Trends, risk factors and outcomes of healthcare-associated infections within the Italian network SPIN-UTI.

BACKGROUND: Implementing infection control measures in light of healthcare-associated infection (HAI) surveillance data can prevent HAIs. Surveillance has been associated with a reduction of HAI in intensive care unit (ICU) patients, though the reasons for this improvement remain unclear. AIM: To evaluate changes in healthcare-associated infection (HAI) rates during three surveys of the Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) network (SPIN-UTI) six-year project and to explore sources of variation of indicators of HAI in the 65 participating ICUs. METHODS: The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance. Cumulative incidence, incidence density, infection rates adjusted for device-days, and device utilization ratios were calculated for each survey and compared. To identify risk factors multiple logistic regression analyses were performed. Crude excess mortality was computed as the difference between the crude overall case-fatality rate of patients with and without HAI. FINDINGS: The risk of ICU-acquired infections increased in the third survey compared with previous (relative risk: 1.215; 95% confidence interval: 1.059-1.394). Among risk factors, the number of hospitalized patients requiring ICU admission and the Simplified Acute Physiology Score II increased from 73.7% to 78.1% and from 37.9% to 40.8% respectively. Although mortality rates remained unchanged, HAIs trebled the risk of death. Acinetobacter baumannii was the most frequently reported micro-organism in the third survey (16.9%), whereas in the previous surveys it ranked third (7.6%) and second (14.3%). CONCLUSIONS: The study highlighted the increased risk of HAI, at least partially explained by the greater severity and number of hospitalized patients requiring ICU admission. Furthermore, the management of intubation procedures and of ventilated patients was identified as a potential target for infection control interventions to decrease the growing risk of HAI in ICUs.

Surveillance and evidence of contamination in hospital environment from meticillin and vancomycin-resistant microbial agents.

INTRODUCTION: Direct contact is undoubtedly the main means of transmission of hospital infections. An investigative study was therefore conducted to assess workplace surfaces at risk from microbial contamination. METHODS: The study was conducted using swabs and contact slides placed on the palms of healthcare workers during their routine patient care and on workplace surfaces (e.g. telephones, computers, medication trolleys, taps) in treatment rooms, operating theatres and wards. Disposable swabs were used for rapid screening and read with a bioluminometer. At the same time, a sample was taken from those testing positive using a contact slide. The samples testing positive for Staphylococci underwent identification to assess resistance to meticillin-resistant Staphylococcus aureus (MRS/MRSA) and to vancomycin (VISA/VRSA). RESULTS: Meticillin-resistant Staphylococcus strains were found on 14.7% (20/136) of samples taken from the hands of workers and 35.7% (15/42) of those from hospital surfaces. An even higher resistance to meticillin and/or vancomycin than that found for S. aureus was identified in nosocomial strains of coagulase negative staphylococci, including S. epidermidis and S. haemolyticus. CONCLUSION: The study concludes that there is thus a need for greater care in complying with procedures designed and support for surveillance to reduce the risk of infection.

Hepatitis E virus (HEV) in sewage from treatment plants of Messina University Hospital and of Messina City Council.

Samples of sewage from treatment plants at the "G. Martino" University Hospital of Messina (AOU) and that of Messina City Council were analysed to detect the hepatits E virus. Samples were taken on sewage entering and exiting the treatment plants on a monthly basis over a one-year period from both the hospital plant (24 samples) and the municipal plant (22 samples). All sewage samples were pretreated by ultrafiltraton and concentration and finally processed by the PCR method to amplify gene material. A total of three samples tested positive: two (8.33%) entering the AOU treatment plant and one (4.5%) entering the municipal plant while no cases of HEV were detected in samples of treated sewage. These findings confirm the presence of the virus in the city of Messina and showed that the two treatment plants to be working efficiently when tested.

Eliminating congenital rubella: a seroepidemiological study on women of childbearing age and MMR vaccine coverage in newborns.

INTRODUCTION: Rubella can have particularly serious effects on the product of conception if contracted during pregnancy. Thus, the main aim of rubella vaccination programmes is to prevent infection during pregnancy. MATERIALS AND METHODS: A seroepidemiological study was conducted from July 2006 to December 2007 on 1000 women of childbearing age, 15 to 45 years old, using specific rubivirus antibody assays, IgG and IgM. A questionnaire administered at the same time allowed us to survey how much women knew about this disease. In addition, MMR vaccine coverage rates were analysed for cohorts born in the local health districts of Messina for the period 1993-2006. RESULTS: An analysis of the replies given to the questionnaire showed an estimated 42.8% of the women to have immunity from rubella, while the serological study showed an immunity coverage rate of80.6%. Vaccination coverage in the local health districts regarding the first dose of MMR was 81% (cohorts 1993-2005), while the rate was only 24% for the second dose (cohorts 1993-2002). CONCLUSIONS: Both immunity coverage in women of childbearing age and that for newborns (for the cohort considered)fall below the 95% target set by the National Elimination Plan for Measles and Congenital Rubella (PNEM). It is therefore necessary to provide women with adequate information about the risks of rubella during pregnancy and about the benefits of vaccination, as well as to recoup subjects at risk or those whose immune status is unknown. Public health authorities also need to make continued efforts to increase the number of MMR vaccinations throughout the region.

[Influence of microclimate factors on ocular discomfort in video display terminal workers]. / Influenza dei fattori microclimatici sul discomfort oculare in lavoratori addetti al VDT.

The objective of the present research was to evaluate the effect of environmental parameters (temperature, air velocity, relative humidity, illumination level, cubature) on ocular symptoms (tiredness, tearing, redness, blinking, itching, burning, photophobia, foreign body sensation, and heaviness) in a group of 54 male Video Display Terminal (VDT) workers. The subjects were employed in a public office placed in Messina and naturally ventilated; the investigation was performed in Spring time. Information about the ocular symptoms, occurring during the workshift, were gathered through a questionnaire; environmental measurements were performed by a data collector LSI. The results showed that 43 subjects out of 54 (79%) reported a lack of eye comfort; in addition the illumination level, temperature and air velocity were not consistent with those suggested by the Italian Regulatory Authority. A significant correlation between illumination level, temperature, air velocity and eye discomfort (tearing, heaviness, blinking, photophobia itching, respectively) was found. The Authors conclude that the inadequate environmental condition, possibility in interaction with the indoor chemical contaminants and the workload at VDT, may be responsible for the irritative eye symptoms complained by VDT-workers at workplace.

[Knowledge of disinfection practices and behaviour of the nursing staff at a hospital]. / Conoscenza delle pratiche di disinfezione e attitudini comportamentali del personale infermieristico di un'azienda ospedaliera.

The authors have carried a study on the knowledge of disinfection practices and the behaviour in operating room in order to control and prevent nosocomial infections. It is necessary for high percent of head nurses and nurses to have guidelines for the disinfection/sterilization procedures with the aim to avoid infections, but a large number of subjects don't know the correct procedures. The knowledge of a correct behaviour in the operating room is greater, although many of nursing staff don't wear the overshoes and the protective glasses. The statistical analysis show that nurses and the subjects with high degree have a greater knowledge of problems. It is important the planning of training and retraining courses directed to the improvement of technical knowledge and behaviour.

[Survey on microclimatic condition of classroom]. / Indagine sulle condizioni microclimatiche delle aule scolastiche.

The results of a research, in winter and spring, on the microclimatic parameters and lighting in eighteen classrooms of primary schools in the town of Messina, are exposed. In a significant number of classrooms values of temperature and relative humidity are registered not in accordance with Italian standards. Thermal indices (PMV and PPD) showed, in both seasons, discomfort conditions in many rooms. A percentage of dissatisfied persons, significantly higher the 10% (56.8% in winter and 70.3% in spring), has been obtained. We used, also, a questionnaire modified by Fanger to evaluate the thermal subjective sensations of the students. The results point out that the thermal subjective sensations expressed by the students are often in disagreement with the Fanger thermal comfort indices obtained by instrument. The authors believe that the Fanger's indices do not reflect the effective environmental conditions.

[Symptoms of ocular discomfort and microclimate: epidemiologic and environmental survey in operating rooms]. / Sintomi da discomfort oculare e microclima: indagine epidemiologica e ambientale nelle sale operatorie.

An epidemiological investigation regarding the ocular symptoms of 213 subjects working in the operating theatres of a hospital of the eastern Sicily was conducted. Information was gathered via a questionnaire designed to identify the ocular symptoms that occurred most frequently during working hours in the operating theatre. The questionnaire was administered by a specialist in Occupational Health, before any decision was made to investigate the indoor air quality. The microclimate parameters (temperature, relative humidity, number of air changes/hour, air velocity, illumination levels) of the operating theatres were also studied. The results of the epidemiological investigation showed that 154 subjects out of 213 (72.3%) reported a lack of eye comfort. The most frequently reported symptoms were fatigue (35.21%) and heaviness (34.27%), followed by burning (25.82%), redness (25.35%), lacrimation (17.84%), itching (2%), blinking (20%), foreign body sensation (19%) and photophobia (10%). The study of the indoor climate of the operating theatres showed that the number of air changes/hour and illumination level were not consistent with those recommended by the Italian Regulatory Authority. Others parameters were considered to be satisfactory. The Authors conclude that the low illumination level may be responsible for the high percentage of subjects suffering from eye fatigue and heaviness. The ineffective rate of room air exchange, possibly interacting with chemicals and aerosols, is thought to be responsible for the other ocular symptoms experienced by the workers. The present study suggests that the operating theatre environment might be a cause of the ocular discomfort often complained of by health care workers. Further studies are needed in this area.

[Water quality and microbiological status of the distribution system: traditional parameters and emerging parameters]. / Qualità dell'acqua e stato microbiologico alla distribuzione: parametri tradizionali e parametri emergenti.

Most pollution of drinking water is caused by inadequacy of the uptake and distribution systems, by insufficient upkeep of the sewage system and by defects or breaks in the disinfection processes. This may be the cause of waterborne epidemic outbreaks and therefore it is necessary carry out routine controls by simple and rapid tests for the detection of intestinal organisms. In the light of minor hepatitis A epidemics occurred in the town of Messina, we have carried out a study to determine the drinking water quality. To this end, in addition to the traditional tests recommended by CEE and required by the 8/2/1985 DPCM (37 degrees C and 20 degrees C viable count, total and faecal coliforms and faecal streptococci), we have carried out P. aeruginosa, coliphages and gram-negative endotoxins tests, in 74 water samples drawn on way in and way out of the tanks and along the piping system. Only 12.5% of the sixteen water samples drawn on way in (before disinfection system) was in compliance with the law. 75% of these samples showed positivity for faecal streptococci. The water quality was lower in the fourteen water samples drawn on way out of the tanks (7.1% was in compliance with the law). The percent of positivity along the piping system for total and faecal coliforms and for faecal streptococci was 34.1, 15.9 and 59.1 respectively. Coliphages were always absent. P. aeruginosa was almost always present in way in water (93.7%). Moreover this microorganism was recovered in 85.7% of the samples drawn on the way out and in 77.3% along the piping system. In the same drawing places endotoxins were present at high percentage (100%, 85.7% and 90.9%). These values come from high test sensitivity and poor water quality. Finally we have pointed out the importance of all the parameters examined. The significance of coliform bacteria is known, but we consider very important, as organisms indicative of pollution, the enterococci, since they P. aeruginosa may survive long time in fresh water though it is not autoctone, but, in general, of faecal origin. Several soluble antigens of this microorganism as well as enterococci show positive LAL tests (1-5-6). The endotoxin content in fresh water reflects the degree of bacterial contamination. We believe, therefore, it is needed to fix an upper limit to endotoxins in drinking water. Coliphages concentrations could be correlated with enteric virus concentrations but the ratio of coliforms to coliphages is about 100:1. Therefore this indicator of viral pollution is helpful only for highly polluted surface waters.

[The presence of a hypothetical extracellular fraction in integral typhoid vaccines prepared on a semi-synthetic medium (author's transl)]. / La presenza di una ipotetica frazione extracellulare in vaccini antitifici allestiti su terreno semisintetico.

The Authors have carried out a research on the purpose of explain the action of a typhoid vaccines prepared on a semi-synthetic medium, which in preliminary tests on mice and men evinced good immunizing power. The tests now performed demonstrate that an acellular filtrate of the vaccine (obtained from 24 h old culture) showed have the characteristics of an exotoxin and developes a strong immunizing power.