Surveillance on Antimicrobial Resistance: Bacteriological Monitoring and Resistance Profiles of Isolates from Surfaces and Equipment at a Ghanaian Tertiary Healthcare Facility

Surveillance on Antimicrobial Resistance: Bacteriological Monitoring and Resistance Profiles of Isolates from Surfaces and Equipment at a Ghanaian Tertiary Healthcare Facility | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Surveillance on Antimicrobial Resistance: Bacteriological Monitoring and Resistance Profiles of Isolates from Surfaces and Equipment at a Ghanaian Tertiary Healthcare Facility Hayford Odoi, Cornelius Cecil Dodoo, Maxwell J. Gbemu, Emmanuel D. Amesimeku, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6923718/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Oct, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted 14 You are reading this latest preprint version Abstract Nosocomial infections play a leading part in the infectious disease burden. Most developing countries, however, have no published data on nosocomial pathogens. This study was undertaken to determine the occurrence of pathogenic microbes contaminating different objects, medical equipment and electronic devices at selected wards in Ho Teaching Hospital (HTH). The methodology involved swabbing 15 different items in 14 selected wards at HTH. The surfaces were swabbed using guidelines by the International Organization for Standardization (ISO 14698-1). The samples were analysed through culture-based methods and biochemical assays. Susceptibility testing was conducted using the Kirby Bauer disk diffusion method employing guidelines from the Clinical Laboratory Standards Institute. Of the total 210 samples analysed, 53.8% (n = 113) were positive for bacteria. 134 bacterial isolates from ten different species were isolated. About 89% of these isolates were Gram-positive while Gram-negative isolates accounted for 11%. Staphylococcus aureus was the most abundant pathogen on all items sampled. Ciprofloxacin was the most active agent against the S. aureus isolates (n = 82, 75.9%) while resistance to tetracycline was high (n = 49, 45.54%). Multidrug-resistant strains of S. epidermidis, S. saprophyticus, S. marcescens, S. sonnei, S. typhi, K. pneumoniae, K. oxytoca and P. mirabilis were identified as contaminants on inanimate objects and equipment at HTH. The highest frequency of bacterial isolates was found in the Neonatal Intensive Care Unit. In conclusion, the high prevalence of Staphylococcus aureus and certain Gram-positive isolates on fomites at the HTH shows a potential risk of nosocomial infections. Nosocomial infection fomites Staphylococcus aureus Gram-negative bacteria Gram-positive bacteria Figures Figure 1 Figure 2 Introduction Infectious diseases remain the highest cause of death in the world, particularly in developing countries [ 1 ]. Healthcare-associated infections (HAI) are majorly responsible for increased morbidity and mortality resulting from infectious pathogens [ 2 ]. These infections become clinically apparent either during hospitalisation or 72 hours after discharge [ 3 ].The most frequent types of nosocomial infections include central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, and ventilator-associated pneumonia. Surgical site infections are the second most common type of HAI mainly caused by S. aureus which results in prolonged hospital stay and risk of death [ 4 , 5 ]. Pathogens that cause HAI usually come from the flora of patients and staff, while most of them are exogenously acquired from contaminated needles, the environment, and instruments[ 6 ]. Common among these pathogens include Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Escherichia coli, Enterobacter species and Proteus mirabilis [ 7 ]. Reports from the World Health Organisation indicate that intensive care units account for a higher risk of acquiring HAI. Thus about 30% of patients are affected by at least one episode of HAI with significant associated morbidity and mortality [ 8 ]. Hospital device surfaces and equipment such as thermometers, stethoscopes, beds, etc., are host to infectious organisms which can cause nosocomial infections. Telephones and intercom devices have been reported to aid in the transfer of opportunistic pathogens that cause nosocomial infections [ 9 ]. Intensive care units present a high risk of acquiring HAI [ 8 ]. Surveillance systems for nosocomial infections are deficient in most countries particularly developing ones [ 10 ]. Due to the complex and standardized principles for confirming infectious disease aetiologies, countries with limited resources struggle with the institution of surveillance systems for appropriate infection control [ 11 , 12 ]. Routine surveillance on the distribution and susceptibility of common pathogenic bacteria from hospital wards/units and hospital equipment provides data for assessing the effectiveness of infection prevention and control. In low- and middle-income countries, regular monitoring of HAI occurrence may be difficult at national levels and hence, national Ministries of Health report less to no information on the burden of HAI. According to a systematic review by Nejad and colleagues, 66% of developing countries have no published data at all [ 13 ]. There is limited data explaining the level of pathogenic microbial contamination in tertiary hospitals, especially in the Volta Region of Ghana. This study aimed to assess the prevalence of epidemiologically significant pathogenic microbes in selected wards/units of Ho Teaching Hospital (HTH) as well as their resistance profiles. Methods An analytical cross-sectional study was carried out on samples obtained from inanimate objects and equipment at various wards and units in HTH to identify the bacterial species contaminating the hospital environment. The items sampled include hospital equipment and items that are utilised by multiple healthcare professionals with the tendency to act as agents of cross-contamination. Study setting and study framework The study, which spanned a period of 6 months, was carried out at HTH, a referral hospital in the Volta Region of Ghana. The samples were taken from the wards (female surgical, male surgical, psychiatric medicine, isolation, labour, accidents & emergency, maternity, baby's, child health, male medical, female medical, gynaecological, and urological) and units (intensive care, neonatal intensive care). Materials and Equipment Growth media like blood agar, mannitol salt agar, pseudomonas cetrimide agar and MacConkey agar were used to isolate the bacteria contaminants in the samples. Sample collection 210 samples were taken from the various wards and care units. Sterile swab sticks were moistened in sterile normal saline and rolled over the targeted surfaces/equipment (thermometer, sphygmomanometer, stethoscope, infusion pumps, computer mouse, keyboard, telephone, main switches, front door handles, nurses, table, trolley, medication drawer tabs, pens, beds and thermometer). The samples were taken in the morning one hour after cleaning and disinfection of the various wards and units. Swabs were taken per ISO 14698-1 guidelines and labelled accordingly . Sample processing was done at the Microbiology Department of the HTH. All isolates were stored in brain heart infusion (Oxoid Ltd., England) with 15% glycerol at −20 °C for further research. Isolation and identification of bacteria from samples Stored samples were revived using nutrient broth in different test tubes for 24 hours at 37 o C. Samples were cultured on blood agar plates at 37°C for 48 hours. Discrete colonies from the blood agar were picked using a sterile platinum loop and Gram stain differentiated. Colonies were primarily identified by colony morphology, microscopy, and standard biochemical tests. Only pathogenic microbes were examined. Gram staining was carried out directly on one characteristic colony from the blood agar for confirmation as Gram-negative bacilli, Gram-positive bacilli or Gram-positive cocci. Biochemical tests like indole, citrate, oxidase and urease were used to confirm the identity of Gram-negative bacterial isolates whereas catalase and coagulase tests were used for Gram-positive isolates. Novobiocin disks were also used in the sensitivity test to differentiate coagulase-negative Staphylococcus epidermidis from Staphylococcus saprophyticus . These disks were gently placed at the centre of petri dishes which contained Muller Hinton’s agar with the growth of coagulase-negative bacterial isolates. Ability of the disk to inhibit growth showed the presence of S. epidermidis . On the other hand, resistance to the disk confirms the identity of S. saprophyticus . Antimicrobial susceptibility testing The isolated microorganisms were tested for susceptibility to commonly used antibiotics in HTH using the Kirby-Bauer disc diffusion technique according to the guidelines set by the Clinical and Laboratory Standards Institute (CLSI, 2022). Briefly, an overnight culture of organisms standardised to 0.5 McFarland was spread on Mueller-Hinton agar. Antibiotic discs containing ampicillin (10 µg), cefuroxime (30 µg), cefotaxime (30 µg), ceftriaxone (30 µg), tetracycline (30 µg), meropenem (10 µg), ciprofloxacin (5 µg), vancomycin (30 µg), amikacin (10 µg), trimethoprim/sulfamethoxazole (1.25 µg/23.75 µg), gentamicin (10 ug) and erythromycin (15 ug) were placed on the surface of the inoculated agar plate and incubated at 37 o C for 24 hr. The diameter of the zones of inhibition around each antibiotic disc was then measured and compared with breakpoint values in CLSI 2022 guidelines (M-100). Statistical analysis Data entry and statistical analysis were performed using Statistical Package for Social Science version 21 (SPSS) and Microsoft Excel 2021. Results Prevalence of bacterial isolates on the wards and units Of the total 210 samples analysed, 53.8% (n = 113) were positive for bacteria. 10 different species of bacteria were isolated from all the samples from the various wards and units (Figure 1). Out of the 10 species isolated, S. aureus had the highest prevalence (81%) while the remaining organisms had less than 5% prevalence. Distribution of Gram-positive and Gram-negative bacteria on the wards and units Three different species of Gram-positive bacteria were identified on the wards and units (Table 1). These were Staphylococcus aureus, Staphylococcus saprophyticus and Staphylococcus epidermidis. S. aureus was the most predominant contaminant of items in the various wards (n=109) and it was found on items in all the care units at the HTH. The Gram-negative organisms isolated from the samples include Klebsiella oxytoca, Klebsiella pneumoniae, Shigella sonnei, Proteus mirabilis, S. typhi, S. marcescens and non-pathogenic coliforms. S. marcescens was the most frequent Gram-negative pathogen (n=5) but was isolated in only four of the fourteen wards/units in the hospital. About 89% (n=119) of the isolates were Gram-positive while Gram-negative isolates accounted for 11% of the isolates. The highest frequency of bacterial isolates was found in the Neonatal Intensive Care Unit (n=17) whilst the lowest numbers were found on items from the Female surgical ward, Intensive Care Unit, Baby’s ward and Urology ward (n=2). Table 1. Distribution of identified bacterial species from surfaces swabbed at the various care units. Organism Number of bacterial species isolated per unit n % A B C D E F G H I J K L M N Staphylococcus aureus 10 2 10 2 2 9 11 13 12 2 12 13 9 2 109 81.3 Staphylococcus saprophyticus 1 1 2 4 3.0 Staphylococcus epidermidis 3 1 1 1 6 4.5 Serratia marcescens 1 1 2 1 5 3.7 Salmonella typhi 1 1 2 1.5 Proteus mirabilis 1 1 0.7 Shigella sonnei 2 2 4 3.0 Klebsiella pneumoniae 1 1 0.7 Klebsiella oxytoca 1 1 0.7 Non-pathogenic (Coliform) 1 1 0.7 TOTAL 10 2 11 2 3 14 13 15 17 2 15 16 12 2 134 Ward/Unit: A: Male surgical; B: Female Surgical; C: Psychological; D: Intensive Care E: Isolation; F: Labour; G: Accident and Emergency; H: Maternity; I: Neonatal Intensive Care; J: Baby’s; K: Children’s; L: Male Medical; M: Female Medical; N: Urology; n=Total number of isolates. Diversity of bacterial contaminants on the inanimate objects and equipment Most of the bacterial contaminants were abundant on beds and wheelchairs present in the various wards (Table 2). Thermometers and medication drawers had the highest microbial diversity with four distinct microbial species as contaminants. Beds, medication drawer tabs, trolleys, front door handles, stethoscopes and thermometers were contaminated with three bacterial species while pens, main switches, telephones and keyboards at the various wards/units had two species of microbial contaminants. Infusion pumps, pens and nurses’ tables were contaminated with only Gram-positive bacteria. Staphylococcus aureus was the most abundant pathogen on all items sampled. Table 2. Bacterial prevalence on swabbed surfaces. ORGANISM NUMBER OF ISOLATES ON SWABBED SURFACES Thermometer Sphygmomanometer Stethoscope Infusion pump Computer mouse Keyboard Telephone Main switches Door handles Nurses table Trolley Medication drawer Pens Beds Wheelchairs TOTAL Staphylococcus aureus 5 7 9 7 9 6 6 8 7 9 7 5 4 11 9 109 Staphylococcus saprophyticus 1 1 2 4 Staphylococcus epidermidis 1 1 1 2 1 6 Serratia marcescens 1 1 2 1 5 Salmonella typhi 1 1 2 Proteus mirabilis 1 1 Shigella sonnei 1 1 1 1 4 Klebsiella pneumoniae 1 1 Klebsiella oxytoca 1 1 Non pathogenic (Coliform) 1 1 Total number of organisms per swabbed item 8 9 10 7 10 7 7 9 10 9 9 8 6 14 11 134 Number of samples taken for each item = 15 Antibiotic resistance profiles of isolates The resistance patterns of the isolated microbes are shown in table 3 below. The isolates of S. aureus showed different resistance patterns with 12 of the isolates being resistant to four of the tested antibiotics. 16 of the isolates were resistant to three different antibiotics while 22 were resistant to two different agents. The most frequent pattern of resistance in the S. aureus isolates was GEN-ERY-TET-CIP while S. typhi, K. pneumoniae and P. mirabilis demonstrated a pattern of resistance that included more than six of the antibiotics tested. S. sonnei isolates were resistant to gentamicin, cefuroxime, ceftriaxone and cefotaxime. The S. typhi isolates were susceptible to tetracycline, ciprofloxacin and meropenem but resistance was observed against cefuroxime (100%), ceftriaxone (100%) and cefotaxime (100%) (Table 3). Table 3: Resistance pattern of bacteria isolates for inanimate objects and equipment at HTH Microorganism Resistance pattern Number of isolates S. aureus (n=109) CIP 3 ERY 6 GEN 9 TET 9 ERY-CIP 1 ERY-TET 7 GEN-CIP 2 GEN-ERY 2 GEN-TET 6 TET-CIP 4 ERY-TET-CIP 6 GEN-ERY-TET 8 GEN-TET-CIP 2 GEN-ERY-TET-CIP 12 S. epidermidis(n=6) GEN-TET 1 ERY 1 TET 1 S. saprophyticus (n=4) ERY-TET-CIP 1 ERY-CIP 1 Serratia marcescens(n=5) CRX-CTX 5 Shigella sonnei (n=4) CRX-GEN-AMP 4 Salmonella typhi(n=2) CTX-CTR-COT-CTX-GEN-AMK-VAN 2 Klebsiella pneumoniae (n=1) CRX-CTR-CTX-GEN-AMP-TET 1 Klebsiella oxytoca (n=1) CHL-CTR-TET-GEN 1 Proteus mirabilis (n=1) GEN-CRX-CHL-CTR-CTX-AMP-TET 1 Cefuroxime-CRX, Chloramphenicol-CHL, Gentamicin-GEN, Ampicillin-AMP, Ceftriaxone-CTR, Tetracycline-TET, Co-trimoxazole-COT, Cefotaxime-CTX Meropenem-MEM, Vancomycin-VAN, Ciprofloxacin-CIP, Amikacin-AMK. For S. aureus isolates, the most prevalent contaminant in the hospital environment, a resistance of 45.54% was observed towards tetracycline and a high susceptibility (75.99%) towards ciprofloxacin (Figure 2). Discussion Nosocomial infections are responsible for an estimated annual healthcare cost of 28–45 billion dollars globally [ 3 ]. In developing countries, the burden of nosocomial infections is high [ 1 ]. Surfaces in hospital environments are highly likely to get colonized by microorganisms which are pathogenic to humans [ 14 ]. These organisms can spread directly between patients and health workers. Surfaces like door handles, nurse station desks, beds, keyboards, telephones, trolleys, and stethoscopes are prone to contamination by pathogenic microorganisms. However, little attention is given to some of these surfaces during disinfection. The study therefore sought to assess potential sources of nosocomial infections in the Ho Teaching Hospital. Swabs from various surfaces in hospital care units/wards were used for the identification of different bacterial species in this study. The focus of this study was on common pathogenic bacterial species. We employed a method that aids routine bacteriological screening of surfaces in healthcare facilities in low- or- middle- income- countries like Ghana. Morphological and biochemical properties like oxidase negative reaction, production of acid on both butt and slant of triple sugar iron agar, indole reaction, catalase and coagulase tests were used for routine identification. Surfaces that are generally encountered by multiple staff were swabbed in all wards/units in the hospital. From a total of 210 surfaces swabbed, 53.8% had positive bacterial cultures indicating a high prevalence of bacterial contaminants on surfaces at the various hospital wards. This finding is confirmed by an earlier work by Tagoe and colleagues who isolated a high percentage of pathogenic and non-pathogenic microbes on fomites at hospitals in the Volta Region indicating a high potential risk of acquiring nosocomial infections [ 15 ]. In a related study, a high prevalence of nosocomial infections in tertiary and secondary care facilities in Ghana was also observed [ 16 ]. The prevalence of high bacterial contaminants in the wards/units could be due to a gap in environmental contamination control. This may be in the form of poor cleaning practices and disregard for standard cleaning and disinfection operating procedures. Surfaces of patient care equipment and inanimate objects such as infusion pumps, stethoscopes, front door handles, beds, wheelchairs and blood pressure apparatus could also be easily ignored during regular disinfection. Ten different bacterial species were identified at the various wards/units. The high microbial diversity identified on objects in the wards/units may lead to polymicrobial infections in both immunocompetent and immunocompromised patients. Gram-positive bacteria accounted for 89% (n = 119) while Gram-negative bacteria accounted for 11% (n = 17) of all bacterial cultures. This conforms to earlier findings [ 7 , 15 ] but contradicts reports by Labi and his colleagues, which indicated Gram-negative isolates as the most common nosocomial isolates [ 16 ]. Staphylococcus aureus accounted for about 92% of all the Gram-positive isolates, while S. marcescens and S. typhi were the most prevalent Gram-negative isolates. Also, S. aureus , a commensal pathogen, was the highest pathogenic isolate with high frequency on beds, stethoscopes, the mouse of computers, nurses’ tables and wheelchairs (Table 2 ). This confirms reports of S. aureus being among the most predominant organisms that are isolated in hospitals and the leading causes of HAIs in Ghana [ 7 , 16 , 17 ]. Some other studies have reported E. coli to be a major cause of nosocomial infections in sub-Saharan Africa, this was however not the case in our work [ 4 , 18 ]. The abundance of these isolates on surfaces could be because these surfaces get little or no cleaning although they are handled by multiple staff leading to a high level of contamination. Also, being a teaching hospital there are a lot of students undergoing training in various health programs accessing the facility occasionally; without proper infection prevention and control practices, these could present contamination. The presence of S. aureus is not surprising because of its ubiquitous nature on the skin and in the environment [ 19 ]. Staphylococci survive for days on some surfaces hence the prevalence of high cultures of Staphylococcus aureus and the detection of K. pneumoniae isolates on objects is a serious healthcare risk at the HTH. These bacterial species are among the six leading pathogens for deaths associated with resistance [ 20 ]. The resistance of the isolates to commonly prescribed antibacterials such as gentamicin, erythromycin, tetracycline, cefuroxime, co-trimoxazole, cefotaxime, meropenem, ciprofloxacin and vancomycin is particularly worrying. These antibiotics constitute the most accessible antibacterial therapeutic options at HTH which relies greatly on empiric therapy (96.8%) than definitive [ 21 ]. The evolution of multi-drug resistant bacterial strains on equipment and surfaces presents a risk of acquisition and spread of these nosocomial pathogens in the hospital. Moreover, the possible evolution of multiple drug-resistant strains in commensal S. aureus suggests the existence of an infectious risk with the possibility of the emergence of methicillin-resistant strains. Evidence of high rates of multi-drug resistance has been reported in hospitals in sub-Saharan Africa with prevalence above 40% [ 4 , 22 , 23 ]. We identified a high percentage of positive cultures in the neonatal intensive care unit (n = 17/134), male medical ward (n = 16/134) and the maternity ward with the least cultures in the intensive care unit and female surgical ward. The presence of healthcare teams and visitors on the wards and their consequent contact with different patients, objects and surfaces without adequate infection control procedures may enhance the possibility of pathogen dissemination if the necessary precautions (especially hand washing) are not observed. Data obtained on the distribution of the isolates from this study reflect some level of efficiency in cleaning and disinfection of hospital surfaces in general and encourage a strengthening of the principles of cleaning and disinfection of hospital surfaces. Conclusion This study shows a high prevalence of Staphylococcus aureus on different inanimate surfaces in wards/units at the Ho Teaching Hospital. The hospital beds were the most contaminated items whilst thermometers and medication drawers had the most diversity. The neonatal intensive care unit had the highest prevalence and diversity of microbes. This study also shows a high prevalence of resistant Gram-positive pathogens and multi-drug resistant Gram-negative bacterial strains as major contaminants of different inanimate surfaces in wards at the Ho Teaching Hospital. The results suggest the need for increased education on environmental disinfection and hospital hygiene. This data is meant to highlight the need to intensify local infection prevention and control measures in hospitals in Ghana. Abbreviations HAI: Healthcare-associated infections HTH: Ho Teaching Hospital Declarations Ethics approval and consent to participate Ethical clearance (UHAS-REC A.2[10] 21-22) for the study was obtained from the Research Ethics Committee of the University of Health and Allied Sciences, Ho, Ghana. This study did not involve any direct contact with humans or animals; it involved the swabbing of inanimate objects and surfaces. This research was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials All generated data have been provided within this manuscript. Access to raw data can be obtained from the corresponding author (Cornelius C. Dodoo, [email protected] ). Competing interests The authors declare no competing interests. Funding No external funding was received for this work. Authors’ Contributions Conceptualisation: HO, CCD; Methodology: HO, MJG, EDA, KA, BA, KT, SK, CB, FA, CCD, PM; Data analysis: HO, CCD; Writing—original draft: HO, CCD; Writing—review and editing: MJG, EDA, KA, BA, KT, SK, CB, FA, PM Acknowledgements We are grateful to the staff and management of the Ho Teaching Hospital for their support and assistance during the conduct of this study. References Melariri H, Freercks R, van der Merwe E, Ham-Baloyi W Ten, Oyedele O, Murphy RA, et al. The burden of hospital-acquired infections (HAI) in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine. 2024;71. Leggett HC, Cornwallis CK, Buckling A, West SA. Growth rate, transmission mode and virulence in human pathogens. Philosophical Transactions of the Royal Society B: Biological Sciences. 2017;372. Kollef MH, Torres A, Shorr AF, Martin-Loeches I, Micek ST. Nosocomial Infection. Crit Care Med [Internet]. 2021;49. Available from: https://journals.lww.com/ccmjournal/fulltext/2021/02000/nosocomial_infection.2.aspx Diop M, Bassoum O, Ndong A, Wone F, Ghogomu Tamouh A, Ndoye M, et al. Prevalence of multidrug-resistant bacteria in healthcare and community settings in West Africa: systematic review and meta-analysis. BMC Infect Dis. BioMed Central Ltd; 2025. Bunduki GK, Masoamphambe E, Fox T, Musaya J, Musicha P, Feasey N. Prevalence, risk factors, and antimicrobial resistance of endemic healthcare-associated infections in Africa: a systematic review and meta-analysis. BMC Infect Dis. 2024;24. Jain A, Agarwal A, Verma RK, Awasthi S, Singh KP. Intravenous device associated blood stream staphylococcal infection in paediatric patients. Indian J Med Res. 2011;134:193–9. Aku FY, Akweongo P, Nyarko K, Sackey S, Wurapa F, Afari EA, et al. Bacteriological profile and antibiotic susceptibility pattern of common isolates of neonatal sepsis, Ho Municipality, Ghana-2016. Matern Health Neonatol Perinatol. 2018;4. Zaidi AKM, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. The Lancet [Internet]. 2005;365:1175–88. Available from: https://doi.org/10.1016/S0140-6736(05)71881-X Walia SS, Manchanda A, Narang RS, Anup N, Singh B, Kahlon SS. Cellular telephone as reservoir of bacterial contamination: Myth or fact. Journal of Clinical and Diagnostic Research. 2014;8:50–3. Okolie OJ, Igwe U, Ismail SU, Ighodalo UL, Adukwu EC. Systematic review of surveillance systems for AMR in Africa. Journal of Antimicrobial Chemotherapy. 2023;78:31–51. Bengtsson-Palme J, Abramova A, Berendonk TU, Coelho LP, Forslund SK, Gschwind R, et al. Towards monitoring of antimicrobial resistance in the environment: For what reasons, how to implement it, and what are the data needs? Environ Int. Elsevier Ltd; 2023. Alp E, Leblebicioglu H, Doganay M, Voss A. Infection control practice in countries with limited resources. Ann Clin Microbiol Antimicrob. 2011. Nejad SB, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ. 2011;89:757–65. Rosenthal VD, Maki DG, Salomao R, Moreno CÁ, Mehta Y, Higuera F, et al. Device-Associated Nosocomial Infections in 55 Intensive Care Units of 8 Developing Countries. Ann Intern Med [Internet]. 2006;145:582–91. Available from: https://doi.org/10.7326/0003-4819-145-8-200610170-00007 Tagoe DNA, Baidoo SE, Dadzie I, Tengey D, Agede C. Potential sources of transmission of hospital-acquired infections in the Volta Regional Hospital in Ghana. Ghana Med J. 2011;45. Labi AK, Obeng-Nkrumah N, Owusu E, Bjerrum S, Bediako-Bowan A, Sunkwa-Mills G, et al. Multi-centre point-prevalence survey of hospital-acquired infections in Ghana. Journal of Hospital Infection. 2019;101:60–8. Newman MJ, Frimpong E, Donkor ES, Opintan JA, Asamoah-Adu A. Resistance to antimicrobial drugs in Ghana. Infect Drug Resist. 2011;4:215–20. Raoofi S, Kan FP, Rafiei S, Hosseinipalangi Z, Mejareh ZN, Khani S, et al. Global prevalence of nosocomial infection: A systematic review and meta-analysis. PLoS One. 2023;18. Girma A. Staphylococcus aureus: Current perspectives on molecular pathogenesis and virulence. Cell Surface. Elsevier B.V.; 2025. Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022;399:629–55. Dodoo CC, Orman E, Alalbila T, Mensah A, Jato J, Mfoafo KA, et al. Antimicrobial prescription pattern in ho teaching hospital, ghana: Seasonal determination using a point prevalence survey. Antibiotics. 2021;10:1–11. Kasanga M, Kwenda G, Wu J, Kasanga M, Mwikisa MJ, Chanda R, et al. Antimicrobial Resistance Patterns and Risk Factors Associated with ESBL-Producing and MDR Escherichia coli in Hospital and Environmental Settings in Lusaka, Zambia: Implications for One Health, Antimicrobial Stewardship and Surveillance Systems. Microorganisms. 2023;11. Dodoo CC, Odoi H, Mensah A, Asafo-Adjei K, Ampomah R, Obeng L, et al. Development of a local antibiogram for a teaching hospital in Ghana. JAC Antimicrob Resist. 2023;5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Oct, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 05 Aug, 2025 Reviews received at journal 21 Jul, 2025 Reviews received at journal 16 Jul, 2025 Reviews received at journal 15 Jul, 2025 Reviewers agreed at journal 11 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviewers agreed at journal 07 Jul, 2025 Reviewers agreed at journal 25 Jun, 2025 Reviewers agreed at journal 25 Jun, 2025 Reviewers invited by journal 25 Jun, 2025 Editor assigned by journal 25 Jun, 2025 Editor invited by journal 23 Jun, 2025 Submission checks completed at journal 21 Jun, 2025 First submitted to journal 21 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6923718","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":476558412,"identity":"a2b3f491-94de-456a-8b84-d4a4030d3724","order_by":0,"name":"Hayford Odoi","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hayford","middleName":"","lastName":"Odoi","suffix":""},{"id":476558413,"identity":"7ddac32c-57d9-4ca3-8efc-338867aedb17","order_by":1,"name":"Cornelius Cecil Dodoo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYFCCBAYJBgYbBgMwhw2IJYjTkka6lsMkaOFvTz5440PF+cTt7McfMHwoO8wgH92AX4vEmWfJljPO3E7c2ZNjwDjj3GEGwzsH8GsxkMgxk+Ztu5244UAOAzNvG1DLjASitJxL3HD++QPmvyRoOZC44UaCATMjUIu8BAEtUL8kG2+48cbgYM+5dB4DQlqgIWYnu+F8+sMHP8qs5eQJOQwFHABiHoMDJOiAAPkGkrWMglEwCkbBMAcA9dhIHWVIvpgAAAAASUVORK5CYII=","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Cornelius","middleName":"Cecil","lastName":"Dodoo","suffix":""},{"id":476558414,"identity":"6e72d60a-7d06-49a9-95af-edefcfe2c705","order_by":2,"name":"Maxwell J. Gbemu","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Maxwell","middleName":"J.","lastName":"Gbemu","suffix":""},{"id":476558415,"identity":"240d7873-ee10-455e-a566-f05383bde257","order_by":3,"name":"Emmanuel D. Amesimeku","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Emmanuel","middleName":"D.","lastName":"Amesimeku","suffix":""},{"id":476558416,"identity":"92dbdcd0-b4c7-4018-b3a7-39f69b0d528f","order_by":4,"name":"Karikari Asafo-Adjei","email":"","orcid":"","institution":"Ho Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Karikari","middleName":"","lastName":"Asafo-Adjei","suffix":""},{"id":476558419,"identity":"550a8e00-d7ed-4e30-a791-af2f22d55889","order_by":5,"name":"Bless Amable","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Bless","middleName":"","lastName":"Amable","suffix":""},{"id":476558421,"identity":"0353bf03-a024-4209-81db-bb6da8ed0f19","order_by":6,"name":"Kwabena Tannor","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Kwabena","middleName":"","lastName":"Tannor","suffix":""},{"id":476558422,"identity":"ba80b2d8-0fc1-4112-883b-ec09b8eb45ec","order_by":7,"name":"Stanley Koranteng","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Stanley","middleName":"","lastName":"Koranteng","suffix":""},{"id":476558423,"identity":"91c5600a-a264-4010-9b2d-399097afa8b6","order_by":8,"name":"Clifford Boateng","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Clifford","middleName":"","lastName":"Boateng","suffix":""},{"id":476558424,"identity":"c209758a-79cd-4faf-b700-7dadfa81f5b6","order_by":9,"name":"Fred Appiah","email":"","orcid":"","institution":"University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fred","middleName":"","lastName":"Appiah","suffix":""},{"id":476558425,"identity":"23eee6aa-c5de-481f-a1de-cb8520524a36","order_by":10,"name":"Prosper Mensah","email":"","orcid":"","institution":"Ho Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Prosper","middleName":"","lastName":"Mensah","suffix":""}],"badges":[],"createdAt":"2025-06-18 13:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6923718/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6923718/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-025-11680-1","type":"published","date":"2025-10-10T15:57:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85744078,"identity":"3ddabfba-2de5-4f83-ae45-3d0a5aaf9789","added_by":"auto","created_at":"2025-07-01 09:15:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40175,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of Gram-positive and negative bacterial isolates.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6923718/v1/125a3ada676f8b6465ba3217.png"},{"id":85744083,"identity":"49bb8799-57e9-43f7-958c-52098830cbbe","added_by":"auto","created_at":"2025-07-01 09:15:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":58289,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eResistance profiles of \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eS. aureus\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e isolates from inanimate objects on the wards/units at HTH.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e%R: Percentage resistance; %S: Percentage susceptibility; %I: Percentage intermediate susceptibility.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6923718/v1/1f67754594611eaecde265a3.png"},{"id":93419722,"identity":"f7e054b3-ed6f-46b0-aed4-58368a0aa358","added_by":"auto","created_at":"2025-10-13 16:06:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1166883,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6923718/v1/de800718-c5d4-4e5a-a64a-e37b036cc01d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Surveillance on Antimicrobial Resistance: Bacteriological Monitoring and Resistance Profiles of Isolates from Surfaces and Equipment at a Ghanaian Tertiary Healthcare Facility","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eInfectious diseases remain the highest cause of death in the world, particularly in developing countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Healthcare-associated infections (HAI) are majorly responsible for increased morbidity and mortality resulting from infectious pathogens [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These infections become clinically apparent either during hospitalisation or 72 hours after discharge [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].The most frequent types of nosocomial infections include central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, and ventilator-associated pneumonia. Surgical site infections are the second most common type of HAI mainly caused by \u003cem\u003eS. aureus\u003c/em\u003e which results in prolonged hospital stay and risk of death [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePathogens that cause HAI usually come from the flora of patients and staff, while most of them are exogenously acquired from contaminated needles, the environment, and instruments[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Common among these pathogens include \u003cem\u003eStaphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Escherichia coli, Enterobacter species\u003c/em\u003e and \u003cem\u003eProteus mirabilis\u003c/em\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Reports from the World Health Organisation indicate that intensive care units account for a higher risk of acquiring HAI. Thus about 30% of patients are affected by at least one episode of HAI with significant associated morbidity and mortality [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Hospital device surfaces and equipment such as thermometers, stethoscopes, beds, etc., are host to infectious organisms which can cause nosocomial infections. Telephones and intercom devices have been reported to aid in the transfer of opportunistic pathogens that cause nosocomial infections [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Intensive care units present a high risk of acquiring HAI [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurveillance systems for nosocomial infections are deficient in most countries particularly developing ones [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Due to the complex and standardized principles for confirming infectious disease aetiologies, countries with limited resources struggle with the institution of surveillance systems for appropriate infection control [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Routine surveillance on the distribution and susceptibility of common pathogenic bacteria from hospital wards/units and hospital equipment provides data for assessing the effectiveness of infection prevention and control. In low- and middle-income countries, regular monitoring of HAI occurrence may be difficult at national levels and hence, national Ministries of Health report less to no information on the burden of HAI. According to a systematic review by Nejad and colleagues, 66% of developing countries have no published data at all [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. There is limited data explaining the level of pathogenic microbial contamination in tertiary hospitals, especially in the Volta Region of Ghana. This study aimed to assess the prevalence of epidemiologically significant pathogenic microbes in selected wards/units of Ho Teaching Hospital (HTH) as well as their resistance profiles.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAn analytical cross-sectional study was carried out on samples obtained from inanimate objects and equipment at various wards and units in HTH to identify the bacterial species contaminating the hospital environment. The items sampled include hospital equipment and items that are utilised by multiple healthcare professionals with the tendency to act as agents of cross-contamination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudy setting and study framework\u003c/p\u003e\n\u003cp\u003eThe study, which spanned a period of 6 months, was carried out at HTH, a referral hospital in the Volta Region of Ghana. The samples were taken from the wards (female surgical, male surgical, psychiatric medicine, isolation, labour, accidents \u0026amp; emergency, maternity, baby\u0026apos;s, child health, male medical, female medical, gynaecological, and urological) and units (intensive care, neonatal intensive care).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMaterials and Equipment\u003c/p\u003e\n\u003cp\u003eGrowth media like blood agar, mannitol salt agar, pseudomonas cetrimide agar and MacConkey agar were used to isolate the bacteria contaminants in the samples.\u003c/p\u003e\n\u003cp\u003eSample collection\u003c/p\u003e\n\u003cp\u003e210 samples were taken from the various wards and care units. Sterile swab sticks were moistened in sterile normal saline and rolled over the targeted surfaces/equipment (thermometer, sphygmomanometer, stethoscope, infusion pumps, computer mouse, keyboard, telephone, main switches, front door handles, nurses, table, trolley, medication drawer tabs, pens, beds and thermometer). The samples were taken in the morning one hour after cleaning and disinfection of the various wards and units. Swabs were taken per ISO 14698-1 guidelines and labelled accordingly . Sample processing was done at the Microbiology Department of the HTH. All isolates were stored in brain heart infusion (Oxoid Ltd., England) with 15% glycerol at \u0026minus;20 \u0026deg;C for further research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIsolation and identification of bacteria from samples\u003c/p\u003e\n\u003cp\u003eStored samples were revived using nutrient broth in different test tubes for 24 hours at 37\u003csup\u003eo\u003c/sup\u003eC. Samples were cultured on blood agar plates at 37\u0026deg;C for 48 hours. Discrete colonies from the blood agar were picked using a sterile platinum loop and Gram stain differentiated. Colonies were primarily identified by colony morphology, microscopy, and standard biochemical tests. Only pathogenic microbes were examined.\u003c/p\u003e\n\u003cp\u003eGram staining was carried out directly on one characteristic colony from the blood agar for confirmation as Gram-negative bacilli, Gram-positive bacilli or Gram-positive cocci. \u0026nbsp;Biochemical tests like indole, citrate, oxidase and urease were used to confirm the identity of Gram-negative bacterial isolates whereas catalase and coagulase tests were used for Gram-positive isolates. Novobiocin disks were also used in the sensitivity test to differentiate coagulase-negative \u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e from \u003cem\u003eStaphylococcus saprophyticus\u003c/em\u003e. These disks were gently placed at the centre of petri dishes which contained Muller Hinton\u0026rsquo;s agar with the growth of coagulase-negative bacterial isolates. Ability of the disk to inhibit growth showed the presence of \u003cem\u003eS. epidermidis\u003c/em\u003e. \u0026nbsp;On the other hand, resistance to the disk confirms the identity of \u003cem\u003eS. saprophyticus\u003c/em\u003e. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAntimicrobial susceptibility testing\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe isolated microorganisms were tested for susceptibility to commonly used antibiotics in HTH using the Kirby-Bauer disc diffusion technique according to the guidelines set by the Clinical and Laboratory Standards Institute (CLSI, 2022). Briefly, an overnight culture of organisms standardised to 0.5 McFarland was spread on Mueller-Hinton agar. Antibiotic discs containing ampicillin (10 \u0026micro;g), cefuroxime (30 \u0026micro;g), cefotaxime (30 \u0026micro;g), ceftriaxone (30 \u0026micro;g), tetracycline (30 \u0026micro;g), meropenem (10 \u0026micro;g), ciprofloxacin (5 \u0026micro;g), vancomycin (30 \u0026micro;g), amikacin (10 \u0026micro;g), trimethoprim/sulfamethoxazole (1.25 \u0026micro;g/23.75 \u0026micro;g), gentamicin (10 ug) and erythromycin (15 ug) were placed on the surface of the inoculated agar plate and incubated at 37 \u003csup\u003eo\u003c/sup\u003eC for 24 hr. The diameter of the zones of inhibition around each antibiotic disc was then measured and compared with breakpoint values in CLSI 2022 guidelines (M-100).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData entry and statistical analysis were performed using Statistical Package for Social Science version 21 (SPSS) and Microsoft Excel 2021.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003ePrevalence of bacterial isolates on the wards and units\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf the total 210 samples analysed, 53.8% (n = 113) were positive for bacteria. 10 different species of bacteria were isolated from all the samples from the various wards and units (Figure 1). Out of the 10 species isolated, \u003cem\u003eS. aureus\u003c/em\u003e had the highest prevalence (81%) while the remaining organisms had less than 5% prevalence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDistribution of Gram-positive and Gram-negative bacteria on the wards and units\u003c/p\u003e\n\u003cp\u003eThree different species of Gram-positive bacteria were identified on the wards and units (Table 1). These were \u003cem\u003eStaphylococcus aureus, Staphylococcus saprophyticus and Staphylococcus epidermidis. S. aureus\u003c/em\u003e was the most predominant contaminant of items in the various wards (n=109) and it was found on items in all the care units at the HTH.\u003c/p\u003e\n\u003cp\u003eThe Gram-negative organisms isolated from the samples include \u003cem\u003eKlebsiella oxytoca, Klebsiella pneumoniae, Shigella sonnei, Proteus mirabilis, S. typhi,\u003c/em\u003e \u003cem\u003eS. marcescens\u0026nbsp;\u003c/em\u003eand non-pathogenic coliforms. S.\u003cem\u003e\u0026nbsp;marcescens\u0026nbsp;\u003c/em\u003ewas the most frequent Gram-negative pathogen (n=5) but was isolated in only four of the fourteen wards/units in the hospital. About 89% (n=119) of the isolates were Gram-positive while Gram-negative isolates accounted for 11% of the isolates. The highest frequency of bacterial isolates was found in the Neonatal Intensive Care Unit (n=17) whilst the lowest numbers were found on items from the Female surgical ward, Intensive Care Unit, Baby\u0026rsquo;s ward and Urology ward (n=2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eDistribution of identified bacterial species from surfaces swabbed at the various care units.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOrganism\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"14\" valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of bacterial species isolated per unit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003eE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003eG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003eH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003eJ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003eK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003eL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eStaphylococcus aureus\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e81.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eStaphylococcus saprophyticus\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSerratia marcescens\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSalmonella typhi\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eProteus mirabilis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eShigella sonnei\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eKlebsiella oxytoca\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-pathogenic (Coliform)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e134\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWard/Unit: A: Male surgical; B: Female Surgical; C: Psychological; D: Intensive Care E: Isolation; F: Labour; G: Accident and Emergency; H: Maternity; I: Neonatal Intensive Care; J: Baby\u0026rsquo;s; K: \u0026nbsp;Children\u0026rsquo;s; L: Male Medical; M: Female Medical; N: Urology; n=Total number of isolates.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDiversity of bacterial contaminants on the inanimate objects and equipment\u003c/p\u003e\n\u003cp\u003eMost of the bacterial contaminants were abundant on beds and wheelchairs present in the various wards (Table 2). Thermometers and medication drawers had the highest microbial diversity with four distinct microbial species as contaminants. Beds, medication drawer tabs, trolleys, front door handles, stethoscopes and thermometers were contaminated with three bacterial species while pens, main switches, telephones and keyboards at the various wards/units had two species of microbial contaminants. Infusion pumps, pens and nurses\u0026rsquo; tables were contaminated with only Gram-positive bacteria.\u003cem\u003e\u0026nbsp;Staphylococcus aureus\u003c/em\u003e was the most abundant pathogen on all items sampled.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eBacterial prevalence on swabbed surfaces.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eORGANISM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"15\" valign=\"top\" style=\"width: 435px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNUMBER OF ISOLATES ON SWABBED SURFACES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003eThermometer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eSphygmomanometer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eStethoscope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eInfusion pump\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eComputer mouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eKeyboard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eTelephone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMain switches\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eDoor handles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eNurses table\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eTrolley\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eMedication drawer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003ePens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eBeds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eWheelchairs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eStaphylococcus aureus\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eStaphylococcus saprophyticus\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSerratia marcescens\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSalmonella typhi\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eProteus mirabilis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eShigella sonnei\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eKlebsiella oxytoca\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNon pathogenic\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;(Coliform)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTotal number of\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eorganisms per\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eswabbed item\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e134 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNumber of samples taken for each item = 15 \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAntibiotic resistance profiles of isolates\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe resistance patterns of the isolated microbes are shown in table 3 below. The isolates of \u003cem\u003eS. aureus\u003c/em\u003e showed different resistance patterns with 12 of the isolates being resistant to four of the tested antibiotics. 16 of the isolates were resistant to three different antibiotics while 22 were resistant to two different agents. The most frequent pattern of resistance in the \u003cem\u003eS. aureus\u003c/em\u003e isolates was GEN-ERY-TET-CIP while \u003cem\u003eS. typhi, K. pneumoniae and P. mirabilis\u0026nbsp;\u003c/em\u003edemonstrated a pattern of resistance that included more than six of the antibiotics tested. \u003cem\u003eS. sonnei\u003c/em\u003e isolates were resistant to gentamicin, cefuroxime, ceftriaxone and cefotaxime. The \u003cem\u003eS. typhi\u003c/em\u003e isolates were susceptible to tetracycline, ciprofloxacin and meropenem but resistance was observed against cefuroxime (100%), ceftriaxone (100%) and cefotaxime (100%) (Table 3).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Resistance pattern of bacteria isolates for inanimate objects and equipment at HTH\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMicroorganism\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResistance pattern\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of isolates\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS. aureus (n=109)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eERY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGEN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eERY-CIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eERY-TET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGEN-CIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGEN-ERY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGEN-TET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTET-CIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eERY-TET-CIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGEN-ERY-TET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGEN-TET-CIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGEN-ERY-TET-CIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS. epidermidis(n=6)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGEN-TET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eERY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS. saprophyticus (n=4)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eERY-TET-CIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eERY-CIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSerratia marcescens(n=5)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCRX-CTX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eShigella sonnei (n=4)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCRX-GEN-AMP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSalmonella typhi(n=2)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCTX-CTR-COT-CTX-GEN-AMK-VAN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eKlebsiella pneumoniae (n=1)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCRX-CTR-CTX-GEN-AMP-TET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eKlebsiella oxytoca (n=1)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCHL-CTR-TET-GEN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eProteus mirabilis (n=1)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGEN-CRX-CHL-CTR-CTX-AMP-TET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCefuroxime-CRX, Chloramphenicol-CHL, Gentamicin-GEN, Ampicillin-AMP, Ceftriaxone-CTR, Tetracycline-TET, Co-trimoxazole-COT, Cefotaxime-CTX Meropenem-MEM, Vancomycin-VAN, Ciprofloxacin-CIP, Amikacin-AMK.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor \u003cem\u003eS. aureus\u003c/em\u003e isolates, the most prevalent contaminant in the hospital environment, a resistance of 45.54% was observed towards tetracycline and a high susceptibility (75.99%) towards ciprofloxacin (Figure 2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eNosocomial infections are responsible for an estimated annual healthcare cost of 28\u0026ndash;45\u0026nbsp;billion dollars globally [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In developing countries, the burden of nosocomial infections is high [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Surfaces in hospital environments are highly likely to get colonized by microorganisms which are pathogenic to humans [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These organisms can spread directly between patients and health workers. Surfaces like door handles, nurse station desks, beds, keyboards, telephones, trolleys, and stethoscopes are prone to contamination by pathogenic microorganisms. However, little attention is given to some of these surfaces during disinfection. The study therefore sought to assess potential sources of nosocomial infections in the Ho Teaching Hospital. Swabs from various surfaces in hospital care units/wards were used for the identification of different bacterial species in this study.\u003c/p\u003e \u003cp\u003eThe focus of this study was on common pathogenic bacterial species. We employed a method that aids routine bacteriological screening of surfaces in healthcare facilities in low- or- middle- income- countries like Ghana. Morphological and biochemical properties like oxidase negative reaction, production of acid on both butt and slant of triple sugar iron agar, indole reaction, catalase and coagulase tests were used for routine identification. Surfaces that are generally encountered by multiple staff were swabbed in all wards/units in the hospital. From a total of 210 surfaces swabbed, 53.8% had positive bacterial cultures indicating a high prevalence of bacterial contaminants on surfaces at the various hospital wards. This finding is confirmed by an earlier work by Tagoe and colleagues who isolated a high percentage of pathogenic and non-pathogenic microbes on fomites at hospitals in the Volta Region indicating a high potential risk of acquiring nosocomial infections [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In a related study, a high prevalence of nosocomial infections in tertiary and secondary care facilities in Ghana was also observed [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The prevalence of high bacterial contaminants in the wards/units could be due to a gap in environmental contamination control. This may be in the form of poor cleaning practices and disregard for standard cleaning and disinfection operating procedures. Surfaces of patient care equipment and inanimate objects such as infusion pumps, stethoscopes, front door handles, beds, wheelchairs and blood pressure apparatus could also be easily ignored during regular disinfection.\u003c/p\u003e \u003cp\u003eTen different bacterial species were identified at the various wards/units. The high microbial diversity identified on objects in the wards/units may lead to polymicrobial infections in both immunocompetent and immunocompromised patients. Gram-positive bacteria accounted for 89% (n\u0026thinsp;=\u0026thinsp;119) while Gram-negative bacteria accounted for 11% (n\u0026thinsp;=\u0026thinsp;17) of all bacterial cultures. This conforms to earlier findings [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] but contradicts reports by Labi and his colleagues, which indicated Gram-negative isolates as the most common nosocomial isolates [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003eStaphylococcus aureus\u003c/em\u003e accounted for about 92% of all the Gram-positive isolates, while \u003cem\u003eS. marcescens\u003c/em\u003e and \u003cem\u003eS. typhi\u003c/em\u003e were the most prevalent Gram-negative isolates. Also, \u003cem\u003eS. aureus\u003c/em\u003e, a commensal pathogen, was the highest pathogenic isolate with high frequency on beds, stethoscopes, the mouse of computers, nurses\u0026rsquo; tables and wheelchairs (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This confirms reports of \u003cem\u003eS. aureus\u003c/em\u003e being among the most predominant organisms that are isolated in hospitals and the leading causes of HAIs in Ghana [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Some other studies have reported \u003cem\u003eE. coli\u003c/em\u003e to be a major cause of nosocomial infections in sub-Saharan Africa, this was however not the case in our work [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe abundance of these isolates on surfaces could be because these surfaces get little or no cleaning although they are handled by multiple staff leading to a high level of contamination. Also, being a teaching hospital there are a lot of students undergoing training in various health programs accessing the facility occasionally; without proper infection prevention and control practices, these could present contamination.\u003c/p\u003e \u003cp\u003eThe presence of \u003cem\u003eS. aureus\u003c/em\u003e is not surprising because of its ubiquitous nature on the skin and in the environment [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Staphylococci survive for days on some surfaces hence the prevalence of high cultures of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e and the detection of \u003cem\u003eK. pneumoniae\u003c/em\u003e isolates on objects is a serious healthcare risk at the HTH. These bacterial species are among the six leading pathogens for deaths associated with resistance [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe resistance of the isolates to commonly prescribed antibacterials such as gentamicin, erythromycin, tetracycline, cefuroxime, co-trimoxazole, cefotaxime, meropenem, ciprofloxacin and vancomycin is particularly worrying. These antibiotics constitute the most accessible antibacterial therapeutic options at HTH which relies greatly on empiric therapy (96.8%) than definitive [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The evolution of multi-drug resistant bacterial strains on equipment and surfaces presents a risk of acquisition and spread of these nosocomial pathogens in the hospital. Moreover, the possible evolution of multiple drug-resistant strains in commensal \u003cem\u003eS. aureus\u003c/em\u003e suggests the existence of an infectious risk with the possibility of the emergence of methicillin-resistant strains. Evidence of high rates of multi-drug resistance has been reported in hospitals in sub-Saharan Africa with prevalence above 40% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe identified a high percentage of positive cultures in the neonatal intensive care unit (n\u0026thinsp;=\u0026thinsp;17/134), male medical ward (n\u0026thinsp;=\u0026thinsp;16/134) and the maternity ward with the least cultures in the intensive care unit and female surgical ward. The presence of healthcare teams and visitors on the wards and their consequent contact with different patients, objects and surfaces without adequate infection control procedures may enhance the possibility of pathogen dissemination if the necessary precautions (especially hand washing) are not observed. Data obtained on the distribution of the isolates from this study reflect some level of efficiency in cleaning and disinfection of hospital surfaces in general and encourage a strengthening of the principles of cleaning and disinfection of hospital surfaces.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis study shows a high prevalence of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e on different inanimate surfaces in wards/units at the Ho Teaching Hospital. The hospital beds were the most contaminated items whilst thermometers and medication drawers had the most diversity. The neonatal intensive care unit had the highest prevalence and diversity of microbes. This study also shows a high prevalence of resistant Gram-positive pathogens and multi-drug resistant Gram-negative bacterial strains as major contaminants of different inanimate surfaces in wards at the Ho Teaching Hospital. The results suggest the need for increased education on environmental disinfection and hospital hygiene. This data is meant to highlight the need to intensify local infection prevention and control measures in hospitals in Ghana.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHAI: Healthcare-associated infections\u003c/p\u003e\n\u003cp\u003eHTH: Ho Teaching Hospital\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance (UHAS-REC A.2[10] 21-22) for the study was obtained from the Research Ethics Committee of the University of Health and Allied Sciences, Ho, Ghana. This study did not involve any direct contact with humans or animals; it involved the swabbing of inanimate objects and surfaces. This research was conducted in accordance with the Declaration of Helsinki.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll generated data have been provided within this manuscript. Access to raw data can be obtained from the corresponding author (Cornelius C. Dodoo, [email protected]).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external funding was received for this work.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualisation: HO, CCD; Methodology: HO, MJG, EDA, KA, BA, KT, SK, CB, FA, CCD, PM; Data analysis: HO, CCD; Writing\u0026mdash;original draft: HO, CCD; Writing\u0026mdash;review and editing: MJG, EDA, KA, BA, KT, SK, CB, FA, PM\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the staff and management of the Ho Teaching Hospital for their support and assistance during the conduct of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMelariri H, Freercks R, van der Merwe E, Ham-Baloyi W Ten, Oyedele O, Murphy RA, et al. The burden of hospital-acquired infections (HAI) in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine. 2024;71. \u003c/li\u003e\n\u003cli\u003eLeggett HC, Cornwallis CK, Buckling A, West SA. Growth rate, transmission mode and virulence in human pathogens. Philosophical Transactions of the Royal Society B: Biological Sciences. 2017;372. \u003c/li\u003e\n\u003cli\u003eKollef MH, Torres A, Shorr AF, Martin-Loeches I, Micek ST. Nosocomial Infection. Crit Care Med [Internet]. 2021;49. Available from: https://journals.lww.com/ccmjournal/fulltext/2021/02000/nosocomial_infection.2.aspx\u003c/li\u003e\n\u003cli\u003eDiop M, Bassoum O, Ndong A, Wone F, Ghogomu Tamouh A, Ndoye M, et al. Prevalence of multidrug-resistant bacteria in healthcare and community settings in West Africa: systematic review and meta-analysis. BMC Infect Dis. BioMed Central Ltd; 2025. \u003c/li\u003e\n\u003cli\u003eBunduki GK, Masoamphambe E, Fox T, Musaya J, Musicha P, Feasey N. Prevalence, risk factors, and antimicrobial resistance of endemic healthcare-associated infections in Africa: a systematic review and meta-analysis. BMC Infect Dis. 2024;24. \u003c/li\u003e\n\u003cli\u003eJain A, Agarwal A, Verma RK, Awasthi S, Singh KP. Intravenous device associated blood stream staphylococcal infection in paediatric patients. Indian J Med Res. 2011;134:193\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eAku FY, Akweongo P, Nyarko K, Sackey S, Wurapa F, Afari EA, et al. Bacteriological profile and antibiotic susceptibility pattern of common isolates of neonatal sepsis, Ho Municipality, Ghana-2016. Matern Health Neonatol Perinatol. 2018;4. \u003c/li\u003e\n\u003cli\u003eZaidi AKM, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. The Lancet [Internet]. 2005;365:1175\u0026ndash;88. Available from: https://doi.org/10.1016/S0140-6736(05)71881-X\u003c/li\u003e\n\u003cli\u003eWalia SS, Manchanda A, Narang RS, Anup N, Singh B, Kahlon SS. Cellular telephone as reservoir of bacterial contamination: Myth or fact. Journal of Clinical and Diagnostic Research. 2014;8:50\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eOkolie OJ, Igwe U, Ismail SU, Ighodalo UL, Adukwu EC. Systematic review of surveillance systems for AMR in Africa. Journal of Antimicrobial Chemotherapy. 2023;78:31\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eBengtsson-Palme J, Abramova A, Berendonk TU, Coelho LP, Forslund SK, Gschwind R, et al. Towards monitoring of antimicrobial resistance in the environment: For what reasons, how to implement it, and what are the data needs? Environ Int. Elsevier Ltd; 2023. \u003c/li\u003e\n\u003cli\u003eAlp E, Leblebicioglu H, Doganay M, Voss A. Infection control practice in countries with limited resources. Ann Clin Microbiol Antimicrob. 2011. \u003c/li\u003e\n\u003cli\u003eNejad SB, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ. 2011;89:757\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eRosenthal VD, Maki DG, Salomao R, Moreno C\u0026Aacute;, Mehta Y, Higuera F, et al. Device-Associated Nosocomial Infections in 55 Intensive Care Units of 8 Developing Countries. Ann Intern Med [Internet]. 2006;145:582\u0026ndash;91. Available from: https://doi.org/10.7326/0003-4819-145-8-200610170-00007\u003c/li\u003e\n\u003cli\u003eTagoe DNA, Baidoo SE, Dadzie I, Tengey D, Agede C. Potential sources of transmission of hospital-acquired infections in the Volta Regional Hospital in Ghana. Ghana Med J. 2011;45. \u003c/li\u003e\n\u003cli\u003eLabi AK, Obeng-Nkrumah N, Owusu E, Bjerrum S, Bediako-Bowan A, Sunkwa-Mills G, et al. Multi-centre point-prevalence survey of hospital-acquired infections in Ghana. Journal of Hospital Infection. 2019;101:60\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eNewman MJ, Frimpong E, Donkor ES, Opintan JA, Asamoah-Adu A. Resistance to antimicrobial drugs in Ghana. Infect Drug Resist. 2011;4:215\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eRaoofi S, Kan FP, Rafiei S, Hosseinipalangi Z, Mejareh ZN, Khani S, et al. Global prevalence of nosocomial infection: A systematic review and meta-analysis. PLoS One. 2023;18. \u003c/li\u003e\n\u003cli\u003eGirma A. Staphylococcus aureus: Current perspectives on molecular pathogenesis and virulence. Cell Surface. Elsevier B.V.; 2025. \u003c/li\u003e\n\u003cli\u003eMurray CJ, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022;399:629\u0026ndash;55. \u003c/li\u003e\n\u003cli\u003eDodoo CC, Orman E, Alalbila T, Mensah A, Jato J, Mfoafo KA, et al. Antimicrobial prescription pattern in ho teaching hospital, ghana: Seasonal determination using a point prevalence survey. Antibiotics. 2021;10:1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eKasanga M, Kwenda G, Wu J, Kasanga M, Mwikisa MJ, Chanda R, et al. Antimicrobial Resistance Patterns and Risk Factors Associated with ESBL-Producing and MDR Escherichia coli in Hospital and Environmental Settings in Lusaka, Zambia: Implications for One Health, Antimicrobial Stewardship and Surveillance Systems. Microorganisms. 2023;11. \u003c/li\u003e\n\u003cli\u003eDodoo CC, Odoi H, Mensah A, Asafo-Adjei K, Ampomah R, Obeng L, et al. Development of a local antibiogram for a teaching hospital in Ghana. JAC Antimicrob Resist. 2023;5. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Nosocomial infection, fomites, Staphylococcus aureus, Gram-negative bacteria, Gram-positive bacteria","lastPublishedDoi":"10.21203/rs.3.rs-6923718/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6923718/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eNosocomial infections play a leading part in the infectious disease burden. Most developing countries, however, have no published data on nosocomial pathogens. This study was undertaken to determine the occurrence of pathogenic microbes contaminating different objects, medical equipment and electronic devices at selected wards in Ho Teaching Hospital (HTH).\u003c/p\u003e \u003cp\u003eThe methodology involved swabbing 15 different items in 14 selected wards at HTH. The surfaces were swabbed using guidelines by the International Organization for Standardization (ISO 14698-1). The samples were analysed through culture-based methods and biochemical assays. Susceptibility testing was conducted using the Kirby Bauer disk diffusion method employing guidelines from the Clinical Laboratory Standards Institute.\u003c/p\u003e \u003cp\u003eOf the total 210 samples analysed, 53.8% (n\u0026thinsp;=\u0026thinsp;113) were positive for bacteria. 134 bacterial isolates from ten different species were isolated. About 89% of these isolates were Gram-positive while Gram-negative isolates accounted for 11%. \u003cem\u003eStaphylococcus aureus\u003c/em\u003e was the most abundant pathogen on all items sampled. Ciprofloxacin was the most active agent against the \u003cem\u003eS. aureus\u003c/em\u003e isolates (n\u0026thinsp;=\u0026thinsp;82, 75.9%) while resistance to tetracycline was high (n\u0026thinsp;=\u0026thinsp;49, 45.54%). Multidrug-resistant strains of \u003cem\u003eS. epidermidis, S. saprophyticus, S. marcescens, S. sonnei, S. typhi, K. pneumoniae, K. oxytoca and P. mirabilis\u003c/em\u003e were identified as contaminants on inanimate objects and equipment at HTH. The highest frequency of bacterial isolates was found in the Neonatal Intensive Care Unit.\u003c/p\u003e \u003cp\u003eIn conclusion, the high prevalence of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e and certain Gram-positive isolates on fomites at the HTH shows a potential risk of nosocomial infections.\u003c/p\u003e","manuscriptTitle":"Surveillance on Antimicrobial Resistance: Bacteriological Monitoring and Resistance Profiles of Isolates from Surfaces and Equipment at a Ghanaian Tertiary Healthcare Facility","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 09:15:22","doi":"10.21203/rs.3.rs-6923718/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-05T05:11:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-21T17:55:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-16T12:33:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-15T10:38:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"183090753942511757482679411963121040478","date":"2025-07-11T08:26:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"41719772305390017540401141553688119739","date":"2025-07-08T17:13:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221035892961378789946753079266925850252","date":"2025-07-07T06:44:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"273331039947297609711849878217094999133","date":"2025-06-26T00:57:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"241987750998264254952816793212975950301","date":"2025-06-25T17:21:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-25T15:13:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-25T15:02:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-23T07:28:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-21T09:21:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-06-21T09:18:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e42bfee3-913c-4898-ac58-4c3e34388ddf","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T16:01:06+00:00","versionOfRecord":{"articleIdentity":"rs-6923718","link":"https://doi.org/10.1186/s12879-025-11680-1","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2025-10-10 15:57:36","publishedOnDateReadable":"October 10th, 2025"},"versionCreatedAt":"2025-07-01 09:15:22","video":"","vorDoi":"10.1186/s12879-025-11680-1","vorDoiUrl":"https://doi.org/10.1186/s12879-025-11680-1","workflowStages":[]},"version":"v1","identity":"rs-6923718","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6923718","identity":"rs-6923718","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}