JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

PERIOPERATIVE NURSES CHAPTER

43^RD ANNUAL SCIENTIFIC CONFERENCE

9^TH -11^TH SEPTEMBER 2026

Harmonizing Knowledge in Perioperative Practice

Microbial Colonization of Surgical Instruments and Surgical Sites Intraoperatively in Main Theatres, Kenyatta National Hospital

​

Dr. Joan Shisoka

​

Quality Improvement through IPC and Risk Management

JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

Surgical site infections (SSIs) are the most frequent postsurgical complications

​

Has the highest impact upon the health or illness process of the patient and satisfaction levels.

​

The burden posed by SSIs on patients is huge which is also reflected in excess health care costs (Richtman et al., 2019).

​

There are no clear guidelines on how long an operating room tray can be exposed to the open environment before the contamination risk becomes unacceptable (Dalstrome et al., 2020).

​

A survey conducted in 14 countries by WHO attributed 8.7% prevalence of SSIs mainly acquired from poorly controlled operating theatres environment. (WHO,2021).

​

Background

​

JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

Broad Objective

To Determine Microbial Colonization of Surgical Instruments and Surgical Sites Intraoperatively in Main Theatres, Kenyatta National Hospital

​

Specific Objectives

1. To determine duration of time taken to microbial colonization on surgical instruments and surgical sites intraoperatively.
2. To compare the types of microbial colonies isolated on the exposed surgical instruments and the surgical site intraoperatively.
3. To explore strategies to counter microbial colonization on surgical instruments and surgical sites intraoperatively. 

​

Objectives

​

JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

Research Design: Mixed methods – Experimental , Sequential Exploratory

Study Site: Main Operating Theatres of Kenyatta National Hospital

​

Study Population:

• 93 Surgical patients – 2 surgical site swabs (pre and post)
• 5 surgery specialties - Orthopaedics, Neuro surgery, Urology, Cardiothoracic and General surgery. (4 hours minimum)
• Sterile surgical instruments – swabs time 0,1,2,3,4 hours (5 swabs)
• KIIs Experts in Perioperative practice –3 Surgeons, 3 Nurses, 3 Anaesthetist

​

Sample calculation done in stratas. 7 samples were obtained per patient hence 93x7= 651 samples

​

Methodology

​

JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

Time to microbial colonization intra-operatively.

​

Surgical Instrument colonization

​

Time taken for microbial colonization on Instruments

​

Findings

​

JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

Occurrence of Microbial Colonization on the surgical sites

​

JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

Surgical Site Colonization

​

JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

Instrument colonization

​

JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

Some instruments were colonized at time 0. A study done in Finland it was found that the sterilization process may not necessarily produce absolute sterility, even when parameters confirming sterilization have been reached (Ovistgaard et al 2020).

​

11.8%; (n=11) patients had microbial colonization on the surgical site pre-surgery. A third of the population got post-surgery microbial colonization on the surgical site (31.2%; n=29).

​

In a study by Sadrizadeh(2023) staphylococcus aureus is the most common organism in SSI due to normal flora of skin and also shed by the personnel in OR.

​

Change of instruments and other surgicals by four hours. A study done by Owusu et al, 2020 concluded change of instruments at 3.5 hours. This was not conclusive

​

Minimize foot traffic in the OR intraoperatively. In a study done in the US, there are no microbiological standards for ORs and most ORs are tested during static conditions when no people are present.(Wagner, 2024)

​

Discussion

​

JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

Actions

​

JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

• By the fourth hour of surgery there was significant microbial colonization on the surgical instruments intraoperatively

​

• Staphylococcus aureus is a dominant microorganism causing surgical site infections.

​

• Surgical instruments and all other surgicals in use intraoperatively should be changed by the fourth hour.

​

• Social wash should be done to all the patients before surgical prepping

​

• A further study needs to be done on the implementation of the developed strategies in the operating theatres.

​

Conclusion

JKUAT is ISO 9001:2015 and ISO 14001:2015 Certified

Setting Trends in Higher Education, Research, Innovation and Entrepreneurship

JKUAT SCHOOL OF NURSING

“In any learning activity mentorship is key”

JS