Prevalence study of Legionella spp. contamination in ferries and cruise ships

BACKGROUND: In the last years, international traffic volume has significantly increased, raising the risk for acquisition of infectious diseases. Among travel-associated infections, increased incidence of legionellosis has been reported among travellers. Aim of our study was: to describe the frequency and severity of Legionella spp. contamination in ferries and cruise ships; to compare the levels of contamination with those indicated by the Italian ministerial guidelines for control and prevention of legionellosis, in order to assess health risks and to adopt control measures. METHOD: A prevalence study was carried out on 9 ships docked at the seaports of northern Sardinia in 2004. Water samples were collected from critical sites: passenger cabins, crew cabins, kitchens, coffee bars, rooms of the central air conditioning system. It was performed a qualitative and quantitative identification of Legionella spp. and a chemical, physical and bacteriological analysis of water samples. RESULTS: Forty-two percent (38/90) water samples were contaminated by Legionella spp.. Positive samples were mainly drawn from showers (24/44), washbasins (10/22). L. pneumophila was isolated in 42/44 samples (95.5%), followed by L. micdadei (4.5%). Strains were identified as L. pneumophila serogroup 6 (45.2%; 19 samples), 2–14 (42.9%), 5 (7.1%) and 3 (4.8%). Legionella spp. load was high; 77.8% of the water samples contained > 10(4 )CFU/L. Low residual free chlorine concentration (0–0,2 mg/L) was associated to a contamination of the 50% of the water samples. CONCLUSION: Legionella is an ubiquitous bacterium that could create problems for public health. We identified Legionella spp. in 6/7 ferries. Microbial load was predominantly high (> 10(4 )CFU/L or ranging from 10(3 )to 10(4 )CFU/L). It is matter of concern when passengers are subjects at risk because of Legionella spp. is an opportunist that can survive in freshwater systems; high bacterial load might be an important variable related to disease's occurrence. High level of contamination required disinfecting measures, but does not lead to a definitive solution to the problem. Therefore, it is important to identify a person responsible for health safety in order to control the risk from exposure and to apply preventive measures, according to European and Italian guidelines

Antimicrobial activities of essential oils against common hospital Fungi species

Introduction: In hospitals and other healthcare settings the presence of airborne and sedimented fungi is an extrinsic risk factor for opportunistic infections involving both immunocompromised and non-immunocompromised persons. In hospitalized patients, it is estimated that 9% of hospital-acquired infections are caused by fungi. Lethality rate varies from 40% to 100% depending on the immunosuppression degree of stakeholders. To prevent healthcare-associated infections, the control of environmental fungal contamination through use of sanitizing/disinfecting practices is basic. However, the widespread use of common disinfectants could promote the growth of antibiotic-resistant superbugs and cause environmental harm. These aspects stimulated the search of new antimicrobial agents. The aim of this study was to evaluate the antimicrobial activity of essential oils of Mentha insularis Req., Mentha pulegium L., Mentha requienii Bentham, Artemisia caerulescens L. ssp. densiflora (Viv), Rosmarinus officinalis L. var. albiflorus, Rosmarinus officinalis L. var. lavandulescens, and Ocotea puchury major Mart. against fungi species frequently found in hospitals and potentially responsible for opportunistic mycoses. Methods: The essential oils’ antifungal activity was carried out by agar disc diffusion technique. Results: All tested essential oils are effective, though to a different degree, against both molds that yeasts assessed. The major antifungal activity was showed by Mentha oils. Particularly, Mentha requienii and Mentha insularis oils were active until 1:8 dilution against Rhodotorula spp. and 1:16 dilution against mixed molds, while M. pulegium was strongly active until 1:2 against both fungi. Conclusions: To the best of our knowledge, few or no data are available in literature on the activity of essential oils against hospital environmental isolates of fungi. Results suggest their potential application in sanitation procedures of the hospital, and in general, of the “care settings”

Evaluation of Legionella Air Contamination in Healthcare Facilities by Different Sampling Methods: An Italian Multicenter Study

Healthcare facilities (HF) represent an at-risk environment for legionellosis transmission occurring after inhalation of contaminated aerosols. In general, the control of water is preferred to that of air because, to date, there are no standardized sampling protocols. Legionella air contamination was investigated in the bathrooms of 11 HF by active sampling (Surface Air System and Coriolis®μ) and passive sampling using settling plates. During the 8-hour sampling, hot tap water was sampled three times. All air samples were evaluated using culture-based methods, whereas liquid samples collected using the Coriolis®μ were also analyzed by real-time PCR. Legionella presence in the air and water was then compared by sequence-based typing (SBT) methods. Air contamination was found in four HF (36.4%) by at least one of the culturable methods. The culturable investigation by Coriolis®μ did not yield Legionella in any enrolled HF. However, molecular investigation using Coriolis®μ resulted in eight HF testing positive for Legionella in the air. Comparison of Legionella air and water contamination indicated that Legionella water concentration could be predictive of its presence in the air. Furthermore, a molecular study of 12 L. pneumophila strains confirmed a match between the Legionella strains from air and water samples by SBT for three out of four HF that tested positive for Legionella by at least one of the culturable methods. Overall, our study shows that Legionella air detection cannot replace water sampling because the absence of microorganisms from the air does not necessarily represent their absence from water; nevertheless, air sampling may provide useful information for risk assessment. The liquid impingement technique appears to have the greatest capacity for collecting airborne Legionella if combined with molecular investigation

Mapping and Assessment of Ecosystems and their Services: An EU ecosystem assessment

This report presents an ecosystem assessment covering the total land area of the EU as well as the EU marine regions. The assessment is carried out by Joint Research Centre, European Environment Agency, DG Environment, and the European Topic Centres on Biological Diversity and on Urban, Land and Soil Systems. This report constitutes a knowledge base which can support the evaluation of the 2020 biodiversity targets. It also provides a data foundation for future assessments and policy developments, in particular with respect to the ecosystem restoration agenda for the next decade (2020-2030). The report presents an analysis of the pressures and condition of terrestrial, freshwater and marine ecosystems using a single, comparable methodology based on European data on trends of pressures and condition relative to the policy baseline 2010. The following main conclusions are drawn: - Pressures on ecosystems exhibit different trends. - Land take, atmospheric emissions of air pollutants and critical loads of nitrogen are decreasing but the absolute values of all these pressures remain too high. - Impacts from climate change on ecosystems are increasing. - Invasive alien species of union concern are observed in all ecosystems, but their impact is particularly high in urban ecosystems and grasslands. - Pressures from overfishing activities and marine pollution are still high. - In the long term, air and freshwater quality is improving. - In forests and agroecosystems, which represent over 80% of the EU territory, there are improvements in structural condition indicators (biomass, deadwood, area under organic farming) relative to the baseline year 2010 but some key bio-indicators such as tree-crown defoliation continue to increase. This indicates that ecosystem condition is not improving. - Species-related indicators show no progress or further declines, particularly in agroecosystems. The analysis of trends in ecosystem services concluded that the current potential of ecosystems to deliver timber, protection against floods, crop pollination, and nature-based recreation is equal to or lower than the baseline value for 2010. At the same time, the demand for these services has significantly increased. A lowered potential in combination with a higher demand risks to further decrease the condition of ecosystems and their contribution to human well-being. Despite the wide coverage of environmental legislation in the EU, there are still large gaps in the legal protection of ecosystems. On land, 76% of the area of terrestrial ecosystems, mainly forests, agroecosystems and urban ecosystems, are excluded from a legal designation under the Bird and Habitat Directives. Freshwater and marine ecosystems are subject to specific protection measures under the Water Framework and Marine Strategy Framework Directives. The condition of ecosystems that are under legal designation is unfavourable. More efforts are needed to bend the curve of biodiversity loss and ecosystem degradation and to put ecosystems on a path to recovery. The progress that is made in certain areas such as pollution reduction, increasing air and water quality, increasing share of organic farming, the expansion of forests, and the efforts to maintain marine fish stocks at sustainable levels show that a persistent implementation of policies can be effective. These successes should encourage us to act now and to put forward an ambitious plan for the restoration of Europe’s ecosystems.JRC.D.3-Land Resource

Ten-Year Evaluation of Thermal Comfort in Operating Rooms

The microclimate is a particularly important environmental aspect in operating rooms (ORs), where more than in other hospital environments, it is extremely important, and at the same time extremely difficult, to reconcile the needs of different types of occupants (patients and operators). Moreover, unsuitable microclimatic conditions may affect the onset of infection. The present study aimed to analyze the periodic monitoring of the microclimatic conditions carried out in ORs over 10 years, to verify the adequacy of the thermal comfort conditions for all occupants. The evaluation of thermal comfort was carried out using the Fanger indices and the standards required by current legislation and specific guidelines. Non-compliant values for at least one parameter were found in 98.8% of the examinations performed in the ORs. A condition of thermal discomfort was calculated for 3.6% of healthcare professionals and 98.3% of patients. The monitoring of microclimatic conditions is particularly important in the OR as an indicator of inadequate functioning of the air conditioning system, which might affect the thermal comfort of all occupants and lead to microbial contamination of the room

Evaluation of fungal contamination in operating rooms using a dusting cloth pad: comparison among different sampling methods

To evaluate microbial contamination in hospitals environments, several methods are available, each one having its limitations. Therefore, the choice of system to use is open. This study compares the ability of a dusting cloth pad (DC pad) with 2 other methods (Rodac contact plate and air sampling) to detect contamination because of filamentous fungi in operating rooms, performing 110 sampling campaigns in hospitals of 3 Italian cities. Overall, 96% of the DC pad samples were positive compared with 51% of Rodac plates (P 6lt; .0001) and 35% of air samples (P < .0001). Authors conclude that the DC pad improves the ability to detect an environmental contamination of filamentous fungi

Monitoraggio di contaminanti ambientali nelle acque del golfo dell'Asinara

PREMESSE: L’industrializzazione ed urbanizzazione delle coste e l’espansione dei traffici marittimi hanno evidenziato il progressivo degrado dell’ambiente marino lungo la fascia costiera. Aspetti ancor più importanti in Sardegna dove il turismo rappresenta una delle principali risorse economiche. Su tali premesse, l’Istituto di Igiene e Medicina Preventiva dell’Università degli Studi di Sassari, con l’Ente Parco dell’Asinara, ha intrapreso uno studio per: valutare la qualità delle acque costiere della Sardegna centro-settentrionale, anche tramite l’utilizzo di indicatori biologici e delineare mappe e modelli sperimentali di rischio ambientale correlato alla presenza di contaminanti microbiologici. MATERIALI E METODI: Lungo una costa di circa 100 Km sono state identificate 3 stazioni di campionamento scelte tra quelle che meglio rappresentavano eventuali situazioni di “rischio” ambientale. Oltre a campioni di acqua di mare sono stati prelevati, anche esemplari di Dicentrarchus labrax e Sparus aurata, recentemente proposti come bioindicatori. I campioni di acqua sono stati analizzati secondo le metodiche I.R.S.A. e quanto previsto dal D.P.R. 470/82 e successive modificazioni (L. 422/00), i pesci secondo il D.Lvo 530/ 92 e D.M.S. 31 luglio 1995. RISULTATI: I valori medi dei parametri chimici ricercati nelle acque di mare risultano entro i limiti previsti dalle normative di riferimento. Assai contenuti sono risultati i valori di Coliformi totali e Streptococchi fecali e assenti Salmonelle e Coliformi fecali. Per quanto riguarda le analisi sugli indicatori biologici, emergono valori di carica batterica totale e Coliformi più elevati per Sparus aurata; in entambi gli indicatori, non sono mai stati isolati Stafilococchi coagulasi-positivi, Salmonella spp. e Vibrio parahaemolyticus. CONCLUSIONI: sebbene preliminari, i risultati del monitoraggio delle acque costiere del Golfo dell’Asinara, anche attraverso l’utilizzo di indicatori biologici, evidenziano che la zona considerata non è interessata da gravi processi di inquinamento, consentendo così di esprimere un giudizio complessivamente soddisfacente sul suo stato di salute.</br

Prevenzione delle infezioni nosocomiali trasmesse per via idrica: valutazione, mediante analisi colturale e real time PCR, dell'efficacia di filtri sterili monouso

L’ospedale costituisce un ambiente particolarmente critico, sia per la coesistenza di tipologie architettoniche, funzionali ed operative molto diverse tra loro che per le caratteristiche degli occupanti. Chi soggiorna in questi ambienti, infatti, è una popolazione particolare, affetta da problemi di salute e talora con ridotte difese immunitarie, più suscettibile, rispetto a quella generale, verso i fattori di rischio ambientale. In particolare, l’acqua rappresenta tuttora il veicolo di infezione in numerose epidemie nosocomiali, anche se il suo ruolo è stato per lungo tempo sottostimato. Le modalità di controllo del sistema idrico comprendono mezzi di disinfezione chimici e fisici che, per quanto potenzialmente efficaci come interventi puntuali, spesso non garantiscono un effetto duraturo nel tempo. Peraltro, gli interventi di bonifica spesso sono influenzati dalla complessità e dallo stato di usura della rete di distribuzione (presenza di “rami morti”, incrostazioni calcaree, biofilm). Sicuramente il trattamento di bonifica maggiormente utilizzato prevede l’impiego di composti a base di cloro che, se da un lato, garantiscono una buona efficacia nei confronti della flora microbica, dall’altro, evidenziano limiti (in particolare negli articolati circuiti idrici ospedalieri), per le difficoltà nel mantenimento di un ottimale tenore di cloro residuo libero nell’intera rete di distribuzione; condizione che incrementa il rischio di acquisizione delle infezioni nei reparti di degenza per immunodepressi. Appare quindi particolarmente utile, soprattutto in tali contesti, sperimentare metodiche alternative di bonifica delle acque che prevengano il rischio infettivo. Inserito in un articolato programma di monitoraggio ambientale rivolto alle sale operatorie ed ai reparti ad “alto rischio” delle strutture ospedaliere e universitarie di Sassari per il controllo della qualità dell’acqua in distribuzione e delle caratteristiche microclimatiche e microbiologiche dell’aria, il presente lavoro si pone l’obiettivo di valutare la capacità di filtri monouso, da applicare nei rubinetti di erogazione, quale supporto nel controllo delle infezioni nosocomiali veicolate dall’acqua

Environmental Surveillance of Legionella spp. in an Italian University Hospital Results of 10 Years of Analysis

The occurrence of Legionella spp. in the water distribution systems of large hospitals and other healthcare facilities is considered particularly dangerous, due to the critical nature of the hospitalized patients. The aim of this study is to present a pluri-annual environmental surveillance in a large university hospital assessing the prevalence of Legionella spp. and underlining its variability over the years. The samples of water were collected in accordance with the Italian National Guidelines and the sampling sites considered in this study were selected favoring wards with very high-risk patients and with patients at increased risk. The laboratory analyzed a total of 305 water samples deriving from 24 different sampling points. Legionella spp. were detected in 39.4% of samples, the majority of which were contaminated by Legionella pneumophila serogroups 2–14 (68.7%). Statistically significant differences were found among different seasons with a linear trend in positive proportion from summer to spring. Several experimental interventions to prevent and reduce Legionella colonization were attempted, but there is no a definitive method for the complete eradication of this microorganism. The permanent monitoring of hospital water distribution systems is fundamental to preventing the potential risk of nosocomial Legionellosis and to implementing procedures to minimize the risk of Legionella spp. colonization