PRESENCE OF PATHOGENIC BACTERIA IN AIR CONDITIONING UNITS OF

ADVENTIST MEDICAL CENTER ILIGAN CITY

Presented to the Faculty of the Department of Medical Technology

Adventist Medical Center College

Brgy. San Miguel, Iligan City

In Partial Fulfillment

of the Requirements for the Degree

BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY

DOMIL VINCENT BUNGABONG

MARTIN CLYDE G. PAGLINAWAN

 LORAINE ZOE C. REDAJA

LEONARDO VITTORIO A. RODRIGO

JOHN RUXEL A. VALMORIA

CHAPTER 1

THE PROBLEM AND ITS SCOPE

Introduction

Nowadays, air-conditioning units is one of the most essential and

common technology that can be found in our households and other important

places like hospitals and laboratories because with these, the temperature of a

room can easily be modified which can allow people to live more comfortably

and contentedly in harsh climate like our country and brings environmental

flexibility. The comfort, the ease and happiness that air-conditioners brings to

our lives is limited and controlled because cooling towers of air-conditioning

units is one of the environment and habitation of a many pathogenic bacteria

that causes nosocomial infections or even worse.

In the past years of Adventist Medical Center Iligan City, there has been a

rapid development of new buildings and offices and a substantial increase in

the number of people working in such spaces in the hospital. Since some of the
rooms of the hospital is required with fresh ambient air in this type of

environment, an air-conditioning (AC) systems is practically the only technical

solution used to both improve the air quality and provide the healthcare

workers and patients with proper working conditions. The atmospheric air,

which is delivered into the building through the AC system, should be free from

most common pollutants and ensure an ideal temperature and moisture.

Unfortunately, bad maintenance of AC systems or their low efficiency can often

lead to unintentional bacterial contamination. In addition, the air circulation

can transmit infectious respiratory disease and allergic reactions. AC units

can spread indoor pollutants such as bacteria, molds, mildew, viruses, and

pollens, however the scope of this study focuses only in bacteria that may

spread through AC units of the hospital that causes nosocomial infections.

According to Kroqulski (2010) the air is not favorable to the growth and

survival of microorganisms, which has no nutrients and usually low moisture

content, it is the most important medium for carrying and spreading of

biological agents. Bacteria suspended in the air can be viable (culturable and

non-culturable) as well as nonviable forms. They can be also attached to dust

particles formed from inorganic matter or to water or saliva droplets.

This study deals with the detection of bacteria present in the air-

conditioning systems of the Adventist Medical Center Iligan City. In addition,

the aim of this study is to assess and evaluate the level of bacterial

contamination in air-conditioned rooms of the hospital and determine what

implications can be derive from the results of the study. Nosocomial infections

are periodic and a local problem in hospitals and nursing homes, where

bacteria may spread easily and patients in hospitals are vulnerable and

susceptible to infection. Through this study, the researchers can detect the

pathogenic bacteria present in air-conditioning units of the hospital.

Conceptual Framework

The concept of the study is shown in schematic diagram on Figure 1. It

shows the different variable in the study. The water samples collected is the

independent variable. The dependent variables comprises the isolated and

identified bacteria. Identified bacteria is a dependent variable.

Independent Variables Dependent Variables

 Confirmato
Swab samples ry of
from Bacterial isolation identifies
air-conditioning and identification bacteria in
units selective
medium

Statement of the Problem

This study aims to find out Detection of Bacteria in Air Conditioning

Units of Adventist Medical Center Iligan City

Specifically, it will seek answers to the following questions:

1) Is there any presence of bacteria in the samples as will be tested in the

laboratory? What are the bacteria found in air-conditioning units?

2) What are the pathogenic and non-pathogenic bacteria found in air-

conditioning units?

3 What implications can be derived from the study?

Scope and Limitation

This research is bound to identify the significant presence or absence of

pathogenic bacteria in air-conditioning units of Adventist Medical Center Iligan

City. If there is a presence of bacteria, the researchers will attempt to know its

health risks. The experimentation will be conducted be conducted at 4 th floor,

Medical Technology Laboratory in Adventist Medical Center and College.

This study will only focus on the presence of pathogenic bacteria in air-

conditioning units. This will not include the presence of viruses, fungi, and

parasites. Not all air-conditioning units with bacteria content are unsafe there

must be a certain percentage or quantity of the bacteria to enable it to become

unsafe and harmful. The study will use at least twenty-five samples from

different air-conditioning units of Adventist Medical Center Iligan City. They will

be tested for the presence or absence of bacteria. Specific laboratory procedure

using different media will be employed to obtain and acquire the needed
information or data results. Factors affecting the air-conditioning units

contamination will not be included.

Significance of the Study

By now most people know that to live on earth is to coexist with an

endless variety of microorganisms that are inconceivably be seen with naked

eyes, and these microbes are commonly unintentionally acquired by any

individuals given any age, gender, race and status from materials always

present in anybodys surroundings such air-conditioners. This study was

conducted in order for the students, teachers, and parents to be awareness in

order to prevent themselves from getting infected with pathogenic bacteria. In

view of this, it is the researchers concern to identify pathogenic bacteria found

in air-conditioners, which may have been contaminated. This study will be very

helpful and beneficial to the following:

Hospital Maintenance.

Hospital Administrssation.

Teachers. They should be informed and be aware of the importance of

cleanliness of air-conditioning units and to always remind the students to be

observant of places they are going with air-conditioning units, for them to

maintain good health and, to avoid disease contamination.

 Students. To be fully aware of the cleanliness of the air-conditioning

units in the classrooms in order to maintain good health and for them to be

always alert on the cleanliness of their environment.

Parents. For parent to remind their children about being extra careful

and watchful to the places with air-conditioning units especially in the

hospitals to avoid diseases that may arise from unmaintained cleanliness of the

air-conditioning units. Moreover, parents should take extra precautions in

providing clean and safe air-conditioning units.

Community. For the whole community to be free of dreaded diseases by

being very careful of their surroundings, making it clean and orderly so that

there will be a fresh and clean community.

Medical Technology Department. The department holds a big part with

regards to the health of everybody by keeping a more functional roles especially

in identifying bacteria and other microorganisms and confirm it as pathogenic

or not. This study is beneficial to the department in acquiring the correct and

accurate scientific data regarding the significance of determining those

contaminated foods.

Future Researchers. The data and results of this study will serve as the

basis of reference for related studies on this subject matter in the near future.
 Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter represents on the discussion of some literature and studies

which are relevant to the present study. Concepts and ideas from these

scientific literatures have opened an avenue of understanding that would lead

to the solution of the problems set in the study.

Related Literature

The sources of the infecting bacteria are environmental, and geographic

variation in the frequency of infection has been documented. Airborne

dissemination of bacteria from cooling towers and evaporative condensers has

been responsible for some epidemics, but potable water systems are perhaps

more important sources.(Winn, 1988)

 According to Pasquarella et al. (2010) in their article entitled Air

microbial sampling: the state of art that air microbial sampling is a subject of

great interest in different fields of human activity; however, generally accepted

indications, concerning both the sampling methods to be used and the

interpretation of the results, are still lacking. The whole theme is greatly

debated and several problems remains to be solved. The aim of this article is to

provide knowledge relating to the problems associated with air microbial

sampling, underlining the aspects to be considered in order to choice the

sampling method on the basis of the objective of the sampling itself and on the

knowledge of the characteristics and limits of the different methods.

The relationship between hospitals location and bacteria and fungi

concentration in hospitals rooms was investigated. Hospitals situated in the

city centre and outside the city were chosen to investigation. The relationship

between bacteria and fungi concentration in indoor and ambient air was

analyzed. In the investigation air-conditioned rooms were isolated. (Kroqulski,

2008)

In addition to what Kroqulski (2010) stated in his article entitled

Microbial air purity in hospitals, Operating theatres with air-conditioning

system that the aim of this study was to show the influence of air conditioning

control for microbial contamination of air inside the operating theatres

equipped with correctly working air-conditioning system. This work was based

on the results of bacteria and fungi concentration in hospital air obtained since

2001. Assays of microbial air purity conducted on atmospheric air in parallel

with indoor air demonstrated that air filters applied in air-conditioning systems

worked correctly in every case. To show the problem of fluctuation of bacteria

concentration more precisely, every sequences of single results from successive

measure series were examined independently.

According to Bardaquim et al. (2014) Sixty samples were collected with

the aid of sterile swabs soaked in peptone water and rubbed into quadrants of

20 cm2. The surfaces investigated were: medication tables, surgical tables,

marble countertops and air conditioning grilles.

Related Studies

Kohler, Gross, Salvaggio, and Hawkins (1976) found that antigens from

thermophilic Actinomycetes species growing in air conditioners and humidifiers

have been implicated in causing hypersensitivity pneumonitis. A similar role for

thermotolerant bacteria has not been documented despite the fact that these

organisms are uniformly present in contaminated humidifiers and air

conditioners, exceeding Actinomycetes colonies by approximately 15-fold, and

often are recovered when cultures are negative for thermophilic Actinomycetes.

In fact, to prevent overgrowth by thermophilic bacteria, inhibitors are

frequently included in media used for culturing Actinomycetes.

Hwan, Park, and Hyun (2014) found that the characterization and

measurement of the concentration of airborne infectious microorganisms in a

laboratory is difficult because of the diversity of infectious microorganisms

handled in a bio laboratory, variation in the efficiencies of air sampling

equipment, different viability of each infectious microorganism, and lack of a

standardized method for measuring individual microorganisms in the air. The

measurement of total airborne bacteria (TAB) has been used by indoor

environment experts as an index of microbial contamination in the air. The

TAB test method has not been demonstrated to be a successful indicator of the

performance of biosafety cabinets (BSCs); however, the assessment of total

airborne fungi has been evaluated to be an indicator of BSC performance.

 Tang (2013) posted that hospital indoor air pollution is associated with

inadequate building environments, including building materials, air

conditioning systems, ventilation rates, and human factors, such as over-

crowding in constrained spaces. Evaluations of operating theater air quality

assessed levels of particulate matter (PM), microbial agents, and volatile organic

compounds (VOCs). Employees, patients, and visitors are significant sources of

airborne microbes in hospitals.

In addition to what Kroqulski (2010) stated in his article entitled

Microbial air purity in hospitals, Operating theatres with air-conditioning

system that aim of this study was to show the influence of air conditioning

control for microbial contamination of air inside the operating theatres

equipped with correctly working air-conditioning system. This work was based

on the results of bacteria and fungi concentration in hospital air obtained since

2001. Assays of microbial air purity conducted on atmospheric air in parallel

with indoor air demonstrated that air filters applied in air-conditioning systems

worked correctly in every case. To show the problem of fluctuation of bacteria

concentration more precisely, every sequences of single result from successive

measure series were examined independently.

Chapter 3
 RESEARCH METHODOLOGY

This chapter presents the research design, research locale,

data gathering procedure, sampling design, sampling technique, scoring of

instruments and statistical tools that were used in the study.

Research Design

The researchers use the experimental research method. This is use to

obtain about the presence of bacteria in air-conditioning units of Adventist

Medical Center Iligan City. The experimental research design is use to

determine the possible presence of bacteria in air-conditioning units. The true

experiment is use because the researchers find the data gathered in the

presence of bacteria. In addition, it explained and discussed the possible

diseases of each bacteria identified can cause.

Research Locale

The study was conducted at the Adventist Medical Center located at the

Brgy. San Miguel, Iligan City. The swab samples were collected in selected air-

conditioning units of the hospital. The culture and isolation of identified

bacteria was done at Medical Technology laboratory of Adventist Medical Center

and College located at Brgy. San Miguel, Iligan City.

Sampling Design

A culture technique was used to determine the prevalence of organisms, its

abundance in the sample being tested, or both. It is one of the primary

diagnostic methods of microbiology. A purposive sampling design is use in the

study which involved taking the number from the same probability

distribution. Cotton swab were made with the specimen streak using the blood

agar and inoculate in 37 C overnight. The sample taken was cultured at the

Medical Technology laboratory of Adventist Medical Center and College and was

isolated and purified to determine the presence of pathogenic bacteria in air-

conditioning units.

Data Gathering Procedure

The researchers gave a letter of respect to the Administration of the

Adventist Medical Center asking permission to conduct a study in the hospital

and take swab samples in the air-conditioning unit approved by the research

adviser as well as the chairperson of the Medical Technology department.

 Gloves, masks, and laboratory gowns were used by the researches to

reduce the possibility of specimen contamination in the proper collection and

preparation of specimen. There were a lot of processes used in bacterial

identification of the sample which were the main focus for the data gathering of

this study. Medical laboratory personnel who are responsible for the bacterial

identification used standard sequence of processes to obtain accurate result.

Figure A

Flowchart of Bacterial Identification

Processes Used in this study
 Collection of specimen

Specimen preparation

Culture, isolation and bacterial

inoculation

Gram staining

Gram positive bacteria Gram negative bacteria

(Cocci) (Bacilli)

Catalase test Oxidase test

Coagulase
Biochemical
test
tests

First, the test tubes and swabs that have been used in experiments had

undergone sterilization through autoclaving. There were thirty-one samples

collected in the vent of air-conditioning units in selected areas of the hospital.

In obtaining the samples, each swabs were used by swiping it to the surface of

the air-conditioning units. Immediately it was transported to the laboratory via

thioglycolate tube. After samples were collected, specimen preparation was

done through swabbing those samples to be tested. Culture media, Blood agar,

Eosin Methylene Blue agar and MacConkey agar, were used in this study which

was the next step after specimen preparation for letting the bacteria to grow.

The inoculating loop use as the instrument for the inoculation of bacteria in

which the swabbed part of the samples were in it and then specimen

inoculated were usually spread over the surface of plated in a standard pattern

so that bacterial colonies are obtained to enhance the growth, isolation and

selection of bacteria (Bailey and Scott, 2007). There were specific incubation

period applied for the bacterial cultivation. In the culture media that were

used, bacteria grew. In order to specify them, smear preparation for gram

staining was the next step in the process in which a sterile needle used to

transfer a small amount of growth from the culture or solid media to the

surface of the slide. After which, proceeding to the gram staining followed.

Gram staining is used for differentiation of the composition of two major

groups of bacteria, gram positive cell walls and gram negative cell walls (Bailey

and Scott, 2007). Catalase test was done because there were bacteria isolated

as gram positive cocci. This test used to differentiate gram positive bacteria if

Staphylococcus or Streptococcus species. Positive reaction will be

Staphylococcus and negative as Streptococcus. Staphylococcus bacteria were

isolated and to find them specific of what Staphylococcus family they belong,

coagulase test was performed to differentiate Staphylococcus species if

Staphylococcus aureus or coagulase-negative Staphylococcus species.

On the other hand, after gram staining, results show that there were

gram negative bacilli isolated also. Other proper processes must be performed

if these kinds of bacteria will be identified in order for them to name

specifically. This must be followed with oxidase test for differentiating between

groups of gram negative bacteria and biochemical tests will be done after

oxidase test for identifying specific bacteria. These two tests were used in this

study. However, fungi usually yeast cells were found in gram staining which

then subjected in germ tube for confirmation.

STATISTICAL TOOLS

The data collected had used this statistical tool:

1. Frequency and Percentage. This was used to establish the number of

respondents and their choices in answering the questions.

% = f/n (100)

Where: % is the percentage

f is the frequency of the responses

n is the total number of respondents

100 is constant
 BIBLIOGRAPHY

A. BOOKS

Betty A. Forbes, Daniel F. Sahm, Alice s. Weissfeld (2007), Baileys &

Scotts.Diagnostic Microbiology, 12th Edition, Missouri, Mosby Elsevier,

pp. 254,265, 341

B. ELECTRONIC SOURCES

http://scholar.google.com.ph/scholar?

start=20&q=related+studies+in+bacteria+in+air+conditioners+in+rooms+of+the

+patients&hl=en&as_sdt=0,5&as_ylo=2013&as_vis=1

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080534/

http://www.plosone.org/article/info%3Adoi

%2F10.1371%2Fjournal.pone.0061093

http://www.sciencedirect.com/science/article/pii/S209379111400002X

http://www.sciencedirect.com/science/article/pii/S0123939214000332

http://journal.publications.chestnet.org/data/Journals/CHEST/20977/294.p

df

http://www.ncbi.nlm.nih.gov/pubmed/21446127
http://www.ncbi.nlm.nih.gov/pubmed/18379608