1,720,964 research outputs found
Etiology, source and prevention of waterborne healthcare-associated infections: a review.
No full textThe purpose of this review is to discuss the scientific literature on waterborne healthcare-associated infections (HCAI) published from 1990 to 2012. The revision focuses on the aquatic bacteria and describes both outbreaks and single cases in relation to patients characteristics, settings, and contaminated sources. An overview of diagnostic methods and environmental investigations is summarized in order to provide guidance for future case investigations. Lastly, on the basis of prevention and control measures adopted, information and recommendations are given. A total of 125 reports were included, 41 of them describing hospitalized children. All cases were sustained by opportunistic pathogens, mainly Legionellaceae, Pseudomonadaceae and Burkholderiaceae. Hot water distribution systems were the primary source of Legionnaires' disease, bottled water was mainly colonized by Pseudomonaceae, and Burkholderiaceae were the leading cause of distilled and sterile water contamination. Intensive care unit was the most frequently involved setting but patient characteristics are the main risk factor, independently of the ward. As the microbes water contamination is difficult to be avoided and disinfection treatments may be insufficient to control the risk of infection, a proactive preventive plan should be put in place. Nursing staff should pay special attention to children and immunosuppressed patients to avoid tap water exposure, also for their personal hygiene, and to regularly use sterile water for rinsing/cleaning device
Igiene delle mani in studenti di infermieristica e medicina durante i tirocini: studio pilota su conoscenze, comportamenti e impatto sulla contaminazione batterica
No full textNonostante esaurienti linee guida,
l’adesione all’igiene delle mani da parte degli operatori sanitari
è preoccupantemente bassa. Per aumentare l’adesione,
sarebbe utile intervenire sull’educazione dei futuri professionisti.
Obiettivo. Raccogliere informazioni su atteggiamenti,
conoscenze e pratica sul campo inerenti l’igiene delle mani
negli studenti dei CdL in Infermieristica e Medicina. In questo
lavoro vengono presentati i risultati dello studio pilota.
Metodo. Cinquanta studenti di ciascun corso hanno compilato
un questionario che indagava le conoscenze sulla corretta
igiene delle mani e sulla sua realizzazione pratica. I dati
raccolti sono stati associati alla contaminazione batterica
delle mani sia all’ingresso che all’uscita dal reparto. Risultati.
Tutti i futuri infermieri hanno eseguito l’igiene delle mani
con frequenza significativamente superiore a quella degli
studenti in Medicina. La carica batterica totale diminuiva significativamente
a fine tirocinio in entrambi i gruppi, ma in
modo più marcato negli studenti infermieri. Le cariche aumentavano
in assenza di pratiche igieniche e l’alternanza tra
lavaggio tradizionale e gel alcolico si è dimostrata la procedura
più efficace. Le conoscenze di ambedue i gruppi, anche
se differenti, sono risultate complessivamente adeguate. Conclusioni.
Gli studenti infermieri ricevono, fin dal primo anno,
una adeguata formazione e mettono in atto l’igiene delle
mani, dato confermato dalle cariche batteriche. I futuri medici,
che apprendono le conoscenze di tali pratiche più avanti
nel corso di studi e svolgono principalmente attività di osservazione
al letto del paziente, sono meno attenti all’igiene
delle mani. Questo dato suggerisce di anticipare l’insegnamento
di questi contenuti prima dell’inizio dei tirocini
Hand hygiene in nursing and medical students during training: a study on knowledge, practices and impact on bacterial contamination.
No full textAim. To collect information about knowledge, behavior and hand hygiene (HH) practices in Italian nursing and medical students combining data with hand bacterial contamination before and after a morning training. Methods. A questionnaire designed to investigate knowledge on HH and its practical realization was administered to a casual sample of 100 nursing and 100 medical students attending our University. Data collected were associated with hand contamination measured at the entrance and exit of the turn of training. Results. All nursing students performed HH during training and the frequency was significantly higher compared to medical students, 39% of which declared not to have done it. At the end of training, hand contamination were significantly reduced in both groups, but more pronounced in nursing students. Scores on the HH knowledge were significantly related to HH practices and self-reported HH compliance and were significantly higher for nursing students. Students were also asked to give their opinion on HH knowledge acquired during the course and a significant increase of adequacy as the medical students progressed through their course was found. Discussion. Since the first year of their course, nursing students receive adequate knowledge and consequently apply HH practices during training activities, data confirmed by total bacterial count. Medical students get HH knowledge later and less attention is devoted to these practices also in relation to the reduced occasions of patient contact during their training. This suggested us to anticipate the Hygiene and Public Health teaching before the start of the training activity
Legionellosis risk in swimming pool and SPA
No full textSpas used for either therapeutic or recreational aims are considered at risk for legionellosis occurrence. Thermal water is normally used at temperature between 30 and 40°C, ideal for Legionella growth, with a potential risk for users. Inhalation of colonized aerosol has been associated with sporadic cases or clusters of both Legionnaires’ disease and Pontiac fever, particularly involving immune depressed subjects. Italian and European guidelines have been issued to prevent and control this risk. At the spring, thermal water can contain small concentrations of legionellae, but within the distribution lines the amplification of these bacteria is promoted by stagnancy and incrustation, a frequent phenomenon also associated with the high mineral content of these waters. In addition, the detachment of dead cells, body lotions/creams residuals and skin debris in swimming pools favorites the bacteria multiplication. The devices/treatments more involved in transmission risk are inhalation therapies, frequently utilized by persons with chronic disease, showers and whirlpools, largely used also in the wellness centers. We revised the studies on Legionella spp presence in hot springs and related structures. The majority of published reports documented the germ contamination both at the source and along the distribution lines up to the point of use with increasing concentrations. Particular water characteristics such as high levels of sulfur and/or carbonate seem to be unfavorable to legionellae colonization but further studies are needed to deep this aspect. Contamination risk is less relevant for swimming pools due to high chlorine content, unless an insufficient disinfection plan is applied. From eighty years, about 50 studies have been published documenting cases of Legionnaires’ disease associated with spas. The majority of them occurred in Japan, where also a large outbreak is described with more than 300 persons involved. In almost all cases, L. pneumophila was the responsible germ and during the environmental inquire Legionella spp was found in many points of the spas: in spring water, in the distribution system, in the tank, in devices for nasal irrigation and aerosol therapy as well as in the whirlpool bath and swimming pool. To study the infection risk, the antibodies against Legionella have been evaluated in workers and patients attending the spa; the antibodies presence was found in a decreasing proportion from therapists to administration personnel. In conclusion, we underline the need for an accurate surveillance and control of Legionella spp and other waterborne germs in spas and other structures where inhalation of aerosolized water is expected
Valutazione dei rischi di malattia da agenti biologici, fisici e chimici nell'era della globalizzazione: dati epidemiologici e strategie di prevenzione
No full textIn questa pubblicazione vengono riportati alcuni dei più attuali contaminanti chimico-fisici e infettivi che attraverso la catena alimentare possono rappresentare un rischio per la salute uman
Monochloramine and chlorine dioxide for controlling Legionella pneumophila contamination: biocide levels and disinfection by-products (DBPs) formation in hospital water networks.
Full text linkLegionella colonization in hospital hot water distribution networks was evaluated
following 36 months of continuous treatment with monochloramine and compared with
chlorine dioxide. Nitrite, nitrate, chlorite, chlorate, bromide, trihalomethanes and
haloacetic acids as well as the biocide concentration at sampled points were
measured. Only 8/84 samples treated with monochloramine were found contaminated
and after the first 8 months of treatment no Legionella was isolated. Chlorine dioxide
was associated with a strong reduction in Legionella contamination compared to pretreatment,
but differences according to the device were observed. Monochloramine
between 2 and 3 mg l−1 and chlorine dioxide between 0.50 and 0.70 mg l−1 were
needed to control Legionella colonization. Comparing no- and post-flush samples, a
higher frequency of no-flush positive samples was noted using chlorine dioxide,
suggesting an increased risk for patients when they open the tap. No increase in
chlorite levels and no water nitrification occurred by using monochloramine. Chlorite at
levels exceeding the limit requested for drinking water was measured when chlorine
dioxide was applied. In conclusion, we highlight that continuous injection of
monochloramine should be considered as an effective alternative to chlorine dioxide in
controlling legionellae contamination inside hospital water distribution system
Legionella e Pseudomonas spp, i maggiori determinanti di infezioni di origine idrica in ospedale: differenze nella contaminazione e nella risposta ai sistemi di disinfezione
No full textIn this study, long-term surveillance of Legionella and Pseudomonas spp contamination in water systems of
a big hospital and effi cacy of disinfection treatments are reported. In the period 2008-2011, 550 hot water
samples from technical rooms and showers/taps of hospital wards were collected for Legionella and Pseudomonas
spp isolation by cultural methods. In the hospital, several measures to control water contamination,
including shock treatments and continuous systems (chlorine dioxide, monochloramine, boiler) have been
employed. Legionella spp was detected in 38.9% of the samples, and the more effective methods in reducing
contamination were in order boiler, monochloramine and chlorine dioxide. Pseudomonas spp was isolated
in 25.4% of the samples, mainly at peripheral sites; the number of positive sites were reduced effi ciently by
boiler, while the other methods did not signifi cantly modify the contamination. Different associations between
the two studied bacteria and some water parameters, such as total bacterial count, pH and metals, were
observed. Our study points out that Legionella and Pseudomonas spp differ for contamination mode and
for response to disinfection systems. The prevalent contamination of pseudomonas at point-of-use suggests
that, besides disinfection, the constant maintenance and replacement of faucets and showers is mandatory
to control this germ
Control of Legionella contamination and risk of corrosion in hospital water networks following various disinfection procedures
Full text linkPhysical and chemical disinfection methods have been proposed with the aim of controlling Legionella water contamination. To date, the most effective procedures for reducing bacterial contamination have not yet been defined. The aim of this study is to assess the long-term effectiveness of various disinfection procedures in order to reduce both culturable and not culturable (NC) legionellae in different hospital water networks treated with heat, chlorine dioxide, monochloramine and hydrogen peroxide. The temperature levels and the biocide concentrations that proved to obtain reliable results were analysed. In order to study the possible effects on the water pipes, we verified the extent of corrosion on experimental coupons after applying each method for six months. The percentage of positive points was at its lowest after treatment with monochloramine, followed by chlorine dioxide, hydrogen peroxide and hyperthermia. A different selection of Legionella spp was observed, as networks treated with chlorine-based disinfectants were mainly contaminated by L. pneumophila serogroup 1, hyperthermia was associated with the serogroups 2-14 and hydrogen peroxide mainly with non-pneumophila species. NC cells were only detected in heat-treated waters, also when the temperature was approximately 60°C. The corrosion rate of the coupons was within a satisfactory limit for water networks, but the morphology changed. We confirm that chemical disinfection controls Legionella colonization more effectively than hyperthermia. Monochloramine was the most effective treatment, while hydrogen peroxide could be a promising alternative to chlorine-based disinfectants due to its ability to select for other less virulent or non-pathogenic species
Students’ hand contamination before and after a training shift: relationship with self-reported hand hygiene adherence
Full text link BACKGROUND: Our objective was to measure hand bacterial contamination in a group of nursing and medical Italian students attending clinical wards for practical training, in order to verify the reliability of the information on hand hygiene (HH) adherence obtained by a self-reporting questionnaire. This questionnaire was administered with the aim to explore the effectiveness of basic education. METHODS: An anonymous questionnaire designed to investigate HH knowledge and practices was administered to a convenience sample of 100 nursing and 100 medical students. Data collected were combined with hand bacterial contamination measured both at the entry and the exit from the ward. RESULTS: HH practices and knowledge were significantly higher in nursing compared to medical students.. The most effective procedure in reducing bacterial contamination was the alternate use of handwashing and handrubbing compared to only one practice and the absence of hand hygiene (geom. mean: 180.3, 410.2 and 907.4 CFU/hand respectively, p<0.001). Hand contamination was significantly higher in students who declared to hardly ever/never implement HH teaching during clinical practice compared to those who stated to have done it frequently/always (geom. mean: 716 vs 277.1 CFU/hand, p<0.02). CONCLUSION: Our investigation adds something new to the topic of HH that is the measure of bacterial hand contamination to verify the reliability of the information obtained by questionnaire. The findings, pointing out some critical aspects in the HH teaching among healthcare students, highlight that solid knowledge results into correct behaviors, and consequently into a reduction of hand contamination
- …
