Characterization of Bacteriological Isolates from Patients and Environment Samples of Burn Ward: A Study from a Tertiary Care Hospital of India

Abstract

Objective: Source of infection in a burn patient is from the patient’s own flora, contaminated environmental surfaces and from health care workers. Insufficiently disinfected hospital environmental surface provides a niche for multidrug resistant bacteria. This study was done to assess the bacteriological profile of the pathogens from burn wound and the surrounding environmental areas. Method: During 6 months wound swabs from burn patients were collected on admission (after 48 hours of admission), on day 5 and then weekly. Environmental samples were also collected from burn ward and studied for the bacteriological and anti-microgram profiles. Results: Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii were the major bacterial isolates from the woundswabs and from theenvironmental samples. ESBL was detected in 56.6% of our Enterobacteriaceae isolates. The environmental sites from which these bacterial isolates were found were nursing counter, sink, dressing trolley, medicine locker and patient’s bed. The percentage of MRSA has decreased from 50 to 5% and there is increased role of Enterococci species causing infections (13.63%). Conclusions: In this study, there appears that the colonizers of the environment may play a role in causationof infection in burn patients.In burns ward, rigorous implementation of infection control program should be warranted, which includes and hygiene and use of personal protective equipment, environmental disinfection, cohort nursing care and antibiotics stewardship programme.

Hospital water as the source of healthcare-associated infection and antimicrobial-resistant organisms

“…For example, a hospital in Zambia found that K. pneumoniae was frequently isolated from a communal bathtub used by burns patients [21]. K. pneumoniae has been found widely in hospital environments including nursing counters, bathroom sinks, dressing trolleys and patient beds [11]. As such, it was hypothesized that water outlets were contaminated with K. pneumoniae from patients, staff and the surrounding environment rather than from the source water [22,23].…”

“…Biofilms are heterogenous communities of microorganisms that can grow on plumbing infrastructure surfaces, within water-related devices and on sediment deposits [11,32]. Once cells have initially adhered to the surface, microbial diversity and metabolic activity typically increases [33].…”

“…Common OPPPs include Legionella spp., nontuberculous mycobacteria and Pseudomonas aeruginosa [8]. These microorganisms form biofilms on the surface of pipes and water-related devices that can also provide refuge to pathogens not typically associated with drinking water including Staphylococcus aureus , Enterobacteriaceae, Klebsiella pneumoniae and Escherichia coli [9–14 ▪ ]. Biofilms provide protection against unfavourable environmental conditions including disinfection processes and deliver the ideal environment for the transfer of antimicrobial resistance genetic elements [10 ▪ ,15].…”