Assessment of Staphylococcal Nosocomial Infections in National Orthopaedic Hospital, Enugu

Abstract

In a comprehensive work to assess staphylococcal nosocomial infections in patients in National Orthopaedic Hospital, Enugu (NOHE), Nigeria and to assess the possible contribution of healthcare workers and fomites, a study was carried out between May 2013 and June 2014. This involved the analysis of a total of 578 samples, 200(35%) comprising of 100 in-patients and 100 healthcare workers ) and 378 samples collected from different fomites within the theatre/ wards. Human samples (wound/nasal swabs, pus, urine and blood) and fomites( hospital equipment/ articles, floors and wall surfaces, sinks, tables, trolleys etc), 277 from wards and 89 from theatres were analyzed using standard bacteriological methods. Antibiograms were carried out on all staphylococcal isolates. Of the 100 patients studied, 85(85%) 43 males and 42 females were positive for staphyloccal nosocomial infections of which there was no statistically significant difference for sex/age (p>0.05). Wound infections 60 (70.4%),ranked highest, followed by urinary tract infections 20( 23.5%), with bacteremia 3 (3.5%) and soft tissue infection 2( 2.4%) being the least, which differences were statistically significant (P<0.05). Road traffic accident cases, 29 (34%) followed by flame burns cases ranked highest amongst the category of patients with staphylococcal nosocomial infections while matchet cut cases with only 1 (1.1 %) positive, was the least which differences was also stastistically significant( P< 0.05). Of the healthcare workers, 93 ; (93%) 42( 45%)males and 51( 55%) females yielded a positive nasal staphylococcal carriage showjng no statistically significant differences (P>0.05) in the sex/age-wise comparison. Nurses were statistically significantly higher than other professional groups in staphylococcal carriage (P<0.05). Similarly, length of stay\ length of service were also statistically significant when the positive cases for staphylococcal infections/carriage were compared among the patients and also for healthcare workers respectively(P<0.05). Number positive for staphylococcal nosocomial infections were also found to be statistically significant (P<0.05) according to total body surface area affected amongst patients with burns injury.Of the 378 fomites analyzed, 200 (53%) yielded positive Staphylococcus aureus isolates with floors ranking highest both for Staphylococcus aureus 40(11.6%) and 22(11%) methicillin resistant Staphylococcus aureus (MRSA).This was followed by walls 30 (8%) and bed railings19 (5%). Generally, the distribution of Staphylococcus aureus were not statistically significant(P >0.05).Antibiogram results show evidence of multiple resistant Staphylococcus aureus and methicillin resistant Staphyloccous aureus in samples analysed such that 33% ,33% , and 45% MRSA were detected amongst patients, healthcare workers and fomites respectively. A total of 31.6% samples in the study yielded Staphylococcus epidermidis isolates. The need for more stringent hygienic practices and regular interventionary fumigation of NOHE and similar further studies at a higher scale in order to appreciate the full epidemiological pattern for a control regimen is hereby stressed.