Microbiological Indoor Air Quality and Associated Factors Among Private Clinics of Harar Town, Harar,

Eastern Ethiopia, 2022.

INVESTIGATORS ADVISORS
Elias Miresa Mr. Tamagnu Sintie (MSc.)
Markos Techane Mr. Liku Muche (MSc.)
Mehirat Siyoum

August , 2022
Harar, Ethiopia
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Content

1. Introduction
2. Statement of the problem
3. Significance of the study
4. Objectives
5. Methods
6. Results
7. Discussion
8. Conclusions
9. Recommendation
10. Acknowledgement
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Introduction

• Indoor Air quality is a term which refers to the quality of air within and around buildings
and structures especially as it relates to the health and comfort of its occupants (Tambekar,
Gulhane et al. 2007).

• Indoor environment are fundamental factors capable of impacting health, wellbeing and
productivity of people(Wemedo, Ede et al. 2012).

• The health care facilities where patients are treated has an influence on the health of the
patient recovering or acquiring infection that may complicate or increase the condition of
the patient (Ekhaise, Isitor et al. 2010).
Statement of the problem

• Pollution of indoor air quality is world’s problem especially in developing

countries. Everywhere they continue to become a significant cause of death
(Wemedo, Ede et al. 2012).

• Bio aerosols contribute about 5–34% of indoor air pollution (Uzoechi, Obi et al.
2017).

• Studies done in Ethiopia showed, high risk of infection due to the high microbial
load in the health care wards (Gebr-silasse et al. 2016).

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Cont.……..

• Researches done in Hawassa, Gonder, Jimma and Adama Hospitals concluded

that, almost in all of the health care wards microbial air quality was above the
sanitary standards of European Commission for non-industrial premises
acceptable values (500-2000 CFU/m3 as high range) (Gebrehiwot et al. 2016).

• Therefore, it is very crucial to assess the contributing factors of this level of

microbial load within health care facilities.

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Significance of the study

• To control indoor microbial load,

• To take corrective actions and

• To create conducive working environment for workers and patients.

• To identify associated factors

• Suggestions

private clinic managers

Harar health bureau

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Objectives

General objective

• To assess microbial indoor air quality and associated environmental factors in private
clinics of, Harar town, Eastern Ethiopia, 2022.

Specific objectives

• To determine bacterial indoor air load

• To determine fungal indoor air load

• To identify environmental factors associated with microbial load of private clinics

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Method and materials

• Study Area: private clinics of Harar town.

• Study period: June 1 to 7, 2022.

• Study Design: Institutional based cross-sectional study

• Source Population : All private clinics of Harar town.

• Study Population: The sample room of Harar private clinics

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Cont.……..

• Inclusion criteria
o Inpatient rooms and outpatient rooms,

o offices and patient waiting room that are occupied by one or more patients
were included in the study.

• Exclusion criteria
o Rooms that are non-functional,

o permanently emptied rooms were excluded.

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Cont.……..

• Sample size determination

• Single population proportion formula with p=50% is used to calculate sample of

rooms which is required for the study.

• Where; z=confidence interval (95%)

• d=margin of error (5%)

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Cont.……..

• Sample size : 260

• Sampling Technique : Stratified sampling method

• Data collectors : 3 environmental health students

• Supervisors : 2 environmental health professionals

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Cont.……..

• Data collection methods :

Passive air sampling technique

Observational checklist

Direct measurement by Electrical aerator sampler instrument

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Cont.……..

• Dependent variable Cleanness of the room

Indoor Bacterial load Cleaning frequency

Indoor Fungal load Proper sealing of waste container

• Independent variable Temperature

Ventilation system Relative humidity

Number of window Velocity of air

Proper waste management

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Cont.……..

• Materials and reagents

Nutrient agar and potato dextrose
agar,
Wrap plastic,
Analytical balance,
Petri dish,
Water bath,
Incubator,
Wash bottle,
 Refrigerator,
Cotton stopper,
Autoclave,
Aluminum foil,
Marker,
Bunsen burner,
Round bottom flask and
Match box,
 Distilled water.
Graduated cylinder,

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Cont.……..

• Operational definition

European Commission for non-industrial premises sanitary standard for

microbial load (Gizaw, Gebrehiwot et al. 2016).
o Less than 50 CFU/m3 as ‘ very low’

o 50– 100 CFU/m3 as ‘ low’ ,

o 100– 500 CFU/m3 as‘ intermediate’ ,

o 500– 2000 CFU/m3 as ‘ high’ and

o above 2000 CFU/m3 as ‘ very high’ load.

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Cont.……..

• Very good: -clean, well, constructed, attractive with no dampness.

• Good: -somewhat clean, some constructed, attractive with no dampness

• Fair: -less clean, some constructional defective, non-attractive dampness

• Bad: -not clean, poor construction, no attractive dampness WHO (2010) indoor
air guideline for microbial and gaseous pollutant (Hänninen 2011).

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Cont.……..

• Data quality control

Before the data collection, training and discussion with supervisors and
laboratory technician was taken.
Ice box was used for the transportation of the media

Any procedures Aseptically performed

Control group was used

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Cont.……..

• Methods of data analysis

Data was entered to epi data version 4.6

Chi-square test was performed

One-way ANOVA was used

Bivariate and multivariate logistic analysis with SPSS 25

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Cont.……..

• Ethical consideration

Before starting data collection permission was obtained from Environmental

Health Department and regional health bureau to clinic owners.
Any type of confidentiality was kept secreted.

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Result

• The result indicates that the range of bacterial load (92 CFU/m3- 3933
CFU/m3)was recorded at morning in laboratory room of specialty clinic and
afternoon injection room of primary clinic.

• The range of fungal load (9 CFU/m3 -1967 CFU/m3 ) in patient waiting of

primary clinic and administration office of specialty clinic respectively.

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Cont.……..

Figure 1. Mean microbial load of private clinics based on their rooms of Harar town, Eastern
Ethiopia, 2022 (n=260).

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Cont.……..

Figure 3. Mean microbial load of private clinics based on their status, Harar town, Eastern Ethiopia,
2022 (N=260).

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Cont.……..

• According to this study, there is no significant difference in mean bacterial load

was found in Harar clinics (F= 0.646, p=0.655). And also there was no significant
difference in mean fungal load (F=0.504, P= 0.707)

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Cont.……..

Table 1.One Way ANNOVA result for the mean bacterial load of clinics of Harar town, Eastern
Ethiopia, 2022
  N Mean Std. Deviation 95% Confidence Interval for Mean Minimum Maximum
 
Lower Bound Upper Bound

LOWER 36 466.9429 315.65776 358.5106 575.3751 92.00 1180.00

MEDIUM 218 906.1514 581.38195 828.5427 983.7601 131.00 3278.00

LOAD OF BACTERIA
SPECIALITY 178 790.4648 579.95815 704.9225 876.0071 131.00 3933.20

Total 432 822.6324 575.48382 768.2121 877.0527 92.00 3933.20

LOWER 36 430.40 286.697 331.92 528.88 105 1167

LOAD OF MEDIM 218 391.57 256.445 357.34 425.81 57 1310

FUNGAL
  SPECIALITY 178 339.21 309.111 293.62 384.81 9 1967

Total 432 373.02 282.794 346.28 399.77 9 1967

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Cont.……..

• According to the European commission sanitary standards for non-industrial

premises the air quality in the sampling rooms were between intermediate and
high level of fungi and bacterial loads respectively.

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Cont.……..

• Associated factors
Table 3.Temperature and relative humidity result of indoor air of Harar
private clinics of Harar town Eastern Ethiopia 2022.
Associated factors Mean Lowest value Highest value

Temperature 26.61oc 19 oc 29 oc
  Morning Afternoon
Time of data collection

Relative humidity 64.63% 59% 68%

  Morning Afternoon
Times of data collection

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Cont.……..

• Environmental factors were tested for an association with indoor microbial loads.
The result of the chi square revealed that Presence of waste enter in to indoor,
proper use of window, the presence of artificial ventilation cleanliness of the room
were significantly associated with microbial indoor air load.

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Cont.……..

• Regression analysis
Candidate variables for bacterial load (p<0.25).
 Presence of shower and toilet near the clinics
 Presence of waste enter in to indoor,
 proper use of window,
 The presence of artificial ventilation and
 Frequency of cleaning
 The variable presence of shower and toilet near the clinics statistical significance (P<0.05).

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Cont.……..

• Candidate variables for fungal load (p<0.25).

Construction activity near the clinics,
The presence of artificial ventilation,
Visible crack in the room celling and
 Presence of waste enter to intimate cell
• Those with statistical significance (P<0.05).
Presence of waste enter to intimate cell and
Visible crack in the room celling

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Discussion

• The finding higher as compared with the study done in

• India (Kotgire, Akhtar et al. 2020),

• Nigeria (Pawar, Dhapte et al.),and

• Gondar (Gizaw, Gebrehiwot et al. 2016).

• But lower than the research conducted in Jimma (Fekadu and Getachewu 2015).

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Cont.……..

• This difference microbial load in the present study may be due to

low cleaning frequency, lack of well ventilated room and poor waste
management (Pillai SD, Ricke SC, 2002).
Unhygienic condition of the room, not opening of the door and window
(Gerba CP J et al, 1975).

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Cont.……..

• In this study, the mean temperature and relative humidity of the rooms
were 26.61oc and 64.63% respectively. Generally favorable for survival and
multiplication of microorganisms..

• This might be the reason for higher load of microorganism in this study as
also suggested by other similar studies (Abdel Hameed AA, Habeeballah T,
2014).

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Cont.……..

• Those clinics that have visible crack in the room celling 1.12 more likely
contributes than those do not have it [AOR= 1.112, (0.325, 0.785)]. This result
was also supported by other studies i.e. building structures and location, poor
design, ventilation system as well as interior or redesign which enhance
microorganism's growth and multiplication in the indoor atmosphere (Brochu,
Ducré-Robitaille et al. 2006)

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Strength and limitation

• Strength

It merged laboratory result with observation result in order to assess the true
picture of the microbial load and its determinate factors.
In addition, this study involves outpatient room, offices other than inpatient
rooms.
• Limitation
• Unable to stablish a temporal link between the outcome and the exposure.
• Indicate only prevalence (not incidence)

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Conclusion

Compared with different indoor air biological standards, higher bacterial

concentration of indoor air and moderate fungal load was found in Harar private
clinics. This microbial load may be due some environmental factors such as
temperature, humidity, insufficient ventilation, presence of unhygienic attached
toilets and poor waste management system, presence of toilet and shower near the
clinics, presence of waste damping site near the clinics. Thus, this microbial load in
those clinics may lead to infections to patients and staffs.

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Recommendation

• We recommended to each Harar private clinic managers, Harar health bureau should

• Do regular Monitoring and evaluation of microbial load in their clinics in order to

decrease a risk of infection for the patients particularly for the most susceptible patients
such as the immune compromised, elderly, and children. Besides, there should be regular
inspection of each clinics premises to assess if there is any condition or situation that may
promote bacterial and fungi growth like leakage and any sanitation problem and Presence
of waste enter to intimate cell etc.

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Cont.……..

• Improve Presence of shower and toilet near the clinics.

• Improve the sanitation of each room’s clinics especially by eliminating

visible crack in the room celling.
• To researchers
• Come up with research design that overcome the limitation of this research.

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Acknowledgment

• Our Research advisors

Mr. Tamagnu Sintie (MSc.)

Mr. Liku Muche (MSc.)

• Our laboratory coordinator

Mr. Wegene.D

• Each private clinics , HU

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Sample reference
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Microbiol Res 7: 28-34.
• Hänninen, O. O. (2011). WHO guidelines for indoor air quality: dampness and mold. Fundamentals of mold growth in
indoor environments and strategies for healthy living, Springer: 277-302.
• Abdollahi, A. and S. Mahmoudzadeh (2012). "Microbial profile of air contamination in hospital wards."
• Fekadu, S. and B. Getachewu (2015). "Microbiological assessment of indoor air of Teaching hospital wards: a case of
Jimma University specialized hospital." Ethiopian journal of health sciences 25(2): 117-122.
• Pawar, A., et al. "Profiling of Microbial Contamination in Internal Atmosphere of Hospital Ward."
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hospital, Northwest Ethiopia." Multidisciplinary respiratory medicine 11(1): 1-7
• Douwes, J., et al. (2003). "Bioaerosol health effects and exposure assessment: progress and prospects." The Annals of
occupational hygiene 47(3): 187-200.
• Kembel, S. W., et al. (2014). "Architectural design drives the biogeography of indoor bacterial communities." PloS one
9(1): e87093.

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 Thank you

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