Bacterial Contamination in Health Care Centers: Differences between Urban and Rural Settings

Ana Monteiro,Elisabete Carolino,Edna Ribeiro,Beatriz Almeida,João Cavaleiro Rufo,Inês Paciência,Carla Viegas,António Sousa Uva,Sandra Cabo Verde

doi:10.3390/atmos12040450

Abstract

This study aims to assess the airborne bioburden of rural and urban Portuguese Primary Health Care Centers (PHCC) using active and passive sampling methods and identify the potential differences in airborne microbiota between both environments. The highest total aerobic mesophilic bacterial load in indoor air were found in the Vaccination Room (448 CFU.m−3) in the Rural PHCC and in the Waiting Room (420 CFU.m−3) for Urban PHCC. The total coliforms contamination level in indoor air was detected only in the Cleaning Supplies Room (4 CFU.m−3) in the Urban PHCC. The most frequent bacteria genera identified was Micrococcus (21% Rural PHCC; 31% Urban PHCC). The surface samples showed a highest total aerobic mesophilic bacterial contamination in the Treatment Room (86 × 103 CFU.m−2) from the Rural PHCC and in the Front Office (200 × 103 CFU.m−2) from the Urban PHCC. The electrostatic dust cloth (EDC) samples showed a highest bacterial load in the Urban PHCC. Total aerobic mesophilic bacterial load in settled dust and in the Heating, Ventilating and Air Conditioning (HVAC) filter samples in the Urban PHCC (8 CFU.g−1 and 6 × 103 CFU.m−2) presented higher values compared with the Rural PHCC (1 CFU.g−1 and 2.5 × 103 CFU.m−2). Urban PHCC presented higher bacterial airborne contamination compared with the Rural PHCC for the majority of sampling sites, and when compared with the indoor air quality (IAQ) Portuguese legislation it was the Rural PHCC in two sampling places who did not comply with the established criteria.

Highlights

Exposure to bioaerosols has become one of the major problems in indoor air quality (IAQ) for occupational and public health [1]
Concerning settled dust samples, our results demonstrate a higher value for bacterial contamination in Urban Primary Health Care Centers (PHCC), when compared with the Rural PHCC
Different PHCC geographic locations were compared and the environmental parameters that may influenced the levels of bacterial contamination were identified

Summary

Introduction

Exposure to bioaerosols has become one of the major problems in indoor air quality (IAQ) for occupational and public health [1]. The importance of assessment and control of contamination in critical environments, such as the physical environment of health care organizations [2,3,4] is a requirement to protect patients and healthcare workers from hospital-acquired (nosocomial) infections and occupational diseases [5]. One of the most serious bacterial pathogens associated with indoor environments is Legionella pneumophila that causes Legionnaire disease and Pontiac fever, which have become a leading public health concern [21]. In view of the number of patients who visit health care facilities, as well as their immune status, the likelihood of exposure and infection is increased in these institutions [23]. The rising incidences of Legionella-associated diseases [23], and the variety of sources of transmission, emphasize the need to understand the prevalence, survival and transmission of Legionella in diverse public settings, namely in health care facilities

Objectives

Methods

Discussion

Conclusion