Healthcare-Associated Infections and Environmental Contamination in ICU Settings: A Persistent Challenge

Abstract

Background & Aims: Healthcare-associated infections remain a major threat in intensive care units, where environmental reservoirs promote pathogen persistence and antimicrobial resistance. Despite national infection-control programs, limited data exist on surface contamination in intensive care units in Jazan, Saudi Arabia. Methods: A cross-sectional study was conducted in intensive care units and pediatric intensive care units of a central hospital and a general hospital. Sixty-five swab samples were collected from five high-touch surfaces per bed—bed rails, ventilator panels, cardiac monitors, and infusion pumps. Samples were cultured on blood and MacConkey agars; isolates were identified using standard microbiological methods and the VITEK system. Antimicrobial susceptibility was assessed by the Kirby–Bauer method following Clinical and Laboratory Standards Institute guidelines. Results: Overall, 76.9% of samples yielded bacterial growth on blood agar and 21.5% on MacConkey agar. Bed rails were the most contaminated (>90%), followed by ventilator panels and monitor keypads. Seventy-eight isolates were recovered, dominated by Enterobacteriaceae (62.8%) and Pseudomonas spp. (29.5%)Staphylococcus aureus (including two methicillin-resistant isolates) and Candida species accounted for 15.4% and 3.8%, respectively. CH showed higher overall contamination (88%) than GH (52%, p < 0.05), while GH exhibited a higher proportion of Gram-negative isolates (32% vs. 16%). Among Enterobacteriaceae, 70% were resistant to ampicillin, 40% to gentamicin, and 25% were multidrug-resistant. Pseudomonas showed 30% piperacillin resistance, and all methicillin-resistant Staphylococcus aureus isolates were oxacillin-resistant. Conclusion: Intensive care unit environments in Jazan hospitals display contamination with clinically relevant and resistant bacteria. Strengthened cleaning protocols, targeted disinfection of high-touch surfaces, and enhanced antimicrobial stewardship are essential to mitigate Healthcare-associated infections and antimicrobial resistance transmission.

References

1. 1.World Health Organization. Global report on infection prevention and control. Geneva: WHO; 2023.
2. 2.Allegranzi B, Bagheri Nejad S, et al. Burden of endemic healthcareassociated infection in developing countries: systematic review and metaanalysis. Lancet. 2011;377(9761):228–
3. 3.O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. London: UK Government; 2016.
4. 4.Tacconelli E et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibioticresistant bacteria. Lancet Infect Dis. 2018;18(3):318–327.
5. 5.Vincent JL et al. Infections in adult intensive-care units in 2017: a global perspective. Intensive Care Med. 2020;46:1783–1799.
6. 6.Zimlichman E et al. Health care– associated infections: a meta-analysis of costs and financial impact on the US health care system.JAMA Intern Med. 2013;173(22):2039–2046.
7. 7.World Health Organization. Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. Geneva: WHO; 2017.
8. 8.AlotaibiBetal.Antimicrobialresistance in intensive care units in Saudi Arabia: a multicenter surveillance study. Saudi Med J.2021;42(5):543–552.