Reducing healthcare-associated infections incidence by a probiotic-based sanitation system: A multicentre, prospective, intervention study

Healthcare Associated Infections (HAI) are a global concern, further threatened by the increasing drug resistance of HAI-associated pathogens. On the other hand, persistent contamination of hospital surfaces contributes to HAI transmission, and it is not efficiently controlled by conventional cleaning, which does not prevent recontamination, has a high environmental impact and can favour selection of drug-resistant microbial strains. In the search for effective approaches, an eco-sustainable probiotic-based cleaning system (Probiotic Cleaning Hygiene System, PCHS) was recently shown to stably abate surface pathogens, without selecting antibiotic-resistant species. The aim of this study was to determine whether PCHS application could impact on HAI incidence. A multicentre, pre-post interventional study was performed for 18 months in the Internal Medicine wards of six Italian public hospitals (January 1st 2016-June 30th 2017). The intervention consisted of the substitution of conventional sanitation with PCHS, maintaining unaltered any other procedure influencing HAI control. HAI incidence in the pre and post-intervention period was the main outcome measure. Surface bioburden was also analyzed in parallel. Globally, 11,842 patients and 24,875 environmental samples were surveyed. PCHS was associated with a significant decrease of HAI cumulative incidence from a global 4.8% (284 patients with HAI over 5,930 total patients) to 2.3% (128 patients with HAI over 5,531 total patients) (OR = 0.44, CI 95% 0.35-0.54) (P<0.0001). Concurrently, PCHS was associated with a stable decrease of surface pathogens, compared to conventional sanitation (mean decrease 83%, range 70-96.3%), accompanied by a concurrent up to 2 Log drop of surface microbiota drug-resistance genes (P<0.0001; Pc = 0.008). Our study provides findings which support the impact of a sanitation procedure on HAI incidence, showing that the use of a probiotic-based environmental intervention can be associated with a significant decrease of the risk to contract a HAI during hospitalization. Once confirmed in larger experiences and other target populations, this eco-sustainable approach might be considered as a part of infection control and prevention (IPC) strategies. Trial registration-ISRCTN International Clinical Trials Registry, ISRCTN58986947

Correlates of HCV seropositivity among familial contacts of HCV positive patients

BACKGROUND: Determinants of intrafamilial HCV transmission are still being debated. The aim of this study is to investigate the correlates of HCV seropositivity among familial contacts of HCV positive patients in Italy. METHODS: A cross-sectional study was conducted with 175 HCV positive patients (index cases), recruited from Policlinico Gemelli in Rome as well as other hospitals in Central Italy between 1995 and 2000 (40% female, mean age 57 ± 15.2 years), and 259 familial contacts. Differences in proportions of qualitative variables were tested with non-parametric tests (χ(2), Yates correction, Fisher exact test), and a p value < 0.05 was considered significant. A multivariate analysis was conducted using logistic regression in order to verify which variables statistically have an influence on HCV positivity in contact individuals. RESULTS: Seropositivity for HCV was found in 8.9% of the contacts. From the univariate analysis, risk factors significantly associated to HCV positivity in the contacts were: intravenous drug addiction (p = 0.004) and intercourse with drug addicts (p = 0.005). The only variables associated significantly and independently to HCV seropositivity in patients' contacts were intercourse with drug addicts (OR = 19.28; 95% CI: 2.01 – 184.94), the retirement status from work (OR = 3.76; 95% CI: 1.17 – 11.98), the time of the relationship (OR = 1.06; 95% CI: 1.00 – 1.11) and tattoos (OR = 7.68; 95% CI: 1.00 – 60.20). CONCLUSION: The present study confirms that having intercourse with a drug addict is the most significant risk factor for intrafamilial HCV transmission. The association with retirement status from work could be related to both a long-term relationship with an index case and past exposure to common risk factors

Selection of the appropriate Limberg flap in the reconstruction of post-excisional nasal defects

Treatment of superficial cutaneous neoplasias involving the nasal pyramid is frequent in plastic surgery. In this article the authors report their experience in the reconstruction of post-excisional nasal defects employing the local rhomboid flap, initially popularized by Alexander Limberg. From 1995 to 2000, 115 patients underwent exeresis for basalioma of the nasal pyramid at the Campus Bio-Medico University in Rome; in 98 cases the Limberg flap was the reconstructive procedure of choice. In spite of its simplicity, the flap requires accurate planning according to the location. The flap is designed for the repair of equilateral rhomboid defects and is marked extending the short diagonal of the defect in either direction for a distance equal to its own length. Two sides of the flap are thus obtained; the third side is designed at an angle of 60°, always with the same length. The fundamental principle for the application of this technique is that the flap has to be rotated and advanced along the lines of maximum extensibility which are perpendicular to the relaxed skin tension lines. Thus the short diagonal part of the flap has to be parallel to the lines of maximum extensibility; only by this careful planning is it possible to easily close the donor site where the major degree of cutaneous tension occurs. At the level of the nasal pyramid the relaxed skin tension lines are placed transversely; the lines of maximum estensibility, which are perpendicular to them, are oriented vertically, thus the rhomboid flap has to be rotated and advanced vertically in the direction of the caudal cranium. The different aesthetic nasal subunits are disthinguished and some guidelines are suggested according to the location. The simplicity of the execution and the minor trauma with respect to the other procedure, as well as the excellent aesthetic results in both young and elderly patients, make the Limberg flap a valid reconstructive procedure for nasal defects

Influence of Sanitizing Methods on Healthcare-Associated Infections Onset: A Multicentre, Randomized, Controlled Pre-Post Interventional Study

Background: Contamination of healthcare surfaces contributes to Healthcare-associated infections (HAIs) transmission, representing a global concern. Conventional chemicals-based sanitation shows limitations in controlling surface contamination and related HAIs onset, and can select multi-resistant pathogen species. Recently, a sanitizing procedure involving probiotic-based detergents was shown to decrease surface pathogens up to 90% more than conventional disinfectants, without selecting resistant species. This study aims to analyse the influence of a probiotic-based sanitizing intervention on HAIs incidence and typology. Design: Seven Italian hospitals representative of all Italian geographical areas will be recruited for participation in a multicentre, prospective, randomised, pre-post interventional study, analysing simultaneously for a consecutive 18- months period both microbial surface contamination and HAIs occurrence. The intervention will consist in the substitution of the conventional cleaning procedure (chlorine-based) with a probiotic-based one. In the preintervention phase, hospitals will maintain conventional sanitizing procedures; in the post-intervention phase, the probiotic-based sanitation will be applied, allowing a buffer period for the stabilization of the new method. The participating hospitals will be randomly allocated in the following groups: no-intervention (one hospital), intervention-1st group (three hospitals) and intervention-2nd group (three hospitals), entering the study with a 5- months delay. During the whole study period, all patients admitted to the recruited hospital wards will be continuously surveyed for HAI occurrence. Meanwhile, surface bioburden will be monitored monthly by both biological and molecular assays. Discussion: This study will be the first to provide robust data on the impact of sanitation procedures on healthcare associated infections onset and typology, as no previously reported studies evaluates simultaneously and continuously for a period of 18 months both the environmental surface bioburden, its resistome and the healthcare associated infections onset. Results: The results generated from this study might be important for the development of future guidelines to modulate environmental microbiota and to ameliorate hospital environmental cleaning, implementing prevention strategies to reduce HAIs onset

Effects of unilateral ovariectomy on female fertility outcome

To compare the fertility outcome among women subjected to unilateral ovariectomy and other abdominal or non-gynaecologic pelvic surgery. In this retrospective cohort study, 113 fertile women, surgically treated between 1990 and 2001 at Sapienza University of Rome with unilateral ovariectomy (UO), appendectomy (AP) or cholecystectomy (CO) for benign disease, were analysed for fertility outcome. Patients with assessed pre-surgical fertility defects, previous abdominal or pelvic surgeries and post-surgical contraception were not included. Thirty-five women underwent UO, 39 were subjected to AP and 39 were treated with CO. After a minimum 10-year post-surgical interval, the overall number of successful pregnancies was 75. The rate of women who experienced at least one post-operative successful pregnancy was: 48.5 % in UO, 41 % in AP and 53.8 % in CO (UO vs. AP, P = 0.55; UO vs. CO, P = 0.99; AP vs. CO, P = 0.53). One patient (2.8 %) in UO, one patient (2.6 %) in AP and two patients (5.1 %) in CO underwent Assisted Reproductive Technology to become pregnant. The rate of women who reported at least one miscarriage was: 10/35 (28.5 %) in UO, 11/39 (28.2 %) in AP, 12/39 (30.8 %) in CO (UO vs. AP, P = 0.93; UO vs. CO, P = 0.89; AP vs. CO, P = 0.81). One ectopic pregnancy was reported in CO group and one stillbirth occurred in one AP patient. No statistical difference in terms of post-operative fertility outcome between patients subjected to UO, AP or CO was found, thus allowing to suppose that the removal of one ovary does not significantly worsen the female fertility outcome respect to other abdominal or pelvic procedures.Purpose: To compare the fertility outcome among women subjected to unilateral ovariectomy and other abdominal or non-gynaecologic pelvic surgery. Methods: In this retrospective cohort study, 113 fertile women, surgically treated between 1990 and 2001 at Sapienza University of Rome with unilateral ovariectomy (UO), appendectomy (AP) or cholecystectomy (CO) for benign disease, were analysed for fertility outcome. Patients with assessed pre-surgical fertility defects, previous abdominal or pelvic surgeries and post-surgical contraception were not included. Results: Thirty-five women underwent UO, 39 were subjected to AP and 39 were treated with CO. After a minimum 10-year post-surgical interval, the overall number of successful pregnancies was 75. The rate of women who experienced at least one post-operative successful pregnancy was: 48.5 % in UO, 41 % in AP and 53.8 % in CO (UO vs. AP, P = 0.55; UO vs. CO, P = 0.99; AP vs. CO, P = 0.53). One patient (2.8 %) in UO, one patient (2.6 %) in AP and two patients (5.1 %) in CO underwent Assisted Reproductive Technology to become pregnant. The rate of women who reported at least one miscarriage was: 10/35 (28.5 %) in UO, 11/39 (28.2 %) in AP, 12/39 (30.8 %) in CO (UO vs. AP, P = 0.93; UO vs. CO, P = 0.89; AP vs. CO, P = 0.81). One ectopic pregnancy was reported in CO group and one stillbirth occurred in one AP patient. Conclusions: No statistical difference in terms of post-operative fertility outcome between patients subjected to UO, AP or CO was found, thus allowing to suppose that the removal of one ovary does not significantly worsen the female fertility outcome respect to other abdominal or pelvic procedures. © 2014 Springer-Verlag

Reducing healthcare-associated infections incidence by a probiotic-based sanitation system: a multicentre, prospective, intervention study.

Healthcare Associated Infections (HAI) are a global concern, further threatened by the increasing drug resistance of HAI-associated pathogens. On the other hand, persistent contamination of hospital surfaces contributes to HAI transmission, and it is not efficiently controlled by conventional cleaning, which does not prevent recontamination, has a high environmental impact and can favour selection of drug-resistant microbial strains. In the search for effective approaches, an eco-sustainable probiotic-based cleaning system (Probiotic Cleaning Hygiene System, PCHS) was recently shown to stably abate surface pathogens, without selecting antibiotic-resistant species. The aim of this study was to determine whether PCHS application could impact on HAI incidence. A multicentre, pre-post interventional study was performed for 18 months in the Internal Medicine wards of six Italian public hospitals (January 1st 2016 - June 30th 2017). The intervention consisted of the substitution of conventional sanitation with PCHS, maintaining unaltered any other procedure influencing HAI control. HAI incidence in the pre and post-intervention period was the main outcome measure. Surface bioburden was also analyzed in parallel. Globally, 11,842 patients and 24,875 environmental samples were surveyed. PCHS was associated with a significant decrease of HAI cumulative incidence from a global 4.8% (284 patients with HAI over 5,930 total patients) to 2.3% (128 patients with HAI over 5,531 total patients) (OR=0.44, CI 95% 0.35-0.54) (P<0.0001). Concurrently, PCHS was associated with a stable decrease of surface pathogens, compared to conventional sanitation (mean decrease 83%, range 70-96.3 %), accompanied by a concurrent up to 2 Log drop of surface microbiota drug-resistance genes (P<0.0001; Pc=0.008). Our study provides findings which support the impact of a sanitation procedure on HAI incidence, showing that the use of a probiotic-based environmental intervention can be associated with a significant decrease of the risk to contract a HAI during hospitalization. Once confirmed in larger experiences and other target populations, this eco-sustainable approach might be considered as a part of infection control and prevention (IPC) strategies. Trial registration - ISRCTN International Clinical Trials Registry, ISRCTN5898694

New strategies to implement flu vaccination in health workers: forum theatre in a university hospital

Every year outbreaks of influenza infects approximately 10% of the population leading to high morbidity and mortality, especially in settings like health care facilities. Even when the influenza vaccination has been recommended for health care workers (HCWs), in order to protect vulnerable individuals and reduce transmission, the average coverage of vaccinated HCWs of the past years has only been 28.6% in European Union (EU) and 15% in Italy, probably due to the lack of trust in vaccines, propagated by the media

Incidence study of surgical site infections in a large University Hospital in Rome, first results

Background Surgical Site Infections (SSI) represent about a quarter of healthcare associated infections (HAI), increase the risk of mortality and hospital stay and extend healthcare costs. The aim of this work is to evaluate the incidence of SSI in patients undergoing surgical procedures of Hospital Units in the Fondazione Policlinico A. Gemelli IRCCS (FPG). Methods This descriptive observational monocentric study has a 30-months duration: the first phase was conducted between July 2018 and March 2019. Patients undergoing abdominal surgery procedures were enrolled. Active infection surveillance was performed, according to the ECDC, during the hospital stay and the surgical outpatient visits. We also performed a post-discharge surveillance (PDS) at 30 days (or 90 days if an implant has been inserted), through a telephone interview, made by a medical doctor resident in Public Health. Results During the first phase were enrolled 431 procedures in 2 Hospital Units, about emergency and hepatobiliary surgery. There were 53 cases of surgical site infection (SSI) highlighted in these procedures. Therefore, SSI’s were reported in 12.09% of the procedures. In particular, in 6.28% of cases, SSIs were diagnosed during the hospital stay. The results of this study showed statistically significant differences (p &lt; 0.005) in incidence rate of emergency (10,70%) and hepatobiliary tract (13,17%) procedures. The average hospital stay was significant higher (p &lt; 0.001) in patients who developed an SSI (17.27 days) than in patients without SSI (4.89 days). Conclusions These preliminary results show that the incidence rate of SSI for gastrointestinal procedures is similar to other European Countries (9.6%). The Hospital Health Management of FPG take care to the surveillance of hospital infections and monitor the correct application of the procedures, in line with the standards defined by Joint Commission International for guarantee high level in patients’ care