Document Type: Original Article

Authors

Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

Abstract

Objective: Emergency medical services systems are at the first line of dealing with patients who suffer from various infections. Conducting investigations on the bacterial contamination of emergency ambulances play a crucial role to improve the occupational health of staff as well as the quality of patient care. Therefore, the aim of the present study was to investigate the presence of Staphylococcus aureus and other life treating bacteria in the urban and rural ambulances and their on-call emergency medical service personnel.
Methods: This descriptive cross-sectional study was conducted on 12 front line pre-hospital emergency urban and rural ambulances in Kashan, Iran, in 2015. A total of 18 sites were sampled in each ambulance and from the nose of personnel. Grown colonies were confirmed based on colony morphology on mannitol salt agar plates, gram stain reaction and biochemical characteristics reactions.
Results: The S. aureus contamination was only isolated from the nose of on-call emergency medical service providers of 12 urban and road ambulances, while no sign of contamination was found in 18 sampling sites of these front-line ambulances. Also, further evaluation of these sampling sites revealed the contamination with coagulase-negative staphylococci in all of them and oxygen tank was introduced as the most contaminated site inside the ambulances. Moreover, the prevalence of equipment contamination was significantly higher in urban ambulances.
Conclusion: Identifying the rate of pathogens in clinical settings like the pre-hospital ambulance setting is an important issue which should be carefully considered.

Keywords

Main Subjects

1. Lowy FD. Staphylococcus aureus infections. N Engl J Med 1998; 339(8): 520-32. doi: 10.1056/nejm199808203390806.
2. Klein E, Smith DL, Laxminarayan R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999-2005. Emerg Infect Dis 2007; 13(12): 1840-6. doi: 10.3201/eid1312.070629.
3. Khan HA, Baig FK, Mehboob R. Nosocomial infections: epidemiology, prevention, control and surveillance. Asian Pac J Trop Biomed 2017; 7(5): 478-82. doi: 10.1016/j.apjtb.2017.01.019.
4. Thompson RL, Cabezudo I, Wenzel RP. Epidemiology of nosocomial infections caused by methicillinresistant
Staphylococcus aureus. Ann Intern Med 1982; 97(3): 309-17. doi: 10.7326/0003-4819-97-3-309
5. Askari E, Soleymani F, Arianpoor A, Tabatabai SM, Amini A, Naderinasab M. Epidemiology of mecAmethicillin resistant Staphylococcus aureus (MRSA) in Iran: a systematic review and meta-analysis. Iran J Basic Med Sci 2012; 15(5): 1010-9.
6. Green BN, Johnson CD, Egan JT, Rosenthal M, Griffith EA, Evans MW. Methicillin-resistant Staphylococcus aureus: an overview for manual therapists. J Chiropr Med 2012; 11(1): 64-76. doi:10.1016/j.jcm.2011.12.001.
7. Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG Jr. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28(3): 603- 61. doi: 10.1128/cmr.00134-14.
8. O’Hara NB, Reed HJ, Afshinnekoo E, Harvin D, Caplan N, Rosen G, et al. Metagenomic characterization of ambulances across the USA. Microbiome 2017; 5(1):125. doi: 10.1186/s40168-017-0339-6.
9. Assiri AM, Hathout HM, Anwar MM, El Dalatony MM, Abdel Kader NM. Occupational infections among health care workers in a secondary care hospital Saudi Arabia. Occup Med Health Aff 2013; 1(7): 1-4. doi: 10.4172/23296879.1000137.
10. Malangu N, Legothoane A. Analysis of occupational infections among health care workers in Limpopo province of South Africa. Glob J Health Sci 2012; 5(1): 44-51. doi: 10.5539/gjhs.v5n1p44.
11. Subramanian GC, Arip M, Saraswathy Subramaniam TS. Knowledge and risk perceptions of occupational infections among health-care workers in Malaysia. Saf Health Work 2017; 8(3): 246-9. doi: 10.1016/j.shaw.2016.12.007.
12. Mansury D, Ghavidel M, Ghazvini K. Latent tuberculosis infection in health care workers: review article. Tehran University Medical Journal 2018;75(10): 708-14.
13. Rago JV, Buhs LK, Makarovaite V, Patel E, Pomeroy M, Yasmine C. Detection and analysis of Staphylococcus aureus isolates found in ambulances in the Chicago metropolitan area. Am J Infect Control 2012; 40(3):201-5. doi: 10.1016/j.ajic.2011.08.021.
14. Nigam Y, Cutter J. A preliminary investigation into bacterial contamination of Welsh emergency ambulances. Emerg Med J 2003; 20(5): 479-82. doi: 10.1136/emj.20.5.479.
15. Vinodhkumaradithyaa A, Uma A, Shirivasan M, Ananthalakshmi I, Nallasivam P, Thirumalaikolundusubramanian P. Nasal carriage of methicillin-resistant Staphylococcus aureus among surgical unit staff. Jpn J Infect Dis 2009; 62(3): 228-9.
16. Al Amiry A, Bissell RA, Maguire BJ, Alves DW. Methicillin-resistant Staphylococcus aureus nasal colonization prevalence among emergency medical services personnel. Prehosp Disaster Med 2013; 28(4): 348-52. doi: 10.1017/s1049023x13003476.
17. Eveillard M, Martin Y, Hidri N, Boussougant Y, Joly-Guillou ML. Carriage of methicillin-resistant Staphylococcus aureus among hospital employees: prevalence, duration, and transmission to households.Infect Control Hosp Epidemiol 2004; 25(2): 114-20. doi: 10.1086/502360.
18. Solberg CO. Spread of Staphylococcus aureus in hospitals: causes and prevention. Scand J Infect Dis 2000; 32(6): 587-95.
19. Roline CE, Crumpecker C, Dunn TM. Can methicillin-resistant Staphylococcus aureus be found in an ambulance fleet? Prehosp Emerg Care 2007;11(2): 241-4. doi: 10.1080/10903120701205125.