Assessment of the neonates’ physical environment for pathogens, through swabbing, at two selected referral hospitals in Rwanda

Abstract

Background: Healthcare-associated infections (HCAI) are estimated to be responsible for 1.7 million diseases and 99,000 deaths yearly. The neonates’ exposure to infections from the physical environment during the first 28 days of life can lead to sepsis, a down-regulation of neonates’ response mechanisms to an invasion of pathogens, resulting in potentially fatal organ dysfunction. Cross-contamination from healthcare personnel's hands accounts for 20- 40% of hospital-related infections. HCAIs from the physical environment harm about 15- 19% of patients in low-income countries, but there is limited information about the neonates’ environment in hospitals in Rwanda.

Purpose: To assess the neonates’ physical environment for pathogens, through swabbing at two selected referral hospitals in Rwanda.

Methods: A quantitative, observational cross-sectional design was used at two selected referral teaching hospitals. Data were gathered using an instrument of selected physical surfaces in NICU and HDU. Data were analyzed using IBM SPSS version 25. The Chi square test was used, and a p-value of < 0.05 was considered significant.

Results: Out of 80 swab samples collected in different areas in the NICU at KFH and the HDU at BUTH, 28 samples representing 35% of all swab samples had pathogen growth. The leading pathogen was Coagulase Negative Staphylococci (CoNS) at 17.5%, Bacillus spp 10.0%, Gram-Negative Bacillus 6.3%, Klebsiella pneumoniae 5.0%, Pseudomonas spp 2.5%, Candida spp 2.5% and Acinetobacter spp 1.3%. CoNS were most prevalent on plastic materials and surfaces. Bacillus spp and K. pneumoniae were predominantly identified on aluminium materials and surfaces. Gram negative Bacillus was shown to be the most prevalent contaminant on ceramic materials and surfaces.

Conclusion: The findings revealed the presence of seven types of pathogens in the neonates’ physical environment at BUTH and KFH. Emphasis on daily routine cleaning and disinfection precautions has to be enforced to increase the safety of hospitalised neonates. Regular testing of critical areas and surfaces, periodic general bleaching and fumigation may minimize cross-contamination within the neonates’ physical environments.