Evaluation of air contamination in orthopaedic operating theatres in hospitals in Southern Italy: The IMPACT project

Postoperative infections are a concern, especially in total knee and total hip arthroplasty. We evaluated the air quality in orthopaedic operating theatres in southeastern Italy to determine the level of bacterial contamination as a risk factor for postoperative infection. Thirty-five hospitals with operating theatres focused on total knee and total hip arthroplasty participated. We sampled the air passively and actively before surgeries began for the day (at rest) and 15 min after the surgical incision (in operation). We evaluated bacterial counts, particle size, mixed vs turbulent airflow systems, the number of doors, number of door openings during procedures and number of people in the operating theatre. We found no bacterial contamination at rest for all sampling methods, and significantly different contamination levels at rest vs in operation. We found no association between the number of people in the surgical team and bacteria counts for both mixed and turbulent airflow systems, and low bacterial loads, even when doors were always open. Overall, the air quality sampling method and type of ventilation system did not affect air quality

Knowledge, experiences, and attitudes toward Mantoux test among medical and health professional students in Italy: A cross-sectional study

BACKGROUND: The World Health Organization's Action Framework for tuberculosis elimination in low-tuberculosis incidence countries includes the screening for active and latent tuberculosis in selected high-risk groups, including health care workers. In this context, medical and health profession students, exposed to nosocomial tuberculosis transmission during training and clinical rotations, are target populations for tuberculosis screening. No updated data are available on tuberculosis screening practice and knowledge of medical and health profession students in Italy. METHODS: Within the activities Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health, we carried out a multicentre cross-sectional study to assess knowledge, attitude and practices on tuberculosis prevention and control among Medical, Dentistry, Nursing and other health professions' students. Students were enrolled in the study on a voluntary basis and were administered a previously piloted structured questionnaire. Logistic regression models were applied to explore knowledge on tuberculosis prevention by selected socio-demographic variables and University-based tuberculosis prevention practice. RESULTS: Students of seventeen Universities across Italy participated in the study, and 58.2% of them received compulsory tuberculin skin test either at enrollment or while attending clinical practice. A total of 5,209 students filled the questionnaire. 37.7% were medicine and dentistry students (Group 1), 44.9% were nursing students (Group 2) and 17.4% were other health professions' students (Group 3). Age and gender had different distributions by groups, as well as knowledge and practice on tuberculin skin test. 84.4% of the study population (95% CI = 83.3-85.3) was aware of the existence of the tuberculin skin test, 74.4% (95% CI = 73.2-75.6) knew what is the first-level screening test for latent tuberculosis and only 22.5% (95% CI = 21.4-23.6) knew how to proceed after a positive tuberculin skin test result. Overall, knowledge on tuberculosis prevention was higher in Group 2 and lower Group 3, as compared to Group 1. CONCLUSION: In Italy, the knowledge on tuberculosis screening among University students is generally good. To reduce some of the criticalities found among the different study courses, it would be appropriate to harmonize both the regulations on tuberculosis screening practices for admission to University courses, and the educational activities on the topic of tuberculosis, to be extended to all workers involved in health care setting

Predicting needlestick and sharps injuries in nursing students: Development of the SNNIP scale

Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students

Immunization coverage among asplenic patients and strategies to increase vaccination compliance: a systematic review and meta-analysis

Background: Asplenic or splenectomized patients have a higher risk (ranging from 10 to 50-fold) than the general population of developing an overwhelming post-splenectomy infection (OPSI). Thus, they should receive specific vaccinations to prevent bacterial infections and influenza. The aim of this meta-analysis was to estimate vaccination coverage (VC) with the recommended vaccines among splenectomized patients; strategies recommended in those studies to improve VC worldwide are considered as well. Research design and methods: Scopus, MEDLINE/PubMed, Google Scholar and ISI Web of Knowledge databases were searched. Research papers, short reports, reviews, and meta-analyses published between January 1, 2010 and July 18, 2020 were included; no geographic restrictions were included. Twenty-four studies were included in the meta-analysis. Results: For anti-pneumococcal vaccination, coverage was 55.1% (95%CI = 41.0–69.2%), for anti-Hib 48.3% (95%CI = 34.3–52.3%), for anti-meningococcal C/ACYW135 33.7% (95%CI = 23.6–43.9%), for anti-meningococcal B 13.3% (95%CI = 7.0–19.5%) and for anti-influenza 53.2% (95%CI = 22.0–84.4%). Most studies determined a lack of adherence to international guidelines by healthcare workers and suggested the need to better educate health professionals in the management of post-splenectomy patients. Conclusions: The meta-analysis showed the suboptimal immunization coverage for the vaccines recommended for asplenic patients. Greater efforts must be made by public health professionals to increase VC in this group of patients at risk. Introducing specific prophylaxis protocols in the clinical routine seems to guarantee better immunization compliance in those patients

Long-term immunogenicity after measles vaccine vs. wild infection: an Italian retrospective cohort study

The persistence of specific IgG after measles infection and after measles vaccination has not been sufficiently investigated. Current evidence suggests that immunity after the disease is life-long, whereas the response after two doses of measles-containing vaccine declines within 10–15 years. This study evaluated the proportion of individuals with detectable anti-measles IgG in two groups, those vaccinated with two doses of anti-MMR vaccine and those with a self-reported history of measles infection. Among the 611 students and residents who were tested, 94 (15%) had no detectable protective anti-measles IgG. This proportion was higher among vaccinated individuals (20%; GMT = 92.2) than among those with a self-reported history of measles (6%; GMT = 213.3; p < .0001). After one or two MMR vaccine booster doses, the overall seroconversion rate was 92%. An important proportion of people immunized for measles did not have a protective IgG titer in the years after vaccination, but among those who had a natural infection the rate was three-fold lower. This finding should be considered in the pre-elimination phase, given the resurgence of measles cases among individuals who after being vaccinated lost their circulating IgG after several years, especially if they failed to receive a natural booster

Prevalence and management of measles susceptibility in healthcare workers in Italy: a systematic review and meta-analysis

Introduction:. The national and international guidelines recommend evaluating all healthcare workers (HCWs) for their measles immune status and possibly vaccinating those who are seronegative. Areas covered:. We conducted a systematic review and meta-analysis in order to estimate the rate of measles susceptibility among HCWs in Italy and to explore possible options for the management of those found to be susceptible. Twenty-three studies were included in the meta-analysis. The prevalence of HCWs susceptible to measles was 11.5% (95%CI=8.1–15.4%) and was higher in studies in which prevalence was evaluated by survey (16.7%; 95%CI=8.9-26.3) than by the direct evaluation of blood specimens (9.1%; 95%CI=6.2-12.5%). Occupational medicine examinations for measles screening with possible subsequent vaccination of seronegatives and the exclusion of susceptible HCWs from high-risk settings were common management strategies. Expert opinion:. HCWs susceptible to measles are an important epidemiological concern in Italy, and efforts to identify and actively offer the vaccine to this population should be increased

Observational study on hospital building heritage and microbiological air quality in the orthopedic operating theater: the IM.PA.C.T. Project

BACKGROUND: The study investigated 35 orthopedic OTs [17 with mixed flow (M-OTs), 18 with turbulent flow (T-OTs)]. METHODS: The OTs were divided into two categories based on recurring architectural and construction solutions, collected by a survey form: type-A (recently built or renovated rooms), and type-B (other OTs). Assessment of microbial air contamination (colony forming units (cfu)/m3 obtained by active sampling via Surface Air System) was then performed. RESULTS: In 97% of the OTs, a Total Viable Count (TVC) was within the limits recommended by ISPESL 2009; all A-type OTs, and 94% of B-type passed. The TVC of type-A OTs [median 15 cfu/m3, range 3-158] was lower than that of type-B OTs [median 28 cfu/m3, range 6-206], although the difference was not significant. The number of people in type-A [mean 8.6, range 6-11] was lower than in type-B [mean 9.6, range 7-13] OTs, and when adjusted to the volume of the OT (person/m3), showed a significant correlation with TVC (ρ = 0.383, p <0.05). CONCLUSIONS: In conclusion, the structural factors examined do not appear to significantly affect the microbiological air quality at the specific sampling point. However, further investigations are required to identify the factors that have the greatest effect on TVC

Aspetti edilizi-impiantistici e qualità dell’aria in sala operatoria negli ospedali della Regione Puglia (Progetto IMPACT)

INTRODUZIONE La Regione Puglia ha promosso il progetto IM.PA.C.T. (Improving the health of Patients by supporting dynamiC healTh systems and new technologies), per valutare gli aspetti igienico-sanitari delle sale operatorie (SO). In questo ambito sono stati indagate le caratteristiche edilizie e impiantistiche che ne influenzano le prestazioni. METODI Lo studio ha coinvolto 35 SO ortopediche [17 con flusso misto (FM), 18 con flusso turbolento (FT)]. Sono stati condotti rilievi architettonici diretti e indiretti, predisponendo una scheda di rilevamento dei dati edilizi e impiantistici e un rilievo fotografico e documentale. Le SO sono state suddivise in due categorie in base alle soluzioni architettoniche e realizzative ricorrenti: tipo A (sale di recente realizzazione o ristrutturazione, con blocchi funzionali prefabbricati); tipo B (le altre, non ricadenti nella prima categoria). Queste soluzioni ricorrenti sono state correlate ai risultati microbiologici dell’aria (UFC/m3 ottenuti mediante campionamento attivo tramite Surface Air System-SAS) per individuare eventuali differenze. RISULTATI Le sale di tipo A presentavano volumi mediamente minori [mediana 117 m3, range 81-150], geometrie regolari in pianta e alzato, disposizione simmetrica delle estrazioni del VCCC, predisposizione delle attrezzature elettromedicali a soffitto; le sale di tipo B volumi maggiori [mediana 132 m3, range 90-193], geometrie irregolari in pianta e alzato, disposizione asimmetrica delle estrazioni del VCCC. Nel 97% delle sale è stata rilevata una Carica Batterica Totale (CBT) entro i limiti raccomandati da ISPESL2009 (180 UFC/m3 per FT): nel 100% delle sale di tipo A, nel 94% tipo B. La CBT delle sale A [mediana 15 UFC/m3, range 3-158] è risultata inferiore a quella delle sale B [mediana 28 UFC/m3, range 6-206], anche se la differenza non è apparsa statisticamente significativa. Complessivamente, il numero di persone presenti nelle sale A [media 9, range 6-11] e B [media 10, range 7-13], rapportato al volume delle SO (persone/m3), mostra una correlazione statistica con la CBT (ρ=0.38, p<005). CONCLUSIONI Nelle sale monitorate si rilevano valori di CBT inferiori ai limiti di riferimento. In quelle di tipo A si osservano CBT e numero medio di persone inferiori a quelle di tipo B, seppur le differenze non raggiungano la significatività statistica. Da queste prime osservazioni si potrebbe ipotizzare che le sale di tipo A, a parità di chirurgia, supportino condizioni organizzative migliori in termini di gestione spaziale, funzionale e procedurale. Per confermare questa ipotesi sarà opportuno estendere l’indagine ad un numero maggiore di SO

Qualità dell’aria in sala operatoria: uso di modelli parametrici in BIM (Building Information Modeling) al fine di individuare criticità e interferenza tra aspetti edilizi e impiantistici.

INTRODUZIONE: Nell’ambito del progetto IM.PA.C.T. (IMproving the health of PAtients by supporting dynamiC healTh systems and new technologies), promosso dalla Regione Puglia, è stata valutata la qualità microbiologica dell’aria nelle sale operatorie (SO) ortopediche in operation, in funzione degli aspetti edilizi ed impiantistici. MATERIALI E METODI: Lo studio, che ha riguardato 33 SO, di cui 17 con impianto di Ventilazione e Condizionamento a Contaminazione Controllata (VCCC) a flusso d’aria misto (FM) e 16 a flusso turbolento (FT), è stato sviluppato in una prima fase predisponendo una scheda di rilevamento dei dati edilizi e impiantistici e, in una seconda fase, generando modelli BIM (Building Information Modeling) per i due tipi di SO, uno a FM e uno a FT. L’indagine è stata realizzata mediante metodologia Scan to BIM, integrando nel modello informatizzato il rilievo mediante laser scanner terrestre (LTS). L’analisi ha permesso di individuare e tipizzare le principali caratteristiche architettoniche e impiantistiche delle SO e le relative criticità; i dati sono stati correlati ai risultati microbiologici dell’aria (UFC/m3 ottenuti mediante Surface Air System-SAS e Coriolis®μ). RISULTATI: La contaminazione microbiologica rilevata differisce rispetto alla tipologia di pianta della SO (i valori mediani crescono all’aumentare della complessità geometrica: 18 UFC/m3 con il SAS, 25 UFC/m3 con il Coriolis®μ per le SO più regolari; 53 UFC/m3 con il SAS, 101 UFC/m3 con il Coriolis®μ per le SO con geometria più complessa), alla posizione delle estrazioni del VCCC (20 UFC/m3 con SAS, 24 UFC/m3 con Coriolis®μ per disposizione simmetrica, 42 UFC/m3 con il SAS, 50 UFC/m3 con il Coriolis®μ per disposizione asimmetrica). CONCLUSIONI: L’applicazione del BIM ha permesso di quantificare fattori sinora valutati qualitativamente e può servire come base per una più approfondita simulazione fluidodinamica dei flussi d’aria. Dai primi dati sembra emergere una relazione tra conformazione geometrica delle SO e carica microbica dell’aria. Successive indagini permetteranno di approfondire anche il ruolo di altri parametri e fornire evidenze scientifiche necessarie a predisporre una condivisa standardizzazione delle caratteristiche più frequentemente riscontrate nelle SO esistenti e possibili interventi di miglioramento