An epidemiological study of nosocomial infections at Mayo Hospital, Lahore

Study was designed to investigate the sources and causes of nosocomial infections in-patients admitted in the Mayo Hospital, Lahore, Pakistan. Of the total 32,620 patients examined during 1997-2001, 4502 (13.80%) were reported to have acquired nosocomial infections during their stay at hospital with different types of bacterial pathogen. Of the total 4502 samples examined; 1287 isolates of Staphylococci (1004 Staph. aureus and 283 Staph. epidermidis) 429 of Streptococci (265 Strep. pyogenes, 128 Strep. pneumoniae and 36 Strep. viridans), 328 of Enterococci (272 Enterococ. faecalis, 56 Enterococ. Faecium), 781 of Pseudomonas (693 Pseudo. aeruginosa and 88 Pseudo. cepacia), 349 of Enierobacter (212 Enterobacter. cloacae and 137 Enterobact. aerogenes), 41 of Acinetobacter Baumann, 266 of Klebsiella (96 Kleb. pneumoniae, 131 Kleb. aerugenese and 39 Kleb. oxytoca), 140 of Proteus (103 Prot. mirabilis and 37 Prot. vulgaris), 1031 of Escherichia coli, 67 of Serratia marescens, 93 of Haemophilus influenzae, 119 isolates of quite uncommon types of Gram positive bacteria, 13 of uncommon Gram negative bacteria, and 189 isolates of yeast and fungi were recovered and characterized. A total of 635 morbid samples consisting of 127 throat swabs, 254 hand swabs, and 254 glove and apron samples were, collected from the staff working; in various hospital wards and tested for bactcrial isolation. From the 635 samples, 119 isolates of Staphylococci (79 Staph. aureus and 40 Staph. epidermidis), 60 of Streptococci (41 Strep. pyogenes, 15 Strep. Pneumoniae and 4 Strep, viridians), 73 of Enterococci (51 Enterococ. faecalis, 22 Enterococ. faecium), 33 of Pseudomonas (22 Pseudo. aeruginosa and 11 Pseudo, cepacia), 15 of Enterobacter (13 Enterobact. cloacae and 2 Enterobact. aerogenes), 24 of Klebsiella (17 Kleb. Pneumoniae, 3 Kleb. Aerugenese and 4 Kleb, Oxyloca), 25 of Escherichia coli and 13 of Haemophilus influenzae were recovered indicating; that the staff of Mayo hospital, Lahore many types of harbours potential pathogens which are transmitted from their to the patients while they receive treatment and come in contact with the carrier hospital staff. A total of 2.677 samples (126 samples of operation theatre air, 65 of ward environment, 610 of water from sterilizers, and 1876 surgical instrument swabs) were also collected and processed for isolation of bacteria. During; the study 226 samples from non-human hospital inmates were also tested. Of those samples, 88 of each were from the legs and viscera (intestines) of cockroaches, and 25 each of nasal and fecal swabs from the cats in the hospital premises. Of the total 226 samples examined, 101 isolates of Staphylococci (85 Staph. aureus and 16 Staph. epidermidis), 146 of Streptococci (61 Strep. pyogenes, 37 Strap. pneumoniae and 48 Strep. viridians), 166 of Enterococci (Enterococ. fecalis and Enterococ. facium), 79 of Pseudomonas aeruginosa, 124 of Enterobacter (96 Enterobact. cloacae and 2. Enterobact, Aerogenes), 47 of Proteus (22 Prot. Mirabilis and 25 Prot. vulgaris), 163 of Escherichia coli, and 30 isolates of yeasts and Fungi were obtained and further characterized. This study revealed that most of the isolates colonizing premises and body surfaces of personnel of Mayo Hospital had developed resistance against the above mentioned commonly used antibiotics. These isolates were found generally resistant to the action of ampicillin, cloxacillin, tetracyclines, cephalosporin, macro ides, beta-lactamase inhibitors, gentamycin, amikacin and quinolones (Ciprofloxacin and Sparfloxacin). The isolation of pathogens from above sources indicates loop-holes in implementation of infection control programmes in the hospitals. Shortcomings in infection management and prevention leads to high incidence of hospital acquired infections. The emergence of various drug resistant bacteria, as observed in the present study is a matter of concern for the biomedical practitioners and necessitates an effective policy on rational use of antibiotics, as very few antibiotics/ antibacterial are now left with broad spectrum efficacy against pathogens being commonly isolated from the patients with various ailments. Both the physicians' anal patients need education on the rational and effective use of antibiotics.