{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T20:54:37Z","timestamp":1783457677614,"version":"3.55.0"},"reference-count":51,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T00:00:00Z","timestamp":1664928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Surgical instruments, be they disposable or reusable, are essential in any surgical procedure. Reusable surgical instruments should be properly sterilized or disinfected before use. However, the protocols are not always followed accordingly. This results in sterilization and disinfection failures, leading to a possible increase in the incidence of surgical site infections. This observational study report on bacterial contaminants identified instruments used for surgical procedures in a major teaching hospital in a resource-limited country. In total, 207 pre-sterilized surgical instruments and instrument parts used at three units\u2014the general surgical theater, and the gastrointestinal (GI) endoscopy and urology endoscopy (uro-endoscopy) units\u2014within the surgical department were randomly sampled and examined for bacterial contamination. Bacteria isolates were identified, and their antimicrobial susceptibility patterns were determined. Bacteria isolates that were identified included Citrobacter spp., Citrobacter freundii, Bacillus cereus, Staphylococcus hominis, and Staphylococcus aureus. Bacillus cereus was the most predominant bacteria isolated (30\/61, 49.1%), and Staphylococcus hominis the least (1\/61, 1.6%). In terms of the number of isolates from the three units examined, the uro-endoscopy unit recorded the highest followed by the general surgical theater and the GI endoscopy. However, there was no association between the various units and bacteria isolated, and no significant difference between the number of isolates among the various units (p = 0.9467, \u03c72 = 0.1095). In this study, even though CFU per device or device part counted was less than 20, bacteria isolated from the instruments used for a surgical procedure is of great concern considering that the setting of the study is a major teaching hospital. Multi-drug resistance was observed in almost all the isolated bacteria. Sterilization processes should be strictly adhered to, taking into consideration the length and temperature in order to reduce the risk of using contaminated instruments in these environments. It is therefore recommended that similar studies should be carried out in surgical departments at different levels of hospitals to ascertain the extent of this problem.<\/jats:p>","DOI":"10.3390\/diseases10040081","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T01:52:21Z","timestamp":1665193941000},"page":"81","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Bacterial Contamination of Surgical Instruments Used at the Surgery Department of a Major Teaching Hospital in a Resource-Limited Country: An Observational Study"],"prefix":"10.3390","volume":"10","author":[{"given":"Enid","family":"Owusu","sequence":"first","affiliation":[{"name":"Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis W.","family":"Asane","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoinette A.","family":"Bediako-Bowan","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Ghana Medical School, University of Ghana, Accra 233, Ghana"},{"name":"Department of Surgery, Korle Bu Teaching Hospital, Accra 233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Afutu","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.ajic.2015.02.017","article-title":"Biochemical and microbial contamination of surgical devices: A quantitative analysis","volume":"43","author":"Canales","year":"2015","journal-title":"Am. J. Infect. Control"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"McDonnell, G., and Sheard, D. (2012). A Practical Guide to Decontamination in Healthcare, Wiley-Blackwell.","DOI":"10.1002\/9781118321287"},{"key":"ref_3","unstructured":"Bommarito, M., Witcher, K., and Thornhill, G. (2022, January 28). The Utility of an ATP System for Monitoring the Cleanliness of Surgical Instruments. Available online: https:\/\/multimedia.3m.com\/mws\/media\/720676O\/utility-of-an-atp-system-for-monitoring-surgical-instruments.pdf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jhin.2012.04.023","article-title":"Surgical site infections linked to contaminated surgical instruments","volume":"81","author":"Dancer","year":"2012","journal-title":"J. Hosp. Infect."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ajic.2013.06.022","article-title":"Microbial contamination of surgical instruments used for laparotomy","volume":"42","author":"Saito","year":"2014","journal-title":"Am. J. Infect. Control"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.ajic.2008.12.010","article-title":"Surgical site infection: Incidence and impact on hospital utilization and treatment costs","volume":"37","author":"Fraeman","year":"2009","journal-title":"Am. J. Infect. Control"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.jtcvs.2012.09.062","article-title":"Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure","volume":"146","author":"Harder","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jhin.2020.01.004","article-title":"Surveillance of surgical site infection in a teaching hospital in Ghana: A prospective cohort study","volume":"104","author":"Owusu","year":"2020","journal-title":"J. Hosp. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S0196-6553(99)70088-X","article-title":"Guideline for prevention of surgical site infection, 1999","volume":"27","author":"Mangram","year":"1999","journal-title":"Am. J. Infect. Control"},{"key":"ref_10","unstructured":"Rutala, W.A., and Weber, D.J. (2008). Guideline for Disinfection and Sterilization in Healthcare Facilities, Department of Health and Human Services."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1086\/511700","article-title":"How to assess risk of disease transmission to patients when there is a failure to follow recommended disinfection and sterilization guidelines","volume":"28","author":"Rutala","year":"2007","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/S0196-6553(99)70050-7","article-title":"Levels of naturally occurring microorganisms on surgical instruments after clinical use and after washing","volume":"27","author":"Chu","year":"1999","journal-title":"Am. J. Infect. Control"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.22207\/JPAM.13.4.65","article-title":"Sterilization of Surgical Tools: Removing Bacterial Endospores with a Combination of Povidone-iodine, Chlorhexidine Gluconate, Ethanol, and Methanol","volume":"13","author":"Razzaq","year":"2019","journal-title":"J. Pure Appl. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Owusu, E., Newman, M.J., Akumwena, A., Bannerman, E., and Pluschke, G. (2017). Evaluating decontamination protocols for the isolation of Mycobacterium ulcerans from swabs. BMC Microbiol., 17.","DOI":"10.1186\/s12866-016-0918-x"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1046\/j.1440-1746.2000.02269.x","article-title":"Reprocessing of flexible endoscopes","volume":"15","author":"Leung","year":"2000","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_16","first-page":"13","article-title":"Intestinal bacterial contamination of surgical instruments used for wound closure during intestinal surgery","volume":"31","author":"Norihiro","year":"2018","journal-title":"J. Perioper. Nurs."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jhin.2018.04.019","article-title":"Multi-centre point prevalence survey of hospital-acquired infections in Ghana","volume":"101","author":"Labi","year":"2018","journal-title":"J. Hosp. Infect."},{"key":"ref_18","first-page":"1","article-title":"Risk factors for surgical site infections in abdominal surgeries in Ghana: Emphasis on the impact of operating rooms door openings","volume":"148","author":"Kurtzhals","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Owusu, E., Ahorlu, M.M., Afutu, E., Akumwena, A., and Asare, G.A. (2021). Antimicrobial Activity of Selected Medicinal Plants from a Sub-Saharan African Country against Bacterial Pathogens from Post-Operative Wound Infections. Med. Sci., 9.","DOI":"10.3390\/medsci9020023"},{"key":"ref_20","first-page":"5","article-title":"Facilitating Identification of Lactose-Fermenting Enterobacteriaceae on MacConkey Agar","volume":"70","author":"Flournoy","year":"1990","journal-title":"Proc. Okla. Acad. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1093\/ajcp\/45.4_ts.493","article-title":"Antibiotic susceptibility testing by a standardized single disk method","volume":"45","author":"Bauer","year":"1966","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_22","unstructured":"National Committee for Clinical Laboratory Standards (2012, November 06). Performance Standards for Antimicrobial Susceptibility Testing. Fifteenth Informational Supplement. 2005. NCCLS Document M100-S15. Available online: http:\/\/www.clsi.org\/."},{"key":"ref_23","unstructured":"Todar, K. (2013, September 08). Todar\u2019s Online Textbook of Bacteriology: Streptococcus Pneumonia. Available online: http:\/\/www.textbookofbacteriology.net\/S.pneumoniae.html."},{"key":"ref_24","unstructured":"Ryan, K.J., and Ray, C.G. (2004). Sherris Medical Microbiology, McGraw Hill. [4th ed.]."},{"key":"ref_25","first-page":"348","article-title":"Sterilizing Service Unit packing area: To glove, or regular hand hygiene, that is the question","volume":"97","author":"Tipple","year":"2017","journal-title":"J. Hosp. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Fujita, T., and Nishiura, H. (2018). Environmental Drivers of Bacillus-Positive Blood Cultures in a Cancer Hospital, Sapporo, Japan. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15102201"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1086\/646779","article-title":"Dissemination of Bacillus cereus in an intensive care unit","volume":"14","author":"Bryce","year":"1993","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/0163-4453(92)91579-Z","article-title":"Bacillus cereus meningitis in two neurosurgical patients: An investigation into the source of the organism","volume":"25","author":"Barrie","year":"1992","journal-title":"J. Infect."},{"key":"ref_29","first-page":"37","article-title":"Bacillus species pseudobacteremia following hospital construction","volume":"10","author":"Loeb","year":"1995","journal-title":"Can. J. Infect. Control"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.jhin.2016.10.013","article-title":"Bacillus species pseudo-outbreak: Construction works and collateral damage","volume":"95","author":"Xercavins","year":"2017","journal-title":"J. Hosp. Infect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1089\/mdr.2020.0543","article-title":"Occurrence, Antibiotic Resistance, Virulence Factors, and Genetic Diversity of Bacillus spp. from Public Hospital Environments in South Africa","volume":"27","author":"Mbhele","year":"2021","journal-title":"Microb. Drug Resist."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1128\/JCM.01467-09","article-title":"Citrobacter spp. simultaneously harboring blaCTX-M, blaTEM, blaSHV, blaampC, and insertion sequences IS26 and orf513: An evolutionary phenomenon of recent concern for antibiotic resistance","volume":"48","author":"Shahid","year":"2010","journal-title":"J. Clin. Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1001\/archderm.143.1.124","article-title":"3rd Spontaneous Citrobacter freundii infection in an immunocompetent patient","volume":"143","author":"Whalen","year":"2007","journal-title":"Arch. Dermatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1097\/01.SMJ.0000051068.52066.E2","article-title":"Sepsis in a renal transplant recipient due to Citrobacter braakii","volume":"96","author":"Gupta","year":"2003","journal-title":"South Med. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3555","DOI":"10.1128\/AAC.46.11.3555-3560.2002","article-title":"Low-virulence Citrobacter species encode resistance to multiple antimicrobials","volume":"46","author":"Pepperell","year":"2002","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"460","DOI":"10.5812\/jjm.2625","article-title":"Fungal and bacterial contamination on indoor surfaces of a hospital in Mexico","volume":"5","author":"Arguilar","year":"2012","journal-title":"Jundishapur J. Microbiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1086\/323130","article-title":"Device-associated infections: A macroproblem that starts with microadherence","volume":"33","author":"Darouiche","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3141","DOI":"10.1111\/1462-2920.14129","article-title":"Colonization of medical devices by staphylococci","volume":"20","author":"Zheng","year":"2018","journal-title":"Environ. Microbiol."},{"key":"ref_39","first-page":"1","article-title":"Staphylococcus aureus Surface Colonization of Medical Equipment and Environment, Implication in Hospital-Community Epidemiology","volume":"3","author":"Omololu","year":"2017","journal-title":"J. Hosp. Med. Manag."},{"key":"ref_40","first-page":"4592830","article-title":"High Occurrence of Staphylococcus aureus Isolated from Fitness Equipment from Selected Gymnasiums","volume":"2018","author":"Bilung","year":"2018","journal-title":"J. Environ. Public Health"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Bediako-Bowan, A., Owusu, E., Labi, A.K., Obeng-Nkrumah, N., Sunkwa-Mills, G., Bjerrum, S., Opintan, J.A., Bannerman, C., M\u00f8lbak, K., and Kurtzhals, J. (2019). Antibiotic use in surgical units of selected hospitals in Ghana: A multi-centre point prevalence survey. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7162-x"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.idc.2016.04.002","article-title":"Disinfection and Sterilization in Health Care Facilities: An Overview and Current Issues","volume":"30","author":"Rutala","year":"2016","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_43","unstructured":"Wagner, W.R., Sakiyama-Elbert, S.E., Zhang, G., and Yaszemski, M.J. (2020). 2.2.8\u2014Biofilms, Biomaterials, and Device-Related Infections. Biomaterials Science, Academic Press. [4th ed.]."},{"key":"ref_44","first-page":"1","article-title":"Bacterial profile and their antimicrobial susceptibility patterns of computer keyboards and mice at Gondar University Hospital, Northwest Ethiopia","volume":"3","author":"Alemu","year":"2015","journal-title":"Biomed. Biotechnol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"814","DOI":"10.5897\/AJMR2013.6512","article-title":"Characterization and determination of antibiotic susceptibility pattern of bacteria isolated from some fomites in a teaching hospital in northern Nigeria","volume":"8","author":"Aminu","year":"2014","journal-title":"Afr. J. Microbiol. Res."},{"key":"ref_46","first-page":"186","article-title":"Bacterial contamination of stethoscopes used by health care workers in a Tertiary Care Hospital in Navimumbai","volume":"3","author":"Gurjeet","year":"2013","journal-title":"Int. J. Pharm. Biol. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/1476-0711-12-39","article-title":"Bacterial contamination, bacterial profile and antimicrobial susceptibility pattern of isolates from stethoscopes at Jimma University Specialized Hospital","volume":"12","author":"Teklu","year":"2013","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Darge, A., Kahsay, A.G., Hailekiros, H., Niguse, S., and Abdulkader, M. (2019). Bacterial contamination and antimicrobial susceptibility patterns of intensive care units medical equipment and inanimate surfaces at Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia. BMC Res. Notes, 12.","DOI":"10.1186\/s13104-019-4658-5"},{"key":"ref_49","first-page":"215","article-title":"Resistance to antimicrobial drugs in Ghana","volume":"4","author":"Newman","year":"2011","journal-title":"Infect. Drug Resist."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Amponsah, O.K.O., Nagaraja, S.B., Ayisi-Boateng, N.K., Nair, D., Muradyan, K., Asense, P.S., Wusu-Ansah, O.K., Terry, R.F., Khogali, M., and Buabeng, K.O. (2022). High Levels of Outpatient Antibiotic Prescription at a District Hospital in Ghana: Results of a Cross Sectional Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191610286"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s42522-020-00021-8","article-title":"Antibiotics stewardship in Ghana: A cross-sectional study of public knowledge, attitudes, and practices among communities","volume":"2","author":"Jimah","year":"2020","journal-title":"One Health Outlook"}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/10\/4\/81\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:46:38Z","timestamp":1760143598000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/10\/4\/81"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,5]]},"references-count":51,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["diseases10040081"],"URL":"https:\/\/doi.org\/10.3390\/diseases10040081","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,5]]}}}