Isolation of Bacteria and Prevalence of Resistant Genes in Isolates from Hospital Waste and Surfaces and its Management in Hospitals in Kenya

Abstract

Control of hospital environment is key to success of healthcare quality. Increasing emergence and spread of pathogenic bacteria is of great concern and continues to challenge infection prevention and epidemiology practice. This study aimed at providing information about the management of hospital environment and wastes in selected hospitals in Kenya, determine prevalence of pathogenic bacteria and their antibiotic susceptibility while detecting presence of resistant genes. A cross sectional study was conducted at Kenyatta National Hospital (KNH)(public) and Kikuyu Mission Hospital (KMH)(private) in Kenya from May 2015 to April 2017. Simple random sampling technique was used to distribute a semi structured questionnaire among 246 health workers in each of the hospitals to capture data on knowledge and management of hospital waste. In microbiological analysis, a total of 246 samples from each of the two hospitals was obtained using sterile cotton swabs from random sampling of hospital different surfaces, drainages, hands of healthcare givers and hospital waste dump site among others. The samples were aseptically collected, transported and processed following standard procedures. Colony morphology and biochemical characterization of bacteria was also determined. The identified microbes were subjected to antibiotics susceptibility test. Detection of genes of interest in this study Bla TEM, Bla CTX-M and Bla SHV in Gram negative bacteria was done using polymerase chain reaction. Data was registered and entered in to SPSS version 16 computer program and analyzed using ANOVA. Results from the study revealed that doctors and public health officers had the highest knowledge in hospital waste management matters. In addition, healthcare facilities whether public or private practiced inappropriate medical wastes management skills. A total of 471 bacterial isolates were recovered, and were distributed as follows; Providentia sp 99 (21%) followed by Staphylococcus aureus 87 (18 %), Escherichia coli (E. coli) 61 (13 %), other Gram negative bacteria were 45 (10%), Pseudomonas sp 44 (9 %), coagulase negative Staphylococcus (CONS) 43 (9%), Serratia sp 31 (7%), Klebsiella sp 30 (6 %), Proteus sp 19 (4%) and Enterobacter sp 12 (3%). Susceptibility test revealed that Escherichia coli isolates were the most sensitive isolate to antibiotics. Imipenem drug showed 100% sensitivity for Gram negative, while Gram-positive isolates, linezolid antibiotic was the most sensitive drug. Extended- spectrum beta lactamases Bla TEM (10%), Bla SHV (3%) and Bla CTX-M (5%) genes were detected in this study. In conclusion, knowledge is above average in the studied hospitals. Positive attitude of doctors and public health officers towards the operational aspects of medical waste management system can be attributed to the microscopic vision of these professionals. The current practices are inappropriate due to lack of proper facilities and information of the individuals concerned. There is high bacterial contamination of objects frequently touched by patients and healthcare workers in hospitals and medical waste harbor potential pathogens and may act as a source of infectious. Antibiotic resistance bacteria reported in tetracycline, cefuroxime and ampicillin. Potencies of gentamicin, ceftriaxone and cefepime decreasing, multidrug existence- suggesting poor hygienic practices. Among the resistant genes detected in this study included Bla TEM (10%), Bla CTX-M (5%) and Bla SHV (3%) which was low. There is need for stringent review of hospital waste management system in Kenya. The frequency of ESBL producing strains among clinical isolates has been steadily increasing. Continued drug resistance surveillance and molecular characteristics of ESBL isolates are necessary to guide the appropriate and judicious antibiotic use.