Disinfection efficiency of peracetic acid (PAA): inactivation of coliphages and bacterial indicators in a municipal wastewater plant.

The aim of the study was to assess the efficiency of low doses of peracetic acid against viral and bacterial indicators in wastewater and to evaluate if the treatment allows regulatory requirements to be satisfied. A total of 31 samplings were carried out, each involving the collection of secondary effluent and of effluent disinfected with 1.2 or 1.5 mg l(-1) of peracetic acid (contact time 20 minutes). In each sample were measured: somatic coliphages, F-specific RNA bacteriophages, Escherichia coli, total and faecal coliforms, enterococci. Peracetic acid disinfection showed significant differences between the reductions of the microorganisms tested: E. coli showed the highest reduction (1.78 and 2.43 Log respectively with 1.2 and 1.5 mg l(-1) of peracetic acid) and phages the lowest (ranging between 0.52 and 0.60 Log). Only a concentration of 1.5 mg l(-1) of peracetic acid would enable the effluent to be discharged into surface waters in compliance with Italian regulations. The variability of microbial resistance against the peracetic acid disinfection treatment, underlines the importance of assessing disinfection efficiency by using more than one indicator microorganism. The detection of E. coli could be usefully accompanied by tests for more resistant microorganisms such as enterococci or coliphages. In conclusion, peracetic acid can be used for the disinfection of effluents even at low doses, with the advantage of reducing costs and preventing the formation of significant amounts of genotoxic by-products.

Legionella waterline colonization: detection of Legionella species in domestic, hotel and hospital hot water systems.

AIMS: An evaluation was made of the prevalence of Legionella species in hot water distribution systems in the city of Bologna (Italy) and their possible association with bacterial contamination (total counts and Pseudomonadaceae) and the chemical characteristics of the water (pH, Ca, Mg, Fe, Mn, Cu, Zn and Total Organic Carbon, TOC). METHODS AND RESULTS: A total of 137 hot water samples were analysed: 59 from the same number of private apartments, 46 from 11 hotels and 32 from five hospitals, all using the same water supply. Legionella species were detected in 40.0% of the distribution systems, L. pneumophila in 33.3%. The highest colonization was found in the hot water systems of hospitals (93.7% of samples positive for L. pneumophila, geometric mean: 2.4 x 10(3) CFU l(-1)), followed by the hotels (60.9%, geometric mean: 127.3 CFU l(-1)) and the apartments with centralized heating (41.9%, geometric mean: 30.5 CFU l(-1)). The apartments with independent heating systems showed a lower level of colonization (3.6% for Legionella species), with no evidence of L. pneumophila. Correlation analysis suggests that copper exerts an inhibiting action, while the TOC tends to favour the development of L. pneumophila. No statistically significant association was seen with Pseudomonadaceae, which were found at lower water temperatures than legionellae and in individual distribution points rather than in the whole network. CONCLUSIONS: The water recirculation system used by centralized boilers enhances the spreading of legionellae throughout the whole network, both in terms of the number of colonized sites and in terms of CFU count. SIGNIFICANCE AND IMPACT OF THE STUDY: Differences in Legionella colonization between types of buildings are not due to a variation in water supply but to other factors. Besides the importance of water recirculation, the study demonstrates the inhibiting action of copper and the favourable action of TOC on the development of L. pneumophila.

[Hygiene education in the Laureate Course of Dentistry and Dental Prosthetics: evaluation of student knowledge about the risk of infection in a dental practice environment]. / L'insegnamento di Igiene nel Corso di Laurea in Odontoiatria e Protesi dentaria: valutazione delle conoscenze degli studenti sul rischio infettivo in ambito odontoiatrico.

Hygiene education for dental students is crucial in order to control and reduce the risk of infections in their future professional practices. The aim of this study was to evaluate the improvement in university students' knowledge of infectious disease prevention, dental instruments and environmental decontamination following the Course in Dental Hygiene and Prevention. 595 questionnaires were submitted to dental students at twelve Italian Universities; 335 were filled out before the Course began and 260 at the end of the same course. The students in both the PRE-course and at the POST-course evaluations demonstrated adequate knowledge regarding the transmission of infections in dental practices, knowledge improved following the Hygiene course.

[Immigration and health: observational study concerning the foreign children attending the Bologna community pediatric service]. / Immigrazione e salute: studio osservazionale sui bambini immigrati utenti dei distretti socio-sanitari del comune di Bologna.

An analysis of the health situation of 2583 immigrant children examined by the Community Paediatric Service in the city of Bologna in 1999 and 2000 was made. The data were obtained from health records, from medical notes made in the districts or during school readmissions. Our investigation showed that: 68.8% of the children were of immigrant couples, 21.6% had at least one Italian parent, 6.0% had lost one or both parents and 3.6%, had been adopted by Italian couples; 68.8% were born in EU countries (1620 in Bologna and 133 in other regions). 99.6% of the children had received all compulsory vaccinations; 1853 subjects had also had one or more optional vaccinations: against whooping-cough 45.2%, measles 46.9% and mumps 33.8%. Only 38.5% of children had pathologies, and those most frequently encountered involved the respiratory and digestive systems. Diseases are more often infectious and allergic as in Italian population. Parasitic infections occurred more frequently than in Italian children; amoebiasis and cutaneous diseases were seen in 1.9% of the children (especially Indians). Cases of tuberculosis were limited. The children more often undergoing diagnostic investigations involving hospitalisation were from Asia and Africa. Only 10.1 of mothers and 7.6% of fathers reported medical problems; allergic pathologies were prevalent.

Decontamination of dental unit water systems with hydrogen peroxide.

AIMS: Transmission of microbial pathogens to patients from water in dental units is a concern. To reduce this risk, the decontaminating efficiency of hydrogen peroxide was evaluated. METHODS AND RESULTS: Three percent hydrogen peroxide diluted 1 : 4 in distilled water (contact time 15 min) was used daily to disinfect the waterlines of a pilot unit previously contaminated with Pseudomonas aeruginosa or Staphylococcus aureus. The behaviour of the test bacteria was seen to differ over time. Staph. aureus numbers slowly decreased until only low numbers were recovered, after which the levels remained stable. Ps. aeruginosa abatement was more rapid and the density of the bacteria reached a peak when the circuit was empty. CONCLUSIONS: Staph. aureus and Ps. aeruginosa treated with hydrogen peroxide fell from 6 to 4 log. SIGNIFICANCE AND IMPACT OF THE STUDY: Treatment of dental unit waterlines with hydrogen peroxide was seen to be able to keep the number of the bacteria under control, as long as the treatment was repeated daily.

Immunomagnetic assay, classic culture method and fermentation tube test in the recovery of Escherichia coli O157 from sewage.

The diffusion of E. coli O157 was studied in the effluents of a large sewage treatment plant. Three methods were used: the Culture Method, Immunomagnetic Separation (IMS) and Fermentation Tube Test. Vero cells assay and PCR were used to assess toxin production and the presence of virulence genes. E. coli O157 were only detected using IMS and the Fermentation Tubes Test: one strain in raw sewage and 2 in a sample of disinfected effluent. The latter resulted positive for the production of verocytotoxin and possessed genes coding for vt2 and type gamma intimin. The best results were obtained with SMAC-CT-BCIG medium. The use of various different recovery techniques confirmed the difficulty involved in isolating E. coli O157 from water samples.

[Tobacco smoking among nursing students: behaviour and knowledge of the correlated risks]. / Fumo di tabacco: comportamenti e conoscenze sulle patologie ad esso correlate tra gli studenti dell'area sanitaria infermieristica.

This study was designed to assess knowledge and consumption of tobacco, during the three years of the university course for nurses in Bologna. A questionnaire consisting of items about personal details, smoking habits, and one open question about knowledge of health risks linked to tobacco consumption 505 students. 43% of males and 33% of females were current smokers. The males were mostly medium and heavy smokers (>11 cigarettes/day) and the females light smokers (<10/day). As regards knowledge an increase in both number and accuracy of the answers given by the third year students was seen. Suggestions for educational programs are given considering that the population in question is part of an "example group" who are supposed to play a role in influencing the behavior of the general population.

[Environmental diffusion of Legionella spp and legionellosis frequency among patients with pneumonia: preliminary results of a multicentric Italian survey]. / Diffusione ambientale di Legionella spp e frequenza di legionellosi in pazienti affetti da polmonite: primi risultatidi uno studio multicentrico italiano.

A multicentric Italian investigation on legionnaires' disease is in course to clarify host factors as well as pathogen associated characteristics involved in the infection/disease. The main goal of the research plan is to account for some critical aspects concerning identification and prevention of legionellosis. To improve knowledge on factors associated with Legionella spp colonisation in hot waters, to detect cases and to characterize risk factors in subjects which develop pneumonia are specific objectives of the research programme. Preliminary results show that hot waters of houses and hotels are frequently contaminated (22.6% and 54.6%, respectively), mainly by L. pneumophila. Microbial concentrations were low in domestic waters (<1.000 ufc/l), but higher in samples from the hotels (geom. mean 1.85 x 10(3) ufc/l). Warming system, age of the plant, type of building were risk factors significantly associated with Legionella spp positivity. The active surveillance on patients affected by pneumonia with search for Legionella urinary antigen allowed the identification of 34 cases, 3 of which of nosocomial origin, corresponding to 4.2% of the screened pneumonia. After informed consent, 26 subjects were recruited for a case-control-study to clarify risk factors for the disease.

[Multicentric survey on hygienic aspects in private dental practice]. / Indagine multicentrica sugli aspetti igienico-sanitari legati all'assistenza odontoiatrica privata.

The aim of this research was to evaluate the knowledge of cross-infection hazards in private dental practices, and their control procedures. The survey, carried out by questionnaire in 11 Italian cities, showed that dental personnel do not completely follow the main procedures for infection control. The interviewed subjects usually wear gloves (95.5%), masks (90.1%) and glasses (91.2%), less frequently caps (23.9%) and coats (54.9%). They use steam sterilizers (92.9%) and periodically check the effectiveness (80.6%). Regarding individuals protection, 20.5% is not vaccinated against HBV and only 55.2% of those previously vaccinated has checked their immunity. Moreover, the majority of subjects underestimate the infection hazards especially for air-transmitted diseases.

Peracetic acid as an alternative wastewater disinfectant to chlorine dioxide.

AIMS: The aim of this study was to compare the efficiency of peracetic acid with that of chlorine dioxide in the disinfection of wastewater from a sewage treatment plant (serving about 650 000 inhabitants) that has been using peracetic acid as a disinfectant since 1998. METHODS AND RESULTS: A total of 23 samplings were made, each consisting of three samples: from secondary effluent, effluent disinfected with 2 mg l(-1) of peracetic acid and effluent disinfected with 2.2 mg l(-1) of chlorine dioxide (contact time 20 min). For each sample, measurements were made of the heterotrophic plate count at 36 degrees C, total and faecal coliforms, Escherichia coli, enterococci, pH, suspended solids and chemical oxygen demand (COD). During the first phase of the experiment the peracetic acid was seen to be less efficient than chlorine dioxide. To improve the disinfectant action a system of mechanical agitation was added which led to a greater efficiency in the inactivation of bacteria of faecal origin. CONCLUSIONS: Both products were found to be influenced by the level of microbial contamination, the amount of suspended solids and COD but not by the pH of the effluent before disinfection. The immediate mixing of the wastewater and disinfectant caused a greater reduction in enterococci. SIGNIFICANCE AND IMPACT OF THE STUDY: Since peracetic acid was seen to produce a high abatement of micro-organisms, it can be considered as a valid alternative to chlorine dioxide in the disinfection of wastewaters.

Tobacco consumption and sports participation: a survey among university students in northern Italy.

Social-demographic information of a total of 1249 students attending the University of Bologna was analyzed by means of an anonymous questionnaire containing 33 questions with particular reference to tobacco smoking and sports activity. Results revealed that 31.6% of the students practise some form of sports regularly (6 hours a week or more), 40.5% occasionally (at least an hour a week for 8 months in a year) and 27.9% do not take part in any kind of sport. Significant differences were seen between those that practise sports (60.4% are non-smokers and 33.5% are habitual smokers) and those that do not (52.9% are non-smokers and 40.1% smoke habitually). The smokers who are active in sports smoke a lower mean number of cigarettes a day than the inactive group and thus belong to the category of light smokers. They also smoke fewer cigarettes on days when they take part in sports activity. As far as knowledge of health risks is concerned, 21.1% of those who practise sports obtained a score between good and excellent compared to 15.9% of those who do not. Although on the whole the results appear to show a certain influence of sports on smoking habits, the kind of study we led and the differences in the number of smokers are not sufficient to consider sports practitioners as a group not at risk for behaviour harmful to the health. Further studies are necessary to verify the cause-effect relationship between sports activity and smoking habits.

Evaluation of the efficiency of peracetic acid in the disinfection of sewage effluents.

AIMS: Evaluation of the efficiency of peracetic acid in the disinfection of wastewater in a large treatment plant. METHODS AND RESULTS: Over a period of 18 months 30 sample collections were made, each consisting of three samples taken from: raw incoming sewage, secondary effluent (after 10-12 h) and secondary effluent disinfected with 1.5-2 mg l(-1) of peracetic acid (contact time: 20 min). Total coliforms and Escherichia coli declined from 10(7) MPN 100 ml(-1) in the raw sewage to 10(2) in the disinfected effluent and the enterococci fell from 10(6) MPN 100 ml(-1) to 702 MPN 100 ml(-1). The reduction of bacteria increased with the rise in temperature and decreased with the rise in BOD5. CONCLUSIONS: Disinfection with peracetic acid reduced levels of faecal contamination by 97%, thus attaining the limit recommended by current Italian law (Escherichia coli

Airborne coagulase negative staphylococci produced by a sewage treatment plant.

Since some coagulase-negative staphylococci species are involved in clinical and environmental situations, the authors carried out a study on the spread of these bacteria in the air of a sewage treatment plant. For these purposes a total of 196 samples were taken from 16 sampling stations, 11 during the day and 5 at night (only at 4 points), using the settle plate technique. Altogether 13 species of coagulase negative staphylococci were isolated: S. haemolyticus, S. xylosus and S. cohnii were particularly common. Station no. 2 (an area almost always kept closed containing the fine screens) was found to be the most contaminated. The presence of coagulase negative staphylococci was favoured by high temperatures and low humidity. No differences were found due to variations in wind speed and direction or between day and night.

Occurrence and seasonal variation of airborne gram negative bacteria in a sewage treatment plant.

A study was carried out to determine the microbial density and the seasonal variation of airborne Gram negative bacteria in a sewage treatment plant. Sampling was made at 16 sites and the settle plate technique was used. Of the 201 samples examined, 43.2% revealed fecal coliforms (mean value = 14 cfu/p/h), 53% Pseudomonas spp. (mean value = 11 cfu/p/h), 46.5% Shigella spp. (mean value = 13 cfu/p/h), 3% Legionella spp. (mean value = 2 cfu/p/h) and 2% Salmonella (mean value = < 1 cfu/p/h). 72% of the samples contained "other" Gram negative bacteria such as Aeromonas hydrophila, Serratia marcescens, Enterobacter cloacae and others. With the exception of Legionella spp. and Salmonella, all other bacteria were more frequent and numerous in the October-March period, when temperatures were lower and humidity higher. Although the oxidation tanks were covered overall contamination was nevertheless high, thus presenting a potential health risk for plant workers.

Recovery of Burkholderia pseudomallei and B. cepacia from drinking water.

Samples of drinking water were examined in order to evaluate the occurrence of two gram-negative bacteria: Burkholderia pseudomallei and B. cepacia. A total of 85 samples were collected from public and private buildings in the province of Bologna (Italy). Other bacteriological indicators (heterotrophic plate count at 22 and 36 degrees C) were also examined, together with physical and chemical parameters (temperature, pH, residual chlorine, total hardness and chemical oxygen demand (COD)). High levels of B. pseudomallei were recovered (mean value = 578 cfu/100 ml) in about 7% of samples, while B. cepacia was recovered in 3.5% (mean value = < 1) of the samples. The two microorganisms were found to correlate positively with heterotrophic plate counts at 22 and 36 degrees C, but not with the physical and chemical parameters taken into consideration.

Water characteristics associated with the occurrence of Legionella pneumophila in dental units.

This study evaluated the incidence of Legionella pneumophila in dental unit water samples and investigated how the occurrence of these bacteria may be related to some physical, chemical and bacteriological characteristics of the water. The samples were taken from the incoming tap water, oral rinsing cup, air-water syringe, ultrasonic scaler, and the turbine of 23 dental units of private and public institutions. Apart from L. pneumophila (serogroup 1 and 3) isolated in 22 out of the 101 (21.8%) water samples tested, two other species were found: L. bozemanii and L. dumoffii. The highest densities and frequency of L. pneumophila were observed in the water coming into the units and in the dental units of public institutions. A negative association between L. pneumophila and 36 degrees C and 22 degrees C heterotrophic total plate counts and other gram-negative bacteria was found. An inverse association between the concentration of L. pneumophila and water temperature was also observed. The values of pH and total hardness did not show any significant difference in the L. pneumophila-positive and -negative dental unit waters. Finally, the chemical oxygen demand (COD) and residual chlorine were found to correlate positively with L. pneumophila.

Tobacco smoking among high school students in Romagna (Italy) and evaluation of a prevention campaign.

The aim of this study was to investigate the smoking habits of a sample of second year high school students in Romagna (Northern Italy) by means of an anonymous self-administered questionnaire and the efficiency of a previous health education campaign. A sample of 2,691 16-year-old pupils (74% of the school population of this age) was randomly selected. Of these, 863 (32.1%) had participated in a prevention campaign while attending middle school. 19.1% of the students who had taken part in the campaign were smokers compared to 23.2% of those who had not. The students' smoking habits were found to be influenced by the type of school and by the role models (parents, siblings, friends, teachers). The campaign appears to have had good results, especially in places where it was carried out on a wide scale. Suggestions are made for making such campaigns more efficient.