MOLECULAR EPIDEMIOLOGY OF THE TRANSMISSION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN KYIV ACUTE CARE HOSPITALS, UKRAINE.

OBJECTIVE: The aim: To evaluate the potential of transmission of methicillin-resistance Staphylococcus aureus (MRSA) in Ukrainian acute care hospitals. PATIENTS AND METHODS: Materials and methods: We performed a multicenter cross-sectional study. Definitions of HAI were used from the CDC/ NHSN. The susceptibility to antibiotics was determined by disk diffusion method according to the EUCAST. The cefoxitin-resistant isolates S.aureus were analyzed for the presence of the mecA gene and femA endogenous control gene using PCR. The virulence factor encoding genes (lukS-PV and lukF-PV) were detected by PCR. RESULTS: Results: Of 2,421 patients with HAIs caused S.aureus included in the study, 28.7% patients had MRSA. Prevalence of nasal carriage rate of MRSA among healthcare workers (HCWs) was 33.3%. MRSA contamination of hands and uniforms/gowns of HCW were 32.2% and 29.7%, respectively. MRSA contamination in the inanimate environment surfaces in near- and extended patients areas were 26.9%. The predominant MRSA contamination in hospital environment surfaces were: room inner door knob (32.8%), bed rails (28.9%), room light switch (28.9%), chair (27.9%), bedside table handle (20.6%), bedside table (20.5%), and tray table (13.7%). The PVL gene was present in 38.7% of MRSA strains, isolated from patients with HAIs and in 55.7% of MRSA, isolated from environment surfaces in patient area. In addition, the PVL genes were detected in over 56.3% of MRSA isolated from HCWs carrier. CONCLUSION: Conclusions: The majority of MRSA is acquired during hospitalization. Environmental surfaces may serve as potential reservoirs for nosocomial MRSA and facilitate transmissions via contact.

EVALUATION OF BACTERIAL CONTAMINATION IN THE INANIMATE ENVIRONMENT SURFACES IN ACUTE CARE HOSPITALS IN KYIV, UKRAINE.

OBJECTIVE: The aim: To evaluate the quality of cleaning and disinfection of surfaces scheduled for daily cleaning and degree of bacterial contamination of hospital rooms and the patients' inanimate environment in Kyiv acute care hospitals, Ukraine. PATIENTS AND METHODS: Materials and methods: We performed a multicenter prospectively study of the quality of cleaning and disinfection of surfaces scheduled for daily cleaning in 9 acute care hospitals by use of an ultraviolet fluorescence targeting method and microbial methods. RESULTS: Results: A total 9,104 environmental samples from were collected and tested. The cleaning and disinfection of surfaces were not being performed properly in most cases. Complete removal of the mark was 49.1%, partial removal was 37,5%, and mark was still visible, i.e. this area had not been processed was 13,4% when the ultraviolet fluorescence targeting method procedures were used, respectively. The predominant bacterial agents in hospital environment surfaces were: Escherichia coli, Enterobacter spp., Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus spp., Citrobacter spp., Acinetobacter spp., and Enterococcus spp. The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 31.5% and of methicillin-resistance in Staphylococcus aureus (MRSA) 14.9%. Vancomycin resistance was observed in 5.2% of isolated enterococci (VRE). Resistance to third-generation cephalosporins was observed in 12.7% E.coli isolates and was in 11.2% K. pneumoniae isolates. Carbapenem resistance was identified in 24.7% of P.aeruginosa isolates and 59.3% of Acinetibacter spp. isolates. CONCLUSION: Conclusions: In a hospital rooms, patient environmental surfaces can be a vehicle for the transmission of multidrug-resistant (MDR) bacterial agents that cause healthcare-associated infections.