Assessment of Microbial Load in Regional Hospitals in Albania

Authors

  • Gjergji Koja Department of Clinical Subjects, Aleksandër Xhuvani University, Elbasan, Albania
  • Florenc Piligriu Department of Clinical Subjects, Aleksandër Xhuvani University, Elbasan, Albania
  • Artan Simaku National Reference Laboratories, Institute of Public Health, Tirana, Albania
  • Shpetim Qyra National Reference Laboratories, Institute of Public Health, Tirana, Albania
  • Erjona Abazaj National Reference Laboratories, Institute of Public Health, Tirana, Albania

DOI:

https://doi.org/10.3889/oamjms.2022.10269

Keywords:

Microbial load, Contamination, Hospital environmental, Albania

Abstract

Background

Contaminated hospital indoor environments can expose patients to microorganisms and different infections. The aimed study was to assess the microbial load in hospital facilities inside Albania Regional Hospitals during the period 2017-2019.

Methods

A cross-sectional study was conducted during the period 2017-2019 for the assessment of microbial contamination in operating rooms, resuscitation, and delivery rooms in 12 regional hospitals in Albania. One thousand and three hundred microbiological specimens were collected from air and surfaces using 5% sheep blood agar (Oxoid, UK) and processed at IPH microbiology laboratory following the standard bacteriological procedures Data were analyzed using Statistical Software Package for Social Sciences (SPSS) version 23.

Results

Out of the total number of samples, 1148 (88.3%) were collected from surfaces and 152 (11.7%) were from the air. Bacterial growth was identified in 314 (24.2%) out of 1300 samples (95% CI 21.89–26.62). From the total site samples processed during the study period, bacterial growth showed 282 (89.8%) samples from surfaces and 32 (10.2%) air samples. There was found a significant association p-value =0.035. Regarding the sampling place collection, the largest number were collected in operating rooms (60.3%) followed by emergency rooms (28.2%), ICUs (7.7%), and maternity units (3.8%). Gram-negative isolates were predominant at 235 (74.8%), while the Gram-positive were at 60 (19.1%). E. coli was the most frequent bacterial isolate (50%) followed by Pseudomonas aeruginosa (23.6%), Staphylococcus aureus (19.1%), and Klebsiella pneumoniae (1.3%). Also, we found a fungal agent such as Aspergillus in 19 (6.1%) samples. The isolated bacteria's overall drug resistance profile revealed that 66.8% of gram-positive bacteria were resistant to two or more antimicrobial drugs tested.

Conclusion

This study revealed that the surface and air and air within different wards of the hospitals studied were contaminated with different types of bacteria. Bacterial loads on the surface and air exceeded normal limits. Additionally, the study pointed out high levels of antimicrobial resistance to the drugs commonly prescribed for isolates. Therefore, intervention strategies need to be strengthened to expand infection prevention practices in hospitals. Continuous monitoring and monitoring of in-hospital pathogen types and susceptibility patterns should be performed on a very regular basis.

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References

Ashuro Z, Diriba K, Afework A, Washo GH, Areba AS, G/Meskel Kanno G, et al. Assessment of microbiological quality of indoor air at different hospital sites of Dilla university: A cross-sectional study. Environ Health Insights. 2022;16:11786302221100047. https://doi.org/10.1177/11786302221100047 PMid:35601190 DOI: https://doi.org/10.1177/11786302221100047

Genovese C, La Fauci V, D’Amato S, Squeri A, Anzalone C, Costa GB, et al. Molecular epidemiology of antimicrobialresistant microorganisms in the 21th century: A review of the literature. Acta Biomed. 2020;91(2):256-73. https://doi.org/10.23750/abm.v91i2.9176 PMid:32420962

Weber DJ, Anderson D, Rutala WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect. 2013;26(4):338-44. https://doi.org/10.1097/qco.0b013e3283630f04 PMid:23743816 DOI: https://doi.org/10.1097/QCO.0b013e3283630f04

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81. https://doi.org/10.1111/j.1469-0691.2011.03570.x PMid:21793988 DOI: https://doi.org/10.1111/j.1469-0691.2011.03570.x

Mirande C, Bizine I, Giannetti A, Picot N, van Belkum A. Epidemiological aspects of healthcare-associated infections and microbial genomics. Eur J Clin Microbiol Infect Dis. 2018;37(5):823-31. https://doi.org/10.1007/s10096-017-3170-x PMid:29340898 DOI: https://doi.org/10.1007/s10096-017-3170-x

Otter JA, Yezli S, French GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol. 2011;32(7):687-99. https://doi.org/10.1086/660363 PMid:21666400 DOI: https://doi.org/10.1086/660363

Andersson AE, Bergh I, Karlsson J, Eriksson BI, Nilsson K. Traffic flow in the operating room: An explorative and descriptive study on air quality during orthopedic trauma implant surgery. Am J Infect Control. 2012;40(8):750-5. https://doi.org/10.1016/j.ajic.2011.09.015 PMid:22285652 DOI: https://doi.org/10.1016/j.ajic.2011.09.015

Hailemariam M, Worku M, Azerefegne E. Intensive care units and operating rooms bacterial load and antibiotic susceptibility pattern. Int J Surg. 2016;4(2):60-4. https://doi.org/10.11648/j.js.20160402.21 DOI: https://doi.org/10.11648/j.js.20160402.21

Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. CLSI Supplement M100. 30th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2020.

Pasquarella C, Pitzurra O, Savino A. The index of microbial air contamination. J Hosp Infect. 2000;46(4):241-56. https://doi.org/10.1053/jhin.2000.0820 PMid:11170755 DOI: https://doi.org/10.1053/jhin.2000.0820

Dancer SJ. How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals. J Hosp Infect. 2004;56(1):10-5. https://doi.org/10.1016/j.jhin.2003.09.017 PMid:14706265 DOI: https://doi.org/10.1016/j.jhin.2003.09.017

Cheesbrough M. Manual of Medical Microbiology. Britain, UK: Oxford Press; 2000.

Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966;45(4):493-6. PMid:5325707 DOI: https://doi.org/10.1093/ajcp/45.4_ts.493

Verde SC, Almeida SM, Matos J, Guerreiro D, Meneses M, Faria T, et al. Microbiological assessment of indoor air quality at different hospital sites. Res Microbiol. 2015;166(7):557-63. https://doi.org/10.1016/j.resmic.2015.03.004 PMid:25869221 DOI: https://doi.org/10.1016/j.resmic.2015.03.004

Genet G, Kibru G, Hemalatha K. Degree of bacterial contamination and antibiotic susceptibility pattern of isolates from housekeeping surfaces in operating rooms and surgical wards at Jimma university specialized hospital, South West Ethiopia. Ethiop Med J. 2012;50(1):67-74. PMid:22519163 DOI: https://doi.org/10.4314/ejhs.v21i1.69039

Rostami N, Alidadi H, Zarrinfar H, Salehi P. Assessment of indoor and outdoor airborne fungi in an educational, research and treatment center. Ital J Med. 2016;11(1):52-6. https://doi.org/10.4081/itjm.2016.663 DOI: https://doi.org/10.4081/itjm.2016.663

Bozic J, Ilic P, Ilic S. Indoor air quality in the hospital: The influence of heating, ventilating and conditioning systems. Braz Arch Biol Technol. 2019;62:1-11. https://doi.org/10.1590/1678-4324-2019180295 DOI: https://doi.org/10.1590/1678-4324-2019180295

Mirzaei R, Shahriary E, Qureshi MI, Rakhshkhorshid A, Khammary A, Mohammadi M. Quantitative and qualitative evaluation of bio-aerosols in surgery rooms and emergency department of an educational hospital. Jundishapur J Microbiol. 2014;7(10):e11688. https://doi.org/10.5812/jjm.11688 PMid:25632321 DOI: https://doi.org/10.5812/jjm.11688

Khan AH, Karuppayil SM. Fungal pollution of indoor environments and its management. Saudi J Biol Sci. 2012;19(4):405-26. https://doi.org/10.1016/j.sjbs.2012.06.002 PMid:23961203 DOI: https://doi.org/10.1016/j.sjbs.2012.06.002

Kim KH, Kabir E, Jahan SA. Airborne bioaerosols and their impact on human health. J Environ Sci (China). 2018;67:23-35. https://doi.org/10.1016/j.jes.2017.08.027 PMid:29778157 DOI: https://doi.org/10.1016/j.jes.2017.08.027

Fischer G, Fodre S, Nehez M. Results of the study to determine marginal pathogen count values in the air of operating rooms. Z Gesamte Hyg. 1972;18:729-33.

La Fauci V, Genovese C, Facciolà A, Palamara MA, Squeri R. Five-year microbiological monitoring of wards and operating theatres in Southern Italy. J Prev Med Hyg. 2017;58(2):E166-72. PMid:28900357

Dehghani M, Sorooshian A, Nazmara S, Baghani AN, Delikhoon M. Concentration and type of bioaerosols before and after conventional disinfection and sterilization procedures inside hospital operating rooms. Ecotoxicol Environ Saf. 2018;164:277-82. https://doi.org/10.1016/j.ecoenv.2018.08.034 PMid:30121503 DOI: https://doi.org/10.1016/j.ecoenv.2018.08.034

Totaro M, Costa AL, Casini B, Profeti S, Gallo A, Frendo L, et al. Microbiological air quality in heating, ventilation and air conditioning systems of surgical and intensive care areas: The application of a disinfection procedure for dehumidification devices. Pathogens. 2019;8(1):8. https: doi.org/10.3390/pathogens8010008 PMid:30650590 DOI: https://doi.org/10.3390/pathogens8010008

Liu MH, Tung TH, Chung FF, Chuang LC, Wan GH. High total volatile organic compounds pollution in a hospital dental department. J Environ Monit Assess. 2017;189(11):571. https://doi.org/10.1007/s10661-017-6265-z PMid:29044438 DOI: https://doi.org/10.1007/s10661-017-6265-z

Banerjee B, Mukhopadhyay C, Ke V, Bupendra A, Varma M. “News on air!”- Air surveillance report from intensive care units of a tertiary care hospital. Asian J Pharm Clin Res. 2016;9(3):247-9. https://doi.org/10.22159/ajpcr. 2016.v9s3.14867 DOI: https://doi.org/10.22159/ajpcr.2016.v9s3.14867

Wise R, Hart T, Cars O, Streulens M, Helmuth R, Huovinen P, et al. Antimicrobial resistance. Is a major threat to public health. BMJ. 1998;317(7159):609-10. https://doi.org/10.1136/bmj.317.7159.609 PMid:9727981 DOI: https://doi.org/10.1136/bmj.317.7159.609

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Published

2022-08-05

How to Cite

1.
Koja G, Piligriu F, Simaku A, Qyra S, Abazaj E. Assessment of Microbial Load in Regional Hospitals in Albania. Open Access Maced J Med Sci [Internet]. 2022 Aug. 5 [cited 2024 Nov. 12];10(B):2273-8. Available from: https://oamjms.eu/index.php/mjms/article/view/10269

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Infective Diseases

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