A Scoping Review of Fomites in Surgery Theaters and Intensive Care Units of Healthcare Facilities in Middle-Income Countries Public
Peng, Tzuhsuan (Spring 2021)
Published
Abstract
Background: Health care-associated infections (HCAIs) pose a substantial burden to healthcare systems and patient safety worldwide. This burden is even more critical in low- and middle-income countries (LMICs). While surgical site infection remains the most common type of HCAIs, critically ill patients in the intensive care unit (ICU) are also subject to HCAIs. A higher HCAI rate in LMICs is attributed to inadequate infection prevention and control (IPC) at healthcare facilities. Fomites, or inanimate objects that can carry pathogens, are often overlooked in IPC and decontamination instruction. As a result, this thesis aims to search the scientific literature to identify potential fomites in surgery theaters and ICUs that may serve as sources of pathogens related to HCAIs in order to inform and improve the World Health Organization’s IPC guidelines.
Methods: A scoping review was conducted to search PubMed, Embase, and CINAHL databases for articles published before February 2021, written in English, and available for abstract. Four main keywords were used for the database search: HCAI, ICU or surgery theater, fomite, and names of middle-income countries. Abstract and title were screened first using inclusion criteria, and subsequently, full texts were evaluated for final inclusion based on exclusion criteria.
Results: The initial database search yielded 241 articles. Of the 45 articles that satisfied the inclusion criteria, eight and 37 studies were carried out in surgery theaters and ICUs, respectively. Multiple medical equipment and supplies (laryngoscopes, suction tips, trolleys, incubators, beds, etc.), environmental surfaces (floor, sinks, tables, operation lamps, etc.), and personal items (mobile phones, clothes, etc.) were found as potential fomites that may threaten HCAI prevention and control. The main transmission routes of pathogens from a fomite to a patient were direct contact and indirect contact through health workers' hands or gloves that touched the fomite.
Conclusions: Various fomites that may be involved in HCAIs were reported. Recommendations for the World Health Organization’s IPC guidelines include monitoring bacterial resistance to disinfectants; coming to a consensus regarding the reuse of single-use medical devices; developing protocols for regular cleaning of personal items; and developing a policy on restricting mobile phone usage in theatres and ICUs.
Table of Contents
Chapter 1: Introduction 1
Chapter 2: Literature Review 4
Definitions and Types of Health Care-Associated Infections (HCAIs) 4
Burden of HCAI 5
HCAI and Fomites in the Surgery Theater 7
HCAI and Fomites in the ICU 8
HCAI Prevention and Control 10
WHO Development of IPC guidelines 11
Chapter 3: Methodology 13
Ethical Consideration 15
Chapter 4: Results 16
Fomites in the Surgery Theater 18
Fomites Related to Medical Equipment and Supplies in Surgery Rooms 18
Fomites Related to Environmental Surfaces in Surgery Rooms 20
Fomites Related to Personal Items in Surgery Rooms 21
Fomites in the ICU 21
Fomites Related to Medical Equipment and Supplies in ICUs 22
Fomites Related to Environmental Surfaces in ICUs 24
Fomites Related to Personal Items in ICUs 25
Transmission Route from Fomite to Patient 27
Chapter 5: Discussion, Conclusion and Recommendations 28
Discussion and Recommendations 28
Medical Equipment and Supplies as a Fomite 29
Environmental Surfaces as a Fomite 31
Personal Items as a Fomite 31
Limitations and Recommendations 32
Conclusion 33
References 35
Appendices 58
Appendix 1: Fomites and Associated Pathogens in the Surgery Theater 58
Appendix 2: Fomites and Associated Pathogens in the ICU 61
About this Master's Thesis
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Mot-clé | |
| Committee Chair / Thesis Advisor |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
A Scoping Review of Fomites in Surgery Theaters and Intensive Care Units of Healthcare Facilities in Middle-Income Countries () | 2021-05-01 13:55:31 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|