 HL WARD n=36 Pediatrics Ward n=48 p-value
CONS 29 (72.5%) 24 (66.67%) 30 (62.5%) 0.688
Enterococcus species 01(2.5%) - - -
Pseudomonas species 04 (10%) 01 (2.78%) 04 (8.33%) 0.368
Acinetobacter species 01(2.5%) 02 (5.55%) 05 (10.43%) 0.197
Klebsiella pneumoniae 01 (2.5%) 01 (2.78%) 03 (6.25%) 0.449
Citrobacter species - 01 (2.78%) - -
Escherichia coli - - 01(2.08%) -
Stenotrophomonas species - 01(2.08%) -
GPB 04 (10%) 07 (19.44%) 04 (8.33%) 0.549
GPB Gram positive bacilli
Table 2: Growth Distribution Of Different Sites In ICU And Ward
Site ICU n=40 HL WARD n=36 Pediatrics Ward n=48 p-value
Bedside Railings 14 (35%) 07(19.44%) 08 (16.67%) 0.227
Injection trolley 06(15%) 06 (16.67%) 01 (2.08%) 0.146
Bed Remote 04(10%) - - -
Water tap handle 04(10%) 03 (8.33%) 06 (12.5%) 0.584
Door Handle 03(7.50%) 07 (19.44%) 07 (14.59%) 0.390
Cardiac Table 02(5%) 03 (8.33%) 08 (16.67%) 0.092
Nursing Station 02(5%) 01 (2.78%) 04 (8.33%) 0.368
Telephone 02(5%) 01 (2.78%) 01 (2.08%) 0.779
Cardiac Monitor 01(2.5%) 04 (11.11%) 03 (6.25%) 0.417
IV set 01(2.5%) 01 (2.78%) 05 (10.42%) 0.102
Mobile 01(2.5%) - 04 (8.33%) 0.179
Hands - 02 (5.56%) - -
Gown - 01 (2.78%) - -
Infusion Pump - - 01 (2.08%) -
DISCUSSION infection control practices. Some of the most frequently encountered
In this study a total of 519 swabs were collected among these 23.89% MDROs on high-touch surfaces in hospitals include MRSA, VRE,
(n=124) were culture positive which is similar to studies by 23.4% ESBL, CRE and Acinetobacter baumannii. In this study we
Yadav et al (10) to 45.8% Meenakshi et al (11). Diversity in hand encountered MRCONS followed by Carbapenem resistant Klebsiella
hygiene practices, cleaning protocols , its frequency, type of pneumoniae and Pseudomonas aeruginosa. MDROs on high-touch
disinfectants used and patient load may be the reason for such varied surfaces can serve as reservoirs for transmission to patients, healthcare
ndings. workers, and visitors. This increases the risk of healthcare-associated
infections (HAIs) and contributes to the spread of antimicrobial
The present study showed maximum growth of Gram positive resistance within healthcare facilities. Also, MDRO-related infections
bacteria 79.84% (99/124) as compared to Gram negative bacteria can result in longer hospital stays, additional treatments, and increased
20.16% (25/124). The predominance of Gram positive bacteria in healthcare costs. Contamination of high-touch surfaces by MDROs
high touch surface areas were also seen in studies by Getachew et al may contribute to the economic burden associated with HAIs. The
(81.6%) (12), Endalafer et al (56.3%) (13), Darge et al (68.4%) (14) study had limitations regarding sample size due to the short duration of
the study period.
Tajedin et al (60.7%) (15) and Maryam et al (52.2%) (16). Gram-
positive bacteria generally have a higher resistance to drying out CONCLUSION
(desiccation) compared to gram-negative bacteria. This enables them Environmental surveillance in hospitals is a comprehensive approach
to persist on dry surfaces for extended periods, making them more that involves regular inspections, testing, and analysis of various
likely to be found on high-touch surfaces in hospitals. environmental factors. It helps identify potential risks or hazards and
allows for timely interventions to maintain a safe and healthy
CoNS are the most common nosocomial pathogens and account for healthcare environment. Environmental surveillance allows for the
hospital acquired infections (17). Our study also shows CoNS early detection of pathogens, including MDROs, on high-touch
(66.94%) as the most common organism isolated from high touch surfaces. Identifying contamination promptly enables healthcare
surface areas , similar ndings were seen in study by Maphossa et al facilities to implement targeted interventions to prevent the spread of
(18) and Firesbhat et al (19). In our study bed side railings and door pathogens and reduce the risk of HAIs. Surveillance data on high-
handles were the most common site contaminated with bacteria. These touch surfaces can inform risk assessments and prioritisation of
are frequently touched by patients, visitors, and healthcare workers, infection control efforts. By identifying surfaces that are consistently
increasing the likelihood of transferring bacteria from person to contaminated or associated with higher transmission risks, healthcare
surface and vice versa. Also these sites may receive less frequent facilities can allocate resources more effectively to target interventions
cleaning compared to other surfaces in the hospital environment due to where they are most needed.
the focus on more visibly soiled areas, this allows bacteria to
accumulate and persist on these surfaces. The most common MDROs Limitation Of Study
found on high-touch surfaces in hospital settings can vary depending The selection of sampling locations within an environment can
on factors such as geographic location, patient population, and introduce bias, as certain areas may be more likely to harbour
72 International Journal of Scientific Research
Volume - 13 | Issue - 07 | July - 2024 PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr

pathogens than others. Environmental swab studies provide a snapshot

of pathogen presence at a specic point in time, but they may not
capture temporal variations or trends. Changes in environmental
conditions, cleaning protocols, or human behaviour can inuence
pathogen levels over time, and these factors may not be adequately
captured over a limited period of duration.

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