THE EFFECTS OF SELECTED DISINFECTANTS ON BACTERIAL ISOLATES FROM HOSPITAL FORMITES

ABSTRACT

This study evaluated the effects of different disinfectants on bacterial isolates from hospital formites. The result showed bacteria flora covering eight species including E. coli, Staphylococcus, Streptococcus, Micrococcus, Proteus, Klebsiella, Pseudomonas, and Enterococcus spp. The activity of the three test disinfectants against the hospital formites bacterial isolate at varying concentration indicates that all the disinfectants were active against each of the isolate at full strength (100% concentration) but showed varieties in their respective activity at diluted concentrations. Izal was effective at minimum concentration of 12.5% (v/v) against E. coli, Staphylococcus, Proteus, and Klebsiella. While it minimum inhibition concentration recorded 25% (quarter strength) against Enterococcus, Streptococcus and Pseudomonas. Dettol did not record any activity at concentration of 6.25% and 12.5% but showed inhibition at the minimum concentration of 25% for E. coli, Enterococcus and Klebsiella and at 50% for proteus, pseudomonas and micrococcus. Ivy was active at 12% concentration against Pseudomonas, Micrococcus and klebsiella and at 25% concentration against E. coli, Enterococcus, Streptococcus and Proteus. Therefore, the result show that the performance of the test disinfectants against the hospital formites bacteria isolates was in the order of potency, Izal ˃ Ivy ˃ Dettol. In general, the minimum concentration of the disinfectants that cause inhibition of the bacteria isolates was 12.5% (v/v) for izal and ivy and 25% for dettol. it was concluded that inanimate objects in hospital environment habor a wide range of bacteria species some of which are pathogenic or potentially pathogenic. This work recommends that the used of this common and popular disinfectant should be encouraged in homes and public places especially in the hospitals.

TABLE OF CONTENTS

                        Title Page                                                                                                        i

                        Certification                                                                                                   ii

                        Dedication                                                                                                      iii

                        Acknowledgement                                                                                          iv

                        Table of Contents                                                                                           v

                        List of Tables                                                                                                  vii

                        Abstract                                                                                                          viii

CHAPTER ONE

1.0                   Introduction                                                                                                    1

1.1                   Aims and Objectives                                                                                      3

CHAPTER TWO

2.0                   Literature Review                                                                                           4

2.1                   Studies on the In Vitro Activity of Five Disinfectants Against

Nosocomial Bacteria                                                                                      4

2.2                   Comparative Efficacy of Selected Disinfectants against Pathogenic

Bacteria Isolated From Hospital Fomites and Disposal Wastes            7

2.3                   Study of Antimicrobial Effects of Some Disinfectants on Bacteria

Isolated From the Operating Theatre of Usmanu Danfodiyo University

Teaching Hospital Sokoto, Nigeria                                                                            9

2.4                   Bacterial Contaminants Associated With Hospital Formites                                    11

2.4.1                Escherichia coli                                                                                              11

2.4.2                Salmonella typhi                                                                                             11

2.4.3                Staphylococcus aureus                                                                                   12

CHAPTER THREE

3.0                   Materials and Method                                                                                     13

3.1                   Sample Collection                                                                                          13

3.2                   Sterilization of Materials                                                                                13

3.3                   Materials and Media Used                                                                              13

3.4                   Media Preparation                                                                                          13

3.5                   Inoculation and Isolation                                                                                14

3.6                   Purification of Isolates                                                                                   14

3.7                   Identification of the Isolates                                                                           14

3.8                   Gram Staining                                                                                                14

3.9                   Biochemical Test                                                                                            15

3.9.1                Catalase Test                                                                                                   15

3.9.2                Indole Test                                                                                                      15

3.9.3                Citrate Utilization Test                                                                                   16

3.9.4                Hydrogen Sulphide (H₂S) Production Test                                                    16

3.9.5                Starch Hydrolysis                                                                   16

3.9.6                Motility, Indole, Urease (MIU)                                                                      17

3.9.7                Coagulase Test                                                                                               17

3.9.8                Oxidase Test                                                                                                   18

3.10                 Comparative Efficacy of Selected Disinfectants on Isolated

Pathogenic Bacteria                                                                                        18

3.10.1              Disinfectant Dilution Method                                                                         18

3.10.2              Agar Diffusion Method                                                                                  18

3.10.3              Minimum Inhibitory Concentration (MIC)                                                    18

CHAPTER FOUR

4.0                   Results                                                                                                            21

CHAPTER FIVE

5.0                   Discussion, Conclusion and Recommendation                                              26

5.1                   Discussion                                                                                                       26

5.2                   Conclusion                                                                                                      27

5.3                   Recommendation                                                                                           27

LIST OF TABLES

CHAPTER ONE

1.1       INTRODUCTION

Disinfection procedures represent the main type of intervention in hospital settings against pathogenic or potentially pathogenic microorganisms (Lineback et al., 2018) and aim to prevent or reduce complications due to infectious organisms. Surface contamination, in particular, is a public health problem, as healthcare-associated infections (HAIs) represent a significant cause of morbidity and mortality worldwide. HAIs develop during hospitalization and a range of different microorganisms are frequently isolate Including multidrug-resistant bacteria, such as vancomycin-resistant enterococci (VRE), Clostridium difficile, Pseudomonas aeruginosa, Acinetobacter spp. and methicillin-resistant Staphylococcus aureus (MRSA) (Vickery et al., 2012). In particular, S. aureus and P. aeruginosa are hazardous microorganisms, able to grow on hard non-porous surfaces (e.g., metal pipes and floor drains) and develop biofilms that protect them from adverse conditions (Jamal et al., 2017). Their resistance to various antimicrobial substances can compromise patients’ therapeutic protocol, increasing the need to improve disinfection procedures in healthcare settings (Laxminarayan et al., 2013).

There are multiple factors contributing to the spread of HAIs, which include healthcare-associated factors (invasive device use, surgical procedures, inappropriate use of antimicrobial therapy), environmental factors (contaminated air-conditioning systems) and patient-related factors (severity of underlying illnesses, use of immunosuppressive agents, prolonged hospital stays) (Al-Tawfiq and Tambyah, 2014).

Nosocomial, or hospital-acquired infections, are defined by the US Center for Disease Control and Prevention as any localized or systemic condition that occurs in a patient as a result of the presence of an infectious agent or its toxin that was not present or incubating at the time of hospital admission (Horan et al., 2008). It has been seen that immune compromised patients are at a threat of nosocomial infections (NI’s) when they undergo surgery or have any underlying disease, and they are even worse affected when admitted in Intensive Care Unit, as the rate of NI’s is almost three times higher than any other departments of the hospital (Divya et al., 2015) To minimize the percentage of patients who acquire NI, several actions such as cleaning, washing and disinfecting hands and the use of isolation material are performed by health-care workers and these actions are called Infection Control Measures. Different types of infections acquired in hospitals include bloodstream infections, surgical wound infections, ventilator associated pneumonia, urinary tract infection, lower respiratory infection, gastrointestinal, skin, soft tissue, ear, nose and throat infections. Although viruses, fungi and parasites are also recognized as sources of nosocomial infections, bacterial agents remain the most commonly recognized cause. In hospitals, inanimate surfaces and equipment like bedrails, door handles, drip stand, medical charts, stethoscopes, ultrasound machine may be contaminated by bacteria. The agents that are usually involved in hospital-acquired infections include Streptococcus sp., Acinetobacter sp., Enterococci, Pseudomonas aeruginosa, coagulase negative Staphylococci, Staphylococcus aureus, Bacillus cereus, Legionella and Enterobacteriaceae family members, namely, Proteus mirabilis, Klebsiella pneumoniae, Escherichia coli and Serratia marcescens. Out of these Enterococci, P. aeruginosa, S. aureus and E. coli have a major role (Horan et al., 2008).  Microorganisms causing nosocomial infection are transmitted in hospitals by several routes including direct or indirect contact, droplet spread, common vehicles like air and vector borne and alternative vehicles, such as blood plasma or food. The effective cleaning and disinfection of inanimate contact surfaces is therefore critical for the prevention and control of nosocomial infections within the health-care environment. Biocides such as antiseptics and disinfectants are widely used as an initial step to control or kill infectious agents from possibly contaminated equipment and specimens.

The effective use of disinfectants is an important factor in preventing nosocomial infections. However, the resistance of pathogens to disinfectants is an emerging problem and is due to the presence of integrons, super integrons, efflux mechanisms and genetic adaptations in the pathogens (Khan et al., 2017). So, in spite of regular use of conventional disinfectants, surfaces and medical equipment are usually not effectively decontaminated and disinfected. There is a need to evaluate the efficacy of disinfectants which are commonly used in our hospitals and to look for newer and better options to disinfect the inanimate surfaces and hospital environments.

1.2       AIMS AND OBJECTIVES

The aim of this study was to investigate the efficacy of three (3) commercially available disinfectants on bacterial isolates from clinical samples and to create awareness for health workers to choose an effective disinfectant.

The objectives are;

1.     To isolate and characterize bacterial isolates associated with clinical samples

2.     To determine the antibacterial activity of the different commercially available disinfectants against the bacterial isolates from clinical samples.

3.     To determine the minimum inhibitory concentration of the various disinfectants on some selected isolates from the clinical samples

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