Control and prevention measures for legionellosis in hospitals: A cross-sectional survey in Italy.

Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2-15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.

Appropriate perioperative antibiotic prophylaxis: challenges, strategies, and quality indicators.

INTRODUCTION: Surgical site infections (SSIs) are common surgical complications and perioperative antibiotic prophylaxis (PAP) contributes to the reduction of the associated risk. The aim of the present review article is to summarize the most recently published studies with a special focus on challenges, strategies and quality indicators of PAP. METHODS: Literature searches in the Medline database, using PubMed, were carried out for studies published from January 2011 to April 2015. Inclusion criteria were all types of epidemiological studies investigating: i. compliance with PAP recommendations at different levels by using process indicators, and ii. the effect of different interventions conducted in order to improve PAP compliance. RESULTS: A total of 28 studies were retrieved. Overall compliance with all included PAP indicators ranged from 9.4% to 80%. Generally, compliance with the PAP process indicators significantly improved after interventions. CONCLUSIONS: The present review summarizes the recent published studies and indicates an overall inadequate compliance with PAP recommendations, underlining the need to develop and to implement successful strategies to improve adherence to guidelines. Different interventions were found efficacious in order to increase compliance with appropriate PAP administration.