Syntax Literate: Jurnal Ilmiah Indonesia �p�ISSN:
2541-0849 e-ISSN: 2548-1398
Vol. 7, No. 11, November
2022
HEPA WATER
PURIFICATION INFLUENCE ON DECREASING GERMS NUMBER IN ISOLATION TREATMENT ROOM
KEDIRI REGENCY HOSPITAL
Joko Sasmito, Indasah��
Institut Ilmu Kesehatan (IIK) Strada Indonesia, Indonesia
Email: [email protected], [email protected]
Abstract
Pure and Fresh, is the air condition that everyone dreams
of anywhere and anytime, including sick people in the Hospital Treatment Room.
The germ index and room dust content also affect the comfort and health of
residents which is a standard quality standard for microbiological and physical
parameters for hospital air. This study aims to analyze the effect of HEPA air
purification in reducing germ numbers in the isolation treatment room of Kediri
Regency Hospital, and the specific purpose of this study is to analyze the
difference in the number of airborne germs in the isolation treatment room of
Kediri Regency Hospital before and after the use of HEPA air purification, This
study uses a pre-experimental design. The sample of this study was 5 class 1
rooms of the Isolation Treatment Room of Kediri Regency Hospital. The sampling
technique is total sampling. The Wilcokson test was
used for data analysis with a significant level (α) = 0.05. The results of
the data analysis showed that there was a difference in the number of airborne
germs in the isolation treatment room of Kediri District Hospital between
before the use of Air Purification HEPA and after the use of Air Purification
HEPA. So the use of Air Purification HEPA has an influence on the number of
airborne germs in the isolation treatment room of Kediri Regency Hospital.
Keywords: Air Purification, HEPA, Influence, Decreasing, Germs
Number.
Introduction
Pure
and Fresh, is the air condition that everyone wants anywhere and anytime,
including sick people in the Hospital Treatment Room. A clean environment in
hospitals is needed to support the health of patients and to reduce the chances
of harm to patients who have weak immune systems (Kemenkes,� 2012). Hospital rooms have different
functions depending on the type of disease or the severity of the patient, and
also depending on different medical procedures, thus requiring air conditioning
with different levels of cleanliness (Kemenkes,� 2012).
As
a reference, the air is declared clean if there are no gases, pollutants and
smoke. It is said to be sterile if the total density or concentration of germ
numbers in the air does not exceed the specified Germ Number Index (Kemenkes, 2004). Air containing microorganisms can be a
medium for disease transmission (airborne disease) this can occur without
contact with patients or with contaminated objects, transmission is by
breathing air. These microorganisms are spread in the air through patients
coughing, sneezing, talking and laughing. In this process, saliva and mucus
come out in the form of droplets or nuclei (Catur Puspawati, 2020). Based on the air microbiological
examination in the second semester of 2020, the Germ Number Index in the
isolation room (Jasmine) of the Kediri District Hospital is Isolation A of 46
CFU/m3 and Isolation B of 24 CFU/m3. This figure shows that not all airborne germ
numbers in the treatment room, especially the isolation room, meet the existing
standards, namely according to the Regulation of the Minister of Health of the
Republic of Indonesia Number: 07 of 2019. Regarding Hospital Environmental
Health Requirements, which is 35 CFU/m3. Meanwhile, the particulate matter
measured based on PM 10 was recorded at 35 g/m3. The data shows the truth of
the fact that room air contains pollutants (germs and dust levels) that can
interfere with health and must be handled.
Hospitals
as a place of health services for the community must meet health requirements,
one of which is air quality. Good air quality is defined as air that is free of
contaminants, causes of irritation, discomfort or disturbance to the health of
occupants. The index of the number of germs and the level of dust (particulate
matter) of the room also affects the comfort and health of the occupants, which
are the standard quality standards for microbiological and physical parameters
for hospital air in accordance with the Regulation of the Minister of Health
No. 7 of 2019. To ensure air quality standards, it is necessary to monitor room
air quality at least 2 (two) times a year, sampling and inspection of air
quality parameters (germs, dust, and gases). (Kemenkes,� 2019).
The
use of air purification (HEPA Filter) is believed to have an important role in
maintaining indoor air quality by reducing small air particles such as smoke
and dust. Air purification has several filtration systems in it, one of which
is the High Efficiency Particulate Air (HEPA) Filter which is effectively
99.97% capable of filtering very fine particles up to 0.3 m. HEPA air
purification is very important in preventing the spread of bacterial and viral
organisms in the air (David A. Christopherson, 2020).
Air purifying systems are proven to be able to help and optimize the
cleanliness of the air and the environment from harmful pathogens such as
fungi, bacteria, and viruses (Hamilton Thorne, 2020).
Himanshu Mittal's
research (2011), on the ability of microorganisms to live in the use of HEPA
filters, showed that microorganisms could not survive after 48 hours of normal
use of HEPA filters. Furthermore, the results of Dae Hoon Park's research (2011), stated that HEPA Air Filters
are able to fight airborne infectious microorganisms, the spread of bacterial
and viral organisms in the air. Not many studies have examined the ability of
HEPA Air Purification in reducing the number of airborne germs and dust levels
in the room. The ability of HEPA Air Purification in cleaning indoor air
pollutants makes researchers interested in analyzing HEPA Air Purification in
reducing germ numbers and particulate matter levels in the isolation treatment
room of the Kediri District Hospital. The germ number index in this study was
measured using Plate Count Agar (PCA) media with the volumetric air sampling
method before and after HEPA Air Purification, while the dust content
(particulate matter) was measured using Low Volume Air Sampler (LVS) equipment
with hydrophobic filter paper with pore size 0.5 m.
Research Method
����������� This study uses a Quantitative
Approach Method. The following is the data collection process.
Data Collection Process
Data collection in
this study was carried out with the following stages:
1. Sampling (germ count) before the Air Purification HEPA Hospital Grade
�NATIF� is turned on.
This was done after the Air Purification HEPA Hospital Grade
"NATIF" had been turned off for 9-10 hours, based on the research of
Neti Yuliana (2008) which stated that maximum bacterial growth (log phase)
occurred at 3 to 9 hours. Meanwhile, Wahyuning (2018) stated that the maximum
bacterial growth (log phase) on Carboxy Methyl Cellulose media occurred at the
8th and 9th hours.
From the results of the two studies, it was concluded that the effect of
using HEPA Air Purification would not give meaning to the room air after being
turned off for 9 hours. This 9 hour time is the basis for this research to
conduct a sampling of indoor air bacteria after the HEPA Air Purification is
turned off.
2. Sampling (germ count) after the Air Purification
HEPA Hospital Grade �NATIF� is turned on.
This is done 2 (two) days after the Air Purification HEPA Hospital Grade
�NATIF� is turned on. In accordance with the results of research by Nunu Wati R
(2014) which stated that there was E. Coli bacteria in agar media that were
stored for 0 days, 2 days, 4 days and 6 days. With the largest number of
colonies occurring on day 2. Agus Niar F (2016) stated that the logarithmic
growth rate of pseudomonas bacteria occurred on day 2 to day 4 and there had
been a slowdown after day 5.
From the results of these two studies, it can be concluded that the largest
number of colonies occurred on day 2, this is what underlies this research to
conduct sampling of indoor air bacteria on day 2 after HEPA Air Purification is
turned on.
The measurement of
variables is carried out in the following way:
The measurement of
the number of germs in the air is done by placing a petri dish containing agar
media in the isolation treatment room. Petri dishes in volumetric air sampling
were left open for 15 minutes so that the agar medium was exposed to room air.
After 15 minutes, each dish was covered and labeled. Petri dishes that have
been labeled are put into the sample box and taken to the Microbiology
Laboratory for microbiological testing. After that, the petri dishes were
incubated for 48 hours at 37oC and then the growth was observed. If for 48
hours a positive result is obtained, namely the agar medium is overgrown with
microorganisms, then proceed with the calculation of bacteria (germ number)
with units of CFU/m3.
Test Statistics
Manual data processing was carried out on the total number of bacterial
colonies (germ numbers) in the room without the use of an air purifier, and in
a room with the use of an air purifier. The data is presented in tabular form
and processing using Microsoft Excel.
In this study, the data obtained from the observations were analyzed
statistically using SPSS analysis, namely the paired sample T test to see:
1. Is there a difference in the number of
germs between a room without the use of an air purifier, and a room with the
use of an air purifier with the interpretation of the results as follows: If
the value is significant / P-Value > 0.05; then Ho is accepted if the value
is significant / P-Value <0.05; then Ho is rejected.
2. Is there a difference in air dust levels
between a room without the use of an air purifier, and a room with the use of
an air purifier with the interpretation of the results as follows: If the value
is significant / P-Value > 0.05; then Ho is accepted if the value is
significant / P-Value <0.05; then Ho is rejected.
In this study, the data obtained
from the observations were analyzed statistically using SPSS analysis, namely
the paired sample T test if the distribution of the research data was normal,
if the distribution of the research data was abnormal then the data were
analyzed using the Wilcoxon test.
Results and Discussion
A. Univariate Analysis
An overview of the airborne germ numbers in
the isolation treatment room of the Kediri Regency General Hospital can be seen
in table 1 below.
Table 1
Overview of Germ Numbers and Dust Levels in the Treatment Group
|
No.
Room |
Room
Name |
Number
of bacteria (CFU
/m3) |
|
|
Before
HEPA |
After
HEPA |
||
|
1 |
Jasmine 1 |
31 |
25 |
|
2 |
Jasmine 2 |
33 |
10 |
|
3 |
Jasmine 3 |
35 |
31 |
|
4 |
Jasmine 4 |
28 |
10 |
|
5 |
Jasmine 5 |
27 |
18 |
Table 2
Descriptive
Statistics
|
|
N |
Mean |
Std. Deviation |
Minimum |
Maximum |
|
Before HEPA |
5 |
30.8000 |
3.34664 |
27.00 |
35.00 |
|
After HEPA |
5 |
18.8000 |
9.25743 |
10.00 |
31.00 |
From table 2, it is known that before the use of HEPA the highest germ number was 35 CFU/m3 and the lowest was 27 CFU/m3 with an average of 30.80 CFU/m3, while after using HEPA the highest germ number was 31 CFU/m3 and the lowest was 10 CFU/m3. with an average of 18.80 CFU/m3.
B. Data Normality Test
An illustration
of the distribution of airborne germ numbers in the isolation treatment room at
the Kediri Regency General Hospital can be seen in the graph below.
1. Normality of the number of germs in the
air before using HEPA
Table 3
Test for Normality of Germ Numbers Before Use of HEPA
|
Tests of
Normality |
||||||
|
|
Kolmogorov-Smirnova |
Shapiro-Wilk |
||||
|
Statistic |
df |
Sig. |
Statistic |
df |
Sig. |
|
|
Before HEPA |
,199 |
5 |
,200* |
,950 |
5 |
,737 |
|
*. This is a lower bound of the true
significance. |
||||||
|
a. Lilliefors Significance Correction |
||||||
From Table 3 above, the significant value of P-Value is: 0.737; so that > from the value of : 0.05 ; then Ho is accepted so that it can be concluded that the distribution of the data on the number of germs before the use of HEPA was not normal.
For more details, it can also be seen from graph 4.1, where the distribution of data is outside a straight line so that the distribution of data is not normal.
Graph 1
Normality of Airborne Germ
Numbers Before HEPA Use
2. Normality of airborne germ numbers after
using HEPA
Table 4
Test for Normality of Germ Numbers Before Use of HEPA
|
Tests
of Normality |
||||||
|
|
Kolmogorov-Smirnova |
Shapiro-Wilk |
||||
|
Statistic |
df |
Sig. |
Statistic |
df |
Sig. |
|
|
After HEPA |
,229 |
5 |
,200* |
,901 |
5 |
,417 |
|
*. This is a lower bound of the true
significance. |
||||||
|
a. Lilliefors Significance Correction |
||||||
From Table 4 above, the significant value of P-Value is: 0.417; so that > from the value of : 0.05 ; then Ho is accepted so that it can be concluded that the distribution of data on the number of germs after using HEPA is not normal.
For more
details, it can also be seen from graph 4.1, where the distribution of the data
is outside a straight line so that the data distribution is not normal.
Graph 2
Normality of airborne germ numbers after
using HEPA
C. Bivariate Analysis
In
this study, paired sample T test analysis could not be used because the
research data were not normally distributed, so the data were tested using the
Wilcoxon test.
Tabel 5
Test Statistik
Wilcoxon
|
Test
Statisticsb |
|
|
|
Aftrer HEPA � Before HEPA |
|
Z |
-2.023a |
|
Asymp. Sig. (2-tailed) |
.043 |
|
a. Based on positive ranks. |
|
|
b. Wilcoxon Signed Ranks Test |
|
From
Table 5 it is known that: The results of statistical tests (Wilcoxon) obtained
a significant value of 0.043 (p value < 0.05), then H0 is rejected, meaning
that there is a difference in the number of airborne germs in the Isolation
treatment room of the Kediri District Hospital between before the use of HEPA
Air Purification and after the use of water. HEPA Purification. So the use of
HEPA Air Purification has an influence on the number of airborne germs in the
Isolation treatment room of the Kediri District Hospital.
Discussion
Based on the results of the bivariate analysis, it proved that there was a difference in the number of airborne germs in the Isolation treatment room of the Kediri District Hospital between before the use of HEPA Air Purification and after the use of HEPA Air Purification. The results of the univariate analysis revealed that all the rooms studied had a decrease in the number of airborne germs.
These findings are in line with Hamilton Thorne (2020), stating that the Air purifying system is proven to be able to help and optimize the cleanliness of the air and the environment from harmful pathogens such as fungi, bacteria, and viruses. According to David A. Christopherson (2020), explained that the use of air purification (HEPA Filter) is believed to have an important role in maintaining indoor air quality by reducing small air particles such as smoke and dust. Air purification has several filtration systems in it, one of which is the High Efficiency Particulate Air (HEPA) Filter which is effectively 99.97% capable of filtering very fine particles up to 0.3 m. HEPA air purification is very important in preventing the spread of bacterial and viral organisms in the air.
Cleaning actions (sweeping and mopping) the isolation treatment room of the
Kediri Regency General Hospital, which was carried out 2 (two) times a day, in
the morning and afternoon. While the cleaning of walls, ceilings and furniture
is carried out once a week or after the room is not occupied by the patient
(the patient goes home), then after the room is not occupied by the patient
(the patient goes home), the room air is disinfected using drymist equipment
with 5% H2O2 material. . The cleaning action factor described above also causes
the air quality in the isolation treatment room of the Kediri Regency General
Hospital to be good, in the sense of meeting the microbiological parameter
quality standards for hospital air in accordance with the Decree of the
Minister of Health no. 1204 of 2004 concerning Hospital Environmental Health
Requirements where the entire value of germ numbers before or after the use of
HEPA Air Purification is still far below the maximum value limit of 200-400
CFU/M3.
Conclusions
Based on the results of the study, it can be concluded that
before the use of HEPA, the highest germ number was 35 CFU/m3 and the lowest
was 27 CFU/m3 with an average of 30.80 CFU/m3. And after the use of HEPA, the
highest germ number was 31 CFU/m3 and the lowest was 10 CFU/m3 with an average
of 18.80 CFU/m3. The results of the Bivariate Analysis proved that there was a
difference in the number of airborne germs in the Isolation treatment room of
the Kediri District Hospital between before the use of HEPA Air Purification
and after the use of HEPA Air Purification. The results of the univariate
analysis revealed that all the rooms studied had a decrease in the number of
airborne germs. The use of air purification (HEPA Filter) is believed to have
an important role in maintaining indoor air quality by reducing small air
particles such as smoke and dust. Air purification has several filtration
systems in it, one of which is the High Efficiency Particulate Air (HEPA)
Filter which is effectively 99.97% capable of filtering very fine particles up
to 0.3 m. HEPA air purification is very important in preventing the spread of
bacterial and viral organisms in the air.
