Environmental dust granulometry and microbial load in the presence of tobacco smoke.

BACKGROUND AND OBJECTIVE: Several studies describe damage from passive smoking in humans. However, it is not clearly understood how different chemical and physical components relate to mechanisms of damage. This investigation was focused on the particulate phase of environmental cigarette smoke. The size of particles is very important in the inhalation process and subsequent deposition of particles in the airways. METHODS: The granulometry of suspended dust and bacterial particles was studied in a 120-m(3) no-smoking room during and after the smoking of one cigarette in ten separate experiments. Granulometry was assessed by a six-channel particle counter. Suspended microbial load was evaluated by a surface air system. The sedimented bacterial load was evaluated by the air microbial index technique, which expresses the total number of microorganisms settling on a Petri plate under gravity. RESULTS: The number of large particles increased during the first minute of smoking, and then decreased to basal levels. The number of medium-sized particles increased during the first 10 min of cigarette smoking, and then decreased to basal levels. The number of small particles increased over the whole experimental period. Bacterial and mycotic load decreased during and up to 60 min after cigarette smoking. Gram-positive cocci did not decrease, while chromogenous bacteria and mycetes decreased at 30 min. There was an increase in the numbers of sedimented bacteria and mycetes at 60 min, a decrease at 120 min and stabilization at 180 min. CONCLUSIONS: Smoking of tobacco accelerates the sedimentation of larger agglomerates of mean-sized smoke particles and bacteria, which may be re-suspended by the movement of people in the room and consequently inhaled.

Correlation between Legionella contamination in water and surrounding air.

We evaluated Legionella pneumophila contamination of water and surrounding air in a burn care department equipped with bathtubs. In water, the bacterium always aerosolized, but in surrounding air, it diluted itself to such a point that it became undetectable at 1 m or more from the source of emission, which indicated that patients were at low risk of inhaling a dangerous quantity of the microbe.

Adherence to international and national recommendations for the prevention of surgical site infections in Italy: results from an observational prospective study in elective surgery.

BACKGROUND: An observational prospective study of the perioperative procedures for prevention of surgical site infections (SSIs) was carried out in a tertiary referral teaching hospital in Liguria, Italy, to evaluate their adherence to international and national standards. METHODS: A 1-month survey was performed in all surgical departments, monitored by turns by trained survey teams. Data regarding presurgical patient preparation and intraoperative infection control practices were collected. RESULTS: A total of 717 elective interventions were actively monitored in 703 patients who underwent surgery. Hair-shaving was performed mainly using a razor (92%) by the nurses (72.8%) on the day before the operation (83.5%). All of the patients showered, either with a common detergent (87%) or with an antiseptic solution (13%). Antimicrobial prophylaxis was administered properly in 75.7% of the patients at induction of anaesthesia; however, according to current Italian guidelines, inappropriate prophylaxis was provided in 55.2% patients. Appropriate antisepsis of the incision area was done in 97.4% of the operations, and nearly 90% of the interventions lasted less than the respective 75th percentile. The doors of the operating theatres were mostly open during the duration of the operation in 36.3% of the cases. CONCLUSIONS: This review of infection control policies identified significant opportunities for improving the safety and the quality of routine surgical practice.

Epidemiological trend in tuberculosis in the Italian region of Liguria: impact of immigration and AIDS.

BACKGROUND: Tuberculosis (TB) uniformly decreased in all industrialized countries from 1950 to 1985. However, since 1985 an upsurge of the disease has been observed, probably due to the increases in AIDS and immigration. It is for this reason that in the last decade all industrialized countries have intensified their controls on TB and a new reduction has been recently observed. METHODS: In this study we collected epidemiological data (mortalities and reported cases) for the region of Liguria over the last 15 years. We then calculated the incidence rate of TB per 100,000 residents according to age, HIV infection and nationality, making a distinction between European Union (EU) citizens and immigrants coming from countries outside the EU. RESULTS: The rate of mortality, after the last peak at the end of the Second World War, has progressively decreased from 1946 to today, so much so that presently we record fewer than two cases per 100,000 people. We observed a consistent downward trend in the incidence rate up to 1987, but from 1988 onwards this trend stopped and, in subsequent years, we detected an increase in the incidence rate, which peaked in 1996. This led to increased interventions, which has resulted in a considerably decreased overall rate of cases of TB during the last few years. The number of TB cases specifically among foreigners increased considerably during the last 5 years, whereas there was a drastic reduction in the number of total TB cases, as well as an interesting reduction in AIDS cases. During the same period there was a progressive decrease in tuberculin skin positivity in all school classes. CONCLUSIONS: The reduction in TB notifications is probably due to an increase in surveillance and control of social and health conditions. These results show that immigrant workers are considered to be a high-risk group, whereas the risk has progressively decreased in the HIV group.