الفهرس 
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Abstract
Infections acquired in intensive care units (ICUs) are a significant cause of morbidity and mortality worldwide. Infections caused by multidrug-resistant bacteria (MDR) are a serious healthcare concern that clinicians who care for critically ill patients face every day. Contamination of inanimate surfaces in the ICU has been linked to infections and pathogen cross-transmission among critically ill patients.
Contamination can occur as a result of direct shedding of microorganisms from the patients in the immediate area of the bed of patient or as a result of bacteria infecting health personnel’ hands. MDR bacteria have been detected as contaminating germs on surfaces, commonly used medical equipment, and high-contact community surfaces in the intensive care unit (e.g., telephones, monitor screens, ventilator surfaces, keyboards, medical charts).
Hand hygiene is critical in preventing cross-contamination, as is maintaining a clean and healthy environment and medical equipment. Cleaning methods and schedules that are effective and efficient are required to ensure clean and healthy environments in healthcare facilities.
The training and retraining of healthcare personnel is a must for imparting current knowledge, encouragement, and quality control. Various courses on training in disinfection procedure have been started by MOH in Egypt as well as CDC.
The aim of this study was to evaluate the effectiveness of the implemented decontamination processes of devices (Ventilator, Cardiac Monitor, Laryngoscope, and Portable suction device) which are commonly used in the intensive care unit of a governmental hospital in Alexandria.
This study was conducted in the 13-beds Intensive care unit (ICU) of a 127 beds main public chest hospital in Alexandria governorate, during the period: from September 2020 till March 2021 which was concomitant with COVID-19 pandemic. Institutional Review Board approvals were obtained prior to samples collection.
The study was conducted on four of commonly used devices in the ICU (Ventilator- monitor- laryngoscope-portable suction device). The current decontamination strategies for the 4 specified devices were identified and compared with manufacture’s recommendations, national and international guidelines for decontamination of these devices. Sixty swab samples from the four devices were collected post disinfection process by the currently implemented decontamination strategies, in weekly visits over a period of 1 month (4 visits). Training of staff on the best practice for decontamination of the 4 devices under study was implemented. Afterwards, sixty other swabs were collected post disinfection of the 4 devices to assess the effect of training. Swabs were also taken after training in a weekly visit over a period of 1 month (4 visits). The sample size was calculated Statistically during study planning.
By observing staff compliance with the guidelines for decontamination of medical equipment, deficiency in some critical steps of decontamination was detected. Training addressed all the defective steps observed in the pre-training phase, and staff observation in the post-training phase showed full compliance with the guidelines.
The microorganisms isolated from medical equipment surfaces in the pre-training phase included clinically significant pathogens such as Klebsiella spp., Proteus spp., Pseudomonas spp., and Candida spp., which were heavily contaminating almost all medical equipment under study at various instances, with counts exceeding 100 CFU per plate. Also, Coagulase Negative Staphylococci (CONS) were detected as heavy contaminants of mainly the ventilator surfaces in high colony counts per plate.
Other pathogens encountered in the pre-training phase included Staphylococcus aureus, Enterococcus spp., as well Aspergillus spp., in addition to environmental contaminants such as Bacillus spp., and Diphteroid spp.
In the post-training phase, no micro-organisms were isolated from almost all medical equipment surfaces, except monitor silence button and left ventilator hand rail which showed bacterial growth (CONS and bacillus spp.).
Almost all medical equipment surfaces were contaminated before training, but after training almost all medical equipment surfaces were clean. The most common pathogens detected in all swabs from the medical equipment under study in the pre-training phase were; CONS (in 29 swabs out of 60, 48.3%), followed by Bacillus spp. (in 20 swabs out of 60, 33,3%), then Klebsiella spp. (in 19 swabs out of 60, 31.7%), Proteus spp. (in 10 swabs out of 60, 16.7%) and candida spp. (in 9 swabs out of 60, 15%). In the post training phase, only CONS and Bacillus spp. were isolated from all medical equipment under study in 2 swabs out of 60 (3.3%) each.
Among the medical equipment under study, the most heavily contaminated were the monitor and portable suction device in 91.67% of all obtained swabs from these devices (N=12), followed by the Ventilator which showed bacterial growth in 89.3% of all pre-training swabs (N=28). Post-training marked improvement was observed with a highly significant difference in contamination percentage in the Ventilator surfaces p<0.0001, Monitor surfaces p=0.002, Laryngoscope p<0.00001 and Portable suction p=0.003 Pre and Post training.
In the pre-training phase, the most commonly isolated pathogen was Klebsiella spp (31.7%), isolated mostly from portable suction device, followed by Proteus spp. (16.7%) isolated mostly from the device. On the other hand, no potentially pathogenic organisms were isolated from all devices in the post-training phase.