Bacterial contamination and antimicrobial susceptibility patterns of intensive care units medical equipment and inanimate surfaces at Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia

doi:10.21203/rs.2.10931/v1

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Bacterial contamination and antimicrobial susceptibility patterns of intensive care units medical equipment and inanimate surfaces at Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia

https://doi.org/10.21203/rs.2.10931/v1

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published 23 Sep, 2019

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Abstract Objective: To determine bacterial contaminants and their antimicrobial susceptibility patterns from medical equipment and inanimate surfaces. Results: Of 130 swabs, 115(88.5%) were culture positive, of which contaminated medical equipment and inanimate surfaces account 70 (83.3%) and 45 (97.8%), respectively. From the culture positive swabs, a total of 154 bacterial isolates were identified, out of which 106 (68.8%) were gram-positive and 48 (31.2%) were gram negative. Most isolates (82%) were resistant to ampicillin and 13%, 8.6%, and 14% were observed in ciprofloxacin, gentamicin and tetracycline respectively. Multi-drug resistant was observed in Escherichia coli (72.7%) and Staphylococcus aureus (58.7%).

Laboratory Diagnostics

General Microbiology

Hospital Medicine

Bacterial contamination

Intensive care unit

medical equipment

inanimate surfaces

Ethiopia

antimicrobial susceptibility pattern

Intensive care unit (ICU) acquired infections are global public health concern [1]. Bacterial contamination of the medical equipment and inanimate surfaces used in the ICU put ICU admitted patients (especially those with an underline disease, impaired immunity and with invasive procedures) at higher risk for hospital-acquired infection [2]. Non-critical medical equipment and inanimate surfaces have a capacity to harbor bacteria for a long period of time and can become into contact with patients and medical personnel during disease management [3-6].

The prevalence of ICU acquired infections in developed countries are indicated to be 5-10%, while their prevalence is shown to exceed 2-20 times higher in developing countries [7]. A high incidence (>50%) of ICU acquired infections are reported as compared with other wards (10%)[1]. This might be due to invasive procedures, presence of debilitating patients, prolonged stays and emerging of multidrug-resistant bacteria [8-10].

Studies have reported that contaminated medical equipment and inanimate surfaces were highly associated with ICU acquired infections [11-16]. Although few studies were carried out in the Hospitals in Ethiopia, most studies were focusing on other wards and those performed in intensive care units were done on single or few medical equipment and inanimate surfaces [17, 18, 19]. Moreover, there is no study done in the study setting related to contamination of ICU medical equipment and inanimate surfaces. Therefore, this study aimed at determining bacterial contaminates and antimicrobial susceptibility patterns from medical equipment and inanimate surfaces in the ICUs of Ayder Comprehensive Specialized Hospital, Northern Ethiopia.

Study area, design and period

A hospital-based cross-sectional study was conducted from October 2016 to June 2017at Ayder Specialized Comprehensive Hospital, Mekelle, Northern Ethiopia. Mekelle city found situated 783 km to the North of Addis Ababa, the capital of Ethiopia. It is the largest hospital serving for more than 4.1 million people of the region and the neighbouring regions. The hospital have adult, neonatal, and pediatric ICUs provides health services for over 2,131 patients annually.

Sampling technique

All non-critical medical equipment and inanimate surfaces that had frequent contact with patients and/or healthcare providers during the study period were included. A total of 130 swabs from medical equipment and inanimate surfaces (55 swabs from Adult, 44 swabs from pediatric and 33 swabs from neonatal) were collected using purposive sampling technique.

Sample collection, handling, and transport

Sterile cotton tipped applicator sticks, moistened with sterile normal saline, was used to collect swab specimen. Swab samples were taken using aseptic techniques (with the presence of a spirit lamp) covering an area of 10 cm by 10 cm (100cm²). All swab samples were inserted in a separate sterile test tube, labeled and transported to the Medical Microbiology and Immunology Laboratory, Mekelle University, using ice box within 1 hour and processed immediately [20].

Laboratory processing

Bacterial culture and identification

Swabs were inoculated on to Blood agar, MacConkey agar and Mannitol salt agar (Oxoid Ltd, UK). The inoculated plates were incubated at 37°C for 24 hours. The inoculated plates were inspected after 24 hrs of incubation and bacterial isolates from culture positive plates were identified at the species level by their colony morphology, gram-staining and biochemical characteristics (catalase, coagulase, urease, indole, oxidase, citrate utilization, glucose and lactose fermentation, gas and hydrogen sulfide production) [20].

Antimicrobial susceptibility testing

Antimicrobial susceptibility testing was performed using modified Kirby-Bauer disk diffusion according to the Clinical and Laboratory Standards Institute (CLSI), guideline [21]. Bacterial isolates were tested for commonly used antibiotics including: amoxicillin-clavulanic acid (AMC, 30mcg), ampicillin (AMP, 10mcg), ceftriaxone (CTR, 30mcg), ciprofloxacin (CIP, 5mcg), chloramphenicol (C, 30mcg), gentamicin (GEN, 10mcg) and tetracycline (TE, 30mcg), cefoxitin (CX, 30mcg), erythromycin (E, 15mcg), penicillin G (P, 10units), amikacin (AK, 30mcg), cefotaxime (CTX, 30mcg), nalidixic acid (NA, 30mcg) (HIMEDIA, Company).

Data analysis

Data were entered into Microsoft Excel. Data were imported and analyzed using Statistical Package for Social Sciences (SPSS) software version 21.0. Descriptive statistics were computed and results were summarized by using tables.

Quality Assurance

Aseptic techniques were used in all the steps of specimen collection and inoculation to minimize contamination. Reagents and antimicrobial discs were checked for expiry date. Sterility of culture media was carried out by incubating 5% of the prepared media prior to inoculation. Escherichia coli (ATCC 25922), Staphylococcus aureus (ATCC 25923) and Pseudomonas aeruginosa (ATCC 27853) reference strains were used to control the performance of culture media and antibiotic discs.

Operational definition

Non-critical medical equipment: is equipment used for the diagnosis and management of the patient in ICU such as Sphygmomanometer, stethoscope, and thermometer.

The inanimate surface is a surface of the material used in ICU during providing patient care such as bedside tables, mattress, computers and computer standing tables.

Bacterial contamination of medical equipment and inanimate

A total of 130 (84 from medical equipment and 46 from inanimate surfaces) swab samples was analyzed, in which bacterial growth was identified in 115(88.5%) of the swab specimens. Bacterial contaminants were isolated in 70(83.3%) and 45(97.8%) from medical equipment and inanimate surfaces, respectively. All the swabs collected from sphygmomanometer, bedside table, computer and computer standing tables were 100% contaminated with bacteria. From the culture positive swabs, a total of 154 bacterial isolates were identified, out of which 106 (68.8%) were gram-positive and 48 (31.2%) were gram-negative bacteria. From the medical equipment swab samples, 32 (35.2%) Coagulase-negative Staphylococcus, 23 (25.3%) Staphylococcus aureus and 13 (14.3%) Citrobacter fraundii and from inanimate surface swab samples, 28 (44.4%) Coagulase-negative Staphylococcus, 23 (36.5%) Staphylococcus aureus and 5(7.9%) Klebsiella pneumoniae was the most commonly isolated bacteria. The total bacterial contaminants in adult ICU, neonatal ICU and pediatric ICU were 63 (40.9%), 55 (36.7%) and 36 (23.4%), respectively as indicated in table 1

Antimicrobial susceptibility patterns of the bacterial isolates

The antimicrobial susceptibility tests of the isolates revealed varying ranges of resistance to the tested antimicrobial agents. More than 50% of Staphylococcus species were found to be resistant to penicillin G, erythromycin, amoxicillin-clavulanic acid, ampicillin, cefoxitin. Methicillin-resistant Staphylococcus aureus was observed in 34(73.9%) of the isolates. More than 74% of gram-negative rods were resistant to amoxicillin-clavulanic acid, ampicillin, and nalidixic acid. Moreover, above 63% of E.coli isolates were resistant to amoxicillin-clavulanic acid, ceftriaxone, ampicillin, cefotaxime, and nalidixic acid [Table 2]. Multidrug resistance was observed in 17(28.3%) of CoNs, 27(58.7%) of Staphylococcus aureus, 3(20%) of Citrobacter freundii and 8(72.7%) of Escherichia coli [Table 3].

In this study, the overall bacterial contamination of noncritical medical equipment and inanimate surfaces were high. In addition to this, in this study, similar bacteria were isolated from swab samples taken from parts of some non-critical medical equipment and inanimate surfaces indicating cross-contamination. The predominant isolate was CoNs. With regard to the antimicrobial susceptibility pattern, the isolates showed a significant resistance pattern.

The findings of this study were compared with other similar studies. This finding is in line with the studies conducted from Ethiopia [17] and Asia [15, 22]. On the other hand, our finding is higher than another study from Ethiopia [19], sub-Saharan Africa [5, 16, 22, 23], Asia [13, 14, 24, 25, 26], Brazil [27], Italy [28] and UK [12]. On the contrary, this finding is lower than the other study from Brazil [29]. The difference might be attributed to the frequency of medical equipment and inanimate surfaces decontamination, types of decontaminants used, improper health professional practice, nature of the medical equipment and inanimate surfaces to harbor bacteria [12-14, 22, 24-28]. This might be through bacterial cross-contamination of surfaces. This was similarly observed in a study conducted in the UK [12].

The predominant bacteria isolated were Coagulase negative staphylococcus. Bacterial contamination of stethoscope in this study was in-line with the study results reported from sub-Saharan Africa [5, 16, 23] and Asia [13, 24].On the other hand, this finding is lower than the studies from Ethiopia[17], Asia [15, 22] and Brazil [29], but higher than studies from Ethiopia [19], Asia[14, 25, 26], Brazil[29, 27], Italy[28] and UK[12]. The bacterial contamination in a sphygmomanometer, was in-line with a study done in the UK [12] but higher than the studies from Nigeria [16], New York [30], Australia [31], France [32] and Iraq [33]. Considering inanimate surfaces, the contamination profile of bedside table was in-line with studies conducted in Brazil [29]. However, our findings from the computer table were higher than the studies done at sub-Saharan Africa [34] and Iraq [35]. Bacterial contamination of computer in this study was in-line with the studies conducted in Ethiopia [36], Egypt [37], and Pakistan [38] and higher than from sub-Saharan Africa [39] and Germany [40]. This might be attributed to the number of user's and prolong the survival time of bacteria on plastic surfaces [39, 40], and the proximity of the equipment or surface to the patient [29, 35], the differences in sample size and method [16, 17].

With regard to the antimicrobial susceptibility pattern of the isolated bacteria to commonly prescribed antibiotics in our study area, the resistance of CoNs to erythromycin and penicillin G was higher than the studies conducted from Ethiopia [17, 19, 36], but lower than a study from sub-Saharan Africa [34].In addition to this, in this study, Staphylococcus aureus has shown resistant to ciprofloxacin and gentamycin, which is higher than the studies conducted from Ethiopia [17, 36], but, lower from sub-Saharan Africa [23, 34] and Asia [22, 26]. The characteristic multidrug resistance observed in this study is in line a study from Ethiopia [36], sub-Saharan Africa [34] and Asia [22]. On the other hand, lower multidrug resistance was observed in other studies from Ethiopia [17, 12], sub-Saharan Africa [23] and Asia [26]. The inconsistent drug-resistant and multidrug-resistant patterns observed might be due to variations in geographic areas, hospital environmental conditions, inappropriate administration of antimicrobial drugs, self-medication practice [17, 22, 23, 26, 32, 34, 36].

Conclusion

In this study, high bacterial contamination was observed in medical equipment and inanimate surfaces. Coagulase-negativeStaphylococcus, Staphylococcus aureus, Citrobacter freundii, Klebsiella pneumonia, and Escherichia coli were the most commonly isolated bacteria. Resistance to amoxicillin-clavulanic acid, ampicillin, and nalidixic acid was observed among the gram-negative bacteria. Resistant to penicillin G, erythromycin, amoxicillin-clavulanic acid, and ampicillin, cefoxitin was shown in gram-positive bacteria. Moreover, a significant multi-drug resistance was observed in the isolated bacteria. These calls for strengthening the existing infection prevention and antibiotic stewardship program with the application of strict follow up to minimize bacterial contamination of medical equipment and inanimate surfaces.

Limitation: This study limited to carry out the extended beta lactam spectrum.

CoNS= Coagulase negative staphylococcus

CLSI= Clinical and Laboratory Standards Institute

ICU= Intensive care Unit

IP= Infection prevention

MDR= Multidrug resistance

SPSS= Statistical Package for Social Sciences

Ethics approval and consent to participate

The study protocol was evaluated and approved by the Research Ethics Review Committee (RERC) of College of Health Sciences, Mekelle University was obtained (REC, 0951/2017). Permission to collect data was obtained from administrative bodies of Ayder comprehensive specialized Hospital to conduct the study. The Ethics involves the permission to disseminate the findings of the study through the scientific workshop and publish in reputable journals.

Consent for Publication

Not applicable

Availability of data and materials

Not applicable

Competing interests

The authors declare that they have no competing interests

Funding

Not Applicable

Authors’ contribution

DA, AM conceived and designed the study. DA, KGA, HH, NS carried out coordination and laboratory analysis of the study. DA and AM carried out the statistical analysis. NS, KGA, HH draft the manuscript. All authors read and approved the final manuscript.

Acknowledgements

We would like to thank the College of Health Sciences, Mekelle University and Medical Microbiology and Immunology Department for their material support during laboratory work. We would also like to extend our appreciation to staffs of Ayder Comprehensive Specialized Hospital for their technical and administrative support.

Author details

¹Medical Microbiologist, Bahidar College of Health Sciences, Ethiopia; ²Medical Microbiologist and Researchers from the Medical Microbiology and Immunology Unit, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia

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Table 1 Profile and distribution of isolated bacteria from medical equipment

Bacterial isolates	Stethoscope parts			Thermometers		Sphygnometers		Mattresses (n=6)	Bedsides		Computers			CS table (n=15)	Total
Bacterial isolates	Ear(n=25)	Tubing (n=17)	Diaphragm (n=19)	TM (n=6)	TS (n=6)	SC (n=10)	SB (n=8)	Mattresses (n=6)	BTT (n=10)	BTB (n=9)	CM (n=7)	CE (n=10)	CS (n=9)	CS table (n=15)	Total
Adult ICU
CoNS	4	3	6	0	0	0	0	1	2	2	2	2	1	1	24
S.aureus	7	4	3	0	0	2	1	2	2	1	0	2	1	2	27
K.pneumonia	0	0	1	0	1	2	1	0	0	1	0	0	0	0	6
E.coli	1	0	2	1	0	0	1	0	0	0	0	0	0	1	6
Total	12	7	12	1	1	4	3	3	4	4	2	4	2	4	63
Pediatric ICU
CoNS	1	1	0	0	0	3	1	2	1	2	0	0	2	2	15
S.aureus	1	1	0	0	0	0	1	1	2	1	1	2	0	0	10
C.fraundii	3	3	2	2	2	0	0	0	1	0	0	0	0	1	14
E.aerogens	1	1	1	0	0	3	3	0	0	0	0	0	0	0	9
S. typhi	0	0	0	0	0	0	0	0	0	1	1	0	0	0	2
P.vulgaris	1	0	0	0	0	0	0	0	0	0	0	0	1	0	2
E.coli	0	1	1	0	0	0	0	0	2	1	0	0	0	0	5
Total	7	7	4	2	2	6	5	3	6	5	2	2	3	3	57
Neonatal ICU
CoNS	3	2	3	3	2	NA	NA	NA	NA	NA	2	2	1	3	21
S.aureus	1	1	0	0	1	NA	NA	NA	NA	NA	1	0	2	3	9
C.fraundii	1	0	0	0	0	NA	NA	NA	NA	NA	0	0	0	0	1
K.pneumonia	1	0	0	0	0	NA	NA	NA	NA	NA	0	1	1	2	5
Total	6	3	3	3	3	NA	NA	NA	NA	NA	3	3	4	8	36

BTB; Bedside Table Bottom, BTT; Bedside Table Top, CE; computer Enter key, CM; computer mouse, CoNs; coagulase negative staphylococcus, CSTable ; computer standing table, CS; computer space bar, Diaphragm; Stethoscope diaphragm, Ear; Stethoscope ear piece, NA; none applicable, TM; Thermometer mercury, TS; Thermometer side, SB; Sphygmomanometer bulb, SC; Sphygmomanometer cuff, Tubing;Stethoscope tubing

Table 2 Antimicrobial susceptibility pattern of gram positives and negative from the medical inanimate surfaces

Isolates (N)	Pattern		E		P		AMC		CIP		CTR		TE		C		GEN		AMP			CX		Total (%)
CoNS (60)	S		20 (33.3)		24(40)		22(37.2)		46(44)		34(57.6)		52(88.1)		41(72.8)		50(83)		4(6.7)			NA		47.4
	I		10 (16.7)		1(1.7)		0		5(8.4)		14(22)		0		4(6.7)		4(6.7)		0			NA		6.7
	R		30 (50)		35(53.3)		38(62.7)		9(13.5)		12(20.3)		8(11.8)		15(23.7)		6(10.1)		56(93.2)			NA		42.5
S.aurues (46)	S		8 (17.4)		9(19.5)		17(36.9)		31(67.4)		19(41.3)		36(78.2)		31(67.4)		35(76)		5(10.8)			12(26.1)		40.5
	I		15 (32.6)		3(6.5)		0		4(8.6)		14(30.4)		3(6.5)		3(6.5)		1(2.1)		0			0		8.8
	R		23 (50)		34(73.9)		29(63)		11(23.9)		13(28.2)		7(15.2)		12(26)		10(21.7)		41(89.1)			34(73.9)		50.5
Total (106)	S		28(26.4)		33(31.1)		39(36.8)		77(72.6)		53(50)		88(83)		75(70.8)		85(80.2)		9(8.5)			12(26.1)		44.9
	I		25(23.6)		4(3.8)		0		9(8.5)		28(26.4)		3(2.8)		7(6.6)		5(4.7)		0			0		7.4
	R		53(50)		69(65.1)		67(63.2)		20(18.9)		25(23.6)		15(14.2)		26(24.5)		16(15.1)		97(91.5)			34(73.9)		47.9
Isolates		Pattern		AMC		CIP		CTR		TE		C		GEN		AMP		CTX		NA	AK		Total (%)

C. fraundii(15)		S		0		14(93.3)		15(100)		14(93.3)		15(100)		15(100)		2(13.3)		15(100)		0	12(80)		68
		I		2(13.3)		0		0		1(6.6)		0		0		1(6.6)		0		0	0		2.6
		R		13(86.6)		1(6.6)		0		0		0		0		12(80)		0		15(100)	3(20)		29.3
K.pnumoniae (11)		S		0		9(81.8)		4(36.3)		6(54.5)		5(33.3)		11(100)		1(9)		2 (18.1)		2 (18.1)	8(72.7)		42.3
		I		1(9)		1(9)		1(9)		2(18.1)		1(9)		0		0		0		4(36.3)	2(18.1)		10.8
		R		10(90.9)		1(9)		6(54.5)		3(27.2)		5(45.4)		0		10(90.9)		9(100)		5(45.4)	1(9)		47.2
E.aerogens(9)		S		0		8(88.9)		9(100)		9(100)		9(100)		9(100)		0		9(100)		0	8(88.9)		67.8
		I		6(66.6)		1(11.1)		0		0		0		0		0		0		0	0		7.8
		R		3(33.3)		0		0		0		0		0		9(100)		0		9(100)	1(11.1)		24.4
P.vulgaris(2)		S		0		2(100)		1(50)		1(50)		2(100)		2(100)		0		1(50)		2(100)	2(100)		65
		I		1(50)		0		0		0		0		0		0		1(50)		0	0		10
		R		1(50)		0		1(50)		1(50)		0		0		2(100)		0		0	0		25
E.coli(11)		S		0		8(72.7)		3(27.3)		6(50)		8(72.7)		7(63.75)		3(25)		3(27.3)		3(27.3)	4(36.4)		40.2
		I		2(18.2)		1(9.1)		0		2(18.2)		0		3(27.3)		0		0		1(9.1)	5(45.4)		12.3
		R		9(81.8)		2(18.2)		8(72.7)		3(27.3)		3(27.3)		1(9.1)		8(72.7)		8(72.7)		7(63.7)	2(18.2)		46.4
Total (48)		S		0		42(84)		33(66)		39(78)		41(82)		45(90)		7(14)		30(60)		7(14)	35(70)		55.8
		I		13(26)		4(8)		1(2)		4(8)		1(2)		4(8)		1(2)		2(4)		5(10)	8(16)		8.6
		R		37(74)		4(8)		16(32)		7(14)		8(16)		1(2)		42(84)		18(36)		38(76)	7(14)		35.6

AMC; Amoxicillin-clavulanic, AMP; Ampicillin, CX; Cefoxitin, CRT; Ceftriaxone, C; Chloramphenicol, CIP; Ciprofloxacin, CoNS; coagulase negative staphylococcus, E; Erythromycin, GEN; Gentamicin, I; intermediate, P; Penicillin G, R; resistant, S; sensitive, TE; Tetracycline,

Table 3 Multidrug resistant (MDR) pattern of isolated bacteria from medical equipments and inanimate surfaces

Bacterial Species	Resisted antimicrobial agents		No. bacteria ( % ) for MDR	Bacterial Species	Resisted antimicrobial agents		No. bacteria ( % ) for MDR
Bacterial Species	No.	Type	No. bacteria ( % ) for MDR	Bacterial Species	No.	Type	No. bacteria ( % ) for MDR
Coagulase negative staphylococcus	R4	E, AMC, CIP, AMP	1(1.7)	S.aurues	R3	CIP,GEN, AMP	1(2.2)
	R5	E,P, AMC,C, AMP	3(5)		R3	E, AMP, CX	1(2.2)
		p, AMC,C,GEN, AMP	2(3.3)		R4	E,P, AMP, CX	4(8.7)
		p, AMC,CIP, TE, AMP	2(3.3)		R4	AMC,C, AMP, CX	1(2.2)
		E, AMC, CIP, TE, AMP	1(1.7)		R5	P, AMC,C, AMP, CX	1(2.2)
		E,P, CIP,C, AMP	1(1.7)			E,P, AMC, AMP, CX	3(6.5)
	R6	E,P, AMC,C, CTR, AMP	2(3.3)			P, AMC, CTR, AMP, CX	1(2.2)
		E,P, AMC, CTR,GEN, AMP	1(1.7)		R6	P, CIP, CTR,C, AMP, CX	1(2.2)
		E,P, AMC, CTR,C, AMP	1(1.7)			E,P, AMC, CTR, AMP, CX	1(2.2)
	R7	E,P, AMC, CTR, TE,C, AMP	1(1.7)			E,P, AMC,C, AMP, CX	2(4.3)
	R7	E,P, AMC, CIP,CTR,GEN, AMP	1(1.7)			E, AMC, C,GEN, AMP, CX	1(2.2)
	R9	E,P, AMC, CIP,CTR, TE,C,GEN, AMP	2(3.3)		R7	E,P, AMC, CTR,C, AMP, CX	2(4.3)
	Total		17(28.3)			p, AMC, CIP, CTR,GEN,AMP, CX	3(6.5)
E.coli	R3	CTR,CTX,AK	1(9.1)			E,P, CIP, CTR,C, AMP,CX,	1(2.2)
	R5	AMC, CTR, AMP,CTX,NA	2(18.2)			E,P, AMC, TE,C, AMP, CX	1(2.2)
		AMC, CTR, AMP,CTX,AK	1(9.1)		R8	E,P, AMC, CIP, TE,GEN, AMP, CX	1(2.2)
		AMC, CTR,C, AMP,CTX	1(9.1)		R9	E,P, AMC, CIP, CTR, TE,GEN, AMP, CX	2(4.3)
	R6	AMC,CIP, CTR,C,CTX, NA	1(9.1)		R10	E,P, AMC,CIP,CTR,TE,C,GEN, AMP, CX	1(2.2)
	R7	AMC, CTR, TE,C, AMP,CTX, NA	1(9.1)		Total		27(58.7)
	R9	AMC,CIP, CTR, TE,C,GEN, MP,CTX,NA	1(9.1)	C.fraundii	R4	AMC, AMP, NA, AK	3(20)
	Total		8(72.7)	C.fraundii	Total		3(20)

P; penicillin, CX; cefoxitin, E; erythromycin, AMC; amoxicillin-clavulanic acid, AMP; ampicillin, CTR; ceftriaxone, CIP; ciprofloxacin, C; chloramphenicol, GEN; gentamicin, TE; tetracycline, AK; amikacin, CTX; cefotaxime, NA; Nalidixic acid, R3; R4; R5; R6; R7; R8; R9; R10; R11; resistant to ( 3, 4, 5, 6, 7, 8, 9, 10, 11 antimicrobial agents), respectively, MDR; non- susceptible to ≥1 agent in ≥3 antimicrobial categories

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Bacterial contamination and antimicrobial susceptibility patterns of intensive care units medical equipment and inanimate surfaces at Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia

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Abstract

Introduction

Materials and Methods

Study area, design and period

Sampling technique

Sample collection, handling, and transport

Laboratory processing

Bacterial culture and identification

Antimicrobial susceptibility testing

Data analysis

Quality Assurance

Operational definition

Results

Bacterial contamination of medical equipment and inanimate

Antimicrobial susceptibility patterns of the bacterial isolates

Discussions

Conclusion

Abbreviations

Declarations

Ethics approval and consent to participate

Consent for Publication

Availability of data and materials

Competing interests

Funding

Authors’ contribution

Acknowledgements

Author details

References

Tables

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