BACTERIAL CONTAMINATION OF DOOR HANDLES IN MURANG'A DISTRICT HOSPITAL, MURANG’A COUNTY, KENYA

Background: Door handles are documented as breeding grounds for pathogens and presents as focal point of high risk common contact surfacing which facilitates transmission of pathogens within the hospital buildings. Hand hygiene has been singled out as the most important and one of the most effective means of preventing pathogens associated with health care services. Broad objective: The objective of the study was to determine the type of bacterial contaminants on door handles within Murang'a District Hospital. Methods: In this cross-sectional study, 122 door-handles of buildings within Murang’a District Hospital were tested for presence of bacteria. Results: The findings showed that 68 doors did not indicate disease causing bacteria. The highest frequencies of disease causing bacteria were E. coli and Citrobacter ssp at a frequency of 11 each. The lowest disease causing bacteria was P. aeruginosa at a frequency of 6. The department had no significance on the type of pathogens identified because Pearson chi-square value was 47.784 at P = 0.923(value of P > 0.05 then the

396 study therefore aimed at generating data on the level of bacterial contamination, as well as identify bacterial contaminants in door handles of buildings in Murang'a District Hospital since generally this data is lacking.

Materials and Methods:-
This was a cross sectional study carried out on all door handles of buildings within Murang'a district hospital, the main referral hospital for the entire Murang'a County and its environs, Murang'a County, Kenya. A total of 122 door handles were conveniently sampled. Door handles of buildings that were not in use during sampling were excluded from the study.
Ethical approval of the study protocol was obtained from Murang'a district hospital infection prevention committee. Door handles from selected frequently touched door handles in all departments, that is offices, pharmacy, wards, theatre, laboratory, toilets, clinics, outpatient, x-ray and comprehensive care clinic were swabbed with sterile cotton wool swabs and inoculation done on both MacConkey and Blood Agar media within one hour of collection. The plates were incubated aerobically at 37 degree Celsius for 24 hours. Gram stain was done and appropriate biochemical tests performed for bacterial identification.

Results:-
The study intended to study the prevalence of pathogenic causing bacteria among door surfaces in Murang'a District Hospital. The following were the frequencies of the doors in each department that were involved in the study.  After each door was tested for bacteria, the following were the findings The findings revealed that of the doors tested, 68 had coagulase negative Staphylococci bacteria. These findings showed that 68 doors did not indicate disease causing bacteria. The highest frequencies of disease causing bacteria were E. coli and Citrobacter ssp at a frequency of 11 each. The lowest disease causing bacteria was P. aeruginosa at 6 doors.

Cross-tabulation Analysis of the Findings:
It was important for the study to identify the departments and their prevalence of bacteria in their door handles. Thus a cross-tabulation analysis was done between the departments and the bacteria identified. The following were the findings. When a chi square analysis was conducted on the above data, the following were the findings. To determine whether there is a relationship between the department and the pathogens identified (h 0 = department has no relationship on the pathogens), a chi-square analysis was done on the data. The findings showed that The Pearson chi-square value was 47.784 at P = 0.923. Now since the value of P > 0.05 then the null hypothesis was accepted. Thus the two variables were not significantly related and department had no significance on the type of pathogens identified.
The study then strived to determine the relationship between the type of door handle and the identified bacteria. The door handles tested were as shown in table 6 below.
When a cross-tabulation analysis was conducted to determine the relationship between the two variables, the following were the findings: To determine the relationship between the type of door handles and the pathogens identified (h 0 = type of door handles has no relationship with pathogens), a chi-square analysis was done on the data.
The following were the findings: The findings show that The Pearson chi-square value is 58.954 at P = 0.001. Now since the value of P < 0.05 then the null hypothesis was rejected. Thus the two variables here were highly significantly related and type of door handles had a high significance on the pathogens identified.

Conclusion:-
The most contaminated door handles in MDH were in the morgue followed closely by those in OPD and ward 6/7. There were no contaminated door handles found in some blocks like kitchen, stores and the resource centre.
Both pathogenic and nonpathogenic organisms were isolated with majority of the isolates being nonpathogenic. Most pathogenic bacteria were found to be Gram negative while the nonpathogenic were Gram positive.