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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 27  |  Issue : 2  |  Page : 164-168

Bacterial contamination of medical equipment and surfaces in the main operating theater of Enugu State University Teaching Hospital


1 Department of Paediatrics, College of Medicine, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria
2 Department of Paediatrics, College of Medicine, University of Nigeria Enugu, Enugu, Nigeria
3 Department of Surgery, College of Medicine, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria
4 Department of Obstetrics and Gynaecology, College of Medicine, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria
5 Department of Community Medicine, College of Medicine, Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria
6 Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Enugu State, Nigeria
7 Department of Surgery, Enugu State University Teaching Hospital, Parklane, Enugu, Enugu State, Nigeria

Date of Submission26-Apr-2021
Date of Decision09-May-2021
Date of Acceptance07-Jan-2022
Date of Web Publication3-Mar-2022

Correspondence Address:
Chukwunonso C Iheji
Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, PMB 1030, Enugu, Enugu State.
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmh.IJMH_17_21

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  Abstract 

Background: Bacterial contamination of operating theaters is a major contributory factor to the high prevalence of post-operative nosocomial infections. The detection of changing trends of microbial counts and micro-flora is key to reducing microbial contamination and good antibiotic stewardship. Objective: The objective of this study was to identify bacterial colonization of surfaces and equipment in Enugu State University Teaching Hospital’s operating theater. It also aimed at determining the sensitivity patterns of the colonized surfaces. Materials and Methods: This cross-sectional study was conducted in the Main Theater of Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, Nigeria. Samples were collected from equipment, operating room surfaces, and cleaning solutions. Results: Out of 92 samples collected from various sites, bacterial growth was observed in 47 (51.1%) specimens. Coagulase-negative Staphylococcus (CoNS) was the most common isolate (36.2%), followed by Staphylococcus aureus (34%). Among S. aureus isolates, 43.8% were methicillin-resistant S. aureus (MRSA), and the remaining were methicillin-susceptible S. aureus (MSSA). There was high Gram-negative resistance to meropenem. All the Gram-negative isolates were susceptible to imipenem. Conclusion: CoNS and S. aureus were the commonest isolates. Increased efforts are needed to reduce the rate of healthcare-associated and surgical site infections in operating theaters.

Keywords: Antimicrobial susceptibility, bacterial, isolates, resistance, theater


How to cite this article:
Ndu IK, Chinawa JM, Emeka CK, Asinobi IN, Ekwochi U, Nduagubam OC, Enebe JT, Chinawa AT, Iheji CC, Onu NN, Eze TC. Bacterial contamination of medical equipment and surfaces in the main operating theater of Enugu State University Teaching Hospital. Int J Med Health Dev 2022;27:164-8

How to cite this URL:
Ndu IK, Chinawa JM, Emeka CK, Asinobi IN, Ekwochi U, Nduagubam OC, Enebe JT, Chinawa AT, Iheji CC, Onu NN, Eze TC. Bacterial contamination of medical equipment and surfaces in the main operating theater of Enugu State University Teaching Hospital. Int J Med Health Dev [serial online] 2022 [cited 2022 Dec 7];27:164-8. Available from: https://www.ijmhdev.com/text.asp?2022/27/2/164/339025




  Introduction Top


Microbial contamination of the hospital environment, especially in “hot zones” like operating theaters, has continued to increase the growing health problems of nosocomial and surgical site infections (SSIs).[1],[2],[3] These hospital-associated infections contribute significantly to patient morbidity and death.[4] Infections at the surgical site delay wound healing, prolong hospitalization, and increase morbidity and the overall costs of care; globally, SSIs account for up to 20% of all hospital-associated diseases.[5],[6] The average pre-operation burden of microbial contamination of operating theaters in Africa is 11.5%. The most common bacteria in operating theater contamination include Staphylococcus species accounting for about 40%, followed by Enterobacter and Escherichia coli.[7]

Reduction of microbial contamination, which depends primarily on improved cleaning and proper disinfection of the hospital environment, especially in high-risk areas, is crucial to stemming down the dissemination of these infections.[8] Environmental monitoring, which involves the microbiological testing of air, surfaces, and equipment, plays a vital role in infection control programs by detecting the changing trends of microbial counts and microflora.[9],[10]

This study was conducted to identify bacterial colonization of surfaces and equipment in Enugu State University Teaching Hospital’s operating theater and determine their sensitivity patterns. This will enhance the fight against healthcare-associated infection and SSI.


  Materials and Methods Top


This cross-sectional study was conducted in the Main Theater of Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria (ESUTH), in February 2020. The main theater complex has three suites with a recovery room and the intensive care unit. A total of 2678 surgeries were carried out in 2019, and the cases ranged from cesarean sections to exploratory laparotomies.

Before the study commenced, ethical approval was sought and obtained from the Research and Ethics Committee of the ESUTH, Enugu, with reference number ESUTHP/C-MAC/RA/034/VOL.11/176.

The sample size was 92 consisting of 25 floors/walls/windows (14 floor surfaces, 9 wall surfaces, 2 window surfaces), 18 electrical appliances (4 suction plug-ins, 4 air-conditioner switches, 3 cardiac monitor plug-ins, 3 light switches, 3 light switches, 1 anesthetic machines plug-ins), 13 doorknobs, 12 portable medical devices (4 surgical boots, 3 drip stands, 3 wheelchairs, 2 trolleys), 10 drums/instrument holder (8 drums, 2 instrument holders), 9 furniture surfaces (4 table surfaces, 4 table drawer handles, 1 chair arm-rest), 4 cleaning solutions (povidone-iodine, methylated spirit, Savlon, water), and 1 operating table.

Samples were collected using sterile cotton swabs soaked in normal saline (0.9% w/v) and were transported to Spectrum Diagnostic and Research Laboratories [The Centre and Coordinator for European Society for External Quality Assessment (ESfEQA) in Nigeria] and inoculated into CLED, Salmonella Shigella Agar, and blood agar. The inoculated agar plate was initially incubated at 37oC for 24–48 h. Distinct bacteria strains were selected based on colony, morphology, Gram staining, oxidase, and or catalase test.

Antimicrobial susceptibility testing was done for each isolate by the agar diffusion method using Standard Nutrient Agar 1 Discs. Methicillin-resistant Staphylococcus aureus (MRSA) were checked by cefoxitin disc using diffusion method; the cefoxitin disc was produced by Oxoid Ltd Company, UK.

Analysis of the data was done with Statistical Package for Social Sciences version 20.0 (Chicago, IL, USA), and results are presented in prose, tables, and charts.


  Results Top


Out of the 92 samples collected from various sites, bacterial growth was observed in 47 (51.1%) specimens, whereas the remaining 45 (48.9%) did not show bacterial growth. A total of 47 bacterial isolates were cultured from the 92 sites. Mixed bacterial flora was obtained from various sites. Coagulase-negative Staphylococcus (CoNS) was the most common isolate cultured from 17 different sites, followed by S. aureus from 16 sites. Details of the specimens and bacterial isolates are shown in [Table 1]. The majority of CoNS isolates were from walls/floors/window surfaces 23.5% (4/17) and portable medical appliances 23.5% (4/17), followed by drums 17.6% (3/17), furniture 17.6% (3/17), doorknobs 11.8% (2/17), and electrical appliances 5.9% (1/17). Of the S. aureus isolates, the majority were from walls/floors/window surfaces 37.5% (6/16) and furniture 37.5% (6/16), followed by portable medical appliances 12.5% (2/16), then doorknobs 6.3% (1/16), and electrical appliances 6.3% (1/16). Among S. aureus isolates, 43.8% (7/16) were MRSA, and the remaining were methicillin-susceptible S. aureus (MSSA). The antibiotic resistance profile of S. aureus isolates is shown in [Table 2]. Of all the antibiotics tested, S. aureus showed the highest resistance to meropenem 62.5% (10/16) and highest susceptibility to imipenem 6.3% (1/16). Among Gram-negative bacteria, E. coli, Pseudomonas, and Proteus were isolated. All the Gram-negative isolates were susceptible to imipenem. The antimicrobial resistance profile of Gram-negative isolates is depicted in [Table 3]. [Figure 1] shows the overall distribution of the bacterial isolates.
Table 1: Swabbed surfaces and their bacterial isolate

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Table 2: Antibiotic resistance pattern of S. aureus (MRSA and MSSA) isolates

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Table 3: Antibiotic resistance pattern of Gram-negative isolates

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Figure 1: Bacterial isolates

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  Discussion Top


Several studies have reported that healthcare service units’ contact surfaces are contaminated by different pathogens that might serve as a source of infections. Bacterial contamination of operating theaters has contributed significantly to the high prevalence of post-operative nosocomial diseases, leading to severe implications for patients and their families.[8],[11] Approximately 50% of SSIs could be avoided through the implementation of adequate preventive evidence-based strategies.[12] Environmental cleaning and disinfection procedures and the implementation of hygienic practices are essential in reducing bacterial contamination and the incidence of nosocomial infections.[12]

In the present study, 92 samples were collected from the hospital’s main operating theater with a bacterial contamination rate of 51.1% (n = 47). This is higher than what was obtained from similar studies in India (4.4%), Baghdad (4%), and Gaza (24.3%).[3],[13],[14] However, the prevalence of bacterial contamination reported in this study is lower than that reported in a survey conducted by Okon et al.[8] in Northeastern Nigeria.

CoNS was the most common isolate cultured, consistent with the similar reported studies.[12],[13],[14],[15] Coagulase-negative Staphylococci are known exogenous organisms usually found as normal skin flora. The majority of the CoNS in our review were isolated from hand contact surfaces (portable medical devices, walls, windows, drums, and doorknobs). This may be reflective of poor hand hygiene among theater staff. Although coagulase-negative Staphylococci are usually regarded as contaminants, they have been found to cause profound systemic infections in the immunocompromised host and have also been implicated in SSI post-median sternotomy.[16]

S. aureus was the second predominant isolate (n = 16) at 34%, which is very high. In similar studies, Najotra et al. reported a S. aureus prevalence of 2.9% in North India and Nwankwo et al. found a prevalence of 2.1% in Maiduguri, Northwest Nigeria. In contrast, Okon et al. at Kano Northeast did not isolate any S. aureus. S. aureus is a potential pathogen and a significant cause of SSI. It has been implicated in several studies as the most common cause of SSI.[17],[18],[19]

Of the Gram-negative bacteria, E. coli (19.1%), P. aeruginosa (6.4%), and Proteus spp. (4.3%) were isolated. This is consistent with the findings of other studies.[8],[11],[15]E. coli suggests fecal contamination and has been implicated in wound sepsis.[17],[18],[19]P. aeruginosa has multiple virulence determinants and intrinsic resistance to commonly used antibiotics and disinfectants and is responsible for many outbreaks in operating theaters.[15],[17],[19]

Furniture surfaces and portable medical devices were the most contaminated sites, whereas the operating table and antiseptic solutions showed no contamination evidence. The theater floor and operating table are cleaned and disinfected at the start of the day and in between surgical procedures. Other surfaces are cleaned when visibly dirty. The antiseptic solutions are freshly prepared, thus reducing the risk of bacterial contamination.

There was a considerable level of resistance of isolated organisms to antimicrobial agents. This may be due to antibiotic misuse, especially in developing countries.[7],[20]S. aureus was significantly resistant to meropenem and ceftriaxone. Similarly, Njoku and Njoku[20] reported high S. aureus resistance to ceftriaxone and meropenem in SSIs in Calabar, Nigeria. Gram-negative isolates showed multidrug resistance with the highest (100%) resistance to ampicillin. This is similar to findings by Okon et al.[8] and Matinyi et al.[7] in Nigeria and Uganda, respectively. E. coli possesses cascades that guard cell membrane permeability and produces Amp C β-lactamase, thus explaining its multi-drug resistance.[7]

Imipenem was the antibiotic to which all bacteria exhibited highest sensitivity. Similar observation was made by Njoku and Njoku[20] and Matinyi et al.[7] in their studies. This increased sensitivity may be due to limited use and hence limited exposure to these organisms.

Due to financial constraints, our study involved only the main theater. Hence, we could not ascertain microbial contamination of other surgical theaters, viz., ophthalmology, obstetrics, and casualty theaters.


  Conclusion Top


The level of bacterial contamination of the surgical operating theater in ESUTH is high. Hand contact surfaces and portable medical devices are the most contaminated sites. High resistance to meropenem and ceftriaxone was noted. Advocacy should be stepped up for adaptation and utilization of a standard cleaning protocol in surgical theaters and for effective antibiotic stewardship. These will reduce the rate of hospital-acquired infection and multi-drug antibiotic resistance.

Acknowledgments

We acknowledge the assistant researchers who helped in processing the data.

Authors’ contributions

NIK conceived and designed this study, whereas NIK, CKE, AIN, EU, NOC, EJT, CAT, ICC, ON, ATA, and TC helped in critical revision of the article. JMC and BFC also did the data analysis/interpretation. All authors have read and approved the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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