Volume 22, Issue 1 (4-2023)
TB 2023, 22(1): 47-60 |
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Ekrami A, hosseini M A, Ekrami H. Comparative Evaluation of the level of contamination of internal hospital surfaces, using two methods: nano biosensor and microbial culture. TB 2023; 22 (1) :47-60
URL: http://tbj.ssu.ac.ir/article-1-3452-en.html
URL: http://tbj.ssu.ac.ir/article-1-3452-en.html
USWR , mahmaimy2020@gmail.com
Keywords: Infection Control, Nanotechnology, Contamination Control Indicators, Healthcare-Associated Infections, Dye Detector Nanosensor
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Comparative Evaluation of the level of contamination of internal hospital surfaces, using two methods: nano biosensor and microbial culture
Ali Ekrami(MS.c)1, Mohammad Ali Hosseini(Ph.D.)2, Hasan Ekrami(B.S.)3
1.MSc in Nursing, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, (USWR) Tehran, Iran.
2.Corresponding auther:Professor of Nursing, Department of Nursing, University of Social Welfare and Rehabilitation Sciences (USWR) Tehran, Iran. Email: Ma.Hosseini @USWR.AC.IR Tel: (+98) 2122180083-92
3.BS in Nursing, Department of Nursing, Golestan University of Medical Sciences, Iran.
Abstract
Background: Today, out of every 5% to 10% of patients admitted to the hospital, one patient is involved in the complications of hospital infections, which has been confirmed to be directly related to the spread of these infections with the contamination of hospital surfaces. Therefore, it is very important to use an efficient method to identify microbial contamination. To this end, this study was carried out to compare the level of contamination of indoor hospital surfaces using two methods of dye detector nanosensor and microbial culture medium (traditional method).
Method: The present descriptive study was carried out with a sample size of 400 cases on ten types of medical equipment for three months using dye detector nanosensor and microbial culture medium. The results were reported as clean and contaminated.
Results: According to the results, 44% of the samples of microbial culture medium and 45.5% of nanosensors were reported positive (contaminated). The samples obtained from static microbial culture, ventilator, and the samples obtained from nanosensor, static, and pulse oximetry were identified as the most contaminated surfaces. Also, E. coli (55.68%), Staphylococcus aureus (28.9%), and Salmonella (23.86%) were recognized as the most common microorganisms.
Conclusion: The amount of contamination detected by both methods is acceptable due to the high sensitivity of both methods and lack of sterile surfaces. Therefore, in cases where only the detection of general contamination is considered, not isolation of bacteria, dye detector nanosensors can be used as a rapid method to control the contamination of surfaces instead of traditional methods.
Keywords: Infection Control, Nanotechnology, Contamination Control Indicators, Healthcare-Associated Infections, Dye Detector Nanosensor
References
1-Mosadeghrad AM, Qazanfari F, Keykhani S. Hospital Infection Control ACCreditation standards: A Comparative Review. Journal of Health and Safety at Work. 2022;12(1):99-122.
2-Noor A, Ishaq AR, Jafri L, Jabeen F, Rani R, Kiani BH, et al. Health Care Associated Infections (HCAIs) a New Threat for World; U-Turn from Recovery to Death. Campylobacter: IntechOpen; 2021.
3-Revelas A. Healthcare–associated infections: A public health problem. Nigerian medical journal: journal of the Nigeria Medical Association. 2012;53(2):59.
4-Haque M, Sartelli M, McKimm J, Bakar MA. Health care-associated infections–an overview. Infection and drug resistance. 2018;11:2321.
5-Tesini BL, Dumyati G. Health Care-Associated Infections in Older Adults: Epidemiology and Prevention. Infectious Disease Clinics. 2023;37(1):65-86.
6-Haque M, Sartelli M, McKimm J, Abu Bakar M. Catheter-Associated Urinary Tract Infections & Health Care-Associated Infections (HAI)-Brief Review. World J Case Rep 2022 Jan-Mar; 01 (1): 1. 2022;8.
7-Onosakponome EO, Nyenke CU, Okafor RA. Health Care Associated Infections.
8-Health UDo, Services H. Agency for Healthcare Research and Quality. (2003). Creating Partnerships, Improving Health: The Role of Community-Based Participatory Research. 2006:03-0037.
9-Kim JM, Park ES, Jeong JS, Kim KM, Kim JM, Oh HS, et al. Multicenter surveillance study for nosocomial infections in major hospitals in Korea. American journal of infection control. 2000;28(6):454-8.
10-Nuvials X, Palomar M, Alvarez-Lerma F, Olaechea P, Otero S, Uriona S, et al. Health-care associated infections. Patient characteristics and influence on the clinical outcome of patients admitted to ICU. Envin-Helics registry data. Intensive Care Medicine Experimental. 2015;3:1-2.
11-McLaws M-L, Taylor P. The Hospital Infection Standardised Surveillance (HISS) programme: analysis of a two-year pilot. Journal of Hospital Infection. 2003;53(4):259-67.
12-Mohammadi M, Vaisi Raiegan A, Jalali R, Ghobadi A, Salari N, Barati H. The prevalence of nosocomial infections in Iranian hospitals. Journal of Babol University of Medical Sciences. 2019;21(1):39-45.
13-Allegranzi B, Storr J, Dziekan G, Leotsakos A, Donaldson L, Pittet D. The first global patient safety challenge “clean care is safer care”: from launch to current progress and achievements. Journal of Hospital Infection. 2007;65:115-23.
14-Vincent J-L. Nosocomial infections in adult intensive-care units. The lancet. 2003;361(9374):2068-77.
15-Johnson NB, Hayes LD, Brown K, Hoo EC, Ethier KA. CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005–2013. 2014.
16-Henriksen K. Advances in patient safety: from research to implementation. 2005.
17-McDermid RC, Stelfox HT, Bagshaw SM. Frailty in the critically ill: a novel concept. Critical Care. 2011;15(1):1-6.
18-Chernow B. Variables affecting outcome in critically ill patients. Chest. 1999;115(5):71S-6S.
19-Dancer SJ. The role of environmental cleaning in the control of hospital-acquired infection. Journal of hospital Infection. 2009;73(4):378-85.
20-Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. American journal of infection control. 2010;38(5):S25-S33.
21-Otter JA, Yezli S, French GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infection Control & Hospital Epidemiology. 2011;32(7):687-99.
22-Aschkenasy MT, Rothenhaus TC. Trauma and falls in the elderly. Emergency Medicine Clinics. 2006;24(2):413-32.
23-García AM, Cross JH, Fitchett EJ, Kawaza K, Okomo U, Spotswood NE, et al. Infection prevention and care bundles addressing health care-associated infections in neonatal care in low-middle income countries: a scoping review. EClinicalMedicine. 2022;44:101259.
24-Forrester JD, Maggio PM, Tennakoon L. Cost of health care–associated infections in the United States. Journal of patient safety. 2022;18(2):e477-e9.
25-Darekordi A, Rezazadeh Zarandi E, Assar S, Rezahosseini O, Assar S. Diagnosis of bacterial infections; traditional and molecular methods: A narrative study. Journal of Rafsanjan University of Medical Sciences. 2018;17(9):865-80.
26-Ekrami M, Emam-Djomeh Z, Ghoreishy SA, Najari Z, Shakoury N. Characterization of a high-performance edible film based on Salep mucilage functionalized with pennyroyal (Mentha pulegium). International journal of biological macromolecules. 2019;133:529-37.
27-Ekrami M, Emam-Djomeh Z, Joolaei-Ahranjani P, Mahmoodi S, Khaleghi S. Eco-friendly UV protective bionanocomposite based on Salep-mucilage/flower-like ZnO nanostructures to control photo-oxidation of kilka fish oil. International Journal of Biological Macromolecules. 2021;168:591-600.
28-Mirzakhani M, Ekrami M, Moini S. Chemical composition, total phenolic content and antimicrobial activities of Zhumeria majdae. Journal of Food and Bioprocess Engineering (JFBE). 2018;1:8.
29-Ekrami A, Ghadermazi M, Ekrami M, Hosseini MA, Emam-Djomeh Z, Hamidi-Moghadam R. Development and evaluation of Zhumeria majdae essential oil-loaded nanoliposome against multidrug-resistant clinical pathogens causing nosocomial infection. Journal of Drug Delivery Science and Technology. 2022;69:103148.
30-Shakouri M, Salami M, Lim L-T, Ekrami M, Mohammadian M, Askari G, et al. Development of active and intelligent colorimetric biopolymer indicator: Anthocyanin-loaded gelatin-basil seed gum films. Journal of Food Measurement and Characterization. 2023;17(1):472-84.
31-Ekrami M, Ekrami A, Hosseini MA, Emam-Djomeh Z. Characterization and Optimization of Salep Mucilage Bionanocomposite Films Containing Allium jesdianum Boiss. Nanoliposomes for Antibacterial Food Packaging Utilization. Molecules. 2022;27(20):7032.
32-Ekrami M, Ekrami A, Moghadam RH, Joolaei-Ahranjani P, Emam-Djomeh Z. Food-based Polymers for Encapsulation and Delivery of Bioactive Compounds. Biopolymers in Nutraceuticals and Functional Foods: Royal Society of Chemistry; 2022. 488-544.
33-Ekrami M, Emam Jomeh Z. Effect of stearic acid on thermal, barrier and morphological properties of salep-based edible film. Journal of food science and technology (Iran). 2016;13(58):161-71.
34-Ekrami M, Emam Jomeh Z, Mirzakhani M. Physical and mechanical properties of biodegradable edible film obtained from Salep. Iranian Journal of Biosystems Engineering. 2014;45(1):45-51.
35-Ekrami A, Hosseini M-A, Fallahi-Khoshknab M. Assessing the sensitivity of the Nano-Biosensor Color Indicator as a method for identifying nosocomial infection reservoirs. Health Technology Assessment in Action. 2022;6(3).
36-Ekrami M, Roshani-Dehlaghi N, Ekrami A, Shakouri M, Emam-Djomeh Z. pH-Responsive Color Indicator of Saffron (Crocus sativus L.) Anthocyanin-Activated Salep Mucilage Edible Film for Real-Time Monitoring of Fish Fillet Freshness. Chemistry. 2022;4(4):1360-81.
37-Ekrami M, Ekrami A, Esmaeily R, Emam-Djomeh Z. Nanotechnology-based Formulation for Alternative Medicines and Natural Products: An Introduction with Clinical Studies. Biopolymers in Nutraceuticals and Functional Foods. 2022:545-80.
38-Leylabadlo HE, Pourlak T, Aghazadeh M, Asgharzadeh M, Kafil HS. Extended-spectrum beta-lactamase producing gram negative bacteria In Iran: A review. African journal of infectious diseases. 2017;11(2):39-53.
39-Karami G, Emtiyazipoor Z, Rasuli Ravandi F, Khazei M. EVALUATING THE EFFECT OF HOSPITAL MEDICAL INSTRUMENTS ON THE NOSOCOMIAL INFECTION RISK. The Journal of Urmia Nursing and Midwifery Faculty. 2015;13(7):579-87.
40-Malik RE, Cooper RA, Griffith CJ. Use of audit tools to evaluate the efficacy of cleaning systems in hospitals. American journal of infection control. 2003;31(3):181-7.
41-Sherlock O, O'Connell N, Creamer E, Humphreys H. Is it really clean? An evaluation of the efficacy of four methods for determining hospital cleanliness. Journal of Hospital Infection. 2009;72(2):140-6.
42-Ghodratollah K, Rezai Mofrad MR, Rabani D, Ghilasi HR. Evaluating the cleaning program efficacy in ICU ward of general hospital using visual and microbial approaches. Archives of Hygiene Sciences. 2014;3(1):30-6.
43-Boyce JM. Environmental contamination makes an important contribution to hospital infection. Journal of hospital infection. 2007;65:50-4.
44-Cooper RA, Griffith CJ, Malik RE, Obee P, Looker N. Monitoring the effectiveness of cleaning in four British hospitals. American journal of infection control. 2007;35(5):338-41.
45-Yousefi M. Investigation of Microbial Contamination in the Environment and Medical Equipment of Different Departments in Two Teaching Hospitals of Mashhad University of Medical Sciences.
46-Saleh HN, Kavosi A, Pakdel M, Yousefi M, Asghari FB, Mohammadi AA. Assessment health status of ICU medical equipment levels at Neyshabur hospitals using ICNA and ACC indices. MethodsX. 2018;5:1364-72.
47-Riyahin AA, Eshraghi M, Gharehbeglou M, Ahmadli Z, Karami G, Shahrzad ME. Evaluation of ICU microbial contamination in Qom hospitals using observational and microbial monitoring methods with three indices of observation, colony count, and Methicillin-Resistant S. AUREUS. Journal of Current Research in Science. 2014;2(6):788.
48-Monteiro A, Cardoso J, Guerra N, Ribeiro E, Viegas C, Cabo Verde S, et al. Exposure and health effects of bacteria in healthcare units: An overview. Applied Sciences. 2022;12(4):1958.
49-Akpochafor M, Eze C, Adeneye S, Ajekigbe A. Assessment of ultrasound equipment as a possible source of nosocomial infection in Lagos state hospitals and radio-diagnostic centres. Radiography. 2015;21(2):154-9.
Ali Ekrami(MS.c)1, Mohammad Ali Hosseini(Ph.D.)2, Hasan Ekrami(B.S.)3
1.MSc in Nursing, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, (USWR) Tehran, Iran.
2.Corresponding auther:Professor of Nursing, Department of Nursing, University of Social Welfare and Rehabilitation Sciences (USWR) Tehran, Iran. Email: Ma.Hosseini @USWR.AC.IR Tel: (+98) 2122180083-92
3.BS in Nursing, Department of Nursing, Golestan University of Medical Sciences, Iran.
Abstract
Background: Today, out of every 5% to 10% of patients admitted to the hospital, one patient is involved in the complications of hospital infections, which has been confirmed to be directly related to the spread of these infections with the contamination of hospital surfaces. Therefore, it is very important to use an efficient method to identify microbial contamination. To this end, this study was carried out to compare the level of contamination of indoor hospital surfaces using two methods of dye detector nanosensor and microbial culture medium (traditional method).
Method: The present descriptive study was carried out with a sample size of 400 cases on ten types of medical equipment for three months using dye detector nanosensor and microbial culture medium. The results were reported as clean and contaminated.
Results: According to the results, 44% of the samples of microbial culture medium and 45.5% of nanosensors were reported positive (contaminated). The samples obtained from static microbial culture, ventilator, and the samples obtained from nanosensor, static, and pulse oximetry were identified as the most contaminated surfaces. Also, E. coli (55.68%), Staphylococcus aureus (28.9%), and Salmonella (23.86%) were recognized as the most common microorganisms.
Conclusion: The amount of contamination detected by both methods is acceptable due to the high sensitivity of both methods and lack of sterile surfaces. Therefore, in cases where only the detection of general contamination is considered, not isolation of bacteria, dye detector nanosensors can be used as a rapid method to control the contamination of surfaces instead of traditional methods.
Keywords: Infection Control, Nanotechnology, Contamination Control Indicators, Healthcare-Associated Infections, Dye Detector Nanosensor
References
1-Mosadeghrad AM, Qazanfari F, Keykhani S. Hospital Infection Control ACCreditation standards: A Comparative Review. Journal of Health and Safety at Work. 2022;12(1):99-122.
2-Noor A, Ishaq AR, Jafri L, Jabeen F, Rani R, Kiani BH, et al. Health Care Associated Infections (HCAIs) a New Threat for World; U-Turn from Recovery to Death. Campylobacter: IntechOpen; 2021.
3-Revelas A. Healthcare–associated infections: A public health problem. Nigerian medical journal: journal of the Nigeria Medical Association. 2012;53(2):59.
4-Haque M, Sartelli M, McKimm J, Bakar MA. Health care-associated infections–an overview. Infection and drug resistance. 2018;11:2321.
5-Tesini BL, Dumyati G. Health Care-Associated Infections in Older Adults: Epidemiology and Prevention. Infectious Disease Clinics. 2023;37(1):65-86.
6-Haque M, Sartelli M, McKimm J, Abu Bakar M. Catheter-Associated Urinary Tract Infections & Health Care-Associated Infections (HAI)-Brief Review. World J Case Rep 2022 Jan-Mar; 01 (1): 1. 2022;8.
7-Onosakponome EO, Nyenke CU, Okafor RA. Health Care Associated Infections.
8-Health UDo, Services H. Agency for Healthcare Research and Quality. (2003). Creating Partnerships, Improving Health: The Role of Community-Based Participatory Research. 2006:03-0037.
9-Kim JM, Park ES, Jeong JS, Kim KM, Kim JM, Oh HS, et al. Multicenter surveillance study for nosocomial infections in major hospitals in Korea. American journal of infection control. 2000;28(6):454-8.
10-Nuvials X, Palomar M, Alvarez-Lerma F, Olaechea P, Otero S, Uriona S, et al. Health-care associated infections. Patient characteristics and influence on the clinical outcome of patients admitted to ICU. Envin-Helics registry data. Intensive Care Medicine Experimental. 2015;3:1-2.
11-McLaws M-L, Taylor P. The Hospital Infection Standardised Surveillance (HISS) programme: analysis of a two-year pilot. Journal of Hospital Infection. 2003;53(4):259-67.
12-Mohammadi M, Vaisi Raiegan A, Jalali R, Ghobadi A, Salari N, Barati H. The prevalence of nosocomial infections in Iranian hospitals. Journal of Babol University of Medical Sciences. 2019;21(1):39-45.
13-Allegranzi B, Storr J, Dziekan G, Leotsakos A, Donaldson L, Pittet D. The first global patient safety challenge “clean care is safer care”: from launch to current progress and achievements. Journal of Hospital Infection. 2007;65:115-23.
14-Vincent J-L. Nosocomial infections in adult intensive-care units. The lancet. 2003;361(9374):2068-77.
15-Johnson NB, Hayes LD, Brown K, Hoo EC, Ethier KA. CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005–2013. 2014.
16-Henriksen K. Advances in patient safety: from research to implementation. 2005.
17-McDermid RC, Stelfox HT, Bagshaw SM. Frailty in the critically ill: a novel concept. Critical Care. 2011;15(1):1-6.
18-Chernow B. Variables affecting outcome in critically ill patients. Chest. 1999;115(5):71S-6S.
19-Dancer SJ. The role of environmental cleaning in the control of hospital-acquired infection. Journal of hospital Infection. 2009;73(4):378-85.
20-Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. American journal of infection control. 2010;38(5):S25-S33.
21-Otter JA, Yezli S, French GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infection Control & Hospital Epidemiology. 2011;32(7):687-99.
22-Aschkenasy MT, Rothenhaus TC. Trauma and falls in the elderly. Emergency Medicine Clinics. 2006;24(2):413-32.
23-García AM, Cross JH, Fitchett EJ, Kawaza K, Okomo U, Spotswood NE, et al. Infection prevention and care bundles addressing health care-associated infections in neonatal care in low-middle income countries: a scoping review. EClinicalMedicine. 2022;44:101259.
24-Forrester JD, Maggio PM, Tennakoon L. Cost of health care–associated infections in the United States. Journal of patient safety. 2022;18(2):e477-e9.
25-Darekordi A, Rezazadeh Zarandi E, Assar S, Rezahosseini O, Assar S. Diagnosis of bacterial infections; traditional and molecular methods: A narrative study. Journal of Rafsanjan University of Medical Sciences. 2018;17(9):865-80.
26-Ekrami M, Emam-Djomeh Z, Ghoreishy SA, Najari Z, Shakoury N. Characterization of a high-performance edible film based on Salep mucilage functionalized with pennyroyal (Mentha pulegium). International journal of biological macromolecules. 2019;133:529-37.
27-Ekrami M, Emam-Djomeh Z, Joolaei-Ahranjani P, Mahmoodi S, Khaleghi S. Eco-friendly UV protective bionanocomposite based on Salep-mucilage/flower-like ZnO nanostructures to control photo-oxidation of kilka fish oil. International Journal of Biological Macromolecules. 2021;168:591-600.
28-Mirzakhani M, Ekrami M, Moini S. Chemical composition, total phenolic content and antimicrobial activities of Zhumeria majdae. Journal of Food and Bioprocess Engineering (JFBE). 2018;1:8.
29-Ekrami A, Ghadermazi M, Ekrami M, Hosseini MA, Emam-Djomeh Z, Hamidi-Moghadam R. Development and evaluation of Zhumeria majdae essential oil-loaded nanoliposome against multidrug-resistant clinical pathogens causing nosocomial infection. Journal of Drug Delivery Science and Technology. 2022;69:103148.
30-Shakouri M, Salami M, Lim L-T, Ekrami M, Mohammadian M, Askari G, et al. Development of active and intelligent colorimetric biopolymer indicator: Anthocyanin-loaded gelatin-basil seed gum films. Journal of Food Measurement and Characterization. 2023;17(1):472-84.
31-Ekrami M, Ekrami A, Hosseini MA, Emam-Djomeh Z. Characterization and Optimization of Salep Mucilage Bionanocomposite Films Containing Allium jesdianum Boiss. Nanoliposomes for Antibacterial Food Packaging Utilization. Molecules. 2022;27(20):7032.
32-Ekrami M, Ekrami A, Moghadam RH, Joolaei-Ahranjani P, Emam-Djomeh Z. Food-based Polymers for Encapsulation and Delivery of Bioactive Compounds. Biopolymers in Nutraceuticals and Functional Foods: Royal Society of Chemistry; 2022. 488-544.
33-Ekrami M, Emam Jomeh Z. Effect of stearic acid on thermal, barrier and morphological properties of salep-based edible film. Journal of food science and technology (Iran). 2016;13(58):161-71.
34-Ekrami M, Emam Jomeh Z, Mirzakhani M. Physical and mechanical properties of biodegradable edible film obtained from Salep. Iranian Journal of Biosystems Engineering. 2014;45(1):45-51.
35-Ekrami A, Hosseini M-A, Fallahi-Khoshknab M. Assessing the sensitivity of the Nano-Biosensor Color Indicator as a method for identifying nosocomial infection reservoirs. Health Technology Assessment in Action. 2022;6(3).
36-Ekrami M, Roshani-Dehlaghi N, Ekrami A, Shakouri M, Emam-Djomeh Z. pH-Responsive Color Indicator of Saffron (Crocus sativus L.) Anthocyanin-Activated Salep Mucilage Edible Film for Real-Time Monitoring of Fish Fillet Freshness. Chemistry. 2022;4(4):1360-81.
37-Ekrami M, Ekrami A, Esmaeily R, Emam-Djomeh Z. Nanotechnology-based Formulation for Alternative Medicines and Natural Products: An Introduction with Clinical Studies. Biopolymers in Nutraceuticals and Functional Foods. 2022:545-80.
38-Leylabadlo HE, Pourlak T, Aghazadeh M, Asgharzadeh M, Kafil HS. Extended-spectrum beta-lactamase producing gram negative bacteria In Iran: A review. African journal of infectious diseases. 2017;11(2):39-53.
39-Karami G, Emtiyazipoor Z, Rasuli Ravandi F, Khazei M. EVALUATING THE EFFECT OF HOSPITAL MEDICAL INSTRUMENTS ON THE NOSOCOMIAL INFECTION RISK. The Journal of Urmia Nursing and Midwifery Faculty. 2015;13(7):579-87.
40-Malik RE, Cooper RA, Griffith CJ. Use of audit tools to evaluate the efficacy of cleaning systems in hospitals. American journal of infection control. 2003;31(3):181-7.
41-Sherlock O, O'Connell N, Creamer E, Humphreys H. Is it really clean? An evaluation of the efficacy of four methods for determining hospital cleanliness. Journal of Hospital Infection. 2009;72(2):140-6.
42-Ghodratollah K, Rezai Mofrad MR, Rabani D, Ghilasi HR. Evaluating the cleaning program efficacy in ICU ward of general hospital using visual and microbial approaches. Archives of Hygiene Sciences. 2014;3(1):30-6.
43-Boyce JM. Environmental contamination makes an important contribution to hospital infection. Journal of hospital infection. 2007;65:50-4.
44-Cooper RA, Griffith CJ, Malik RE, Obee P, Looker N. Monitoring the effectiveness of cleaning in four British hospitals. American journal of infection control. 2007;35(5):338-41.
45-Yousefi M. Investigation of Microbial Contamination in the Environment and Medical Equipment of Different Departments in Two Teaching Hospitals of Mashhad University of Medical Sciences.
46-Saleh HN, Kavosi A, Pakdel M, Yousefi M, Asghari FB, Mohammadi AA. Assessment health status of ICU medical equipment levels at Neyshabur hospitals using ICNA and ACC indices. MethodsX. 2018;5:1364-72.
47-Riyahin AA, Eshraghi M, Gharehbeglou M, Ahmadli Z, Karami G, Shahrzad ME. Evaluation of ICU microbial contamination in Qom hospitals using observational and microbial monitoring methods with three indices of observation, colony count, and Methicillin-Resistant S. AUREUS. Journal of Current Research in Science. 2014;2(6):788.
48-Monteiro A, Cardoso J, Guerra N, Ribeiro E, Viegas C, Cabo Verde S, et al. Exposure and health effects of bacteria in healthcare units: An overview. Applied Sciences. 2022;12(4):1958.
49-Akpochafor M, Eze C, Adeneye S, Ajekigbe A. Assessment of ultrasound equipment as a possible source of nosocomial infection in Lagos state hospitals and radio-diagnostic centres. Radiography. 2015;21(2):154-9.
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Received: 2022/10/19 | Accepted: 2023/03/5 | Published: 2023/04/30
Received: 2022/10/19 | Accepted: 2023/03/5 | Published: 2023/04/30
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