Infection Prevention Control Strategies of New Delhi Metallo-ß-lactamase Producing Klebsiella pneumoniae.

The spread of multi-drug resistant organisms (MDROs) is increasing at an alarming rate worldwide. Among these, Carbapenemase-producing New Delhi Metallo-ß-lactamase (NDM) poses a significant clinical threat, and appropriate measures must be taken to prevent or limit its penetration into still-free territories. The present report describes two independent cases of patients from Ukraine colonized by NDM-producing Klebsiella pneumoniae and admitted to two separate wards of an acute university hospital in a territory not yet affected by Carbapenemase producers of this class. Moreover, this report illustrates the infection prevention control (IPC) strategies promptly implemented by the IPC operational team to verify the possible spread of the microorganism in the ward and avoid any possible further contamination. The identification of genes coding for Carbapenemases, performed using real-time PCR, revealed no other cases within the wards involved. These cases emphasize the importance of early case recognition of multidrug-resistant bacteria, the necessity of effective inter-hospital communication, the need for effective antimicrobial stewardship protocol, and the importance of adequate IPC policies. Additionally, we highlight the need to improve screening procedures in the case of patients from countries with a high prevalence of MDRO, as essential measures to prevent potential nosocomial outbreaks and/or endemization.

Multicomponent Training and Optimal Dosing Strategies for Adults with Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

(1) Background: Non-pharmacological interventions have demonstrated efficacy in the prevention, management, and control of hypertension. Multicomponent training confers a host of benefits to the general populace. The aim of this research was to assess the impact of multicomponent training on the blood pressure of adults with hypertension and ascertain the nature of the dose-response relationship. (2) Methods: This systematic review adhered to the PRISMA guidelines and was registered in PROSPERO. Eight studies were included, following a literature search across PubMed, Web of Science, Cochrane, and EBSCO. Randomized controlled trials implementing multicomponent training interventions on adults with hypertension were considered for inclusion. A quality assessment was performed using the PEDro scale, with a random-effects model utilized for all analyses. (3) Results: Multicomponent training yielded a significant reduction in systolic (MD = -10.40, p < 0.001) and diastolic (MD = -5.97, p < 0.001) blood pressure relative to the control group. Interventions lasting over 14 weeks with a minimum frequency of three sessions per week, each lasting 60 min, were deemed most effective. (4) Conclusion: An optimal training intensity was achieved with 30 min of aerobic exercise at 75% of the heart rate reserve, whereas sets of 10 repetitions at 75% of one repetition maximum produced the best outcomes in strength training.

Impact of the COVID-19 Pandemic on the Prevalence of HAIs and the Use of Antibiotics in an Italian University Hospital.

The COVID-19 pandemic has massively affected healthcare systems globally, causing a possible reduction in attention to traditional infection prevention programs. The objective of this study was to estimate the prevalence of healthcare-associated infections (HAIs) and the use of antimicrobials in an Italian University Hospital and to investigate whether the intensification of hospital infection control measures during the COVID-19 pandemic has affected the prevalence of bacterial HAIs. A point prevalence survey was conducted according to the simplified ECDC protocol. The survey identified a local HAI prevalence of 9.0%, revealing an increase compared to pre-pandemic values (7.3%). The survey also identified an antimicrobial exposure of 40.8%, revealing a decrease in their use compared to the study carried out in the pre-pandemic era (44.6%). Among the organizational challenges experienced during the COVID-19 pandemic, despite the greater attention paid to infection prevention measures aimed at reducing SARS-CoV-2, many healthcare facilities had to contend with the controlled availability of personnel, physical space limitations and a large number of patients. Active surveillance in hospital wards and the consequent reporting by personnel specialized in infection control is fundamental for hospitals to recognize gaps in prevention and report any observed increases in HAIs.

Controlling Infectious Risk in Transfusion: Assessing the Effectiveness of Skin Disinfection in Blood Donors.

Bacterial infectious risk is a major problem in transfusion medicine. The type of micro-organisms isolated during bacterial contamination of blood products indicates that the donor's skin is its main source. In this context, the primary measures to reduce this risk are: (a) optimal disinfection of the donor's arm and (b) satellite bag diversion of the initial volume of blood collected. This work aimed to verify the effectiveness of skin disinfection of the blood donor's venipuncture site. Two methodological approaches were used: (a) qualitative and quantitative microbiological testing of the skin at the collection site, before and post-disinfection; (b) qualitative microbiological testing of the first deviated blood. Pre-disinfection testing showed skin microbial load values between 3 and >200 CFU/plate. More than two-thirds of the isolates were Gram-positive bacteria (77.8%) of which 57.7% were staphylococci. Among Gram-negative bacteria, Pseudomonadaceae, Enterobacteriaceae, and Acinetobacter spp. were isolated from the blood donors (BDs). Post-disinfection, a 100% reduction in microbial load was observed in 84.4% of BDs. Microbiological testing of the first blood diverted sample revealed the presence of microbial flora in 1.9% samples; of the isolates, 83.3% were non-aureus staphylococci. This study highlights the importance of the correct application of skin disinfection procedures in order to ensure blood safety.

Antimicrobial Resistance, Healthcare-Associated Infections, and Environmental Microbial Contamination.

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Ten-Year Evaluation of Thermal Comfort in Operating Rooms.

The microclimate is a particularly important environmental aspect in operating rooms (ORs), where more than in other hospital environments, it is extremely important, and at the same time extremely difficult, to reconcile the needs of different types of occupants (patients and operators). Moreover, unsuitable microclimatic conditions may affect the onset of infection. The present study aimed to analyze the periodic monitoring of the microclimatic conditions carried out in ORs over 10 years, to verify the adequacy of the thermal comfort conditions for all occupants. The evaluation of thermal comfort was carried out using the Fanger indices and the standards required by current legislation and specific guidelines. Non-compliant values for at least one parameter were found in 98.8% of the examinations performed in the ORs. A condition of thermal discomfort was calculated for 3.6% of healthcare professionals and 98.3% of patients. The monitoring of microclimatic conditions is particularly important in the OR as an indicator of inadequate functioning of the air conditioning system, which might affect the thermal comfort of all occupants and lead to microbial contamination of the room.

Web-based analysis on the role of Digital Media in Health Communication: the experience of VaccinarSinSardegna Website.

BACKGROUND AND AIM: Vaccinarsinsardegna.org website is a medical and scientific communication portal regarding vaccinations of Sardinia region. This article aims to present the structure of the portal, to demonstrate the actions carried out to provide accurate information for users and to analyse the website's activity from its launch until the current pandemic period in terms of dissemination and visibility. METHODS: Various metrics such as the number of visits to the site (sessions, number of users and average session duration), user behaviour (pages viewed, bounce rate and organic search) and the session acquisition path (direct traffic, referrals and social traffic) were recorded, extrapolated and processed with Google Analytics. Qualitative and normally distributed quantitative variables were summarised with absolute (relative) frequencies and means. The statistical differences between the two periods (before and during the anti-COVID-19 vaccination campaign) were evaluated applying the Wilkoxon runk-sum test. A two-tailed p-value less than 0.01 was considered to be statistically significant. RESULTS: The metrics recorded using Google Analytics show that from its publication to date, the VaccinarSinSardegna.org portal has significantly increased its visibility: in fact, the number of users who have accessed the site, the number of sessions and individual web pages visited have grown exponentially. These findings are confirmed by the increasing number of visits to both versions of the regional website (Italian- and English-language) during the COVID-19 emergency and COVID-19 vaccination campaign. When the total values recorded over the period were compared, an overall increase in metrics was observed-the number of individual users, visits and individual pageviews rose in a statistically significant way. CONCLUSIONS: Based on the success on VaccinarSinSardegna and given its potential for expansion to include further collaborations with national and international scientific bodies, the authors affirm that similar initiatives should be implemented in the fight against vaccine hesistancy.

Influenza Vaccination Strategies in Healthcare Workers: A Cohort Study (2018-2021) in an Italian University Hospital.

Vaccinating healthcare workers (HCWs) is the most effective intervention for preventing nosocomial influenza infection. However, influenza vaccination coverage (VC%) among HCWs remains low. The aim of the study was to analyse the trend of VC% among healthcare workers in an Italian hospital through a three-year vaccination project covering three influenza seasons (2018-2019, 2019-2020, and 2020-2021). A gap analysis was performed at the case base (2018-2019), on-site vaccination was trialled in the 2019-2020 season, and an integrated vaccination offer (on-site vaccination and the classic offer at a vaccination clinic) was implemented for the 2020-2021 season. For each unit of vaccinated HCWs, the following variables were recorded: main demographic details, area of affiliation (medical/surgical/services), and professional category. Logistic regression analyses were performed to assess the relationship between outcome (undergoing vaccination in 2020-2021) and other variables related to the healthcare workers' characteristics. In the three seasons, VC% values of 13.2%. 27.7%, and 58.9% were recorded, respectively (p < 0.005). The highest VC% was recorded among physicians (94.93%), in the medical area (63.27%), and males (62.59%) and in general among the youngest HCWs. Comparison of the coverage values recorded in the three seasons showed that in the last season considered (2020-2021) about 80% of health workers preferred to be vaccinated in the workplace instead of using the standard vaccination delivery method (invitation to attend the vaccination clinic). Our study suggests that the integrated vaccination offer may lead to an increase in VC% among HCWs compared to the classical offer modalities.

ATP Bioluminescence for Assessing the Efficacy of the Manual Cleaning Procedure during the Reprocessing of Reusable Surgical Instruments.

Achieving sterilization by adopting proper practices is essential to ensure that surgical instruments do not transmit microorganisms to patients. As the effectiveness of sterilization mandates effective cleaning, it is necessary to verify the success of cleaning procedures. In this study, we used the adenosine triphosphate (ATP) bioluminescence method for assessing the efficacy of the manual cleaning procedure during the reprocessing of reusable surgical instruments. The ATP bioluminescence assay was performed on 140 surgical instruments of 12 different types, both before being cleaned (baseline) and after each of the cleaning procedures (i.e., decontamination, manual washing, drying, and visual inspection). For each instrument, two swabs were used as follows: one to sample the entire surface (test point 1) and the other to sample the most difficult part of the surface to clean (test point 2). Overall, for each type of instrument, there was a decrease in contamination ranging from 99.6 to >99.9% (log reduction from 2.40 to 3.76). Thus, in order to standardize the assessment of cleanliness, it may be useful to introduce the bioluminescence method into the daily routine or, at least, at regular time intervals as a complementary check combined with visual inspection. This would allow real-time verification of the achievement of an adequate level of cleanliness.

Air microbial contamination in dental clinics: comparison between active and passive methods.

The aim of this study was to evaluate the correlation between the microbial air contamination values obtained by active sampling (colony-forming units per cubic metre, CFU/m3) and by passive sampling (Index of microbial air contamination, IMA) and to calculate the corresponding equations. Air sampling was performed in ten dental clinics (DC), before (T0), during (T1) and after (T2) the clinical activity, for five consecutive days, once a month for a period of three months, for a total of 450 air samplings. The correlation was evaluated using the Spearman test, and a p value below 0.05 was considered statistically significant. A statistically significant correlation was found considering both the results obtained from the total observations and from the single sampling times, T0, T1 and T2. Different correlation patterns were observed stratifying by DC. Both methods were able to evaluate the microbial air quality and highlight critical situations; therefore, both can be used with this aim. However, in particular during the activity, passive sampling resulted more sensitive, and for its simplicity, economy and standardization by IMA, as suggested by several authors, can be suggested for routine monitoring.

Population Distrust of Drinking Water Safety. Community Outrage Analysis, Prediction and Management.

The aim of the work is to evaluate the effectiveness of the risk communication strategies in cases of unsafe drinking water supply in Sardinia, the Italian context with the highest population distrust in drinking water safety. During the period 2010⁻2015, the ordinances published on the institutional websites were analyzed, and the population risk perception was evaluated by applying, for the first time in public health threats, the "OUTRAGE Prediction & Management" software released by Sandman. Overall, 417 ordinances issued by the Sardinian Municipalities were found. Only 1.5% of the ordinances reported information about parameters, concentrations, and risks to health, whereas 4.8% indicated only the parameters and non-standard levels. By contrast, 53.2% specified only the non-standard parameter, and 40.5% indicated a generic non-drinking motivation. The outrage assessment showed values exceeding the threshold of risk acceptance, attributable to the lack and low clarity of the information reported by the ordinances. The present study allowed us to highlight critical issues in risk communication of the quality of drinking water.

Valor pronóstico de la escala INTERHEART-colesterol para pacientes que ingresan por dolor torácico / Prognostic value of the interheart-cholesterol risk score in patients hospitalized for chest pain

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Chemical, biological, morphoanatomical and antimicrobial study of Ocotea puchury-major Mart.

Ocotea puchury-major Mart. is a tree native to the Brazilian rain forest, where it is popularly known as puxurì. In local folk medicine the leaves are used for their sedative, gastroenteric and antireumatic properties. The morphoanatomical study determined those features useful in distinguishing this species from other closely related taxa. Chemical analysis was focused on the study of the volatile oil. Gas chromatography-mass spectrometry analyses indicated safrol as the main compound of the volatile oil (39%). The results confirm and authenticate the use of its leaves in folk medicine. Furthermore, safrol is economically important as the starting material for hemisynthesis of several products. The antimicrobial activity of the essential oil was studied which showed promising activity against environmental microorganisms as well as anti-inflammatory activity.

[In vitro evaluation of antimicrobial activity of absorbable topical hemostatic agents used in the operating room]. / Valutazione in vitro dell'attività antimicrobica di dispositivi medici emostatici in uso in chirurgia.

The aim of this study was to evaluate the antimicrobial activity of three absorbable, sterile, regenerated oxidized cellulose gauzes against ATCC and clinical isolates of bacterial and fungal strains, in particular those most frequently involved in surgical site infections. The three cellulose devices showed rapid antimicrobial activity against the microbial species tested. Their use could be a valuable adjunct to antibiotic prophylaxis in the prevention of surgical site infections.

Chemical composition and antibacterial activity of the essential oil from Mentha requienii Bentham.

The chemical composition of essential oil obtained by hydrodistillation of the fresh aerial parts of Mentha requienii Bentham (Lamiaceae) collected on the Gennargentu Mountains (Sardinia, Italy) has been investigated by gas chromatography and gas chromatography-mass spectrometry. The main constituents that resulted were pulegone (78%), menthone (0.5%), isomenthone (18%), isopulegone (1.3%) and limonene (1.76%). In vitro antifungal activity is evaluated in order to identify new means that could be helpful in the prevention of contamination in indoor environments.

Carotid resistive index in treated hypertensive patients: relationship with target organ damage.

AIM: The resistive index (RI) is a hemodynamic parameter that reflects local wall extensibility and related vascular resistance. We analyze the relationship between common carotid RI and target organ damage in treated hypertensive patients. METHODS: We analyzed 265 consecutive hypertensive patients. Risk factors, cardiovascular history and treatments were collected; blood test, urinary albumin excretion (UAE), echocardiography to determine left ventricular mass index (LVMI), ankle-brachial index (ABI) and carotid echo-Doppler ultrasound to calculate the carotid intima-media thickness (IMT) and RI of both common carotids arteries were performed. RESULTS: A positive correlation was found between carotid RI and age, systolic blood pressure, heart rate, carotid IMT, LVMI, UAE and a negative correlation was found with diastolic blood pressure and ABI. Subjects at the top quartile of carotid RI showed a higher prevalence of left ventricular hypertrophy and peripheral artery disease (increased IMT, carotid plaques and lower ABI) compared with those with low RI (p < 0.05). Multiple regression analysis demonstrated that age, systolic and diastolic blood pressure and LVMI independently influence carotid RI. CONCLUSION: Carotid RI is related with age, systolic-diastolic blood pressure and LVMI in hypertensive patient. This evaluation could predict the presence of early cardiovascular damage and provide an accurate estimation of overall risk in this population.

Italian multicentre study on microbial environmental contamination in dental clinics: a pilot study.

The dental practice is associated with a high risk of infections, both for patients and healthcare operators, and the environment may play an important role in the transmission of infectious diseases. A microbiological environmental investigation was carried out in six dental clinics as a pilot study for a larger multicentre study that will be performed by the Italian SItI (Society of Hygiene, Preventive Medicine and Public Health) working group "Hygiene in Dentistry". Microbial contamination of water, air and surfaces was assessed in each clinic during the five working days of the week, before and during treatments. Air and surfaces were also examined at the end of the daily activity. A wide variation was found in microbial environmental contamination, both within the participating clinics and relative to the different sampling times. Microbial water contamination in Dental Unit Water Systems (DUWS) reached values of up to 26x10(4)cfu/mL (colony forming units per millilitre). P. aeruginosa was found in 33% of the sampled DUWS and Legionella spp. in 50%. A significant decrease in the Total Viable Count (TVC) was recorded during the activity. Microbial air contamination showed the highest levels during dental treatments and tended to decrease at the end of the working activity (p<0.05). Microbial buildup on surfaces increased significantly during the working hours. As these findings point out, research on microbial environmental contamination and the related risk factors in dental clinics should be expanded and should also be based on larger collections of data, in order to provide the essential knowledge aimed at targeted preventive interventions.

Prevalence study of Legionella spp. contamination in ferries and cruise ships.

BACKGROUND: In the last years, international traffic volume has significantly increased, raising the risk for acquisition of infectious diseases. Among travel-associated infections, increased incidence of legionellosis has been reported among travellers. Aim of our study was: to describe the frequency and severity of Legionella spp. contamination in ferries and cruise ships; to compare the levels of contamination with those indicated by the Italian ministerial guidelines for control and prevention of legionellosis, in order to assess health risks and to adopt control measures. METHOD: A prevalence study was carried out on 9 ships docked at the seaports of northern Sardinia in 2004. Water samples were collected from critical sites: passenger cabins, crew cabins, kitchens, coffee bars, rooms of the central air conditioning system. It was performed a qualitative and quantitative identification of Legionella spp. and a chemical, physical and bacteriological analysis of water samples. RESULTS: Forty-two percent (38/90) water samples were contaminated by Legionella spp.. Positive samples were mainly drawn from showers (24/44), washbasins (10/22). L. pneumophila was isolated in 42/44 samples (95.5%), followed by L. micdadei (4.5%). Strains were identified as L. pneumophila serogroup 6 (45.2%; 19 samples), 2-14 (42.9%), 5 (7.1%) and 3 (4.8%). Legionella spp. load was high; 77.8% of the water samples contained > 10(4) CFU/L. Low residual free chlorine concentration (0-0.2 mg/L) was associated to a contamination of the 50% of the water samples. CONCLUSION: Legionella is an ubiquitous bacterium that could create problems for public health. We identified Legionella spp. in 6/7 ferries. Microbial load was predominantly high (> 10(4) CFU/L or ranging from 10(3) to 10(4) CFU/L). It is matter of concern when passengers are subjects at risk because of Legionella spp. is an opportunist that can survive in freshwater systems; high bacterial load might be an important variable related to disease's occurrence. High level of contamination required disinfecting measures, but does not lead to a definitive solution to the problem. Therefore, it is important to identify a person responsible for health safety in order to control the risk from exposure and to apply preventive measures, according to European and Italian guidelines.