Analyze Study of Water in Emergency Departments at General Hospitals of the Syrian Coast

 

Oussama Mansour¹*, Ahlam habib², Rim Harfouch³

¹Department of  Pharmaceutical Chemistry, Faculty of  Pharmacy, Al Andalus University, Tartous, Syria.

²Department of Chemistry, Faculty of Pharmacy, Al Andalus University, Tartous, Syria.

³Department of Microbiology, Faculty of  Pharmacy, Al Andalus University, Tartous, Syria.

 

ABSTRACT:

In this paper, the samples of Emergency departments water were collected in sterilized flasks from general hospitals of the Syrian Coast, during the period (15/5/2015 to 20-11 - 2015). The  water samples were analyzed for pH, Turbidity, Electrical conductivity, TDS, Sal%, Iron, Copper, Ammonia, Nitrate, Nitrite, Sulphate, Phosphate, Chloride, as well as  the microbial analysis. The result was: the physicochemical values of hospital water samples were within a permissible limit by the standard procedure mentioned in WHO and Syrian standards S.N.S:45/2007, the microbial analysis shows that hospital water got polluted with E. coli and Coli form. The purpose of this study is to make physicochemical and microbiological tests to assess the safety of hospital water on patients' health.

 

 

 

INTRODUCTION:

Contamination of hospital water with potentially pathogenic organisms and chemical pollutants at general hospitals of the Syrian Coast is very common. [2,3,6,17, 19]. The hospital water should be free from the various contaminations,  organic and inorganic pollutants as well as all its parameter like pH, Turbidity, Electrical Conductivity, percentage of salts (Sal%), Chloride, Total Dissolved Solid(TDS), Nitrate, Nitrite, Ammonia, Phosphate, Copper, Iron, sulfate  should be within a permissible limit by standard procedure mention in WHO and Syrian standards S.N.S:45/2007. [1,8,9,10,11,12, 14, 15, 18, 21]  From bacteriological side, hospital water must be free of pathogenic bacteria as: coli form, Escherichia coli.[.2, 4, 5, 16, 17, 20].

 

Most coli forms are present in large numbers among the intestinal flora of humans and other warm-blooded animals, and are thus found in fecal wastes. E. coli is the most common coliform among the intestinal flora of warm-blooded animals and its presence might be principally associated with fecal contamination. No E. coli are  allowed in drinking water.[13] Hospital Water is a Source of Infectious Microorganisms, This results to Patient exposure to waterborne microorganisms in the hospital while showering, bathing, drinking water. It can also occur through contact with contaminated medical equipment such as flexible endoscopes, tube feed bags, and respiratory equipment that have been rinsed with tap water. The hands of healthcare personnel washed using tap water can also lead to patient exposure. [2,3,6]

 

MATERIALS AND METHODS:

Sampling and Testing:

Samples of water were taken from general hospitals and centers of the Syrian Coast (Lattakia and Tartous) twice during the period (15/5/2015 to 20-11 - 2015) the 22 samples were taken during this period. we recollected The water samples from tap water of Emergency departments  by using 500 ml flasks; these flasks were sterilized by autoclave at 121 c˚ and 1 atm.

 

The Physicochemical Analysis Methods:

The analyzation procedure was in the water analysis laboratory of Kadmous.

1-Free Chlorine was analyzed by Chlorine color meter from HACH company with DPD Method; Chlorine in the sample as hypochlorous acid or hypochlorite ion(free chlorine or free available chlorine) immediately with DPD (N,N-diethyl-p-phenylenediamine) indicator to form a pink color which is proportional to the chlorine concentration.

 

2-Ammonia was analyzed by DR/890 colorimeter from HACH company with Salicylate Method; Ammonia compounds combine with chlorine to form monochloramine; Monochloramine reacts with salicylate to form 5-aminosalicylate; The  5-aminosalicylate is oxidized in the presence of a sodium nitroprusside catalyst to form a blue-colored compound; The blue color is masked by the yellow color from the excess reagent present to give a final green colored solution.

 

3-Nitrite was analyzed by DR/890 colorimeter from HACH company with Diazotization Method (powder pillows): Nitrite in the sample reacts with sulfanilic acid to form an intermediate diazonium salt; this couples with chromotropic acid to produce a pink colored complex directly proportional to the amount of nitrite present.

 

4-Nitrate was analyzed by DR/890 colorimeter from HACH company with Cadmium Reduction Method: Cadmium metal reduces nitrates present in the sample of nitrite; the nitrite ion reacts in an acidic medium with sulfanilic acid to form an intermediate diazonium salt which couples to gentisic acid to form an amber-colored product.

 

5-Copper was analyzed by DR/890 colorimeter from HACH company with Bicinchoninate Method: Copper in the sample reacts with a salt of  bicinchoninic acid contained in CuVer 1 or 2 Copper reagent to forma purple colored complex in proportion to the Copperconcentration; This method includes procedures for both powder pillow and AccuVac reagents.

 

6- Iron was analyzed by DR/890 colorimeter from HACH company with FerroVer Method: FerroVer iron reagent reacts with all soluble iron and most insoluble forms of iron in the sample to produce soluble ferrous iron; This reacts with 1,10-phenanthroline indicator in the reagent to form an orange color in proportion to the iron concentration.

 

7- Phosphorus was analyzed by DR/890 colorimeter from HACH company with Orthophosphate Method: Orthophosphate reacts with molybdate in an acid medium to produce a phosphomolybdate complex; Ascorbic acid then reduces the complex, giving an intense molybdenum blue color.

 

8-Sulfate  was analyzed  by DR/890 colorimeter from HACH company with SulfaVer 4 method: Sulfate ionsin the sample reacts with barium in the  SulfaVer 4 sulfate reagent to form insoluble barium sulfate; The amount of turbidity formed is proportional to the sulfate concentration; the SulfaVer 4 also contains a stabilizing agent to hold the precipitate in suspension.

 

9- pH was measured by sension1 pH meter from HACH company. Take 100ml of the sample water in a clean and dry beaker, then put device electrode, then take the reading of the device scanner.

 

10- Turbidity was measured by Turbidity instrument from HANNA company. Fill the device cell with the sample water, then put the cell in the device hejira, then take the reading of the device scanner.

 

11-Electrical Conductivity, TDS, sal% are measured sension5cond meter from HACH company. Take 100ml of the sample water in a clean and dry beaker, then put device electrode, then take the reading of the device scanner.

 

The Microbial Analysis:

This method consists of filtering 100ml of water sample on a sterile filter with a 0.45-mm pore size which retains bacteria, incubating this filter on a selective medium and enumerating typical colonies on the filter. Coliform bacteria form yellow colonies or green colonies. The results should be identical with World Health Organization (WHO) and Syrian S.N.S:45/2007 standards. There were Incubation conditions 72 h at 37.5C° and Using Incubator name ( Memmert cat.21076.00.500).We Used the medium ( AGAR DE Chapman TTC ISO 9308-1) which was prepared by weighing 56.2g of material, then by  solving the material in the 1L of distilled water with heating, then by sterilizing the mixture in the autoclave for 15min at 121C ° and 1 atm.

 

RESULTS AND DISCUSSION:

Tables explain the physicochemical and bacteriological analyzes values of Emergency departments water in selected hospitals. The data show the physicochemical parameters values of hospital water samples were within a permissible limits by standard procedure mentioned in WHO and Syrian standards S.N.S:45/2007, the microbial analysis shows that few hospitals water got polluted with E. coli and Coli form. This was due to chloride ion lack and bacteria development in hospitals water. The chlorination lack explains water survival for long period in hospitals tanks.

Table(1) show the Physicochemical analyses data of Emergency departments water in hospitals:

Parameter	Permissible Limits Prescribed by WHO and Syrian S.N.S:45/2007 standards	Assad University Hospital (Latakia)	Maternity Military Hospital (Latakia)	Tishreen Hospital (Latakia)	Military Hospital (Latakia)	Maternity and Children Hospital (Latakia)	National Hospital (latakia)
Chloride	0.2-0.5 mg/l	0.03	0.02	0.01	0.21	0.01	0.01
pH	6.5 – 8.5	7.04	6.75	8.00	8.07	8.51	8.50
Conductivity	300 – 1500  µs ̸ cm	497	487	488	480	453	453
Turbidity	>5 NTU	1.39	0.95	2.58	1.55	0.93	0.52
C˚		25.8 C˚	26.5C˚	23.3C˚	24.1C˚	25.1C˚	24.5C˚
Sal%		0.2%	0.2%	0.2%	0.2%	0.2%	0.2%
TDS	150 – 1000 mg/l	241	236	236	232	219	219
Color		NATUR	NATUR	NATUR	NATUR	NATUR	NATUR
Unflavored and Odorant		NATUR	NATUR	NATUR	NATUR	NATUR	NATUR
Ammonia	0 – 0.05 mg/l	0.00	0.00	0.01	0.04	0.00	0.00
Nitrite	0 – 0.2 mg/l	0.016	0.019	0.028	0.022	0.002	0.001
Nitrate	50 mg/l	10.4	8.9	4.3	5.5	11.7	3.1
Sulphate	250 mg/l	20	20	0.04	0.10	20	17
Copper	1 mg/l	0.15	0.15	0.05	0.17	0.08	0.09
Iron	0.5 mg/l	0.02	0.02	0.01	0.00	0.00	0.00
Phosphate	0.5 mg/l	0.04	0.03	0.04	0.10	0.14	0.01

 

Table(2) show the Physicochemical analyses data of Emergency departments water in hospitals:

parameter	permissible limits prescribed by WHO and Syrian S.N.S:45/2007 standards	Diabets Center Hospital (Latakia)	Andalus Hospital (Tartous)	Kadmous Hospital (Tartous)	National Jableh Hospital (Tartous)	Nationalbanias Hospital (tartous)
Chloride	0.2-0.5 mg/l	0.01	0.04	0.05	0.04	0.10
pH	6.5 – 8.5	8.55	8.01	7.19	7.81	7.60
Conductivity	300 – 1500 µs ̸ cm	436	479	523	482	493
Turbidity	>5 NTU	0.70	2.26	1.15	3.35	3.28
C˚		24.8 C˚	22.6C˚	19.8C˚	24.5C˚	24.2C˚
Sal%		0.2%	0.2%	0.3%	0.2%	0.2%
TDS	150 – 1000 mg/l	210	232	253	233	238
Color		NATUR	NATUR	NATUR	NATUR	NATUR
Unflavored and Odorant		NATUR	NATUR	NATUR	NATUR	NATUR
Ammonia	0 – 0.05 mg/l	0.00	0.00	0.00	0.02	0.00
Nitrite	0 – 0.2 mg/l	0.002	0.019	0.019	0.023	0.017
Nitrate	50 mg/l	9.5	6.3	16.9	0.0	0.0
Sulphate	250 mg/l	18	35	32	15	18
Copper	1 mg/l	0.00	0.12	0.09	0.06	0.16
Iron	0.5 mg/l	0.00	0.02	0.02	0.00	0.06
Phosphate	0.5 mg/l	0.03	0.05	0.03	0.01	0.04

 

Table(3) show the microbial results for the detection and enumeration of E.coli and Coliforms of Emergency departments water in hospitals:

	Permissible limits prescribed by WHO and Syrian S.N.S:45/2007 standards	Assad university hospital (latakia)	Maternity military hospital (latakia)	Tishreen hospital (latakia)	Military Hospital (latakia)	Maternity and Children Hospital (latakia)	National Hospital (latakia)
E.coli	0 / 100 ml	-	-	-	-	-	100 cell
Total Coliform	0 / 100 ml	-	-	-	-	-	180 cell

 

Table(4) show the microbial results for the detection and enumeration of E.coli and Coliforms of Emergency departments water in hospitals:

	Permissible Limits Prescribed by WHO and Syrian S.N.S:45/2007 Standards	Diabets Center Hospital (Latakia)	Andalus Hospital (Tartous)	Kadmous Hospital (Tartous)	National Jableh Hospital (Tartous)	Nationalbanias Hospital (Tartous)
E.coli	0 / 100 ml	60 cell	4 cell	12 cell	10 cell	1 cell
Total Coliform	0 / 100 ml	84 cell	4 cell	32 cell	17 cell	1 cell

 

 

CONCLUSION:

The results obtained during our study explains the physicochemical and bacteriological water quality of the Emergency departments in selected hospitals. The results indicate that the physicochemical parameters values are within a permissible limits by WHO and Syrian standards, the microbial analysis indicate a contamination by E.coli and Coli forms. The contamination which could cause a risk on patients' health and the medical crew .So hospital tanks needs cleaning and sterilization constantly. Mainly the References and studies about hospitals water recommends putting  micron filters in the special points of the hospital water system. Such as places before the water reach the tap in patients’ rooms or showers. This procedure retains water asepsis in hospitals.

 

ACKNOWLEDGEMENT 

I would like to thank Ms. Lina Wakkaf  for the language assistance provided during the writing process of this article.

 

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Received on 27.04.2016          Modified on 24.05.2016

Accepted on 20.06.2016        © RJPT All right reserved