Abstract
OBJECTIVE The purpose of the study was to monitor the bacterial and fungal loads on the Chiropractic treatment tables used within the DFC Chiropractic Training Clinic at the University of Johannesburg, as well as to develop a hygiene protocol guideline. METHODOLOGY Surface samples were taken from the head piece and thoraco-abdominal sections of the chiropractic treatment tables at University of Johannesburg chiropractic-training clinic. Samples were taken using the RODAC (Replicate Organism Detection and Counting) agar contact plates with Tryptone Soya Agar (growth nutrients for bacteria and fungi) and two commonly used disinfectant neutralisers; Polysorbate 80 (inactivates phenols, hexachlorophene, and formalin) and Lecithin (neutralises quaternary ammonium compounds). Two of the chiropractic treatment tables were selected as control room tables, the surfaces of these tables were sampled before disinfection, and then sampled after disinfection to monitor the effectiveness of the disinfectant. The samples were collected over an 8 week period, on Mondays before the clinic opened and on Thursdays after the clinics’ normal hours of operation, in order to ensure none of the patients, students, or clinicians were aware of the study and thus change their normal habits. Samples were then counted to determine the bacterial and fungal counts on each plate and some organisms were isolated and identified via the VITEK® 2 instrument. All data from the samples collected on the chiropractic treatment tables were sent to STATKON and entered into an IBM SPSS 23.0 database. VI Before statistical analysis, the data set was reviewed and aligned by Ms. Juliana Van Staden, the project biostatistician, for ease of interpretation. RESULTS During the eight weeks of monitoring surface hygiene of experimental chiropractic treatment tables, the results demonstrated that the treatment tables are not adequately disinfected when compared to the control beds. Surface sampling results before and after disinfection of the control rooms (G13 and G35) chiropractic treatment tables demonstrated a 96% (1.4 log reduction) and 92% (1.1 log reduction) reduction was achievable, resulting in results comparable to proposed Levels of Hygiene (Adequate, Inadequate and Inadequate) as described by Wirtanen, Nurmi, Kalliohaka, Mattila, Heinonen, Enbom, Salo, and Salmela, (2012). Based on the control data these levels were adapted for the chiropractic clinic environment. Only 33% of the samples taken of the experimental chiropractic treatment tables had microbial loads below 10 CFU/25cm2 (which is below the Adequate level of hygiene (0 – 10 CFU/25cm2) as proposed in this research). 67% of the samples had Fair (11 - 25 CFU/25cm2) to Inadequate (>25 CFU/25cm2) Levels of Hygiene. When comparing the treatment table surfaces there were significant statistical differences (p-value = 0.025) in bacterial microbial loads (CFU/25cm2) on these surfaces. Bacterial microbial loads were greater on the head piece (Md = 16, IQR = 33) than on the thoraco-abdominal section (Md = 14, IQR = 26). Another significant statistical difference is noted on microbial loads (CFU/25cm2) between bacteria and fungi on the thoracoabdominal section of the treatment table (p-value = 0.005), there seems to be higher counts of fungi (Md = 20, IQR = 23) than bacteria (Md = 14, IQR = 26) on this surface. When comparing outside (peripheral) – (Md = 20, IQR = 23) – and inside (central) – (Md = 17.5, IQR = 19) – treatment rooms, a significant difference VII (p-value = 0.041) between the total fungal counts on the chiropractic treatment table surfaces was demonstrated. Another observation identified when studying the data between fungi and bacteria is the significant statistical difference (p-value = 0.000) in fungal counts from samples that were taken on Mondays (Md = 24, IQR = 20) and Thursdays (Md = 15, IQR = 21). DISCUSSION The results from the control rooms demonstrate that the disinfectant and disinfection procedure used by the researcher was effective enough to make a considerable reduction in bacterial and fungal contamination on the chiropractic treatment table surfaces. Results from the experimental treatment rooms demonstrated that there was poor hygiene practices amongst the chiropractic interns because of the high microbial counts. This may also be due to a number of other variables such as environmental factors, number of patients treated and the presence of resistant strains of bacteria or fungi microorganisms. The results did demonstrate that environmental factors do play a role in the growth and survival of the microorganisms and thus, should be considered as a variable when monitoring surface hygiene. CONCLUSION Overall, the information gathered in this study both supports and emphasizes the need for an effective disinfection protocol for the prevention of bacterial and fungal build-up on the chiropractic treatment tables at the UJ chiropractic-training clinic. This disinfection protocol was developed and is recommended for implementation within the clinic. It is important to also implement hygiene monitoring systems to monitor both the hygiene practices of the clinic staff and also identify possible pathogenic microorganisms on the treatment table surfaces or within the clinic environment.
M.Tech. (Chiropractic)