The Influence of Surgical Staff Behavior on Air Quality in a Conventionally Ventilated Operating Theatre during a Simulated Arthroplasty: A Case Study at the University Hospital of Parma.

Surgical staff behavior in operating theatres is one of the factors associated with indoor air quality and surgical site infection risk. The aim of this study was to apply an approach including microbiological, particle, and microclimate parameters during two simulated surgical hip arthroplasties to evaluate the influence of staff behavior on indoor air quality. During the first hip arthroplasty, the surgical team behaved correctly, but in the second operation, behavioral recommendations were not respected. Microbiological contamination was evaluated by active and passive methods. The air velocity, humidity, temperature, and CO2 concentration were also monitored. The highest levels of microbial and particle contamination, as well as the highest variation in the microclimate parameter, were recorded during the surgical operation where the surgical team behaved "incorrectly". Turbulent air flow ventilation systems appeared more efficient than in the past and very low air microbial contamination was reached when behavior was correct. Therefore, adherence to behavioral recommendations in operating theatres is essential to not undermine the effectiveness of the heating, ventilation, and air conditioning systems and employed resources.

Passive air sampling: the use of the index of microbial air contamination.

BACKGROUND: Bioaerosol plays an important role in human life with potentially infectious, allergic and toxic effects. Active and passive methods can be used to assess microbial air contamination, but so far there is not a unanimous consensus regarding the indications about methods to be used and how to interpret the results. The passive method has been standardized by the Index of Microbial Air contamination (IMA). Classes of contamination and maximum acceptable levels of IMA have been proposed, related to different infection or contamination risks. The aim of this study was to provide information about the use of the passive sampling method, with reference to the IMA standard. METHODS: We searched PubMed and Scopus for articles published until January 2020 reporting the citation of the article by Pasquarella et al. "The index of microbial air contamination. J Hosp Infect 2000". Only studies in English language where the IMA standard was applied were considered. Studies regarding healthcare settings were excluded. RESULTS: 27 studies were analyzed; 12 were performed in Europe, 8 in Asia, 5 in Africa, 2 in America. Cultural heritage sites, educational buildings and food industries were the most common indoor monitored environments; in 8 studies outdoor air was monitored. CONCLUSIONS: This review has provided a picture of the application of standard IMA in different geographic areas and different environments at risk of airborne infection/contamination. The analysis of the results obtained, together with a wider collection of data, will provide a useful contribution towards the definition of reference limits for the various types of environments to implement targeted preventive measures.

["Activate your Wait" project : pilot study carried out at a thermal centre]

Physical activity is recognised as a major health determinant, with positive effects on health, environmental sustainability and economy. National surveillance data show that one out of three Italians - adult and elderly alike - declares to be sedentary, with a progressively increasing trend. From the urgent need to implement strategies to promote physical activity the "Activate your Wait" ("Attiva l'Attesa") project was born, aimed at transforming the waiting pauses during day to day life into opportunities to perform simple stretching and active mobilization exercises. The pilot study was carried out at the Terme S. Egidio, Suio Terme Castelforte (Latina). The results of the questionnaire distributed in the pre-intervention phase, aimed at assessing the users' interest in the project and physical activity in general, are reported. The questionnaire was administrated in the waiting rooms in September 2018 and September 2019. A total of 129 subjects responded to the questionnaire: 43% declared themselves sedentary, 73% reported willingness to perform simple physical exercises while waiting, and 76% believed that physical activity during waiting moments could have a positive impact on health. The project's subsequent goal is to identify suitable exercises to be proposed during the intervention period, which can be easily reproduced independently by users in their everyday life.

[Air microbial sampling: the state of the art]. / Il campionamento microbiologico dell'aria: lo stato dell'arte.

Air microbial sampling is a subject of great interest in different fields of human activity; however, generally accepted indications, concerning both the sampling methods to be used and the interpretation of the results, are still lacking. The whole theme is greatly debated and several problems remains to be solved. The aim of this article is to provide knowledge relating to the problems associated with air microbial sampling, underlining the aspects to be considered in order to choice the sampling method on the basis of the objective of the sampling itself and on the knowledge of the characteristics and limits of the different methods.

[Treatment of thermal pool waters]. / Il trattamento delle acque nelle piscine termali.

No laws currently exist regarding the treatment of spa pool water, since it is not completely logical that these should have the same requirements as normal swimming pools. The problem arises especially with regards to the use of chlorine as a disinfectant, which may actually annulate the therapeutic effects of spring waters by altering their physical-chemical characteristics. Possible choices may be represented by frequent replacement of pool water, which may be easily achievable for small pools but more difficult to implement for larger pools, or by alternative disinfection methods such as ozone or ultraviolet rays. The efficacy of these methods must be shown through frequent chemical and microbiological analyses and future, to be hoped-for laws or guidelines, will need to be aimed at defining safety performance standards rather than prescribing analytical intervention and control methods. Beyond the choice of disinfection method, it is extremely important to highlight some relevant hygienic measures that bathers should take and that play a fundamental role in preventing infectious diseases which may be acquired in pools. The most important of these include: showering before entering the pool, wearing slippers around the pool, not urinating in the pool, not bathing if affected by diarrhea, wearing a bathing cap, avoiding the use of contact lenses while bathing and avoiding exchanging towels. Pool managers have the important role of avoiding overcrowding of the facilities and ensuring that all technological systems function properly.

The implementation of a Community Health Centre-based primary care model in Italy. The experience of the Case della Salute in the Emilia-Romagna Region.

BACKGROUND: The Comunity Health Centre (CHC) primary care model is a team-based health care delivery model intended to provide comprehensive and continuous medical care to patients within a defined community. The CHC, Case della Salute in Italian, model was introduced in the Emilia-Romagna Region in 2010. METHODS: We present updated data on the implementation on the CHC Case della Salute primary care model in the Emilia-Romagna Region. RESULTS: There are 67 operating CHCs in Emilia-Romagna (update March 2015); 26 small (39%), 24 medium (36%) and 17 large (25%). Since 2011 the number of operating CHCs has increased by 60%, reaching 55% of the target planned CHCs (n. = 122). There is, on average, one running CHC per 66.524 inhabitants. 16% of total general practitioners (GPs) and 8.4% of total family paediatricians working in Emilia-Romagna have their practice in CHCs. CHCs offer primary and specialist integrated care, prevention services, health education and social care. DISCUSSION: Although preliminary results suggest CHCs have fostered primary care's quality and efficiency, more research is needed to assess their impact on improving clinical, social and economic outcomes.

[The evaluation process of public health action: the challenge of epidemiology]. / Valutazione dell'efficacia degli interventi in Sanità Pubblica: il ruolo dell'epidemiologia.

This paper aims to focus the need of a correct use of epidemiology in the evaluation process of public health actions. It has been described the challenge of epidemiology, at first used mainly for aetiological studies but now much more involved in health services research. Then, considering the fact that in public health every act has to be judged on the basis of its suitability and efficacy, but also of the few financial resources available, the authors stated the importance of the identification of the actual role of the epidemiologists in the evaluation processes and, meanwhile, of their specific training programs. It is eventually underlined that public health, though becoming more and more complex, needs measurable and concrete evaluation indexes and criteria which could lead to a correct selection of the targets and of the actions needed.

Proposal for a biological environmental monitoring approach to be used in libraries and archives.

In cultural-heritage-related indoor environments, biological particles represent a hazard not only for cultural property, but also for operators and visitors. Reliable environmental monitoring methods are essential for examining each situation and assessing the effectiveness of preventive measures. We propose an integrated approach to the study of biological pollution in indoor environments such as libraries and archives. This approach includes microbial air and surface sampling, as well as an investigation of allergens and pollens. Part of this monitoring plan has been applied at the Palatina Library in Parma, Italy. However, wider collections of data are needed to fully understand the phenomena related with biological contamination, define reliable contamination threshold values, and implement appropriate preventive measures.

Effect of mobile unidirectional air flow unit on microbial contamination of air in standard urologic procedures.

BACKGROUND: Infection is one of the most feared complications of surgery. New instrumentation is being developed to reduce deposition of bacteria. METHODS: We investigated 45 major surgical procedures (21 radical nephrectomies [RN] and 24 radical retropubic prostatectomies [RRP]) in our urology department during 2007. In about one-half of the interventions, an ultraclean air flow mobile (UAF) unit was used. Bacterial sedimentation was evaluated by nitrocellulose membranes placed on the instrument tray and by settle plates positioned at four points in the operating room. In 27 operations, an additional membrane was located near the incision. RESULTS: Bacterial counts on the nitrocellulose membranes during RN were 230 colony-forming units (cfu)/m(2)/h with the UAF unit and 2,254 cfu/m(2)/h without the unit (p = 0.001). During RRP, the values were 288 cfu/m(2)/h and 3,126 cfu/m(2)/h respectively (p = 0.001). The membrane placed near the incision during RN showed a microbial count of 1,235 cfu/m(2)/h with the UAF unit and 5,093 cfu/m(2)/h without the unit (p = 0.002); during RRP, the values were 1,845 cfu/m(2)/h and 3,790 cfu/m(2)/h, respectively (difference not significant). Bacterial contamination detected by settle plates during RN showed a mean value of 2,273 cfu/m(2)/h when the UAF unit was used and 2,054 cfu/m(2)/h without the unit; during RRP, the values were 2,332 cfu/m(2)/h and 2,629 cfu/m(2)/h with and without the UAF unit, respectively (NS). No statistically significant differences were detected in the clinical data registered in patients operated on under standard conditions and while the UAF unit was functioning. CONCLUSIONS: The UAF appears able to reduce microbial contamination at the operating table, reaching a bacterial number obtained in ultraclean operating theatres.