Fungal Contamination of Small Surgical Instruments at the Sterilization Units of a Tertiary University Hospital in Abidjan, Côte d'Ivoire, West Africa

Abstract

Background: Reusable surgical equipment can be a source of healthcare-associated infections. In Côte d'Ivoire, West Africa, data on fungal contamination of small surgical instruments are limited. Objective: To assess fungal carriage in small surgical instruments at a university hospital in Angré, Côte d'Ivoire. Methods: This cross-sectional study was conducted using small surgical instruments in six departments of a tertiary university hospital in Angré from February to July 2024. Samples were collected by swabbing instruments before sterilization and after opening random sterile sets. Direct examination and culture on Sabouraud dextrose agar medium containing chloramphenicol were performed. Fungal spores and hyphae were identified macroscopically and microscopically, whereas yeasts were identified using chromogenic medium and VITEK 2. Results: Of 313 samples, 70 yielded positive culture (22.4%). Fungi on surgical instruments were identified most frequently at the ear, nose and throat service (34.8%), followed by the dental service (30.4%) and intensive care unit (28.6%). The most frequently isolated mold species was Aspergillus niger (47.2%), followed by Aspergillus flavus (30.6%), Mucor spp. (21.3%), and Aspergillus fumigatus (0.9%). Among the yeasts, the most frequently identified was Candida albicans (50%), followed by Candida krusei (25%) and Candida parapsilosis (25%). Fungi identification was more frequent before sterilization (64.3%) than after opening sterile sets (35.7%). Conclusion: This study revealed the presence of fungi on small surgical instruments before sterilization and after opening random sterile sets. Implementing advanced environmental control, improving sterilization steps, and monitoring may help reduce nosocomial fungal infections from surgical instruments.