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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