1,721,293 research outputs found
L’incrocio di Shibuya e la scelta dello strumento di regolazione della crisi
No full textThe atomistic and compartmentalized analysis of each voluntary crisis and insolvency proceedings (Strumenti di Regolazione della Crisi), while more straightforward, often fails to fully capture their limitations and potential. A comparative and synoptic approach, on the other hand, provides an excellent opportunity for self-assessment of one’s actual understanding of the various tools, and might serve as valuable training for what should initially be done by the entrepreneur’s advisor and, if necessary, later by the expert appointed for the negotiated crisis resolution proceeding (Composizione Negoziata della Crisi)
Indagine sulle infezioni correlate all'assistenza sanitaria in un reparto di terapia intensiva. Studio pilota
Full text linkOgni anno in Europa 4.100.000 pazienti acquisiscono infezioni correlate all’assistenza (ICA) e circa 37.000 muoiono a causa di queste a tale numero si aggiungono 110.000 morti indirettamente associabili alle ICA. I costi stimati delle ICA si aggirano intorno ai 6.000.000.000 €. Le ICA più frequenti riguardano gli apparati genito-urinario e respiratorio, le setticemie e le infezioni post-chirurgiche. Il 20-30% delle ICA è prevenibile tramite buone pratiche di igiene. La percentuale più alta di morti da ICA è dovuta ai ricoveri in Reparti di Terapia Intensiva (RTI). Per tale motivo la nostra ricerca è finalizzata all’individuazione di parametri ambientali associabili al reperimento di microrganismi responsabili di ICA e di casi di ICA all’interno di un RTI.
Abbiamo osservato un RTI di Neurochirurgia in un grande ospedale romano per un periodo di circa 18 mesi (ottobre 2015 - marzo 2017), monitorando la qualità microbiologica dell’aria indoor e di alcune superfici critiche, quali bordo letto, carrello farmaci e monitor, e alcune grandezze fisiche microclimatiche quali la temperatura dell’aria (Ta), l’umidità relativa (UR) e la velocità dell’aria (Va), con relativa valutazione del benessere termico che ha sicuramente influenza sul comportamento del personale e nello sviluppo delle pratiche assistenziali sia infermieristiche che mediche.
La raccolta parziale dei dati relativi alle superfici critiche evidenzia delle non conformità, in alcuni campionamenti abbiamo isolato microrganismi patogeni ambientali quali: Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomanas aeruginosa e Staphilococcus aureus meticillina-resistente.
Per quanto riguarda la carica microbica mesofila totale a 37 °C questa è risultata non conforme rispetto al limite di 50 ufc/24 cm2 nel 17,77% dei prelievi per il bordo letto, nel 4,34% dei prelievi per il carrello dei farmaci e nell’1,96% dei prelievi per il monitor. La densità microbica è risultata variabile da un livello minimo di 300 ufc/24 cm2 riscontrato sul bordo letto.
Nei restanti mesi della ricerca con l’elaborazione definitiva dei risultati a disposizione, cercheremo di mettere in relazione le grandezze fisiche sopraindicate con i microrganismi rinvenuti sulle superfici inanimate limitrofe al letto del cliente, per capire in che modo e quanto possano partecipare alla loro sopravvivenza.
I risultati evidenziano la necessità di mantenere un’elevata attenzione nell’applicazione dei protocolli di sanificazione delle superfici critiche e delle linee guida operative correlate all’assistenza sanitaria, al fine di garantire sempre un elevato standard igienico
Use of a dusting cloth for mycological surveillance of operating rooms: results of an Italian pilot study
Full text linkTo compare the ability of different sampling methods to
detect a mycological contamination of air and surfaces in operating
rooms (ORs)
CONTROLLO DELLA BIOCONTAMINAZIONE IN AMBITO OSPEDALIERO PER MEZZO DI UV-C E FILTRI HEPA
No full textIn ambiente ospedaliero, in particolare nelle sale operatorie, in rianimazione, nei reparti immunodepressi, etc., è essenzialeche la qualità dell’aria, con riferimento al contenuto di particellato, che può presentarsi anche come biologicamente attivo, sia di livello molto elevato. In generale il controllo della qualità si realizza immettendo nell’ambiente notevoli portate di aria,prelevata totalmente dall’esterno, sottoposta a più stadi di filtrazione, due o tre, l’ultimo dei quali collocato immediatamente a monte dell’ingresso in ambiente. A difesa del paziente, e degli operatori, normative nazionali e internazionali impongonovincoli stringenti relativi alla presenza di particellato inerte e biologicamente attivo.
Da tempo è noto il carattere germicida delle radiazioni UV-C, in particolare di lunghezza d’onda pari a circa 254 nm, che danneggerebbero irreversibilmente il DNA della maggior parte dei microorganismi, inibendone le capacità riproduttive. Ildanneggiamento aumenta con la dose di radiazione incidente, cioè il prodotto tra potenza incidente e tempo di irraggiamentodel microorganismo. Generalmente, quando si irradia l’aria da immettere in ambiente, le lampade germicide vengono installatein modo che la potenza radiante colpisca le particelle, aerotrasportate dalla corrente nelle canalizzazioni, prima dell’ingresso inambiente. La dose incidente sul particellato, anche per potenze elevate, risulta bassa, poiché il tempo di esposizione è quasisempre ridotto, come evidenziato in precedenti lavori sperimentali.
In questo lavoro vengono presentati alcuni risultati sperimentali relativi alle prestazioni di lampade germicide irradiantidirettamente la superficie di filtri HEPA. Le misure effettuate permettono di affermare che, nelle condizioni indagate, l’irraggiamento sul filtro comporta una significativa riduzione della carica biologica, molto maggiore di quella fornita dal filtronon irradiato. Le perdite di carico attraverso il filtro irraggiato aumentano nel tempo più lentamente e il valore di raddoppio (rispetto al filtro nuovo), potrebbe verificarsi in un tempo pressoché quadruplo rispetto al caso di filtro non irraggiato.The contamination of air-handling units is a widespread phenomenon in buildings with air-conditioning (HVAC) systems and in hospitals. The germicide capacity of UV-C rays is known and into HVAC systems the UV-C lamps are generally located inside the air ducts. Aim of the paper is to evaluate the effectiveness of UV-C lamps for disinfection in case of direct irradiation of HEPA filter surface. An ad hoc experimental HVAC system, with HEPA filters and UV-C lamps, was built. During the period of activity, using first only HEPA filter and then also UV lamps, air samples were collected and total microbial and fungal count was performed; in addition, pressure drop through the filter was measured. Obtained results suggest that, in studied conditions, the radiation on filter surface reduces significantly microbial load and pressure drop through the filter, with respect to the case of not irradiated filter
Bio-contamination control in hospital environment by means of UV-C rays and HEPA filters
No full textThe contamination of air-handling units is a widespread phenomenon in buildings with air-conditioning (HVAC) systems and in hospitals. The germicide capacity of UV-C rays is known and into HVAC systems the UV-C lamps are generally located inside the air ducts. Aim of the paper is to evaluate the effectiveness of UV-C lamps for disinfection in case of direct irradiation of HEPA filter surface. An ad hoc experimental HVAC system, with HEPA filters and UV-C lamps, was built. During the period of activity, using first only HEPA filter and then also UV lamps, air samples were collected and total microbial and fungal count was performed; in addition, pressure drop through the filter was measured. Obtained results suggest that, in studied conditions, the radiation on filter surface reduces significantly microbial load and pressure drop through the filter, with respect to the case of not irradiated filter
Trend of Legionella colonization in hospital water supply
No full textBACKGROUND: In many nosocomial Legionella outbreaks water distribution systems are the most frequent source of infection.
OBJECTIVES: Considering the hospital waterline old age, an investigation on colonization by Legionella spp was carried out in order to evaluate the pipeline system weaknesses and to implement environmental preventive measures.
METHODS: From 2004 to 2010, overall 97 samples from the water line were collected. The samples were analyzed according to the italian Legionella spp standard methods; water temperature, pH and residual free chlorine were determined at the time of collection. X2 test, exact-test and t-test were used to compare proportions and means.
RESULTS: Overall 28 samples (23.7%) were positive for Legionella spp, and five of them (17.9%) exceeded the threshold level >104 cfu/L. The number of positive samples varied along the years, showing a significant increasing trend (X2 for trend = 11.5; p104 cfu/L occurred in the C-building. No cases of nosocomial legionellosis were reported during the study period.
CONCLUSIONS: Hospital water system showed a diffuse colonization by Legionella spp, although the degree of contamination reached the threshold level (>104 cfu/L) only in a small percentage of samples, showing a substantial effectiveness of the control measures applied
Effectiveness of UV Radiation for Reducing Aspergillus Niger Contamination in Air-Conditioning Systems. Preliminary results
No full textSurveillance of Legionella Waterline Colonization in a Hospital of Rome, Italy
No full textBACKGROUND: In many hospital’s legionella outbreaks, hot water systems are the most frequent source of infection.
OBJECTIVES: Considering the old age of the hospital waterline, an investigation on legionella water colonization was performed to evaluate the system weakness and to implement environmental preventive measures.
METHODS: Three repeated campaigns of water sampling were performed in different seasons from February 2004 to June 2006. Overall, 66 water samples were collected: 52 in wards with at-risk patients from 3 buildings (two old (A-B) and one new (C)); other 14 samples from boilers. The samples were analysed, following national legionella standard methods; water temperature, pH and residual free chlorine were determined at the time of collection.
RESULTS: A total of 8 samples (12.1%) resulted positive for Legionella spp. In hospital wards 6 (11.5%) samples were positive and the isolates were L. gormanii (1) and L. pneumophila (5). The highest colonization rate was observed in building C (26.7%), vs 5.5% in B and 5.3% in A. 14.3% samples from boilers were also colonized by L. pneumophila. The percentage of positive samples was: 6.7% in autumn-winter and 23.8% in spring-summar campaigns. The average temperature was lower in colonized samples (39.1° vs 46.5°). In 71.4% of samples the level of L. pneumophila contamination was beween 103 and 104 CFU/L.
CONCLUSION: Hospital water system seams to be affected by Legionella colonization most frequently in spring-summar and in the new buildings (C). It is necessary now to investigate on the temperature level mantained in hot-water system and also to observe if the structural characteristics of water ducts of C-building can influence the colonization observed
Use of a dusting cloth for the mycological surveillance of operating rooms
No full textWe compare the ability of a new sampling method (DC pad) with Rodac contact plate to detect a contamination due to filamentous fungi (FF) of surfaces in operating rooms (ORs). The study refers to the results of 84 sampling campaigns. Surface samples were collected from the scialytic lamps: half of upper surface was sampled with two Rodac contact plates. The other half of upper surface was all rubbed with one DC pad. The Χ2 test and Wilcoxon two sample test were used to compare the proportions of samples positive for FF and the difference in CFU of fungi collected. Overall, 89.3% of the DC pad samples and 44.0% of the Rodac plates were positive (p<0.005). The average number of CFU of FF collected on scialitic lamps was significantly higher using DC pads than Rodac plates (9.7 versus 1.5; p<0.001)
Effectiveness of UV Radiation for reducing Aspergillus niger and Actynomices contamination in air-conditioning systems.
No full textThe effectiveness of UV radiation lamps in order to reduce fungal contamination of HEPA filters, to extend filter efficacy and to reduce maintenance costs, is experimentally studied by means of a dedicated air conditioning unit. An experimental HVAC system, with HEPA filters and UV-C lamps (lambda=254 nm), was built. Two experiments were performed. After disinfection and control of airtightness, the internal surface of the HVAC system was contaminated (1) with A. niger spores and (2) with Actynomices. Temperature level was 300 K and Relative Humidity (RH) ranged from 30-90%. The results show that the addition of UV-C lamps to HVAC system reduces A. niger and Actynomices air concentrations; the effectiveness increases with the decrease of RH level in the HVAC system
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