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OJHAS Vol. 9, Issue 3:
(Jul - Sep, 2010) |
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| Pen of Health
Care Worker as Vector of Infection |
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Prashant Patil, Sandip
Hulke, Avinash Thakre, Manisha Gaikwad,
Laxmi Narayan Medical College, Bhopal |
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Address For Correspondence |
Prof &
Head, Dept. of Physiology,
LNMC,
Bhopal.
E-mail:
prashantpatil1411@gmail.com |
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Patil P, Hulke S, Thakre A, Gaikwad M. Pen of Health
Care Worker as Vector of Infection. Online J Health Allied Scs.
2010;9(3):15 |
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Submitted: May 29, 2010;
Suggested revision: Jul 13, 2010; Resubmitted: Jul 18, 2010; Accepted:
Sep29, 2010; Published: Oct 15, 2010 |
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| Abstract: |
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Nosocomial
infections are the major concern in tertiary hospitals. Health care
workers and their belonging are known to act as vector in transmission
of infections. In present study, the writing pen of health care workers
was worked out for carrying infection. The swab from writing pen of
health care workers were cultured for any growth of microorganism and
compared with swab from pen of the non health care workers. It was found
that the rate of growth of microorganism were more in pen of health
care workers. Similarly the organism attributed to the nosocomial infection
was grown from the pens of health care workers. These organisms might
be transmitted from the hands of health care workers. The writing pen
which health care worker are using became the vectors of transmission
of infection. So to prevent it, the most important way is to wash the
hands and pen properly after examining the patients.
Key Words:
Pen; Vector; Microorganism; Health care worker; Nosocomial infection |
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It
is well known fact that nosocomial infection is an important problem
in hospital. As early as in 1861, it was demonstrated that microorganism
were transmitted to the patient by the contaminated hands of health
care workers. In ICCU, ICU, NICU and operating room requires almost
sterilized/ disinfected atmosphere so as to carry out precious treatment.
Similarly persons working in these departments must have strict personal
hygiene so that they do not become vector of infection. Many of the
personal instruments of medical health care worker such as stethoscope,
mobile, pen are used by them on daily basis in hospital. It is well
known fact that stethoscope, mobile phones, apron of health care workers
act as a carrier of infection.(1-9) They carry potential
pathogens which can be transmitted from patients to patients. In the
same way the pen with which the doctor writes is also vehicle for carrying
pathogens. (10) Very few studies have been done to know the role of
personal pen of medical health care worker in carrying the potential
pathogens. In the present study, the role of pen as vector of infection
is evaluated in transmitting the pathogens in the hospital.
The
study was conducted in tertiary health care centre in Bhopal. Sample
size was 48. Samples were collected from the hospital and controls were
from the Medical College. A printed questionnaire was filled regarding
the hygiene practice and awareness.(Table 1)
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Table 1: Health Awareness among HCW and NHCW |
| |
HCW(48) |
NHCW(48) |
| Yes |
% |
No |
% |
Yes |
% |
No |
% |
| Do you know
pen can transmit infection? |
31 |
65.58 |
17 |
34.42 |
5 |
10.41
|
43 |
89.59
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| Do you wash
your hands regularly after examining the patients? |
12 |
25 |
36 |
75 |
- |
- |
- |
- |
| Do you clean
your pen regularly? |
0 |
0 |
48 |
100 |
0 |
0 |
48 |
100 |
Sample collection:
Separate
Decron swab with the polypropelene stick was used for taking the swabs.
The stick with the swab was rolled over area of pen coming in contact
with hand during writing. The swab was inoculated on the site in sheep
blood agar for culture in all four quadrant of the plate, and incubated
overnight at 370 C. Antibiotic sensitivity was done on
ready to use hi media disc (Makie Macurtney) as per protocol.(11) Such
sample collection was done on 48 writing pen from the hospital staff
using them daily. Similar sample collection was done 48 writing pen
from the staff of medical college, not working in the hospital (includes
clerical staff, class IV staff, and teaching staff).
The
bacterial growth was measured in the following manner.
0: No growth
1+: Growth
in 1 quadrant
2+: Growth
in 2 quadrant
3+: Growth
in 3 quadrant
4+: Growth
in all 4 quadrant
Identification
of growth was done on the basis of gram stain and appropriate biochemical
tests. The bacterial colonies were counted in all four quadrants where
growth was found. Analysis was done using student’s unpaired t test
and chi square test.
Out
of 96 subjects pen, 44 (91.66%) from the health care workers (HCW) showed
the positive growth of organisms while 34 (71.84 %) pens from non health
care workers (NHCW) showed the positive growth. In 4 (8.33%) pens from
health care workers (HCW) and 14 (29.16%) from non health care workers
(NHCW) showed no growth of organisms and difference was statistically
significant (p< 0.05).
Statistically
significant scanty, light, moderate and heavy growth of organisms was
seen in health care worker. 19 (39.58%), 10 (20.83%), 9 (18.75%) and
6 (12.5%) of the pen from HCW while 18 (37.5%), 11(22.91%), 3 (6.25%),
and 2 (4.16%) pens from NHCW showed the scanty, light, moderate and
heavy growth of organisms. (Table 2).
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Table 2:
Quantification of Growth |
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Quantification of growth |
PEN Hospital (n=48)
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PEN College (n=48) |
p
value |
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n |
F(%) |
n |
F(%) |
| No Growth |
4 |
8.33 |
14 |
29.16 |
0.0015* |
| Scanty Growth |
19 |
39.58 |
18 |
37.5 |
0.0236* |
| Llight
Growth
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10 |
20.83 |
11 |
22.91 |
0.0207* |
| Moderate Growth |
9 |
18.75 |
3 |
6.25 |
0.0004** |
| Heavy Growth |
6 |
12.5 |
2 |
4.16 |
0.0025** |
*p <
0.05 significant change; **p
< 0.01 very significant |
Commonest
type of organism grown was S. aureues. It was grown in 21 (43.75%)
in HCWS. In NHCWS S. epidermidis was the commonest organism &
was grown in 18 (37.5%). In HCW other pathogenic organism grown were
E. coli (9, 18.75%), Klebsiella (8, 16.66%), Enterobacter (9, 18.75%),
Diptheroids (10, 20.83%), Pseudomonas (5, 10.41%). Non pathogenic organism was found
in HCW, it was S. epidermidis (13, 27.08%). (Table 3)
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Table 3:
Type of Organism Grown |
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Type of organism |
PEN Hospital (n=48) |
PEN College (n=48) |
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n |
F(%)
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n
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F(%)
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| S.
aureus |
21 |
43.75 |
12 |
25 |
| E. coli |
9 |
18.75 |
6 |
12.5 |
| Klebsiella |
8 |
16.66 |
6 |
12.5 |
| Enterobacter |
9 |
18.75 |
10 |
20.83 |
| Pseudomonas |
5 |
10.41 |
2 |
4.16 |
| Diphtheroids |
10 |
20.83 |
8 |
16.66 |
| MRSA
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8 |
16.66 |
0 |
0 |
| S. epidermidis |
13 |
27.08 |
18 |
37.5 |
In
NHCWS pathogenic organism grown were E. coli (6, 12.5%), Klebsiella
(6, 12.5%), Enterobacter (10, 20.83%), Pseudomonas (24, 16%) while nonpathogenic
organism grown were S. epidermidis (18, 37.5%) & Diptheroids (8, 16.6%).(Table
3)
Average
number of colonies of bacteria were counted it was found that in all
above organism the number of colonies in HCWS were statistically significant
as compared with NHCW except for S. epidermidis where no significant
difference was seen.(Table 4)
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Table 4:
Frequency of Average Number of Colonies per Bacteria
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| Bacteria |
Pen (H) |
Pen (C) |
P Value |
| S.
aureus |
18.25 ± 9.452 |
6.458 ± 5.247 |
P<0.0001 |
| E. coli |
14.06 ± 7.361 |
5.708 ± 4.635 |
P<0.0001 |
| Klebsiella |
11.17 ± 7.725 |
3.958 ± 4.202 |
P<0.0001 |
| Enterobacter |
8.167 ± 6.058 |
2.063 ± 3.316 |
P<0.0001 |
| Pseudomonas |
22.27 ± 9.567 |
4.563 ± 4.907 |
P<0.0001 |
| Diphtheroids |
14.79 ± 6.240 |
2.604 ± 2.648 |
P<0.0001 |
| MRSA
|
7.271 ± 6.696 |
0 |
P<0.0001 |
| S.. epidermidis |
6.792 ± 6.977 |
8.729 ± 8.617 |
NS |
Methicillin
resistant S. aureus was found in 8(16.66%) of the pens of HCW while
in pen from NHCW it was 0 % (Table 3). Average numbers of colonies
for MRSA were 7.271±6.696. (Table 4).
In
the present study it has been seen that the writing pen used by the
health care workers is contaminated by the pathogens. This study indicated
that the contamination of the writing pen of HCWS is highly significant
when compared with the pen of NHCWS (P<0.01). In this study bacterial
load and its contamination on the pen was compared with HCWS and NHCWS
and we had not come across such study in India. One study was done by
Christian Diaz et al.(10)They also found that pens of health care worker
were highly contaminated by the potential pathogens. Comparative growths
of colonies from writing pens of HCWS were much more in our study. It
may be because of poor hygiene and hand washing practice in HCWS.
Similar
type of study was done on mobile phone and stethoscope.(1-5) In
these studies it has been found that mobile phones of HCW are significantly
contaminated by potential pathogens. Similar studies have been done
on the stethoscope and significant growth was seen on stethoscope.(1-5)
Most
important pathogens which were found in our studies are S. aureus,
E. coli, P. aeruginosa and Klebsiella. In other studies done
on mobile phone organism growth was same as in ours. This indicates
that these bacterial floras must be present in hospital environment.
MRSA was found in the pen from HCW there was no MRSA growth from NHCW. This
indicates that these strains of pathogens are also present in hospital
environment. These pathogens may have been transmitted from patient
to HCW hand which in turn are transmitted to other patients while examination.
In
response to our questionnaires it was found that most of the HCWS & NHCWS
do not know about the fact that there pen can be vehicle of transmission
of infection. It was found that 65.58% of the HCW acknowledged the fact
that the pen can be vector of transmission of infection while 10.41
% of NHCW acknowledged this fact. Only 25% of the HCW wash their hands
after examining patients. Fatma Ulger et al (9) found that the microorganisms
on the hands and mobiles phones were similar. That indicates that the
microorganisms are transmitted from the hands. So in the present study
the contamination of pen may due the hands. So the hand washing can
decrease the contamination of pen through the hands.
Resident flora of the body normally do not cause the infection unless
the person is immunocompromised, but the transient flora tends to be
more pathogenic and are responsible for nosocomial acquired infections.
These transient floras may be picked up by the hands of HCW when they
touch the patients or contaminated pen. So the frequent hand washing
could remove this transient flora.
- Semmelweiss IP,
Dic Aetilogic, der Begriff und die prophylaxis des kindbettfiebers. Budapest;
CA Harheben’s Verlag’s- Expendition. 1861
- Mangi RJ
et al. Contaminated stethoscope as a source of nosocomial infection.
Yale journal of Biology and Medicine. 1972;45:600-604.
- Youngster I et al. The stethoscope as vector of infectious disease in paediatric ward.
Acta
paediatric Sept 2008;97(9):1253-1255
- Chawla K et
al. Bacterial cell phones; do cell phones carry potential pathogens.
OJHAS 2009;8(1):8 Available at
http://www.ojhas.org/issue29/2009-1-8.htm
- Jones JS et al.
Stethoscope potential vector of infection? Ann Emergency Medicine Sept
1995:26(3):296-299.
- Tambekar DH et al.
nosocomial hands of doctor’s mobile phones in hospital. J Med Sci Jan 2008,8(1):73-76.
- Goldblatt JG et
al. Use of cellular telephones and transmission of pathogens by medical
staff in New York and Israel. Infection Control Hospital Epidemiology.
2007 Apr;28(4):500-503.
- Kitajama et al.
Prevention of methicillin resistant Staphylococcus aureus infection
in neonate. Paediatric International April 2003;45(2):238-245.
- Ulger F et al.
Are we aware how contaminated our mobile phones with nosocomial pathogens?
Ann. Clin. Micro and Antimicro 2009;8;7 doi 10.1186/1476-0711-8-7
- Diaz C et al. What’s on the doctor’s ball point pen?
The Lancet Dec 1997;350(9094):1824.
- Bauer AW, Kirby
WMM et al. Antibiotic susceptibility testing by standardized single
disc diffusion method. Am. J. Clin Pathology.1996:45:493-496
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