RESUMO
BACKGROUND: Recent studies have questioned the role of unidirectional airflow ventilation system in reducing surgical site infection (SSI) in prosthetic implant surgery. The aim of the ISChIA study ("Infezioni del Sito Chirurgico in Interventi di Artroprotesi" which means "Surgical site infections in arthroplasty surgery") was to evaluate, as a contribution to this debate, the association between heating, ventilation and air conditioning systems, microbial air contamination and surgical site infection in hip and knee arthroplasty. METHODS: The study was performed from March 2010 to February 2012 in 14 hospitals, for a total of 28 operating theatres: 16 were equipped with vertical unidirectional airflow ventilation (U-OTs), 6 with mixed airflow ventilation (M-OTs), 6 with turbulent airflow ventilation (T-OTs). Microbial air contamination in the operating theatre was evaluated by means of passive (Index of Microbial Air contamination, IMA) and active (Colony Forming Units per cubic metre, cfu/m3) sampling. SSI surveillance was carried out according to the Hospitals in Europe Link for Infection Control through Surveillance protocol. RESULTS: A total of 1,285 elective prosthesis procedures (61.1% hip and 38.9% knee) were included in the study. The results showed a wide variability of the air microbial contamination in operating theatres equipped with unidirectional airflow. The recommended values of ≤2 IMA and ≤10 cfu/m3 were exceeded, respectively, by 58.9% and 46.4% of samples from U-OTs and by 87.6% and 100% of samples from M-OTs. No significant difference was observed between SSI cumulative incidence in surgical procedures performed in U-OTs compared with those performed in T-OTs. A lower risk of SSI, even though not statistically significant, was shown in surgical procedures performed in U-OTs with a microbial air contamination within the recommended values (≤2 IMA and ≤10 cfu/m3) compared with those performed in U-OTs where these limits were exceeded, and compared with those performed in T-OTs with microbial air contamination within the recommended values for this type of OTs (≤25 IMA, ≤180 cfu/m3. CONCLUSION: ISChIA study did not show a protective effect of unidirectional airflow compared with turbulent airflow in arthroplasty surgery. However, the frequent exceeding of recommended air microbial contamination values in OTs equipped with unidirectional airflow, and the lower SSI risk in surgical procedures performed in compliant U-OTs compared with those performed in non-compliant U-OTs and with those performed in compliant T-OTs, suggest the need of further studies, which should consider air microbial contamination and other aspects of SSI prevention that may negate the potential benefits of the ventilation system; differences in intrinsic and extrinsic risk factors, medical treatment and surgical technique are also to be considered. Training interventions aimed at improving the behaviour of operators are essential.
Assuntos
Ar Condicionado/efeitos adversos , Microbiologia do Ar , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Calefação/efeitos adversos , Salas Cirúrgicas/estatística & dados numéricos , Infecção da Ferida Cirúrgica/prevenção & controle , Ventilação , Ar Condicionado/normas , Microbiologia do Ar/normas , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Calefação/normas , Humanos , Itália , Vigilância da População , Infecção da Ferida Cirúrgica/microbiologia , Ventilação/métodos , Ventilação/normasRESUMO
BACKGROUND: In 2014, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI), in collaboration with the National Association of Medical Hospital Managers (ANMDO), conducted a survey on the availability of procedures for cleaning and disinfecting ambulances in order to assess the practices in use. METHODS: An online questionnaire was prepared through the Survey Monkey® platform and a web link access was sent to a convenience sample of ANMDO doctors working in healthcare management in public and private healthcare facilities. RESULTS: Ninety-six questionnaires were collected (26% response rate). In 73% of cases there was a procedure for cleaning and disinfecting ambulances, which had been produced at a company level (67%) and involved various professionals. In 21% of cases the procedure had been prepared in expectation of an epidemic or following an epidemic (5%). The recommendations had been presented to the staff (90%), in 28% of cases through training events with verification of the knowledge acquired. Monitoring of the implementation of the procedure is planned in the majority of cases (88%), mainly through direct observation (92%). In 67% of cases the tender specifications for ambulance services did not include a section dedicated to cleaning and disinfection and, in the absence of a procedure, this was provided by the hospital in only 51% of case. CONCLUSION: This survey represented a first step towards the development of guidelines for standardising procedures and providing indications useful for their evaluation and monitoring their implementation.
Assuntos
Ambulâncias/normas , Desinfecção/normas , Guias como Assunto/normas , Zeladoria/normas , Desinfecção/métodos , Contaminação de Equipamentos/prevenção & controle , Humanos , Higiene , Itália , Sociedades Médicas , Inquéritos e Questionários/estatística & dados numéricosRESUMO
BACKGROUND: The high diffusion of endoscopes worldwide and the need for effective reprocessing methods requested the development of guidelines and implementation of surveillance procedures at local level. STUDY DESIGN: In order to collect data on everyday's practice and adherence to available guidelines, endoscopy units from different public institutions were surveyed using a dedicated questionnaire. METHODS: Between July and November 2015 a survey was carried in 12 main hospitals from 10 different Italian regions, involving 22 endoscopy units. The state of the art of national and international guidelines was investigated to compare the protocols adopted at local level. RESULTS: In all the surveyed hospitals, the reprocessing activity is based on pre-established protocols in adherence with principal guidelines. Enzymatic detergents, which are recommended by the international guidelines, are used in 55.6% of units and peracetic acid is currently the most widely used chemical disinfectant. Discrepancies were observed in the application of periodic quality controls. CONCLUSION: Updated guidelines are generally applied in reprocessing practice. Quality controls may represent a critical issue to improve effectiveness and surveillance. The whole of acquired data can promote a positive trend towards the application of best practices.
Assuntos
Desinfecção/normas , Endoscópios Gastrointestinais/normas , Reutilização de Equipamento/normas , Fidelidade a Diretrizes/normas , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Ácido Acético , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Detergentes , Desinfetantes , Desinfecção/métodos , Duodenoscópios/microbiologia , Duodenoscópios/normas , Endoscópios Gastrointestinais/microbiologia , Contaminação de Equipamentos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Itália , Controle de Qualidade , Sociedades Médicas/normasRESUMO
BACKGROUND: In Italy there are no rules concerning the establishment of a hospital hygiene structure in hospitals and other healthcare settings, and the hospital organization plans vary widely. The aim of the survey, carried out by the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive medicine and Public health, was to evaluate the presence in the hospital organization plan of a structure referred to as Hospital hygiene, or including in its denomination the words "hygiene" or "hospital hygiene", the activities carried out, the relation to other areas, like patient safety, the type and quantity of professionals involved, the strengths and the critical aspects. METHODS: A semi-structured questionnaire was administered to Healthcare Trusts representing all Italian Regions through the members of the above Study Group. RESULTS: 35 Trusts, 13 in Northern, 8 in Central, 14 in Southern Italy (including Sicily and Sardinia), completed the questionnaire. In 19 Trusts (54.3%) a structure whose denomination included the words "hospital hygiene" or "hygiene" was present. The activities related to the management of infectious risk were most represented, carried out autonomously or in collaboration, but many other activities were covered. In all hospitals the activities of the Hospital Hygiene Unit inter-linked with those of the clinical risk, with different forms of collaboration. CONCLUSION: This survey, even though on a limited sample, provided a picture of hospital hygiene at a national level, showing a considerable heterogeneity and highlighting critical issues but also strengths. It is essential to share organizational and management models that enhance and promote hospital hygiene, to ensure the appropriateness of healthcare practices offered in a safe and comfortable environment to patients, operators, and visitors.
Assuntos
Infecção Hospitalar/prevenção & controle , Administração Hospitalar , Higiene , Controle de Infecções/organização & administração , Inquéritos e Questionários , Hospitais , Humanos , Itália , Sociedades Médicas , Inquéritos e Questionários/estatística & dados numéricosRESUMO
BACKGROUND: Surgical Site Infection (SSI) is one of the major complications following insertion of hip or knee prosthesis. The aim of the present study was to describe rates of SSIs and associated risk factors during hip and knee prosthesis procedures in Italian hospitals. METHODS: Italian hospitals were invited to join the ISChIA (Surgical Site Infections in Arthroplasty Surgery) project and participated in the study on a voluntary basis. SSI surveillance was performed according to the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) -SSI protocol. The study population consisted of all patients who had a prosthetic knee or hip joint replacement between March 2010 and February 2011. Only elective operations were include. RESULTS: A total of 14 hospitals and 1285 surgical procedures were included. SSI cumulative incidence was 1.3 per 100 hip and 2.4 per 100 knee surgical procedures; a significant positive trend of SSI incidences was observed with increasing SSI risk index. In multivariate analysis, considering hip procedures, the single independent risk factor associated to SSI was operation length (RR: 4.54; 95%CI: 1.06-19.48). For knee procedures, no significant risk factor was identified. CONCLUSIONS: In the present study, SSI cumulative incidence was in the range of European data. However, a larger number of operations is needed to better estimate SSI rates. A second edition of the ISChIA project has been already conducted and results of the two surveys will provide new insight to further our knowledge for infection control.
Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Vigilância da População , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Feminino , Humanos , Incidência , Itália , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Estudos Prospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Adulto JovemRESUMO
The Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI) and the Local Health Authority of Foggia, Apulia, Italy, after the National Convention "Safe water in healthcare facilities" held in Vieste-Pugnochiuso on 27-28 May 2016, present the "Vieste Charter", drawn up in collaboration with experts from the National Institute of Health and the Ministry of Health. This paper considers the risk factors that may affect the water safety in healthcare facilities and reports the current regulatory frameworks governing the management of installations and the quality of the water. The Authors promote a careful analysis of the risks that characterize the health facilities, for the control of which specific actions are recommended in various areas, including water safety plans; approval of treatments; healthcare facilities responsibility, installation and maintenance of facilities; multidisciplinary approach; education and research; regional and national coordination; communication.
Assuntos
Instalações de Saúde/normas , Segurança/normas , Microbiologia da Água/normas , Abastecimento de Água/normas , Instalações de Saúde/legislação & jurisprudência , Promoção da Saúde , Humanos , Itália , Saúde Pública/legislação & jurisprudência , Saúde Pública/normas , Fatores de Risco , Segurança/legislação & jurisprudência , Purificação da Água/legislação & jurisprudência , Purificação da Água/normas , Abastecimento de Água/legislação & jurisprudênciaRESUMO
BACKGROUND: The rate of surgical site infections (SSI) is strongly influenced by operating room quality, which is determined by the structural features of the facility and its systems and by the management and behavior of healthcare workers. The aim of the present study was to assess microbial contamination in the operating room during hip- and knee-replacement procedures, the behavior of operating room staff and the incidence of SSI through postdischarge surveillance. METHODS: Microbial contamination was evaluated by active and passive sampling at rest and in operating conditions. Organizational and behavioral characteristics were collected through observational assessment. The incidence of SSI was evaluated in 255 patients, and follow-up examinations were carried out 30 and 365 days after the procedure. RESULTS: The mean values of the airborne and sedimenting microbial loads were 12.90 CFU/m3 and 0.02 CFU/cm2/h, respectively. With regard to outcome, the infection rate proved to be 0.89% and was associated with knee-replacement procedures. The microorganism responsible for this superficial infection was Staphylococcus aureus. CONCLUSIONS: Clinical outcomes proved to be satisfactory, owing to the limited microbial load (in both at-rest and operating conditions), the appropriate behavior of the staff, compliance with the guidelines on preoperative antibiotic prophylaxis, and efficient management of the ventilation system.
Assuntos
Salas Cirúrgicas , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica , Antibioticoprofilaxia , Artroplastia do Joelho , Humanos , Infecções EstafilocócicasRESUMO
OBJECTIVE: To describe the occurrence of CRKP infections in a tertiary care hospital and to analyse the allelic profiles of the clinical strains involved and the most frequent carbapenemases. DESIGN: The study analyzed cases of infection due to CRKP in the period 2013-2014; 147 cases were recorded, most of which (82.31%) were in-hospital infections. SETTING: A hospital in northern Italy. METHODS: We retrospectively collected: data on patient characteristics and the microbiological characteristics of CRKP. Isolates from 72 of the in-hospital cases underwent molecular typing (MLST); in addition, in each isolate, a procedure for the detection of the blaKPC gene was carried out. RESULTS: The in-hospital death rate was 24.0% in 2013 and 37.5% in 2014. However, the difference between these two values did not prove statistically significant (P > .05). Analysis of mortality revealed that bloodstream infections were more frequently associated with death than other infections (χ2 = 14.57, P < .001). The age-adjusted Cox proportional hazard model revealed that the patients with bacteremia due to CRKP had a 3-fold higher risk of death (HR 3.11; 95% CI 1.66 - 5.84, P< .001) than those with infections of other sites. MLST revealed that the prevalent allelic profile was ST 512 (79.62%); the most frequent carbapenemase was KPC-3 (83.8%). CONCLUSIONS: Our results are in line with those of recent studies, which have shown that the spread of CRKP in Italy is a matter of concern and that further efforts have to be made to prevent the potential dissemination of carbapenemase-producing clones of K. pneumoniae, whenever possible.
Assuntos
Carbapenêmicos/farmacologia , Farmacorresistência Bacteriana , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos , Feminino , Humanos , Itália/epidemiologia , Klebsiella pneumoniae/patogenicidade , Masculino , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Estudos RetrospectivosRESUMO
Glycopeptide resistance in Staphylococcus aureus is a source of great concern because, especially in hospitals, this class of antibiotics, particularly vancomycin, is one of the main resources for combating infections caused by methicillin-resistant Staphylococcus aureus strains (MRSA). Reduced susceptibility to vancomycin (VISA) was first described in 1996 in Japan; since then, a phenotype with heterogeneous resistance to vancomycin (h-VISA) has emerged. H-VISA isolates are characterised by the presence of a resistant subpopulation, typically at a rate of 1 in 10(5) organisms, which constitutes the intermediate stage betweenfully vancomycin-susceptible S. aureus (VSSA) and VISA isolates. As VISA phenotypes are almost uniformly cross-resistant to teicoplanin, they are also called Glycopeptides-intermediate Staphylococcus aureus strains (GISA) and, in the case of heterogeneous resistance to glycopeptides, h-GISA. The overall prevalence of h-VISA is low, accounting for approximately 1.3% of all MRSA isolates tested. Mortality due to h-GISA infections is very high (about 70%), especially among patients hospitalised in high-risk departments, such as intensive care units (ICU). Given the great clinical relevance of strains that are heteroresistant to glycopeptides and the possible negative impact on treatment choices, it is important to draw up and implement infection control practices, including surveillance, the appropriate use of isolation precautions, staff training, hand hygiene, environmental cleansing and good antibiotic stewardship.
Assuntos
Infecção Hospitalar/epidemiologia , Staphylococcus aureus Resistente à Meticilina/fisiologia , Infecções Estafilocócicas/epidemiologia , Resistência a Vancomicina/fisiologia , Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Daptomicina , Higiene das Mãos , Humanos , Controle de Infecções , Prevalência , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/fisiologia , Vancomicina/uso terapêuticoRESUMO
Invasive disease caused by Neisseria meningitidis is associated with high mortality and high disability rates and mainly affects children under one year of age. Vaccination is the best way to prevent meningococcal disease, especially in infants and toddlers. The introduction of massive meningococcal serogroup C vaccination has drastically reduced the incidence of disease caused by this serogroup, and serogroup B has now become the main causative agent in several industrialized countries. The first serogroup B vaccines, which were used for more than two decades, were based on outer membrane vesicles and proved to be protective only against specific epidemic strains in Cuba, Norway, Brazil and New Zealand. Moreover, these often elicited a scant immune response in young children. Innovative genomics-based reverse vaccinology subsequently enabled researchers to identify genes encoding for surface proteins that are able to elicit a strong immune response against several B strains. This important discovery led to the development and recent approval in Europe of the four-component meningococcal serogroup B (4CMenB) vaccine. Large clinical trials have shown high immunogenicity and tolerability and acceptable safety levels of 4CMenB in infants and toddlers. This vaccine is expected to cover a large number of circulating invasive strains and may also be efficacious against other serogroups. Young children are particularly vulnerable to the devastating consequences of meningococcal disease. Given the high performance of 4CMenB and its non-interference with routine vaccinations, this age-group will be the first to benefit from the introduction of this vaccine.
Assuntos
Meningite Meningocócica/prevenção & controle , Vacinas Meningocócicas/uso terapêutico , Neisseria meningitidis/patogenicidade , Vacinação , Criança , Pré-Escolar , Humanos , Lactente , Meningite Meningocócica/microbiologia , Meningite Meningocócica/patologia , Neisseria meningitidis/efeitos dos fármacosRESUMO
OBJECTIVES: To establish the possible sources and routes of transmission of a multidrug-resistant Acinetobacter baumannii outbreak involving 22 patients. STUDY DESIGN: Descriptive, retrospective study. METHODS: An environmental investigation was undertaken, monitoring surfaces, air and water. Reconstruction of the spread of the infection took several factors into account such as intrahospital movements of patients and healthcare personnel, hospitalization of patients in the same ward and in chronologically compatible periods, and length of stay. A. baumannii clinical samples were typed using the Multilocus Sequence Typing scheme. RESULTS: The outbreak originated from a patient admitted to the sub-intensive care unit, and the infection subsequently spread to other wards. The allelic profile proved to be the same for all the clinical isolates. Environmental monitoring yielded negative results for A. baumannii. CONCLUSIONS: The results suggest that this epidemic spread through cross-transmission involving healthcare workers.
Assuntos
Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/transmissão , Acinetobacter baumannii/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Surtos de Doenças , Farmacorresistência Bacteriana Múltipla , Acinetobacter baumannii/genética , Microbiologia Ambiental , Feminino , Humanos , Unidades de Terapia Intensiva , Itália/epidemiologia , Masculino , Tipagem de Sequências Multilocus , Transferência de Pacientes , Estudos Retrospectivos , Adulto JovemRESUMO
An experimental study was conducted in a hospital in Liguria (northern Italy) on two groups of patients with the same disease severity who were undergoing the same type of surgery (primary hemiarthroplasty). Our aim was to assessing the results of a quality-improvement scheme implemented in the operating room. The quality-improvement protocol involved analyzing a set of parameters concerning the operating team's behavior and environmental conditions that could be attributed to the operating team itself A program of training and sanitary education was carried to rectify any improper behavior of the operating staff Two hundred and six hip-joint replacement operations (primary hip hemiarthroplasty--ICD9-CM 81.51) all conducted in the same operating room were studied: 103 patients, i.e. operations performed before the quality-improvement scheme and 103 patients, i.e. operations performed after the quality improvement scheme; all were comparable in terms of type of surgery and severity. The scheme resulted in an improvement in both behavioral and environmental parameters and an 80% reduction in the level of microbial air contamination (p < 0.001). Patient outcomes improved in terms of average postoperative hospitalization time, the occurrence and duration of fever (> 37.5 degrees C) and microbiological contamination of surgical wounds. From an economic point of view, facility efficiency increased by 28.57%, average hospitalization time decreased (p < 0.001) and a theoretical increase of Euro 1,441,373.58 a year in revenues was achieved.
Assuntos
Salas Cirúrgicas/economia , Salas Cirúrgicas/normas , Melhoria de Qualidade/economia , Antibacterianos/economia , Artroplastia de Quadril/economia , Artroplastia de Quadril/normas , Infecção Hospitalar/economia , Eficiência , Feminino , Preços Hospitalares , Humanos , Capacitação em Serviço , Itália , Tempo de Internação/economia , Masculino , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/normas , Complicações Pós-Operatórias/economiaRESUMO
Surgical site infections (SSI) account for 14% to 17% of all hospital-acquired infections and 38% of nosocomial infections in surgical patients. SSI remain a substantial cause of morbidity and death, possibly because of the larger numbers of elderly surgical patients or those with a variety of chronic and immunocompromising conditions, and emergence of antibiotic-resistant microorganisms. Factors causing surgical site infection are multifarious. Several studies have identified the main patient-related (endogenous risk factors) and procedure-related (external risk factors) factors that influence the risk of SSI. The rate of surgical wound infections is strongly influenced by operating theatre quality, too. A safe and salubrious operating theatre is an environment in which all sources of pollution and any micro-environmental alterations are kept strictly under control. This can be achieved only through careful planning, maintenance and periodic checks, as well as proper ongoing training for staff Many international scientific societies have produced guidelines regarding the environmental features of operating theatres (positive pressure, exchanges of filtered air per hour, air-conditioning systems with HEPA filters, etc.) and issued recommendations on healthcare-associated infection, including SSI, concerning surveillance methods, intervention to actively prevent SSI and approaches to monitoring the implementation of such strategies. Therefore, the prevention of SSI requires a multidisciplinary approach and the commitment of all concerned, including that of those who are responsible for the design, layout and functioning of operating theatres.
Assuntos
Controle de Infecções/métodos , Salas Cirúrgicas , Infecção da Ferida Cirúrgica/prevenção & controle , Arquitetura de Instituições de Saúde , Humanos , Fatores de Risco , Ventilação , Microbiologia da Água , Abastecimento de ÁguaRESUMO
INTRODUCTION: Tobacco smoking, which usually begins in teenage, is one of the most important lifestyle risk factors for chronic diseases and a major public health problem worldwide. The aims of the study were to determine the prevalence of tobacco smoking and the mean age of initiation among adolescents in Genoa (Italy) and to identify some socio-demographic predictors that could be associated with the onset of smoking. MATERIALS AND METHODS: 2,301 randomly selected students (14-19 years old) in Genoa completed an ad hoc questionnaire. The Kaplan-Meier method was used to evaluate the instantaneous risk of experimenting with smoking. A multivariate logistic regression model was used to determine whether current or previous smoking status was associated with socio-demographic characteristics. RESULTS: 59.5% of respondents had tried smoking, while 35.6% defined themselves as current smokers. No difference in current smoking prevalence emerged between males and females (35.2% and 35.9%, respectively, p = 0.83). The mean age on initiation was 13.5 years for males and 13.9 years for females. The instantaneous probability of trying smoking changed with age, reaching a maximum at 14 years. Subjects who tried smoking before this age were more inclined to continue smoking. The probability of being a current smoker was significantly higher among students from unmarried-parent families and those attending vocational and technical secondary schools. CONCLUSIONS: There is a great need for the activation of new health promotion interventions and enforcement of those already existing, in order to raise awareness of the damage caused by smoking among adolescents, especially those belonging to high-risk groups.
Assuntos
Fumar/epidemiologia , Adolescente , Comportamento do Adolescente , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Masculino , Prevalência , Fatores de Risco , Inquéritos e Questionários , População Urbana , Adulto JovemRESUMO
INTRODUCTION: Microbiological surveillance of endoscopes is a safety measure for verifying the quality of reprocessing procedures and identifying contaminated devices, but duodenoscope-related outbreaks are still reported. AIM: To assess the effectiveness of duodenoscope reprocessing procedures in Italy. METHODS: Between December 2019 and April 2020, data obtained from microbiological surveillance post-reprocessing in 15 Italian endoscopy units were collected. Sampling was carried out after reprocessing or during storage in a cabinet. In keeping with international guidelines and the Italian position paper, the micro-organisms were classified as high-concern organisms (HCOs) and low-concern organisms (LCOs). FINDINGS: In total, 144 samples were collected from 51 duodenoscopes. Of these, 36.81% were contaminated: 22.92% were contaminated with HCOs and 13.89% were contaminated with LCOs [2.08% with an LCO load of 11-100 colony-forming units (CFU)/device and 0.69% with an LCO load of >100 CFU/device]. The contamination rate was 27.5% in samples collected after reprocessing, 40% in samples collected during storage in a cabinet that was compliant with EN 16442:2015 (C-I), and 100% in samples collected during storage in a cabinet that was not compliant with EN 16442:2015 (NC-I). The respective HCO rates were 15.00%, 27.27% and 66.67%. Correlation between LCO contamination and storage time was demonstrated (Spearman's rho=0.3701; P=0.0026). The Olympus duodenoscope TJFQ180V demonstrated the lowest rate of contamination (29.82%), although the contamination rate was 100% for duodenoscopes stored in an NC-I cabinet. CONCLUSION: Microbiological surveillance, along with strict adherence to reprocessing protocols, may help to detect endoscope contamination at an early stage, and reduce the risk of duodenoscope-associated infections.
Assuntos
Desinfecção , Contaminação de Equipamentos , Humanos , Desinfecção/métodos , Endoscópios , Duodenoscópios/microbiologia , Endoscopia GastrointestinalRESUMO
Mercury toxicity is a highly interesting topic in biomedicine due to the severe endpoints and treatment limitations. Selenite serves as an antagonist of mercury toxicity, but the molecular mechanism of detoxification is not clear. Inhibition of the selenoenzyme thioredoxin reductase (TrxR) is a suggested mechanism of toxicity. Here, we demonstrated enhanced inhibition of activity by inorganic and organic mercury compounds in NADPH-reduced TrxR, consistent with binding of mercury also to the active site selenolthiol. On treatment with 5 µM selenite and NADPH, TrxR inactivated by HgCl(2) displayed almost full recovery of activity. Structural analysis indicated that mercury was complexed with TrxR, but enzyme-generated selenide removed mercury as mercury selenide, regenerating the active site selenocysteine and cysteine residues required for activity. The antagonistic effects on TrxR inhibition were extended to endogenous antioxidants, such as GSH, and clinically used exogenous chelating agents BAL, DMPS, DMSA, and α-lipoic acid. Consistent with the in vitro results, recovery of TrxR activity and cell viability by selenite was observed in HgCl(2)-treated HEK 293 cells. These results stress the role of TrxR as a target of mercurials and provide the mechanism of selenite as a detoxification agent for mercury poisoning.
Assuntos
Quelantes/farmacologia , Mercúrio/farmacologia , Selenito de Sódio/farmacologia , Tiorredoxina Dissulfeto Redutase/metabolismo , Animais , Biocatálise/efeitos dos fármacos , Domínio Catalítico , Sobrevivência Celular/efeitos dos fármacos , Quelantes/química , Cisteína/metabolismo , Relação Dose-Resposta a Droga , Ativação Enzimática/efeitos dos fármacos , Glutationa/farmacologia , Células HEK293 , Humanos , Cloreto de Mercúrio/antagonistas & inibidores , Cloreto de Mercúrio/metabolismo , Cloreto de Mercúrio/farmacologia , Mercúrio/antagonistas & inibidores , Mercúrio/metabolismo , Compostos de Mercúrio/metabolismo , Intoxicação por Mercúrio/prevenção & controle , Compostos de Metilmercúrio/antagonistas & inibidores , Compostos de Metilmercúrio/metabolismo , Compostos de Metilmercúrio/farmacologia , Estrutura Molecular , NADP/farmacologia , Ratos , Proteínas Recombinantes/antagonistas & inibidores , Proteínas Recombinantes/metabolismo , Compostos de Selênio/metabolismo , Selenocisteína/metabolismo , Selenito de Sódio/metabolismo , Espectrometria de Massas por Ionização por Electrospray , Tiorredoxina Dissulfeto Redutase/antagonistas & inibidores , Tiorredoxina Dissulfeto Redutase/genéticaRESUMO
In Italy, more than 3 million people annually sustain a domestic injury; the elderly experience it the most. From a healthcare perspective, elderly falls are a major clinical issue with an outgrowing socioeconomic burden. The aim of the study was to evaluate the epidemiology of injurious falls in a community dwelling population, admitted to the emergency room (ER) because of a domestic injury, to assess the socioeconomic burden. Seventy-four hospitalized patients among 227 were examined. Falls represented the main cause of admittance to the ER; the average cost for fall-related hospitalization was of 5479.09.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/economia , Acidentes por Quedas/economia , Acidentes por Quedas/mortalidade , Acidentes Domésticos/economia , Acidentes Domésticos/mortalidade , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Grupos Diagnósticos Relacionados/economia , Feminino , Idoso Fragilizado/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Humanos , Itália/epidemiologia , MasculinoRESUMO
INTRODUCTION: Recent discoveries in cell therapy research present new opportunities for cellular products to be used to treat severe, and as yet incurable, diseases. It is therefore essential to implement a quality control programme in order to ensure that safe cells and tissues are provided. METHODS: In a preliminary phase of the setting up of a the cellfactory, monitoring was carried out monthly over a 6-month period in one out of three cell therapy laboratories and filter rooms in order to evaluate the microbial contamination of air and surfaces and the presence of airborne particulates. RESULTS: The mean total bacterial and fungal loads measured in the air in the centre of the filter room were 20.7 +/1 28.9 colony-forming units (cfu)/m3 and 9.2 +/- 15.4 cfu/m3, respectively, and 5.2 +/- 4.1 cfu/m3 and 6.8 +/- 13.4 cfu/m3, respectively, in the laboratory. The mean fungal load values recorded on the surfaces sampled in the laboratory were in 6 out of 18 cases higher than the reference values (5 cfu/plate). As to the results of particulate monitoring, with regard to the 0.5 microm particles, about 83% of the samples revealed values below the limit of 350.000 particles per cubic metre. CONCLUSIONS: In this set-up phase, monitoring was able to pick out structural and organisational flaws acceptable in a laboratory compliant with Good Manufacturing Practices class C (Annex 1), but not in a class B facility. Thanks to this preliminary monitoring phase, and by correcting these flaws, the clean room facility could achieve compliance to class B.
Assuntos
Microbiologia do Ar , Bancos de Espécimes Biológicos/normas , Terapia Baseada em Transplante de Células e Tecidos , Monitoramento Ambiental/métodos , Células Cultivadas , Ambiente Controlado , Humanos , Tamanho da Partícula , Controle de QualidadeRESUMO
INTRODUCTION: In dentistry, as in surgery, there is a risk of cross-infection for both patients and staff The aim of this research was to evaluate procedures and behaviors enacted by dental staff which might engender a risk for themselves and their patients. METHODS: A questionnaire was administered to 106 dental workers in Genoa (Italy), both public and private. Whenever personal interviews were conducted, the facilities involved were also inspected and the activities of the dental staff were observed directly. RESULTS: This research highlighted some critical points in both structural and organizational features and in the management of infective hazards in the sample considered. In some cases, inadequacies were noted with regard to the prevention of cross-infections, such as the lack of disinfection of work surfaces and the handles of chair-set accessories. DISCUSSION AND CONCLUSIONS: The particular nature of dental work, in which aerosols of blood and saliva may be produced by rotating instruments, engenders a risk of infection. Application of the various preventive measures available can significantly reduce microbial contamination and the risk of occupational infection and cross-infections. Furthermore, improvement in the structural and organizational features of dental surgeries and the continuing education of health-care workers is indispensable to the control and prevention of infectious diseases.
Assuntos
Infecção Hospitalar/prevenção & controle , Odontologia/organização & administração , Odontólogos/organização & administração , Controle de Infecções Dentárias/métodos , Padrões de Prática Odontológica/organização & administração , Adulto , Competência Clínica , Odontologia/estatística & dados numéricos , Odontólogos/estatística & dados numéricos , Desinfecção/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Itália , Pessoa de Meia-Idade , Saúde Ocupacional , Assistência ao Paciente , Projetos Piloto , Padrões de Prática Odontológica/estatística & dados numéricos , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
This study aimed to quantify the blood content of aerosols produced during dental, maxillofacial and autopsy procedures and to identify those activities which involve the greatest risk of infection due to exposure to blood-containing aerosols. A total of 132 air samples were taken in several dental cubicles, a maxillofacial operating theatre and an autopsy room. The concentration of haemoglobin (Hb) in the samples was quantified and, for each day of sampling, the concentration of blood/m(3) of air aspirated (muL blood/m(3) air) was calculated. Hb was detected in 38.64% of samples. The mean concentration of Hb in the samples was 0.10+/-0.19 microg Hb/m(3) of aspirated air, with a range of 0-0.72 microg Hb/m(3). No statistically significant differences in the concentration of blood aerosol per m(3) of aspirated air were noted among the three types of activity analysed (P>0.05). Although there is, as yet, no concrete proof of the risk of infection through blood-containing aerosols, minimising the production and dispersal of aerosols and spatters is strongly recommended.