Environmental Infection Control in Intensive Care Units at Gaza Governorates: Interventional Study

Abstract

Background: Worldwide, many lives are lost because of the spread of infections in health facilities. Microbial organisms spreading in everything around us (air, water, food and inanimate surfaces). Most of these infections can be prevented by well-established processes for decontamination and cleaning of soiled instruments. High-risk areas such as intensive care units (ICUs) require special ventilation systems that designed to provide clean air with high efficiency, which need to be considered in the hospitals construction. It is also imperative for health care administrators to ensure implementation of the infection control program in health care facilities. This study aimed to evaluate the environmental infection control (EIC) measures in the general ICUs in Gaza. Methodology: A three-months descriptive cross sectional study was done to evaluate the two main general ICUs in Gaza "Shifa Complex and European Gaza Hospital (EGH)". A total of 196 microbiological samples for air, water, and inanimate surfaces were surveyed. Both ambient air and inspiratory air from mechanical ventilator machines (MV) were sampled and cultured for bacterial and fungal count. Also, 20 water specimens were tested for bacterial presence. In addition, 120 swabbed cultures from surfaces and equipments were growing in a pre-enrichment media before incubation. Moreover, a total of 516 reading for climate temperature (T) and relative humidity (RH) were gathered as the most important factors assist in bacterial multiplication. Results: The study revealed that 62% of the infection prevention and control (IPC) measures in Shifa ICU were unfit, in comparison with EGH ICU (53%). Also, the total bacterial count within indoor air in both ICUs ranged from (1170 to 1470) cfu/m3 (standard is less than 50 cfu/m3 ). Moreover, results revealed the presence of bacterial count that ranged from 73 to 90 cfu/m3 in the inspired air from MVs. However, fungal count was 830 cfu/m3 at Shifa, while free at EGH MVs. The climate temperature average during day hours was significantly high than the standard in about 4^oC, thus 79.73% of HCPs (P=0.000) saw that their provided care was affected negatively by unsatisfactory T. RH average was 59% in both units, at a high limit of the international standard. On the other hand, count of total and fecal coliform in all water sources were negative. The study revealed that 96% of pre-enriched swabbed cultures in Shifa were positive, closely the same as EGH (93%). Bacterial findings in both units were: Pseudomonas 38.5% (n=24), E-coli 32% (n=20), and Klebsilla 16% (n=10). However, Staph arues was 16.1% (n=5) in EGH ICU and free at Shifa. Conclusions: Periodic monitoring of ventilation system efficiency is desired to ensure optimal indoor air quality, Palestinian IPC should to be updated to include standards about air and ventilation system, particularly bacterial and fungal count in indoor air. Also standards for climate T and RH average in ICUs is necessary. Urgent interventions are required to improve methods of disinfecting the hospital environmental surfaces and equipments especially MVs. Although, the study supported using of pre-enrichment media rather than dry method and direct culture for inanimate surfaces outbreak examinations. Vital system and implementations for healthcare waste disposal and laundry system  essentially required  to be  more developed.

Key words: Infection control, Indoor air, inspired air from mechanical ventilators, Water, Inanimate Surfaces, Temperature, Relative Humidity.