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

Comunicazione e tecniche di counseling nella formazione del medico: esperienza nel corso di laurea in medicina e chirurgia dell'Università di Parma

INTRODUZIONE: La comunicazione riveste oggi un ruolo fondamentale nell’attività degli operatori sanitari, nella prevenzione, diagnosi, terapia e riabilitazione. Ancora scarsa è l’attenzione prestata nei corsi di studio alle potenzialità che le competenze relative alle tecniche di comunicazione, e in particolare a specifiche tecniche di counseling, svolgono nella pratica medica; la carenza di tali competenze viene da molti operatori sanitari riconosciuta come uno dei punti deboli del percorso formativo universitario. Nell’ambito del Corso di Igiene, Sanità Pubblica e Politiche della Salute, del Corso di Laurea in Medicina e Chirurgia dell’Università degli Studi di Parma, a partire dall’anno accademico 2012/2013 è stata inserita una Attività Didattica Elettiva (ADE) sulla comunicazione, con l’obiettivo di fornire elementi conoscitivi di base da appplicare nella pratica professionale e valutarne bisogni e gradimento. METODI: L’ADE è stata offerta a studenti del 3°, 4°, 5°e 6° e ha previsto lezioni partecipate, role playing, esercitazioni pratiche e di tecnica corporea. L’analisi dell’attività formativa è stata effettuata attraverso il rapporto tra abbandoni e richiesta di frequenza; la valutazione anonima dell’esperienza da parte degli studenti. RISULTATI: Hanno partecipato all’ADE 40 studenti all’anno. Nessuno studente ha abbandonato la frequenza. La maggior parte degli studenti ha dichiarato di aver scelto l’ADE per curiosità e aver scoperto l’importanza della comunicazione nella professione medica, e ha espresso il bisogno di una specifica formazione sul tema. CONCLUSIONI: L’esperienza riportata evidenzia l’esigenza di inserire nella formazione di base del medico la comunicazione, con particolare riferimento ai modelli di counseling, strumento fondamentale nello sviluppo di empowerement. Le competenze comunicative rappresentano una componente essenziale della qualità dell’attività sanitaria ed è fondamentale che vengano acquisite a cominciare dai corsi di laurea

Appropriate perioperative antibiotic prophylaxis: challenges, strategies, and quality indicators

INTRODUCTION: Surgical site infections (SSIs) are common surgical complications and perioperative antibiotic prophylaxis (PAP) contributes to the reduction of the associated risk. The aim of the present review article is to summarize the most recently published studies with a special focus on challenges, strategies and quality indicators of PAP. METHODS: Literature searches in the Medline database, using PubMed, were carried out for studies published from January 2011 to April 2015. Inclusion criteria were all types of epidemiological studies investigating: i. compliance with PAP recommendations at different levels by using process indicators, and ii. the effect of different interventions conducted in order to improve PAP compliance. RESULTS: A total of 28 studies were retrieved. Overall compliance with all included PAP indicators ranged from 9.4% to 80%. Generally, compliance with the PAP process indicators significantly improved after interventions. CONCLUSIONS: The present review summarizes the recent published studies and indicates an overall inadequate compliance with PAP recommendations, underlining the need to develop and to implement successful strategies to improve adherence to guidelines. Different interventions were found efficacious in order to increase compliance with appropriate PAP administration

Detergenti contenenti microrganismi “probiotici”:<BR>esiste un loro ruolo per la sanificazione <BR>degli ambienti sanitari?

La sanificazione degli ambienti ospedalieri riveste un ruolo importante per le implicazioni di ordine igienico-sanitario che influiscono sulla qualità e la sicurezza delle cure erogate e sull’efficienza ed efficacia dell’organizzazione dei servizi. In questo ambito è di recente emerso un orientamento verso l’impiego di detergenti con minor impatto ambientale, coerentemente con le raccomandazioni europee sul green procurement. alla luce delle conoscenze attuali, appare a nostro parere opportuno adottare il “principio di precauzione” e procrastinare l’introduzione dei detergenti contenenti microganismi “probiotici” fra le pratiche ammissibili per la sanificazione in ambiente ospedaliero in attesa di ulteriori evidenze di efficacia e sicurezz

[Detergents containing micro-organisms "probiotics": is there a role for the sanitation of healthcare settings?]

La sanificazione degli ambienti ospedalieri riveste un ruolo importante per le implicazioni di ordine igienico-sanitario che influiscono sulla qualità e la sicurezza delle cure erogate e sull’efficienza ed efficacia dell’organizzazione dei servizi. In questo ambito è di recente emerso un orientamento verso l’impiego di detergenti con minor impatto ambientale, coerentemente con le raccomandazioni europee sul green procurement. Alcuni produttori, seguendo tale tendenza, hanno suggerito l’uso di detergenti contenenti batteri “probiotici”. Prodotti a base di microrganismi viventi sono stati, fino ad oggi, validati e impiegati in ambito ambientale per il bio-risanamento (bio-remediation), ovvero l’utilizzo di sistemi biologici con l’obiettivo di ridurre l’inquinamento dell’aria, delle acque o del suolo. Il bio-risanamento sfrutta le vie metaboliche dei micrororganismi, in particolare di quelli che sono in grado di metabolizzare sostanze inquinanti, quali ad esempio fenoli, benzene, toluene, olii, idrocarburi aromatici, in modo naturale (convertendoli in acqua e anidride carbonica), con un basso impatto ambientale e offrendo una valida alternativa ai metodi tradizionali che non risultano sempre efficaci oltre ad essere costosi

Compliance with guidelines on antibiotic prophylaxis in hip and knee arthroplasty in Italy: results of the GISIO-ISChIA project

BACKGROUND: The Perioperative Antibiotic Prophylaxis (PAP) contributes considerably to the total amount of antibiotics used in hospitals and has been shown to be associated with increase in antibiotic resistance and healthcare costs. The level of compliance with the national guidelines of current practices of PAP for elective hip and knee prosthesis procedures in a network of Italian hospitals (the multicentre Surgical Site Infection surveillance project GISIO-ISChIA), has been evaluated. METHODS: Compliance of the current prophylactic antibiotic practices with the published national guidelines was assessed for each included operative procedure, considering indication, timing of administration, prescribed antimicrobial agent and total duration of prophylaxis. RESULTS: A total of 14 hospitals and 1285 surgical procedures were included. 99.4% of patients received antimicrobial prophylaxis pre-operatively and 73.0% of patients received PAP within the recommended time period (within 60 minutes before incision). The rate of compliance with discontinuation of PAP within 24 hours after initiation of surgery was 70.2%. Taking into account all doses administered, the antibiotic was chosen appropriately in 57.7% of patients. PAP was performed appropriately, in accordance with national guidelines, in 43.6% of surgical operations. CONCLUSIONS: Given the increasing number of replacement procedures in Italy and in Europe, the gap between the evidence-based guidelines and practice must be appropriately addressed in order to improve PAP practices

Air microbial sampling in operating theatres by active and passive methods: equation correlation from the GISIO-ISChIA study results and comparison with the EU GGMP recommendation, towards the definition of threshold values

: The aim of this study was to calculate the equation of correlation between the microbial air contamination values obtained by active sampling (colony-forming units per cubic metre, CFU/m3) and by passive sampling (Index of microbial air contamination, IMA), by using the data from the ISChIA study, and to compare the values obtained with the recommended limits defined by the EU Guidelines to Good Manufacturing Practice (EU GGMP), 2008, for clean areas used to manufacture sterile medicinal products. Air sampling was performed during 335 elective prosthesis procedures. Correlation between CFU/m3 and IMA values was evaluated using the Spearman test; p&lt;0.05 was considered to indicate significance. This equation was used to calculate the IMA values corresponding to the CFU/m3 recommended threshold values by EU GGMP for the different Grades of microbial contamination. The following correlation equation was obtained: y = 1.86 + 0.12x, where "x" = cfu/m3 value and "y" = IMA value. The relationships between CFU/m3 and IMA values obtained from active and passive sampling during the ISChIA study showed to be in line to those suggested by the EU GGMP for pharmaceutical manufacturing for Grade C and D. This study shows that the EU GGMP relationship could be considered valid also for operating theatres. Both methods, active and passive samplings, can be used to evaluate microbial air quality and highlight critical situations; however, in particular during the activity, passive sampling estimating the risk posed by airborne microorganisms to the surgical wound, can be considered more relevant, and for its simplicity, economy and standardization, can be suggested for routine microbial monitoring