Influence of high-efficiency particulate air filtration on indoor air fungal contamination in a hospital in Mashhad, Iran
Abstract
Introduction: Poor hospital Indoor Air Quality (IAQ) may result in various occupational hazards, hospital-acquired infections, and sick hospital syndrome. Air-control measures are vital to reduce airborne biological particle dissemination in hospitals. This study aimed to evaluate the effectiveness of High-Efficiency Particulate Air (HEPA) filters in decreasing indoor fungal pollution in an organ transplantation hospital in Mashhad.
Materials and methods: In this work, 96 specimens were collected from the air of three operating rooms and the Intensive Care Unit (ICU) ward. Sampling was performed using National Institute for Occupational Safety and Health (NIOSH-0800) instructions in two stages before and after using HEPA filters. Fungal density was reported based on the number of colonies per m3(CFU/m3).
Results: According to the results before using HEPA filters, the colony frequency of Aspergillus was 50%, which was the highest among the detected fungi. Penicillium with a frequency of 23% was followed by Aspergillus. After using HEPA filters, the frequency of Aspergillus and Penicillium decreased by 40% and 6% to 10% and 17%, respectively. The mean concentrations of fungi in all three operating rooms and ICU before use and after using HEPA filters were 9.52 and 3.11 (CFU/m3), respectively indicating a reduction of about 67%, which is statistically significant (P≤0.005).
Conclusion: Hence, using these filters is recommended considering the good performance and high efficiency of HEPA filters in reducing fungal contamination and its consequences.
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Hassanvand MS, Alimohammadi M, Afhami S,
et al. Fungal air quality in hospital rooms: a case
study in Tehran, Iran. Journal of Environmental
Health Science and Engineering. 2013;11(1):1-
4.
2. Wan GH, Chung FF, Tang CS. Longterm surveillance of air quality in medical center
operating rooms. American journal of infection
control. 2011;39(4):302-8.
3. Abbasi F, Samaei MR. The effect of
temperature on airborne filamentous fungi
in the indoor and outdoor space of a hospital.
Environmental Science and Pollution Research.
2019;26(17):16868-76.
4. Man Lai K, Nasir ZA, Taylor J.
Bioaerosols and hospital infections. Aerosol
Science: Technology and Applications.
2014:271.
5. Yarahmadi M, Yunesian M, Pourmand
M, Shahsavani A, Mubedi I, Nomanpour B, et al.
Evaluating the efficiency of lettuce disinfection
according to the official protocol in Iran. Iranian
journal of public health. 2012;41(3):95.
6. Edwards MR, Bartlett NW, Hussell T,
Openshaw P, Johnston SL. The microbiology
of asthma. Nature Reviews Microbiology.
2012;10(7):459-71.
7. King M-F, Noakes C, Sleigh P, CamargoValero M. Bioaerosol deposition in single
and two-bed hospital rooms: A numerical and
experimental study. Building and Environment.
2013;59:436-47.
8. Hoseini M, Jabbari H, Naddafi K,
Nabizadeh R, Rahbar M, Yunesian M, et al.
Concentration and distribution characteristics of
airborne fungi in indoor and outdoor air of Tehran
subway stations. Aerobiologia. 2013;29(3):355-
63.
9. Weaver L, Michels H, Keevil C. Potential
for preventing spread of fungi in air‐conditioning
systems constructed using copper instead of
aluminium. Letters in applied microbiology.
2010;50(1):18-23.
10. Sautour M, Sixt N, Dalle F, l'Ollivier
C, Calinon C, Fourquenet V, et al. Prospective
survey of indoor fungal contamination in hospital
during a period of building construction. Journal
of Hospital infection. 2007;67(4):367-73.
11. Sohrabi N, Ghadiri K, Akya A,
Ghashghaee HA, Sharifi EJ, Shahveisizadeh F,
et al. Evaluation of airborne fungal pollution in
the burn ward of Imam Khomeini hospital, the
referral burn center in the west of Iran. Journal
NI. 2014;1(1).
12. Faure O, Fricker-Hidalgo H, Lebeau
B, Mallaret M, Ambroise-Thomas P, Grillot R.
Eight-year surveillance of environmental fungal
contamination in hospital operating rooms
and haematological units. Journal of hospital
infection. 2002;50(2):155-60.
13. Ortiz G, Yagüe G, Segovia M, Catalán
V. A study of air microbe levels in different
areas of a hospital. Current microbiology.
2009;59(1):53-8.
14. Li C-S, Hou P-A. Bioaerosol
characteristics in hospital clean rooms. Science
of the Total Environment. 2003;305(1-3):169-
76.
15. Abdolahi A. Concurrence of nosocomial
infections with microorganisms spreading in
the air of hospital wards. Medical Laboratory
Journal. 2009;3(2):0-.
16. Shams AA, Niknam N, Jabbari A,
HASAN ZA, Mengelizadeh N, GHANBARY
SA, et al. Assessment of safety management in
different wards of AL Zahra hospital in Isfahan
city in 2013. 2014.
17. Safety WP, Organization WH. WHO
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World Health Organization; 2009. Report No.:
9241597909.
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F, Gbaguidi-Haore H, Millon L. Fungal
aerocontamination exposure risk for patients in
3 successive locations of a pediatric hematology
unit department: Influence of air equipment and
building structure on air quality. American journal
of infection control. 2017;45(10):e109-e13.
19. Lonon M. Bioaerosol Sampling (Indoor
Air) Culturable organisms: bacteria, fungi,
thermophilic actinomycetes Method 0800.
National Institute for Occupational Safety and
Health http://www cdc gov/niosh/docs/2003-
154/pdfs/0800 pdf (accessed January 8, 2015).
1998.
20. Sajjadi SA, Ketabi D, Joulaei F. Fungal
assessment of indoor air quality in wards and
operating theatres in an organ transplantation
hospital. Health Scope. 2018;7(4).
21. Marr KA, Carter RA, Crippa F, Wald A,
Corey L. Epidemiology and outcome of mould
infections in hematopoietic stem cell transplant
recipients. Clinical Infectious Diseases.
2002;34(7):909-17.
22. Santos L, Santos J, Rebelo A, da Silva M.
Indoor air quality in community health centers:
A preliminary study. Occup Saf Hyg. 2013:443-
7.
23. Zotti CM, Ioli GM, Charrier L, Arditi
G, Argentero P, Biglino A, et al. Hospitalacquired infections in Italy: a region wide
prevalence study. Journal of Hospital Infection.
2004;56(2):142-9.
24. Verde SC, Almeida SM, Matos J,
Guerreiro D, Meneses M, Faria T, et al.
Microbiological assessment of indoor air
quality at different hospital sites. Research in
microbiology. 2015;166(7):557-63.
25. Panagopoulou P, Filioti J, Petrikkos G,
Giakouppi P, Anatoliotaki M, Farmaki E, et al.
Environmental surveillance of filamentous fungi
in three tertiary care hospitals in Greece. Journal
of Hospital Infection. 2002;52(3):185-91.
26. Bhatia L, Vishwakarma R. Hospital
indoor airborne microflora in private and
government-owned hospitals in Sagar City,
India. World J Med Sci. 2010;5(3):65-75p.
27. Gangneux J-P. Prevention of nosocomial
invasive aspergillosis: protective measures and
environmental surveillance. MIKOLOGIA
LEKARSKA. 2004;11(2):153-6.
28. Sudharsanam S, Swaminathan S,
Ramalingam A, Thangavel G, Annamalai R,
Steinberg R, et al. Characterization of indoor
bioaerosols from a hospital ward in a tropical
setting. African health sciences. 2012;12(2):217-
25.
29. Augustowska M, Dutkiewicz J.
Variability of airborne microflora in a hospital
ward within a period of one year. Annals of
Agricultural and Environmental Medicine.
2006;13(1):99-106.
30. Lacey J, Dutkiewicz J. Bioaerosols and
occupational lung disease. Journal of aerosol
science. 1994;25(8):1371-404.
31. Rocha CA, Báez NA, Villarroel EV,
Quintero GM. Study of bioaerosols in surgical
theaters and intensive care units from a public
general hospital. The Journal of Bioscience and
Medicine. 2012;2(3):1-10.
32. Awosika S, Olajubu F, Amusa N.
Microbiological assessment of indoor air of
a teaching hospital in Nigeria. Asian Pacificjournal of tropical biomedicine. 2012;2(6):465-8.
33. Pegues D, Ohl M, Miller S. Salmonella,
including Salmonella typhi. Infections of the
Gastrointestinal Tract. Edited by MJ Blaser, PD
Smith, JI Ravdin, HB Greenberg, RL Guerrant.
Philadephia. Lippincott Williams and Wilkins;
2002.
34. Goh J, Juliana J, Malina O, Ngah Z,
Norhafizalena O. Prevalence of Penicillium
specific Ig E level and allergy symptoms among
office workers in a selected company in Bangi,
Malaysia. Trop Biomed. 2007;24(1):37-46.
35. Khan AH, Karuppayil SM,
Manoharachary C, Kunwar I, Waghray
S. Isolation, identification and testing for
allergenicity of fungi from air-conditioned indoor
environments. Aerobiologia. 2009;25(2):119-
23.
36. Hahn T, Cummings KM, Michalek AM,
Lipman BJ, Segal BH, McCarthy PL. Efficacy
of high-efficiency particulate air filtration in
preventing aspergillosis in immunocompromised
patients with hematologic malignancies.
Infection Control & Hospital Epidemiology.
2002;23(9):525-31.
37. Araujo R, Cabral JP, Rodrigues AG.
Air filtration systems and restrictive access
conditions improve indoor air quality in clinical
units: Penicillium as a general indicator of
hospital indoor fungal levels. American journal
of infection control. 2008;36(2):129-34.
Hassanvand MS, Alimohammadi M, Afhami S,
et al. Fungal air quality in hospital rooms: a case
study in Tehran, Iran. Journal of Environmental
Health Science and Engineering. 2013;11(1):1-
4.
2. Wan GH, Chung FF, Tang CS. Longterm surveillance of air quality in medical center
operating rooms. American journal of infection
control. 2011;39(4):302-8.
3. Abbasi F, Samaei MR. The effect of
temperature on airborne filamentous fungi
in the indoor and outdoor space of a hospital.
Environmental Science and Pollution Research.
2019;26(17):16868-76.
4. Man Lai K, Nasir ZA, Taylor J.
Bioaerosols and hospital infections. Aerosol
Science: Technology and Applications.
2014:271.
5. Yarahmadi M, Yunesian M, Pourmand
M, Shahsavani A, Mubedi I, Nomanpour B, et al.
Evaluating the efficiency of lettuce disinfection
according to the official protocol in Iran. Iranian
journal of public health. 2012;41(3):95.
6. Edwards MR, Bartlett NW, Hussell T,
Openshaw P, Johnston SL. The microbiology
of asthma. Nature Reviews Microbiology.
2012;10(7):459-71.
7. King M-F, Noakes C, Sleigh P, CamargoValero M. Bioaerosol deposition in single
and two-bed hospital rooms: A numerical and
experimental study. Building and Environment.
2013;59:436-47.
8. Hoseini M, Jabbari H, Naddafi K,
Nabizadeh R, Rahbar M, Yunesian M, et al.
Concentration and distribution characteristics of
airborne fungi in indoor and outdoor air of Tehran
subway stations. Aerobiologia. 2013;29(3):355-
63.
9. Weaver L, Michels H, Keevil C. Potential
for preventing spread of fungi in air‐conditioning
systems constructed using copper instead of
aluminium. Letters in applied microbiology.
2010;50(1):18-23.
10. Sautour M, Sixt N, Dalle F, l'Ollivier
C, Calinon C, Fourquenet V, et al. Prospective
survey of indoor fungal contamination in hospital
during a period of building construction. Journal
of Hospital infection. 2007;67(4):367-73.
11. Sohrabi N, Ghadiri K, Akya A,
Ghashghaee HA, Sharifi EJ, Shahveisizadeh F,
et al. Evaluation of airborne fungal pollution in
the burn ward of Imam Khomeini hospital, the
referral burn center in the west of Iran. Journal
NI. 2014;1(1).
12. Faure O, Fricker-Hidalgo H, Lebeau
B, Mallaret M, Ambroise-Thomas P, Grillot R.
Eight-year surveillance of environmental fungal
contamination in hospital operating rooms
and haematological units. Journal of hospital
infection. 2002;50(2):155-60.
13. Ortiz G, Yagüe G, Segovia M, Catalán
V. A study of air microbe levels in different
areas of a hospital. Current microbiology.
2009;59(1):53-8.
14. Li C-S, Hou P-A. Bioaerosol
characteristics in hospital clean rooms. Science
of the Total Environment. 2003;305(1-3):169-
76.
15. Abdolahi A. Concurrence of nosocomial
infections with microorganisms spreading in
the air of hospital wards. Medical Laboratory
Journal. 2009;3(2):0-.
16. Shams AA, Niknam N, Jabbari A,
HASAN ZA, Mengelizadeh N, GHANBARY
SA, et al. Assessment of safety management in
different wards of AL Zahra hospital in Isfahan
city in 2013. 2014.
17. Safety WP, Organization WH. WHO
guidelines on hand hygiene in health care.
World Health Organization; 2009. Report No.:
9241597909.
18. Bellanger A-P, Reboux G, Demonmerot
F, Gbaguidi-Haore H, Millon L. Fungal
aerocontamination exposure risk for patients in
3 successive locations of a pediatric hematology
unit department: Influence of air equipment and
building structure on air quality. American journal
of infection control. 2017;45(10):e109-e13.
19. Lonon M. Bioaerosol Sampling (Indoor
Air) Culturable organisms: bacteria, fungi,
thermophilic actinomycetes Method 0800.
National Institute for Occupational Safety and
Health http://www cdc gov/niosh/docs/2003-
154/pdfs/0800 pdf (accessed January 8, 2015).
1998.
20. Sajjadi SA, Ketabi D, Joulaei F. Fungal
assessment of indoor air quality in wards and
operating theatres in an organ transplantation
hospital. Health Scope. 2018;7(4).
21. Marr KA, Carter RA, Crippa F, Wald A,
Corey L. Epidemiology and outcome of mould
infections in hematopoietic stem cell transplant
recipients. Clinical Infectious Diseases.
2002;34(7):909-17.
22. Santos L, Santos J, Rebelo A, da Silva M.
Indoor air quality in community health centers:
A preliminary study. Occup Saf Hyg. 2013:443-
7.
23. Zotti CM, Ioli GM, Charrier L, Arditi
G, Argentero P, Biglino A, et al. Hospitalacquired infections in Italy: a region wide
prevalence study. Journal of Hospital Infection.
2004;56(2):142-9.
24. Verde SC, Almeida SM, Matos J,
Guerreiro D, Meneses M, Faria T, et al.
Microbiological assessment of indoor air
quality at different hospital sites. Research in
microbiology. 2015;166(7):557-63.
25. Panagopoulou P, Filioti J, Petrikkos G,
Giakouppi P, Anatoliotaki M, Farmaki E, et al.
Environmental surveillance of filamentous fungi
in three tertiary care hospitals in Greece. Journal
of Hospital Infection. 2002;52(3):185-91.
26. Bhatia L, Vishwakarma R. Hospital
indoor airborne microflora in private and
government-owned hospitals in Sagar City,
India. World J Med Sci. 2010;5(3):65-75p.
27. Gangneux J-P. Prevention of nosocomial
invasive aspergillosis: protective measures and
environmental surveillance. MIKOLOGIA
LEKARSKA. 2004;11(2):153-6.
28. Sudharsanam S, Swaminathan S,
Ramalingam A, Thangavel G, Annamalai R,
Steinberg R, et al. Characterization of indoor
bioaerosols from a hospital ward in a tropical
setting. African health sciences. 2012;12(2):217-
25.
29. Augustowska M, Dutkiewicz J.
Variability of airborne microflora in a hospital
ward within a period of one year. Annals of
Agricultural and Environmental Medicine.
2006;13(1):99-106.
30. Lacey J, Dutkiewicz J. Bioaerosols and
occupational lung disease. Journal of aerosol
science. 1994;25(8):1371-404.
31. Rocha CA, Báez NA, Villarroel EV,
Quintero GM. Study of bioaerosols in surgical
theaters and intensive care units from a public
general hospital. The Journal of Bioscience and
Medicine. 2012;2(3):1-10.
32. Awosika S, Olajubu F, Amusa N.
Microbiological assessment of indoor air of
a teaching hospital in Nigeria. Asian Pacificjournal of tropical biomedicine. 2012;2(6):465-8.
33. Pegues D, Ohl M, Miller S. Salmonella,
including Salmonella typhi. Infections of the
Gastrointestinal Tract. Edited by MJ Blaser, PD
Smith, JI Ravdin, HB Greenberg, RL Guerrant.
Philadephia. Lippincott Williams and Wilkins;
2002.
34. Goh J, Juliana J, Malina O, Ngah Z,
Norhafizalena O. Prevalence of Penicillium
specific Ig E level and allergy symptoms among
office workers in a selected company in Bangi,
Malaysia. Trop Biomed. 2007;24(1):37-46.
35. Khan AH, Karuppayil SM,
Manoharachary C, Kunwar I, Waghray
S. Isolation, identification and testing for
allergenicity of fungi from air-conditioned indoor
environments. Aerobiologia. 2009;25(2):119-
23.
36. Hahn T, Cummings KM, Michalek AM,
Lipman BJ, Segal BH, McCarthy PL. Efficacy
of high-efficiency particulate air filtration in
preventing aspergillosis in immunocompromised
patients with hematologic malignancies.
Infection Control & Hospital Epidemiology.
2002;23(9):525-31.
37. Araujo R, Cabral JP, Rodrigues AG.
Air filtration systems and restrictive access
conditions improve indoor air quality in clinical
units: Penicillium as a general indicator of
hospital indoor fungal levels. American journal
of infection control. 2008;36(2):129-34.
| Files | ||
| Issue | Vol 7 No 3 (2022): Summer 2022 | |
| Section | Original Research | |
| DOI | https://doi.org/10.18502/japh.v7i3.10543 | |
| Keywords | ||
| Fungal contamination; Nosocomial infections; High-efficiency particulate air (HEPA) filters ; Ventilation system | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ketabi D, Yazdani M, Sajjadi SA, Joulaei F. Influence of high-efficiency particulate air filtration on indoor air fungal contamination in a hospital in Mashhad, Iran. JAPH. 2022;7(3):299-308.
