Hand Hygiene Knowledge, Hand Contamination and Practice of Italian Nursing and Medical Students

Background: Our objective was to measure hand bacterial contamination in a group of Italian nursing and medical students attending clinical wards for practical training, in order to verify the reliability of the information on hand hygiene (HH) adherence obtained by a self-reporting questionnaire. This questionnaire was administered with the aim of exploring the effectiveness of basic education. Methods: In this cross-sectional study, an anonymous questionnaire designed to investigate HH knowledge and practices was administered to a convenience sample of 100 nursing and 100 medical students. Data collected was combined with hand bacterial contamination measured both at the point of entry and exit from the ward. Results: HH practices and knowledge were significantly higher in nursing compared to medical students. The most effective procedure in reducing bacterial contamination was the alternate use of hand washing and hand rubbing compared to only one practice and the absence of hand hygiene (geom. mean: 180.3, 410.2 and 907.4 CFU/hand respectively, p<0.001). Hand contamination was significantly higher in students who declared to have hardly ever/never implemented HH teaching during clinical practice compared to those who stated to have done it frequently/always (geom. mean: 716 vs 277.1 CFU/hand, p<0.02). ConclusionS: Our investigation adds something new to the topic of HH that is the measure of bacterial hand contamination to verify the reliability of the information obtained by questionnaire. The findings, pointing out some critical aspects in HH teaching among healthcare students, highlight that solid knowledge results in correct behaviour, and consequently in a reduction of hand contamination

Students’ hand contamination before and after a training shift: relationship with self-reported hand hygiene adherence

BACKGROUND: Our objective was to measure hand bacterial contamination in a group of nursing and medical Italian students attending clinical wards for practical training, in order to verify the reliability of the information on hand hygiene (HH) adherence obtained by a self-reporting questionnaire. This questionnaire was administered with the aim to explore the effectiveness of basic education. METHODS: An anonymous questionnaire designed to investigate HH knowledge and practices was administered to a convenience sample of 100 nursing and 100 medical students. Data collected were combined with hand bacterial contamination measured both at the entry and the exit from the ward. RESULTS: HH practices and knowledge were significantly higher in nursing compared to medical students.. The most effective procedure in reducing bacterial contamination was the alternate use of handwashing and handrubbing compared to only one practice and the absence of hand hygiene (geom. mean: 180.3, 410.2 and 907.4 CFU/hand respectively, p&lt;0.001). Hand contamination was significantly higher in students who declared to hardly ever/never implement HH teaching during clinical practice compared to those who stated to have done it frequently/always (geom. mean: 716 vs 277.1 CFU/hand, p&lt;0.02). CONCLUSION: Our investigation adds something new to the topic of HH that is the measure of bacterial hand contamination to verify the reliability of the information obtained by questionnaire. The findings, pointing out some critical aspects in the HH teaching among healthcare students, highlight that solid knowledge results into correct behaviors, and consequently into a reduction of hand contamination

Legionellosis risk in swimming pool and SPA

Spas used for either therapeutic or recreational aims are considered at risk for legionellosis occurrence. Thermal water is normally used at temperature between 30 and 40°C, ideal for Legionella growth, with a potential risk for users. Inhalation of colonized aerosol has been associated with sporadic cases or clusters of both Legionnaires’ disease and Pontiac fever, particularly involving immune depressed subjects. Italian and European guidelines have been issued to prevent and control this risk. At the spring, thermal water can contain small concentrations of legionellae, but within the distribution lines the amplification of these bacteria is promoted by stagnancy and incrustation, a frequent phenomenon also associated with the high mineral content of these waters. In addition, the detachment of dead cells, body lotions/creams residuals and skin debris in swimming pools favorites the bacteria multiplication. The devices/treatments more involved in transmission risk are inhalation therapies, frequently utilized by persons with chronic disease, showers and whirlpools, largely used also in the wellness centers. We revised the studies on Legionella spp presence in hot springs and related structures. The majority of published reports documented the germ contamination both at the source and along the distribution lines up to the point of use with increasing concentrations. Particular water characteristics such as high levels of sulfur and/or carbonate seem to be unfavorable to legionellae colonization but further studies are needed to deep this aspect. Contamination risk is less relevant for swimming pools due to high chlorine content, unless an insufficient disinfection plan is applied. From eighty years, about 50 studies have been published documenting cases of Legionnaires’ disease associated with spas. The majority of them occurred in Japan, where also a large outbreak is described with more than 300 persons involved. In almost all cases, L. pneumophila was the responsible germ and during the environmental inquire Legionella spp was found in many points of the spas: in spring water, in the distribution system, in the tank, in devices for nasal irrigation and aerosol therapy as well as in the whirlpool bath and swimming pool. To study the infection risk, the antibodies against Legionella have been evaluated in workers and patients attending the spa; the antibodies presence was found in a decreasing proportion from therapists to administration personnel. In conclusion, we underline the need for an accurate surveillance and control of Legionella spp and other waterborne germs in spas and other structures where inhalation of aerosolized water is expected

Etiology, source and prevention of waterborne healthcare-associated infections: a review.

The purpose of this review is to discuss the scientific literature on waterborne healthcare-associated infections (HCAI) published from 1990 to 2012. The revision focuses on the aquatic bacteria and describes both outbreaks and single cases in relation to patients characteristics, settings, and contaminated sources. An overview of diagnostic methods and environmental investigations is summarized in order to provide guidance for future case investigations. Lastly, on the basis of prevention and control measures adopted, information and recommendations are given. A total of 125 reports were included, 41 of them describing hospitalized children. All cases were sustained by opportunistic pathogens, mainly Legionellaceae, Pseudomonadaceae and Burkholderiaceae. Hot water distribution systems were the primary source of Legionnaires' disease, bottled water was mainly colonized by Pseudomonaceae, and Burkholderiaceae were the leading cause of distilled and sterile water contamination. Intensive care unit was the most frequently involved setting but patient characteristics are the main risk factor, independently of the ward. As the microbes water contamination is difficult to be avoided and disinfection treatments may be insufficient to control the risk of infection, a proactive preventive plan should be put in place. Nursing staff should pay special attention to children and immunosuppressed patients to avoid tap water exposure, also for their personal hygiene, and to regularly use sterile water for rinsing/cleaning device

Igiene delle mani in studenti di infermieristica e medicina durante i tirocini: studio pilota su conoscenze, comportamenti e impatto sulla contaminazione batterica

Nonostante esaurienti linee guida, l’adesione all’igiene delle mani da parte degli operatori sanitari è preoccupantemente bassa. Per aumentare l’adesione, sarebbe utile intervenire sull’educazione dei futuri professionisti. Obiettivo. Raccogliere informazioni su atteggiamenti, conoscenze e pratica sul campo inerenti l’igiene delle mani negli studenti dei CdL in Infermieristica e Medicina. In questo lavoro vengono presentati i risultati dello studio pilota. Metodo. Cinquanta studenti di ciascun corso hanno compilato un questionario che indagava le conoscenze sulla corretta igiene delle mani e sulla sua realizzazione pratica. I dati raccolti sono stati associati alla contaminazione batterica delle mani sia all’ingresso che all’uscita dal reparto. Risultati. Tutti i futuri infermieri hanno eseguito l’igiene delle mani con frequenza significativamente superiore a quella degli studenti in Medicina. La carica batterica totale diminuiva significativamente a fine tirocinio in entrambi i gruppi, ma in modo più marcato negli studenti infermieri. Le cariche aumentavano in assenza di pratiche igieniche e l’alternanza tra lavaggio tradizionale e gel alcolico si è dimostrata la procedura più efficace. Le conoscenze di ambedue i gruppi, anche se differenti, sono risultate complessivamente adeguate. Conclusioni. Gli studenti infermieri ricevono, fin dal primo anno, una adeguata formazione e mettono in atto l’igiene delle mani, dato confermato dalle cariche batteriche. I futuri medici, che apprendono le conoscenze di tali pratiche più avanti nel corso di studi e svolgono principalmente attività di osservazione al letto del paziente, sono meno attenti all’igiene delle mani. Questo dato suggerisce di anticipare l’insegnamento di questi contenuti prima dell’inizio dei tirocini

A Culture-Proven Case of Community-Acquired Legionella Pneumonia Apparently Classified as Nosocomial: Diagnostic and Public Health Implications

We report a case of Legionella pneumonia in a 78-year-old patient affected by cerebellar haemangioblastoma continuously hospitalised for 24 days prior to the onset of overt symptoms. According to the established case definition, this woman should have been definitely classified as a nosocomial case (patient spending all of the ten days in hospital before onset of symptoms). Water samples from the oncology ward were negative, notably the patient’s room and the oxygen bubbler, and the revision of the case history induced us to verify possible contamination in water samples collected at home. We found that the clinical strain had identical rep-PCR fingerprint of L. pneumophila serogroup 1 isolated at home. The description of this culture-proven case of Legionnaires’ disease has major clinical, legal, and public health consequences as the complexity of hospitalised patients poses limitations to the rule-of-thumb surveillance definition of nosocomial pneumonia based on 2–10-day incubation period

Legionella e Pseudomonas spp, i maggiori determinanti di infezioni di origine idrica in ospedale: differenze nella contaminazione e nella risposta ai sistemi di disinfezione

In this study, long-term surveillance of Legionella and Pseudomonas spp contamination in water systems of a big hospital and effi cacy of disinfection treatments are reported. In the period 2008-2011, 550 hot water samples from technical rooms and showers/taps of hospital wards were collected for Legionella and Pseudomonas spp isolation by cultural methods. In the hospital, several measures to control water contamination, including shock treatments and continuous systems (chlorine dioxide, monochloramine, boiler) have been employed. Legionella spp was detected in 38.9% of the samples, and the more effective methods in reducing contamination were in order boiler, monochloramine and chlorine dioxide. Pseudomonas spp was isolated in 25.4% of the samples, mainly at peripheral sites; the number of positive sites were reduced effi ciently by boiler, while the other methods did not signifi cantly modify the contamination. Different associations between the two studied bacteria and some water parameters, such as total bacterial count, pH and metals, were observed. Our study points out that Legionella and Pseudomonas spp differ for contamination mode and for response to disinfection systems. The prevalent contamination of pseudomonas at point-of-use suggests that, besides disinfection, the constant maintenance and replacement of faucets and showers is mandatory to control this germ

Monochloramine and chlorine dioxide for controlling Legionella pneumophila contamination: biocide levels and disinfection by-products (DBPs) formation in hospital water networks.

Legionella colonization in hospital hot water distribution networks was evaluated following 36 months of continuous treatment with monochloramine and compared with chlorine dioxide. Nitrite, nitrate, chlorite, chlorate, bromide, trihalomethanes and haloacetic acids as well as the biocide concentration at sampled points were measured. Only 8/84 samples treated with monochloramine were found contaminated and after the first 8 months of treatment no Legionella was isolated. Chlorine dioxide was associated with a strong reduction in Legionella contamination compared to pretreatment, but differences according to the device were observed. Monochloramine between 2 and 3 mg l−1 and chlorine dioxide between 0.50 and 0.70 mg l−1 were needed to control Legionella colonization. Comparing no- and post-flush samples, a higher frequency of no-flush positive samples was noted using chlorine dioxide, suggesting an increased risk for patients when they open the tap. No increase in chlorite levels and no water nitrification occurred by using monochloramine. Chlorite at levels exceeding the limit requested for drinking water was measured when chlorine dioxide was applied. In conclusion, we highlight that continuous injection of monochloramine should be considered as an effective alternative to chlorine dioxide in controlling legionellae contamination inside hospital water distribution system