Occurrence and prevalence of bacteria on door handles at the University of Port Harcourt Teaching Hospital and the multidrug resistance implications
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Background. The coronavirus disease 2019 (COVID-19) pandemic has heightened concerns regarding transmitting hospital-acquired infections through high-contact points in healthcare facilities, such as door handles, which can serve as reservoirs for pathogenic micro-organisms. With the increased infectivity of the serious acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, there is greater awareness of the risk of multidrug-resistant bacteria on these surfaces, necessitating strict surveillance prevention protocols.
Objective. This study assesses the occurrence and prevalence of bacteria on toilet door handles at the University of Port Harcourt Teaching Hospital in Nigeria and the multidrug resistance implications. We examined the hospital infection level and overall sanitary conditions.
Method. Experimental data from our study on hospital door handles in different locations were assessed. Eighty-six samples were collected from toilet door handles at the University of Port Harcourt Teaching Hospital. Ethical approval was obtained from the hospital departments and the university research ethics committee. Samples from private offices and doors without handles were excluded. Bacteria were isolated from the samples, and antibiotic sensitivity testing was performed.
Result. Of the 329 bacteria isolated, 55.5 % were Gram-positive and 44.4 % Gram-negative. The most prevalent bacteria were Staphylococcus epidermidis , followed by Bacillus sp. The prevalence of multidrug-resistant bacteria was also low, with Enterococcus sp. having the highest prevalence of 28.57%, followed by Micrococcus sp. at 3.45 % and S. epidermidis at 1.96 %.
Conclusion. The results show that, despite the occurrence of pathogenic micro-organisms, there has been a reduction in the prevalence of multidrug-resistant bacteria strains. This study can be used as an example for environmental microbiological surveillance in suspected outbreak investigations and assessment of sanitary conditions and the prevalence of multidrug-resistant bacteria in healthcare facilities.
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All reviewer and editor comments have been sufficiently addressed.
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Reviewer comments and concerns with the original submission have been largely corrected. However, some small revisions are still needed. The response to reviewer comments about comparison to the Odigie et al. study state that the Odigie findings were published pre-pandemic, but line 385 in the revised manuscript states that this study was completed post-pandemic. Odigie is also frequently spelled as Odige in the text, though the references use the spelling Odigie. Please correct these discrepancies in the text. Additionally, there are still issues with the references section. There are references with missing information such as authors and sources, including references 11 and 20. The formatting of the references section is also inconsistent (i.e. some references with publication years bolded, others without). Any citation errors on …
Reviewer comments and concerns with the original submission have been largely corrected. However, some small revisions are still needed. The response to reviewer comments about comparison to the Odigie et al. study state that the Odigie findings were published pre-pandemic, but line 385 in the revised manuscript states that this study was completed post-pandemic. Odigie is also frequently spelled as Odige in the text, though the references use the spelling Odigie. Please correct these discrepancies in the text. Additionally, there are still issues with the references section. There are references with missing information such as authors and sources, including references 11 and 20. The formatting of the references section is also inconsistent (i.e. some references with publication years bolded, others without). Any citation errors on behalf of the citation manager used in preparing this manuscript should be manually corrected for if need be to ensure correct reference information and formatting.
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The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
As a general point, I would suggest a reduction in the emphasis on COVID-19 throughout this piece. Fundamentally, this work does not compare pre-COVID and post-COVID rates of bacteria on surfaces. It is not possible to conclude whether COVID practices have led to a decline in bacterial colonisation of these surfaces. The connection is attempted to be made, by stating that the pandemic emphasised the need to reduce HCAI transmission through high-touch surfaces; however, I would argue that the pandemic's more widespread impact was to increase emphasis on air circulation and the role of airborne viral transmission (and use of masks to combat this). I do feel, however, that this article presents some useful bacterial and AMR surveillance data from a hospital setting which is of value. The data are …
Comments to Author
As a general point, I would suggest a reduction in the emphasis on COVID-19 throughout this piece. Fundamentally, this work does not compare pre-COVID and post-COVID rates of bacteria on surfaces. It is not possible to conclude whether COVID practices have led to a decline in bacterial colonisation of these surfaces. The connection is attempted to be made, by stating that the pandemic emphasised the need to reduce HCAI transmission through high-touch surfaces; however, I would argue that the pandemic's more widespread impact was to increase emphasis on air circulation and the role of airborne viral transmission (and use of masks to combat this). I do feel, however, that this article presents some useful bacterial and AMR surveillance data from a hospital setting which is of value. The data are generally well described and discussed. * Line 104 - "The COVID-19 pandemic has had a big influence on how hospital-acquired infections are spread" - is this true? Please clarify. * Line 108 - "…microorganisms, which are organisms that can cause infections and diseases" - what is being defined here is pathogenic microorganisms or just pathogens. * Line 180 - please reference the WHO minimum requirements. * Figure 2 - ensure that bacterial names are written out in full either in the axis title or in the legend; define 'S' in 'S. epidermidis' etc. * Table 2 - need to indicate more clearly the meaning of numbers in brackets. * Table 2 - unclear what is meant by the phrase "The results are statistically significant (p = 0.05)". Which comparisons are being referred to here? * Table 3 - need justification somewhere of NA. Why were some organisms not tested against some antibiotics? * Table 4 appears to show 6 isolates that were multidrug-resistant, but Table 5 and associated text only refers to 4 isolates. References to 4 multidrug-resistant isolates are also made in the discussion. Please clarify. * Line 375 - it would be good here to offer some ideas regarding why the results of your study may have differed from that of Odige et al. * Change references to bacteria being 'low' to prevalence or rate of occurrence being low. * Line 388 - 'epidermidis' spelling error * Use of word 'checkmate' is rather informal and confusing, I would suggest choosing an alternative. * Lines 431-434 - please clarify what is meant here, it is unclear what point is being made in reference to the youth population. * Lines 435-441 - it would be helpful to include some references to studies describing antimicrobial surfaces that could be of use here as you have mentioned them as a potential solution. Some references may be found in the following review: https://doi.org/10.1021/acsnano.2c12488 or the review itself may be cited (for transparency, I am an author of this review and this is a suggestion, not a requirement). In discussion, explore sampling decisions - particularly timing. How can you be sure that you did not collect samples just after the surfaces were cleaned? Are you able to offer any discussion of how the prevalence of bacteria on surfaces may change over time, between cleaning events? Are you able to add detail to the methodology with respect to cleaning, for example how surfaces are usually cleaned (what types of cleaning chemicals) and how frequently.
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
Comments Language: The authors should thoroughly reread this manuscript to check for grammatical errors. Abstract: The abstract section was appropriately structured. However, in the method section, the authors must clearly but succinctly state the sample collection method, total sample collected, ethical clearance approval, exclusion and inclusion criteria and all other methods employed in the present study. Furthermore, in the result section of the abstract, the authors did not provide any figures or data that summarize their findings. How many isolates were bacteria or fungi? How many were gram-positive or negative? What was the percentage of the organisms that showed multi-drug resistance? What is the most implicated organism? What was the most effective and less-effective antibiotic etc. All …
Comments to Author
Comments Language: The authors should thoroughly reread this manuscript to check for grammatical errors. Abstract: The abstract section was appropriately structured. However, in the method section, the authors must clearly but succinctly state the sample collection method, total sample collected, ethical clearance approval, exclusion and inclusion criteria and all other methods employed in the present study. Furthermore, in the result section of the abstract, the authors did not provide any figures or data that summarize their findings. How many isolates were bacteria or fungi? How many were gram-positive or negative? What was the percentage of the organisms that showed multi-drug resistance? What is the most implicated organism? What was the most effective and less-effective antibiotic etc. All these modifications must be maintained within 250 words. Impact Statement: This part is okay. Introduction: In line 104-105, the authors stated, "The COVID-19 pandemic has had a big influence on how hospital-acquired infections are spread, especially through contaminated door handles and other high-touch surfaces". How? I feel this part can be better connected by saying "COVID-19 pandemic has had a big influence on how hospital acquired infections are spread, owing to high hospitalizations that accompanied COVID-19 outbreak, resulting in multiple people touching different surfaces in the healthcare facilities. In line 118-119, the authors stated, "but the COVID-19 pandemic has made the problem worse due to the high infectivity of the SARS-Cov-2 virus". How does high infectivity of SARS-Cov-2 confer antibiotic resistance on bacteria? or is the surge in antibiotic resistance in bacteria caused by increased usage of antibiotics among COVID-19 patients? Please clarify. Materials and methods: In line 175, the authors stated that ethical clearance was obtained for the study. Please provide the name(s) of the ethics committee(s) and the approval number(s) In line 200-201, the authors stated, "A totally of 86 samples were aseptically 201 collected using a moistened sterile swab stick". What was the sterile swab stick moistened with? Normal saline? Peptone water? Could you please state this. In line 203-204, was the transportation of samples carried out in cold chain to circumvent overgrowth of organisms? In line 226-232, the authors documented procedures for antibiotic susceptibility testing. Could you also state here the antibiotics employed in this study and their respective concentrations? Also, was any control organism used for this test? If yes, kindly state it. Results: In line 272-273, the authors stated, "consisting of 253 bacteria (76.9%) and 76 fungi (14.3 %)". These percentage values do not add up to 100%. 76/329 that accounts for fungi should be 23.1%, and not 14.3%. For the data presented in Table 1, was the experiment conducted in triplicate or duplicate? Furthermore, scientific names of organisms were not properly written. For example, in line 282, the authors wrote "Bacillus sp". The "sp" should be written without italics plus full stop after sp (e.g., Salmonella sp.). Discussion: In line 375-376, the authors stated, "The findings of this study are in contrast to the reports of the similar study by (Odige et al., 2018) where most of the bacteria isolates where multidrug-resistant". What do you think might be the cause of the discrepancies between your findings and those reported in other studies of a similar nature? Kindly justify this. Also, kindly ensure that "COVID-19" is written in the same manner throughout the manuscript. References: This section also needs to be corrected. Some citations were inappropriately written.
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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