Water safety in healthcare facilities. The Vieste Charter.

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.

An unusually long-lasting outbreak of community-acquired Legionnaires' disease, 2005-2008, Italy.

An unusually long-lasting community-acquired outbreak of Legionnaires' disease (LD) occurred in the inhabitants of a town in northern Italy from 2005 to 2008. Overall, 43 cases were diagnosed including five deaths. Hundreds of water samples were collected for Legionella isolation but only two clinical samples were obtained. Clinical strains were ST23 as were environmental isolates detected in most Legionella-positive patients' homes and those from a public fountain. Although no Legionella was found in the municipal water mains, a continuous chlorination was applied in 2008. This action resulted in a halving of cases, although incidence remained tenfold higher than the Italian average incidence until the end of 2013, when it dropped to the expected rate. Retrospective analyses of prevalent wind direction suggested that a hidden cooling tower could have been the main cause of this uncommon outbreak, highlighting the importance of implementation of cooling tower registers in supporting LD investigations.

Interlaboratory trial on the analysis of alkylphenols, alkylphenol ethoxylates, and bisphenol A in water samples according to ISO/CD 18857-2.

ISO/CD 18857-2 (International Organization for Standardization, Geneva) describes a new international standard method for the determination of octylphenol, nonylphenol, their mono- and diethyoxylates, and bisphenol A in nonfiltered samples of drinking, ground, surface, and wastewater. The method is based on the extraction of the analytes from an acidified water sample by solid phase extraction, solvent elution, derivatization, and determination by gas chromatography with mass spectrometric detection. For validation of this method, 14 laboratories from 4 different countries in Europe and Canada participated in an interlaboratory trial to determine the performance characteristics of the method, which are intended for publication in the corresponding standard. The interlaboratory trial was evaluated according to ISO 5725-2 and included two duplicate nonfiltered water samples: surface water containing the target compounds in an analyte concentration range from 0.05 to 0.4 microg/L and wastewater containing the target compounds in a concentration ranged from 0.1 to 5 microg/L. The repeatability variation coefficients (within-laboratory precision) varied for all samples and compounds between 1.9 and 7.8%, showing a sufficiently high repeatability of the method. The reproducibility variation coefficients (between-laboratory precision) were found to vary within a satisfactory range of 10.0-29.5% for surface water and 10.8-22.5% for wastewater. The recoveries as a measure of accuracy varied from 98.0 to 144.1% for surface water and from 95.4 to 108.6% for wastewater. The determined concentrations of the samples compared well to the "true" values, thus showing very satisfactory accuracy of the method. In the chromatogram of the surface water sample, a high unresolved background made up of coextractable matrix compounds was apparent. It is conceivable that compounds from this background may be responsible for enhanced recoveries of 144.1% for 4-nonylphenol (mixture of isomers) and of 123.4% for 4-nonylphenol monoethoxylate (mixture of isomers) in the surface water samples. The isotope-marked standard compounds developed in this context proved to be reliable internal standards that allow a precise and accurate quantitation of all compounds specified in ISO/CD 18857-2. The results of the interlaboratory trial confirmed that the analytical method is robust and reliable and can be used as a standard method to analyze the target compounds in water samples.

Genotoxicity of the disinfection by-products resulting from peracetic acid- or hypochlorite-disinfected sewage wastewater.

Wastewater disinfection is routinely carried out to prevent the spread of human pathogens present in wastewater effluents. To this aim, chemical and physical treatments are applied to the effluents before their emission in water bodies. In this study, the influence of two widely used disinfectants, peracetic acid (PAA) and sodium hypochlorite (NaClO), on the formation of mutagenic by-products was investigated. Wastewater samples were collected before and after disinfection, in winter and in summer, at a pilot plant installed in a municipal wastewater-treatment plant. Samples were adsorbed using silica C18 cartridges and the concentrates were tested for mutagenicity in the Salmonella typhimurium reversion test with strains TA98 and TA100. Non-concentrated water samples were tested with two plant genotoxicity assays (the Allium cepa root anaphase aberration test and the Tradescantia/micronucleus test). Mutagenicity assays in bacteria and in Tradescantia showed borderline mutagenicity in some of the wastewater samples, independent of the disinfection procedure applied. Negative results were obtained in the A. cepa anaphase aberration test. These results indicate that, in the conditions applied, wastewater disinfection with PAA and NaClO does not lead to the formation of significant amounts of genotoxic by-products.

Peracetic acid and sodium hypochlorite effectiveness in reducing resistant stages of microorganisms.

A comparative study on the efficacy of peracetic acid and sodium hypochlorite in inactivating resistant stages of microorganisms such as Cryptosporidium, Giardia and Cl. perfingens was carried out. Furthermore the evaluation of the potential reciprocal correlation among the concentrations of the organisms was performed. The results obtained indicate that, at the same experimental conditions, peracetic acid and sodium hypochlorite have nearly similar reduction power against the resistant stages of Giardia and Cl. perfringens. Both the oxidants are instead less efficient in the abatement of Cryptosporidium oocysts. Findings have also confirmed our previous studies on the absence of association between Clostridium and the protozoa.

Mapping elements distribution in carapace of Caretta caretta: A strategy for biomonitoring contamination in sea turtles?

This study analyzed the carapace distribution of Ca, Cd, Cr, Cu, Mg, Mn, Pb, Sb, U, V and Zn by GF-AAS and ICP-AES in one specimen of Caretta caretta from Mediterranean Sea. Calcium, Mg, Mn, Pb, U, Zn were mainly distributed in the central area while Cd, Cr, Cu, Sb, V in lateral areas. Cadmium, Cr, Mg, Mn, Sb, U and V were different between lateral areas. The different distribution may be related to several exposures during lifetime and/or the shell ossification during growth. Carapace may be a suitable matrix for metal biomonitoring, however, further studies are required to confirm these findings.

Pilot-plant comparative study of peracetic acid and sodium hypochlorite wastewater disinfection.

Peracetic acid (PAA) use in wastewater disinfection was assessed by examining its performances in a pilot plant fed by the effluent from a conventional activated-sludge treatment plant. The influence of PAA initial concentrations (0.5-4.0 mg/l) and contact times (8-38 min) on the presence of seven microorganisms (total coliforms, fecal coliforms, fecal streptococci, Escherichia coli, Pseudomonas sp., Salmonella sp., and bacteriophages anti-E. coli) and on residual biocide and halogenated organic compound (AOXs) concentrations were evaluated. The data so obtained were compared to the corresponding results acquired using sodium hypochlorite (HYP) in the same experimental conditions. The biocide effect of PAA against total and fecal coliforms, E. coli, Pseudomonas sp. and Salmonella sp. was similar to that shown by HYP. The former disinfectant was, however, less efficient than the latter in the reduction of fecal streptococci and bacteriophages anti-E. coli. In both cases the biocide quantities initially introduced in the sewage resulted in the presence of significant concentrations at the end of the contact time. No significant variation of AOX content was detected in the effluent treated with PAA, whereas a progressive increment of such compounds was found when increasing quantities of HYP were added to the sewage.

Elements in Wastewater for Agricultural Use

With the increase in the application of wastewaters for agricultural purposes, the determination of the concentrations of some elements that can be found in such waters and their temporal behavior are of great interest. In this work, treated and untreated sewage samples were analyzed to determine the concentrations of Al, Ca, Cd, Cr, Cu, Fe, K, Mg, Na, Ni, Pb, and Zn. Ca, Mg, and Na concentrations were determined to estimate the sodium adsorbed ratio index. Total residue and setteable solids volume in every samples were also determined. With a view to understanding the effects of rainwater on such parameters and on treatment plant process efficiency, rain data for the period of observations were also collected. Analyses were conducted by atomic absorption spectrophotometry. A Perkin-Elmer Model 460 with a nebulizer-flame system and a Perkin-Elmer Model 5000 with an HGA graphite furnace were used to perform analyses. Principal components analysis was performed to simplify the description of the above 13 parameters and gain a better understanding of their interrelationships. Preliminary results showed that rainwater's impact on the concentrations of the investigated elements cannot be considered as simple dilution. Each parameter follows its own evolution; there is no correlation between treated and untreated sewage.

Reduction of microorganisms in sewage effluent using hypochlorite and peracetic acid as disinfectants.

A comparative study on peracetic acid and sodium hypochlorite in inactivating bacteria and viruses was carried out. Therefore the disinfection actions of peracetic acid, in comparison with sodium hypochlorite, was evaluated against the usual indicators of faecal contamination, the pathogen Salmonella, Pseudomonas spp., bacteriophages anti-Escherichia coli, F+/phage and the phage of Bactericides fragilis B40-8 and enteroviruses. Under the experimental conditions, no representative results were obtained for enteroviruses and phages because of their low concentration in the sewage effluent. On the other hand, the indicator organisms were reduced substantially by the sodium hypochlorite and peracetic acid concentrations, while more variable results were obtained against Pseudomonas and bacteriophages anti-Escherichia coli.

[Hygienic aspects of the Tiber river: presence of pathogenic protozoa and correlation with microbiological and physico-chemical parameters]. / Aspetti igienico-sanitari delle acque del flume Tevere: presenza di protozoi patogeni e rapporti di correlazione con parametri microbiologici e chimico-fisici.

An investigation on the hygienic quality of the Tiber river was conducted with the aim both to enumerate Giardia cysts and Cryptosporidium oocysts in the water and to determine possible correlations between them and bacterial indicators, pathogens and physico-chemical parameters. A low hygienic water quality was evidenced, with high counts of microorganisms. Furthermore, variable concentrations of Giardia and Cryptosporidium were observed. No correlation was found between the protozoa concentrations and that of the other microorganisms, whilst a significant correlation with redox potential and Giardia cysts was calculated.

[Genotoxic and ecotoxic effects of urban waste water disinfected with sodium hypochlorite or peracetic acid]. / Effetti genotossici ed ecotossicologici di acque reflue urbane sottoposte a disinfezione con ipoclorito di sodio o acido peracetico.

Genotoxic and ecotoxicologic effects of urban wastewater disinfected with sodium hypochlorite or peracetic acid were analyzed. The formation of genotoxic species was studied by determining clastogenic and mutagenic activity of aqueous samples and their extracts with in vivo and in vitro tests, respectively. In particular, we have applied citogenetic tests to Allium cepa roots and Tradescantia inflorescence (Allium cepa test and Tradescantia/micronuclei test) and reversion test to Salmonella typhimurium according to the microsuspension procedure (Kado test). The latter is the method of choice for the analysis of complex matrices due to its high sensitivity and specificity. The mutagenic activity of disinfected effluents was similar to the corresponding untreated wastewater both sampled in four different periods. Therefore, the disinfection process did not seem to contribute to aquatic mutagenicity in the examined range of biocide concentration. The potential toxicity of disinfected wastewater for aquatic organisms was evaluated using Daphnia magna. The acute toxicity of peracetic acid in sewage was 0.4 mg/L (24 h E(L)C50). By comparing this value with peracetic acid concentrations detected in effluents from a pilot plant it is expected that treated wastewater would show acute toxic effects on aquatic organisms. Dissociation compounds (hydrogen peroxide and acetic acid) and possible by-products of peracetic acid did not seem to contribute significantly to the toxicity of sewage treated with peracetic acid.

Distribution of chlorinated organic pollutants in harbor sediments of Livorno (Italy): a multivariate approach to evaluate dredging sediments.

Dredging is a very important procedure for harbor management. In Italy the guidelines for the offshore dumping of dredged materials are issued by the Ministry of Environment. They described a few steps of dredging activities, such as the sampling strategy, but do not deal with limits or guide-values for the chemical, physical and biological composition of the resulting sediments. The quality of dredged materials is mainly dependent on the presence of inorganic and organic pollutants. In particular, polychlorinated biphenyls (PCBs) and organo-chlorinated pesticides are seen as a high priority in marine environment by international organizations because of their persistence, toxicity and bioaccumulation capacity. In this article the presence of some PCBs and organo-chlorinated pesticides in sediment samples collected from the harbor of Livorno (Northern Tyrrhenian Sea) was investigated. The concentration of HCHs, Aldrin, Chlordanes, DDEs, DDTs, and PCBs in 12 representative sites ranged between <1 microg kg(-1) and 95, 19, 32, 35, 107, and 111 microg kg(-1), respectively. The application of univariate and multivariate statistical techniques, such as linear regression analysis and principal component analysis, to the experimental data showed a different distribution of PCBs in the two sediment layers. On the contrary, the vertical distribution of the other investigated pollutants was more homogeneous and affected by random variability. The multivariate approach was an important tool to establish more rational criteria for the management of dredged materials.