00:00:00
Speaker 1: University of Joesburg, studying finding that multidrug-resistant bacteria and potentially harmful molds in air samples collected at an inner-city clinic, and this is raising concerns about infection risk for vulnerable patients. Leading that study from the University of Joesburg's Water and Health Research Center, Dr. Leigh Hynam. Leigh, a very good morning and welcome to the show.
00:00:25
Speaker 2: Hi, thanks for having me.
00:00:26
Speaker 1: How are you? I'm very well, thank you very much. How are you this Friday morning?
00:00:29
Speaker 2: I'm great.
00:00:31
Speaker 1: Talk to us about the study and what it found.
00:00:35
Speaker 2: So our study was a single site study. We found that about half of the bacteria that we sampled were associated with respiratory infection. And almost all of these that we isolated were multi-drug resistant, with a few of them being extensively drug resistant. So We expected some of them to be multidrug-resistant, but not as many as this, not almost all of them. So between 97% and 100% of the ones that we isolated were multidrug-resistant.
00:01:10
Speaker 1: Do we know why? I mean, is this a clinic that, for example, attends to TB patients who then will be coming into the environment having a multidrug-resistant clinic TB, and therefore that's what you're going to be sampling in the air in that clinic?
00:01:28
Speaker 2: So, no, we didn't sample TB. We sampled simple bacteria that would cause things like bronchitis and pneumonia. TB takes a lot of culturing. They're quite complicated organisms, so they take more advanced culture techniques than we actually currently employ at our research unit. The clinic, I don't want to go into too much detail about what the clinic does and what kind of clinic it is, just from the point of view that we don't want to draw attention to which clinic it is and single them out, just from an ethical point of view. We did guarantee them anonymity. The reason that antibiotic-resistant bacteria exist is complicated, but one of the reasons is Sorry, one of the reasons that bacteria become antibiotic resistant is because patients stop taking their antibiotics as soon as they start feeling better. So we essentially start treating with antibiotics. The first bacteria that are eliminated by those antibiotics are ones that are sensitive, that are able to be destroyed by the medication. And then as the patient becomes a little bit better, they start feeling better, they stop taking the medication. And so essentially the ones that are resistant, the bacteria that are resistant, survive and become more prevalent in the environment. So we actually select for more resistant bacteria.
00:03:03
Speaker 1: The study also identifying potentially harmful molds in the air. What are those and what risks do they pose?
00:03:12
Speaker 2: Fungi are everywhere. Molds are in the environment naturally, as with bacteria as well. I mean, bacteria are all over us, inside of us, in the air. The molds that we found specifically, some of them are pathogenic, but some of them are also indicators of structural damage inside buildings, a buildup of damp in the indoor air environment as well. So it can be an indicator that The healthcare facility is not in a good state, that there's been poor maintenance, but they can pose a risk to the health of both the healthcare workers and the patients. This is dependent, though, on the number of moles that we find, so the number of cells per cubic meter in the air. Now, there are no established guidelines for what is a safe level versus what is an indication level of if there's infection. prevention control measures that need to be stepped up versus what is a normal or safe level for people to be in contact with. In other countries, there are guidelines in place, but these vary from country to country. And the differences in the guidelines internationally are vast. So there's a gap in the knowledge of what is the safe level of bacteria and mold in the environment, in the indoor air environment specifically, regarding what is safe to breathe in, what levels would pose an infection risk, and what levels should be instituted as a mandatory minimum normal level for healthcare environments or just any indoor air environment. So part of our study was looking at... what kind of disease-causing organisms would be present in the clinic, but there needs to be further research.
00:05:13
Speaker 1: Because once those guidelines are set, I imagine, Lee, we would need to have regular and almost routine monitoring of air quality and putting in place measures to address the high levels of bacteria, moulds, all of that, if they exist in that environment, right? Exactly.
00:05:34
Speaker 2: Exactly. The same way that we monitor water quality and other air quality parameters. So there should be a minimum number of specific bacteria in the water that we drink, and that's monitored on a regular basis by water providers. As soon as there's a set number of bacteria in the water that doesn't conform to the minimum standard, then interventions need to be put in place. So investigations occur where We find out why there's a spike in the bacterial levels, and then measures are taken to correct. The same thing should apply to air quality, in particular in the healthcare environment, because patients are more at risk. If you're going to a clinic or a hospital, already you're in a space where your immune system might not be functioning properly. You're already sick. That's not just for patients. I mean, healthcare workers are then also exposed on a daily basis to those bacteria. So there's a risk for healthcare workers as well. And by the same token, already in place in businesses, in healthcare facilities, there should already be monitoring of the indoor air quality as regards other substances. So Are there chemical pollutants in the air? Is there particulate matter in the air that could pose a health risk? What we're suggesting is that, yes, there should also be bacterial monitoring. And this would not impose too much of an increased burden on environmental protection officers or infection protection and prevention and control officers. It's quite a simple process to do air sampling. It takes about 10 minutes. So sample collection, hospitals generally have laboratories on site or close by that could analyze the samples and do the count and then do interventions as and when that would be required.
00:07:41
Speaker 1: It's an important study, Lee. Thank you very much for chatting to us about it. Dr. Lee Hain is the lead author of a study. that found, sadly, multi-drug-resistant bacteria and potentially harmful molds in unacceptably high levels at a single-site clinic in Johannesburg. Dr. Heiner is with the University of Joburg's Water and Health Research Center.
Speaker 1: University of Joesburg, studying finding that multidrug-resistant bacteria and potentially harmful molds in air samples collected at an inner-city clinic, and this is raising concerns about infection risk for vulnerable patients. Leading that study from the University of Joesburg's Water and Health Research Center, Dr. Leigh Hynam. Leigh, a very good morning and welcome to the show.
00:00:25
Speaker 2: Hi, thanks for having me.
00:00:26
Speaker 1: How are you? I'm very well, thank you very much. How are you this Friday morning?
00:00:29
Speaker 2: I'm great.
00:00:31
Speaker 1: Talk to us about the study and what it found.
00:00:35
Speaker 2: So our study was a single site study. We found that about half of the bacteria that we sampled were associated with respiratory infection. And almost all of these that we isolated were multi-drug resistant, with a few of them being extensively drug resistant. So We expected some of them to be multidrug-resistant, but not as many as this, not almost all of them. So between 97% and 100% of the ones that we isolated were multidrug-resistant.
00:01:10
Speaker 1: Do we know why? I mean, is this a clinic that, for example, attends to TB patients who then will be coming into the environment having a multidrug-resistant clinic TB, and therefore that's what you're going to be sampling in the air in that clinic?
00:01:28
Speaker 2: So, no, we didn't sample TB. We sampled simple bacteria that would cause things like bronchitis and pneumonia. TB takes a lot of culturing. They're quite complicated organisms, so they take more advanced culture techniques than we actually currently employ at our research unit. The clinic, I don't want to go into too much detail about what the clinic does and what kind of clinic it is, just from the point of view that we don't want to draw attention to which clinic it is and single them out, just from an ethical point of view. We did guarantee them anonymity. The reason that antibiotic-resistant bacteria exist is complicated, but one of the reasons is Sorry, one of the reasons that bacteria become antibiotic resistant is because patients stop taking their antibiotics as soon as they start feeling better. So we essentially start treating with antibiotics. The first bacteria that are eliminated by those antibiotics are ones that are sensitive, that are able to be destroyed by the medication. And then as the patient becomes a little bit better, they start feeling better, they stop taking the medication. And so essentially the ones that are resistant, the bacteria that are resistant, survive and become more prevalent in the environment. So we actually select for more resistant bacteria.
00:03:03
Speaker 1: The study also identifying potentially harmful molds in the air. What are those and what risks do they pose?
00:03:12
Speaker 2: Fungi are everywhere. Molds are in the environment naturally, as with bacteria as well. I mean, bacteria are all over us, inside of us, in the air. The molds that we found specifically, some of them are pathogenic, but some of them are also indicators of structural damage inside buildings, a buildup of damp in the indoor air environment as well. So it can be an indicator that The healthcare facility is not in a good state, that there's been poor maintenance, but they can pose a risk to the health of both the healthcare workers and the patients. This is dependent, though, on the number of moles that we find, so the number of cells per cubic meter in the air. Now, there are no established guidelines for what is a safe level versus what is an indication level of if there's infection. prevention control measures that need to be stepped up versus what is a normal or safe level for people to be in contact with. In other countries, there are guidelines in place, but these vary from country to country. And the differences in the guidelines internationally are vast. So there's a gap in the knowledge of what is the safe level of bacteria and mold in the environment, in the indoor air environment specifically, regarding what is safe to breathe in, what levels would pose an infection risk, and what levels should be instituted as a mandatory minimum normal level for healthcare environments or just any indoor air environment. So part of our study was looking at... what kind of disease-causing organisms would be present in the clinic, but there needs to be further research.
00:05:13
Speaker 1: Because once those guidelines are set, I imagine, Lee, we would need to have regular and almost routine monitoring of air quality and putting in place measures to address the high levels of bacteria, moulds, all of that, if they exist in that environment, right? Exactly.
00:05:34
Speaker 2: Exactly. The same way that we monitor water quality and other air quality parameters. So there should be a minimum number of specific bacteria in the water that we drink, and that's monitored on a regular basis by water providers. As soon as there's a set number of bacteria in the water that doesn't conform to the minimum standard, then interventions need to be put in place. So investigations occur where We find out why there's a spike in the bacterial levels, and then measures are taken to correct. The same thing should apply to air quality, in particular in the healthcare environment, because patients are more at risk. If you're going to a clinic or a hospital, already you're in a space where your immune system might not be functioning properly. You're already sick. That's not just for patients. I mean, healthcare workers are then also exposed on a daily basis to those bacteria. So there's a risk for healthcare workers as well. And by the same token, already in place in businesses, in healthcare facilities, there should already be monitoring of the indoor air quality as regards other substances. So Are there chemical pollutants in the air? Is there particulate matter in the air that could pose a health risk? What we're suggesting is that, yes, there should also be bacterial monitoring. And this would not impose too much of an increased burden on environmental protection officers or infection protection and prevention and control officers. It's quite a simple process to do air sampling. It takes about 10 minutes. So sample collection, hospitals generally have laboratories on site or close by that could analyze the samples and do the count and then do interventions as and when that would be required.
00:07:41
Speaker 1: It's an important study, Lee. Thank you very much for chatting to us about it. Dr. Lee Hain is the lead author of a study. that found, sadly, multi-drug-resistant bacteria and potentially harmful molds in unacceptably high levels at a single-site clinic in Johannesburg. Dr. Heiner is with the University of Joburg's Water and Health Research Center.
