• 0 Review(s)

Product Category: Projects

Product Code: 00007194

No of Pages: 92

No of Chapters: 1-5

File Format: Microsoft Word

Price :



Bacterial contamination of the labour and delivery room is of clinical concern because it is one of the major risk factors of sepsis in neonates and most life threatening nosocomial infections for mothers after undergoing childbirth procedures.  Three hundred (300) consecutive samples were collected from fomites and anterior nares of the health care workers from six (6) different Primary Health Centres (PHCs). These were screened for the presence of bacterial pathogens. Preliminary identification of bacteria isolates were performed based on gram stain reactions, colony characteristics of the organisms like hemolysis on blood agar, changes in physical appearance in differential media and enzyme activities of the organisms. Antibiotic susceptibility testing was done by using Kirby-Bauer disc diffusion technique. The isolates of clinical importance observed were Staphylococcus aureus (35.1%), Bacillus spp.(15.5%)  Streptococcus spp. (14.8%), E. coli (10.1%), Coagulase Negative Staphylococcus (CONS) spp. (8.1%), Proteus spp. (7.4%), Pseudomonas aeruginosa (5.4%), ,Klebsiella spp.(1.3%).  Eight (8) antibiotics used against S.aureus which was the most prevalent isolate showed below 50% sensitivity and almost the same with E.coli. High level resistance to commonly prescribed and administered antibiotics such as amoxicillin clavulanate, penicillin, amoxicillin, ampicllin, cefalexin and cotrimoxazole was observed. The percentage of Extended Spectrum Beta-lactamase (ESBL) among E coli isolates was 64.2%, and the least was Pseudomonas aeruginosa (14.2%). Percentages of biofilm forming organisms are S aureus(39.3%), and the least was klebsiella spp(1.0%).The plasmid profile of 15 resistant isolates was studied and the study revealed that 3 isolates had plasmids. The types of bacteria most frequently isolated were consistent with the isolates which could cause nosocomial infections.  Constant disinfection of surfaces and items under a strict infection control policy will check the transmission of infectious agents from these fomites.


Cover Page

Title Page                                                                                                                     i

Declaration                                                                                                                  ii

Certification                                                                                                                iii

Dedication                                                                                                                   iv

Acknowledgements                                                                                                    v

Table of Contents                                                                                                        vi

List of Table                                                                                                                ix

List of Figure                                                                                                              x

Abstract                                                                                                                      xi

CHAPTER I: INTRODUCTION                                                                           1

1.1. Why do These Deaths Occur                                                                               4

1.2.     Statement of the Problem                                                                                11

1.3. Aims and Objectives of the Study                                                                      12

CHAPTER 2:  LITERATURE REWIEW                                                                        14

2.1. Nigerian Maternity Wards and Infections                                                           14

2.2. Nosocomial Infections                                                                                         17

2.3. Epidemiology of Nosocomial Infections                                                             18

2.3.1. Endogenous infection, self-infection, or auto-infection.                                  22

2.3.2. Cross-contamination followed by cross-infection.                                           22

2.3.3. The transition from contamination to infection.                                               23

2.4. The Sources of Infection                                                                                     24

2.5. The Routes of Transmission                                                                                 25

2.6. Sepsis in the Maternity Setting                                                                            26

2.7. Some Hospital Pathogens related with Hospital Environment                            28

CHAPTER 3: MATERIALS AND METHODS                                                   36

3.1. Study Design                                                                                                       36

3.2. Study Area and Health Facility Selection                                                           36

3.3. Sample Collection                                                                                                37

3.4. Specimen Processing                                                                                            37

3.5. Media Preparation                                                                                                38

3.6. Gram staining Technique                                                                                     38

3.7. Total viable count                                                                                   39

3.8. Isolation and Identification of Bacteria                                                              39

3.9. Biochemical Tests                                                                                                39

3.9.1. Catalase  test                                                                                                     40

3.9.2. Coagulase test                                                                                                   40

3.9.3. Oxidase test                                                                                                      40

3.9.4. Indole test                                                                                                         41

3.9.5. Citrate utilization                                                                                              41

3.9.6. Motility test                                                                                                      41

3.9.7. Sugar fermentation                                                                                           42

3.10. Antibiotic Susceptibility Test                                                                            42

3.11. Determination of Multiple Antibiotic Resistance (MARI) Index                         42

3.12. Biofilm Production                                                                                            43

3.13. Extended Spectrum Beta-Lactamase (ESBL) Producers Screening and

       Confirmation                                                                                                        43

3.14. Plasmid Extraction (Alkaline lysis Method)                                          44

3.15. Plasmid Analysis                                                                                                45

3.16. Plasmid Curing                                                                                                  45

CHAPTER 4: RESULTS AND DISCUSSION                                                    46

4.1. Results                                                                                                                 46

4.2. Discussion                                                                                                            67

CHAPTER 5: CONCLUSION AND RECOMMENDATIONS                                     71

5.1. Conclusion                                                                                                           71

5.2. Recommendations                                                                                               72




4.1: Percentage and types of Bacterial Isolates from the study                                 50

4.2:  Frequency and Types of Bacterial Isolates from Fomites in PHC                     51

4.3:  Frequency and Types of Bacterial Isolates from Fomites in PHC 2                  52

4.4:  Frequency and Types of Bacterial Isolates from Fomites in PHC 3                  53

4.5: Frequency and Types of Bacterial Isolates from Fomites in PHC 4                   54

4.6: Frequency and Types of Bacterial Isolates from Fomites in PHC 5                   55

4.7: Frequency and Types of Bacterial Isolates from Fomites in PHC 6                   56

4.8: Total Distribution Pattern of The Bacterial Isolates from Fomites                      57

4.9: Isolates with Biofilm Production potential                                                          58

4.10: Bacteria Isolates from the Anterior Nares of Health care Workers                   59

4.11a: Antibiogram for Gram Positive Isolates                                                         60

4.11b: Antibiogram for Gram Negative Isolates                                                        61

4.12 Multiple Antibiotics Resistance Index (MARI) of Bacterial Isolates

           from the six PHCs                                                                                           62

4.13: Extended Spectrum Beta-Lactamase Producers                                               63

4.14: Plasmid Profiles of the Isolated Pathogens                                                       64

4.15: Distribution of Cured Plasmids                                                                         65




4.1:   Plasmid profile of bacterial isolates from the study                                          66








In Nigeria, the most populous country in Africa, 45,000 women die in childbirth every year, (UNICEF 2004, UNFPA 2011, and WHO 2004). This represents the third highest estimated number of women that die through childbirth globally. India and Ethiopia have maternal deaths, of 110,000 and 46,000 respectively (WHO, 2004).


More than 8 million infants die before birth or in the first few weeks of life; the majority of these infants’ mortality occur in developing countries.  A great number of this infant mortality is due to transmittable diseases, complications related to the pregnancy, and complications that came up during delivery (WHO, 2015). To minimize this form of maternal and infants deaths, interventions which are priority should be taken before birth, all through the process of childbirth, and also without delay after birth, this is because, the first week after childbirth has been seen as the most susceptible period for both mother and child (WHO, 2009).


The dissemination of health-care associated infections (HAI) often originates from cross contamination. The most common means of pathogen transference occurs between the hands of health professionals and patients (UNFPA, 2011). However, the hospital environment may contribute with the dissemination of pathogens. Environments occupied by colonized and/or infected patients generally can become contaminated (UNICEF, 2004). The presence of bacteria is common in inanimate surfaces and equipment (WHO, 2004).

The dissemination of nosocomial infection is complex and has multifactor causes. In this sense, addressing the environment in bacteria dissemination aims at achieving a better understanding of HAI control, defining policies for control and building awareness about the subject among health professionals (UNFPA, 2011).


The single most successful and helpful approach of reducing mothers’ deaths during childbirth is by providing skilled care during and after childbirth, (Family Care International, 2008). This means that the skilled attendant — example, a trained midwife, nurse, or doctor, should have the necessary skills and should be supported by a primary health centre and a hospital with adequate supplies and equipment, and also a better and easy means of communication with referral and transport.  An experienced healthcare worker should have the knowledge on how to provide certain healthcare needs and also should be able to recognize difficulties in childbirth so as to be able to calm the woman condition if need arises, before referring her to another facility that can have emergency obstetric care (EOC). This includes administering drugs, caring for abortion complications, stopping bleeding, managing prolonged labour, providing blood transfusions, and performing Caesarean section operations (Singh, 2002)


"Maternal mortality is responsible for a few major health problems for which medical intervention is the key to the solution," (Peju, 2008).The provision of adequate urgent obstetric care and infection free environment is an important way of reducing maternal mortality drastically.

Some factors have the potentials to contribute to the contaminations of environmental surfaces in the spread of pathogens which are healthcare associated,  these  factors depend on the following: the tendency of that very pathogen to continue to remain alive on various environmental surfaces that are dry, the rate by which the surface is being contaminated by both the patients and healthcare providers; example, by touching and  most importantly, if the  contamination level is adequately high enough to cause the spread of the pathogens in a patients (Weber et al., 2010).


Before now, it was believed that environmental surfaces do not play an  important part in the spread of endemic pathogens that are healthcare associated, but recent data however have shown that surfaces  that are contaminated aid in the endemicity and epidemic spread of some pathogens that are responsible for nosocomial infections  (Otter et al., 2011).


Prevention and controlling of diseases which may bring more harm to the patients, patient’s relations and health-care personnel within the hospital environment is the duty of all the health personnel within that hospital environment. Studies carried out globally have proven that a good percentage of pathogenic aerobic bacteria do stick on surfaces within the hospital environment (Weber et al, 2010), and this poses a serious health issues for the healthcare personnel, patients and even patients relatives. Contamination of hospital surfaces by pathogens that persist on the surfaces and the cross contamination of these surfaces by these persistent organism could increase the danger by which healthcare associated infection would be acquired (Otter et al., 2011), which could then result to high  treatment cost, considerable morbidity, lengthened  stay in the hospital, failure  of treatment and occasionally death.



Hospital environment is a reservoir of wide varieties of microorganisms. Several strains of pathogenic bacteria have been frequently reported colonizing medical equipments (like Stethoscopes) (Otter et al., 2011). These pathogens include superbugs like Vancomycin Resistant Enterococcus spp., Methicillin Resistant and Sensitive Staphylococcus species and Multidrug resistant, P. aeruginosaE. coliKlebsiella spp. and Streptococcus spp.(Youngster et al., 2008).


Health care-associated infections (HAI) remain a major cause of patient morbidity and mortality. An estimated 20% to 40% of HAI have been attributed to cross infection via the hands of health care personnel. This contamination has been via direct contact with the patient or indirectly by touching contaminated environmental surfaces. Prolonged periods in the hospital stay terms of hospital infection have been associated with frequent surface contamination in hospital rooms and health care workers’ hands. In some cases, the extent of patient-to-patient transmission has been found to be directly proportional to the level of environmental contamination (Al-Maani et al., 2014).


Medical equipments used in the non-critical care setting are less likely to have standard disinfection and cleaning protocols than equipments in the critical care setting. Thus medical care equipments are more likely to carry considerable number of pathogenic microorganisms (Youngster et al., 2008). The contamination of stethoscope particularly the diaphragm is reported mainly due to lack of regular disinfection (before and after examining each patient). A study from India reported that, 45% of general practitioners disinfect their stethoscope once a year or never and 35% disinfect their stethoscope monthly (Weber et al., 2010).


Infection prevention protocols are effective in reducing the health care associated infections (Alothman et al., 2009). The use of 70% propyl alcohol has been found to be effective in reducing contamination of stethoscopes and other medical equipments than other agents like detergents (Nelson et al., 2006). However, a study conducted by Hayden and his colleagues shows that, the implementation of such programs were hindered by poor compliance of Physicians, Nurses and other health care workers (Hayden et al., 2006). Inconvenience, time pressures, and skin damage from frequent washing of hands are some of the reasons quoted by the health care personnel that made them not to adhere to infection prevention protocols in that particular study (Fauci et al., 2008). A routine disinfection of stethoscope is hardly undertaken in most of the health care institutions worldwide (Nelson et al., 2006).


During auscultation stethoscope contamination is common; if the same stethoscope is used for the next patient without disinfection, it might bring risk of infection to the patient and may continuously impose the risk serially to all patients (Whittington et al., 2009). Draping of stethoscopes around the neck is still a commonly seen practice, resulting in the risk of recontamination of the diaphragm of the stethoscope from the unclean earpieces, with normal flora and pathogenic bacterial strains harbouring in the ears of the healthcare workers (HCWs). The universal and unavoidable use of the stethoscope and its direct contact with multiple patients makes it an important potential factor in the dissemination of microorganisms from one patient to another (Bdareen, 2009).


Exposure of the already susceptible hospitalized patient to resident flora (in most cases are multidrug resistant pathogens unless proved) of the hospital environment may worsen the clinical condition of the patient. Periodic surveillance of medical equipments and hospital environments may help in identifying potential bacterial pathogens and associated factors (WHO, 2009).


The hospital environment is contaminated by a variety of pathogenic and non-pathogenic microorganisms that can persist on surfaces for prolonged periods. Numerous studies have demonstrated that the hands and gloves of healthcare workers readily acquire pathogens after contact with contaminated hospital surfaces and can transfer these organisms to subsequently touched patients and inanimate surfaces. The acquisition of nosocomial pathogens by a patient and the resultant development of infection depend on a multifaceted interplay between the environment, a pathogen and a susceptible host. However, there is good evidence that infection transmission via hospital surfaces and medical equipment can occur. For these reasons, hospitals must implement evidence-based infection prevention measures that will reduce the risk of transmission of pathogens via contaminated hospital surfaces and medical equipment and hold personnel accountable for adhering to these measures (Bdareen, 2009).


Environmental surfaces act as a reservoir for bacterial and viral gathering and proliferation. These organisms can be expelled from an infected or colonized patient either through direct contact, aerosol droplets, or feces. Clostridium difficile has been shown to last 5 months on hospital floors (Amazian et al., 2010).It has also been found on shoes and stethoscopes of healthcare workers (Belghiti Alaoui et al., 2015). Methicillin-resistant Staphylococcus aureus (MRSA) can live on plastic laminate surfaces for 2 days and can spread rapidly through contact [Arias, 2010]. Vancomycin-resistant enterococci (VRE) can survive on gowns of health care workers as well as medical equipment, bed rails, counters, bedside tables and sheets (Nelson et al., 2006). One study showed that VRE could live for up to 58 days on countertops. Acinetobacter baurmannii survival can last for up to 33 days on plastic laminate surfaces (Arias, 2010). As cell phone use becomes more widespread in the hospital setting, they are considered as a possible source for cross contamination (Nelson et al., 2006). Noroviruses can also contaminate the environment, persist after drying and may even become re-aerosolized during floor sweeping.  The advent of molecular epidemiology is helping with a better understanding of the role of the environment in nosocomial infection by confirming that environmental isolates are the same as patient isolates (Belghiti Alaoui et al., 2015).


Environmental surfaces and semi-critical items have been implicated in the transmission of infections. Relatively speaking, the intensive care unit (ICU) patient will be more susceptible to infection because of possible breaks in their skin due to trauma or surgery, indwelling medical devices, or general immune suppression due to disease state or chemotherapy. For these patients, a lower inoculum of microbes can cause an infection and microbes that are normally not pathogenic to healthy individuals can cause an infection. Hence the contaminated item in the ICU could play a more significant role in the transmission of infection to this population (Nelson et al., 2006).


Predominant evidence suggests that the airborne microflora of indoor environments remain major causes of hospital infections (Li and Hou, 2003; Hota, 2004; Saka et al., 2016). Many infections are spread by the direct contact, because healthcare workers do not wash their hands effectively before attending the patients (Arias, 2010). It has been estimated that the airborne route of transmission accounts for between 10 to 20% of endemic nosocomial infections (Li and Hou, 2003). Most airborne microorganisms found in hospitals are disseminated within the building by the staff, patients and visitors. Only a minority of these microorganisms is seen in the air and there are usually fungal spores which were infiltrate from outside. Generally, the higher the occupancy level the greater the microbial burden in the air. Consequently, the air bioburden within hospitals tends to be very transient and can fluctuate widely, depending on occupancy levels and the tasks being performed (Arias, 2010). Activities, such as bed making, release huge number of microorganisms into the atmosphere. According to study the total viable count in a patient room exceeded 6 X 103 colony forming units per cubic meter of air during vigorous bed making (Greene et al., 1960). Bacterial spores can remain viable for years and are very resistant to environmental stresses such as heat, cold and UV radiation (Nevalainen et al., 1993).


Many species appear to lower their metabolic rate and reduce in size under conditions of nutrient starvation (Roszak and Colwell, 1987) and has also been observed by a number of investigators (Butkeviczi, 1988; Greene et al., 1960; Novitsky and Morita, 1977). The predominant mechanism that makes the pathogens airborne is the production of aerosol droplets by sneezing or coughing and their subsequent loss of water, which allows them to float in the air over considerable distances and for a longtime (Emmerson, 1995). Blessing-Moore et al., (1979) recovered Pseudomonas aeruginosa from settle plates located near patients with cystic fibrosis and airborne Pseudomonas spp. were linked with an outbreak of nosocomial bacteraemia at a hospital in the USA (Grieble et al., 1974).


Inanimate objects which become contaminated with pathogenic bacteria and then spread infection to others are often referred to as fomites. Most outbreaks of infection associated with inanimate objects are caused by items that should be sterile but have been contaminated (Roszak and Colwell, 1987).

The hypothesis that environmental microorganism cause human diseases arises from two facts, firstly, our interaction with the inanimate environment is constant and close, secondly environmental objects are usually contaminated often with important human pathogens. Unfortunately, though it is fairly easy to assess the prevalence of microorganism in the environment, it is relatively difficult to establish the role the organisms in the environment play in causing human disease (Nevalainen et al., 1993).


There are no systematic studies of the relative importance of various environmental factors in ensuring a safe delivery room environment; however it is known that contaminated fluid or equipment in the delivery room may result in contaminations and lead to outbreaks of  infections (Arias, 2010).


Management of health-care waste is an integral part of hospital hygiene and infection control. Health-care waste should be considered as a reservoir of pathogenic microorganisms, which can cause contamination and give rise to infection. If waste is inadequately managed, these microorganisms can be transmitted by direct contact, in the air, or by a variety of vectors. Infectious waste contributes in this way to the risk of nosocomial infections, putting the health of hospital personnel, and patients, at risk (Hota, 2004).


Mothers and neonates are vulnerable to get infections from the surrounding environment of the Hospital. The chances of infection increases, if the precautions are not taken appropriately, especially by nursing staff who is the prime person, responsible for taking care of neonates in the Hospital. Infection control is a more substantial area of concern in Labor and delivery room because these neonates do not adapt to their surroundings immediately after they come out of the womb of mothers. In addition to this, mothers might be exposed to infection due to multiple examinations by health care providers during the process of labor. Moreover, in lower middle income countries, neonatal deaths are due to infections acquired at home or in the hospital and around 36% of the neonatal deaths occur due to infection (WHO, 2004). Healthcare professionals always aim to preserve the maternal and newborn health, but sometimes little negligence can put their health at risk which should not be overlooked. Multiple factors can cause infection in the labour room, therefore it is important to assess various factors of maternal and neonatal infection (WHO, 2009).




Today the increasing number of antenatal deliveries and the effect of the hospital environment on women’s birth experience have become critical issues. The transition of childbirth from home to hospital and thus the trend of defining birth as a pathological event have created hospital settings that regard medical safety first.


At birth, newborns, especially premature and low birth weight neonates are devoid of efficient structural barriers, of a protective endogenous microbial flora and of a mature immune system. The newborn represents one of the most vulnerable populations among the pediatric group, especially neonates delivered in a contaminated primary health care (PHC) facilities, where the large-scale use of medical devices and lack of maturation of a child’s immune system increase the chances of acquiring nosocomial infections which the causative organisms may be bacterial, viral, or fungal in origin (Nevalainen et al., 1993).  Nevertheless, nosocomial infections remain a major cause of preventable morbidity and mortality in developing countries where infection rates are relatively high with poor infection control practices, lack of supervision and inappropriate use of limited resources. The major pathogens of neonatal infections differ not only from country to country and from nursery to nursery, but also change within years in the same nursery (Belghiti et al., 2009).


Healthcare workers not only contaminate their hands after direct patient contact but also after touching inanimate surfaces and equipment in the labour ward zone (the patient and her immediate surroundings). Inadequate hand hygiene before and after entering a labour zone may result in cross-transmission of pathogens and patient colonization or infection. A number of equipment items and commonly used objects in labour wards carry bacteria which, in most cases, show the same antibiotic susceptibility profiles of those isolated from patients. This study is to provide updated evidence about contamination of inanimate surfaces and equipment in labour wards in light of the concept of labour zone and the possible implications for bacterial pathogen cross-transmission to mother and child during childbirth.


For these reasons, effective surveillance was very important to evaluate the epidemiology, associated risk factors, causative organisms and outcomes based on understanding the epidemiology of nosocomial infection in our locality. Therefore, this study was conducted to determine the types and prevalence of bacterial pathogens associated with labour ward environments and antibiotic susceptibility pattern of these isolates from six different primary health centers (PHCs) within Umuahia metropolis.


General objective;

The aim of this study is to investigate the Bacterial contamination that is associated with labour ward environment from selected primary health care (PHC) setting in Umuahia metropolis.

Specific objective;

1.                  Evaluation of overall bacterial spectrum associated with labour ward           environment from selected PHC settings in the study.

2.                  Evaluation of the distribution of the bacterial strains isolated from tools and           sections of labour and delivery wards such as delivery coach, delivery forceps,            mucus extractor, scissors, cord clamp,etc.

3.                  To evaulate the antibiotic susceptibility pattern of the bacteria isolated

4.                  To determine resistant factors associated with such isolates.

5.                  To determine the plasmid profile of some resistant bacteria.

Click “DOWNLOAD NOW” below to get the complete Projects


+(234) 0814 780 1594

Buyers has the right to create dispute within seven (7) days of purchase for 100% refund request when you experience issue with the file received. 

Dispute can only be created when you receive a corrupt file, a wrong file or irregularities in the table of contents and content of the file you received. shall either provide the appropriate file within 48hrs or send refund excluding your bank transaction charges. Term and Conditions are applied.

Buyers are expected to confirm that the material you are paying for is available on our website and you have selected the right material, you have also gone through the preliminary pages and it interests you before payment. DO NOT MAKE BANK PAYMENT IF YOUR TOPIC IS NOT ON THE WEBSITE.

In case of payment for a material not available on, the management of has the right to keep your money until you send a topic that is available on our website within 48 hours.

You cannot change topic after receiving material of the topic you ordered and paid for.

Ratings & Reviews


No Review Found.

To Review

To Comment