Development of an integrated environmental monitoring protocol for SARS-CoV-2 contamination. Applications at the IRCSS San Martino Polyclinic Hospital in Genoa, Italy.

SCIENTIFIC BACKGROUND: Environmental sampling of SARS-CoV-2 is a fundamental tool for evaluating the effectiveness of non-specific prophylaxis measures in counteracting virus spread. The purpose of our work was to evaluate the effectiveness of the different sampling methods in the hospital setting to assess their correlation with the structural, functional, and operational situation of the monitored departments and to define the dynamics of the spread of the virus in indoor environments. METHODS: The monitoring (air bubbling sampling, surface wipe test) was carried out at the San Martino Polyclinic Hospital (Genoa, Italy) in the period since April 2020 to June 2021. The presence of viral RNA in the collected samples was evaluated by qPCR. The infection capacity of the samples collected was also evaluated by an in vitro challenge test on cells sensitive to SARS-CoV-2 infection. RESULTS: The percentage of positivity with respect to the number of tests performed (sensitivity) were air bubbler 50%, wipe test 17%, and challenge test 11%. Only 20% of the samples tested positive in the wipe test and 43% of the samples tested positive in the bubbler sampling were also positive in the challenge test. All the positivity obtained was detected at a distance of less than 2 m and height of less than 1.5 from COVID-19 patients. CONCLUSIONS: Environmental contamination from SARS-CoV-2 detected at the San Martino Polyclinic Hospital is found lower than similar assessments performed in other hospitals both in Italy and abroad. Our study predicted that environmental monitoring of SARS-CoV-2 must be carried out in an integrated way by not using a single sampling method, as each individual test has a different biological significance and performance. However, the virus detected by wipe test only is often a degraded viral fragment and not an intact infecting virion.

Efficacy of safety catheter devices in the prevention of occupational needlestick injuries: applied research in the Liguria Region (Italy).

Healthcare workers who use or may be exposed to needles are at risk of needlestick injuries, which can lead to serious infections by bloodborne pathogens. These injuries can be avoided by eliminating the unnecessary use of needles and using safety devices. The present study was aimed at evaluating the impact of a safety-engineered device, with passive fully automatic needlestick protection, on the rate of needlestick injuries among healthcare workers. The setting of the study was a network of five public healthcare institutions situated in a Northern Italian Region. Data on the type of device, the number of employees and the number of catheter devices used per year were collected through regular meetings with healthcare workers over a period of five years. The most notable result of this study was the huge risk reduction associated with safety devices. Indeed, the risk of needlestick injuries due to conventional devices was found to be 25-fold higher than that observed for safety devices. However, it is noteworthy that a considerable part of this excess can be explained by the different background number of devices used. Moreover, descriptive analysis suggested that individuals with a poor/moderate training level had a lower risk than those with good/high training, though the difference was not statistically significant. In conclusion, there is convincing evidence of a causal connection between the introduction of safety devices and the reduction in needlestick injuries. This consideration should prompt the introduction of safety devices into daily clinical practice.

Mobile laminar air flow screen for additional operating room ventilation: reduction of intraoperative bacterial contamination during total knee arthroplasty.

BACKGROUND: Surgical site infections are important complications in orthopedic surgery. A mobile laminar air flow (LAF) screen could represent a useful addition to an operating room (OR) with conventional turbulent air ventilation (12.5 air changes/h), as it could decrease the bacterial count near the operating field. The purpose of this study was to evaluate LAF efficacy at reducing bacterial contamination in the surgical area during 34 total knee arthroplasties (TKAs). MATERIALS AND METHODS: The additional unit was used in 17 operations; the LAF was positioned beside the operating table between two of the surgeons, with the air flow directed towards the surgical area (wound). The whole team wore conventional OR clothing and the correct hygiene procedures and rituals were used. Bacterial air contamination (CFU/m(3)) was evaluated in the wound area in 17 operations with the LAF unit and 17 without the LAF unit. RESULTS: The LAF unit reduced the mean bacterial count in the wound area from 23.5 CFU/m(3) without the LAF to 3.5 CFU/m(3) with the LAF (P < 0.0001), which is below the suggested limit for an OR with ultraclean laminar ventilation. There were no significant differences in the mean bacterial count in the instrument table area: 28.6 CFU/m(3) were recorded with the LAF (N = 6) unit and 30.8 CFU/m(3) (N = 6) without the LAF unit (P = 0.631). During six operations with LAF and six without LAF, particle counts were performed and the number of 0.5 µm particles was analyzed. The particle counts decreased significantly when the LAF unit was used (P = 0.003). CONCLUSION: When a mobile LAF unit was added to the standard OR ventilation, bacterial contamination of the wound area significantly decreased to below the accepted level for an ultraclean OR, preventing SSI infections.

[The regions' contribution to assessment of work-related stress: an operative guide]. / Il contributo delle Regioni sulla valutazione del rischio stress lavoro-correlato: la guida operativa.

In order to formulate indications for work-related stress assessment established by Italian health and safety regulation (D.Lgs. 81/2008), the interregional technical committee has instituted a working group to define an operative guide. The guide indicates the elements that must be considered in the evaluation, criteria and methods for the assessment, the minimum requirements for the evaluation instruments, and the specific contents of the risk assessment document.The medical surveillance and the role of health and safety local authorities are also considered. The risk assessment must examine work organization indicators and the direct or indirect effects of work-related stress, like morbility, frequent accidents, changing job requests, legal actions, etc. Detecting subjective factors is a second step of the assessment, which must be carried out if the work organization indicators show considerable work-related stress problems, and only in the companies which employ more then ten workers.

[Consensus Document. Update on latex exposure and use of gloves in Italian health care settings]. / Documento di Consenso. Aggiornamenti in tema di esposizione a latice e impiego di guanti in ambito sanitario.

This consensus document was prepared by an Italian working group including occupational health professionals involved for many years in the management of glove- and latex-related problems in health care settings. The aim of this document was to address the most significant technical, epidemiological, clinical, environmental and prevention problems related to the use of gloves and latex. The group's recommendations are based on scientific evidence and practical experience but they cannot be considered as final. These topics need to be periodically revised. The following points should be taken into account: glove quality seems to have improved considerably but the information on glove features provided by the manufacturers is often still inaccurate or incomplete; the regulations in force provide that the manufacturers perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results be reported in the technical data sheets. Thus the manufacturers have only to declare that their products are "in accordance with the rules"; therefore, purchasers should require the manufacturing companies to supply detailed information and verify their reliability. Moreover, the rules should be adapted to higher quality standards; occupational physicians must be involved for the correct choice and purchase of protective gloves; the use of gloves (in particular latex gloves) and latex devices in health care settings should be based on specific criteria: procedures must be available stating which kind of gloves are suitable for specific tasks. When exposure to latex cannot be avoided it is necessary to choose products that have good biocompatibility (e.g., powder free-gloves with low allergen content); once and for all latex powdered gloves should no longer be commercially available! labels for latex devices (including gloves) should report the extractable latex allergen content. Limit values for extractable latex allergens should be established; the use of synthetic rubber gloves should be encouraged since some materials (e.g., neoprene and nitrile rubber) appear to have physical properties and protective efficacy similar to latex, plus good biocompatibility; more studies should be promoted to verify the protective efficacy of new synthetic materials; health care workers should be informed about the advisability and usefulness of using materials other than latex; health care services should not cause additional risks but rather highlight the advantages for workers and patients if the use of latex gloves and devices is minimized.

[Latex and synthetic polymers gloves: protective effectiveness against biological risk]. / Guanti di latice e guanti di polimeri sintetici: efficacia protettiva nei confronti di agenti biologici.

BACKGROUND: The quick evolution of knowledge about latex and, especially, its effectiveness as protection against biological risks on one hand, and, on the other hand, as trigger of cutaneous, respiratory and sistemic allergic diseases, required a marked distinction between conditions in which latex is necessary and conditions in which latex could be substituted by syntetic polymers. OBJECTIVES: The aim of this study is to verify protective effectiveness of gloves made of syntetic polymers against biological risks compared with latex gloves which until now have been considered as the best protection. METHODS: Literature review. RESULTS: The most recent studies seem to consider neoprene gloves as the safest protection to replace latex in working activities with high biological risk exposure. CONCLUSION: The literature review marked the lack of studies exclusively focused on glove permeability towards biological agents. It seems therefore necessary to investigate this topic to validate results and to guarantee a suitable protection to workers daily exposed to biological risk.

Prevention of Risks from Occupational Exposures to Antineoplastic Drugs: Consensus Document.

Ever-increasing numbers of cancer patients have been treated with antineoplastic drugs in the past few years. Among patients treated with these drugs, an increased risk of a "second neoplasm" has been observed, mainly as a function of increased life expectancy. On the basis of this observation, the International Agency for Research on Cancer has classified a number of antineoplastic drugs as carcinogenic or probably carcinogenic for humans. Various categories of workers are at risk for exposure to antineoplastic drugs, absorbing these substances mainly through inhalation or dermal contact. Although the absorbed doses are notably lower than those administered to patients, review of the literature reveals increased risks of spontaneous abortions and chromosomal aberrations in subjects who have worked without adequate protection. A working group, Prevention of Occupational Risks Due to Handling Antineoplastic Drugs in Health Care, was established by the Italian Institute of Prevention and Safety at Work (Istituto Superiore per la Prevenzione e Sicurezza sul Lavoro-ISPESL) in February 1995. This group reviewed the epidemiologic studies and research on cytogenetic indicators of genotoxicity in occupationally exposed subjects. In addition, the group made recommendations for environmental and biological monitoring of exposure and health surveillance, and developed guidelines for primary and secondary prevention. The group's recommendations are summarized in a consensus document, but cannot be considered definitive, since work practices continue to evolve and will have to be examined further in the future. Thus, more research is needed to achieve answers to the questions raised by the working group. The main topics to be addressed are indicated in the consensus document. In particular, it will be necessary to evaluate working conditions nationwide, using standardized protocols for risk assessment, to achieve precise estimates of workers' exposures.

[Criteria and methods for the study of occupational exposure to antineoplastic agents]. / Criteri e metodi per lo studio dell'esposizione occupazionale a chemioterapici antiblastici.

Risk assessment for occupational exposure to antiblastic chemotherapeutic drugs (ACD) is carried out by means of environmental and biological monitoring. These practices are not widespread and furthermore their results are frequently difficult to interpret. This paper discusses some of the most important aspects of risk assessment for ACD and in particular for their exposure evaluation. The following guidelines are proposed: a) working rooms, working procedures, type and quantity of drugs, and preventive measures must be checked using a standardized scheme for collecting data: an example of a check list experimented in some Italian hospitals is presented; b) cyclophosphamide, 5-fluorouracil, and Pt coordination compounds have been identified as tracers of drug mixtures usually administered, and their determination is recommended both in environmental and biological samples; c) for a correct evaluation of exposure, ACD should be determined firstly on the contaminated surfaces or on work clothes and secondly in urine of workers; the measurement of ACD in air must be limited to well documented conditions of high exposure and the urinary mutagenicity tests should be avoided; d) the biological monitoring practices should be enhanced, in particular the determination of ACD adducts to proteins and nucleic acids as promising indicators of effective dose.

[Guidelines for the health protection and safety of workers exposed to antineoplastic drugs]. / Linee guida per la tutela della salute e per la sicurezza dei lavoratori esposti a chemioterapici antiblastici.

The guidelines must guarantee that occupational exposure to antineoplastic chemotherapeutic drugs is kept at the lowest level possible. Occupational exposure to these drugs can involve different categories of workers and different job tasks, such as stocking, preparation, administration, disposal, maintenance of safety cabinets and room cleaning where these activities are performed. Preventive measures should include the institution of "Centralized Units for handling antineoplastic chemotherapeutic drugs", where only specifically trained personnel are employed. Cleaning and decontamination procedures must be easily feasible and specific safety cabinets should be used in the rooms. Personnel must use adequate protective equipment and follow standardized working procedures. Information programs for the personnel should be carried out covering occupational risks, safe preventive measures and the explanation of environmental and biological monitoring.