Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : DC36 - DC41 Full Version

Bacterial Contaminants and their Antimicrobial Profile from Hospital Surfaces and Equipments of Various Areas in a Tertiary Care Hospital of Gujarat, India


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55783.16399
Patel Purav, Patel Komal, Raval Payal

1. Associate Professor, Department of Microbiology, Nootan Medical College and Research Centre, Mehsana, Gujarat, India. 2. Assistant Professor, Department of Microbiology, Nootan Medical College and Research Centre, Mehsana, Gujarat, India. 3. Assistant Professor, Department of Microbiology, GMERS Medical College, Vadnagar, Gujarat, India.

Correspondence Address :
Dr. Patel Komal,
Plot No-624, Part-2, Sector-6B, Near G2 Circle, Gandhinagar-382006, Gujarat, India.
E-mail: drkomalpatel3011@gmail.com

Abstract

Introduction: Nosocomial infection is an important concern for healthcare professional in tertiary care centre as they have significant negative impact on patient’s recovery as well as mortality and morbidity. These infections are mostly acquired through contaminated areas of hospitals.

Aim: To access the bacteriological profile of various hospital surfaces and equipments those are exposed to patient in routine clinical care.

Materials and Methods: This cross-sectional study was conducted in tertiary care centre in North Gujarat region, India over the duration of one month in October 2021. Swabs from surfaces were collected using aseptic precautions for aerobic culture. Microorganisms isolated from samples were subjected to identification and antibiotic sensitivity tests. Frequency and distribution of microorganisms were analysed according to different working areas in hospital.

Results: Out of 494 samples, total 171 samples (34.61%) showed bacterial growth, of which 186 different organisms were isolated. Highest number of isolates were Bacillus spp. (28.49%), Staphylococcus aureus (12.90%), Pseudomonas aeruginosa (9.14%), Klebsiella spp. (7.53%) and Acinetobacter spp. (7.53%).

Conclusion: Various surface areas in hospital always need a constant surveillance as they are found contaminated in various studies across the globe. So, intermittent microbiological surveillance is must in a tertiary care hospital in setting up infection control protocol.

Keywords

Antimicrobial susceptibility testing, Bacteriological contamination, Healthcare associated infections

Hospital Acquired Infections (HAIs) are important concern in tertiary care centre now-a-days as they increase morbidity, mortality and duration of stay in hospital for patients. Such infection can be acquired by infected patients or it can originate from person’s own microbial flora (1). Also different studies across the globe represents that these pathogens in hospital environment were found in almost all the areas but majority of the studies, focus was mainly on intensive care and operation units only may be because of critical health conditions of patients and occurrence of multidrug resistant organisms in these areas (1),(2),(3),(4),(5),(6),(7). Hospital acquired pathogens e.g. S. aureus, Pseudomonas, E. coli, Klebsiella, Acinetobacter are likely to be multidrug resistant organisms which are major concern for clinicians because they limit the therapeutic options for the patients (3),(4). Bacteria has the ability to remain viable even upto months on certain inanimate surfaces in the hospital due to lower temperature and humid environment (5). Various hospital surfaces and medical equipments are often contaminated by the infected patients during the diagnostic and therapeutic procedures and these organisms can be transmitted to other patients or healthcare workers by direct or indirect contacts (6),(7).

The present study was focused on a number of bacterial species, such as E. coli, methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant Enterococci (GRE), Acinetobacter baumannii, and Pseudomonas aeruginosa. From the published research studies it was observed that the hands of healthcare workers who were directly exposed to infected patients were at high risk of harboring various pathogens, 30% of which were MRSA, 20% were GRE, and 15% were gram negative bacilli (8),(9). Knowledge regarding microbial profile in hospital environment is important aspect in hospital infection control program as it always vary in different Institutions. So, aim of the present study was to determine the distribution of bacterial pathogens which are prevalent on hospital surfaces and instruments of various departments in tertiary care centre and analysis of their antimicrobial susceptibility pattern.

Material and Methods

This cross-sectional study was conducted at Microbiology laboratory, Tertiary care centre in North Gujarat region over the duration of one month in October 2021. This is tertiary care teaching institute which is a major referral centre for other hospitals of North Gujarat, India. As the present study did not involve any procedure or data related to human subject, ethical permission was waived off from Institutional Ethical Committee (IEC).

Different Operation Theatres (OTs) (Emergency, Orthopaedics, Surgery, Ophthalmology, Ear, Nose and Throat (ENT) and Gynaecology), Intensive Care Unit (ICU) (Medical, Paediatric, Surgical) and patient care areas (wards, dialysis units, laboratory, and administrative areas) were examined in the present study. Convenient sampling method was used in the present study in which total of 494 surface swabs were collected from routinely touched medical equipment, floors, wall, and waiting areas, workstation (keyboards, computer, mouse), water tap and sinks.

No exact calculation was made to determine sample size but efforts were put to cover maximum areas of hospital which were routinely exposed to infected patients. Most critical and most representative locations were chosen as sampling sites after consultation with head of each respective department. All samples were collected in morning after the routine cleaning was completed and no prior information was given to staff before the sample collection. Moreover, samples in OTs and dialysis unit were collected before the start of procedures. Sample collection was done by using cotton swabs pre-moistened with sterile normal saline according to ISO/DIS 14698-1 (10).

Sample Processing

After the collection, samples were immediately sent to the Institutional microbiology laboratory for processing. After sample receiving in the lab, each swab was immersed in a liquid nutrient broth (BHI) and incubated at 37±1°C for 24 hrs under aerobic conditions. A loopful of turbid broth was subcultured on Nutrient agar (Himedia) and MacConkey agar (Himedia). After 24 hrs of incubation under aerobic condition at 37°C, pure colonies from Nutrient agar were used for Biochemical reactions for identifications of isolates. Gram negative bacteria were further identified by Gram stain and standard biochemical tests like Triple Sugar Iron Agar (TSI), Urea, Citrate, Sulfide Indole Motility (SIM) medium, growth in Lysine Iron Agar (LIA), Mannitol, Malonate, and Oxidase test. On the other hand, gram positive bacteria were further identified by Gram stain, optochin, bacitracin, CAMP (Christie-Atkins-Munch-Peterson) test, catalase, coagulase, bile esculin, and salt tolerance test (11).

Antibiotic Susceptibility Testing

Antimicrobial susceptibility testing of isolated organisms were done by disk diffusion methods by Kirby-Bauer (12). An inoculum of each isolate approximately 1×108 colony forming unit (cfu)/mL were used by using the 0.5% McFarland Standard and aseptically flooded on the surface of sterile Mueller-Hinton Agar (Himedia). Antibiotics were selected in reference to Clinical Laboratory Standards Institute (CLSI) guidelines (13),(14) and local availability. Different antibiotic disks (Himedia) were tested: penicillin (1 IU), gentamicin (10 μg), kanamycin (30 μg), erythromycin (15 μg), ampicillin (10 μg), amoxicillin-clavulanic acid (30 μg), cefoxitin (30 μg), ceftazidime (30 μg), ceftriaxone (30 μg), cefepime (30 μg), tetracycline (30 μg), levofloxacin (5 μg), imipenem (10 μg), piperacillin (100 μg), piperacillin/tazobactam (100/10 μg), ticarcillin (75/10 μg), sulfamethoxazole/trimethoprim (75/25 μg), ciprofloxacin (5 μg), chloramphenicol (30 μg), and fusidic acid (10 μg). They were aseptically placed on the seeded plates and then incubated at 37±1°C for 24 hrs. Zone diameters of the drugs were measured by antibiotic zone scale and interpreted by using CLSI criteria (14).

Extended-Spectrum beta-lactamase (ESBL) in Enterobacteriaceae isolates was performed in-vitro by double-disk synergy test in which combining amoxicillin-clavulanic acid along with third-generation cephalosporin was used. Appearances of a synergistic image between these antibiotics reflect a production of ESBL by the strain (13),(14). Resistance to methicillin among S. aureus strains was investigated using a cefoxitin disk under standard susceptibility testing. Strains with an inhibition diameter of less than 22 mm were considered MRSA (13),(14). Metalo-betalctamase (MBL) production among non fermenter was determined with ceftazidime (CAZ) disk by modified double disk synergic test and disk potentiation test using ethylenediaminetetraacetic acid (EDTA) and 2-mercaptopropionic acid (as chelating agents) to detect MBL production. Glycopeptide resistant Enterococci (GRE) was identified by detecting vancomycin resistance using Minimal Inhibitory Concentration (MIC) testing (13),(14),(15). Quality control strains of E. faecalis American Type Culture Collection (ATCC) 29212, S. aureus ATCC® 25923, E. coli ATCC® 25922, K. pneumoniae ATCC®1705 and Pseudomonas aeruginosa ATCC® 27853 were used to confirm the result of antibiotics, media and to assess the quality of the general laboratory procedure.

Statistical Analysis

No statistical method was applied in analysis. The data was collected in Microsoft Excel sheet and results were presented as count and percentage.

Results

Total of 494 samples were collected from different areas of hospital for culture and sensitivity. (Table/Fig 1) shows number of samples collected from different areas at glance. From each respective area samples collected from hospital equipments, floor, wall, bedside table, door/window handle, sinks and water tap, etc.

Out of these 494 samples, total 171 samples (34.62%) showed bacterial growth, of which 186 different organisms were isolated in this study. Out of 186 isolates, 106 (56.99%) were gram positive organisms and 80 (43.01%) were gram negative organisms. Highest number of isolates were Bacillus spp. (28.49%) followed by Staphylococcus aureus (12.90%). Among gram negative bacteria Pseudomonas aeruginosa was most isolated (9.14%) followed by Klebsiella spp. (7.53%) and Acinetobacter spp. (7.53%). From a bacteriological point of view, the numbers of isolates were highest from toilet area (85.71%), labour room (75%, 15/20), emergency room (68.18, 15/22). ICUs (22.06%, 15/68) and OTs (18.24% 31/170) were having less bacterial threshold as compared to other areas. Distribution of organisms among different areas in hospital is shown in (Table/Fig 2).

Different antibiotic panel were selected for gram positive, gram negative and Pseudomonas isolates. In case of Bacillus spp. AST was not performed and they were considered as environmental contaminants. (Table/Fig 3) shows antibiotic susceptibility results of various gram positive isolates in the present study. Staphylococcus aureus was the highest in number (n=24) among all gram positive cocci which showed highest resistance to penicillin (62.5%) and erythromycin (54.17). It showed good susceptibility towards linezolid (100%), levofloxacin (79.17%) and cefoxitin (66.67%). Coagulase negative staphylococci (CoNS) also showed highest resistance to penicillin (73.68%). CoNS showed good sensitivity to linezolid (100%), levofloxacin (78.95%), gentamicin (78.95%) and cefoxitin (73.68%). Enterococci were highest resistant to penicillin (70%) and clindamycin (70%). Meanwhile it showed good susceptibility to linezolid (90%), Vancomycin (80%), levofloxacin (80%) and doxycycline (80%). (Table/Fig 4) shows antibiotic testing results for gram negative organism. In which Pseudomonas showed highest resistance to ampicillin (88.24%) followed by ampicillin/sulbactam (70.59%), aztreonam (70.59%) and ceftazidime (70.59%). Acinetobacter spp. was also showed highest resistant to ampicillin (85.72%) and cefotaxime (85.72%). Klebsiella spp. showed highest resistance to ceftriaxone (92.86%) followed by ampicillin (78.58%), ceftazidime (78.58%) and sulfamethoxazole+trimethoprim (78.58%). E. coli showed highest resistance to ampicillin (75%), aztreonam (75%) and sulfamethoxazole+trimethoprim (75%). Proteus spp. and Citrobacter spp. showed highest resistance to ampicillin (71.43%) and (83.34%) respectively. Meropenem showed 100% sensitivity to Proteus spp. and Citrobacter spp., Burkholderia cepacia complex and Enterobacter spp. It showed very good sensitivity to Pseudomonas (82.35%), Acinetobacter spp. (71.41%), Klebsiella spp. (85.72%) and E. coli (87.5%). Amikacin also showed good sensitivity to Pseudomonas (88.23%), Enterobacter spp. (100%), Citrobacter spp. (83.34%) and Klebsiella spp. (71.41%). Piperacillin-tazobactam was highest sensitive to Citrobacter spp. (83.34%). Cefepime also showed good sensitivity to Proteus spp. (85.71%).

Detection of MRSA, GRE, MBL and ESBL for Staphylococcus aureus, Enterococcus, Pseudomonas aeruginosa and Acinetobacter spp. Klebsiella and E. coli is shown in (Table/Fig 5).

Discussion

In the present study, total samples were collected among which 238 were only from operation theatres and ICUs. Apart from these, rest of the samples were collected from emergency area, various wards, labour room, diagnostic laboratories, administrative offices, reception, pharmacy, etc. Out of total of 494 samples, 171 samples fermenter (34.62%) were positive for bacterial growth from which total 186 organisms were isolated. Various studies were conducted at different places which showed different positivity rate for bacterial growth. The study of Chaoui L et al., from Morocco showed highest positivity rate (88%) from various surfaces in hospital (15). In study of Sebre S et al., from Ethiopia showed positivity rate of 86% (16). Similarly study of Alphonce C et al., in Tanzania (17), Yadav M et al., in north east India (18), Najotra DK et al., in Kashmir (19), Ochie K and Ohagwu CC in Nigeria (20) showed positivity rate of 61.4%, 23.4%, 4.4% and 47.2% respectively. Significant differences in positivity rate are found across the globe. Various factors affect the results such as infection control practices, house keeping protocols, hand hygiene, target area for sampling, sampling methods, time of sampling, etc. (21).

In the present study total of 186 isolates were recovered from 171 samples from various sites in hospitals. Among these, Bacillus spp. was the most common organism found in hospital surfaces and equipments. Similar results were found in two previous studies of Sukesh K in Telangana (22) and Najotra DK et al., in Kashmir (19). Among gram positive cocci, Staphylococcus aureus was most common isolate and among gram negative bacilli, Pseudomonas, Acinetobacter and Klebseilla spp. were common isolates. In the study of Chaoui L et al., (15), Enterobacteriaceae were common isolated organism followed by Acinetobacter spp. and Pseudomonas spp. while in study of Sebre S et al., non fermenters e.g. Pseudomonas, Acinetobacter among gram negative and Staphylococcus aureus among gram positive isolates were common (16). In study of Yadav M et al., in north east India (18), Staphylococcus aureus, Acinetobacter spp., Pseudomonas spp. were commonly isolated organisms. Similar result was found in study of Alphonce C et al., in Tanzania (17) also. In the present study in ICUs and OTs 46 (19.33%) out of 238 samples were culture positive. Various studies showed culture positivity rate like 23.4% in Yadav M et al., (18), 63.57% from medical instruments in Kandwal P et al., (23). In present study most of the organisms (n=57) organisms were found from frequently touched objects like door/window handles, elevator buttons, sink and water taps, etc. These sites are frequently touched by both patients and healthcare workers and is one of the common reasons for cross-infection in hospital set-up. In each infection control protocol, prime focus is given to hand hygiene to prevent contamination of such objects, so, cross-infection in hospital can be reduced (24),(25). Bacteria frequently colonise the dialysis machine, thus, bacterial infection could be major risk for patients undergoing dialysis frequently. In the present study total of 16 samples were collected from dialysis centre, out of which 5 organism were isolated which shows 31.25% rate similar 30% in study of Gorke A (26).

Out of total 24 isolates of Staphylococcus aureus, 8 (33.33%) MRSA while among Enterococcus spp. (n=10), 2 were found to be GRE. Among gram negative isolates, 22.6% of total Pseudomonas and Acinetobacter were producing MBL. While among Enterobacteriaceae, 47.7% were producing ESBL. These results are similar to fond in earlier study of Chaoui L et al., (15). Multidrug Resistant Organisms (MDRO) are major concern for clinicians as they found to be resistant for most of the available treatment. Also they led to increased stay, cost and morbidity and mortality among the hospitalised patients. The frequency and types are variable in different population and institutions. Failing to implement, follow the proper infections control policy and contact precautions has led to increase the frequency of MDRO in healthcare set-up (27),(28).

Among gram positive isolates, in both S. aureus and CONs showed highest resistance to penicillin drug. Similar results were found in study of Sebre S et al., (16). They showed highest sensitivity to linezolid and good sensitivity to cefoxitin, gentamicin and levofloxacin. While enterococci showed excellent sensitivity to linezolid, vancomycin, doxycyline and levofloxacin while they showed good amount of resistance to aminoglycoside. Among gram negative bacilli, Pseudomonas showed good sensitivity to meropenem, gentamicin and amikacin in the present study. While Acinetobacter had higher rate of resistance as compared to Pseudomonas which showed good sensitivity to meropenem. Klebsiella spp. and E. coli showed very good sensitivity to meropenem and levofloxacin, but showed resistance to aminoglycoside and cephalosporin. The results are quite similar to study of Kamini W et al., Tsering Y et al., and Roopashree S et al., in India (29),(30),(31). Meropenem is the most sensitive drug for all other isolates e.g. Proteus, Citrobacter, Stenotrophomonas, Burkholderia, Enterobacter and Serratia. Proteus and Citrobacter showed good sensitivity to cefepime (85.71%) and (100%) apart from meropenem. Stenotrophomonas and Burkholderia were sensitive to piperacillin-tazobactam apart from cefepime and meropenem in the present study. Only two isolates were found for Serratia spp. and they were sensitive to most of the antibiotics in the panel except ampicillin and piperacillin. The frequency and distribution and multidrug resistance isolates varies from region to region as well as in different Institutions which depend the cleaning practices, antibiotic policies and adherence to protocol and Standard Operating Procedure (SOPs) made to prevent HAIs. Various studies across the India have been published in recent time which shows rising trends of antimicrobial resistance among different pathogens (22),(27),(29),(30),(31). This can be very serious concern for microbiologists and clinicians working in tertiary care institutes. These MDRO can easily contaminate the different surfaces and equipments in the hospitals in routine use making control of hospital acquired infection difficult and also can lead to intermittent outbreak of infection in hospital.

Limitation(s)

The present study was cross-sectional and performed at single point of time in hospital working areas. Day to day and seasonal variations in bacteriological profile of hospital environment can be missed out in the present study.

Conclusion

Many organisms were found in the study that may contaminate the hospital environment. Apart from Bacillus spp., Staphylococcus, Pseudomonas. Acinetobacter and Klebsiella were predominant organisms isolated in the present study. Similar organisms are also responsible for HAIs which could be major concern for infection control practices in tertiary care centre. All the healthcare professionals must be aware of this danger of transmission of pathogenic organisms from inanimate surfaces to patients, attendants and healthcare professionals. Also intermittent surveillance of different areas in hospital is warranted at regular interval to get an idea of bacteriological profile in respective Institution so one can modify/implement infection control practices accordingly.

References

1.
Mora M, Mahnert A, Koskinen K, Pausan MR, Oberauner-Wappis L, Krause R, et al. Microorganisms in confined habitats microbial monitoring and control of intensive care units, operating rooms, clean rooms and the International Space Station. Front Microbiol. 2016; 7:1573. [crossref] [PubMed]
2.
Bakkali M, Hmid K, Kari K, Zouhdi M, Mzibri M. Characterization of bacterial strains and their resistance status in hospital environment. J Trop Dis. 2015;4(180):2.
3.
Russotto V, Cortegiani A, Graziano G, Saporito L, Raineri SM, Mammina C, et al. Bloodstream infections in intensive care unit patients: Distribution and antibiotic resistance of bacteria. Infect Drug Resist. 2015;8:287. [crossref] [PubMed]
4.
Tabah A, Koulenti D, Laupland K, Misset B, Valles J, De Carvalho FB, et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units. Eurobact international cohort study. Intensive Care Med. 2012;38(12):1930-45. [crossref] [PubMed]
5.
Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006;6(1):130. [crossref] [PubMed]
6.
Huang S, Datta R, Platt R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med. 2006;166(18):1945-51. [crossref] [PubMed]
7.
Nseir S, Blazejewski C, Lubret R, Wallet F, Courcol R, Durocher A. Risk of acquiring multidrug resistant gram negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect. 2011;17(8):1201-08. [crossref] [PubMed]
8.
Bernard L, Kereveur A, Durand D, Gonot J, Goldstein F, Mainardi JL, et al. Bacterial contamination of hospital physicians’ stethoscopes. Infect Control Hosp Epidemiol. 1999;20(9):626-28. [crossref] [PubMed]
9.
Bhalla A, Pultz NJ, Gries DM, Ray AJ, Eckstein EC, Aron DC, et al. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol. 2004;25(2):164-67. [crossref] [PubMed]
10.
Biocontamination Control. Part 1: General Principles and Methods, International Organization for Standardization (ISO), Clean Rooms and Associated Controlled Environments. Accessed on Dec 15.2021 from International Organization for Standardization (ISO), Geneva, Switzerland, 2003, http://www.iso.org.
11.
Garcia L. Clinical Microbiology Procedures Handbook. 3rd Edition ed. American Society for Microbiology. 2010. [crossref]
12.
Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol.1966;45(4):493-96. [crossref] [PubMed]
13.
AACC, Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplements (M100-S24), AACC, Washington, DC, USA, 2014.
14.
M100. Performance standards for antimicrobial susceptibility testing, Clinical and laboratory standard institute, 2020 30th edition.
15.
Chaoui L, Mhand R, Mellouki F, Rhallabi N. Contamination of the Surfaces of a Health Care Environment by Multidrug-Resistant (MDR) Bacteria. Int J Microbiol. 2019. Article ID 3236526. 7 pages. doi.org/10.1155/2019/3236526. [crossref] [PubMed]
16.
Sebre S, Abegaz WE, Seman A, Awoke T, Desalegn Z, Mihret W, et al. Bacterial profiles and antimicrobial susceptibility pattern of isolates from inanimate hospital environments at Tikur Anbessa specialized teaching Hospital, Addis Ababa, Ethiopia. Infect Drug Resist. 2020;13:4439-48. [crossref] [PubMed]
17.
Alphonce C, Reuben S, Bushi L, Benjamin C, Witness S, Charles E, et al. Bacterial contaminants on exposed surfaces and their antibiotic sensitivity patterns at the Benjamin Mkapa Hospital, Dodoma-Tanzania. Asian J Infect Dis. 2021:01-11.
18.
Yadav M, Pal R, Sharma SH, Khumanthem SD. Microbiological surveillance of operation theatre in a tertiary care hospital in North East India. Int J Res Med Sci. 2017;5(8):3448-53. [crossref]
19.
Najotra DK, Malhotra AS, Slathia P, Raina S, Dhar A. Microbiological surveillance of operation theatres: Five year retrospective analysis from a tertiary care hospital in North India. Int J Appl Basic Med Res. 2017;7(3):165-68. [crossref] [PubMed]
20.
Ochie K, Ohagwu CC. Contamination of X-ray equipment and accessories with nosocomial bacteria and the effectiveness of common disinfecting agents. African Journal of Basic & Applied Sciences.2009;1(1-2):31-35.
21.
Dancer SJ. The role of environmental cleaning in the control of hospital-acquired infection. J Hosp Infect. 2009;73(4):378-85. [crossref] [PubMed]
22.
Sukesh K, Bommala Y, Syed H. A clinical study on bacteriological profile in microbiology surveillance of operation theatres. J Microbiol Relat Res. 2020;6(2):27-31
23.
Kandwal P, Roy R, Rana S, Mahawal B. Bacterial colonization of medical equipments: A surveillance study of NICU and PICU instruments. Trp J Path & Micr. 2019;5(12):1026-30. [crossref]
24.
Mehta Y, Gupta A, Todi S, Myatra S, Samaddar DP, Patil V, Bhattacharya PK, Ramasubban S. Guidelines for prevention of hospital acquired infections. Indian J Crit Care Med. 2014;18(3):149-63. [crossref] [PubMed]
25.
De Geyter D, Blommaert L, Verbraeken N, Sevenois M, Huyghens L, Martini H, et al. The sink as a potential source of transmission of carbapenemase-producing Enterobacteriaceae in the intensive care unit. Antimicrob Resist Infect Control. 2017;6:24. [crossref] [PubMed]
26.
Gorke A. Microbial contamination of haemodialysis catheter connections. EDTNA ERCA J . 2005;31(2):79-84. [crossref] [PubMed]
27.
Bryan P, Elaine L . Multiple drug resistant organisms in healthcare: The failure of contact precautions. J Infect Prev. 2015;16(4):178-81. [crossref] [PubMed]
28.
Jane S, Emily R, Mguerite J, Linda C. Management of multidrug-resistant organisms in healthcare settings, 2006. Available from: https://www.cdc.gov/infection control/guidelines/mdro/1 of 74 [accessed on Dec 23, 2021].
29.
Kamini W, Jayaprakasam M, Balaji V, Arunaloke C, Arti K, Pallab R, et al. Establishing antimicrobial resistance surveillance & research network in India: Journey so far. Indian J Med Res. 2019;149(2):164-79. [crossref] [PubMed]
30.
Tsering Y, Dechen C, Sumit K, Jyotsna K. Antimicrobial susceptibility trends among pathogens isolated from blood: A 6-year retrospective study from a tertiary care hospital in east sikkim, India. J Lab Physicians. 2020;12(1):03-09. [crossref] [PubMed]
31.
Roopashree S, Prathab A, Sandeep T. Bacteriological profile and antibiotic susceptibility patterns of wound infections in a tertiary care hospital in South India. Ind J of Micr R. 2021;8(1):76-85. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/55783.16399

Date of Submission: Feb 19, 2022
Date of Peer Review: Mar 12, 2022
Date of Acceptance: Apr 08, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 22, 2022
• Manual Googling: Apr 07, 2022
• iThenticate Software: Apr 12, 2022 (16%)

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