High bacterial load of indoor air in hospital wards: the case of University of Gondar teaching hospital, Northwest Ethiopia

Pathogenic bacteria and fungi in bioaerosols from specialized hospitals in Shandong province, East China

Bacteria and fungi are abundant and ubiquitous in bioaerosols in hospital environments. Understanding the distribution and diversity of microbial communities within bioaerosols is critical for mitigating their detrimental effects. Our knowledge on the composition of bacteria or fungi in bioaerosols is limited, especially the potential pathogens present in fine particulate matter (PM2.5) from specialized hospitals. Thirty p.m.2.5 filter samples were collected from five hospitals (i.e., oral, dermatology, chest, eye, and general hospitals) in Shandong Province, East China. The diversity of bacteria and fungi was analyzed at the species level using single-molecule real-time sequencing of the 16 S and internal transcribed spacer 1 (ITS) ribosomal genes, respectively. Significant differences were detected across sampling sites in terms of microbial diversity and community composition in PM2.5 as well as pollution concentrations. The range of PM2.5 concentrations observed in hospital halls was higher, ranging from 39.0 to 46.2 μg/m3, compared to the wards where the concentrations ranged from 10.7 to 25.2 μg/m3. Furthermore, microbial variations in PM2.5 bioaerosols were associated with hospital type. The most dominant pathogens identified were Vibrio metschnikovii, Staphylococcus epidermidis, Staphylococcus haemolyticus, Fusarium pseudensiforme, and Aspergillus ruber. Among these, A. ruber was identified as an opportunistic fungus in a hospital setting for the first time. Nine potentially novel strains of F. pseudensiforme, showing 84.5%-92.0% ITS sequence similarity to known Fusarium isolates, were identified in PM2.5 samples from all hospitals (excluding an eye hospital). This study highlights the importance of hospital environments in shaping microbial aerosol communities. To the best of our knowledge, this is the first study to provide insights into the bacterial and fungal biodiversity of PM2.5 in specialized hospitals, enriching research in healthcare environmental microbiology and carrying significant public health implications.

Bacterial indoor air contaminations in hospitals in MENA region: a systematic review

Poor indoor air quality in healthcare settings has been tied with the increase in hospital-acquired infections. Thus, this systematic review was conducted to assess the levels and compositions of bacteria in indoor hospital air in the Middle East and North Africa (MENA) region. We examined results provided by different search engines published between 2000 and 2021. Our data showed that most studies were conducted in Iran (80.9%) with a bacterial concentration mean of 172.9 CFU/m3. Comparing sensitive and non-sensitive areas of hospitals, no significant difference was detected in the mean bacterial concentration. The most investigated sensitive hospital areas were operating rooms and intensive care units with mean indoor bacterial concentrations of 180.3 CFU/m3 and 204.6 CFU/m3, respectively. Staphylococcaceae, Enterobacteriaceae, Pseudomonadaceae, and Bacillaceae were commonly identified bacterial families. In conclusion, the mean concentrations of the airborne bacteria were within the acceptable limit compared to WHO standards (300 CFU/m3) for the air in areas occupied by immunosuppressed people.

Potential airborne human pathogens: A relevant inhabitant in built environments but not considered in indoor air quality standards

Potential airborne human pathogens (PAHPs) may be a relevant component of the air microbiome in built environments. Despite that PAHPs can cause infections, particularly in immunosuppressed patients at medical centers, they are scarcely considered in standards of indoor air quality (IAQ) worldwide. Here, we reviewed the current information on microbial aerosols (bacteria, fungal and viruses) and PAHPs in different types of built environments (e.g., medical center, industrial and non-industrial), including the main factors involved in their dispersion, the methodologies used in their study and their associated biological risks. Our analysis identified the human occupancy and ventilation systems as the primary sources of dispersal of microbial aerosols indoors. We also observed temperature and relative humidity as relevant physicochemical factors regulating the dispersion and viability of some PAHPs. Our analysis revealed that some PAHPs can survive and coexist in different environments while other PAHPs are limited or specific for an environment. In relation to the methodologies (conventional or molecular) the nature of PAHPs and sampling type are pivotal. In this context, indoors air-borne viruses are the less studies because their small size, environmental lability, and absence of efficient sampling techniques and universal molecular markers for their study. Finally, it is noteworthy that PAHPs are not commonly considered and included in IAQ standards worldwide, and when they are included, the total abundance is the single parameter considered and biological risks is excluded. Therefore, we propose a revision, design and establishment of public health policies, regulations and IAQ standards, considering the interactions of diverse factors, such as nature of PAHPs, human occupancy and type of built environments where they develop.

Indoor air bacterial load and antibiotic susceptibility pattern of isolates at Adare General Hospital in Hawassa, Ethiopia

Background

Air is the agent of pathogenic microbes that cause significant problems in the hospital environment. Multidrug resistance poses a major therapeutic challenge to these airborne microorganisms in hospital indoor environments.

Method and materials

This study was conducted at Adare General Hospital in Hawassa City, Sidama, Ethiopia. A cross-sectional study was conducted. The proportional allocation method was used to select the sampled 50 rooms from the total available rooms in each category of wards and staff offices. A total of 100 indoor air samples were collected using settle plates in all units twice a day, morning (9:00-4:00 a.m.) and afternoon (3:00-4:00 p.m.). The types and number of colonies were determined in the laboratory, and the pathogenic bacteria were isolated by appropriate bacteriological techniques. Antimicrobial susceptibility testing was performed on Mueller-Hinton agar for each potentially pathogenic bacterium isolated. For each bacterium, a total of 12 antibiotics were tested using the Kirby-Bauer disk diffusion method. The test organism was adjusted to McFarland turbidity standards of 0.5. Data were entered and analyzed using the SPSS version 25 window. Descriptive analysis and one-way analysis of variance were performed.

Results

The indoor air bacterial load of Adare General Hospital was found in the range between 210 and 3,224 CFU/m3. The highest indoor air bacterial load was identified from the gynecology ward with a mean of 2,542.5CFU/m3 at p < 0.05. From 100 indoor air samples, a total of 116 bacterial pathogen isolates were obtained. Gram-positive isolates predominated at 72.4%, of which 37.1% were Staphylococcus aureus, 26.7% were coagulase-negative Staphylococci, and the rest 8.6% were Streptococcus pyogenes. The isolation of pathogenic bacteria Staphylococcus aureus and coagulase-negative Staphylococci showed a high level of resistance to ampicillin.

Conclusion

A high bacterial load was found in the study area as compared to different indoor air biological standards. Staphylococcus aureus and coagulase-negative Staphylococci were the isolated predominant bacteria. Attention should be given to preventing and minimizing those environmental factors that favor the multiplication of bacteria in the indoor environment of a hospital for the safe health of patients, visitors, and staff.

A new approach of microbiome monitoring in the built environment: feasibility analysis of condensation capture

BACKGROUND

Humans emit approximately 30 million microbial cells per hour into their immediate vicinity. However, sampling of aerosolized microbial taxa (aerobiome) remains largely uncharacterized due to the complexity and limitations of sampling techniques, which are highly susceptible to low biomass and rapid sample degradation. Recently, there has been an interest in developing technology that collects naturally occurring water from the atmosphere, even within the built environment. Here, we analyze the feasibility of indoor aerosol condensation collection as a method to capture and analyze the aerobiome.

METHODS

Aerosols were collected via condensation or active impingement in a laboratory setting over the course of 8 h. Microbial DNA was extracted from collected samples and sequenced (16S rRNA) to analyze microbial diversity and community composition. Dimensional reduction and multivariate statistics were employed to identify significant (p < 0.05) differences in relative abundances of specific microbial taxa observed between the two sampling platforms.

RESULTS

Aerosol condensation capture is highly efficient with a yield greater than 95% when compared to expected values. Compared to air impingement, aerosol condensation showed no significant difference (ANOVA, p > 0.05) in microbial diversity. Among identified taxa, Streptophyta and Pseudomonadales comprised approximately 70% of the microbial community composition.

CONCLUSION

The results suggest that condensation of atmospheric humidity is a suitable method for the capture of airborne microbial taxa reflected by microbial community similarity between devices. Future investigation of aerosol condensation may provide insight into the efficacy and viability of this new tool to investigate airborne microorganisms.

IMPORTANCE

On average, humans shed approximately 30 million microbial cells each hour into their immediate environment making humans the primary contributor to shaping the microbiome found within the built environment. In addition, recent events have highlighted the importance of understanding how microorganisms within the built environment are aerosolized and dispersed, but more importantly, the lack in development of technology that is capable of actively sampling the ever-changing aerosolized microbiome, i.e., aerobiome. This research highlights the capability of sampling the aerobiome by taking advantage of naturally occurring atmospheric humidity. Our novel approach reproduces the biological content in the atmosphere and can provide insight into the environmental microbiology of indoor spaces. Video Abstract.

Environmental bacterial and fungal contamination in high touch surfaces and indoor air of a paediatric intensive care unit in Maputo Central Hospital, Mozambique in 2018

Background

The hospital environment serves as a reservoir of microorganisms which may be associated with healthcare-associated infections (HCAI). The study of environmental contamination with microorganisms is a method for the assessment of hospital environmental hygiene. We sought to evaluate the environmental colonisation of a national reference hospital unit, using the total aerobic colony count (ACC) and the isolated microorganisms, as assessment tools.

Methods

A cross-sectional study was conducted in the Paediatric Intensive Care Unit (PICU) of the Hospital Central de Maputo during a four-week period in 2018. Surfaces and air were sampled before and after room cleaning, using swabs and passive air method. Those samples were processed at the microbiology laboratory where total ACC levels were evaluated, and microorganisms were isolated, identified and assessed for antibiotic susceptibility.

Discussion

Comparison of the total median ACC of the indoor air (287 cfu/m³ before and 195 cfu/m³ after) and surfaces (0.38 cfu/cm² before and 0.33 cfu/cm² after) before and after room cleaning did not show significant differences (P>0.05). Microorganisms of epidemiological importance, including coagulase negative staphylococci (CoNS), Klebsiella pneumoniae and Serratia odorifera were isolated and all of these three were multi-drug resistant (MDR).

Conclusion

The results showed controlled contamination levels on high touch surfaces in the patient environment and a high level of contamination of the indoor air suggesting deficiencies in the PICU environmental decontamination process. There was evidence of the presence of fungi and MDR species of epidemiological importance in the context of HCAI.

Assessment of Indoor Air Quality of Four Primary Health Care Centers in Qatar

Airborne bacteria pose a potential risk to human health upon inhalation in the indoor environments of health care facilities. Airborne bacteria may originate from various sources, including patients, workers, and daily visitors. Hence, this study investigates the quantity, size, and identification of airborne bacteria indoors and outdoors of four Primary Health Care Centers (PHCC) in Doha, Qatar. Air samples were collected from the lobby, triage room, and outside environment of the centers, including, Qatar University (QU-HC), Al-Rayyan (AR-HC), Umm-Ghuwailina (UG-HC), and Old Airport (OA-HC) between August 2020 and March 2021, throughout both the hot and the cold seasons. Samples were collected using an Anderson six-stage cascade impactor. The mean of the total colony-forming units was calculated per cubic meter of air (CFU/m³). QU-HC had the lowest mean of total bacterial count compared with other centers in the indoor and outdoor areas with 100.4 and 99.6 CFU/m³, respectively. In contrast, AR-HC had the highest level, with 459 CFU/m³ indoors, while OA-HC recorded the highest bacterial concentration of the outdoor areas with a total mean 377 CFU/m³. In addition, 16S rRNA sequencing was performed for genera identification. Staphylococcus, Acinetobacter, Bacillus, and Pseudomonas were the four most frequently identified bacterial genera in this study. The abundance of airborne bacteria in the four health centers was higher in the cold season. About 46% of the total airborne bacterial count for three PHCC centers exceeded 300 CFU/m³, making them uncompliant with the World Health Organization’s (WHO) recommendation for indoor settings. Consequently, an IAQ standards should be shaped to establish a baseline for measuring air pollution in Qatar. Additionally, it is crucial to understand seasonal fluctuations better so that hospitals can avoid rising and spreading infection peaks.

Determination of the indoor air bacterial profile in Jimma University Specialized Hospital, Southwest Ethiopia

Objective:

Microorganisms are one of the main indoor air contaminants. In a hospital setting, a range of hospital-acquired infectious diseases are caused due to indoor air pollution. Studies conducted on hospital patients and healthcare workers revealed that indoor air pollution is causing more severe health problems than outdoor air pollution. Thus, this study aimed to determine the bacterial indoor air quality in Jimma University Specialized Hospital in southwest Ethiopia.

Method:

An institution-based cross-sectional study was conducted from late May to October 2020. Indoor air samples were collected through a passive method by exposing prepared sample plates for prescheduled exposure time, and bacterial species were identified using morphology and biochemical tests.

Result:

Based on the findings, neither of the wards showed a similar microbial concentration. Among the studied wards, the minimum and the maximum bacterial distribution ranged from 280 to 6369 cfu/m³, respectively. Staphylococcus aureus, coagulase-negative spp., Klebsiella spp., Escherichia coli, Bacillus spp., Proteus spp., and Streptococcus spp. were bacterial isolates. Statistically, the concentration of the bacteria in all the studied wards was tested significantly different (p ⩽ 0.001).

Conclusion:

Among studied wards, the emergency outpatient ward showed a maximum bacterial concentration in contrast to the minor operating room. Based on the criteria of the World Health Organization on hospital-acquired infections, studied wards were highly contaminated.

Bacterial Contamination Level of Indoor Air and Surface of Equipment in the Operation Room in Dil-Chora Referral Hospital, Dire Dawa, Eastern Ethiopia

Purpose

This study investigated the bacterial contamination level of the indoor air and surface of the operation room, surgical, and gynecology wards of Dilchora Referral hospitals between January and August 2020.

Methods

A laboratory based cross-sectional study was carried out on the OR and wards of Dilchora referral hospital in Eastern Ethiopia. A passive air sampling method was used to collect 128 indoor air samples; the bacterial load was enumerated and the result was expressed as colony forming units (CFU/m3). Additional qualitative analysis was carried out to identify particular bacterial species that were isolated from the indoor air and swabs taken from the surface of the equipment using conventional techniques. All laboratory data were entered and analyzed using MS Excel 2007 and SPSS version 20.

Results

The mean bacterial counts of 94.63 CFU/dm/hr in major OR during active time as well as 509.75 and 509.38 CFU/dm/hr in male and female clothing rooms during the afternoon were unacceptable (>450 CFU/dm2). Similarly, 43.75% of the bacterial counts found in the afternoon samples fell short of Fisher's criterion. The difference between the bacterial counts recorded in the morning and afternoon was significant (p=0.000). A total of 54 (42.2%) indoor air samples and 28 (93.3%) cotton swabs were positive for bacterial growth, with S. aureus (51.04%) and Bacillus sp (55%) being the dominant bacteria isolated from indoor air and the surface of equipment, respectively.

Conclusion

The bacterial load of investigated wards is considerably "high" to "very high", which implies a significant risk of hospital acquired infections. Therefore, devising effective control strategies targeted on surface cleansing and sterilizing of the air environment and practicing periodic microbial surveillance of the hospital environment is a paramant.

Microbial Indoor Air Quality and Associated Factors in Jimma Town Prison Administration, Southwestern Ethiopia

Indoor air quality determines the well-being of occupants. It has been linked to sick building syndrome and building-related diseases which lead to many socio-economic problems including reduced productivity and impaired learning. Indoor air quality problem is more serious for prisoners, due to their confinement and exposure condition. However, it has not been studied in our study setting. Thus, this study aimed to determine the indoor air microbial quality and associated factors in Jimma town prison administration, Southwestern Ethiopia. A cross-sectional study design was employed in August 2021. Data on the general condition of the prison rooms and occupancy were collected by trained data collectors using an observational checklist. The microbial sample was collected using a sterilized Petri dish. A total of 19 triplicate air samples were collected using Mannitol salt agar and Sabouroad dextrose agar media for the growth of S. aureus and fungi respectively. Data were analyzed using SPSS version 23 and presented using tables and a graph. The effect of predictor variables on the microbial load was also analyzed by using linear regression. The finding of this study revealed that the microbial load of indoor air at Jimma town prison administration ranged from 891 to 15 439 and 315 to 3067 CFU/m³ for S. aureus and fungi respectively. Both S. aureus and the fungal load of the indoor environment were positively affected by the temperature of the room. Whereas, the floor space per inmate affects the concentration of S. aureus alone. Almost all rooms of the prison administration had microbial load beyond the acceptable limit. Higher temperature, less floor space per inmate, bad floor cleanness conditions, inadequate ventilation, and dampness were contributing factors to the high load of S. aureus and fungus. Thus, additional rooms are required to reduce overcrowding and keep room temperature.

Prevalence of Methicillin and β−Lactamase Resistant Pathogens Associated with Oral and Periodontal Disease of Children in Mymensingh, Bangladesh

Oral and periodontal diseases (OPD) is considered one of the main problems of dentistry worldwide. This study aimed to estimate the prevalence of oral and periodontal pathogenic bacteria along with their antimicrobial resistance pattern in 131 children patients aged between 4–10 years who attended in Mymensingh Medical College Hospital during October 2019 to March 2020. OPD pathogens were identified through isolation, cultural and biochemical properties, and nucleic acid detection. The isolates were subjected to antimicrobial susceptibility to 12 antibiotics commonly used in dentistry. In addition, the isolates were analyzed molecularly for the presence of six virulence and three antibacterial resistance genes. Five pathogens were identified, of which Staphylococcus aureus (S. aureus) (49%) and S. salivarius (46%) were noticed frequently; other bacteria included S. mutans (16.8%), S. sobrinus (0.8%) and L. fermentum (13.7%). The virulence genes—clumping factor A (clfA) was detected in 62.5% isolates of S. aureus, and gelatinase enzyme E (gelE) gene was detected in 5% isolates of S. salivarius, while other virulence genes were not detected. All the tested isolates were multidrug-resistant. The overall prevalence of MDR S. aureus, Streptococcus spp. and L. fermentum was 92.2%, 95.1% and 100%, respectively. It was observed that a high proportion of isolates were found resistant to 5–8 antibiotics. A majority of S. aureus, Streptococcus spp., and L. fermentum isolates tested positive for the β−lactamase resistance genes blaTEM and cfxA, as well as the methicillin resistance gene mecA. Phylogenetically, the resistance genes showed variable genetic character among Bangladeshi bacterial pathogens. In conclusion, S. aureus and S. salivarius were major OPD pathogens in patients attended in Mymensingh Medical College Hospital of Bangladesh, and most were Beta-lactam and methicillin resistant.

Indoor air microbial load, antibiotic susceptibility profiles of bacteria, and associated factors in different wards of Arba Minch General Hospital, southern Ethiopia

The levels of indoor air microbial load in hospitals are very crucial to the health of patients and health care workers and are to be regularly monitored and maintained at an acceptable level. However, this problem remains overlooked, particularly in developing countries including Ethiopia. A hospital-based cross-sectional study is designed to determine the indoor air microbial load (settle plate technique), microbial isolates (standard microbiological techniques), bacterial susceptibility profiles (Kirby-Bauer disk diffusion technique), and associated factors, in different wards of the title Hospital, southern Ethiopia. An observational checklist was used to collect relevant information related to the associated factors; descriptive and inferential statistics were applied using Statistical Package for Social Sciences (SPSS); p-values ≤ 0.05 in the multivariable analysis were considered statistically significant. The total average bacterial and fungal load of the selected wards was 1914±1081.4 Colony Forming Units (CFU)/m³ (95% CI: 1718.5–2109.48 CFU/m³) and 1533.7±858.8 CFU/m³ (95% CI: 1378.5-1688CFU/m³) respectively. The highest mean bacterial (1914±1081.4 CFU/m³) and fungal (1533.7±858.8 CFU/m³) loads were found in the male surgical and female medical wards respectively. A total of 229 bacterial and 139 fungal isolates were obtained; Gram-positive bacteria were the predominant type, 130 (56.7%), particularly the isolates of Staphylococcus aureus, 46 (20.1%). The predominant fungal isolates were Aspergillus sp., 53(38%). Percentages of multidrug-resistant (MDR), extended-spectrum beta-lactamase (ESBL), and carbapenemase producers respectively were 48.5, 26.5, and 25%. High room crowd index [p = 0.003; Adjusted Odds Ratio (AOR) 12.5 (Confidence Interval (CI) 95%: 2.42–65)], presence of damp/wet materials [p = 0.025; AOR 7 (CI 95%: 1.3–37.4)], intense room traffic [p = 0.004; AOR 9.6 (CI 95%: 1.2–79.3)], inappropriate storage of food and drugs [p = 0.008; AOR 7.5 (CI 95%: 1.7–32)], and unclean environment [p = 0.03; AOR 5.8 (CI 95%: 1.2–28)] showed statistical significance concerning the indoor air microbial loads; most of the wards in Arba Minch General Hospital (AMGH) stand high and not in an acceptable level as per the WHO and the European Commission standards on indoor air microbial load. Periodic air surveillance and infection prevention control programs are required to reduce the transmission of these microbes to inpatients, visitors, and health care workers.

Assessment of Microbiological Quality of Indoor Air at Different Hospital Sites of Dilla University: A Cross-Sectional Study

BACKGROUND

In both residential and hospital indoor environments, humans can be exposed to airborne microorganisms. The hospital's indoor air may contain a large number of disease-causing agents brought in by patients, staff, students, visitors, ventilation, or the outside. Hospitalized patients are at a higher risk of infection due to confined spaces, crowdedness, and poor infection prevention practices, which can accumulate and create favorable conditions for the growth and multiplication of microorganisms. Therefore, the aim of this study was to evaluate the indoor air bacterial load in Dilla University Hospital, Southern Ethiopia.

METHODS

An institutional-based cross-sectional study design was used to assess the bacterial load in the indoor air at Dilla University Hospital. To determine the bacterial load, a passive air sampling technique was used. The settle plate method was used to collect data, which involved exposing Petri-dishes filled with blood agar media to the indoor air of the sampled rooms for 60 minutes.

RESULT

A total of 72 indoor air samples were collected once a week for 2 weeks at 14-day intervals from 18 rooms in 8 wards, and samples were collected twice a day in the morning and afternoon. The mean bacterial concentrations ranged from 450 to 1585.83 CFU/m³ after 60 minutes of culture media exposure. The mean bacterial concentrations in the obstetrics, surgical, pediatric, gynecology, and medical wards exceeded WHO guidelines. A high indoor air bacterial load was found in 58 (80.6%) of the samples in this study. Gram-positive bacteria in the air were the most common 51 (71%) of the bacterial population measured in all indoor environments. Fungal growth was found in 65 (90.3%) of the samples. Temperatures (26.5°C-28.3°C) and relative humidity (61.1%-67.8%) in the rooms were both above WHO guidelines, creating favorable conditions for bacterial growth and multiplication.

CONCLUSION

The majority of the wards at Dilla University Hospital had bacterial loads in the air that exceeded WHO guidelines. Overcrowding, high temperatures, inadequate ventilation, improper waste management, and a lack of traffic flow control mechanisms could all contribute to a high concentration of bacteria in the indoor air. To control the introduction of microorganisms by patients, students, caregivers, and visitors, it is critical to regularly monitor indoor air bacterial load and implement infection prevention and control measures.

Water as a Source of Indoor Air Contamination with Potentially Pathogenic Aeromonas hydrophila in Aquaculture

Human activities influence the presence of potentially pathogenic bacteria in indoor air. The aim of this study was to determine the effect of the experimental rearing of European grayling and European perch in a recirculating aquaculture system on the contamination of indoor air with potentially pathogenic Aeromonas hydrophila (PPAH) and the resulting health risks to humans. The PPAH counts, their resistance to seven antibiotics, and the multiple antibiotic resistance (MAR) index were determined in samples of indoor air and water from rearing tanks. The PPAH counts were highest in the laboratory bioaerosol where two fish species were reared. The calculated indoor/outdoor ratio (I/O > 1) demonstrated that tank water was the internal source of PPAH emissions. The unconstrained PCA revealed strong positive relationships (p ≤ 0.05) between the PPAH counts in the indoor air and water samples. Most of the PPAH strains isolated from laboratory air were resistant to tetracycline, cefotaxime, and erythromycin, and 26–82% of the isolates exhibited multiple drug resistance. The values of the MAR index were similar in samples of laboratory air and water (0.23–0.34 and 0.24–0.36, respectively). Agglomerative clustering revealed two clusters of strains isolated from laboratory air and tank water. The results of this study indicate that aquaculture can be a source of indoor air contamination with PPAH.

Evaluation of bio-aerosols type, density, and modeling of dispersion in inside and outside of different wards of educational hospital

Exposure to bioaerosols in the air of hospitals is associated with a wide range of adverse health effects due to the presence of airborne microorganisms. Intensity and type of health effects depend on many factors such as the type, density, and diversity of bioaerosols in hospital environments. Therefore, identifying and determining their distribution in hospital environment contribute to reduce their adverse effects and maintain the physical health of patients and staff, as well as find the source of infections and possible allergies due to the presence of bioaerosols. Therefore, the present study was conducted to determine the type and concentration of the bacterial and fungal bioaerosols, and their distribution in the indoor and outdoor air of a teaching hospital to establish a reference for future studies or measures. The air samples were collected with a one-stage Anderson sampler and particle mass counter for a period of four months in the fall and winter of 2019. In total, 262 bacterial and fungal samples were collected from the air of the wards of Tohid Hospital, Sanandaj, Iran. Antibiotic resistance test, bacterial identification by PCR method, and modeling the dispersion of concentrations of bio-aerosols were also conducted. In order to identify bacteria and fungi, some biochemical and molecular tests and microscopic and macroscopic characteristic methods were applied, respectively. The results showed that the highest and lowest densities of the bioaerosols were observed in lung and operating wards (336.67 and 15.25 CFU/m3). Moreover, the highest and least concentrations of particles were seen in the emergency and operating wards, respectively. The most common fungi isolated from the hospital air were Penicillium (24.7%), Cladosporium (23. 4%), Aspergillus niger (13.3%), and Aspergillus Flavus (11.4%). Furthermore, the highest concentration of the isolated bacterium was Staphylococcus hemolyticus (31.84%). Most bacteria showed the highest resistance to gentamicin. The overall average hospital air pollution to bioaerosols was slightly higher than the standards proposed by international organizations. Due to the high concentration of bioaerosols and particles in the studied hospital, providing suitable conditions such as temperature, humidity, proper ventilation, and intelligent air conditioning system using efficient ventilation systems, and restricting the entrance of wards can reduce airborne particles in hospital environment.

Bacterial contamination rates and drug susceptibility patterns of bacteria recovered from medical equipment, inanimate surfaces, and indoor air of a neonatal intensive care unit and pediatric ward at Hawassa University Comprehensive Specialized Hospital, Ethiopia

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Bacterial contamination rates for medical equipment, inanimate surfaces, and indoor air in an Ethiopian hospital were found to be high.

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Most isolated bacterial species were known causes of human disease.

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Most of the isolated bacteria were antibiotic resistant.

Introduction: Bacterial contamination of medical equipment, inanimate surfaces, and indoor air of the hospital environment is the main source of hospital-acquired infection in developing countries.

Objective: The aim of this study was to determine the bacterial contamination rates for medical equipment, inanimate surfaces, and indoor air, and the drug susceptibility profiles of bacteria, in the neonatal intensive care unit and pediatric ward of Hawassa University Comprehensive Specialized Hospital (HUCSH).

Methods: A hospital-based cross-sectional study was carried out from October 20 to December 30, 2020. Samples were collected from medical equipment, inanimate surfaces, and indoor air of the neonatal intensive care unit and pediatric ward, and processed using standard microbiological methods. Data entry and analysis were carried out using SPSS software version 25.0.

Results: Of the total samples collected, 171 (74.7%; 95% CI 68.4‒83.5) were culture positive. These comprised 33 (58.9%) of samples taken from medical equipment, 26 (42.6%) from inanimate surfaces, and 112 (100%) from indoor air . Micrococcus species (41.3%), Acinetobacter species (13.7%), and Klebsiella pneumoniae (10.2%) were the most commonly isolated bacteria.

Conclusions: High bacterial contamination rates of medical equipment, inanimate surfaces, and indoor air of the neonatal intensive care unit and pediatric ward were found. Most of the bacterial species isolated were known causative agents of hospital-acquired infection. Around one-quarter of the bacteria were multidrug resistant.

Utilization of Community-Level Fluoride-Filtered Water and its Associated Factors in Dugda Woreda of East Shewa Zone, Oromia Region, Ethiopia

BACKGROUND

Long-term consumption of water containing an excessive amount of fluoride causes dental and skeletal fluorosis. De-fluoridation options differ in terms of scale, efficacy, long-term viability, and user acceptance. Therefore, this study aimed to identify the challenges of using fluoride-filtered water and its associated factors among households.

METHODS

A cross-sectional study was conducted from April to May, 2018 among 405 randomly selected households in Dugda Woreda of Ethiopia Rift Valley East Shewa Zone, Oromia Region. A structured interviewer-administered questionnaire was used to collect the data. SPSS version 20 was used to enter and analyze the collected data. Logistic regression analysis was used to identify association between dependent and independent factors and explained by odds ratio with 95%CI.

RESULTS

A total of 228 (56.3%) households were found to utilize fluoride filtered water from community water supply schemes for drinking and cooking purposes. No family history of fluorosis (AOR = 44.4, 95%CI: 18.8, 104.74), monthly income of less than 1000 ETB (AOR = 0.03, 95%CI: 0.004, 0.23), good knowledge of community fluoride filter schemes (AOR = 5.93, 95%CI: 1.30, 26.9), and not afford to pay bill of ⩾0.50 ETB [AOR = 0.4, 95%CI: 0.20, 0.91] were factors significantly associated with utilization of community-level fluoride-filtered water.

CONCLUSION

In this study, more than half of the households used fluoride filtered water. Family monthly income, affordability, presence of family members with the history of fluoride exposure, and knowledge about community fluoride filter schemes were factors significantly associated with utilization of community-level fluoride-filtered water.

Bacterial Pathogens and Their Antimicrobial Resistance Patterns of Inanimate Surfaces and Equipment in Ethiopia: A Systematic Review and Meta-analysis

BACKGROUND

Hospital-acquired infections have remained a serious cause of mortality, morbidity, and extended hospitalization. Bacterial contamination of inanimate surfaces of the hospital environment and equipment is considered a major contributing factor to the development of several nosocomial infections worldwide. The hospital environment and many devices are an important reservoir of many clinically important bacterial agents including multidrug-resistant pathogens. Therefore, this systematic review and meta-analysis are aimed at investigating bacterial pathogens and their antimicrobial resistance patterns of inanimate surfaces and equipment in Ethiopia.

METHODS

An exhaustive literature search was carried out using the major electronic databases including PubMed, Web of Science, MEDLINE, EMBASE, CINAHL, Google Scholar, Cochrane Library, Scopus, and Wiley online library to identify potentially relevant studies without date restriction. Original articles which address the research question were identified, screened, and included using the PRISMA flow diagram. Data extraction was prepared in Microsoft Excel, and data quality was assessed by using 9-point Joanna Briggs Institute critical appraisal tools. Then, data were exported to STATA 16.0 software for analyses of pooled estimation of outcome measures. Estimation of outcome measures at a 95% confidence interval was performed using DerSimonian-Laird's random-effects model. Finally, results were presented via text, figures, and tables.

RESULTS

A total of 18 studies with 3058 bacterial isolates recovered from 3423 swab specimens were included for systematic review and meta-analysis. The pooled prevalence of bacterial contamination of inanimate surfaces and equipment was found 70% (95% CI: 59, 82). Among the Gram-negative bacterial species, the prevalence of ampicillin-resistant K. pneumoniae was the highest 80% (95% CI: 78, 92) followed by Citrobacter species 78% (95% CI: 57, 83).

CONCLUSION

This study has shown a high prevalence of bacterial contamination of inanimate surfaces and equipment in Ethiopia.

Diversity of Bioaerosols in Selected Rooms of Two Schools and Antibiotic Resistance of Isolated Staphylococcal Strains (Bydgoszcz, Poland): A Case Study

The present study is aimed at evaluating microbiological air pollution in libraries, cafeterias and selected classrooms of two schools in Bydgoszcz city, northern Poland and determining the antibiotic resistance of Staphylococcal strains isolated from the indoor air. One of the investigated schools (School A) is located in the very center of the city, in the vicinity of a park, among old houses and stone-lined streets, while the other (School B), among modern residential buildings, close to a street with heavy traffic. In each school, air samples were collected in the morning, always from all three sampling sites, using the MAS-100 sampler. Selective growth media were used for bacteria and mold isolation and quantifying analysis. The antibiotic resistance of the isolated mannitol-positive staphylococci was assessed using the disc diffusion method in accordance with EUCAST recommendations. The highest mean concentration of heterotrophic bacteria was recorded in the cafeterias: 884 CFU m−3 in School A and 1906 CFU m−3 in School B. Molds were the most abundant in the library and cafeteria in School B, where their average concentration exceeded 300 CFU m−3. Cladosporium and Penicillium species prevailed, while Fusarium, Acremonium and Aspergillus were less abundant. Airborne mannitol-positive staphylococci were recorded at low concentrations, ranging from 6 to 11 CFU m−3 on average. According to the taxonomic analysis, Staphylococcus aureus isolates were the most abundant in both schools, followed by S. xylosus, S. haemolyticus and S. saprophyticus. The antibiograms indicated that resistance to erythromycin was common in 62.5% of the isolated staphylococcal strains. Levofloxacin and gentamicin were the most effective antibiotics. No multidrug-resistant strains were identified.

Indoor Culturable Fungal Load and Associated Factors among Public Primary School Classrooms in Gondar City, Northwest Ethiopia, 2018: A Cross-sectional Study

Background

Fungi are heavy threats to public health in indoor environments, particularly in residential buildings, offices, and schools where people spend a lot of time indoors. This study was conducted to investigate the load of culturable fungi and associated factors in a school indoor environment.

Methods

Institutional based cross-sectional study was conducted in eight public primary school classrooms in Gondar City from March to April 2018. Settle plate technique was used to determine the culturable fungal load. Log transformed linear regression analysis was employed. The beta-coefficient with a 95% confidence interval was used to determine the degree and direction of the association with a p-value less than 0.05.

Results

The highest and the lowest mean culturable fungal loads recorded were 1140.29 CFU/m³ and 211.25 CFU/m³, respectively. Aspergillus, Mucor, Penicillium, Candida, Microsporum, Trichophyton, Rhizopus, Alternaria and Fusarium species were isolated. Age of buildings (β= -0.122, 95%CI -0.238,-0.007), area of classroom (β= 0.639, 95% CI 0.285, 0.993), temperature (β= -0.189, 95% CI -0.325,-0.047), humidity (β= -0.023, 95% CI -0.043, -0.002) and PM10 (β= -0.01, 95% CI -0.015,-0.005) were associated with culturable fungal load.

Conclusions

High culturable fungal load was found in school classrooms in Gondar City. Age of buildings, area of classrooms, temperature, humidity, and PM10 were predictors of the culturable fungal load. Therefore, proficient corrective methods are needed to combat the problem of indoor air quality in a school indoor environment by controlling factors contributing to growth of fungi.

Indoor bacterial load and its correlation to physical indoor air quality parameters in public primary schools

Background

Poor indoor air quality is a great problem in schools due to a high number of students per classroom, insufficient outside air supply, poor construction and maintenance of school buildings. Bacteria in the indoor air environment pose a serious health problem. Determination of bacterial load in the indoor environment is necessary to estimate the health hazard and to create standards for indoor air quality control. This is especially important in such densely populated facilities like schools.

Methods

Institutional based cross-sectional study was conducted among 51 randomly selected classrooms of eight public primary schools from March 29–April 26, 2018. To determine the bacterial load passive air sampling settle plate method was used by exposing a Petri dish of blood agar media for an hour. The Pearson correlation matrix was employed to assess the correlation between bacterial load and physical parameters.

Results

The grand total mean bacterial load was 2826.35 CFU/m³ in the morning and 4514.63 CFU/m³ in the afternoon. The lowest and highest mean bacterial load was recorded at school 3 (450.67 CFU/m³) and school 5 (7740.57 CFU/m³) in the morning and afternoon, respectively. In the morning relative humidity (r = − 0.7034), PM2.5 (r = 0.5723) and PM10 (r = 0.6856); in the afternoon temperature (r = 0.3838), relative humidity (r = − 0.4014) were correlated with indoor bacterial load. Staphylococcus aureus, Coagulase-negative Staphylococcus species and Bacillus species were among isolated bacteria.

Conclusions

High bacterial load was found in public primary schools in the Gondar city as compared to different indoor air biological standards. Temperature, relative humidity and particulate matter concentration (PM2.5 and PM10) were associated with the indoor bacterial load. Staphylococcus aureus, Coagulase-negative Staphylococcus species and Bacillus species were among isolated bacterial species. Attention should be given to control those physical factors which favour the growth and multiplication of bacteria in the indoor environment of classrooms to safeguard the health of students and teachers in school.

Indoor Air Quality and Potential Health Risk Impacts of Exposure to Antibiotic Resistant Bacteria in an Office Rooms in Southern Poland

The aims of this article are to characterize: the quantity of culturable bacterial aerosol (QCBA) and the quality of culturable bacterial aerosol (QlCBA) in an office building in Southern Poland during the spring. The average concentration of culturable bacterial aerosol (CCBA) in this building ranged from 424 CFU m^-3 to 821 CFU m^-3, below Polish proposals for threshold limit values. Size distributions were unimodal, with a peak of particle bacterial aerodynamic diameters less than 3.3 μm, increasing potentially adverse health effects due to their inhalation. The spring office exposure dose (SPED) of bacterial aerosol was estimated. The highest value of SPED was in April (218 CFU kg^-1), whereas the lowest was in June (113 CFU kg^-1). Analysis was undertaken to determine the antibiotic resistance of isolated strains and their ability to form biofilms, which may facilitate the spread of antibiotic resistance genes. In the course of the study, it was found that Staphylococcus xylosus had the greatest ability to form biofilms, while the strains with the highest antibiotic resistance were Micrococcus luteus D and Macrococcus equipercicus. Given that mainly antibiotic-sensitive bacteria from bioaerosol were isolated, which transfers resistance genes to their plasmids, this shows the need for increased monitoring of indoor air quality in workplaces.

Surfaces and Air Bacteriology of Selected Wards at a Referral Hospital, Northwest Ethiopia: A Cross-Sectional Study

Background

The hospital environment is a source of medically important pathogens that are mostly multidrug resistant (MDR) and posing a major therapeutic challenge. The aim of this study was to assess the surface and air bacteriology of selected wards at Felege Hiwot Referral Hospital (FHRH), Northwest Ethiopia.

Methods

A cross-sectional study was carried out from 15th February to 30th April 2017. A total of 356 surface and air samples were collected from selected wards using 5% sheep blood agar (Oxoid, UK) and processed at FHRH microbiology laboratory following the standard bacteriological procedures. Pure isolates were tested against the recommended antibiotics using Kirby-Bauer disc diffusion methods, and the susceptibility profile was determined based on Clinical Laboratory Standards Institute (CLSI). Data were entered and analyzed using SPSS version 23 for Windows.

Results

Of the total 356 samples processed, 274 were from surfaces and 82 were from air. Among these, 141 (39.6%) showed bacterial growth, yielding a total of 190 isolates. Gram-positive isolates were predominant at 81.6% (n=155), while the gram negatives were at 18.4% (n=35). The main isolates were coagulase negative staphylococci (CoNs), 44%, followed by S. aureus, 37.4%, and Klebsiella species at 11.6%. The bacterial load on surfaces and air was found beyond the standard limits. Besides, the antimicrobial susceptibility profile of the isolates showed that about 75% of the identified isolates were found resistant for two and more antimicrobial agents tested.

Conclusions

This study showed high degree of bacterial load that is beyond the standard limits on both surfaces and air samples of the hospital. Furthermore, some 75% of the isolates were found multidrug resistant. Therefore, it is important to evaluate and strengthen the infection prevention practice of the hospital. Moreover, stakeholders should also reinforce actions to decrease the pressure of antimicrobial resistance in the studied area.