Indagine sulle infezioni correlate all'assistenza sanitaria in un reparto di terapia intensiva. Studio pilota

Ogni anno in Europa 4.100.000 pazienti acquisiscono infezioni correlate all’assistenza (ICA) e circa 37.000 muoiono a causa di queste a tale numero si aggiungono 110.000 morti indirettamente associabili alle ICA. I costi stimati delle ICA si aggirano intorno ai 6.000.000.000 €. Le ICA più frequenti riguardano gli apparati genito-urinario e respiratorio, le setticemie e le infezioni post-chirurgiche. Il 20-30% delle ICA è prevenibile tramite buone pratiche di igiene. La percentuale più alta di morti da ICA è dovuta ai ricoveri in Reparti di Terapia Intensiva (RTI). Per tale motivo la nostra ricerca è finalizzata all’individuazione di parametri ambientali associabili al reperimento di microrganismi responsabili di ICA e di casi di ICA all’interno di un RTI. Abbiamo osservato un RTI di Neurochirurgia in un grande ospedale romano per un periodo di circa 18 mesi (ottobre 2015 - marzo 2017), monitorando la qualità microbiologica dell’aria indoor e di alcune superfici critiche, quali bordo letto, carrello farmaci e monitor, e alcune grandezze fisiche microclimatiche quali la temperatura dell’aria (Ta), l’umidità relativa (UR) e la velocità dell’aria (Va), con relativa valutazione del benessere termico che ha sicuramente influenza sul comportamento del personale e nello sviluppo delle pratiche assistenziali sia infermieristiche che mediche. La raccolta parziale dei dati relativi alle superfici critiche evidenzia delle non conformità, in alcuni campionamenti abbiamo isolato microrganismi patogeni ambientali quali: Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomanas aeruginosa e Staphilococcus aureus meticillina-resistente. Per quanto riguarda la carica microbica mesofila totale a 37 °C questa è risultata non conforme rispetto al limite di 50 ufc/24 cm2 nel 17,77% dei prelievi per il bordo letto, nel 4,34% dei prelievi per il carrello dei farmaci e nell’1,96% dei prelievi per il monitor. La densità microbica è risultata variabile da un livello minimo di 300 ufc/24 cm2 riscontrato sul bordo letto. Nei restanti mesi della ricerca con l’elaborazione definitiva dei risultati a disposizione, cercheremo di mettere in relazione le grandezze fisiche sopraindicate con i microrganismi rinvenuti sulle superfici inanimate limitrofe al letto del cliente, per capire in che modo e quanto possano partecipare alla loro sopravvivenza. I risultati evidenziano la necessità di mantenere un’elevata attenzione nell’applicazione dei protocolli di sanificazione delle superfici critiche e delle linee guida operative correlate all’assistenza sanitaria, al fine di garantire sempre un elevato standard igienico

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

Inquinamento microbiologico delle sale operatorie: analisi critica di due decenni di sorveglianza

Obiettivo dello studio è stato quello di analizzare i risultati delle campagne di monitoraggio microbiologico delle sale operatorie effettuate negli ultimi due decenni presso il Policlinico di Roma, al fine di descrivere l’andamento nel tempo dei livelli di contaminazione riscontrati e di valutare eventuali cambiamenti significativi. Sono stati presi in esame i campionamenti microbiologici dell’aria effettuati all’interno di 14 blocchi operatori tra il 1992 ed il 2010. I risultati dei campionamenti sono stati aggregati in quattro periodi di tempo (1992-1996; 1996-2000; 2001-2005; 2006-2010) ed è stato analizzata la distribuzione nel tempo dei risultati dei campionamenti rispetto al limite proposto all'ISPESL per le sale at-rest (≤35 UFC/mc). La stessa analisi è stata ripetuta dopo la stratificazione per livello di rischio delle sale operatorie (AR e BR). Al fine di verificare il livello di significatività delle variazioni temporali nelle distribuzioni dei risultati si è fatto ricorso al test del x2 per il trend. Si è osservato un significativo trend in diminuzione del numero di sale con livelli di contaminazione superiori a quello indicato (x2 per trend=8,94; p<0,025). Tale riduzione ha riguardato soprattutto le sale operatorie AR (x2 per trend=7,33; p<0,05). I risultati ottenuti fanno ritenere che le misure adottate nelle sale ad AR siano risultate efficaci. Una maggiore attenzione dovrà essere posta alle sale operatorie a BR

The Gas Pixel Detector as an X-ray photoelectric polarimeter with a large field of view

The Gas Pixel Detector (GPD) is a new generation device which, thanks to its 50 um pixels, is capable of imaging the photoelectrons tracks produced by photoelectric absorption in a gas. Since the direction of emission of the photoelectrons is strongly correlated with the direction of polarization of the absorbed photons, this device has been proposed as a polarimeter for the study of astrophysical sources, with a sensitivity far higher than the instruments flown to date. The GPD has been always regarded as a focal plane instrument and then it has been proposed to be included on the next generation space-borne missions together with a grazing incidence optics. Instead in this paper we explore the feasibility of a new kind of application of the GPD and of the photoelectric polarimeters in general, i.e. an instrument with a large field of view. By means of an analytical treatment and measurements, we verify if it is possible to preserve the sensitivity to the polarization for inclined beams, opening the way for the measurement of X-ray polarization for transient astrophysical sources. While severe systematic effects arise for inclination greater than about 20 degrees, methods and algorithms to control them are discussed.Comment: 11 pages, 8 figure

Measurement of the position resolution of the Gas Pixel Detector

The Gas Pixel Detector was designed and built as a focal plane instrument for X-ray polarimetry of celestial sources, the last unexplored subtopics of X-ray astronomy. It promises to perform detailed and sensitive measurements resolving extended sources and detecting polarization in faint sources in crowded fields at the focus of telescopes of good angular resolution. Its polarimetric and spectral capability were already studied in earlier works. Here we investigate for the first time, with both laboratory measurements and Monte Carlo simulations, its imaging properties to confirm its unique capability to carry out imaging spectral-polarimetry in future X-ray missions.Comment: Submitted to Nuclear Instruments and Methods in Physics Research Section A; 15 figures, 3 table

Re-testing the JET-X Flight Module No. 2 at the PANTER facility

The Joint European X-ray Telescope (JET-X) was the core instrument of the Russian Spectrum-X-gamma space observatory. It consisted of two identical soft X-ray (0.3 - 10 keV) telescopes with focusing optical modules having a measured angular resolution of nearly 15 arcsec. Soon after the payload completion, the mission was cancelled and the two optical flight modules (FM) were brought to the Brera Astronomical Observatory where they had been manufactured. After 16 years of storage, we have utilized the JET-X FM2 to test at the PANTER X-ray facility a prototype of a novel X-ray polarimetric telescope, using a Gas Pixel Detector (GPD) with polarimetric capabilities in the focal plane of the FM2. The GPD was developed by a collaboration between INFN-Pisa and INAF-IAPS. In the first phase of the test campaign, we have re-tested the FM2 at PANTER to have an up-to-date characterization in terms of angular resolution and effective area, while in the second part of the test the GPD has been placed in the focal plane of the FM2. In this paper we report the results of the tests of the sole FM2, using an unpolarized X-ray source, comparing the results with the calibration done in 1996.Comment: Author's accepted manuscript posted to arXiv.org as permitted by Springer's Self-Archiving Policy. The final publication is available at http://rd.springer.com/article/10.1007%2Fs10686-013-9365-

Effect of urban wastewater discharge on the abundance of antibiotic resistance genes and antibiotic-resistant Escherichia coli in two Italian rivers

Background: Wastewater treatment plants (WWTPs) are microbial factories aimed to reduce the amount of nutrients and pathogenic microorganisms in the treated wastewater before its discharge into the environment. We studied the impact of urban WWTP effluents on the abundance of antibiotic resistance genes (ARGs) and antibiotic-resistant Escherichia coli (AR-E. coli) in the last stretch of two rivers (Arrone and Tiber) in Central Italy that differ in size and flow volume. Methods: Water samples were collected in three seasons upstream and downstream of the WWTP, at the WWTP outlet, and at sea sites near the river mouth, and analyzed for the abundance of ARGs by qPCR and AR-E. coli using cultivation followed by disk diffusion assays. Results: For all studied genes (16S rRNA, intI1, sul1, ermB, blaTEM, tetW and qnrS), absolute concentrations were significantly higher in the Tiber than in the Arrone at all sampling sites, despite their collection date, but the prevalence of target ARGs within bacterial communities in both rivers was similar. The absolute concentrations of most ARGs were also generally higher in the WWTP effluent with median levels between log 4 and log 6 copies per ml but did not show differences along the studied stretches of rivers. Statistically significant site effect was found for E. coli phenotypic resistance to tetracycline and ciprofloxacin in the Arrone but not in the Tiber. Conclusions: In both rivers, diffuse or point pollution sources other than the studied WWTP effluents may account for the observed resistance pattern, although the Arrone appears as more sensitive to the wastewater impact considering its lower flow volume

Legionella control in the water system of antiquated hospital buildings by shock and continuous hyperchlorination: 5 years experience

To control the presence of Legionella in an old hospital water system, an integrated strategy of water disinfection-filtration was implemented in the university hospital Umberto I in Rome. Due to antiquated buildings, hospital water system design and hospital extension (38 buildings), shock hyperchlorination (sodium hypochlorite, 20-50 ppm of free chlorine at distal points for 1-2 h) followed by continuous hyperchlorination (0.5-1.0 mg/L at distal points) were adopted, and microbiological and chemical monitoring of the water supply was carried out in the university hospital (December 2006-December 2011). Overall, 1308 samples of cold 45°C (17.8%) water were collected, determining residual free chlorine (0.43 ± 0.44 mg/L), pH (7.43 ± 0.29) and trihalomethanes (8.97 ± 18.56 μg/L). Legionella was isolated in 102 (9.8%) out of 1.041 water samples without filters (L. pneumophila sg 1 17.6%, L. pneumophila sg 2-14 28.4%, L. non pneumophila 53.9%), and in none of the 267 samples with filters. Legionella was recovered in 23 buildings out of 38 and 29 samples (28.4%) exceeded 103 cfu/L. When considering the disinfection treatment Legionella was isolated: before shock hyperchlorination (21.1%), 15 days after shock hyperchlorination (7.8%), 30 days after shock hyperchlorination (3.5%), during continuous hyperchlorination (5.5%) and without continuous hyperchlorination (27.3%). Continuous hyperchlorination following the shock treatment achieved >70% reduction of positive samples, whereas no continuous hyperchlorination after shock treatment was more frequently associated to Legionella isolation (OR 6.41; 95% CI 3.10-13.26; p 0.5 < 1.0 mg/L) deteriorated water quality (organoleptic and chemical). However, shock and continuous hyperchlorination remains a valid-term option in old buildings with no water system rational design, managing problems due to hospital extension and absence of a proper hot water recirculation system

Characteristics of COVID-19 cases in Italy from a sex/gender perspective

Introduction: Coronavirus disease 19 (COVID-19) is an infectious disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). To date, few data on clinical features and risk factors for disease severity and death by gender are available. Aim: The current study aims to describe from a sex/gender perspective the characteristics of the SARS-CoV-2 cases occurred in the Italian population from February 2020 until October 2021. Method and results: We used routinely collected data retrieved from the Italian National Surveillance System. The highest number of cases occurred among women between 40 and 59 years, followed by men in the same age groups. The proportion of deaths due to COVID-19 was higher in men (56.46%) compared to women (43.54%). Most of the observed deaths occurred in the elderly. Considering the age groups, the clinical outcomes differed between women and men in particular in cases over 80 years of age; with serious or critical conditions more frequent in men than in women. Conclusions: Our data clearly demonstrate a similar number of cases in women and men, but with more severe disease and outcome in men, thus confirming the importance to analyse the impact of sex and gender in new and emerging diseases