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Abu-Rub LI, Johar ARA, Al Mana H, Abdelrahman HA, Althani AA, Qotba H, Yassine HM, Eltai NO. Bacterial indoor air contaminations in hospitals in MENA region: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:1218-1232. [PMID: 35658652 DOI: 10.1080/09603123.2022.2083087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
| | - Al-Reem A Johar
- Research and Development Department, Barzan Holdings, Doha, Qatar
| | - Hassan Al Mana
- Biomedical Research Center, Qatar University, Doha, Qatar
| | | | | | - Hamda Qotba
- Clinical Research Department, Primary Health Care Corporation, Clinical Research Primary Healthcare Center, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Nahla O Eltai
- Biomedical Research Center, Qatar University, Doha, Qatar
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Gimenes de Castro B, Mari Fredi B, Dos Santos Bezerra R, Alcantara QA, Milani Neme CE, Mascarelli DE, Carvalho Tahyra AS, Dos-Santos D, Nappi CR, Santos de Oliveira F, Pereira Freire F, Ballestero G, Menuci Lima JB, de Andrade Bolsoni J, Lourenço Gebenlian J, Lopes Bibo N, Soares Silva N, de Carvalho Santos N, Simionatto Zucherato V, Chagas Peronni K, Guariz Pinheiro D, Dias-Neto E, Gambero Gaspar G, Roberto Bollela V, da Silva Silveira V, Maria Fontes A, Maria Martinez-Rossi N, Nanev Slavov S, Paulo Bianchi Ximenez J, Barbosa F, Araújo Silva W. Metabarcoding approach to identify bacterial community profiling related to nosocomial infection and bacterial trafficking-routes in hospital environments. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2023; 86:803-815. [PMID: 37565650 DOI: 10.1080/15287394.2023.2243978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Nosocomial infections (NIs) appear in patients under medical care in the hospital. The surveillance of the bacterial communities employing high-resolution 16S rRNA profiling, known as metabarcoding, represents a reliable method to establish factors that may influence the composition of the bacterial population during NIs. The present study aimed to utilize high-resolution 16S rRNA profiling to identify high bacterial diversity by analyzing 11 inside and 10 outside environments from the General Hospital of Ribeirão Preto Medical School, Brazil. Our results identified a high bacterial diversity, and among these, the most abundant bacterial genera linked to NIs were Cutibacterium, Streptococcus, Staphylococcus, and Corynebacterium. A Acinetobacter was detected in cafeterias, bus stops, and adult and pediatric intensive care units (ICUs). Data suggest an association between transport and alimentation areas proximal to the hospital ICU environment. Interestingly, the correlation and clusterization analysis showed the potential of the external areas to directly influence the ICU pediatric department microbial community, including the outpatient's clinic, visitor halls, patient reception, and the closest cafeterias. Our results demonstrate that high-resolution 16S rRNA profiling is a robust and reliable tool for bacterial genomic surveillance. In addition, the metabarcoding approach might help elaborate decontamination policies, and consequently reduce NIs.
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Affiliation(s)
| | - Bruno Mari Fredi
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Rafael Dos Santos Bezerra
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- Regional Blood Center, General Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Queren Apuque Alcantara
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- Center for Medical Genomics, General Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | | - Douglas Dos-Santos
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Camilla Rizzo Nappi
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | - Giulia Ballestero
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | | - Naira Lopes Bibo
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | | - Kamila Chagas Peronni
- Department of the Research and Innovation, Institute for Cancer Research, Guarapuava, Parana, Brazil
| | - Daniel Guariz Pinheiro
- Department of Technology, School of Agricultural and Veterinarian Sciences, São Paulo State University, Jaboticabal, São Paulo, Brazil
| | - Emmanuel Dias-Neto
- Laboratory of Medical Genomics, International Research Center, A.C. Camargo Cancer Center, Jaboticabal, São Paulo, Brazil
| | - Gilberto Gambero Gaspar
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Valdes Roberto Bollela
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Vanessa da Silva Silveira
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Aparecida Maria Fontes
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Nilce Maria Martinez-Rossi
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Svetoslav Nanev Slavov
- Regional Blood Center, General Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - João Paulo Bianchi Ximenez
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fernando Barbosa
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Wilson Araújo Silva
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- Regional Blood Center, General Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- Department of the Research and Innovation, Institute for Cancer Research, Guarapuava, Parana, Brazil
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Ibrahim F, Samsudin EZ, Ishak AR, Sathasivam J. Hospital indoor air quality and its relationships with building design, building operation, and occupant-related factors: A mini-review. Front Public Health 2022; 10:1067764. [PMID: 36424957 PMCID: PMC9679624 DOI: 10.3389/fpubh.2022.1067764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Indoor air quality (IAQ) has recently gained substantial traction as the airborne transmission of infectious respiratory disease becomes an increasing public health concern. Hospital indoor environments are complex ecosystems and strategies to improve hospital IAQ require greater appreciation of its potentially modifiable determinants, evidence of which are currently limited. This mini-review updates and integrates findings of previous literature to outline the current scientific evidence on the relationship between hospital IAQ and building design, building operation, and occupant-related factors. Emerging evidence has linked aspects of building design (dimensional, ventilation, and building envelope designs, construction and finishing materials, furnishing), building operation (ventilation operation and maintenance, hygiene maintenance, access control for hospital users), and occupants' characteristics (occupant activities, medical activities, adaptive behavior) to hospital IAQ. Despite the growing pool of IAQ literature, some important areas within hospitals (outpatient departments) and several key IAQ elements (dimensional aspects, room configurations, building materials, ventilation practices, adaptive behavior) remain understudied. Ventilation for hospitals continues to be challenging, as elevated levels of carbon monoxide, bioaerosols, and chemical compounds persist in indoor air despite having mechanical ventilation systems in place. To curb this public health issue, policy makers should champion implementing hospital IAQ surveillance system for all areas of the hospital building, applying interdisciplinary knowledge during the hospital design, construction and operation phase, and training of hospital staff with regards to operation, maintenance, and building control manipulation. Multipronged strategies targeting these important determinants are believed to be a viable strategy for the future control and improvement of hospital IAQ.
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Affiliation(s)
- Farha Ibrahim
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
- Training Management Division, Ministry of Health, Johor Bahru, Malaysia
| | - Ely Zarina Samsudin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Ahmad Razali Ishak
- Centre for Environmental Health and Safety, Faculty of Health Sciences, Universiti Teknologi MARA, Selangor, Malaysia
| | - Jeyanthini Sathasivam
- Public Health Division, Johor Health State Department, Ministry of Health, Johor Bahru, Malaysia
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Assessment of Indoor Air Quality of Four Primary Health Care Centers in Qatar. Microorganisms 2022; 10:microorganisms10102055. [PMID: 36296331 PMCID: PMC9608370 DOI: 10.3390/microorganisms10102055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Exposure and Health Effects of Bacteria in Healthcare Units: An Overview. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12041958] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Healthcare units consist of numerous people circulating daily, such as workers, patients, and companions, and these people are vehicles for the transmission of microorganisms, such as bacteria. Bacteria species may have different allergenic, pathogenic, infectious, or toxic properties that can affect humans. Hospital settings foment the proliferation of bacteria due to characteristics present in the indoor hospital environment. This review article aims to identify the potential health effects caused by bacterial contamination in the context of healthcare units, both in patients and in workers. A search was carried out for articles published in PubMed, Web of Science and Scopus, between 1 January 2000 and 31 October 2021, using the descriptor hospital exposure assessment bacteria. This bibliographic research found a total of 13 articles. Bacteria transmission occurs mainly due to the contact between healthcare workers and patients or through the handling of/contact with contaminated instruments or surfaces. The most common bacterial contaminants are Escherichia coli, Pseudomonas aeruginosa, Staphylococcus spp., Staphylococcus aureus and Micrococcus luteus, and the principal health effects of these contaminants are hospital-acquired infections and infections in immunocompromised people. A tight control of the disinfection methods is thus required, and its frequency must be increased to remove the microbial contamination of wards, surfaces and equipment. A better understanding of seasonal variations is important to prevent peaks of contamination.
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