Bacteriological Analysis of Water Samples from Different Points in a Tertiary Care Hospital

Abstract

Introduction: Water is a critical component of public health, and failure to supply safe water will place a heavy burden on humanity. Drinking water is the major source of microbial pathogens in developing regions. Water contamination can be a major source of infection in a hospital. Aim: To determine the percentage of contamination (if contamination is present) with calculation of prevalence of bacteria and to analyse the bacteriological profile of the organisms present. Materials and Methods: Hi Media test kit was used to collect water samples from 20 different points in the hospital and was subjected to incubation for 24-48 hours. The bottles that showed colour change were further subjected to culture and sensitivity with identification of organism. Results: There was 100% contamination of the water samples and the organisms identified include E.coli, Klebsiella, Enterobacter, Citrobacter, Proteus, NF GNB, Salmonella, Pseudomonas and Acinetobacter. Some of these organisms and isolates were found to be resistant to Cefuroxime, Ampicillin, Amoxicillin- clavulanic acid, Cefoperazone, Imipenem. Conclusion: These results provoked the authors to reconsider the efficacy of the existing water purification systems and analyse where the point of contamination is, take corrective measures and use the apt method of purification systems to improve the quality of life of the patients.

Full text

Journal of Clinical and Diagnostic Research. 2019 Nov, Vol-13(11): DC04-DC09
44
DOI: 10.7860/JCDR/2019/41826.13272
Original Article
Microbiology Section
Bacteriological Analysis of Water Samples from
Different Points in a Tertiary Care Hospital
INTRODUCTION
Hospital is a common source of microorganisms. People, both
the staff and the patients are at an increased risk of acquiring the
infections from the hospital. Nosocomial infection is the clinical
infection that develops after 48-72 hours of admission to a hospital
resulting from exposure to organisms endemic within the Hospital.
These infections were neither overtly present nor within the
incubation period in the patients at the time of admission. Infections
that are clinically evident after discharge but contracted from the
hospital are also a part of this spectrum [1]. There are many ways
through which this type of spread is known to occur such as air
and fomites, doctors and staff nurse (because of meeting several
patients a day), irrational use of antibiotics, improper disposal of
waste, ineffective aseptic precautions, improper screening system,
improper air condition system [2].
Also, water is a critical component of public health, and failure
to supply safe water will place a heavy burden on humanity [3].
Drinking water is the major source of microbial pathogens in
developing regions [4]. Furthermore, water may be contaminated
by disease causing pathogens from garbage piling, improper waste
disposal and excessive use of agriculture chemicals, all of which
is very common in Bangalore. Drinking water being transported
through distribution networks will be subjected to both chemical
and microbiological quality changes [5].
Lack of safe drinking water and proper sanitation leads to number
of diseases such as cholera, dysentery, salmonellosis, typhoid
and everyday millions of lives are claimed [6]. It is estimated that
1.1 billion people in developing countries have no access to clean
water and 2.4 billion people have no sanitation. Consequently,
250 million people are exposed to water borne diseases resulting in
10-20 million deaths every year [7].
Coliform bacteria are a commonly used bacterial indicator of
sanitary quality of foods and water. Coliforms include the genera like
Citrobacter, Enterobacter, Klebsiella, Escherichia, etc., Presence
of these organisms indicate the presence of other pathogenic
organisms like viruses, protozoa and parasites.
Fecal coliforms are a group of Fecal Indicator Bacteria (FIB) used
to assess water quality throughout the world [8]. FIB is a group
of microorganisms of the commensal flora of gut used to indicate
the potential occurrence of pathogens in water. This group includes
Escherichia coli, Enterococcus, Clostridia, etc.
There are three types of water contamination namely physical
contamination, chemical contamination and bacteriological
contamination. Contamination of the water supply can occur at the
source, the storage tank, the overhead tanks, the pipe lines and
ineffective purification systems.
Water is one of the main sources of contamination. There is a dearth
of data in South India (Bangalore) regarding the contamination of
water supply in a hospital which is beneficial for providing quality
of water. Since there have not been many studies conducted to
determine the bacteriological analysis of water in Bangalore, this
paper aims to determine the prevalence of bacteria along with its
bacteriological profile using Hi Media Water Coliform Kit.
The Hi Media Water Coliform Kit is a simple and an easy method
to determine the presence of microorganisms. It is a commercially
available ready water testing kit in India for speedy and accurate
detection of microbes in potable water. The samples that prove to
be contaminated will be subjected to culture and sensitivity with
antibiotic sensitivity testing to determine the bacteriological profile
of the organisms. This method can pave way to determine if the
water supply in a hospital can be a significant source of infection
contributing to nosocomial and post OP infections.
MATERIALS AND METHODS
In an attempt to determine the percentage of contamination of
water samples along with the determination of bacteriological
profile with its prevalence, this descriptive study was undertaken
for a period of 1 October 2016 to 30 November 2016 in a tertiary
care hospital in Bangalore, Karnataka, India. Institutional Ethics
YASHRAJ KIRANKUMAR1, GIRIDHARA UPADHYAYA2, VASUNDHARA BHATIA3
Keywords: Coliform, Communicable diseases, Culture and sensitivity, Drug resistance, Water contamination
ABSTRACT
Introduction: Water is a critical component of public health,
and failure to supply safe water will place a heavy burden
on humanity. Drinking water is the major source of microbial
pathogens in developing regions. Water contamination can be
a major source of infection in a hospital.
Aim: To determine the percentage of contamination (if
contamination is present) with calculation of prevalence of
bacteria and to analyse the bacteriological profile of the
organisms present.
Materials and Methods: Hi Media test kit was used to collect
water samples from 20 different points in the hospital and
was subjected to incubation for 24-48 hours. The bottles that
showed colour change were further subjected to culture and
sensitivity with identification of organism.
Results: There was 100% contamination of the water samples
and the organisms identified include E.coli, Klebsiella,
Enterobacter, Citrobacter, Proteus, NF GNB, Salmonella,
Pseudomonas and Acinetobacter. Some of these organisms and
isolates were found to be resistant to Cefuroxime, Ampicillin,
Amoxicillin- clavulanic acid, Cefoperazone, Imipenem.
Conclusion: These results provoked the authors to reconsider
the efficacy of the existing water purification systems and
analyse where the point of contamination is, take corrective
measures and use the apt method of purification systems to
improve the quality of life of the patients.

www.jcdr.net Yashraj Kirankumar et al., Bacteriological Analysis of Water Samples at Different Points in a Tertiary Care Hospital
Journal of Clinical and Diagnostic Research. 2019 Nov, Vol-13(11): DC04-DC09 55
Bronchoscopy room19.
Orthopaedics ward20.
Procedure
The 20 different source points of water were chosen for •
bacteriological water analysis based on the usage and patient
inflow after studying the floor plan of the hospital. Each of the
chosen 20 points had metal taps that were most commonly
used by doctors, staff nurse and patients. Plastic taps were
excluded. For collection of water samples, each tap was opened
and the water was allowed to flow through for 2 minutes. The
tap was then closed. Later, the tap was cleaned with spirit
thoroughly immediately after which it was lit using a spirit lamp.
This procedure was employed for removing any bacteria that
were already present due to their use. After the tap cooled
down, it was opened and 100 mL of water was collected after
letting the first 30-50 mL of water flow through it. The water
was directly collected in the 2 sterile bottles provided in the kit.
Once the water was collected, the cap of the bottle was closed
immediately to prevent contamination. After collection of water,
the nutrient media was added to the two bottles and labeled ‘A’
and ‘B’ respectively and mixed gently in rotatory movements.
All the sample bottles were then incubated at 37°C for 24
hours. All the bottles were inspected for colour change after
24 hours. Any bottle with colour change was noted and each
of it was cultured on MacConkey agar (MA) and Blood agar
(BA) by streaking and all the culture plates were incubated at
37°C for 24 hours.
On day 3, each culture plate was checked for growth •
Clearance was taken before commencing the study (Reference
number: KIMS IEC/ UG-29/ 2016). Twenty different water source
points in the hospital were chosen for the study. Physical and
chemical analysis of water was excluded from the study. Isolation
of other organisms such as viruses, protozoa, parasites was also
excluded from this study. Although E.coli was included in the study,
Clostridium and Enterococcus were not included in this study as
the study focuses more on gram negative bacteriological profile for
water contamination.
Clostridium was excluded as the media and incubator for anaerobic
culture was not available at the time of the study. Other organisms
such as E.coli, Klebsiella, Enterobacter, Citrobacter, Proteus,
NF GNB, Salmonella, Pseudomonas, Acinetobacter, Vibrio were
included in the study. Isolation of these organisms can help in the
investigation of nosocomial infection. It can help in the treatment
of such infections. The data obtained can be significant in case of
any nosocomial outbreak ultimately helping in identification of the
source of infection.
Materials Used
This study uses single use test kits- Hi Water test kit (K015) •
supplied by Himedia Laboratories Pvt., Ltd., 20 sets of the kits
were used (Batch no. LOT0000280691 and LOT0000264880),
each containing 2 sterile bottles and 2 different nutrient Medias
‘A’ and ‘B’. Medium ‘A’ contains peptone (2 gm/Pack); Lactose
(0.5 gm/pack); dipotassium hydrogen phosphate (0.15 g/pack);
Ferric ammonium citrate (0.075 g/pack); Sodium thiosulphate
(0.1 g/pack); Sodium lauryl Sulphate (.01 g/pack); Bromo cresol
purple (0.005 g/pack) which helps in detection of Salmonella
species, E. coli, Citrobacter species. Medium ‘B’ contains
Peptone (1.2 g/pack); sucrose (2 g/pack); Sodium thiosulphate
(0.65 g/pack);sodium citrate (1 g/pack); Bile salt (0.6 g/pack);
Sodium chloride (1 g/pack); Indicator mix (0.06 g/pack) and
helps in detection of Vibrio species. Detection of organism
growth is based on change in colour of the medium.
Blood agar plates and Mac Conkey agar plates, Loop for •
streaking, burner for heating the loop during streaking,
Incubator, microscope, spirit, test tubes for biochemical tests
with the reagents if any, filter paper impregnated with oxidase
reagent.
Points of Water Sample Collection
Neonatal Intensive care unit1.
Labour room2.
Surgery Intensive care unit3.
Dialysis room4.
Causality5.
Medicine Intensive care unit6.
Heart center7.
Central/Main Intensive care unit8.
Microbiology lab9.
UD- Hotel (canteen)10.
Neurosurgery Operation Theatre Scrub sink11.
Obstetrics and Gynaecology Operation Theatre Scrub sink12.
Surgery Major Operation Theatre Scrub sink13.
Surgery ward14.
Surgery Minor Operation Theatre Scrub sink15.
Medicine ward16.
Orthopaedics minor Operation Theatre Scrub sink17.
Dermatology minor Operation Theatre Scrub sink18.
[Table/Fig-1]: Different types of colonies were noted and
were subjected to the following three biochemical tests.
Indole testa.
Mannitol Motility testb.
Triple sugar iron (TSI) test [9]c.
The test tubes were incubated at 37°C for 24 hours and the •
test tubes were noted for positive indole test i.e., formation of a
cherry red layer after using Kovac’s reagent [Table/Fig-2]. Gas
[Table/Fig-1]: Images showing growth obtained on culture plates.
[Table/Fig-2]: Image showing test tubes for Mannitol motility test, TSI test, Indole test.

Yashraj Kirankumar et al., Bacteriological Analysis of Water Samples at Different Points in a Tertiary Care Hospital www.jcdr.net
Journal of Clinical and Diagnostic Research. 2019 Nov, Vol-13(11): DC04-DC09
66
[Table/Fig-3]: Image showing antibiotic sensitivity testing by disc diffusion method.
Sl.
No Source point Sample Colour
Colonies
isolated Mannitol Motility TSI Indole Organism Antibiotic sensitivity
1 NICU
A Black LF P P A/A H2S N Proteus Sensitive to all
B Yellow
LF P P K/A P E. coli Sensitive to all
PLF P N K/A N Klebsiella Sensitive to all
2 Labour room
A Yellow
LF P P K/A P E. coli Sensitive to all except A, AC, CPZ
NLF P P K/A P E. coli Sensitive to all except A, AC, CPZ
B Yellow LF P N K/A N Klebsiella Sensitive to all
3 Surgery ICU
A Black
LF P N A/A P Klebsiella Sensitive to all
NLF P N A/A N Klebsiella Sensitive to all
B Yellow
NLF P P K/A P E. coli Sensitive to all
LF P P K/A N Enterobacter Sensitive to all
PLF N N K/A N NF GNB Sensitive to all
4 Dialysis Room
A Black
LF P N A/A N Klebsiella Sensitive to all
NLF P N A/A N Klebsiella Sensitive to all
PLF P P A/A H2S N Citrobacter Sensitive to all
B Yellow
LF N P A/A H2S N Proteus Sensitive to all
NLF P P A/A P E. coli Sensitive to all
Swarmimg N P A/A H2S N Proteus Sensitive to all
formation/blackish discolouration/colour of ‘But’ and ‘slant’ of
the test tube in case of TSI test done using stab and streak
method; and motility noted in mannitol motility test.
The organism was narrowed down by understanding the •
morphology of colonies formed on the agar plates and by
three biochemical tests. Further, the sensitivity of the organism
to different drugs was determined by Kirby- Bauer method.
The organism was streaked using a loop and an antibiotic disc
was placed [Table/Fig-3]. This was further incubated at 37°C
for 24 hours and the sensitivity was determined by analysing
Others) in the Water Sample
Eighteen samples were contaminated with E.coli (including
neurosurgery OT) indicating a prevalence of 90%, 13 with
Klebsiella, 9 with Enterobacter, 8 with Citobacter, 2 with
Proteus, 2 with NF GNB,1 with Salmonella (seen in MICU), 1
with Pseudomonas (seen in UD Hotel), 1 with Acinetobacter.
Isolation of organisms other than coliforms indicates that there
is a good chance of significant spread of nosocomial infection
through water. There is an increased risk of nosocomial
infection, especially in immuno compromised patients creating
difficulty in treating patients and increased mortality and
morbidity [Table/Fig-6].
3. To Determine the Bacteriological Profile of the
Organisms Present
Most of the isolates were sensitive to all drugs. However, a few
isolates of E.coli, Citrobacter, Enterobacter were resistant to
Ampicillin, Amoxicillin- clavunalic acid, Imipenem, Cefoperazone,
Cefuroxime. Antibiotic testing is essential as it helps in further
management of the patients and also helps to analyse the severity
of contamination. Such sensitivity patters shows us that there is an
indiscriminate use of antibiotics and genetically multi drug strains
are emerging.
DISCUSSION
Hospital water quality is directly related to patient’s health. A similar
study on microbiological status of drinking water suggested that
there was contamination with S. aureus, S. intermedius, S. felis and
S. saccharolyticus which was sensitive to erythromycin, tetracycline,
norfloxacin, ciprofloxacin. The antibiotic sensitivity was done by
disc diffusion method [9]. In another similar study done in Yaounde
University teaching hospital which concluded that 75% of water
samples of hospital were culture positive with Burkholderia cepacia,
Klebsiella, Acinetobacter, Citrobacter, Serratia causing increased
risk of nosocomial infection [10].
The above results obtained in this study indicate that E.coli
was a major contaminant of water in the hospital followed by
Klebsiella, Enterobacter, Citrobacter, Proteus, NFGNB, Salmonella,
Pseudomonas, Acinetobacter. Isolation of Salmonella poses
increased risk of Typhoid fever. Pseudomonas is notorious to cause
infection and sepsis, more commonly in immunocompromised
patients. With a contamination rate of 100%, one can infer that
the zone of inhibition [9].
RESULTS
The results obtained are tabulated as shown in [Table/Fig-4].
Based on the colonies obtained in the culture plates, biochemical
reactions, it was found that the samples were contaminated with
Salmonella species, Enterobacter, Klebsiella, E.coli, Citrobacter,
Proteus, NF GNB, Pseudomonas, Acinetobacter. Pseudomonas
was confirmed by performing Oxidase test which turned out to
be positive.
1. Percentage of Contamination
Since colour change has been observed in all samples, both ‘A’
and ‘B’ and culture has revealed that there is growth in all samples,
there is 100% contamination of water at all source points of
the hospital [Table/Fig-5].
2. To Identify the Prevalence of Bacteria (Coliform and

www.jcdr.net Yashraj Kirankumar et al., Bacteriological Analysis of Water Samples at Different Points in a Tertiary Care Hospital
Journal of Clinical and Diagnostic Research. 2019 Nov, Vol-13(11): DC04-DC09 77
5 Casuality
A Black LF P P K/A H2S N Citrobacter Sensitive to all except A, AC, IPM
B Black LF P P K/A P E. coli Sensitive to all except A, AC, IPM
6 MICU
A Black
NLF P P A/A N Enterobacter Sensitive to all except CPZ, A, AC
LF P P K/A P E. coli Sensitive to all except CPZ, A, AC
B Green
LF P P K/A H2S N Salmonella typhi Sensitive to all
PLF P N K/A N Klebsiella Sensitive to all
7 Heart center
ADark
red
LF P P A/A P E. coli Sensitive to all except CPZ, A, AC
NLF P N A/A N Klebsiella Sensitive to all
B Yellow
LF P P A/A N Enterobacter Sensitive to all except CPZ, A, AC
NLF P N A/A N Klebsiella Sensitive to all
8 ICU Main
A Yellow
LF P P A/A H2S N Citrobacter Sensitive to all
NLF P P A/A N Enterobacter Sensitive to all
BDark
Yellow
LF P P K/A N Enterobacter Sensitive to all
PLF P P K/A P E. coli Sensitive to all
9 Microioloy lab
A Black LF P P A/A H2S N Citrobacter Sensitive to all except AC and A
BDark
Green
PLF P P K/A N Enterobacter Sensitive to all except AC and A
LF P P K/A P E. coli Sensitive to all
10 UD Hotel
A Yellow
Spreading LF N P K/K N NF GNB Sensitive to all
NLF P N A/A N Klebsiella Sensitive to all
B Black Oxidase P, NLF P P K/K N Pseudomonas Sensitive to all
11 Neurosurgery OT
A Black
LF P P A/A H2S N Cirtobacter Sensitive to all except AC and A
PLF P P A/A H2S N Cirtobacter Sensitive to all except AC and A
B Black
LF P P A/A P E. coli Sensitive to all
NLF P N A/A N Klebsiella pneumonia Sensitive to all
12 OBG OT
A Black LF P P A/A N Enterobacter Sensitive to all
B Yellow LF N N K/K N Acinetobacter Sensitive to all
13 General surgery OT
A Black
LF P P A/A P E. coli Sensitive to all except CPZ, A, AC
NLF P P A/A P E. coli Sensitive to all except CPZ, A, AC
B Black LF P N A/A N Klebsiella pneumonia Sensitive to all
14 Surgery ward
A Green
LF P P A/A N Enterobacter Sensitive to all
NLF P P A/A P E. coli Sensitive to all
B Green P N A/A N Klebsiella pneumonia Sensitive to all
15 Surgery minor OT
A Black
LF P P A/A H2S N Citrobacter Sensitive to all
PLF P P A/A H2S N Citrobacter Sensitive to all
BDark
yellow LF P P A/A P E. coli Sensitive to all except A, AC, CPZ
16 Medicine ward
A Black
LF P P A/A H2S N Citrobacter Sensitive to all except A, AC, IPM
NLF P P A/A H2S N Citrobacter Sensitive to all except A, AC, IPM
B Yellow LF P P A/A P E. coli Sensitive to all except A, AC, CPZ
17 Orthopaedics minor OT
A Yellow
LF P P A/A H2S N Citrobacter Sensitive to all
NLF P P A/A H2S N Citrobacter Sensitive to all
B Yellow
LF P P A/A P E. coli Sensitive to all
NLF P N A/A N Klebsiella pneumonia Sensitive to all
18 Dermatology minor OT
A Yellow
LF P P A/A P E. coli Sensitive to all
NLF P P A/A N Enterobacter Sensitive to all
B Yellow
LF P P A/A N Enterobacter Sensitive to all
NLF P N A/A N Klebsiella pneumonia Sensitive to all
19 Bronchoscopy
ADark
Yellow LF P P A/A P E. coli Sensitive to all
B Green NLF P P A/A N Enterobacter Sensitive to all except CXM
20 Orthopaedics ward
A Yellow
LF P P A/A N Enterobacter Sensitive to all except A, AC, CPZ
NLF P P A/A P E. coli Sensitive to all except A, AC, CPZ
B Yellow
LF P N A/A N Klebsiella pneumonia Sensitive to all
NLF P N A/A N Klebsiella pneumonia Sensitive to all
[Table/Fig-4]: Summary of colonies isolated and noted after subjected to the three different biochemical tests as the samples were taken from 20 different source points of
water along with various organisms and its antibiotic sensitivity.
the existing water treatment of the hospital is not up to the mark
showing that the water is unfit for use and could be one of the
potential sources of infections in patients. This could be because
of patients coming in direct contact with water, doctors washing

Yashraj Kirankumar et al., Bacteriological Analysis of Water Samples at Different Points in a Tertiary Care Hospital www.jcdr.net
Journal of Clinical and Diagnostic Research. 2019 Nov, Vol-13(11): DC04-DC09
88
their hands and touching patients, scrubbing before surgery. Post-
operative patients, Diabetics and immune-compromised patients
are at a higher risk of acquiring these diseases, possibly increasing
the disability and morbidity of the patient with increase in duration
of hospital stay and delayed recovery time, creating more trouble to
patients who probably cannot afford the extended treatment. The
above results were discussed in detail with the hospital management.
The concerned authorities promised to take necessary action to
reduce water contamination by cleaning the water tanks and
installation of new water purification systems. Studies suggest that
there is an increased risk of postoperative infections, mainly due
to water. Prevention is always better than cure. With that in mind,
measures have to be taken to prevent possible risk of transmission
of communicable diseases and help prevent further complications,
reduce mortality and morbidity of patients coming to the hospital.
The following steps can be taken at different levels.
Doctors can use sterile gloves while examining the patients. In
the Operation theatre, after scrubbing, spirit can be used. Spirit
should also be used before and after examining a patient to prevent
spread of infection. Furthermore, each department of the hospital
has to take initiative to clean the water taps regularly, fumigate the
wards and operation theatre regularly. Regular water testing helps
in monitoring of the water quality. With the advancement in science
and technology, use of biosensors and spectrophotometric methods
are now trending for detection of microorganisms. Proper waste
disposal and Proper sewage treatment plan has to be maintained by
using closed dustbins, frequent cleaning of water tanks, changing
of old pipes and keeping the tanks closed. Good hygiene is also
very essential. Studying the patterns of infection in patients can
help identify the root cause and source of infection. The hospital
administrative department can install automatic taps that reduces
the infection as it eliminates manual opening of taps.
Regular inspection by the hospital authorities is needed. The
hospital can install and use the techniques for water treatment such
as Boiling, UV light, chemicals like chlorine, electronic purification,
and filtration by reverse osmosis.
According to WHO, about 1.1 billion people globally drink unsafe water
and the vast majority of diarrhea associated diseases reported across
the globe is attributable to unsafe water, sanitation and hygiene. Since
water-borne diseases are still major health burden in many parts of
the world, allowing the water to come to a rolling boil followed by
cooling is sufficient to inactivate bacteria, virus and protozoa [11].
This method is simple to practice, easy and cost effective. UV Light
is an expensive but good bactericidal agent. Chlorine, a commonly
used chemical method of water purification is good bactericidal
agent. In chlorination of water, chlorine forms hydrochloric acid and
hypochlorous acid which is bactericidal in nature. It is available in
solid, liquid and gaseous forms. Hydrogen peroxide may be used in
emergencies. Oxidation using ozone is also done but it is toxic and
expensive. Filtration of water, however, is one of the best methods
for water filtration in large scale [12].
Although mechanical filters such as ceramic filters, Katadyn filters,
berkefeld filter, chamberland filter can used, reverse osmosis is one
of the most efficient methods of water purification and cost efficient
on a large scale. It uses a membrane with microscopic holes that
filter out the bacteria. The mechanism of action can be broken down
into 5 stages. In stage one, the sand, silt and dust particles are
removed. In the second stage, there is an activated carbon filter that
removes all the chemical impurities. In stage three, there is a gag
filter that removes the bad taste and odour producing substances.
In stage four, the water passes through 0.0001 mm pore allowing
only water molecules to pass through. In stage five, Bacteriostatic
silver impregnated activated carbon prevents the growth of bacteria
and removes the odour [12]. One or more of the above methods
can be used to keep the water clean and fit for use.
Water is a main source of hospital acquired infections. Maintaining
water fit for use will reduce the number for hospital acquired infections.
Installation of reverse osmosis in the hospital premises is the best
method for water purification [13]. It paves way for preventing the
occurrence of multi drug resistance bacteria. It has good efficiency
and is a one time investment. The results are worthy.
LIMITATION
This study does not include the physical and chemical contamination
of water. Furthermore, Viruses, Parasites and protozoa were
excluded from study due to lack of facility.
CONCLUSION
One or more of the above methods, individually or in combination
could be used to treat water. Water from different points of the
hospital has to be taken again and culture and sensitivity must be
done to check the efficacy of the system.
Proper water facilities are an essential requisite to ensure infections
do not spread through contaminated water. The Hospital should
inspect the water sources using the floor map and look for points
of possible contamination and fix it. This study also provides a
cautionary tool to maintain a proper sanitation and hygiene in
a health care center so as to prevent occurrence of diseases in
already immunosuppressed patients. The other methods like
boiling, chlorination etc., can also be employed. Water quality in a
hospital should be maintained strictly to help build a better quality
of life of patients.
REFERENCES
Ananthanarayan, Paniker. Ananthanarayan and Paniker’s Textbook of [1]
Microbiology, 9th edition. Universities Press. Page 644.
Ahmadi Jalali Moghadam M, Honarmand H, Asfaram Meshginshahr S. [2]
Contamination of hospital water supplies in Gilan, Iran, with Legionella
pneumophila, Escherichia coli, and Pseudomonas aeruginosa. Interdisciplinary
Perspectives on Infectious Diseases. 2015;2015:809842.
Mara D, Lane J, Scott B. Sanitation and health. PLoS Med. [3]
2010;7(11):e1000363.
Ashbolt NJ. Microbial contamination of drinking water and disease outcomes in [4]
developing regions. Toxicology. 2004;198:229-38.
Boe-Hansen R. Microbial growth in drinking water distribution systems. Lyngby: [5]
Environment & Resources DTU. Technical University of Denmark, 2001. 49 p.
Organism Samples positive Total number of samples Prevalence
E. coli 18 20 90%
Klebsiella 13 20 65%
Enterobacter 9 20 45%
Citrobacter 8 20 40%
Proteus 2 20 10%
NF GNB 2 20 10%
Salmonella 1 20 5%
Pseudomonas 1 20 5%
Acinetobacter 1 20 5%
Vibrio 0 20 0%
[Table/Fig-6]: Indicates the prevalence of the organisms.
No. of samples Growth positive Growth negative Percentage
20 20 0 100%
[Table/Fig-5]: Image showing contamination in all the bottles.

www.jcdr.net Yashraj Kirankumar et al., Bacteriological Analysis of Water Samples at Different Points in a Tertiary Care Hospital
Journal of Clinical and Diagnostic Research. 2019 Nov, Vol-13(11): DC04-DC09 99
PARTICULARS OF CONTRIBUTORS:
1. Graduate/Student, Department of Microbiology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India.
2. Associate Professor, Department of Microbiology, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India.
3. Senior Resident, Department of Microbiology, Hindu Rao Hospital, New Delhi, India.
PLAGIARISM CHECKING METHODS: [Jain H et al.]
• PlagiarismX-checker:Apr25,2019
• ManualGoogling:Jul18,2019
• iThenticateSoftware:Oct10,2019(6%)
ETYMOLOGY: Author Origin
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:
Mr. Yashraj Kirankumar,
112, Surabhi, 3rd Main, 5th Stage, BEML Layout, Next to Swargarani Church,
Rajarajeshwari Nagar, Bangalore-560098, Karnataka, India.
E-mail: yashraj96@gmail.com
Date of Submission: Apr 24, 2019
Date of Peer Review: Jun 17, 2019
Date of Acceptance: Jul 30, 2019
Date of Publishing: Nov 01, 2019
AUTHOR DECLARATION:
• FinancialorOtherCompetingInterests: No
• WasEthicsCommitteeApprovalobtainedforthisstudy? Yes
• Wasinformedconsentobtainedfromthesubjectsinvolvedinthestudy? NA
• Foranyimagespresentedappropriateconsenthasbeenobtainedfromthesubjects. NA
Zamxaka M, Pironchev G, Muyiwa NYO. Microbiological and physico-chemical [6]
assessment of the quality of domestic water sources in selected rural communities
of the Eastern Cape Province, South Africa. Water SA. 2004;30:333-40.
Desta K. Physico-chemical and bacteriological quality assessment of drinking [7]
water from source to households distribution Point in Debrezeit town. M.Sc.
thesis, Addis Ababa University, Ethiopia;2009.
Sadowsky M, Whitman. 8R 2011. Conclusions and Future Use of Fecal Indicator [8]
Bacteria for Monitoring Water Quality and Protecting Human Health, p 295-302.
In Sadowsky M, Whitman R (ed), The Fecal Bacteria. ASM Press, Washington,
DC. doi: 10.1128/9781555816865.ch13
Aditi FY, Rahman SS, Hossain MM. A study on the microbiological status of [9]
mineral drinking water. Open Microbiol J. 2017;11:31-44.
Gonsu KH, Guenou E, Toukam M, Ndze VN, Mbakop CD, Tankeu DN. [10]
Bacteriological assessment of the hospital environment in two referral hospitals
in Yaoundé-Cameroon. Pan Afr Med J. 2015;20:224.
World Health Organization (WHO). The World Health Report, Switzerland: World [11]
Health Organization, 2002
Suryakantha AH. Community Medicine with Recent Advances. 3[12] rd Edition.
Jaypee Brothers Medical Publishers. Page 27-40.
Gao HF, Tang ZH. The control system design for central water purifying water [13]
treatment in hospital, Chemical engineering transactions. AIDIC. 2015;46:919-
24. DOI:10.3303/CET1546154, 2015
List of Abbreviations:
E- coli- Escherichia Coli
SICU- Surgery Intensive care unit
MICU- Medicine Intensive care unit
ICU- Intensive care unit
OBG- Obstetrics and Gynaecology
OT- Operation Theatre
BA-Blood agar
MA- MacConkey agar
NICU- Neonatal Intensive care unit
MM- Mannitol Motility
TSI- Triple Sugar Iron
LF- Lactose Fermenting
NLF- Non Lactose fermenting
NF GNB- Non fermenting gram negative bacilli
P- Positive
N- Negative
A/A- Acid/Acid
K/K- Base/Base
A/K- Acid/Base
K/A- Base/Acid
H2S- Hydrogen Sulphide
CPZ- Cefoperazone
A- Ampicillin
AC- Amoxicillin- clavulanic acid
IMP- Imipenem
CXM- Cefuroxime
Post- OP- Post Operation
PLF- Pale Lactose Fermenting