MICROBIOLOGICAL ASSESSMENT OF INDOOR AND OUTDOOR AIR OF FAITH MEDIPLEX HOSPITAL, BENIN CITY

ABSTRACT

This study was aimed at investigating the microbial load and the quality of indoor air Faith Mediplex Centre, Benin City, to ascertain their contribution to infection rate in the hospital. Air samples were assessed for three (3) months (June-August, 2015) using the settled plate methods. The study sites were divided into five (5) units; male medical ward, female medical ward, treatment room, operating theatre and outside the hospital gate. The result obtained reveal the isolation of six (6) bacterial isolates and four (4) fungal isolates which include Staphylococcus aureus, Staphylococcus epidermidis, Bacillus spp., Serrantia mercescen, Klebsiella spp., and Micrococcus spp. for the bacterial isolates, while the four (4) fungal isolates include Aspergillus niger, Aspergillus  flavus, Penicillium spp.and Candida albicans. The highest bacterial load and fungal load of 95.5cfu/min and 43.5cfu/min respectively were recorded outside the hospital gate, and the lowest bacterial and fungal load of 45cfu/min and 26.5cfu/mins respectively were recorded in the male medical ward for both bacterial and fungal. The most frequently occurring bacterial and fungal isolates wereStaphylococcus aureus and Aspergillus nigerrespestively, occurring at 100%. All units that were included in the study were contaminated with bacteria and fungi. The bacteria and fungi concentrations of air obtained in this study might be potential risk factors for spread of nosocomial infection in the Hospital hence a high level of hygiene must be practiced by both patients and health care providers.

TABLE OF CONTENTS

Cover page      -           -           -           -           -           -           -           -           -           i

Title page        -           -           -           -           -           -           -           -           -           ii

Certification    -           -           -           -           -           -           -           -           -           iii

Approval         -           -           -           -           -           -           -           -           -           iv

Dedication      -           -           -           -           -           -           -           -           -           v         

Acknowledgement      -           -           -           -           -           -           -           -           vi

Table of contents        -           -           -           -           -           -           -           -           vii       

List of Tables  -           -           -           -           -           -           -           -           -           xi

List of Figures -           -           -           -           -           -           -           -           -           xii

Abstract          -           -           -           -           -           -           -           -           -           xiii

CHAPTER ONE

1.0  Introduction         -           -           -           -           -           -           -           -           1

1.1  AimsandObjectives          -           -           -           -           -           -           -           -           3

CHAPTER TWO

2.0 Literature Review -           -           -           -           -           -           -           -           4

2.1 Microbes in Indoor Environmemt -           -           -           -           -           -           4

2.2 Bio-Aerosols         -           -           -           -           -           -           -           -           5

2.2.1 Factors Infleuncing Bio-Aerosols          -           -           -           -           -           7

2.2.2 Sources of Bio-Aerosols in Indoor        -           -           -           -           -           7

2.2.2.1 Health Care Facilities  -           -           -           -           -           -           -           7

2.2.3 Role of Bio-Aerosols in Healthcare Settings     -           -           -           -           8         

2.2.4 Health Effect of Bio-Aerosols   -           -           -           -           -           -           8         

2.2.4.1 Infectioue Diseases     -           -           -           -           -           -           -           9         

2.2.4.2 Respiration Diseases   -           -           -           -           -           -           -           10       

2.2.4.3 Cancer -           -           -           -           -           -           -           -           -           11

2.2.5 Modes of Transmission  -           -           -           -           -           -           -           12

2.2.6 Control Measures for Reducing Bio-Aerosols   -           -           -           -           12

2.3 Hospital Environment       -           -           -           -           -           -           -           13

2.3.1 Hospital Microbial Load            -           -           -           -           -           -           14

2.3.2 Level of Airborne Microoganisms in Hospitals -           -           -           -           15       

2.3.3 Sources and Factors Infleuncing Bio-Aerosols in Hospitals-    -           -           17

2.3.4 Health Risks-     -           -           -           -           -           -           -           -           18

2.3.5 Control Measures           -           -           -           -           -           -           -           20

2.4 Hospital Acquired Infectiins (HAIs)/Nosocomial Infections       -           -           21       

2.4.1 Role of Airborne Infectious Agent in Nosocomial Infections  -           -           23       

CHAPTER THREE

3.0 Materials and Methods                 -           -           -           -           -           -           25

3.1 Study Area-          -           -           -           -           -           -           -           -           25

3.2 Sterilization of Materials   -           -           -           -           -           -           -           25       

3.2.1 Autoclaving       -           -           -           -           -           -           -           -           25       

3.2.2 Dry heat -           -           -           -           -           -           -           -           -           25       

3.3 Media Used and Their Preparation           -           -           -           -           -           26       

3.3.1 Nutrient Agar (NA)       -           -           -           -           -           -           -           26

3.3.2 Potato Dextrose Agar (PDA)    -           -           -           -           -           -           26

3.4 Sample Collection -           -           -           -           -           -           -           -           26       

3.5 Bacteria Identification      -           -           -           -           -           -           -           27

3.5.1 Gram Staining    -           -           -           -           -           -           -           -           27       

3.6 Biochemical Tests -           -           -           -           -           -           -           -           28       

3.6.1 Catalase Test      -           -           -           -           -           -           -           -           28

3.6.2 Coagulase Test   -           -           -           -           -           -           -           -           28       

3.6.3 Citrate Test        -           -           -           -           -           -           -           -           29       

3.6.4 Glucose Test      -           -           -           -           -           -           -           -           29       

3.6.5 Oxidase Test      -           -           -           -           -           -           -           -           29       

3.6.7 Indole Test         -           -           -           -           -           -           -           -           30       

3.6.7 Motility Test      -           -           -           -           -           -           -           -           30       

3.7 Fungi Identification          -           -           -           -           -           -           -           30

CHAPTER FOUR

4.0 Results      -           -           -           -           -           -           -           -           -           31

CHAPTER FIVE

5.0 Discussion -           -           -           -           -           -           -           -           -           39

5.1 Conclusion            -           -           -           -           -           -           -           -           41

References      -           -           -           -           -           -           -           -           -           42

Appendix A    -           -           -           -           -           -           -           -           -           59

Appendix B    -           -           -           -           -           -           -           -           -           61

Appendix C    -           -           -           -           -           -           -           -           -           63

LIST OF TABLES

Table 1: Occurrence and distribution of bacterial isolated from the different                                    sampling sites, Faith Mediplex Hospital (June - August 2015) -           33

Table 2: Cultural, Morphological and Biochemical characteristics of                                       bacterial isolates            -           -           -           -           -           -           -           34

Table 3: Occurrence and distribution of fungal isolated from the different                                        sampling sites, Faith Mediplex Hospital (June - August 2015) -           35       

Table 4: Cultural and Morphological characteristics of fungal isolates         -           36       

LIST OF FGIURES

Figure 1: Frequency of Bacterial load recorded in the different sampling sites                                               of Faith Mediplex Hospital from June - August 2015    -           -           37

Figure 2: Frequency of Fungal load recorded in the different sampling sites

               of Faith Mediplex Hospital from June - August 2015         -           -           38       

CHAPTER ONE

1.0     INTRODUCTION

        Air supplies us with oxygen which is essential for our bodies to live. Pure air is a mixture of gases that are invisible, colorless and odorless consisting of 78% nitrogen, 21% oxygen and other gases as well as varying amounts of water vapor (Murray et al., 1995). This pure air can become contaminated in various ways affecting humans, plants and animals. Air pollution is the introduction into the atmosphere of chemicals, particulate matter or biological materials that causes discomfort, disease or death to humans, damage to other living organisms including food crops. Both indoor air and outdoor air can become polluted by pesticides. These pesticides contain active and inert substances such as cyclodiene which is associated with symptoms such as dizziness, headaches, weakness, muscle twitching and nausea (Hays et al., 1995).

        Good indoor air quality (IAQ) is important for all of us; most people spend 90 % or more of their time indoors. Most of this time consists of the hours spent at home or at work, while school age children spend 20 % of their time in schools (Clench-Aas et al., 1999). Good IAQ consists of many aspects; it is an interaction of a functioning and efficient ventilation and the lowest achievable amount of chemical, inorganic or organic and microbial compounds which should not evoke symptoms in the occupants (Spengler et al., 2001).

       Microorganisms such as bacterial and fungal spores are almost always present in the air. The quality of indoor environment, however, is not easily defined or readily controlled, and can potentially place human occupants at risk (Jaffal, et al., 1997a). Airborne transmission is one of the routes of spreading disease that is responsible for several nosocomial infections (Claudete et al., 2006).

        Exposure to bio-aerosols, containing airborne microorganisms and their by-products, can result in respiratory disorders and other adverse health effects such as infections, hypersensitivity pneumonitis and toxic reactions (Gorny et al., 2002; Fracchia et al., 2006).

        Indoor air quality is a term which refers to the air quality within and around buildings and structures especially as it relates to the health and comfort of its occupants. Indoor air can be polluted by various compounds such as carbon monoxide, volatile organic compounds (VOCs), particulate matter and microbial contaminants (moulds, bacteria, viruses) and any action that introduces harmful contaminants into the air within the building. The concern for quality indoor air is necessary especially in institutionalized settings that accommodate a large number of people such as hospitals, nursing homes, prisons, schools, family because contaminated air can cause both mild and severely irritating health conditions (Tambeker et al., 2007). The quality of air in hospitals in relation to microbial contamination at a given time period is determined by the quality of air entering into the building, the number of occupants in the building, their physical activities and resultant aerosol generation, human traffic and the efficiency of ventilation (Adebolu and Vhirterhre, 2002).                     

        Indoor air quality in hospitals is a concern due to presence of airborne microorganisms that may cause nosocomial infections (Beggs CB, 2003). Few published reports have studied the seasonal fluctuations in microbial loads over time in hospital environment (Augustowska and Dutkiewicz, 2006). While studies in developing countries have documented presence of nosocomially significant bacteria and fungi in indoor air of healthcare facilities (Sudharsanam et al., 2008; Ekhaise et al., 2008), these studies were not performed over extended time periods to ascertain the influence of seasonal changes on airborne microbial loads.

        Nosocomial infection also known as hospital acquired infection is an infection acquired in a hospital environment, which was not present in the patient at the time of admission (Beggs, 2003). Hospitals are potentially conducive for antimicrobial resistant and virulent pathogens to proliferate. Large numbers of microorganisms are found in indoor air and it is of great importance to carry out regular survey as a yardstick of determining standard of cleanliness in hospitals (Williams et al., 1956). The sources of hospital airborne infection or contamination could be traced to a variety of factors. These include the patient’s own normal flora, linens, bed sheets, staff clothes, visitors and the materials such as flowers. Activity of patients (sneezing, coughing, talking, yawning) and the number of patients per room may likewise be sources of hospital infection (Jaffal et al., 1997a; Ekhaise et al., 2008; 2010). It has also been reported that microbiological pollutants such as animal droplets, plants, building materials and air conditioning system have played significant role in the spread of airborne microflora. Materials such as files kept close to bedside in surgical wards have been implicated as a viable source (Burge et al., 2000).

1.1     AIMS AND OBJECTIVES

        This study was aimed at investigating the microbial load and the quality of indoor air of four difference wards/units and outside the hospital gate of Faith Mediplex Centre, Benin City.

i.            To isolate and characterize the airborne micro-flora from hospital environment and to ascertain their contribution to infection rate in the hospital.

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