الفهرس 
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Abstract
In the present work we conducted an observational study on adherence to contact
precautions prior to interventions planned by the institution‟s infection prevention and
control program. The study aimed to assess the proportion of patients indicated by positive
culture for which contact precautions were initiated, adherence to the contact precautions
protocol by staff members including doctors and nurses and differences in prevelance of
MDRO before and after educational program
In this study 150 patients(75 before training ,75 after training) were included and
were divided into 3 phases to observe transmission of MDR-bacteria before and after
training on contact precautions (sputum C/S,urine C/S,swab from wound C/S and blood
C/S were collected from each patient)
Klebsiella pneumoniae spp was the most common isolated organism (26.7%) isolated
mostly from sputum and urine , followed by E.coli spp(22.6%), Acinetobacter spp(18.7%),
MRSA spp(12%), Pseudomonas spp(4%) and proteus spp (1.3%). All klebsiella pneunoniae
isolates were sensitive to Colistin and Tigecycline, 75% were Resistant to Carbapenem.
All E.coli isolates were sensitive to Colistin and Tigecycline,while 46.7% were
sensitive to Amikacin,58.8% were sensitive to Tazobactam-Piperacillin.
All Acinetobacter isolates were sensitive to colistin and tigecycline, 35,7% were
sensitive to amikacin only. All MRSA isolates were sensitive to Vancomycin,
Clarithromycin, Clindamycin, Tigecycline and Erythromycin.
All pseudomonas isolates were sensitive to: tested Aminoglycosides (amikacin,
Gentamicin and Tobramycin) as well as Colistin.
However two isolates were sensitive to Meropenem (66.7%) and one isolate was
sensitive to Impenem(33.3%).
The one Proteus isolate was sensitive to Tazobactam-Piperacillin, Impenem and
Meropenem and resistant to all other antibiotics.
During pre interventional period, doctors were observed during this phase, It was
found that Gloving upon entering to patient was the most common practiced precaution
among all other taken precaution(62.9%),followed by Doffing gown & gloves after patient
contact(51.4%). However hand washing before donning and after doffing gown and gloves
was unsatisfactory(57.1%,60%)
It was noticed that, the more number of patients present in ICU (compared to
doctors), the less compliance of doctors to contact precautions.
Compliance of staff (nurse) to contact isolation precautions when dealing with
patients infected or colonized with MDRO in ICU, It was found that Gloving upon
entering to patient was the most common practiced precaution(54.3%). other precautions
results indicated poor compliance.
The more number of patient present in ICU (compared to nurse), the less compliance
of nurse to contact isolation precautions.
In the post interventional surveillance period E.coli was the most common isolated
organism (14.7%),followed by Acinetobacter spp (12%), klebseilla pneumonaie (10.6%),
MRSA (8%), proteus spp(2.7%) and pseudomonas spp(1.4%).
All isolates of E.Coli sensitive to Colistin &Tigecycline,90.9%were sensitive to
Meropenem and 63.6% were sensitive to Amikacin.
However all isolates were resistant to Trimethoprim-Piperacillin, Rifampicin,
Levofloxacin, Cefepime, Ceftazidime and Tobramycin.
All isolates of Acinetobacter were sensitive to Colistin & Tigecycline while 66,7%
were sensitive to Amikacin.
All Klebseilla isolates were sensitive to colistin &Tigecycline,87.5%were sensitive
to Meropenem,62.5% were sensitive to Amikacin.
All MRSA isolates were sensitive to: Vancomycin, Erythromycin, Clindamycin,
Clarithromycin and Tigecycline.
The two proteus isolates were sensitive to: Amikacin, Unasyin, Meropenem,
Gentamicin and Tazobactam-Piperacillin.
Pseudomonas isolate was sensitive to Colistin, Meropenem and Gentamicin.
After training there was significant reduction in number of bacterial isolates from
21.33% to 12.33% p value = 0.003*. This reduction was noticed among Klebseilla spp p
value = 0.020*
After training for ICU staff, there was significantly improvement in adherence to
contact precautions measures when dealing with MDRO patients. including hand washing
with Alcohol based solution (p<0.001* ) and gowning upon entering to patient (p<0.001*)
Other precautions also showed significant improvement As Gloving upon entering to
patient, Doffing gown & gloves and hand hygiene after doffing gown &gloves.