Microbial contamination of disinfectants and antiseptics in four major hospitals in Trinidad

Objective. To assess the microbial contamination of disinfectants and antiseptics in major hospitals on the Caribbean island of Trinidad. Methods. For this cross-sectional study, disinfectants and antiseptics were sampled from the pharmacy departments, the pediatric/neonatal wards, and the surgical wards of four hospitals. The samples were cultured for aerobic bacteria on nutrient agar using the surface plating method. The antibiotic sensitivity of bacterial isolates was determined by the disk diffusion method, using 14 antimicrobial agents. We studied a total of 180 samples: 60 of chlorhexidine gluconate (Habitane), 60 of chlorhexidine gluconate and cetrimonium bromide (Savlon), and 60 of methylated spirit. Results. Of the 180 samples studied, 11 of them (6.1 percent) were contaminated by aerobic bacteria. All bacteria isolated were Pseudomonas spp. Of the 11 contaminated samples, 6 of them (54.5 percent) occurred at the pharmacy level while 5 (45.5 percent) were from diluted pre-use or in-use samples in the pediatric/neonatal wards or the surgical wards. Chlorhexidine gluconate and cetrimonium bromide accounted for 9 of the 11 contaminated disinfectants/antiseptics (81.8 percent), and chlorhexidine gluconate accounted for the remaining 2 (18.2 percent). Only two of the four hospitals had contaminated disinfectant/antiseptic samples. All 24 isolates of Pseudomonas spp. tested were resistant to one or more of the 14 antimicrobial agents tested, with the prevalence of resistance to ciprofloxacin, norfloxacin, tobramycin, and gentamicin being 58.3 percent, 50.0 percent, 45.8 percent, and 41.7 respectively. Conclusions. Our results show that contaminated disinfectants/antiseptics pose a health risk to patients, particularly in the pediatric and surgical wards. The high prevalence of resistance to antimicrobial agents exhibited by the Pseudomonas spp. that were isolated is of special theraputic concern (AU)

Microbial contamination of disinfectants and antiseptics in four major hospitals in Trinidad

OBJECTIVE: To assess the microbial contamination of disinfectants and antiseptics in major hospitals on the Caribbean island of Trinidad. METHODS: For this cross-sectional study, disinfectants and antiseptics were sampled from the pharmacy departments, the pediatric/neonatal wards, and the surgical wards of four hospitals. The samples were cultured for aerobic bacteria on nutrient agar using the surface plating method. The antibiotic sensitivity of bacterial isolates was determined by the disk diffusion method, using 14 antimicrobial agents. We studied a total of 180 disinfectant/antiseptic samples: 60 of chlorhexidine gluconate (Hibitane), 60 of chlorhexidine gluconate and cetrimonium bromide (Savlon), and 60 of methylated spirit. RESULTS: Of the 180 samples studied, 11 of them (6.1 percent) were contaminated by aerobic bacteria. All bacteria isolated were Pseudomonas spp. Of the 11 contaminated samples, 6 of them (54.5 percent) occurred at the pharmacy level while 5 (45.5 percent) were from diluted pre-use or in-use samples in the pediatric/neonatal wards or the surgical wards. Chlorhexidine gluconate and cetrimonium bromide accounted for 9 of the 11 contaminated disinfectants/antiseptics (81.8 percent), and chlorhexidine gluconate accounted for the remaining 2 (18.2 percent). Only two of the four hospitals had contaminated disinfectant/antiseptic samples. All 24 isolates of Pseudomonas spp. tested were resistant to one or more of the 14 antimicrobial agents tested, with the prevalence of resistance to ciprofloxacin, norfloxacin, tobramycin, and gentamicin being 58.3 percent, 50.0 percent, 45.8 percent, and 41.7 percent, respectively. CONCLUSIONS: Our results show that contaminated disinfectants/antiseptics pose a health risk to patients, particularly in the pediatric and surgical wards. The high prevalence of resistance to antimicrobial agents exhibited by the Pseudomonas spp. that were isolated is of special therapeutic concern

Inoculation injuries in hospitals in Trinidad and Tobago

This paper reviews the frequency of inoculation injures, which occurred in hospitals in Trinidad and Tobago from 1991 to 1997, inclusive. A total of 397 cases of inoculation injuries were detected. Significantly more of this injures occurred during diagnostic or therapeutic procedures (231, or 58.2 percent: G=41.2, df 9, p < 0.001) than during disposal of needles and other sharps (136, or 34.3 percent), certain situations remote from patient care (21, or 5.2 percent), and "rogue incidents" related to unsafe disposal with later injury to janitors or others (9, or 2.3 percent). No statistically significant monthly or seasonal variations occurred in the incidence of reported inoculation injuries. The two institutions that saw the largest number of patients, the Port-of-Spain General and San Fernando General Hospitals, accounted for the largest number of cases of inoculation injury, with 139 (35.0 percent) and 135 (34.0 percent), respectively. Interestingly enough, there were 42 reported inoculation incidents at the St. Ann's Hospital for the Mentally Impaired and 23 (52.5 percent of these were bites, most of them occurring during attempted procedures. Nurses were the main recipients of inoculation injuries (287 cases, or > 72 percent), followed by doctors (9.3 percent), and ward maids (6.2 percent). The main modes of inoculation were needle sticks (305, pr 76.8 percent). Bites (34, 8.6 percent) injuries with sharps other than needles (29, or 7.3 percent), and splashes (29, or 7.3 percent) were the other types seen. One recipient was found to be infected with HIV following accidental inoculation. The infection control methodologies used in hospitals in Trinidad and Tobago was reviewed and recommendations for preventing injuries are outlined.(AU)

Significance of polymicrobic bacteriuria in a teaching hospital in Trinidad

OBJECTIVE: To compare microbial prevalence (mixed versus pure), define microbial combination in mixed urine cultures among inpatients and outpatients to identify factors that might allow a more objective interpretation of polymicrobic urine cultures. DESIGN: Case series. SETTING: The study involved inpatients (hospitalized) and outpatients (those attending outpatient clinics and the accident and emergency department) of the San Fernando General Hospital in southern Trinidad. MAIN OUTCOME MEASURES: Prevalence rates of bacterial isolates in mixed and pure cultures of urine specimens were determined using standard techniques and Kirby-Bauer disc diffusion methodology. RESULTS: The results showed that of 5,089 urine specimens, 1,491 (29.3 percent) yielded positive cultures. Of these positive cultures, 524 (35.1 percent) revealed significant polymicrobic bacteriuria. Eighty five percent yielded two organisms 13.2 percent had three organisms and 1.8 percent had four organisms. Repeat cultures 157 patients revealed the same organisms in only 57.3 percent of them. Almost all of the repeat cultures were from patients with in-dwelling Foley catheters. E. coli was the most common single isolate (42.8 percent), while Klebsiella, Enterobacter and Proteus organisms were most often encountered in mixed cultures. All isolates were relatively sensitive to routinely used antibiotics for urinary pathogens. CONCLUSION: The prevalence rate of polymicrobic bacteriuria at our institution was 10.2 percent. More than 65 percent of positive cultures were from patients with Foley catheters on open drainage (inpatients) and closed drainage (outpatients). Most were men with out-flow obstruction who either refused surgery, were unfit for surgery, or had to wait long periods to be booked for surgery. No cases developed bacteremia secondary to bacteriuria. All urinary isolates were susceptible to routinely used antimicrobial agents.(Au)

Nosocomial infections in a rural regional hospital in a developing country: infection rates by sites, services, cost and developing control practices

OBJECTIVE: To assess the prevalence of nosocomial infections at a rural government hospital from 1992 to 1995. DESIGN: Retrospective review of data from 1992 to 1995 regarding rates of nosocomial infection, cost to government, and infection control practices. SETTINGS: 653 bed rural hospital providing primary and tertiary care. PATIENTS: Patients admitted to the hospital between 1992 and 1995 who were found with hospital acquired infections during their stay. INTERVENTIONS: None. RESULTS: Over the 4 year period, 7,158 nosocomial infections were identified from 72,532 patients (10.0/100 admissions). High nosocomial infection rates were found on the intensive-care unit (67/100 admissions), urology (30/100 admissions), neurosurgery (29.5/100 admissions), and newborn nursery (28.4/100 admissions). Urinary tract infections (4.1/100 admissions) accounted for most nosocomial infections (42 percent), followed by postoperative wound infections (26.8 percent) with a rate of 2.6/100 admissions. Nosocomial pneumonias and bloodstream infections also were common with 13.2 percent and 8.0 percent respectively. The highest rates occurred on the intensive care unit for both pneumonia (26.4/100 admissions) and bloodstream infection (7.0/100 admissions). The cost to the government for nosocomial infections was estimated at US $697,00 annually (US $1 = $6 Trinidad and Tobago). Poor infection control practices, inadequate handwashing facilities, lack of supplies, and nonexistent garbage cans on most wards were quite evident. CONCLUSIONS: Strict adherence to proper infection control practices, such as handwashing techniques, and improvement of facilities are crucial steps in preventing cross infections in the hospital environment. Implementing these measures may substantially reduce the massive drain on the hospital budget in treating nosocomial infections. The saved revenue could go toward improvement of ward facilities and reduction of overcrowding, thus further reducing cross-infection.(AU)

AIDS/Hepatitis, and tuberculosis: implications for the dentist and dental profession

Dentists worlwide treat and manage patients with a variety of oral and systemic complaints. Bacterial fungal and viral infections are commonly seen in dentist practice. Although primarily sexually transmissible, serious diseases such as hepatitis B, herpes, HIV/AIDS and tuberculosis are the major infections for which the dentist must reduce or eliminate the risk of transmission. The best approach to minimize cross-infection to, or from, a patient or other health care worker (HCW) is to use "Universal Precautions" that is, to treat every patient as if they were a carriers of some infection. However, unlike infection control strategies of developed countries, in developing countries these precautions may need to be modified to match the socioeconomic constraints of the region. Governments and HCWs should work together to make vaccinations against hepatitis B a national priority, and improve the education of patients and colleages concerning the risks from all STDs including HIV/AIDS, hepatitis B and tuberculosis. (AU)

Summary report of Workshop on Leprosy in the Caribbean: steps to elimination

Under the auspices of the Caribbean Epidemiology Centre (CAREC/PAHO) and with funding from Aide Aux Lepreux Emmaus Suisse (ALES) a three day workshop was organised on the above subject for member countries of CAREC that have several new leprosy cases per year. Participants included Antigua & Barbuda, Barbados, Dominica, Grenada, Guyana, Jamaica, Saint Lucia, St. Vincent & the Grenadines, Suriname, Trinidad & Tobago and the Turks & Caicos Islands ... The range of expertise available to the meeting included epidemiology, dermatology, physicians involved in the primary health care system, senior public health nurses and leprosy control officers (AU)