Are liquids an efficient vehicle of healthcare associated infections? A review of reported cases in Italy (2000- 2014)

INTRODUCTION: In the field of healthcare-associated infections (HCAIs), one of the most reported, studied and discussed sources of infections is water, partly due to its controllability, but also because healthcare facilities, especially hospitals, require a significant quantity of water per day. In addition to water, during healthcare procedures, other liquids can serve as source of infections. The present study reports a review of those HCAIs associated to liquid vehicles occurred in Italy during the period 2000-2014. METHOD: The review focused on cases of liquid-associated HCAIs in both sporadic cases and outbreaks according to the definition provided by both Word Health Organization and United States' Centers for Disease Control and Preventions in 2011. The review included all original papers published in peer-reviewed journals, in which the association between the infection and the exposure to contaminated water/other fluid was demonstrated by epidemiological and/or molecular methods. Articles describing cases due to parenteral transmitted pathogens (by blood or blood-derived fluids) were excluded. RESULTS: During the period 2000-2014, 34 episodes have been described for a total of about 400 cases of infection. Isolations included genus Legionella, Pseudomonas, Serratia, Ralstonia, Burkolderia, Klebsiella and other pseudomonadaceae. The results confirm that HCAIs can be associated also to liquids other than piped water. The large majority of articles refers to hospital wards where patients with high risk of infections are usually admitted. DISCUSSION: The review highlights a great number of HCAIs, but if we consider that the large part of HCAIs are not reported in literature, it is clear that the burden of this phenomenon is by far higher. Many cases of HCAI were identified in the context of local surveillance systems, demonstrating their role in HCAI control. With regard to diagnosis, the isolation and identification of the etiological agent is critical to reach the source of infection and to plan the necessary disinfection measures. Therefore, it is possible to conclude that, through a multiple approach of engineering and hygiene measures, as well as surveillance ad management of hospital liquids, the risk for contracting "water born" HCAIs may be controlled

Health inequalities and inadequate housing. The case of exceptions to hygienic requirements for dwellings in Italy

Negli ultimi decenni, i requisiti igienici italiani per le abitazioni sono stati modificati da più deroghe. Scopo del presente lavoro è analizzare le deroghe introdotte a livello nazionale, regionale e locale. Le deroghe più importanti riguardavano l'uso abitativo di seminterrati e sotterranei e il restauro di edifici. Il documento descrive anche le norme in materia di indennità per violazione degli abusi nell'edilizia. Gli autori sottolineano la necessità di maggiore uniformità e chiarezza nella determinazione degli standard sanitari delle abitazioni, nonché di una semplificazione della legislazione esistente.In the past decades, Italian hygienic requirements for dwellings have been modified by multiple derogations. Aim of the present work is to analyse the derogations introduced at a national, regional, and local level. The most important derogations were related to the habitable use of semi-basements and garrets, and building restoration. The paper also describes the regulations regarding indemnity for infringement of building abuses. The authors underline the need for more uniformity and clarity in the determination of health standards of dwellings, as well as for a simplification of the existing legislation

Development of an innovative method for the evaluation of fungal contamination of surfaces

The objective of this technical report is to compare the ability to capture fungal spores through samples performed with three different methods: Rodac contact plates, cotton pad and a pad prepared with a dusting cloth (DC pads) selected from those available on the market. The tests were conducted using a suspension of Aspergillus niger conidia equal to 0.5 MacFarland diluted 1/30, 1/40, 1/50, 1/100. With each of these dilutions 3 sterile tiles of stainless steel were contaminated, each divided into 16 small squares, in the center of which 0.1 ml of the dilution chosen was placed and left to dry (for a total of 12 sheets). In addition, we have used other 6 tiles to repeat the experience with dilutions 1/40 and 1/50. A total of 288 squared surfaces were contaminated: 96 of these were sampled with Rodac contact plates, 96 with cotton pads and 96 with DC and then inseminated in Petri plates. Sabouraud dextrose agar was used as culture medium for the first 12 plates, while, for the other 6 plates Sabouraud dextrose agar added with lecithin and polysorbate 80 was used. All plates were incubated at 37 degrees for 18 hours. To estimate the differences among the sampling methods and the dilutions tested, multiple linear regression was used. The analysis showed that the number of colonies harvested at dilution 1/40 is 13% higher (P = 0.09) than the number harvested at dilution 1/50 and the number of colonies harvested at dilution 1/30 is 6% higher than dilution 1/50 (P = 0.52). With regard to the comparison between the number of colonies harvested with Rodac contact plates, with cotton pads and DC pads, regression analysis shows that cotton pads harvest a number of fungal cfu 5 times higher than those detected with Rodac plates, while DC pads harvest a number of fungal ufc 6 times higher than those detected with Rodac plates (P < 0.00005). These results, although preliminary, indicate that DC pads are a sensitive and simple approach for the environmental control of fungal contamination

Adeguare le risposte ai nuovi problemi dell'abitare in una società che cambia

Il lavoro focalizza l’attenzione sulle conseguenze sanitarie delle recenti trasformazioni sociali ed economiche e pone l’accento soprattutto sul problema dell’emergenza abitativa, sia in termini quantitativi che qualitativi. Ne emerge un quadro preoccupante, soprattutto nelle periferie delle grandi città, con problematiche igienico-sanitarie sovrapponibili a quelle dell’epoca dell’Unità d’Italia. Gli autori analizzano quindi le evidenze di rischio correlato al degrado abitativo e presentano alcuni esempi che quantificano l’efficacia sanitaria del risanamento ambientale. Il lavoro si conclude sottolineando la necessità di porre tale problematica di nuovo al centro dell’agenda della Sanità Pubblica, sia in termini di valutazione dell’impatto sanitario, sia in termini di formazione e sensibilizzazione dei diversi attori sociali coinvolti, recuperando anche quel ruolo politico enfatizzato da Rudolf Virchow già alla fine del diciannovesimo secolo

Human tularemia in Italy. Is it a re-emerging disease?

In order to evaluate whether tularemia is re-emerging in Italy, data on mortality and morbidity (obtained by the National Institute of Statistics; ISTAT), Italian cases described in the scientific literature and data concerning hospitalizations for tularemia (obtained by the National Hospital Discharge Database) were analysed. From 1979 to 2010, ISTAT reported 474 cases and no deaths. The overall number of cases obtained from the literature review was at least 31% higher than that reported by ISTAT. Moreover, the number of cases reported by ISTAT was 3·5 times smaller than hospitalized cases. The real frequency of the disease should be carefully investigated and taken into account in order to implement specific prevention measures.Tularemia is a contagious infectious disease due to Francisiella tularensis that can cause serious clinical manifestations and significant mortality if untreated. Although the frequency and significance of the disease has diminished over the last decades in Central Europe, over the past few years, there is new evidence suggesting that tularemia has re-emerged worldwide. To know the real epidemiology of the disease is at the root of correct control measures. In order to evaluate whether tularemia is re-emerging in Italy, data on mortality and morbidity (obtained by the National Institute of Statistics; ISTAT), Italian cases described in the scientific literature and data concerning hospitalizations for tularemia (obtained by the National Hospital Discharge Database) were analysed. From 1979 to 2010, ISTAT reported 474 cases and no deaths. The overall number of cases obtained from the literature review was at least 31% higher than that reported by ISTAT. Moreover, the number of cases reported by ISTAT was 3·5 times smaller than hospitalized cases. In Italy tularemia is sporadic, rarely endemic and self-limiting; but, although the trend of reported tularemia does not support the hypothesis of a re-emerging disease, the study demonstrates a wide underreporting of the disease. The real frequency of the disease should be carefully investigated and taken into account in order to implement specific prevention measures

Riuso delle acque grigie in ambiente domestico: implicazioni per la sanità pubblica

The Authors describe the main microbiological characteristics of gray and rain waters, the evidence of infections related to the reuse of such waters and the main Italian and international standards and guidelines in this regard. In light of the review, the authors conclude that the limits defined by the Italian regulations are very precautionary and should ensure a very low risk of bacterial and/or viral infection (< 10.5 and 10.9 cases/year). It remains an open problem the risk of parasitic infections, for which the evidences to draw final conclusions are not sufficient yet

Indagine sull'inquinamento acustico nel quartiere Nomentano di Roma e sulla sua percezione da parte dei residenti

The Authors describe the results of an investigation, carried out in the Nomentano quarter of Rome, to evaluate noise pollution level by road traffic and the annoyance in a resident sample. The measurement places have been subdivided according to three categories of streets ("flowing ", "quarter" and "local" streets); the LAeq (equivalent continuous level of noise) was taken during the day (from 7 am to 19 pm), the evening (from 19 pm to 23 pm) and the night (from 23 pm to 7 am). The results have been compared with previous study's data taken in 1988 and with the prescribed noise's limit values of the current national regulations. Lden values, the Community recommended acoustic parameter were also calculated. At the same time an interview was carried out to investigate resident's annoyance level; the results are discussed in relationship with registered noise levels

A Simulation Model for Logical and Operative Clash Detection

The introduction of the Building Information Modeling (BIM) approach has facilitated the management process of documents produced by different kinds of professionals involved in the design and/or renovation of a building, through identification and subsequent management of geometrical interferences (Clash Detection). The methodology of this research proposes a tool to support Clash Detection, introducing the logical-operative dimension, that may occur with the presence of a construction site within a hospital structure, through the integration of a BIM model within a Game Engine environment, to preserve the continuity of daily hospital activities and trying to reduce negative impacts, times and costs due to construction activities

How walkable is the city? Application of the Walking Suitability Index of the Territory (T-WSI) to the city of Rieti (Lazio Region, Central Italy) // Quanto è pedonale la città? Applicazione dell’indice di idoneità territoriale al cammino (T-WSI) alla città di Rieti

È stato applicato un metodo atto a valutare la praticabilità pedonale di un quartiere urbano, basata sull’osservazione diretta. Lo strumento, denominato indice di idoneità territoriale al cammino (T-WSI), misura la praticabilità pedonale delle strade di un quartiere. Comprende 12 indicatori ponderati, suddivisi in 4 categorie: viabilità, sicurezza, urbanità, piacevolezza. Ciascun indicatore può appartenere a una di queste categorie, con relativo punteggio: eccellente (100), buono (75), scarso (35), cattivo (0). Nello studio il T-WSI è applicato a 12/15 quartieri di Rieti, una piccola città (47.912 abitanti) del Lazio. I punteggi medi di T-WSI rilevati nei quartieri variano tra 24,2 e 61,2. In media, la sicurezza e l’urbanità sono le categorie che raggiungono punteggi molto bassi. Il T-WSI ha permesso di mettere in evidenza le criticità delle strade che potrebbero ostacolare la praticabilità pedonale. Pertanto potrebbe essere una buona base per supportare le amministrazioni pubbliche nel processo decisionale relativo alla politica di sviluppo locale per favorire l’attività fisica.A method to evaluate the walkability of an urban neighbourhood based on direct observation has been applied. This tool, called the Walking Suitability Index of the Territory (T-WSI), measures the walkability of every street of an environmental area. It includes 12 weighted indicators, each divided into 4 categories: practicability, safety, urbanity, and pleasantness. Each indicator can obtain one of the following values: excellent (100), good (75), poor (35), bad (0). T-WSI is applied to 12/15 urban neighbourhoods of Rieti, a small city (47,912 inhabitants) located in Lazio Region (Central Italy). The average of T-WSI scores range from 24.2 to 61.2 among urban neighbourhoods. On average, safety and urbanity are the categories which reach very low scores. The T-WSI allows to underline several street criticalities that could hinder walkability and could be a good basis to support public decision-makers about health policy and local development aimed at encouraging physical activity

Time trend of Legionella colonization in the waterline of a hospital of Rome, Italy

Background: In many hospital’s Legionella outbreaks, hot water systems are the most frequent source of infection. Objectives: Considering the old age of the hospital waterline, an investigation on Legionella spp. water colonization was performed to evaluate the system weakness and to implement environmental preventive measures. Methods: From 2004 to 2010, a total of 5 sampling campaigns were performed, collecting 99 water samples from 13 wards and 3 other points of the water line (boilers, point of connection with public water line, hospital waterworks). The samples were analyzed, following national Legionella spp. standard methods. Results: A total of 28 samples (28.3%) were positive for Legionella spp. There has been an increasing time trend until 2008, from 4.5% to 75% in 2008; in the first month of 2010 only 26.3% of the samples were positive. The boiler was positive in 45.5% of samples collected since 2006. In total, surgeries were positive in 38% of cases (8/21): 100% of positive samples in 2006 and 2008, reduced at 50% in the first month of 2010. Only in these wards Legionella spp. were found four times to be >10,000 cfu/L. Among other wards, emergency medicine and oncology are the most contaminated (31% of positive samples). The worst year was 2008 with 75% of positive samples. Conclusion: Hospital water system seems to be affected by Legionella spp. colonization most frequently from 2006 to 2010. The high percentage of positivity in 2008 was related to the presence of a building yard in the hospital. In 2010 there was an improvement, although boilers, surgery, medicine and oncology are still contaminated. It is necessary now to investigate the temperature level mantained in hot-water system and also to observe if the structural characteristics of water ducts could have influenced the colonization observed