Comparison of Microbial Contamination Levels Among Hospital Operating Rooms and Industrial Clean Rooms

Microbial contamination in industrial clean rooms was compared quantitatively and qualitatively with that of hospital operating rooms. The number of aerobic mesophilic microorganisms which accumulated on stainless-steel strips exposed for periods up to 21 weeks to the intramural air of four operating rooms was at least 1 log higher than the accumulation on strips exposed in four clean rooms, and was essentially the same as that found in two factory areas. Volumetric air samplings showed that there were significantly higher numbers of airborne viable particles per cubic foot of air in operating rooms than in industrial clean rooms. In contrast to clean rooms, where most of the airborne contaminants were those associated with human hair, skin, and respiratory tract, the hospital operating rooms showed a very high level of microorganisms associated with dust and soil.     

Airborne fungi in the hospitals of metropolitan Delhi

Summary The fungal airspora of a large hospital in Delhi Metropolis was studied from May 1989 – April 1991, using Andersen Six Stage Volumetric Sampler and Burkard Personal Slide Sampler. Simultaneously, samples were also collected from outside the hospital to act as a control. Samplers were operated for 10 min. each time, at 10 - day intervals. Additional samples were also collected from different sections of 3 other hospitals. Some of the dominant forms encountered wereCladosporium spp.,Aspergillus flavus, Smut,Fusarium spp.,Aspergillus niger, Alternaria spp.,Penicillium citrinum, Aspergillus versicolor, andPenicillium oxalicum. Aspergillus flavus showed significantly high concentration inside hospital (n=66, x=53 CFU m^–3, p<0.05) as compared to outside air. The peak period for fungi was observed to be from June – September. The spore concentration was much lower in hospital units receiving filtered air as compared to control environment, but in naturally ventilated hospitals the concentration was similar to that of outside air.     

医院病房环境真菌监测分析

目的 调查医院各病区环境中真菌含量及分布特点.方法 运用分离培养及DNA测序方法对医院不同病区、不同环境中真菌进行监测分析.结果 医院不同病区真菌含量不同,呼吸科、血液科、小儿科空气中真菌含量较高,分别为400、225和200 CFU/m3,其中以烟曲霉菌( 325 CFU/m3)、黄曲霉菌( 275 CFU/m3)、枝孢霉菌( 125 CFU/m3)、根霉( 125 CFU/m3)为主;老年病科、肿瘤科和血液科空调出气口真菌含量较高,分别为0.559、0.500和0.323 CFU/cm2,以链格孢霉(0.441 CFU/cm2)、根霉(0.412 CFU/cm2)、烟曲霉菌(0.294 CFU/cm2)为主;不同环境中真菌含量不同,其中以空气和空调出气口真菌含量最高,分别为130 CFU/m3、0.173 CFU/cm2.结论 真菌广泛存在于医院环境中,且不同病区、不同环境真菌污染程度不同,因而我们必须制订健全的消毒管理制度,预防医院真菌感染.     

Method of isolating conditionally-pathogenic Gram-negative microorganisms, agents of intrahospital infections, from air

The possibility of detecting Pseudomonas aeruginosa and other Gram-negative bacteria in the air of the burn department at the Institute of Surgery was studied. The investigation of large volumes of air (0.5-1 m3) in the wards and the corridor with the use of a new bacteriological aerosol sampler, model IIAB-5, resulted in the detection of Pseudomonas aeruginosa. Besides, in a number of other rooms Klebsiella, Proteus, Citrobacter and Enterobacter were detected in the air. The possibility of the spread of Gram-negative opportunistic bacteria through the air in hospital conditions is discussed.     

Study of small air ions concentrations versus asthma attacks in the region of Athens-Greece after the Chernobyl disaster

A consequence of the Chernobyl disaster was the isolated increase of small air ions for a limited time period over Athens-Greece. Taking advantage of this unique condition we studied the relation of log daily mean concentrations of small positive air ions, small negative air ions, NO2 and SO2 with the total daily number of asthma attacks attendances at the region's largest chest diseases hospital for 35 days following the disaster and during a same time period in the preceding four years. No correlation was found between air ionization and asthma attacks, though the study was of a rather short duration and several possible influencing factors such as aeroallergen concentrations were not taken into consideration.     

Daily hospital respiratory admissions and winter air mass types, Birmingham, UK

 A synoptic climatological approach is used to investigate linkages between air mass types (weather situations), the daily mean particulate matter with a size of 10 μm or less (PM10) concentrations and all respiratory hospital admissions for the Birmingham area, UK. Study results show distinct differential responses of respiratory admission rates to the six winter air mass types identified. Two of the three air masses associated with above average admission rates (continental anticyclonic gloom and continental anticyclonic fine and cold) also favour high PM10 levels. This association is suggestive of a possible linkage between weather, air quality and health. The remaining admissions-sensitive air mass type (cool moist maritime) does not favour high PM10 levels. This is considered to be indicative of a direct weather-health relationship. A sensitising mechanism is proposed to account for the linkages between air mass type, PM10 concentrations and respiratory response. Received: 4 August 1997 / Received after revision: 8 January 1999 / Accepted: 20 January 1999     

北京市大气细颗粒污染物与老年呼吸系统疾病急诊就医关系的病例交叉研究

目的:探讨北京市大气细颗粒污染物对呼吸系统疾病急诊的影响。方法:收集2013年3月-2014年3月解放军305医院以及西三环的总参军训部北京第八干休所门诊部的临床病例急诊数据、北京市环境监测中心的大气细颗粒污染物和气象条件数据资料,应用病例交叉设计研究方法进行数据分析。结果:在控制气温、相对湿度的影响后,单向回顾性1:1配对病例交叉分析结果显示,滞后0天细颗粒物污染对慢性支气管炎、哮喘、慢性阻塞性肺病急诊影响的OR值最大,细颗粒物日平均浓度每升高10μg/m3,对应的OR值分别为1.032、1.033、1.035。结论:该研究区域内大气细颗粒物污染物浓度升高可以导致呼吸系统疾病相关的慢性支气管炎、哮喘、慢性阻塞性肺病疾病的急诊增加。     

Hospital sources of Aspergillus: New routes of transmission?

With the continuing increase in the number of severely immunocompromised patients, hospitals are faced with the growing problem of invasive aspergillosis and other opportunistic fungal infections. Since treatment of these infections are difficult and outcome is often fatal, preventive measures are of major importance in the control of invasive filamentous fungal infections. Until recently, inhalation of airborne conidia was believed to be the primary route of acquiring Aspergillus infection. Despite the fact, that efforts to filter the hospital air has led to a reduction of airborne conidia paralleled by a decrease in the frequency of invasive infections, the correlation between the concentration of Aspergillus conidia in hospital air and the risk of invasive infections remains unclear. Furthermore, alternative modes of transmission may exist and should be recognized and investigated. The discovery of hospital water as a potential source of Aspergillus fumigatus and other filamentous fungi may suggest a new route for the transmission of invasive filamentous fungal infections. Epidemiological studies, based on molecular characterization and comparisons of fungal isolates recovered from patients and environment, are needed to expand our understanding of these alternative routes of transmission.     

Aspergillus fumigatus and other thermotolerant fungi generated by hospital building demolition.

On 13 September 1981, a 51-year-old seven-story building within our hospital complex was demolished by explosives. The concern that this event might release large numbers of thermotolerant fungi (TF), potentially hazardous to immunosuppressed patients, led us to seal hospital windows and doors. The air-handling systems were also manipulated. Concentrations of airborne TF, especially Aspergillus fumigatus, were determined before and after demolition, using Andersen and Cassella air samplers with inhibitory mold agar plates. Two outdoor and two hospital ward locations were sampled. The plates were incubated at 37 degrees C; the CFU per cubic meter were counted at 72 h. The outdoor concentration of TF increased at one site by an average of 1.8 log10 (10(2) to 10(5] over the predemolition level. A. fumigatus increased 3.3 log10 (10(0) to 10(4] at the other outdoor site. The indoor TF concentrations increased about 1 log10 (10(1) to 10(2] after demolition. Counts on the hospital wards were not remarkable when compared with previous surveillance air sampling. Protective measures apparently minimized the infiltration of TF during explosive demolition.     

Detection of antibiotic resistance genes associated with methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci in hospital air filter dust by PCR

Dust from the pre-filters of stand-alone hospital isolation room air cleaners was tested by PCR for the presence of antibiotic resistance genes associated with methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci. Resistance genes for three classes of antibiotics (aac(6′)-aph(2″), ermA, and mecA) were detected in multiple samples, indicating the presence of genetic material and likely cells of multidrug-resistant MRSA and other staphylococci in hospital air and that stand-alone air cleaners can reduce airborne levels of these contaminants. Screening for vanA was negative. Our results further suggest that dust may serve as an important reservoir of genetic elements that can confer drug resistance.     

Enumeration of Airborne Bacteria in Hospital

An investigation of the “normal” bacterial content of the air of a large general hospital is described. In many different places within five different areas 70 to 200 settle-plate or slit-sampler bacterial counts were carried out. Average counts were most often of the same order as or lower than other published results and were proportional to human activity. The use of the logarithms of the counts showed no advantage, and conventional statistics should be applied with caution in evaluating such studies. Slitsampler and settle-plate counts of all bacteria showed no correlation, whereas those of Staph. aureus were correlated. There is a lack of parallelism between hospital infection and air bacteria counted by current methods, which are, therefore, not suitable for routine use.     

Distribution of bacterial contamination in a teaching hospital in Tehran - a special focus on Staphylococcus aureus

There are documents that confirm the cycle of bacterial transmission between patients, staff, and the inanimate environment. The environment may have more effect on intensive care units (ICUs), because the patients who require intensive care have unstable clinical conditions and are more sensitive to infections. The aim of this study was to determine the prevalence of bacteria in air and inanimate surface in the ICUs and to compare the microbial levels to standard levels.Air and inanimate surface in the four ICUs of a teaching hospital underwent weekly surveillance by means of air sampler and swabs for a period of six-month. Total bacterial counts were evaluated onto trypticase soy agar and mannitol salt agar (MSA).A total of 725 samples [air (168) and inanimate surfaces (557)] were collected. The total mean ± SD CFU/m3 of airborne bacteria in all of the ICUs were 115.93 ± 48.04. The most common bacteria in air of the ICUs were Gram-positive cocci (84.2%). The total mean ± SD airborne of Staphylococcus aureus was 12.10±8.11 CFU/m3. The highest levels of S. aureus contamination were found in ventilators and bed ledges. More suitable disinfection of hospital environments and monthly rotation in utilization of the various disinfectant agents are needed for the prevention of airborne and inanimate transmission of S. aureus.     

Cold Air Plasma To Decontaminate Inanimate Surfaces of the Hospital Environment

The hospital environment harbors bacteria that may cause health care-associated infections. Microorganisms, such as multiresistant bacteria, can spread around the patient''s inanimate environment. Some recently introduced biodecontamination approaches in hospitals have significant limitations due to the toxic nature of the gases and the length of time required for aeration. This study evaluated the in vitro use of cold air plasma as an efficient alternative to traditional methods of biodecontamination of hospital surfaces. Cultures of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli, and Acinetobacter baumannii were applied to different materials similar to those found in the hospital environment. Artificially contaminated sections of marmoleum, mattress, polypropylene, powder-coated mild steel, and stainless steel were then exposed to a cold air pressure plasma single jet for 30 s, 60 s, and 90 s, operating at approximately 25 W and 12 liters/min flow rate. Direct plasma exposure successfully reduced the bacterial load by log 3 for MRSA, log 2.7 for VRE, log 2 for ESBL-producing E. coli, and log 1.7 for A. baumannii. The present report confirms the efficient antibacterial activity of a cold air plasma single-jet plume on nosocomial bacterially contaminated surfaces over a short period of time and highlights its potential for routine biodecontamination in the clinical environment.     

The role of R plasmids in the resistance of bacteria in air

The study of Escherichia coli J 53, used as a model, has revealed that some R plasmids isolated from Serratia marcescens and Klebsiella pneumoniae, found to be the cause of the outbreak of hospital infection, ensure, besides multiple drug resistance, also their viability in the air.     

A respiratory alert model for the Shenandoah Valley, Virginia, USA

Respiratory morbidity (particularly COPD and asthma) can be influenced by short-term weather fluctuations that affect air quality and lung function. We developed a model to evaluate meteorological conditions associated with respiratory hospital admissions in the Shenandoah Valley of Virginia, USA. We generated ensembles of classification trees based on six years of respiratory-related hospital admissions (64,620 cases) and a suite of 83 potential environmental predictor variables. As our goal was to identify short-term weather linkages to high admission periods, the dependent variable was formulated as a binary classification of five-day moving average respiratory admission departures from the seasonal mean value. Accounting for seasonality removed the long-term apparent inverse relationship between temperature and admissions. We generated eight total models specific to the northern and southern portions of the valley for each season. All eight models demonstrate predictive skill (mean odds ratio = 3.635) when evaluated using a randomization procedure. The predictor variables selected by the ensembling algorithm vary across models, and both meteorological and air quality variables are included. In general, the models indicate complex linkages between respiratory health and environmental conditions that may be difficult to identify using more traditional approaches.     

Airborne bacteria and antibiotic resistance genes in hospital rooms

The microbial biodiversity of bioaerosols in recently occupied hospital rooms was assessed in a pulmonology unit. Environmental samples and isolates were also screened for antibiotics resistance genes. Biofilms from sink drains were also studied to evaluate whether sink drains constitute a potential source of bioaerosols in this environment and a reservoir for opportunistic bacteria and antibiotic resistance genes. Stenotrophomonas maltophilia was by far the most frequently isolated microorganisms from the biofilm, followed by Enterobacter cloacae. Airborne bacterial concentration ranged from 14 to 74 CFU m⁻³ and fungi ranged from 50 to 600 CFU m⁻³. Biofilm bacteria were outnumbered in aerosols by microorganisms affiliated with human skin flora. Nonetheless, they were recovered from air samples in low concentrations. Erythromycin resistance genes were detected in all air samples collected from hospital rooms, and tetracycline resistance genes were detected sporadically. Antibiotic resistance genes were found in a single drain suggesting that genes present in DNA extracts from air samples were not aerosolized from sink drains, but rather from an unknown source. Results obtained in this study suggest that bacteria from sink drains were not aerosolized in significant concentration. They still remain a concern because of the risk of aerial transmission associated with their presence.     

Controlled trial of oxygen in uncomplicated myocardial infarction.

Two-hundred consecutive patients thought to have suffered a myocardial infarction were admitted to a randomised, double-blind controlled trial of oxygen or air administered by MC mask throughout the first 24 hours in hospital. Forty-three patients in whom myocardial infarction was not subsequently confirmed were excluded from the analysis. The remaining air and oxygen groups were comparable except for a significantly higher PaO2 and serum aspartate aminotransferase level in the oxygen group. There was no significant difference in mortality, incidence of arrhythmias, use of analgesics, or systolic time intervals between the two groups, although a higher incidence of sinus tachycardia was found in those given oxygen. There appears to be no evidence of benefit from the routine administration of oxygen in uncomplicated myocardial infarction.     

Hospital Patient‐Care and Outside‐the‐Hospital Energy Profiles for Hemodialysis Services

Studies investigated the patient‐care (in‐hospital) and outside‐the‐hospital energy consumptions for delivering the hemodialysis (HD) service. A life cycle inventory methodology was used for this patient‐based analysis for two hospitals located in Wichita, Kansas. It was found that, for both hospitals, the actual HD machines consumed approximately 3.5 kilowatt‐hours (kWh) of electrical energy per HD, only 8% to 16% of the total energy used for delivering the HD service (in hospital). This increases to 9.6 to 28.9 kWh of hospital billable energy for the whole system of HD machine, auxiliaries, and dialysis water treatment. Converting these hospital direct electrical energy values to natural resource energy (nre) then adding the cradle‐to‐gate natural resource energy for the manufacturing and supply chain of all the HD consumables, the total is 78 to 149 kWh nre/HD. The nre measures all the direct fuel burned to generate energy and is thus directly related to emissions to the air, water, and land and is a direct secondary impact on public health from HD. The ratio of outside‐the‐hospital energy to direct hospital HD electrical energy consumption is 4:1 to 7:1, so a broader base exists for improvement than just the hospital.