Environmental Surface Contamination and Antimicrobial Resistant Bacterial Pathogens at a Regional Referral Hospital in Eastern Uganda. A repeated Cross-Sectional Study.

Introduction Environmental surface contamination is a key driver of hospital acquired infections (HAIs), which affect 15-19% of patients in low-income countries and lead to poor clinical outcomes and increased mortality. Although hospital surface environments are known to facilitate bacterial pathogen transmission, systematic evaluations of hospital safety and infection risks on environmental surfaces remain limited in resource constrained settings. This study sought to establish the surface contamination and antimicrobial-resistant bacterial pathogens at Soroti regional referral hospital, Eastern Uganda, across two time periods: July 2022 and December 2025. Methods A descriptive repeated cross-sectional study was conducted across two rounds of data collection. A total of 110 microbiological samples were collected from three wards, neonatal intensive unit (NICU) and the main operating theatre. The sampling sites included handwashing sinks, staff hands, patient beds, weighing scales, operating beds, treatment tables, patient files, and door handles. Standard microbiological culture, Gram staining, and antibiotic sensitivity testing was performed. Data was collected using the Kobo Toolbox, exported to Microsoft Excel, and analyzed using Stata version 15.0. Results Of the 110 samples, 97.3% showed bacterial growth, predominantly of gram-negative bacteria with 83.3% (n=20) of samples from the male ward having gram negative organisms, 100% (n=22) of samples from female ward, 85.7% (n=12) of samples from pediatric ward and 100% (n=12) of samples from theatre, making 70% of the organisms. The NICU exhibited a higher proportion of gram-positive bacteria (71.1%). The association between site and absence of growth was statistically significant (p = 0.005) and primary pathogens identified were Klebsiella pneumoniae, Escherichia coli, Acinetobacter and Enterococcus species, several of which exhibited high-level resistance to multiple antibiotics. Conclusion This study identified key contamination hotspots, particularly the NICU and patient beds, with distinct bacterial profiles. These findings underscore the urgent need to strengthen infection prevention and control measures to reduce the risk of Environmental surface contamination in hospital settings.