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Effectiveness of ATP bioluminescence to assess hospital cleaning: a review
Full text linkIntroduction. Contamination of hospital surfaces plays an important role in the transmission of several healthcare-associated microorganisms, therefore methods for evaluating hospital surfaces' cleaning gain particular importance. Among these, there are visual inspection, quantitative microbiology, fluorescent markers and adenosine triphosphate (ATP) bioluminescence. The latter seems to provide interesting features, detecting the presence of ATP on surface (as Relative Light Units, RLU), a proxy of organic matter and microbial contamination. Several studies have investigated the effectiveness of this technology; with this research, we aim to summarize the most significant results. Methods. A systematic review was conducted. The keywords (namely, "ATP", "bioluminescence", "hospital" and "surfaces") were searched in PubMed/MEDLINE and Scopus databases, in order to find relevant data, from January 2000 to October 2014. After the selection, we globally considered 27 articles. Results. Most of the studies were conducted in United Kingdom and in USA. Different threshold RLU benchmark values were identified by analyzed studies. Fourteen of these researches compared the ATP bioluminescence with microbiological methods, 11 identified a significant correlation between the two methods, although poor or not complete for 5. Discussion. ATP bioluminescence is not a standardized methodology: each tool has different benchmark values, not always clearly defined. At the moment, we can say that the technique could be used to assess, in real time, hospital surfaces where cleanliness is required, but not sterility
Effectiveness of ATP bioluminescence to assess hospital cleaning: a review
No full textBackground
Healthcare-associated infections represent a cause of patients
morbidity and mortality. Contamination of hospital surfaces
plays an important role in the transmission of several
healthcare-associated microorganisms. In this perspective
methods for evaluating hospital surfaces’ cleaning gain
importance. Traditionally, these include visual inspection
and quantitative microbiology; more recently fluorescent
markers and ATP bioluminescence have been introduced.
This latter seems to provide interesting perspectives, detecting
the presence of ATP on surface (as Relative Light Units, URL),
a proxy of organic matter and microbial contamination.
Several studies have investigated the effectiveness of this
technology in health care environment. The aim of this study
was to summarize the most significant results on the subject.
Methods
A literature review was conducted. The keywords: ‘‘ATP’’ AND
‘‘Bioluminescence’’ AND ‘‘Hospital’’ AND ‘‘Surfaces’’ were
searched in Pubmed and Scopus databases to find relevant data
from 2000 to March 2014. In Pubmed we found 17 studies, 3
of which were judged irrelevant and 1 was a review; so we
considered 13 studies. In Scopus we found 96 papers, 25 of
which were appropriated and already included in Pubmed.
Finally we considered 25 articles.
Results
11 studies were carried out in UK, 8 in the USA, 3 in Australia,
1 in Turkey, Japan and Italy. 12 studies (48 %) compared the
effectiveness of ATP bioluminescence to assess microbiological
contamination in hospital surfaces with aerobic colony count
(ACC), 11 evidenced a significant correlation between the two
methods, although poor for 5 studies. 20 studies indicated a
RLU benchmark value, discerning between clean and dirt
surfaces. This was 250 for 9 studies, 500 for 4, 100 for 3. One
paper considered 2 values 250 and 500 RLU and others 3 taken
as cutoff: 127, 45 and 300 RLU.
Conclusions
ATP bioluminescence is a not standardized methodology: each
tool has different benchmark values, not always defined. In
addition there is only a poor correlation between ACC and
RLU. The technique requires better accuracy, nevertheless,
with a proper calibration of each tool, it is useful in hospital
surfaces where is required cleanliness, but not sterility, for real-
time results.
Key messages
Prevention measures play a central role to avoid infections,
among them the evaluation of hospital surfaces’ cleaning
gain importance.
Visual assessment, quantitative microbiology and biolumi-
nescence can be use alternatively, depending on the
operating conditions (time, resources, surfaces, etc.)
Is it possible to sanitize athletes’ shoes?
Full text linkContext: Footwear should be designed to avoid trauma and injury to the skin of the feet that can favor bacterial and fungal infections. Procedures and substances for sanitizing the interior of shoes are uncommon but are important aspects of primary prevention against foot infections and unpleasant odor.
Objective: To evaluate the efficacy of a sanitizing technique for reducing bacterial and fungal contamination of footwear.
Design: Crossover study.
Setting: Mens Sana basketball team.
Patients or Other Participants: Twenty-seven male athletes and 4 coaches (62 shoes).
Intervention(s): The experimental protocol required a first sample (swab), 1/shoe, at time 0 from inside the shoes of allathletes before the sanitizing technique began and a second sample at time 1, after about 4 weeks, April 2012 to May 2012, of daily use of the sanitizing technique.
Main Outcome Measure(s): The differences before and after use of the sanitizing technique for total bacterial count at 368C and 228C for Staphylococcus spp, yeasts, molds, Enterococcus spp, Pseudomonas spp, Escherichia coli, and total coliform bacteria were evaluated.
Results: Before use of the sanitizing technique, the total bacterial counts at 368C and 228C and for Staphylococcus sppwere greater by a factor of 5.8 (95% confidence interval [CI] 1⁄43.42, 9.84), 5.84 (95% CI1⁄4 3.45, 9.78), and 4.78 (95% CI1⁄4 2.84,8.03), respectively. All the other comparisons showed a
reduction in microbial loads, whereas E coli and coliforms wereno longer detected. No statistically significant decrease inyeasts (P 1⁄4 .0841) or molds (P 1⁄4 .6913) was recorded probably because of low contamination.
Conclusions: The sanitizing technique significantly reduced the bacterial presence in athletes’ shoes. Key Words: athlete’s foot, foot infections, bacterial infections, fungal infections, basketball, hygien
Indagine sulla contaminazione microbica di stetoscopi, telefoni e tastiere di computer presso una casa di cura
No full textGenitori e vaccinazione anti-HPV
No full textIntroduzione: In Italia la vaccinazione anti-HPV è offerta gratuitamente a tutte le ragazze nel dodicesimo anno di vita a partire dal 2008. I vaccini attualmente in commercio sono due ed entrambi mostrano immunogenicità, sicurezza ed efficacia. Naturalmente l’efficacia di una qualsiasi vaccinazione dipende dal grado di copertura raggiunto nella popolazione, che è influenzato dalla sua accettazione e dal livello di conoscenza dell’argomento. Appaiono, pertanto, fondamentali campagne informative sull’argomento rivolte sia alle adolescenti che ai propri genitori. Alcuni lavori hanno, infatti, dimostrato che l’accettazione della vaccinazione da parte di questi ultimi non è universale a causa di preoccupazioni legate al timore di incoraggiare pratiche sessuali precoci. Il nostro studio si propone di: 1) verificare il livello di informazione, di genitori con figlie tra i 12 e i 19 anni, in tema di infezione e vaccinazione da HPV, 2) identificare le ragioni di non adesione vaccinale, 3) identificare le figure maggiormente attive nelle campagne di informative, 4) verificare il trend di adesione.
Metodi: Sulla base di un questionario utilizzato dal Ministero ne è stato costituito uno ad hoc per gli obiettivi dell’indagine. Lo studio ha coinvolto tre istituti scolastici di Siena, due scuole medie inferiori ed un istituto liceale. Sono stati distribuiti 1200 questionari ai genitori delle studentesse nate nelle coorti comprese tra il 1993 e il 2000. Sono state condotte analisi descrittive circa la percentuale di adesione, le motivazioni di mancata vaccinazione, la qualità e la modalità delle informazioni ricevute. Inoltre si sono confrontati con il test del X2 i trend di adesione alla vaccinazione nelle coorti di nascita ottenute con il questionario con la fonte dati istituzionale del Dipartimento di Prevenzione dell’ Azienda ASL di Siena. Le analisi sono state condotte con Epinfo 7 ed Excel.
Risultati: La percentuale di ritorno del questionario è stata pari al 54%. La maggioranza delle studentesse (il 79%) si è sottoposta alla vaccinazione anti-HPV. Il 70% dei genitori ha dichiarato di ritenere sufficiente la propria conoscenza sulla tematica. Una discreta parte di essi (67%) ha ottenuto informazioni da personale sanitario, quale ginecologi, pediatri, medici di medicina generale, sebbene alcuni (il 33%) abbiano appreso informazioni da fonti non ufficiali, come: parenti, amici, internet, radio, televisione, riviste. Si è, inoltre, evidenziato un quadro eterogeneo anche riguardo le motivazioni di mancata adesione. Analizzando le informazione rilevate dai questionari è stato identificato un trend di adesione da cui non sono emerse differenze statisticamente significative (P=0,62) tra le diversi coorti di nascita. Ciò contrasta con i dati ufficiali dai quali si rileva, invece, un trend crescente di adesione alla vaccinazione.
Conclusioni: Dall’indagine è emerso che la maggioranza di studentesse si è sottoposta alla vaccinazione. Per contro, nonostante il 70% dei genitori si ritenga sufficiente informato sulla tematica, alcuni di essi hanno appreso informazioni da fonti non interattive o da soggetti non esperti. In quest’ottica sarebbe auspicabile, ottimizzare la cooperazione tra Dipartimenti di Prevenzione delle Asl, Medici di Medicina Generale, Pediatri e Ginecologi al fine di garantire un’informazione adeguata e costante sul problema. La scuola potrebbe assumere un ruolo di collaborazione attiva con tali figure, promuovendo progetti e campagne educazionali sull’argomento
Use of a fluorescent marker for assessing hospital cleanliness
No full textBackground
Scientific evidence indicates that contamination of hospital
surfaces plays a role in the spread of healthcare-associated
infections (HAIs). Hospital cleaning practices and methods for
their assessment are important for HAIs prevention. Aims of
the study were: i)to assess the daily cleaning procedures of
different surfaces in hospital bathrooms with a fluorescent
marker, ii)to study correlations between results obtained by
this method and microbial contamination.
Methods
We enrolled 44 bathrooms of six hospital wards (A, B and C
medical; D, E and F surgical) in which we analysed 218 surfaces
(basin, toilet seat, flush button, inside door handle, light switch
and floor). We applied a UV-fluorescent marker to these
surfaces and the following day we assigned a score according
how completely the marker had been removed. On the floor of
each bathroom we also placed Petri dishes to assess bacterial
colony forming units (CFU). The Wilcoxon test was used for
comparisons between wards, Fisher’s exact test for removal
scores comparisons between different objects, Spearman’s
coefficient for correlations between CFU score and marker
removal score.
Results
Ward F proved to be less clean than wards A (p = 0.04), B
(p = 0.003) and E (p = 0.002). Medical units as a whole were
cleaner than surgical units (p = 0.0016). Basins were cleaner
than the other surfaces (P < 0.05), floors were dirtier than toilet
seats (p = 0.048) and the latter were dirtier than door handles
(p = 0.013). CFU score and mark removal score did not seem
to be correlated.
Conclusions
Differences in cleanliness between wards and surfaces may
indicate discrepancies in cleaning procedures. The UV marker
proved to be a practical and effective method for checking the
removal of dirt and dust. An early identification of inadequate
cleaning practices allows the repetition of them until good
hygiene standard are reached. UV marker could replace visual
inspection, in a multistep process later including quantitative
methods
Healthcare-associated infections and antimicrobial use: Siena 2012
No full textBackground
Healthcare-associated infections (HAI) and antimicrobial
resistance of ‘‘bugs’’ represent important public health
problems. HAI are associated with increases in mortality,
morbidity, length of hospital stay and costs. The aims of
this study were to determine the prevalence of HAI and the
use of antimicrobial agents (AA) in an Italian teaching
hospital.
Methods
Cross sectional study. We participated at the project
‘‘Hospitals in Europe Link for Infection Control through
Surveillance’’, ed. 2012, by the European Centre for Disease
Prevention and Control (ECDC). Medical records (MR)
collection was carried out in all the wards, in the period 19
to 30 November 2012. Case definitions, inclusion/exclusion
criteria and data collections were defined by a protocol.
Descriptive analysis and comparison with international
literature were made.
Results
467 MR were collected. 32 HAI were identified. 224 patients
were receiving AA.
The most common type of HAI was pneumonia/respiratory 9/
32 (28,1%) followed by bloodstream and urinary tract
infections, both 4/32 (12,5%,) and decubitus ulcers 3/32
(9,4%).
The most commonly microorganisms identified were
Staph.Aureus (17,1%), followed by:E.Coli (14,3%), Candida
Albicans and Staph.Epidermidis (both 11,4%), Pseudomonas
Aeruginosa (8,6%), Clostr.Difficile and Kleb.Pneumoniae
(both 5,7%).
The most widely used AA were -Lactam antibiotics,
(including penicillin derivates 77/303, cephalosporins 75/303
and Carbapenems 28/303) followed by fluoroquinolones 42/
303 and glycopeptide antibiotics 27/303. The reason for AA use
was included in patients’ MR only in 38,3% of cases. Surgical
prophylaxis, prolonged for more than 1 day (30,7%), was the
most common reason for AA use. Other reasons were:
treatment of HAI (21,4%) and medical prophylaxis/treatment
of community infection (both 19,5%).
Conclusions
Our results are partially in line with European ones. Urinary
tract emerged to be less common in our experience. This
positive results could be attributable to a better sensitization to
this problem in our Hospital. Microorganisms responsible for
HAI and AA used were similar to those detected in Europe.
Attentions have to be particularly addressed to microorgan-
isms which became resistant also because of the misuse of AA.
Key messages
Prevalence of HAI recorded by us does not seem greater
than European data. However in Italy some studies reported
an increase of resistant bacteria.
We reported that reasons for antimicrobial agents (AA) use
were included in only 38,3% patients’ medical records. This
is relevant: the overuse/misuse of AA, may cause increase of
resistant bacteria
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