Hospital Indoor Research Articles

Pathogenic Aerobic Bacterial Contaminants on Non-Critical Hospital Surfaces within Paediatric Ward of a Nigerian Hospital

The study was a cross-sectional study of indoor hospital surfaces within paediatric wards to determine the pattern of pathogenic aerobic bacterial contaminants on non-critical surfaces within paediatric wards of UITH, Ilorin. A total of 201 surface swab samples were collected, using sterile ethylene oxide sterilized swab sticks premoistened with sterile normal saline, from selected non-critical surfaces and were aseptically cultured on media and incubated aerobically at 35°C to 37°C for 18 to 24 hours. Identification of bacterial isolates was carried out using standard microbiological procedure. Non-critical surfaces within paediatric wards: emergency paediatrics-unit 1 (EPU 1), emergency paediatric-unit 2 (EPU 2), paediatric medical-ward (PMW), paediatric surgical-ward (PSU) and neonatal intensive care unit (NICU). A prevalence of 67.7% was recorded for surface contamination; Staphylococcus aureus was the predominant isolate 39.4% and Pseudomonas aeruginosa 1.3% was the least contaminant isolated from this study. Wash sinks were the most commonly contaminated site amongst surfaces studied with a proportion of 123.5%, medical tables were the least contaminated with 33.33%. Among the wards sampled, EPU2 has the highest contamination level with 87.5% while NICU has the least contamination with 67.6%. This study showed that most of the sites sampled had bacterial contaminants indicating potential sources of cross contamination from surfaces to hands of healthcare workers, patients and vice-versa. It is pertinent to understand that non-critical hospital surfaces are important in the passive transmission of healthcare associated infectious pathogens. Thorough cleaning, disinfection of these surfaces and proper hand washing practices will break the chain of transmission.

Fate of airborne coagulase-negative staphylococci

Hospital indoor air can be a source for transmitting nosocomial infections in resource limited settings. This study was undertaken over two months period (February – March 2010) in Chennai, India, to 1) characterise bacteria isolated from indoor air of healthcare facility; and 2) establish whether environmental and clinical isolates are similar by molecular typing methods. Daily visits were made to microbiology laboratory to determine clustering of cases of nosocomial infections. Patients with illnesses related to respiratory tract and skin and soft tissues were included. Clinical strains (from laboratory) with similar antibiogram patterns were systematically stocked. Indoor air samples were collected from such locations by exposed plate method for 30 minutes. Growth was identified by standard microbiological procedures. Phenotypically similar strains were further subjected to genotyping by polymerase chain reaction and pulsed field gel electrophoresis (PFGE) to confirm similarity. Coagulase-negative Staphylococci (CNS) were only isolated from both environmental and clinical samples during the study period. Totally, 15 clinical and six environmental strains of CNS were isolated over two months. One airborne and one clinical strain, isolated subsequently from a patient in the same location, had similar phenotypic (biochemical and antibiogram) characteristics. Isolates were identified as Staphylococcus haemolyticus using API STAPH system (bioMe´rieux), and confirmed to be methicillin resistant CNS using appropriate primers. When subjected to typing by PFGE, they were found to be similar (F=0.51). This is the first study documenting the similarity of CNS of environmental and clinical origin, thus establishing the possibility of air as a source for transmitting nosocomial infections.

Metagenomic Human Repiratory Air in a Hospital Environment.

Hospital-acquired infection (HAI) or nosocomial infection is an issue that frequent hospital environment. We believe conventional regulated Petri dish method is insufficient to evaluate HAI. To address this problem, metagenomic sequencing was applied to screen airborne microbes in four rooms of Beijing Hospital. With air-in amount of sampler being setup to one person’s respiration quantity, metagenomic sequencing identified huge numbers of species in the rooms which had already qualified widely accepted petridish exposing standard, imposing urgency for new technology. Meanwhile,the comparative culture only got small portion of recovered species and remain blind for even cultivable pathogens reminded us the limitations of old technologies. To the best of our knowledge, the method demonstrated in this study could be broadly applied in hospital indoor environment for various monitoring activities as well as HAI study. It is also potential as a transmissible pathogen real-time modelling system worldwide.

Pollution levels and characteristics of phthalate esters in indoor air in hospitals

The concentrations of phthalate esters (PAEs) in Chinese hospitals were investigated by simultaneously determining concentrations of gas- and particle-phase PAEs. PAEs were detected in two third-class first-grade hospitals, two second-class first-grade hospitals, and a community health service center. Hospital drugstores had the highest concentration (24.19μg/m3), which was 1.54 times that of newly decorated houses. The second highest concentration was found in the transfusion rooms, averaging 21.89μg/m3; this was followed by the concentrations of PAEs in the nurse's workstations, the wards, and the doctor's offices, with mean concentrations of 20.66, 20.0, and 16.92μg/m3, respectively. The lowest concentrations were found in the hallways (16.30μg/m3). Of the six different kinds of PAEs found, major pollutants included diethyl phthalates, dibutyl phthalates, butylbenzyl phthalates and di(2-ethylhexyl) phthalates, comprising more than 80% of all PAEs present. Meanwhile, a comparison between different wards showed that PAE concentrations in the maternity wards were 1.63 times higher than in the main wards. Based on known health hazards, our results suggest that the PAEs seriously influence the health of the pregnant women and babies; therefore, it is of great importance to take the phthalate concentrations in hospitals into consideration. In addition, hospital indoor air was more seriously contaminated than the air of newly decorated houses.

Resource Allocation in Hospital Networks Based on Green Cognitive Radios

Pervasive wireless communication and computing can facilitate a variety of e-health applications to communicate patient medical data and information to the doctors/caregivers in an e-Health environment. With the advancement of medical devices and practicing methods the concept of in-cooperating latest communication techniques have taken a new direction by enabling cognitive radio networks in e-Health applications. This paper presents an approach to solve the joint call admission control and power allocation problem in a hospital environment based on green cognitive radio. Specifically, a multi-objective non-convex mixed integer non-linear programming (MINLP) problem of wireless access in an indoor hospital environment is formulated to maximize the number of admitted secondary users and minimize transmit power and carbon dioxide emission. Along with that the throughput requirement of all secondary users and interference constraints for the protected and primary users are also satisfied. In this paper, we invoke outer approximation approach based linearization technique to solve MINLP problem. The proposed method gives guaranteed $$\varepsilon $$? convergence to the optimal solution results with reasonable computational complexity. Simulation results verify the effectiveness of the proposed approach method.

Microbiological assessment of indoor air quality at different hospital sites

Poor hospital indoor air quality (IAQ) may lead to hospital-acquired infections, sick hospital syndrome and various occupational hazards. Air-control measures are crucial for reducing dissemination of airborne biological particles in hospitals.The objective of this study was to perform a survey of bioaerosol quality in different sites in a Portuguese Hospital, namely the operating theater (OT), the emergency service (ES) and the surgical ward (SW). Aerobic mesophilic bacterial counts (BCs) and fungal load (FL) were assessed by impaction directly onto tryptic soy agar and malt extract agar supplemented with antibiotic chloramphenicol (0.05%) plates, respectively using a MAS-100 air sampler.The ES revealed the highest airborne microbial concentrations (BC range 240–736 CFU/m3 CFU/m3; FL range 27–933 CFU/m3), exceeding, at several sampling sites, conformity criteria defined in national legislation [6]. Bacterial concentrations in the SW (BC range 99–495 CFU/m3) and the OT (BC range 12–170 CFU/m3) were under recommended criteria. While fungal levels were below 1 CFU/m3 in the OT, in the SW (range 1–32 CFU/m3), there existed a site with fungal indoor concentrations higher than those detected outdoors. Airborne Gram-positive cocci were the most frequent phenotype (88%) detected from the measured bacterial population in all indoor environments. Staphylococcus (51%) and Micrococcus (37%) were dominant among the bacterial genera identified in the present study. Concerning indoor fungal characterization, the prevalent genera were Penicillium (41%) and Aspergillus (24%).Regular monitoring is essential for assessing air control efficiency and for detecting irregular introduction of airborne particles via clothing of visitors and medical staff or carriage by personal and medical materials. Furthermore, microbiological survey data should be used to clearly define specific air quality guidelines for controlled environments in hospital settings.

A hybrid power line and visible light communication system for indoor hospital applications

Modern hospitals are beginning to adopt E-HEALTH as efficient complements to the traditional healthcare services. To support the E-HEALTH services, a locatable, radiation-free and high-capacity communication system is urgently needed in hospitals. Power line communication (PLC) systems can use the ubiquitous power line network to power the light-emitting diode (LED) lamps while serving as the backbone network for the indoor visible light communication (VLC) systems naturally. In this article, a hybrid broadband power line and visible light communication system with orthogonal frequency division multiplexing modulation is proposed for the indoor hospital applications, which gives a brand-new solution to replace the conventional wireless communication systems in hospitals. A general-purpose system model is provided and some basic techniques to enhance system performance are also investigated. Moreover, a feasible demonstration which supports over 48Mbps data rate within a bandwidth of 8MHz is implemented in the laboratory.

Field-Measurement of CO2 Level in General Hospital Wards in Nanjing

Hospital indoor air quality (IAQ) has a significant impact on patients’ and health care workers’ health and the indoor carbon dioxide (CO2) level is considered to be an indicator to evaluate IAQ in some cases. This article presents a long-term field-measurement of indoor CO2 level in a general hospital ward in Nanjing. Four months’ data are collected and analyzed to reveal variation rule of CO2 levels in wards in this periods. The results indicate that the variation rule of indoor CO2 level is associated to patients’ living habit. The use of natural ventilation is capable to keep the indoor CO2 level below 1000ppm in transition season while it is much higher in heating season due to closing openings to maintain thermal comfort. The results also demonstrate a “ω” shape of changing of CO2 levels within a day in heating season.

QPRR: QoS-Aware Peering Routing Protocol for Reliability Sensitive Data in Body Area Network Communication

The reliability, energy efficiency and real-time display of patient's data are important factors for body area network (BAN) communication in indoor hospital environments. In this paper, we propose a novel routing protocol by considering the quality of service (QoS) requirements of BAN data with strict reliability requirements. Our proposed algorithm increases the reliable delivery of critical BAN data at the destination. We have performed extensive simulations in the OMNeT++-based simulator Castalia 3.2 to demonstrate the better performance of the proposed QoS-based routing protocol for reliability sensitive data in terms of lower network routing traffic (Hello packets) overhead, less reliability packets dropped, lower end-to-end delay (latency), less packets dropped due to media access control (MAC) buffer overflow and higher throughput in both stationary and movable patient scenarios. The scalability of the protocol is demonstrated by using two cases that simulate a 24 beds and a 46 beds real hospital environment with a 49 and 93 nodes, respectively. It is shown that, even in the larger real hospital scenarios, simulating a hospital with 24 and 46 beds requiring the transmission of critical data packets with stringent reliability requirements, QPRR outperforms comparable protocols.

Molecular characterization of Aspergillus infections in an Iranian educational hospital using RAPD-PCR method.

The nosocomial infections by Aspergillus species are associated with constructions and increased dust loads in hospital indoors. Our main object was to find the environmental sources of Aspergillus species causing hospital acquired infections. The clinical and environmental samplings were performed during 18 months from spring 2010 to summer 2011 in Imam educational hospital, Urmia, Iran. A morphological diagnosis was performed including microscopic characterization of isolated aspergillus from cultured specimens and polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) for the identification in the level of species. Random amplified polymorphic DNA - PCR RAPD-PCR using random primers for rDNA gene was performed to compare Aspergillus isolates of clinical cases with the relevant environmental sources. Use of RAPD method resulted various differential patterns, so that some Aspergillus isolates from the clinical and hospital indoor were completely matched (matched pairs) and some other Aspergillus isolates were not matched. In the case of matched pairs, Aspergillus niger and A. flavus isolated from broncoalveolar lavage and sinus discharge were relevant to those of air conditioner and walls surfaces, respectively. The hospital sources for the Aspergillus clinical isolates included air condition and walls. RAPD-PCR analysis can play a trivial role to find the hospital sources of Aspergillus clinical isolates.

Pseudomonas Isolates of Holy Family Red Crescent Medical College Hospital : Changing Patterns Over 12 Years

Pseudomonas is one of the most common gram negative microorganism identified in the clinical specimen of hospital indoor and outdoor patients. This was a retrospective study done among the patients attending Holy Family Red Crescent Medical College Hospital during January to December 2012. A total 457 patients with Pseudomonas were isolated of which 274 (60%) as indoor patient and 183 (40%) was outdoor patients. Males predominated being 251 (55%) while 206 (45%) was females. Majority of the patients were in the age group of 15-29 years. Urine was the most common specimens (70%) and others (pus, swab, blood etc) were (30%). Throughout our 12 years observation , it was found that imipenem and meropenem are the most effective drugs against Pseudomonas followed by amikacin and ciprojloxacin.

Design and Application of the Indoor Environment Monitoring & Control System at Tianjin First Central Hospital

With advance of our human beings science and technology and enhance of the living standards, more and more people have addressed higher requirements on the environmental conditions in a hospital, therefore, the traditional and no-intelligent monitoring devices are being replaced by the automated and networked monitoring systems gradually. In this case, application of the wireless sensor network just fits this need. This paper proposes the Tianjin First Central Hospital indoor environment monitoring & control system of distributed acquisition and execution, and centralized management by focusing on the needs for the technical indicators of the hospital indoor environment. During design of the system, an universal design concept was put forward, and also a non-standard communication protocol for the wireless sensor network designed independently in combination with the OSI open standard. In this paper, realization of the communication protocol among the nodes with embedded software and the operation mechanism of the modes themselves are discussed, also a console panel has been developed for the data center. Several software design algorithms are proposed with respect to the network layout. This paper also describes the test platform of the Tianjin First Central Hospital indoor environment monitoring & control system established with the network components designed, and provides the test and verification results, including the monitored data of the various gases, corresponding automatic control functions, and underlay BER analysis. The results show that this system can basically realize automatic monitoring on the Tianjin First Central Hospital indoor environment. At present, the sensitive gases include CO, CO2, O2, NH3 and formaldehyde, sensitive environments temperature, humidity and light intensity, and controlled targets ventilation and lighting. This paper offers an optional solution for environment monitoring and has certain theoretical value and engineering significance.

A new patient monitoring framework and Energy-aware Peering Routing Protocol (EPR) for Body Area Network communication

The recent research in Body Area Networks (BANs) is focused on making its communication more reliable, energy efficient, secure, and to better utilize system resources. In this paper we propose a novel BAN architecture for indoor hospital environments, and a new mechanism of peer discovery with routing table construction that helps to reduce network traffic load, energy consumption, and improves BAN reliability. The three scenarios with fixed and variable number of packets sent by source nodes are considered for better analysis. Static nodes are considered in first and second scenarios whereas mobile nodes are used in third scenario. We have performed extensive simulations in the OMNeT++ based Castalia-3.2 simulation environment to show that our proposed protocol has better performance in terms of reduced BAN traffic load, increased successful transmission rate, reduced number of packets forwarded by intermediate nodes, no packets dropped due to buffer overflow, and overall lower energy consumption when compared with a similar protocols.

Advances in ambient intelligence technologies

This special issue contains selected papers from the 3rd International Conference on Ambient Systems, Networks and Technologies (ANT 2012), which was held at Niagara Falls, Ontario, Canada, August 27–29, 2012. The conference attracted a large number of scientific papers that contributed to the state-of-the-art in the areas of pervasive and ambient information systems. All the papers selected for this special issue have undergone two rounds of rigorous review process. Based on the reviewers’ feedback, seven papers were selected for publication from eight best papers invited from ANT 2012. The accepted papers cover interesting works on new developments in ambient intelligence such as adaptable intelligence systems, smart environments, body area networks, and network security. The first paper by Zhang, Khedri, and Jaskolka, ‘‘An Aspect-Oriented Language for Feature Modeling’’, proposes a new language called AO-PFA for developing ambient systems. Built on top of Product Family Algebra (PFA) and by using the aspect-oriented technology, AOPFA offers capabilities in dealing with unpredictable changes in ambient applications. The paper by Hoelzl, Kurz, and Ferscha, ‘‘Goal Oriented Recognition of Composed Activities for Reliable and Adaptable Intelligence Systems’’, focuses on activity and context recognition, an important research topic for adaptable ambient intelligence systems. The paper proposes a goal oriented approach to dynamically create and instantiate models to recognize high level composed activities in an opportunistic way. The paper by Li, He, and Arora, ‘‘ThermoNet: FineGrain Assessment of Building Comfort and Efficiency’’, describes ThermoNet, a hybrid wireless sensor network solution for monitoring and optimizing energy consumption of the Heating, Ventilation, and Air Conditioning systems in large buildings. The paper reports some interesting findings based on the data collected from a realworld environment. The paper by Menon, Jayaraman, and Govindaraju, ‘‘Probabilistic Spatio-Temporal Retrieval in Smart Spaces’’, deals with uncertainties of object tracking in smart spaces. The paper proposes a data model that supports computation of probabilities of spatio-temporal queries giving the uncertainty of the location of an occupant. The paper by Knapen et al., ‘‘Exploiting GraphTheoretic Tools for Matching in Carpooling Applications’’, studies carpooling for commuting and proposes a Global CarPooling Matching Service (GCPMS) that provides advice on how to combine commuting trips by carpooling. In order to evaluate the matching performance of the GCPMS, a multi-agent system is also developed and some initial experimental results are reported. The paper by Khan et al. ‘‘A New Patient Monitoring Framework and Energy-Aware Peering Routing Protocol (EPR) for Body Area Network Communication’’, proposes a new architecture of Body Area Networks for indoor hospital environments. The paper presents an EPR for reducing the traffic load and energy consumption while increasing the number of packets successfully delivered to the destinations. The final paper by Beitollahi and Deconinck, ‘‘ConnectionScore: A Statistical Technique to Resist Application-Layer DDoS Attacks’’, describes a Q. Z. Sheng J. Ma School of Computer Science, The University of Adelaide, Adelaide, SA 5005, Australia e-mail: qsheng@cs.adelaide.edu.au

A QoS-aware Routing Protocol for Reliability Sensitive Data in Hospital Body Area Networks

The reliability, energy efficiency, and real-time display of patient's data are important factors for Body Area Network (BAN) communication in indoor hospital environments. In this paper we propose a novel routing protocol by considering the QoS requirements of BAN data with strict reliability requirements. Our proposed algorithm increases the reliable delivery of critical BAN data at the destination We have performed extensive simulations in the OMNeT++ based simulator Castalia to demonstrate the better performance of the proposed QoS based routing protocol for reliability sensitive data in terms of successful transmission rate, lower network routing traffic (hello packets) overhead, and lower end-to-end delay (latency) in both stationary and movable patient scenarios.

HumanizaSUS: uma experiência de humanização e gestão da comunicação em organizações hospitalares

O presente artigo é um estudo sobre a humanização no ambiente interno de hospitais. Apresenta, em um primeiro momento, uma abordagem sobre a complexidade do ser humano, expondo a importância da valorização de sua subjetividade. Após esse enfoque, explora-se o conceito de humanização e as implicações que esta produz tanto na relação funcionário-paciente, quanto na relação funcionário-funcionário. Para tal, explora-se a relação intrínseca que há entre a humanização e a comunicação. A fim de embasar a relação apresentada, é utilizado como exemplo o HumanizaSUS, presente no sistema de saúde do Brasil.

Comparison of previous reports in indoor patients-a potential tool for internal quality assurance in clinical biochemistry

Laboratory testing is an important and integral part of the decision-making process and strongly influences medical diagnosis and therapies. Normally the extraneous results in a clinical report raise a doubt towards the quality assurance program of a laboratory. This communication is intended to highlight the potential use of previous reports of indoor patient in an indoor hospital laboratory as a tool for quality assurance. In this study approximately 10% of the doubtful reports were picked up randomly and the results were compared with the earlier reports of the patient retrieved from database. The study revealed that there was a significant reduction of more than 80% in the test repeats resulting in decrease in expenses on repeat tests (80%).There was a significant average reduction of time and human resource investment, decrease in the instrument working hours and increased workflow efficiency due to reduction in the test repeats. Moreover there was an increase in the confidence level of consultant towards quality control program and authenticity of the reports.

Fate of airborne Coagulase negative Staphylococci

Hospital indoor air can be a source for transmitting nosocomial infections in resource limited settings. This study was undertaken over two months period (February – March 2010) in Chennai, India, to 1) characterise bacteria isolated from indoor air of healthcare facility; and 2) establish whether environmental and clinical isolates are similar by molecular typing methods. Daily visits were made to microbiology laboratory to determine clustering of cases of nosocomial infections. Patients with illnesses related to respiratory tract and skin and soft tissues were included. Clinical strains (from laboratory) with similar antibiogram patterns were systematically stocked. Indoor air samples were collected from such locations by exposed plate method for 30 minutes. Growth was identified by standard microbiological procedures. Phenotypically similar strains were further subjected to genotyping by polymerase chain reaction and pulsed field gel electrophoresis (PFGE) to confirm similarity. Coagulase-negative staphylococci (CNS) were only isolated from both environmental and clinical samples during the study period. Totally, 15 clinical and six environmental strains of CNS were isolated over two months. One airborne and one clinical strain, isolated subsequently from a patient in the same location, had similar phenotypic (biochemical and antibiogram) characteristics. Isolates were identified Corresponding Author Ms. Suchithra Sudharsanam Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Porur, Chennai 600116, India. Email: suchisanam@gmail.com

Identification of Candida species isolated from hospital acquired infections cases and hospital indoor environments

Nosocomial infections have tremendous health and financial costs with an estimated incidence of 2,000,000 infections per year, 20,000 deaths per year, and added costs of 2 billion per year (Pfaller and Diekema, 2007). During times of prolonged antibiotic treatment and severe immunosuppression, fungi as opportunistic organisms can cause hospital acquired infections. This group includes

Characterization of coagulase-negative staphylococci isolated from hospital indoor air and a comparative analysis between airborne and inpatient isolates of Staphylococcus epidermidis

A total of 108 coagulase-negative staphylococci (CoNS) were collected from hospital indoor air. The majority of the isolates were able to produce biofilms and displayed multiresistance profiles. The most frequent species identified were Staphylococcus epidermidis (n=27) and Staphylococcus haemolyticus (n=17). Potential virulence traits (icaAD, aap, hld, atlE and sesB) and genotypic profiles were compared for S. epidermidis isolates from indoor air (n=27) and from patients (n=26) who had been admitted to the hospital 8-34 months after air sampling. Overall, the virulence factors tested were more frequently found among S. epidermidis recovered from clinical origin than from air sources (P=0.003). Indeed, the group of patient isolates exhibited superior ability to accumulate biofilms (P<0.0001). Despite this, genotyping using PFGE revealed that identical clones of S. epidermidis could be recovered from both patient and indoor air samples. In addition, some airborne isolates displayed virulence profiles and levels of biofilm accumulation similar to those found in patient isolates. Therefore, further studies are necessary to clarify the importance of hospital indoor air as a route of transmission for CoNS isolates (mainly S. epidermidis).