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Abstract
This study was carried out to evaluate the level of asepsis at various stages of the surgical procedures during the undergraduate students’ wet-lab sessions. Skin and/or wound swabs were collected from different wet lab groups, sessions and stages. The swabs were processed for bacteriological isolation using standard microbiological procedures. A total of 62 isolates of bacteria belonging to 8 genera: Staphylococcus (n=38), Streptococcus (n=1), Corynebacterium n=4), Escherichia (n=7), Proteus (n=8), Klebsiella (n=2), Serratia (n=1) and Acinetobacter (1), were isolated. The most commonly isolated species of bacteria were Staphylococcus equorum (n=31) and Proteus spp. (n=7), which were detected in swabs from ungloved and gloved hands of surgeon and his assistant, patient’s surgical sites and surgical site infections. All the isolates (Gram-positive and negative) were resistant to at least one antibiotic with resistance to the β-lactam antibiotics: ampicillin (89.3% and 100% and amoxicillin (75% and 100%) most observed. The bacteria were more susceptible to doxycycline (75%) and imipenem (87.5%) respectively. Majority of the isolates (83.3%, n=30) were multidrug resistant, presenting in one of 24 different multidrug resistance patterns. The detection of these bacteria from the normally aseptic surgical procedure indicates a break in asepsis. Similarly, the danger of spreading multidrug resistant bacteria to the surgical wounds may result in wound infection, dehiscence, delayed healing and increased cost of post-surgical management. It is recommended that adherence to stringent pre-surgical and intra-surgical asepsis should be observed.
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References
- Andrade, N., Schmiedt, C.W., Cornell K, Radlinsky, M.G., Heidingsfelder, L., Clarke, K., Hurley, D.J.and Hinson, W.D. (2016). Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery. Vet. Surg., https://doi.org/10.1111/vsu.12483.
- Basak, S., Singh, P. and Rajurkar, M. (2016). Multidrug resistant and extensively drug resistant bacteria: A study. J. Pathogens, Pp 1-5. Resistant Bacteria: A Study. Journal of Pathogens, www.dx.doi.org/10.1155/2016/4065603.
- Bauer, A.W., Kirby, W.M.M., Sherris, J.C.and Turck, M. (1966). Antibiotic susceptibility testing by a standardized single disk method. Am. J. Clin. Pathol., 36: 493-496.
- CDC (2014). Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP) Accessed from www.cdc.gov/hai/organisms/organisms.html on 23rd April, 2020 2018.
- Chaudhary, R., Thapa, S.K., Rana, J.C.and Shah, P.K. (2017). Surgical site infections and antimicrobial resistance pattern. J. Nepal Health Res. Counl., 15(36): 120-123.
- Cheesbrough, M. (2006). District Laboratory Practice in Tropical Countries, 2nded. Cambridge University Press, Cambridge CB2 2RU, UK. 5th Printing, 2010: 45-70.
- Clinical and Laboratory Standards Institute (CLSI) (2016). Performance standards for antimicrobial susceptibility testing; Twenty-sixth informational supplement. CLSI document M100-S26. Wayne, PA: Clinical and Laboratory Standards Institute
- Davis., M.F., Iverson, S.A, Baron, P., Vasse, A, Silbergeld, E.K., Lautenbach, E.and Morris, D.O. (2012). House.hold transmission of meticillin-resistant Staphylococcus aureus and other staphylococci. Lancet Infect. Dis., 12: 703-716.
- De Oliveira, A.C.and Gama, C.S. (2016). Surgical antisepsis practices and use of surgical gloves as a potential risk factors to intraoperative contamination. Esc. Ann. Nery, 20(2):370-377.
- Godebo G., Kibru, G.and Tassew, H. (2013). Multidrug-resistant bacteria isolates in infected wounds at Jimma University Specialized Hospital, Ethiopia. Ann. Clin. Microbiol. and Antimicrob., Pp. 12: 17.
- Harper, T. A. M., Bridgewater, S., Brown, L., Pow-Brown P., Stewart-John, A.and Adesiyun, A.A. (2013). Bioaerosol sampling for airborne bacteria in a small animal veterinary teaching hospital. Inf. Ecol. Epidemiol., 3(1): 20376.
- Meakins, L.B., Gilman, O.P., Parsons, K.J, Burton, N.J.and Langley-Hobbs, S.J. (2016). Colored indicator undergloves increase the detection of glove perforations by surgeons during small animal orthopedic surgery: A randomized controlled trail. Vet. Surg., 45(6): 709-714.
- Mundhada, A.S.and Tenpe, S. (2015). A study of organisms causing surgical site infections and their antimicrobial susceptibility in a tertiary care Government Hospital. Indian J. Pathol. Microbiol., 58:195-200.
- Nelson, L. (2011). Surgical site infections in small animal surgery. Vet. Clin. Small Anim., 41:1041-1056.
- Pirvanescu, H., Balasoiu, M., Ciurea, M.E., Balasoiu, A.T.and Manescu, R. (2014). Wound infections with multidrug resistant bacteria. Chirurgia (Bucur), 109(1): 73-79.
- Spagnolo, A.M., Ottria, G., Amicizia, D., Perdelli, F.and Cristina, M.L. (2013). Operating theater quality and prevention of surgical site infections. J. Prev. Med. Hyg., 54(3): 131-137.
- Walker, I. A., Rashamwalla,and Wilson, I. H. (2012). Surgical Safety checklists: do they improve outcomes? British J. Anaesthesiol., 109(1): 47-54.
- Weese, J.S. (2008). A review of multidrug resistant surgical site infections. Vet. Comp. Orthop. Traumatol., 21(1):1-7.
References
Andrade, N., Schmiedt, C.W., Cornell K, Radlinsky, M.G., Heidingsfelder, L., Clarke, K., Hurley, D.J.and Hinson, W.D. (2016). Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery. Vet. Surg., https://doi.org/10.1111/vsu.12483.
Basak, S., Singh, P. and Rajurkar, M. (2016). Multidrug resistant and extensively drug resistant bacteria: A study. J. Pathogens, Pp 1-5. Resistant Bacteria: A Study. Journal of Pathogens, www.dx.doi.org/10.1155/2016/4065603.
Bauer, A.W., Kirby, W.M.M., Sherris, J.C.and Turck, M. (1966). Antibiotic susceptibility testing by a standardized single disk method. Am. J. Clin. Pathol., 36: 493-496.
CDC (2014). Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP) Accessed from www.cdc.gov/hai/organisms/organisms.html on 23rd April, 2020 2018.
Chaudhary, R., Thapa, S.K., Rana, J.C.and Shah, P.K. (2017). Surgical site infections and antimicrobial resistance pattern. J. Nepal Health Res. Counl., 15(36): 120-123.
Cheesbrough, M. (2006). District Laboratory Practice in Tropical Countries, 2nded. Cambridge University Press, Cambridge CB2 2RU, UK. 5th Printing, 2010: 45-70.
Clinical and Laboratory Standards Institute (CLSI) (2016). Performance standards for antimicrobial susceptibility testing; Twenty-sixth informational supplement. CLSI document M100-S26. Wayne, PA: Clinical and Laboratory Standards Institute
Davis., M.F., Iverson, S.A, Baron, P., Vasse, A, Silbergeld, E.K., Lautenbach, E.and Morris, D.O. (2012). House.hold transmission of meticillin-resistant Staphylococcus aureus and other staphylococci. Lancet Infect. Dis., 12: 703-716.
De Oliveira, A.C.and Gama, C.S. (2016). Surgical antisepsis practices and use of surgical gloves as a potential risk factors to intraoperative contamination. Esc. Ann. Nery, 20(2):370-377.
Godebo G., Kibru, G.and Tassew, H. (2013). Multidrug-resistant bacteria isolates in infected wounds at Jimma University Specialized Hospital, Ethiopia. Ann. Clin. Microbiol. and Antimicrob., Pp. 12: 17.
Harper, T. A. M., Bridgewater, S., Brown, L., Pow-Brown P., Stewart-John, A.and Adesiyun, A.A. (2013). Bioaerosol sampling for airborne bacteria in a small animal veterinary teaching hospital. Inf. Ecol. Epidemiol., 3(1): 20376.
Meakins, L.B., Gilman, O.P., Parsons, K.J, Burton, N.J.and Langley-Hobbs, S.J. (2016). Colored indicator undergloves increase the detection of glove perforations by surgeons during small animal orthopedic surgery: A randomized controlled trail. Vet. Surg., 45(6): 709-714.
Mundhada, A.S.and Tenpe, S. (2015). A study of organisms causing surgical site infections and their antimicrobial susceptibility in a tertiary care Government Hospital. Indian J. Pathol. Microbiol., 58:195-200.
Nelson, L. (2011). Surgical site infections in small animal surgery. Vet. Clin. Small Anim., 41:1041-1056.
Pirvanescu, H., Balasoiu, M., Ciurea, M.E., Balasoiu, A.T.and Manescu, R. (2014). Wound infections with multidrug resistant bacteria. Chirurgia (Bucur), 109(1): 73-79.
Spagnolo, A.M., Ottria, G., Amicizia, D., Perdelli, F.and Cristina, M.L. (2013). Operating theater quality and prevention of surgical site infections. J. Prev. Med. Hyg., 54(3): 131-137.
Walker, I. A., Rashamwalla,and Wilson, I. H. (2012). Surgical Safety checklists: do they improve outcomes? British J. Anaesthesiol., 109(1): 47-54.
Weese, J.S. (2008). A review of multidrug resistant surgical site infections. Vet. Comp. Orthop. Traumatol., 21(1):1-7.