AMBO UNIVERSITY

COLLEGE OF MEDICAL AND HEALTH SCIENCES

PUBLIC HEALTH MICROBIOLOGY SEMINAR SUBMITTED

TO DEPARTMENT OF MEDICAL LABORATORY SCIENCES
Title: Microbiology of air and inanimate surfaces in hospital
environment
 
BY: HAMSALU NAGASA (BSc, MSc CANDIDATE)

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 Outline

• Introduction
• Microbiology of air and inanimate surfaces in hospital
environment
– Nosocomial pathogens on inanimate surfaces
– Nosocomial pathogens in air of hospital environment

• Laboratory diagnosis
• Prevention and control

2
• Conclusion
• Recommendations
• References

3
 Introduction
• A nosocomial infection is a localized or a systemic infection

– resulting from an adverse reaction to infectious agents or its

toxins
– develops in 48 hours or more after admission and
– was not incubating on admission (Edwardson, 2018)

• It affects high number of patients globally,

– increasing mortality rate and financial losses significantly.

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• WHO reported that approximately 15% of all hospitalized
patients suffer from these infections
• The incidence is higher in middle and low income countries
– between 3.5% and 12% in high income countries
– between 5.7% and 19.1% middle and low income countries
(Khan, Baig and Mehboob et al, 2017).
• HAIs lead to increased mortality, morbidity, and costs for
patients, their families, and health systems (Jaouhar et al.,
2020).
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• Identified general risk factors for nosocomial infections
include
– prolonged LOS,
– presence of medical comorbid conditions,
– use of invasive devices, and

– use of antibiotics as well as poor hand hygiene (Grasselli et

al., 2017).
• Healthcare-associated infection is a problem of public health
importance in Ethiopia (Birhanu and Endalamaw, 2020).

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• There are 4 types of NIs these are:

1. catheter –associated urinary tract infections (CA-UTIs),

2. surgical site infections (SSIs) ,

3. central line-associated bloodstream infections (CL-BSIs),

4. ventilator associated pneumonia(VAP) (Tolera et al.,
2018).
• Pathogens responsible for nosocomial infections are bacteria,
viruses and fungal parasites (Khan, Baig and Mehboob et al,
2017).
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• Bacteria such as • Viruses includde
– Acinetobacter, – Hepatitis B and C,
– Bacteroides fragilis, – influenza, HIV, HSV,

– Clostridium difficile, – rotavirus.

– Methicillin-resistant • Fungal include
Staphylococcus aureus – Aspergillus spp.,
(MRSA), – C. albicans,
– Enterobacteriaceae – C. neoformans (Khan,
family like Klebsiella Baig and Mehboob et al,
species and E. coli. 2017) 8
 Microbiology of air and inanimate surfaces in hospital environment

• Hospital environment represents a new ecological place for

– nosocomial pathogens,
– antibiotic-resistant microorganisms and
– reservoirs of resistance gene,
• commonly, found on various surfaces within hospitals

– medical equipment, housekeeping surfaces, workplaces and

lobby (furniture) (Sebre et al, 2020).

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• NIs can be
– endogenous originate—the patient’s own flora, or
– exogenous—the pathogen comes from other patients, staff,
or the hospital environment: water, air, or surfaces (Chaoui
et al., 2019).

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1. Nosocomial pathogens on inanimate surfaces

• Inanimate surfaces are

– the surface of the inert hospital environment and
– the surface of the material used during patient treatment
and management such as
• bedside tables, mattress,
• computers, computer standing tables,
• ophthalmic solutions or multidose eye drops,

• white coats/scrubs,
• telephone, and handwashing sink (Kiros et al., 2021).
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• Nosocomial pathogens can persist on inanimate surfaces and

– Can be acquired at a high rate by hands after contact with

environmental surfaces(‘ Ewin, D and Wilcox, et al, 2020).
• The acquisition and severity of nosocomial infections depend on
– the characteristics of microorganisms and
– the rate of contamination of hospital environment. (Worku,
Derseh and Kumalo, 2018)

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 Hospital surfaces and frequently used medical equipment are
contaminated by a variety of pathogenic Mos , including

• Viruses • Bacteria
– Influenza virus, – S. aureus,
– rhinovirus, – Enterococcus,
– SARS-Cov-2, and other – Streptococcus,
(Phan et al., 2020). – Acinetobacter,
• Fungi
– E. coli, Salmonella,
– Candida,
– Shigella, Klebsiella,
– Aspergillus and
– Proteus, and
– Rhodotorula species
(Gabrielle et al., 2018). – Pseudomonas spp. (Worku,
Derseh and Kumalo, 2018)

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• The ability of microorganisms to survive on surfaces is
– due to their production of adhesion molecules and biofilms
(Ahmed et al., 2019)
• The contamination of surfaces depends on

– their characteristics, such as whether they are smooth,

porous, or rough and/or
– on their state, such as whether they are dry, wet, new, or old
(Chaoui et al., 2019).

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• Contamination of the medical equipment facilitates the rapid
spreading of hospital MOs from
– patient to patient,
– healthcare workers to the patients, and
– inanimate surfaces to all bodies (Kiros et al., 2021)

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2. Nosocomial pathogens in air of hospital environment

• The transmission modes of microbial infection in hospitals are

often
– in the form of airborne, contact, and droplet.
• Low air quality of hospitals can lead to
– HAI or nosocomial infection and

– sick building syndrome (SBS)(Fard and Aali, et al, 2019)

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• Bioaerosols in healthcare settings are originated from
– outdoor air,
– respiratory droplets of people,
– air conditioning stuff, and

– cleaning activities (Nasiri et al., 2021).

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• Indoor environments might be especially hazardous because of
– their reduced ventilation,
– lack of ultraviolet light which rapidly inactivates the virus
and
– because it can become less diluted than it would in outdoor
environments (Copat et al., 2020).

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• Airborne microorganisms are spread from numerous sources,
including
– air conditioning systems and
– respiratory droplets produced by patient coughing or sneezing
(Mirhoseini et al., 2016).
• Airborne hospital microorganisms are apparently harmless to
healthy people.
• Nevertheless, they can cause adverse health effects in
immunocompromised individuals(Bonadonna, Briancesco and
Coccia, 2017).

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 Laboratory diagnosis

• Air samples are collected by using plate exposure methods

while the surface swabs are collected aseptically by using
sterile swabs sticks.
– taken before cleaning of the hospitals and
– bacteria from air samples are isolated by plate exposure
method before incubation
• Then, streaked on the bacteriological media using sterile swab
sticks to make an inoculum on the plates (Onifade et al., 2020).

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 1. Passive Air sampling method

• Culture plates (e.g. BA& SDA) are kept exposed in the air for
1 hr,
– at 1m above the floor and 1m from the wall.
• Then, the plate is incubated and the Mos are identified by

– using colony morphology,

– preliminary tests and
– different staining techniques (Valentina and Umadevi,
2019).

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 2. Surfaces Sampling
• 2 types of sampling methods: direct and indirect.

1. Direct method involves the collection of cells directly on to

medium which is then incubated,

– by using contact plates, dipslides and petrifilms

2. indirect method involves the collection of cells on to a collector,

– suspending them into a liquid medium then culturing.

– It includes swabs, sponges and wipes (Rawlinson, Ciric and

Cloutman-green et al, 2019).

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• Each swab sample is pre-enriched in sterile BHI
– then incubated at 37°C for 24 hours.
• A loop full of the turbid broth is then sub-cultured on different
culture media based on
– the type of microorganism being isolated (Ababa et al,
2020).

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 Prevention and control

• Proper equipment sterilization,

• adequate decontamination of surfaces,
• chemical spraying and
• good hand hygiene practices of healthcare providers (Kiros et
al., 2021).

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 Conclusion

• Inanimate surfaces and air in hospital environment are

reservoir for many Mos which
– Include bacteria, viruses and fungi
– They cause HAIs.
• These result in increased mortality, morbidity and costs for
patients, their families.
• plate exposure and surface swab methods are commoly used
sampling techniques

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 Recommendation

• Healthcare workers are expected to conduct the risk

assessment routinely
– to keep the hospital environment save.
– To keep the hospitals’ indoor air healthy for patients to
breathe
– To reduce the level of indoor contaminant or outdoor
originated pollutants in the air

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 Reference
• Ababa, A. (2020) ‘Bacterial Profiles and Antimicrobial Susceptibility Pattern of
Isolates from Inanimate Hospital Environments at Tikur Anbessa Specialized
Teaching’, pp. 4439–4448.

• Ahmed, E. H. et al. (2019) ‘Bacteriological Monitoring of Inanimate Surfaces and

Equipment in Some Referral Hospitals in Assiut City , Egypt’, 2019.

• Birhanu, Y. and Endalamaw, A. (2020) ‘Surgical site infection and pathogens in

Ethiopia : a systematic review and meta- analysis’, pp. 1–8.
• Copat, C. et al. (2020) ‘The role of air pollution ( PM and NO 2 ) in COVID-19
spread and lethality : A systematic review’, Environmental Research, 191(July), p.
110129. doi: 10.1016/j.envres.2020.110129.
• Edwardson, S. (2018) ‘Nosocomial infections in the ICU’, Anaesthesia and
Intensive Care Medicine, 20(1), pp. 14–18. doi: 10.1016/j.mpaic.2018.11.004.
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• Bonadonna, L., Briancesco, R. and Coccia, A. M. (2017) ‘Analysis of Microorganisms in
Hospital Environments and Potential Risks’, pp. 53–62. doi: 10.1007/978-3-319-49160-8.
• Busl, K. M. (2017) ‘Nosocomial Infections in t h e N e u ro i n t e n s i v e C a re Unit’,
Neurologic Clinics of NA. doi: 10.1016/j.ncl.2017.06.012.
• Chaoui, L. et al. (2019) ‘Contamination of the Surfaces of a Health Care Environment by
Multidrug-Resistant ( MDR ) Bacteria’, 2019.

• Fard, R. F. and Aali, R. (no date) ‘Sustainable Development Airborne Antibiotic

Resistant Bacteria : Hospital Indoor Air Pollution and the Challenge of Nosocomial
Infection’, pp. 12–14.
• Fraser, J. L. et al. (2021) ‘International Journal of Infectious Diseases Healthcare-
associated outbreaks of bacterial infections in Africa , 2009 – 2018 : A review’,
International Journal of Infectious Diseases, 103, pp. 469–477.

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• Gabrielle, L. et al. (2018) ‘Aerobic Bacteria and Fungi on the Surfaces of a
Tertiary Assistance Hospital from Northern Brazil’, 12(1), pp. 1–7. doi:
10.9734/JAMB/2018/42991.
• Grasselli, G. et al. (2017) ‘Nosocomial Infections During Extracorporeal
Membrane Oxygenation: Incidence, Etiology, and Impact on Patients’
Outcome’, pp. 1–8. doi: 10.1097/CCM.0000000000002652.
• ‘Healthcare Associated Infection Research group Investigating the dispersal of
microbes in a hospital setting following hand drying using either paper towels
or a jet air dryer Final report’ (2020).
• Jaouhar, S. et al. (2020) ‘Infectious Risk of the Hospital Environment in the
Center of Morocco : A Case of Care Unit Surfaces’, 2020.

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