Indoor environment assessment of special wards of educational hospitals for the detection of fungal contamination sources: A multi-center study (2019-2021)
Authors:   Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran, Ghazanfari Mona ,   Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Yazdani Charati Jamshid ,   Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran, Keikha Nasser ,   Infectious Disease and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran, Kholoujini Mahdi ,   Beheshti Hospital, Hamadan University of Medical Sciences, Hamadan, Iran, Kermani Firoozeh ,   Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Nasirzadeh Yaser ,   Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Roohi Behrad ,   Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Minooeianhaghighi Mohammad Hassan ,   Department of Medical Microbiology, Faculty of Medicine, Infectious Diseases Research Center, Gonabad University of Medical Sciences, Gonabad, Iran, Salari Bahram ,   Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Jeddi Seyed Ali ,   Department of Laboratory Sciences, School of Allied Sciences, Abadan University of Medical Sciences, Abadan, Iran, Didehdar Mojtaba ,   Department of Medical Parasitology and Mycology, School of Medicine, Arak University of Medical Sciences, Arak, Iran, Shokri Azar ,   Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran, Ameri Seyahooei Sekhavat ,   Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran, Aslani Narges ,   Infectious and Tropical Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran, Nazeri Mehdi ,   Department of Medical Parasitology and Mycology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran, Ghojoghi Aynaz ,   Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Amirizad Kazem ,   Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran, Azish Maryam ,   Department of Medical Parasitology and Mycology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran, Nosratabadi Mohsen ,   Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran,   Department of Medical Laboratory Sciences, Sirjan Faculty of Medical Sciences, Sirjan, Iran, Zakerian Mohammad Reza ,   Shohada Hospital-Gonbad, Golestan University of Medical Sciences and Health Services, Gorgan, Iran, Hedayati Shakiba ,   Student Research Committee Center, Mazandaran University of Medical Sciences, Sari, Iran, Hatamipour Hedieh ,   Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Abastabar Mahdi ,   Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran,   Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Haghani Iman ,   Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran,   Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Hedayati Mohammad T. ,   Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran,   Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Published: July 2023

Background and Purpose: The hospital environment was reported as a real habitat for different microorganisms, especially mold fungi. On the other hand, these opportunistic fungi were considered hospital-acquired mold infections in patients with weak immune status. Therefore, this multi-center study aimed to evaluate 23 hospitals in 18 provinces of Iran for fungal contamination sources. Materials and Methods: In total, 43 opened Petri plates and 213 surface samples were collected throughout different wards of 23 hospitals. All collected samples were inoculated into Sabouraud Dextrose Agar containing Chloramphenicol (SC), and the plates were then incubated at 27-30ºC for 7-14 days. Results: A total of 210 fungal colonies from equipment (162, 77.1%) and air (48, 22.9%) were identified. The most predominant isolated genus was Aspergillus (47.5%), followed by Rhizopus (14.2%), Mucor (11.7%), and Cladosporium (9.2%). Aspergillus (39.5%), Cladosporium (16.6%), as well as Penicillium and Sterile hyphae (10.4% each), were the most isolates from the air samples. Moreover, intensive care units (38.5%) and operating rooms (21.9%) had the highest number of isolated fungal colonies. Out of 256 collected samples from equipment and air, 163 (63.7%) were positive for fungal growth.The rate of fungal contamination in instrument and air samples was 128/213 (60.1%) and 35/43 (81.2%), respectively. Among the isolated species of Aspergillus, A. flavus complex (38/96, 39.6%), A. niger complex (31/96, 32.3%), and A. fumigatus complex (15/96, 15.6%) were the commonest species. Conclusion: According to our findings, in addition to air, equipment and instrument should be considered among the significant sources of fungal contamination in the indoor environment of hospitals.