Investigating the changing taxonomy and antimicrobial resistance of bacteria isolated from door handles in a new infectious disease ward pre- and post-patient admittance

Background Healthcare associated infections (HAIs) are a significant burden to health systems, with a higher risk of morbidity, mortality and increased financial costs. Antimicrobial resistance (AMR) further compounds the issue as viable treatment options are constrained. The hospital environment plays a significant role in the development of HAIs, with effective microbial monitoring providing the foundation for targeted interventions and improved infection prevention and control strategies. Methods This project sampled door handles in an infectious disease ward at the newly built Royal Liverpool University Hospital. Sampling was performed prior to the first patients being admitted to the ward and then six and twelve months after this date. We also investigated the phenotypic antibiotic resistance of all Staphylococcus spp. identified. Results Prior to patient admission, the majority of isolates identified (57%) were Staphylococcus spp., reducing to 32% and 29% at six and twelve months respectively where Bacillus spp. accounted for 51% of isolates. No ESKAPE pathogens were identified. Antibiotic susceptibility testing of the Staphylococcus spp. showed the rates of resistance were relatively low for all isolates prior to patient admittance, with the exception of cefoxitin (56%). Overall, resistance was highest after six months of ward use, with only tetracycline showing an increase in resistance at each consecutive time point. Despite an increase in isolates susceptible to all antibiotics after 12 months, the rate of multi-drug resistance remained high. Summary This study highlighted the prevalence of a resistant reservoir of bacteria recoverable on high touch surfaces, emphasising the importance of extensive cleaning protocols and efficient, ongoing, environmental surveillance. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by Innovate UK. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.