International Journal of Pathogen Research

Background: Hospital sanitary facilities may harbour pathogenic and antimicrobial-resistant microorganisms, creating routes for healthcare-associated transmission.

Aims: This study assessed sanitary facilities in referral hospitals in Abakaliki, Ebonyi State, as reservoirs of pathogenic microorganisms and evaluated their antimicrobial susceptibility patterns.

Study Design: An experimental design and purposive sampling were used to select two (2) referral  hospitals.

Place and Duration of the Study: The study was conducted in referral hospitals in Abakaliki Metropolis, Ebonyi State, south-eastern Nigeria.

Methodology: One hundred and forty (140) samples were collected from bathroom floors, toilet seats,                  door handles, flush knobs, toilet covers, tap knobs, toilet knobs, and wash-hand basins using                              sterile swabs moistened with normal saline. Microbiological methods were used for isolation and identification, while antimicrobial susceptibility was evaluated by the Kirby–Bauer disc-diffusion                  technique. For in vitro pathogenicity testing, bacterial isolates were cultured on blood-enriched nutrient agar for 24 hours at 37 ± 2 °C. Fungal isolates were cultured on Sabouraud dextrose agar enriched with glucose and egg yolk for five days at 30 ± 2 °C to detect lipase, protease, and phospholipase activities. Thermotolerance was assessed for five days at 37 ± 2 °C. Bacterial pathogenicity was determined                      from alpha-, beta-, and gamma-haemolysis; fungal pathogenicity was based on thermotolerance and enzyme production.

Results: Borehole water was the main source, and flush toilets were the main facilities. Total viable bacterial counts ranged from 2.0 × 10¹ to 8.2 × 10² cfu/swab, coliform counts from 4.0 × 10¹ to 8.0 × 10¹ cfu/swab, and fungal counts from 2.0 × 10¹ to 1.2 × 10² cfu/swab. Toilet seats had the highest bacterial count, bathroom floors the highest coliform count, and door handles the highest fungal count. Bacterial isolates were Pseudomonas, Escherichia, Klebsiella, Enterobacter, Proteus, Bacillus, Micrococcus, Streptococcus, and Staphylococcus species; fungal isolates were Candida, Rhizopus, Aspergillus, Penicillium, and Mucor species. Of 24 Staphylococcus isolates, 9 (37.5%) produced beta-haemolysis and 7 (29.2%) gamma-haemolysis. Of 16 Streptococcus isolates, 2 (33.3%) produced alpha-haemolysis and 2 (33.3%) beta-haemolysis. Of 16 Aspergillus isolates, 5 (31.2%) produced alpha-haemolysis and 3 (18.7%) beta-haemolysis. Inhibition zones ranged from 12 to 36 mm. Bacillus, Escherichia, Streptococcus, and Micrococcus species resisted some antibiotics, while Aspergillus and Rhizopus species resisted fluconazole and ketoconazole.

Conclusion: Pathogenic microorganisms were present on sanitary facilities used by inpatients and outpatients in the two (2) hospitals. High microbial loads and resistance to antimicrobial agents indicate that these facilities may contribute to healthcare-associated infection transmission.