Air Microbial Contamination at the Holy Mosque, Makkah, Saudi Arabia

Commencement and Monitoring: Microbiological Surveillance in Operation Theaters at a Tertiary Care Center in North India

INTRODUCTION

Preserving sterility and safety in hospital operation theaters (OTs) is vital. We have implemented a comprehensive microbiological surveillance program for OTs, encompassing both commencement and ongoing monitoring. This study assesses the prevalence of microorganisms, identifies their types, and detects contamination on surfaces and in the air.

METHODS

Commencement and monitoring samples were collected from October 2021 to July 2023, from nine OTs. OTs were cleaned with soap and water, disinfected, and fogged with quaternary ammonium compounds. After sealing the OTs overnight, samples were collected aseptically. Air was sampled using the settle plate method, and surfaces were swabbed. Six surfaces, namely, the floor, wall, table, light, anesthesia workstation, and door handle, were swabbed. Samples were transported immediately to the institution's microbiology laboratory.

RESULTS

During OT commencement, 247 swabs from nine OTs yielded 19 (7.29%) positives for bacterial growth. These microorganisms were primarily non-pathogenic, including aerobic spore-forming bacilli and Micrococcus, with an average bioload of 9.5 colony-forming units (CFU)/m3 of air. During OT monitoring, swab positivity was 10.79% (23/213). The General Surgery OT and Obstetrics and Gynecology OT showed the highest bacterial growth (5/23). Surface sampling revealed prevalent methicillin-resistant coagulase-negative staphylococci (MRCoNS) (9/23), followed by methicillin-sensitive Staphylococcus aureus (MSSA) (4/23) and methicillin-sensitive coagulase-negative staphylococci (MSCoNS) and aerobic spore-forming bacilli (ASB) (3/10). The General Surgery, Obstetrics and Gynecology, and ENT OTs displayed elevated air bioloads of 53, 49, and 47 CFU/m3, respectively.

CONCLUSION

In newly constructed non-operational OTs, non-pathogenic organisms prevailed. However, as the OTs became functional, pathogenic organisms became more prevalent. Sampling emphasized contamination in areas with high patient loads, such as General Surgery, Obstetrics and Gynecology, and ENT OTs. Notably, OT tables and OT walls exhibited higher pathogenic microorganism presence. By combining both initial commencement and ongoing monitoring, the institution has effectively managed the microbial environment within its OTs.

Microbial surveillance of Hajj tents: Bioaerosol sampling coupled with real-time multiplex PCR

BACKGROUND

Respiratory tract infections are common among pilgrims attending annual Hajj in Mecca, Saudi Arabia. Pilgrims typically spend most of the Hajj period inside ventilated tents, where microorganisms may be transmitted through bioaerosols and droplets.

OBJECTIVE

To perform microorganism surveillance inside Hajj tents and assess the similarities between microorganisms isolated from tent bioaerosol samples and nasopharyngeal swabs (NP) of tent occupants.

METHODS

Respiratory microorganisms in bioaerosols collected from Hajj tents over a 4-day period were compared with NP of tent occupants using real-time multiplex polymerase chain reaction analysis.

RESULTS

A total of 152 samples were collected: 120 tent bioaerosol samples collected on days 9, 10, 11, and 12 of Dhu al-Hijjah, and 32 NP collected on day 12 of Dhu al-Hijjah (corresponding to 23/08/2018). Eighty-three (69.2%) bioaerosol samples tested positive for at least 1 microorganism, with the number of pathogens increasing over the 4 days of sampling. Twenty-seven (84.38%) NP swabs from tent occupants also tested positive. Microorganisms identified in pilgrim nasal carriage and tent bioaerosol samples were similar, and included K. pneumonia, S. aureus, S. pneumonia, human adenovirus, Moraxella, influenza A, and H. influenza.

CONCLUSIONS

The data suggest that the Hajj tent environment may contribute to the spread of airborne infections during Hajj. This can have important ramifications for novel pathogens with pandemic potential.

Long-Term Studies of Biological Components of Atmospheric Aerosol: Trends and Variability

Background: Biological components of atmospheric aerosol affect the quality of atmospheric air. Long-term trends in changes of the concentrations of total protein (a universal marker of the biogenic component of atmospheric aerosol) and culturable microorganisms in the air are studied. Methods: Atmospheric air samples are taken at two locations in the south of Western Siberia and during airborne sounding of the atmosphere. Sample analysis is carried out in the laboratory using standard culture methods (culturable microorganisms) and the fluorescence method (total protein). Results: Negative trends in the average annual concentration of total protein and culturable microorganisms in the air are revealed over more than 20 years of observations. For the concentration of total protein and culturable microorganisms in the air, intra-annual dynamics is revealed. The ratio of the maximum and minimum values of these concentrations reaches an order of magnitude. The variability of concentrations does not exceed, as a rule, two times for total protein and three times for culturable microorganisms. At the same time, for the data obtained in the course of airborne sounding of the atmosphere, a high temporal stability of the vertical profiles of the studied concentrations was found. The detected biodiversity of culturable microorganisms in atmospheric air samples demonstrates a very high variability at all observation sites. Conclusions: The revealed long-term changes in the biological components of atmospheric aerosol result in a decrease in their contribution to the atmospheric air quality index.

A process mining approach in big data analysis and modeling decision making risks for measuring environmental health in institutions

This paper aimed to introduce a process-mining framework for measuring the status of environmental health in institutions. The methodology developed a new software-based index namely Institutional Environmental Health Index (IEHI) that was integrated from ontology-based Multi-Criteria Group Decision-Making models based on the principles of fuzzy modeling and consensus evaluation. Fuzzy Ordered Weighting Average (OWA) with the capability of modeling the uncertainties and decision-making risks along with Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) were employed as the computation engine. The performance of the extended index was examined through an applied example on 20 mosques as public institutions. IEHI could analyze big data collected by environmental health investigators and convert them to a single and interpretable number. The index detected the mosques with very unsuitable health conditions that should be in priority of sanitation and suitable ones as well. Due to the capability of defining the type and numbers of criteria and benefitting from specific and user-friendly software namely Group Fuzzy Decision-Making, this index is highly flexible and practical. The methodology could be used for numerating the environmental health conditions in any intended institution or occupation. The proposed index would provide e-health assessment by more efficient analysis of big data and risks that make more realistic decisions in environmental health system.

Pilot Survey of Knowledge, Attitudes and Perceptions of Hajj Deployed Health Care Workers on Antibiotics and Antibiotic Prescriptions for Upper Respiratory Tract Infections: Results from Two Hajj Seasons

Antimicrobial resistance (AMR) is a global public health issue. Upper respiratory tract infections (URTIs) are common illnesses during Hajj, for which antibiotics are often inappropriately prescribed. Hajj healthcare workers' (HCW) knowledge, attitudes and perceptions (KAP) about AMR and antibiotic use for URTIs are not known. We conducted a survey among HCWs during Hajj to explore their KAP regarding antibiotic use for URTIs in pilgrims. Electronic or paper-based surveys were distributed to HCWs during the Hajj in 2016 and 2017. A total of 85 respondents aged 25 to 63 (median 40) years completed the surveys. Most participants were male (78.8%) and were physicians by profession (95.3%). Around 85% and 19% of respondents claimed to have heard about AMR and antimicrobial stewardship programs, respectively, among whom most had obtained their knowledge during their qualification. Implementation of URTI treatment guidelines was very low. In conclusion, HCWs at Hajj have significant knowledge gaps regarding AMR, often do not use standard clinical criteria to diagnose URTIs and display a tendency to prescribe antibiotics for URTIs.

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.

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

BACKGROUND

The air inhaled by people is abundantly populated with microorganisms which also are called bioaerosols. Bioaerosols is a colloidal suspension, formed by liquid droplets and particles of solid matter in the air, whose components contain or have attached to them viruses, fungal spores and conidia, bacterial endospores, plant pollen and fragments of plant tissues. They account for 5-34 % of indoor air pollution.

METHODS

A cross-sectional study was conducted to assess the bacteriological concentration and to identify specific species of bacteria in the indoor air of Gondar University teaching hospital. Air samples were taken from 14 randomly selected wards. Bacterial measurements were made by passive air sampling technique i.e., the settle plate method. In each ward five Petri dishes were exposed for 30 and 60 min in the morning and afternoon. Bacteria were collected on nutrient agar and blood agar media. Both quantitative and qualitative analyses were conducted. The quantitative analysis was mainly conducted to determine bacterial load or number of bacteria in the indoor air. Bacterial load was enumerated as colony forming units. Qualitative analysis was conducted to identify specific species of bacteria. For this study we have selected Staphylococcus aureus and Streptococcus which had high public health concern. Mannitol test was used to isolate Staphylococcus aureus, whereas Bacitracin test was conducted to isolate Streptococcus pyogene.

RESULT

The result of this study indicated that the highest bacterial load which was 1468 CFU/m(3) has been recorded at 2:00 PM in Ward C at 60 min exposure time and the lowest bacterial concentration (i.e., 480 CFU/m(3)) was recorded at 8:00 AM in physiotherapy ward. Based on the result bacterial concentration of indoor air of Gondar University teaching hospital was found between 480 and 1468 CFU/m(3). The result of one way ANOVA showed that the highest mean bacterial concentration (1271.00 CFU/m(3)) was found in Medical ward and the least (583.25 CFU/m(3)) concentration was found in ward D and the grand total average concentration was 878.43 CFU/m(3). Favorable conditions for growth and multiplication of bacteria like temperature (26.5-29.5 °C), humidity (64.5-85 %), presence of unhygienic attached toilets, poor waste management system and poor ventilation system were observed during the survey. Staphylococcus aureus was identified in 10 wards and Streptococcus pyogenes was isolated in 8 hospital wards.

CONCLUSIONS

Compared with different indoor air biological standards, higher concentration of indoor air bacterial load was found in Gondar University teaching hospital. The higher bacterial load may be due to temperature, humidity, presence of unhygienic attached toilets, poor waste management system and poor ventilation system. Therefore, attention must be given to control those environmental factors which favor the growth and multiplication of microbes in indoor environment. In addition, also the ventilation condition, cleanliness of toilets, sweeping methods and waste disposal system of the compound should be improved.

Evaluation of aerial microbial pollutants in Al-Haram Al-Nabawi during pilgrimage of 2013

Al-Madinah Al-Munawwarah is the second holiest site in Islam. The possibility of new emerging microbes is valid due to the increased number of pilgrims. The objectives of the current study were to estimate the numbers of fungi and bacteria inside and outside Al-Haram Al-Nabawi and to find whether new bacterial and fungal species have emerged compared to previous studies. Air samples were collected twice a day from 12 spots and four directions during the pilgrim year of 2013 for four consecutive weeks by using the sedimentation method. Thirty five genera and fifty eight species were identified. The most recovered bacterial genera were Staphylococcus, Micrococcus, Bacillus, and Dermacoccus with 32.47%, 18.18%, 12.85%, and 11.23%, respectively. Fifty nine isolates of fungi were molecularly identified. Aspergillus species had the highest percentage (78%). The other fungal genera identified (Alternaria triticina, Emericella nidulans, Emericella striata, Mucor circinelloides, Penicillium chrysogenum, Penicillium minioluteum, Rhizopus arrhizus, Rhizopus oryzae, and Syncephalastrum racemosum) had less than 5% frequency. In places such as Al-Haram Al-Nabawi, a large and crowded public (millions) exist especially during pilgrimages and Ramadan, thus, exposure to microorganisms is high. On the other hand, microorganism infectivity depends on many factors including their virulence, landing site, and person’s immunity. For those reasons, many aspects should be considered to avoid aerosol contaminants.

MALDI-TOF mass spectrometry and identification of new bacteria species in air samples from Makkah, Saudi Arabia

BACKGROUND

During the Hajj season, respiratory symptoms are very common among pilgrims. Here, we investigated the viable bacterial population in air samples collected around the slaughterhouses used during the Hajj.

METHODS AND RESULTS

We collected air samples on three days from four different sites: slaughterhouses at Al-Kakia, Al-Meaisim and Al-Sharaia, and from a waste disposal area designated for the remnants of slaughter. Samples were cultured on blood agar plates for 48 h, and bacterial isolates were identified using MALDI-TOF MS. A dendrogram using the spectra of the unidentified bacterial species was constructed, and PCR amplification and sequencing of the 16S rRNA gene was performed for one isolate per cluster. In total, 2500 colonies appeared on the nutrient agar plates, and 244 were purified for further analysis. Good identification was obtained for 202 (83%) isolates by MALDI-TOF MS. The most common genera were Bacillus (n=94, 45%) and Staphyloccocus (n=55, 26%). Poor identification was obtained for 42 (17%) isolates, and their spectra clustering revealed that these isolates belonged to 10 species. Four of these were considered to be new species.

CONCLUSIONS

During the Hajj, the air was contaminated by many environmental bacterial agents, and MALDI-TOF MS was successfully adapted for their rapid identification.

Environmental sampling for respiratory pathogens in Jeddah airport during the 2013 Hajj season

BACKGROUND

Respiratory tract infections (RTIs) are common during the Hajj season and are caused by a variety of organisms, which can be transmitted via the air or contaminated surfaces. We conducted a study aimed at sampling the environment in the King Abdul Aziz International (KAAI) Airport, Pilgrims City, Jeddah, during Hajj season to detect respiratory pathogens.

METHODS

Active air sampling was conducted using air biosamplers, and swabs were used to sample frequently touched surfaces. A respiratory multiplex array was used to detect bacterial and viral respiratory pathogens.

RESULTS

Of the 58 environmental samples, 8 were positive for at least 1 pathogen. One air sample (1 of 18 samples, 5.5%) tested positive for influenza B virus. Of the 40 surface samples, 7 (17.5%) were positive for pathogens. These were human adenovirus (3 out of 7, 42.8%), human coronavirus OC43/HKU1 (3 out of 7, 42.8%), Haemophilus influenzae (1 out of 7, 14.2%), and Moraxella catarrhalis (1 out of 7, 14.2%). Chair handles were the most commonly contaminated surfaces. The handles of 1 chair were cocontaminated with coronavirus OC43/HKU1 and H influenzae.

CONCLUSION

Respiratory pathogens were detected in the air and on surfaces in the KAAI Airport in Pilgrims City. Larger-scale studies based on our study are warranted to determine the role of the environment in transmission of respiratory pathogens during mass gathering events (eg, Hajj) such that public health preventative measures might be better targeted.

Influenza vaccination among Australian Hajj pilgrims: uptake, attitudes, and barriers

BACKGROUND

Hajj is the largest annual mass gathering where the risk of respiratory infection is high. Although the Saudi Arabian authority recommends influenza vaccination for Hajj pilgrims, the uptake is variable. Influenza vaccine uptake data among Australian Hajj pilgrims is not readily available. Therefore, we aimed to estimate the influenza vaccination uptake rate and identify both attitudes and barriers to vaccine uptake from two consecutives surveys at Hajj in 2011 and 2012.

METHODS

Using an anonymous self-administered questionnaire, surveys were conducted in Mecca, Saudi Arabia, among Hajj pilgrims from Australia in 2011 and 2012. Pilgrims staying in "Australian" tents were recruited serially.

RESULTS

In 2011, 431 Australian pilgrims completed the survey-median age was 42 (range 7-86) years, 55% were male; 65% reported receiving influenza vaccine. In 2012, 535 pilgrims of median age 43 (range 12-83) years completed the survey, 62% were male; 89% reported receiving the vaccine. Both in 2011 and 2012, common reasons for not receiving the vaccine were the pilgrims' reliance on their "natural immunity" (33 and 26%, respectively, p = 0.4) and believing that they would rarely catch influenza or come in contact with influenza patients (18 and 29%, respectively, p = 0.1). In 2012, when asked why they had received the vaccine, 65% pilgrims responded that it was because of the tour group leaders' recommendation.

CONCLUSION

Influenza vaccine uptake among Australian Hajj pilgrims seems satisfactory and increasing but could be better because many pilgrims have misconceptions about vaccines. Tour operators may play a greater role in promoting vaccination.