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Gund MP, Naim J, Rupf S, Gärtner B, Hannig M. Bacterial contamination potential of personal protective equipment itself in dental aerosol-producing treatments. Odontology 2024; 112:309-316. [PMID: 37702832 PMCID: PMC10925564 DOI: 10.1007/s10266-023-00848-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
Personal protective equipment (PPE) has long been a high priority in dental aerosol-producing treatments. Since COVID-19 pandemic, its importance has increased yet again. While importance of PPE in preventing transmission and thus possible infection of pathogens is well known, contamination potential of PPE after treatment itself is less investigated. This review aims to give an overview of the current literature and contamination potential (viral, blood, bacterial) of components of protective equipment itself. The literature search was performed using the Medline database; furthermore, a hand search was conducted. Last search took place on 23 November 2022. Two categories of hygiene-related keywords were formed (category A: mask, face shield, goggles, eyewear, personal protective equipment; category B: contamination, aerosol). Each keyword from one category was combined with all keywords from the other one. In addition, the keyword "dental" was always added. First, a title and abstract screening was performed. Afterward, a full-text analysis was followed for the included studies. A total of 648 search hits were found in the Medline database. 47 were included after title and abstract screening. 22 studies were excluded after full-text analysis, 25 studies were included. The hand search resulted in 4 studies that were included. Bacterial contamination of PPE after treatment has been adequately studied, contamination with blood less. Microorganisms mainly originate from the oral and cutaneous flora; however, a transmission of potential pathogens like Staphylococcus aureus or Escherichia coli was also described. Studies showing transmission pathways starting from PPE and its various components are lacking. No measures have yet been described that fully protect the protective equipment from contamination. There is growing awareness that PPE itself can be a source of pathogen transmission, and thus possible infection. Therefore, not only wearing of protective clothing, but also conscious handling of it is crucial for transmission and possible infection prevention. However, studies showing transmission pathways starting from PPE and its various components are lacking. Several studies have investigated what measures can be taken to protect the protective equipment itself. So far, none of the methods evaluated can prevent contamination of PPE.
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Affiliation(s)
- Madline Priska Gund
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany.
| | - Jusef Naim
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany
| | - Stefan Rupf
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany
- Chair of Synoptic Dentistry, Homburg, Germany
| | - Barbara Gärtner
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Matthias Hannig
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany
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Marcotrigiano V, Stingi GD, Nugnes PT, Mancano S, Lagreca VM, Tarricone T, Salerno G, Pasquale P, Marchet P, Sava GA, Citiulo A, Tissi M, Oliva S, Cinquetti S, Napoli C. Collective Catering Activities and Official Controls: Dietary Promotion, Sustainability and Future Perspectives. Healthcare (Basel) 2023; 11:healthcare11091347. [PMID: 37174889 PMCID: PMC10178468 DOI: 10.3390/healthcare11091347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Ensuring safe meals with suitable hygienic-sanitary and nutritional features is an essential requirement to guarantee health in different settings. This study aims to evaluate the compliance of collective catering menus adopted in both school canteens and healthcare facilities in a regional area where specific guidelines have been issued, assessing many matters from food weight to single courses and from the use of wholegrain pasta and bread to the rotation of seasonal fruit and vegetables. Overall, 85 menus, edited by freelance professionals and endorsed by the Food Hygiene and Nutrition Service staff of the Local Health Authority, were assessed from 2018 to 2022, highlighting critical issues potentially attributable at a local level to the lack of complete knowledge of the existence of guidelines and official reference documents among nutrition professionals. Since the preliminary outcomes show non-compliance in both sectors investigated, it is essential to continue to strengthen the role of prevention departments entrusted with services dedicated to food and nutritional safety and promote joint official controls performed by healthcare workers and other professionals with different backgrounds in order to ensure safe food for the target population that use collective catering services. In school canteens and healthcare facilities, providing and administering food is an opportunity to promote health through a balanced diet and safe food and offers opportunities for the development of community well-being and the local economy in a sustainable manner, understood in economic, environmental and social terms.
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Affiliation(s)
- Vincenzo Marcotrigiano
- Prevention Department, Local Health Authority BT, Barletta-Andria-Trani, 76125 Trani, Italy
| | | | - Prudenza Tiziana Nugnes
- Food Hygiene and Nutrition Service, Prevention Department, Local Health Authority BT, Barletta-Andria-Trani, 76125 Trani, Italy
| | - Sabrina Mancano
- Food Hygiene and Nutrition Service, Prevention Department, Local Health Authority BT, Barletta-Andria-Trani, 76125 Trani, Italy
| | - Vita Maria Lagreca
- Food Hygiene and Nutrition Service, Prevention Department, Local Health Authority BT, Barletta-Andria-Trani, 76125 Trani, Italy
| | - Teresa Tarricone
- Food Hygiene and Nutrition Service, Prevention Department, Local Health Authority BT, Barletta-Andria-Trani, 76125 Trani, Italy
| | - Gerardo Salerno
- Department of Neurosciences, Mental Health and Sensory Organs "NESMOS", Sapienza University of Rome, 00189 Rome, Italy
| | - Pietro Pasquale
- Apulia Region, Health and Wellness Promotion Section, Food Hygiene and Preventive Nutrition Organizational Structure, 70126 Bari, Italy
| | - Paola Marchet
- Prevention Department, Local Health Authority "AULSS 1 Dolomiti", 32100 Belluno, Italy
| | - Giovanni Andrea Sava
- Food Hygiene and Nutrition Service, Prevention Department, Local Health Authority "AULSS 1 Dolomiti", 32100 Belluno, Italy
| | - Alessandro Citiulo
- Food Hygiene and Nutrition Service, Prevention Department, Local Health Authority "AULSS 1 Dolomiti", 32100 Belluno, Italy
| | - Monica Tissi
- Food Hygiene and Nutrition Service, Prevention Department, Local Health Authority "AULSS 1 Dolomiti", 32100 Belluno, Italy
| | - Stefania Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Sandro Cinquetti
- Prevention Department, Local Health Authority "AULSS 1 Dolomiti", 32100 Belluno, Italy
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
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Dionisi S, Giannetta N, Liquori G, De Leo A, D’Inzeo V, Orsi GB, Di Muzio M, Napoli C, Di Simone E. Medication Errors in Intensive Care Units: An Umbrella Review of Control Measures. Healthcare (Basel) 2022; 10:healthcare10071221. [PMID: 35885748 PMCID: PMC9320368 DOI: 10.3390/healthcare10071221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/11/2022] [Accepted: 06/22/2022] [Indexed: 11/20/2022] Open
Abstract
Medication errors are defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.” Such errors account for 30 to 50 percent of all errors in health care. The literature is replete with systematic reviews of medication errors, with a considerable number of studies focusing on systems and strategies to prevent errors in intensive care units, where these errors occur more frequently; however, to date, there appears to be no study that encapsulates and analyzes the various strategies. The aim of this study is to identify the main strategies and interventions for preventing medication errors in intensive care units through an umbrella review. The search was conducted on the following databases: PubMed, CINAHL, PsycInfo, Embase, and Scopus; it was completed in November 2020. Seven systematic reviews were included in this review, with a total of 47 studies selected. All reviews aimed to evaluate the effectiveness of a single intervention or a combination of interventions and strategies to prevent and reduce medication errors. Analysis of the results that emerged identified two macro-areas for the prevention of medication errors: systems and processes. In addition, the findings highlight the importance of adopting an integrated system of interventions in order to protect the system from harm and contain the negative consequences of errors.
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Affiliation(s)
- Sara Dionisi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy; (S.D.); (G.L.); (A.D.L.)
| | - Noemi Giannetta
- School of Nursing, UniCamillus—Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy;
| | - Gloria Liquori
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy; (S.D.); (G.L.); (A.D.L.)
| | - Aurora De Leo
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy; (S.D.); (G.L.); (A.D.L.)
- Nursing, Technical, Rehabilitation, Assistance and Research Direction, IRCCS Istituti Fisioterapici Ospedalieri—IFO, 00144 Rome, Italy;
| | - Victoria D’Inzeo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (V.D.); (M.D.M.)
| | - Giovanni Battista Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy;
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (V.D.); (M.D.M.)
| | - Christian Napoli
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
| | - Emanuele Di Simone
- Nursing, Technical, Rehabilitation, Assistance and Research Direction, IRCCS Istituti Fisioterapici Ospedalieri—IFO, 00144 Rome, Italy;
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From Survey Results to a Decision-Making Matrix for Strategic Planning in Healthcare: The Case of Clinical Pathways. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137806. [PMID: 35805466 PMCID: PMC9265412 DOI: 10.3390/ijerph19137806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 01/25/2023]
Abstract
Background: It is a well-known fact that the information obtained from a survey can be used in a healthcare organizational analysis; however, it is very difficult to compare the different results found in the literature to each other, even through the use of metanalysis, as the methodology is often not consistent. Methods: Data from a survey analyzing the organizational and managerial responses adopted in pathology-specific clinical pathways (CPs) during the first two waves of the COVID-19 pandemic were used for constructing a decisional matrix, a tool called SPRIS system, consisting of four different sheets. The first sheet reports the results of the survey and, using a streetlight color system, identifies strengths and weaknesses; the second one, by assigning a priority score, establishes the priority of intervention on each of the strengths and weaknesses identified; the third sheet reports the subjective items of the questionnaire in order to identify threats and opportunities and their probability of happening; in the last sheet, a SWOT Analysis is used to calculate the performance index of the whole organization. Results: The SPRIS system, applied to data concerning the adaptation of four CPs to the COVID-19 pandemic, showed that, whereas all the CPs had a good performance index, some concerns remained unsolved and need be addressed. Conclusions: The SPRIS system showed to be an easily constructed tool that is able to give an overview of the organization analyzed by the survey and to produce an index that can be used in a direct quality comparison between different services or organizations.
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Gallè F, Sabella EA, Di Muzio M, Barchielli B, Da Molin G, Ferracuti S, Liguori G, Orsi GB, Napoli C. Capturing the Features of Physical Activity in Old Adults during the COVID-19 Pandemic: Results of an Italian Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116868. [PMID: 35682451 PMCID: PMC9180786 DOI: 10.3390/ijerph19116868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 12/24/2022]
Abstract
The restriction measures adopted to control the COVID-19 pandemic had significant consequences on individuals’ lifestyles. This study is aimed at assessing the amount and type of habitual physical activity (PA) in older adults during the advanced phase of the pandemic and their possible relationships with sociodemographic aspects. A questionnaire that included sociodemographic characteristics and the Physical Activity Scale for the Elderly (PASE) was administered online to elderly subjects living in the Apulia region, South Italy. A sample of 939 participants (57.1% F; mean age 75.9 ± 6.3) was obtained. In total, 68.8% of female respondents reported a decrease in PA during the pandemic, while 55.1% of men maintained their previous levels (<0.001). The total PASE score did not differ between gender groups (median value 91.7 in males vs. 90.0 in females; p = 0.067). However, differences were registered in leisure activities, particularly regarding walking (23.8 ± 14.8 in males vs. 20.2 ± 14.6 in females; p = 0.001). Higher PA levels were related with lower age (OR 0.253; 95% CI 0.192−0.333; p = 0.001). Since inactivity can affect elderly health and wellbeing, and considering the impact of the COVID-19 lockdown on this habit, health promotion strategies to counteract the negative effects of the pandemic should include interventions aimed at increasing PA in this sub-group of the population, especially among women and elderly subjects.
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Affiliation(s)
- Francesca Gallè
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, Via Medina 40, 80133 Naples, Italy;
- Correspondence:
| | - Elita Anna Sabella
- Inter-University Research Centre “Population, Environment and Health”, University of Bari Aldo Moro, Piazza Cesare Battisti 1, 70121 Bari, Italy; (E.A.S.); (G.D.M.)
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa, 1015, 00189 Rome, Italy;
| | - Benedetta Barchielli
- Department of Dynamic, Clinical Psychology and Health, “Sapienza” University of Rome, Via degli Apuli 1, 00185 Rome, Italy;
| | - Giovanna Da Molin
- Inter-University Research Centre “Population, Environment and Health”, University of Bari Aldo Moro, Piazza Cesare Battisti 1, 70121 Bari, Italy; (E.A.S.); (G.D.M.)
| | - Stefano Ferracuti
- Department of Human Neurosciences, “Sapienza” University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, Via Medina 40, 80133 Naples, Italy;
| | - Giovanni Battista Orsi
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy;
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Tzoutzas I, Karoussis I, Maltezou HC. Air Quality in Dental Care Facilities: Update to Current Management and Control Strategies Implementing New Technologies: A Comprehensive Review. Vaccines (Basel) 2022; 10:847. [PMID: 35746455 PMCID: PMC9227829 DOI: 10.3390/vaccines10060847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
The quality of indoor air in healthcare facilities, with an emphasis on dental offices, attracted the attention of the scientific community in the late 1960s. Since then, it has become evident that the indoor air quality is critical in modern dental care facilities for limiting the spread of airborne infections, including vaccine-preventable diseases, and a key component of safety for healthcare personnel and patients. In the past decades, the role of indoor air quality has also been recognized in non-healthcare facilities, given the increasing time spent indoors by humans. During the provision of dental care services, mainly in the field of restorative dentistry, high-speed dental handpieces emitting air and water are used, producing large quantities of aerosol and hovering inside the operations area. In modern dental offices, new devices emitting air/powder for cavities improvement and cleaning as well as for periodontal prophylactic cleaning and aesthetics are used. In addition, a new therapeutic protocol for the removal of bacterial biofilm, targeting treatment for peri-implant diseases and conditions using air-abrasive decontamination technology, has been introduced in daily dental practice. The aim of this non-systemic review is to present the current state of knowledge on the nature and dynamics of air splatters and to provide an update to management and control strategies in dental care facilities, focusing on air purification and ultraviolet devices proposed and used. The findings arising from the limited number of related published articles documenting the reduction in levels of particular matter 2.5 (PM2.5), PM10 and volatile organic compounds, allow us to conclude that the continuous operation of air purifiers during and after treatment, contributes considerably to the improvement of the indoor air quality in dental care facilities. Moreover, the utilization of air purifiers is highly recommended in dental practice to mitigate spread of infections, including vaccine-preventable diseases. Frequent cleaning and maintenance of the purifier sieves and filters and frequent renovation of the indoor air through physical ventilation by mean of open windows is imperative. More research on environmental contamination and particularly on viral contamination under real dental care conditions is needed.
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Affiliation(s)
- Ioannis Tzoutzas
- School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (I.T.); (I.K.)
| | - Ioannis Karoussis
- School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (I.T.); (I.K.)
| | - Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 15123 Athens, Greece
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Caggiano G, Lopuzzo M, Spagnuolo V, Diella G, Triggiano F, D’Ambrosio M, Trerotoli P, Marcotrigiano V, Barbuti G, Sorrenti GT, Magarelli P, Sorrenti DP, Napoli C, Montagna MT. Investigations on the Efficacy of Ozone as an Environmental Sanitizer in Large Supermarkets. Pathogens 2022; 11:pathogens11050608. [PMID: 35631128 PMCID: PMC9147425 DOI: 10.3390/pathogens11050608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
Awareness of the importance of the microbial contamination of air and surfaces has increased significantly during the COVID-19 pandemic. The aim of this study was to evaluate the presence of bacteria and fungi in the air and on surfaces within some critical areas of large supermarkets with and without an ozonation system. Surveys were conducted in four supermarkets belonging to the same commercial chain of an Apulian city in June 2021, of which two (A and B) were equipped with an ozonation system, and two (C and D) did not have any air-diffused remediation treatment. There was a statistically significant difference in the total bacterial count (TBC) and total fungal count (TFC) in the air between A/B and C/D supermarkets (p = 0.0042 and p = 0.0002, respectively). Regarding surfaces, a statistically significant difference in TBC emerged between A/B and C/D supermarkets (p = 0.0101). To the best of our knowledge, this is the first study evaluating the effect of ozone on commercial structures in Italy. Future investigations, supported by a multidisciplinary approach, will make it possible to deepen the knowledge on this method of sanitation, in light of any other epidemic/pandemic waves.
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Affiliation(s)
- Giuseppina Caggiano
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (P.T.); (M.T.M.)
- Correspondence: ; Tel.: +39-(0)-80-5478-475
| | - Marco Lopuzzo
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.L.); (V.S.); (F.T.); (M.D.); (G.B.)
| | - Valentina Spagnuolo
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.L.); (V.S.); (F.T.); (M.D.); (G.B.)
| | - Giusy Diella
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (P.T.); (M.T.M.)
| | - Francesco Triggiano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.L.); (V.S.); (F.T.); (M.D.); (G.B.)
| | - Marilena D’Ambrosio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.L.); (V.S.); (F.T.); (M.D.); (G.B.)
| | - Paolo Trerotoli
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (P.T.); (M.T.M.)
| | - Vincenzo Marcotrigiano
- Department of Prevention, Food Hygiene and Nutrition Service, Local Health Unit BT, Barletta-Andria-Trani, 76125 Trani, Italy; (V.M.); (G.T.S.); (P.M.); (D.P.S.)
| | - Giovanna Barbuti
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.L.); (V.S.); (F.T.); (M.D.); (G.B.)
| | - Giovanni Trifone Sorrenti
- Department of Prevention, Food Hygiene and Nutrition Service, Local Health Unit BT, Barletta-Andria-Trani, 76125 Trani, Italy; (V.M.); (G.T.S.); (P.M.); (D.P.S.)
| | - Pantaleo Magarelli
- Department of Prevention, Food Hygiene and Nutrition Service, Local Health Unit BT, Barletta-Andria-Trani, 76125 Trani, Italy; (V.M.); (G.T.S.); (P.M.); (D.P.S.)
| | - Domenico Pio Sorrenti
- Department of Prevention, Food Hygiene and Nutrition Service, Local Health Unit BT, Barletta-Andria-Trani, 76125 Trani, Italy; (V.M.); (G.T.S.); (P.M.); (D.P.S.)
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Maria Teresa Montagna
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (P.T.); (M.T.M.)
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Medication Adherence in Chronic Older Patients: An Italian Observational Study Using Medication Adherence Report Scale (MARS-5I). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095190. [PMID: 35564585 PMCID: PMC9100757 DOI: 10.3390/ijerph19095190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023]
Abstract
Background: the world population is aging, and the prevalence of chronic diseases is increasing. Chronic diseases affect the quality of life of patients and contribute toward increased healthcare costs if patients do not adhere to treatment. This study defines the medication adherence levels of patients with chronic diseases. Methods: an observational cross-sectional study was carried out. Patients aged 65 years and older with chronic diseases were included in this study. The medication adherence report scale was used. Results: overall, 98 patients aged 65 years and older were included. The mean age of responders was 78.65 years. Study population: 71.43% were always adherent; 9.79% often adherent; 14.89% sometimes adherent; 3.87% rarely adherent; and 1% never adherent. The internal consistency of the MARS-5I was good: Cronbach’s alfa value of 0.77. Conclusions: the MARS-5I is an effective self-report instrument to measure the medication adherence of patients. However, further studies are needed to explore factors affecting medication adherence to avoid clinical consequences for patients and high healthcare costs for healthcare facilities. Healthcare communication could be improved to ensure better transitional care.
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Impact of the COVID-19 Pandemic on Clinical Pathways for Non-SARS-CoV-2 Related Diseases in the Lazio Region, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020635. [PMID: 35055455 PMCID: PMC8776184 DOI: 10.3390/ijerph19020635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/01/2023]
Abstract
Clinical pathways (CPs) are multidisciplinary clinical governance tools necessary for the care management of the patients, whose aim is to outline the best practicable path within a health organization related to an illness or to a complex clinical situation. The COVID-19 pandemic emergency has created the need for an organizational renewal of care pathways based on the principles of “primary health care” recommended by the WHO. In Italy, the Hospitals and Local Health Authorities (ASL) have tried to guarantee the continuity of non-deferrable treatments and the maximum safety of both patients and health professionals. This study analyzes the organizational and managerial responses adopted in pathology-specific care pathways to assess how CPs as diagnostic tools responded to the COVID-19 pandemic in the first two waves. Twenty-four referents of Operational Units (UU OO) from Hospitals (AO) and Local Health Authorities (ASL) of the Lazio Region (Central Italy) that apply four different CPs responded to a survey, which analyzes the managerial and organizational responses of CPs in regard to different contexts. Results show that the structural and organizational adjustments of the CPs have made it possible to maintain an adequate level of care for specific treatment processes, with some common critical aspects that require improvement actions. The adjustments found could be useful for dealing with new outbreaks and/or new epidemics in order to try to mitigate the potential negative impact, especially on the most vulnerable patient categories.
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Marcotrigiano V, Stingi GD, Fregnan S, Magarelli P, Pasquale P, Russo S, Orsi GB, Montagna MT, Napoli C, Napoli C. An Integrated Control Plan in Primary Schools: Results of a Field Investigation on Nutritional and Hygienic Features in the Apulia Region (Southern Italy). Nutrients 2021; 13:nu13093006. [PMID: 34578882 PMCID: PMC8470469 DOI: 10.3390/nu13093006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/19/2022] Open
Abstract
Data concerning overweight and obesity in children and adolescent populations are alarming and represent one of the most serious public health problems of our time. Moreover, it is demonstrated that the school environment may play an important role in health promotion with regard to nutritional aspects. This article reports the results of a study conducted in the Apulia region (Southern Italy), aimed at providing an integrated surveillance of the behaviors related to nutrition habits in students and the hygienic and nutritional conditions of the school’s canteens attended by enrolled students. To this purpose, a sample of 501 students attending primary school (third class—children approximately eight years old) replied to a validated questionnaire, and official controls (OC), of both food and nutritional safety, were performed in 22 primary schools. A team of healthcare professionals carried out the study, and the implementation of all the prescribed improvement actions were subsequently verified through follow-up OC. The results of our study show a critical situation in the student sample, with 41.3% of children having a weight excess (overweight or obesity). With regard to the children’s behaviors, only 59.8% of children ate at least one fruit or had a fruit juice for breakfast, and 10.8% did not have breakfast at all. Overall, 40.1% of the total children played outdoors the afternoon before the survey and 45% reported going to school on foot or by bicycle. During the afternoon, 83.5% of the sample watched television or used video games/tablets/mobile phones, while 42.3% played sports. The schools had an internal canteen with on-site preparation of meals in 36.4%, the remaining 63.6% received meals from external food establishments. With regard to OC, for the hygienic–sanitary section, eleven prescriptions were issued, in the great part related to the structure and organization of the canteen. For the nutritional section, nine corrective actions were prescribed, mainly related to official documents and management. The follow-up OC showed that all prescriptions were subsequently addressed. Eating at school was less frequent among obese and overweight students compared with those with normal weight. Although this evidence needs to be further confirmed, it highlights the potential role that the school canteens may play in health promotion and prevention of nutritional disorders. On the other hand, in order to fulfill its health promotion task, the school canteens have to comply with official regulations and guidelines; therefore, OC during the management of the food service at school are needed.
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Affiliation(s)
- Vincenzo Marcotrigiano
- Food Hygiene and Nutrition Service, Local Health Unit BT, Department of Prevention, 76125 Trani, Italy; (G.D.S.); (P.M.)
- Correspondence:
| | - Giacomo Domenico Stingi
- Food Hygiene and Nutrition Service, Local Health Unit BT, Department of Prevention, 76125 Trani, Italy; (G.D.S.); (P.M.)
| | - Simona Fregnan
- Clinic for Diabetology and Endocrinology, Unique District, Local Health Unit BA, 70121 Bari, Italy;
| | - Pantaleo Magarelli
- Food Hygiene and Nutrition Service, Local Health Unit BT, Department of Prevention, 76125 Trani, Italy; (G.D.S.); (P.M.)
| | - Pietro Pasquale
- Apulia Region, Health and Wellness Promotion Section, Food Hygiene and Preventive Nutrition Organizational Structure, 70126 Bari, Italy;
| | - Samuele Russo
- Department of Computer, Control, and Management Engineering, Sapienza University of Rome, 00185 Rome, Italy; (S.R.); (C.N.)
| | - Giovanni Battista Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Christian Napoli
- Department of Computer, Control, and Management Engineering, Sapienza University of Rome, 00185 Rome, Italy; (S.R.); (C.N.)
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
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11
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Environmental Surveillance of Legionella spp. in an Italian University Hospital Results of 10 Years of Analysis. WATER 2021. [DOI: 10.3390/w13162304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The occurrence of Legionella spp. in the water distribution systems of large hospitals and other healthcare facilities is considered particularly dangerous, due to the critical nature of the hospitalized patients. The aim of this study is to present a pluri-annual environmental surveillance in a large university hospital assessing the prevalence of Legionella spp. and underlining its variability over the years. The samples of water were collected in accordance with the Italian National Guidelines and the sampling sites considered in this study were selected favoring wards with very high-risk patients and with patients at increased risk. The laboratory analyzed a total of 305 water samples deriving from 24 different sampling points. Legionella spp. were detected in 39.4% of samples, the majority of which were contaminated by Legionella pneumophila serogroups 2–14 (68.7%). Statistically significant differences were found among different seasons with a linear trend in positive proportion from summer to spring. Several experimental interventions to prevent and reduce Legionella colonization were attempted, but there is no a definitive method for the complete eradication of this microorganism. The permanent monitoring of hospital water distribution systems is fundamental to preventing the potential risk of nosocomial Legionellosis and to implementing procedures to minimize the risk of Legionella spp. colonization.
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12
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Zheng J, Ni X, Yuan W, Hou L. Nursing strategies for COVID-19 prevention and control in a selected dental clinic. Int Nurs Rev 2021; 68:189-195. [PMID: 34053076 PMCID: PMC8206999 DOI: 10.1111/inr.12652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
Aim To comprehensively introduce the prevention and control measures that we can take in dental clinics during the pandemic period of coronavirus disease 2019 (COVID‐19) and provide some practical experience for the development of nursing and health policies applicable to COVID‐19. Background The outbreak of COVID‐19 has placed the global health system under threat, which seriously influences the normal operations of human society. Safe and effective nursing measures should be taken to ensure the normal operation of dental clinics. Sources of evidence We searched and referenced many references on the PubMed database. Through the combination of related literatures and our experience, we describe various strategies, including personnel management, personal protection, disinfection and isolation, adopted in the dental clinic of our Chinese hospital during the pandemic of COVID‐19. Discussion/Conclusions We introduced strategies for the nursing staff in dental clinics to assist them with the prevention and control of COVID‐19. The successful implementation of the protective measures could ensure the safety of medical staff and patients, and contributed to the normal operation of dental clinics during the pandemic period. Conclusions for nursing and health policy During the pandemic, frontline nurses are under physical and mental pressure facing the threat of infection while at work. In addition to pandemic prevention, we should also pay attention to the needs of nursing staff. More reasonable and effective nursing and health policies should be formulated to ensure their safety and protect their rights and interests. This is the only way that the prevention and control of COVID‐19 can be achieved, and we can prepare for future public health events.
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Affiliation(s)
- Jiali Zheng
- Department of Oral and Craniomaxillofacial Surgery, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Ni
- Department of Oral and Craniomaxillofacial Surgery, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weijun Yuan
- Department of Oral and Craniomaxillofacial Surgery, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Hou
- Department of Nursing, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Taheri S, Shahabinezhad G, Torabi M, Parizi ST. Investigation of Microbial Contamination in the Clinic and Laboratory of the Prosthodontics Department of Dental School. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Veronesi L, Colucci ME, Napoli C, Castiglia P, Liguori G, Torre I, Righi E, Farruggia P, Tesauro M, Montagna MT, Gallè F, Masia MD, Di Onofrio V, Caggiano G, Tinteri C, Panico M, Pennino F, Cannova L, Pasquarella C. Air microbial contamination in dental clinics: comparison between active and passive methods. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:165-167. [PMID: 32275284 PMCID: PMC7975899 DOI: 10.23750/abm.v91i3-s.9440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/23/2022]
Abstract
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.
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15
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Zeinali T, Bozorgvar E, Habibi M, Akbari N, Barikbin B. Suction Hoses of Dental Units as a Potential Source of Microbial Contamination. Oman Med J 2020; 35:e107. [PMID: 32181009 PMCID: PMC7073387 DOI: 10.5001/omj.2020.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/02/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Dental units are necessary tools for modern dentistry. Microbial contamination of dental units is thought to be the result of biofilm formation in various parts of the unit. We aimed to identify the total microbial count in the suction hose of dental units, and detect the presence of Pseudomonas aeruginosa. METHODS Random sampling of suction hoses of dental units in Birjand, Iran, was performed in dental clinics on the first (n = 115) and last (n = 115) working days of the week. Total viable counts of bacteria and detection of P. aeruginosa were performed on plate count agar and cetrimide agar, respectively. Plates were incubated at 37 °C for 48 hours. RESULTS None of the samples were free from bacterial contamination. P. aeruginosa was detected in 22.6% and 18.3% of samples taken on the first and last working days, respectively. CONCLUSIONS Suction hoses were heavily contaminated with bacteria, especially opportunistic pathogens, and current disinfection does not adequately control the contamination.
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Affiliation(s)
- Tayebeh Zeinali
- Infectious Diseases Research Center, Department of Public Health, School of Health, Birjand University of Medical Sciences, Birjand, Iran
| | - Elham Bozorgvar
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Moghgan Habibi
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Narjes Akbari
- School of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
| | - Behnam Barikbin
- Social Determinants of Health Research Center, Department of Environmental Health Engineering, School of Health, Birjand University of Medical Sciences, Birjand, Iran
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16
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De Giglio O, Napoli C, Apollonio F, Brigida S, Marzella A, Diella G, Calia C, Scrascia M, Pacifico C, Pazzani C, Uricchio VF, Montagna MT. Occurrence of Legionella in groundwater used for sprinkler irrigation in Southern Italy. ENVIRONMENTAL RESEARCH 2019; 170:215-221. [PMID: 30594053 DOI: 10.1016/j.envres.2018.12.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
Legionellae are opportunistic bacteria that cause various conditions after exposure to contaminated aerosols, ranging from a serious type of pneumonia to a mild case of an influenza-like illness. Despite the risks of exposure, little is known about the occurrence of Legionella in natural environments and, even though studies have shown that there is a potential risk of transmission via inhalation, it does not have to be detected in groundwater that is used for irrigation. The culture methods traditionally used to detect Legionella have several limits that can be partly solved by applying molecular techniques. Samples from 177 wells in Apulia, Southern Italy, were collected twice, in winter and in summer, and analyzed. When compared with the guidelines, 145 (81.9%) of the sampled wells were suitable for irrigation use. The culture-based method highlighted the presence of different species and serogroups of Legionella in 31 (21.2%) of the 145 wells that were shown to be suitable for irrigation use. A greater number of wells returned positive results for Legionella in summer than in winter (p = 0.023), and the median concentrations were mostly higher in summer (500 CFU/L) than in winter (300 CFU/L). The median temperature in the Legionella positive well waters was significantly higher than that in the negative ones, both in winter and in summer (p < 0.001). Using molecular techniques, Legionella non-pneumophila was found in 37 of the 114 wells earlier detected as suitable for irrigation use but negative for Legionella by the culture-based methods. The distribution of Legionella differ significantly in porous aquifers compared to the karst-fissured ones both with quantitative polymerase chain reaction (qPCR) (p = 0.0004) and viable cells by propidium monoazide (PMA-qPCR) (p = 0.0000). Legionella concentrations were weakly correlated with temperature of water both with qPCR (ρ = 0.47, p = 0.0033) and PMA-qPCR (ρ = 0.41, p = 0.0126). Our data suggest that water that aerosolizes when sprinkled on plants represents a potential source of Legionellosis, with a higher risk from exposure in summer. On a practical level, this finding is important for workers (farmers and gardeners) who are in contact with waters used for irrigation.
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Affiliation(s)
- Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Christian Napoli
- Department of Medical and Surgical sciences and translational Medicine, Sapienza University of Rome, Italy.
| | - Francesca Apollonio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Silvia Brigida
- Water Research Institute, National Research Council, Bari, Italy.
| | - Angelo Marzella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Carla Calia
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Maria Scrascia
- Department of Biology, University of Bari "Aldo Moro", Bari, Italy.
| | - Claudia Pacifico
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Carlo Pazzani
- Department of Biology, University of Bari "Aldo Moro", Bari, Italy.
| | | | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
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17
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Lizzadro J, Mazzotta M, Girolamini L, Dormi A, Pellati T, Cristino S. Comparison between Two Types of Dental Unit Waterlines: How Evaluation of Microbiological Contamination Can Support Risk Containment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E328. [PMID: 30682855 PMCID: PMC6388184 DOI: 10.3390/ijerph16030328] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 01/16/2023]
Abstract
Infection risk management in a dental unit waterline (DUWL) involves healthcare personnel and patients and is related to routine exposure to water and aerosols that may contain bacterial species. To improve water safety plans, maintenance, and sanitation procedures, analyses of heterotrophic plate counts (HPCs) at 36 °C, and two other microorganisms frequently associated with biofilms, Pseudomonas aeruginosa and Legionella spp., were performed in order to evaluate differences in microbiological contamination between two types of DUWLs: Type A, provided by a water tank, and Type B, directly connected to municipal water. The data showed that the water supply and water safety plan differentially influenced microbiological contamination: Type A DUWLs were more contaminated than Type B DUWLs for all microbiological parameters tested, with significant changes in the percentage of positive samples and contamination levels that were beyond the limits of standard guidelines. The results obtained show how the storage tank, the absence of anti-retraction valves, and the disinfection procedures performed are the main critical points of Type A DUWLs, which confirms that dental unit management (maintenance/sanitization) is often missed or not correctly applied by stakeholders, with an underestimation of the real risk of infection for patients and operators.
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Affiliation(s)
- Jessica Lizzadro
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Ada Dormi
- Department of Medical and Surgical Science, DIMEC, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Tiziana Pellati
- GVM Care & Research, via Emaldi 10, 48124 Lugo di Ravenna, Italy.
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
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18
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Bolookat F, Hassanvand MS, Faridi S, Hadei M, Rahmatinia M, Alimohammadi M. Assessment of bioaerosol particle characteristics at different hospital wards and operating theaters: A case study in Tehran. MethodsX 2018; 5:1588-1596. [PMID: 30622921 PMCID: PMC6313819 DOI: 10.1016/j.mex.2018.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This study was aimed to investigate the types and number of bacterial and fungal bioaerosols in indoor air of hospitals according to the type of wards and operating theaters. Bacterial and fungal samples were collected using the passive sampling method of 1/1/1 scheme during a six months' period in the Khatam-Al-Anbia hospital, Tehran, Iran. A simple linear regression was used to determine the relationship between bioaerosol concentrations and the number of active beds. Bacterial bioaerosol concentrations were mainly higher than fungi in all sampling sites. A significant association was found between airborne fungal concentrations and the numbers of beds (R2 = 0.76, p < 0.05), but not observed for bacteria (R2 = 0.02, p < 0.05). Our findings provided an exposure database of airborne bacterial and fungal bioaerosol in hospital wards and operating theaters in Tehran. •Due to the importance of the exposure risk to bioaerosols for patients and medical personnel, we focused on identification of the density and diversity of bacterial and fungal bioaerosols in different wards and operating theaters.•Our results showed that the numbers of the beds have a significant effect on airborne fungal concentrations.•The results of this study can be used to set indoor air quality standards for hospital wards and operating theatres.
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Affiliation(s)
- Fatemeh Bolookat
- Department of Environment Engineering, Faculty of Environment & Energy, Islamic Azad University Science and Research Branch, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Faridi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hadei
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Rahmatinia
- Student Research Committee, Department of Environmental Health Engineering, School of Public Health and safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Alimohammadi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
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19
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Montagna MT, De Giglio O, Napoli C, Diella G, Rutigliano S, Agodi A, Auxilia F, Baldovin T, Bisetto F, Arnoldo L, Brusaferro S, Busetti M, Calagreti G, Casini B, Cristina ML, Di Luzio R, Fiorio M, Formoso M, Liguori G, Martini E, Molino A, Mondello P, Mura I, Novati R, Orsi GB, Patroni A, Poli A, Privitera G, Ripabelli G, Rocchetti A, Rose F, Sarti M, Savini S, Silvestri A, Sodano L, Spagnolo AM, Tardivo S, Teti V, Torregrossa MV, Torri E, Veronesi L, Zarrilli R, Pacifico C, Goglio A, Moro M, Pasquarella C. Control and prevention measures for legionellosis in hospitals: A cross-sectional survey in Italy. ENVIRONMENTAL RESEARCH 2018; 166:55-60. [PMID: 29864633 DOI: 10.1016/j.envres.2018.05.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/09/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2-15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.
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Affiliation(s)
- Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy.
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Christian Napoli
- Department of Medical and S urgical Sciences and Translational Medicine, Sapienza University of Roma, Square A. Moro 5, 00185 Roma, Italy
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Serafina Rutigliano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Str. S. Sofia, 87, Comparto 10 Edificio C, 95123 Catania, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milano, Str. Pascal 36, 20133 Milano, Italy
| | - Tatjana Baldovin
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Hygiene and Public Health Unit, Str. Loredan, 18.35131 Padova, Italy
| | - Francesco Bisetto
- Presidio Ospedaliero di Camposampiero, AULss6 Euganea Str. P. Cosma 1, 35012 Camposampiero, PD, Italy
| | - Luca Arnoldo
- Department of Medicine, University of Udine, Str. Colugna 50, 33100 Udine, Italy
| | - Silvio Brusaferro
- Department of Medicine, University of Udine, Str. Colugna 50, 33100 Udine, Italy
| | - Marina Busetti
- University Hospital ASUITS, Microbiology Unit, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Gioia Calagreti
- Hospital "Alto Tevere", AUSL Umbria 1, Città di Castello, PG, Italy
| | - Beatrice Casini
- Department of Translational Research, N.T.M.S. - Hygiene and Epidemiology Unit, University of Pisa, Str. S. Zeno 35-39, 56127 Pisa, Italy
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Str. A. Pastore 1, 16132 Genova, Italy
| | | | | | - Maurizio Formoso
- Hospital "Miulli", Str. 127 km 4.1, Santeramo-Acquaviva delle Fonti, BA, Italy
| | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University "Parthenope", Napoli, Italy
| | - Enrica Martini
- AOU "Ospedali Riuniti", Str. Conca, 71, 60126 Ancona, Italy
| | - Andrea Molino
- Hospital "Madonna delle Grazie", Contrada Cattedra Ambulante s.nc. 75100 Matera, Italy
| | | | - Ida Mura
- Department of Biomedical Science, University of Sassari, Sassari, Italy
| | | | - Giovanni Battista Orsi
- Department of Public Health and Infectious Disease, Sapienza University of Roma, Roma, Italy
| | - Andrea Patroni
- ASST Valcamonica, Str. Manzoni 142, 25040 Esine, BS, Italy
| | - Anna Poli
- Hospital "San Giovanni di Dio", Str. Torre Galli 3, 50143 Firenze, Italy
| | - Gaetano Privitera
- Department of Translational Research, N.T.M.S. - Hygiene and Epidemiology Unit, University of Pisa, Str. S. Zeno 35-39, 56127 Pisa, Italy
| | - Giancarlo Ripabelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Rocchetti
- ASO "SS. Antonio, Biagio and C. Arrigo", Str. Venezia 17, 15121 Alessandria, Italy
| | | | - Mario Sarti
- Hospital "OCSAE", Str. Giardini 1355, Baggiovara, MO, Italy
| | - Sandra Savini
- AOU "Ospedali Riuniti", Str. Conca, 71, 60126 Ancona, Italy
| | - Antonio Silvestri
- Hospital "San Camillo Forlanini", Circonvallazione Gianicolense 87, 00152 Roma, Italy
| | - Luisa Sodano
- Hospital "San Camillo Forlanini", Circonvallazione Gianicolense 87, 00152 Roma, Italy
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genova, Str. A. Pastore 1, 16132 Genova, Italy
| | - Stefano Tardivo
- Department of Diagnostic and Public Health, University of Verona, Str. Le Grazie 8, 37134 Verona, Italy
| | | | - Maria Valeria Torregrossa
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Str. Vespro, 133, 90127 Palermo, Italy
| | - Emanuele Torri
- Department of Health ans Social Policy, Str. Gilli 4, 38123 Trento, Italy
| | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma, Str. Volturno 39, Parma, Italy
| | - Raffaele Zarrilli
- Department of Public Health, University of Napoli "Federico II", Str. S. Pansini, 5, Napoli, Italy
| | - Claudia Pacifico
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Matteo Moro
- Hospital "San Raffaele", Str. Olgettina 60, 20132 Milano, Italy
| | - Cesira Pasquarella
- Department of Medicine and Surgery, University of Parma, Str. Volturno 39, Parma, Italy
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Montagna MT, De Giglio O, Cristina ML, Napoli C, Pacifico C, Agodi A, Baldovin T, Casini B, Coniglio MA, D'Errico MM, Delia SA, Deriu MG, Guida M, Laganà P, Liguori G, Moro M, Mura I, Pennino F, Privitera G, Romano Spica V, Sembeni S, Spagnolo AM, Tardivo S, Torre I, Valeriani F, Albertini R, Pasquarella C. Evaluation of Legionella Air Contamination in Healthcare Facilities by Different Sampling Methods: An Italian Multicenter Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017. [PMID: 28640202 PMCID: PMC5551108 DOI: 10.3390/ijerph14070670] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Healthcare facilities (HF) represent an at-risk environment for legionellosis transmission occurring after inhalation of contaminated aerosols. In general, the control of water is preferred to that of air because, to date, there are no standardized sampling protocols. Legionella air contamination was investigated in the bathrooms of 11 HF by active sampling (Surface Air System and Coriolis®μ) and passive sampling using settling plates. During the 8-hour sampling, hot tap water was sampled three times. All air samples were evaluated using culture-based methods, whereas liquid samples collected using the Coriolis®μ were also analyzed by real-time PCR. Legionella presence in the air and water was then compared by sequence-based typing (SBT) methods. Air contamination was found in four HF (36.4%) by at least one of the culturable methods. The culturable investigation by Coriolis®μ did not yield Legionella in any enrolled HF. However, molecular investigation using Coriolis®μ resulted in eight HF testing positive for Legionella in the air. Comparison of Legionella air and water contamination indicated that Legionella water concentration could be predictive of its presence in the air. Furthermore, a molecular study of 12 L. pneumophila strains confirmed a match between the Legionella strains from air and water samples by SBT for three out of four HF that tested positive for Legionella by at least one of the culturable methods. Overall, our study shows that Legionella air detection cannot replace water sampling because the absence of microorganisms from the air does not necessarily represent their absence from water; nevertheless, air sampling may provide useful information for risk assessment. The liquid impingement technique appears to have the greatest capacity for collecting airborne Legionella if combined with molecular investigations.
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Affiliation(s)
- Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genova, Italy.
| | - Christian Napoli
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Roma, Via di Grottarossa 1035, 00189 Roma, Italy.
| | - Claudia Pacifico
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via Sofia 87, 95123 Catania, Italy.
| | - Tatjana Baldovin
- Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padova, Via Loredan 18, 35131 Padova, Italy.
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35/39, 56127 Pisa, Italy.
| | - Maria Anna Coniglio
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via Sofia 87, 95123 Catania, Italy.
| | - Marcello Mario D'Errico
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, via Tronto, 10/a Torrette di Ancona, 60020 Ancona, Italy.
| | - Santi Antonino Delia
- Department of Biomedical Science and Morphological and Functional Images, University of Messina, Via C.Valeria snc, 98125 Messina, Italy.
| | - Maria Grazia Deriu
- Department of Biomedical Science-Hygiene Section, University of Sassari, Via Padre Manzella 4, 07100 Sassari, Italy.
| | - Marco Guida
- Department of Biology, University of Napoli "Federico II", Via Cinthia 26, 80126 Napoli, Italy.
| | - Pasqualina Laganà
- Department of Biomedical Science and Morphological and Functional Images, University of Messina, Via C.Valeria snc, 98125 Messina, Italy.
| | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University "Parthenope", Via Medina 40, 80133 Napoli, Italy.
| | - Matteo Moro
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy.
| | - Ida Mura
- Department of Biomedical Science-Hygiene Section, University of Sassari, Via Padre Manzella 4, 07100 Sassari, Italy.
| | - Francesca Pennino
- Department of Public Health, University of Napoli "Federico II", Via S.Pansini 5, 80131 Napoli, Italy.
| | - Gaetano Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35/39, 56127 Pisa, Italy.
| | - Vincenzo Romano Spica
- Department of Movement, Human and Health Sciences, Public Health Unit, University of Roma "Foro Italico", P.zza Lauro De Bosis 6, 00135 Roma, Italy.
| | - Silvia Sembeni
- Department of Diagnostic and Public Health, University of Verona, Strada le Grazie 8, 37134 Verona, Italy.
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genova, Italy.
| | - Stefano Tardivo
- Department of Diagnostic and Public Health, University of Verona, Strada le Grazie 8, 37134 Verona, Italy.
| | - Ida Torre
- Department of Public Health, University of Napoli "Federico II", Via S.Pansini 5, 80131 Napoli, Italy.
| | - Federica Valeriani
- Department of Movement, Human and Health Sciences, Public Health Unit, University of Roma "Foro Italico", P.zza Lauro De Bosis 6, 00135 Roma, Italy.
| | - Roberto Albertini
- Department of Medicine and Surgery, University of Parma, Medical Immunology Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy.
| | - Cesira Pasquarella
- Department of Medicine and Surgery, University of Parma, Via Volturno 39, 43125 Parma, Italy.
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Pasquarella C, Balocco C, Pasquariello G, Petrone G, Saccani E, Manotti P, Ugolotti M, Palla F, Maggi O, Albertini R. A multidisciplinary approach to the study of cultural heritage environments: Experience at the Palatina Library in Parma. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 536:557-567. [PMID: 26245537 DOI: 10.1016/j.scitotenv.2015.07.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/16/2015] [Accepted: 07/22/2015] [Indexed: 06/04/2023]
Abstract
The aim of this paper is to describe a multidisciplinary approach including biological and particle monitoring, and microclimate analysis associated with the application of the Computational Fluid Dynamic (CFD). This approach was applied at the Palatina historical library in Parma. Monitoring was performed both in July and in December, in the absence of visitors and operators. Air microbial monitoring was performed with active and passive methods. Airborne particles with a diameter of ≥0.3, ≥0.5, ≥1 and ≥5 μm/m3, were counted by a laser particle counter. The surface contamination of shelves and manuscripts was assessed with nitrocellulose membranes. A spore trap sampler was used to identify both viable and non-viable fungal spores by optical microscope. Microbiological contaminants were analyzed through cultural and molecular biology techniques. Microclimatic parameters were also recorded. An infrared thermal camera provided information on the surface temperature of the different building materials, objects and components. Transient simulation models, for coupled heat and mass-moisture transfer, taking into account archivist and general public movements, combined with the related sensible and latent heat released into the environment, were carried out applying the CFD-FE (Finite Elements) method. Simulations of particle tracing were carried out. A wide variability in environmental microbial contamination, both for air and surfaces, was observed. Cladosporium spp., Alternaria spp., Aspergillus spp., and Penicillium spp. were the most frequently found microfungi. Bacteria such as Streptomyces spp., Bacillus spp., Sphingomonas spp., and Pseudoclavibacter as well as unculturable colonies were characterized by molecular investigation. CFD simulation results obtained were consistent with the experimental data on microclimatic conditions. The tracing and distribution of particles showed the different slice planes of diffusion mostly influenced by the convective airflow. This interdisciplinary research represents a contribution towards the definition of standardized methods for assessing the biological and microclimatic quality of indoor cultural heritage environments.
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Affiliation(s)
- C Pasquarella
- Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Italy
| | - C Balocco
- Department of Industrial Engineering, University of Florence, Italy
| | - G Pasquariello
- Central Institute of Graphic Arts, Ministry of Cultural Heritage and Activities and Tourism, Rome, Italy
| | - G Petrone
- Department of Industrial Engineering, University of Catania, Italy
| | - E Saccani
- Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Italy
| | - P Manotti
- Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Italy
| | - M Ugolotti
- Hygiene Unit, University Hospital of Parma, Italy
| | - F Palla
- STEBICEF Department, Laboratory of Biology and Biotechnology for Cultural Heritage, University of Palermo, Italy
| | - O Maggi
- Department of Environmental Biology, "Sapienza" University of Rome, Italy
| | - R Albertini
- Department of Clinical and Experimental Medicine, University of Parma, Italy
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Faridi S, Hassanvand MS, Naddafi K, Yunesian M, Nabizadeh R, Sowlat MH, Kashani H, Gholampour A, Niazi S, Zare A, Nazmara S, Alimohammadi M. Indoor/outdoor relationships of bioaerosol concentrations in a retirement home and a school dormitory. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:8190-200. [PMID: 25516249 DOI: 10.1007/s11356-014-3944-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 12/01/2014] [Indexed: 05/20/2023]
Abstract
The concentrations of bacterial and fungal bioaerosols were measured in a retirement home and a school dormitory from May 2012 to May 2013. In the present work, two active and passive methods were used for bioaerosol sampling. The results from the present work indicated that Bacillus spp., Micrococcus spp., and Staphylococcus spp. were the dominant bacterial genera, while the major fungal genera were Penicillium spp., Cladosporium spp., and Aspergillus spp. The results also indicated that the indoor-to-outdoor (I/O) ratios for total bacteria were 1.77 and 1.44 in the retirement home and the school dormitory, respectively; the corresponding values for total fungal spores were 1.23 and 1.08. The results suggested that in addition to outdoor sources, indoor sources also played a significant role in emitting bacterial and fungal bioaerosols in the retirement home and the school dormitory indoor.
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Affiliation(s)
- Sasan Faridi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
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Caggiano G, Napoli C, Coretti C, Lovero G, Scarafile G, De Giglio O, Montagna MT. Mold contamination in a controlled hospital environment: a 3-year surveillance in southern Italy. BMC Infect Dis 2014; 14:595. [PMID: 25398412 PMCID: PMC4236478 DOI: 10.1186/s12879-014-0595-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 10/29/2014] [Indexed: 02/08/2023] Open
Abstract
Background Environmental monitoring of airborne filamentous fungi is necessary to reduce fungal concentrations in operating theaters and in controlled environments, and to prevent infections. The present study reports results of a surveillance of filamentous fungi carried out on samples from air and surfaces in operating theaters and controlled environments in an Italian university hospital. Methods Sampling was performed between January 2010 and December 2012 in 32 operating theaters and five departments with high-risk patients. Indoor air specimens were sampled using a microbiological air sampler; Rodac contact plates were used for surface sampling. Fungal isolates were identified at the level of genera and species. Results Sixty-one samples (61/465; 13.1%) were positive for molds, with 18 from controlled environments (18/81; 22.2%) and 43 (43/384; 11.2%) from operating theaters. The highest air fungal load (AFL, colony-forming units per cubic meter [CFU/m3]) was recorded in the ophthalmology operating theater, while the pediatric onco-hematology ward had the highest AFL among the wards (47 CFU/m3). The most common fungi identified from culture of air specimens were Aspergillus spp. (91.8%), Penicillium spp., (6%) and Paecilomyces spp. (1.5%). During the study period, a statistically significant increase in CFU over time was recorded in air-controlled environments (p = 0.043), while the increase in AFL in operating theaters was not statistically significant (p = 0.145). Molds were found in 29.1% of samples obtained from surfaces. Aspergillus fumigatus was the most commonly isolated (68.5%). Conclusions Our findings will form the basis for action aimed at improving the air and surface quality of these special wards. The lack of any genetic analysis prevented any correlation of fungal environmental contamination with onset of fungal infection, an analysis that will be undertaken in a prospective study in patients admitted to the same hospital. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0595-z) contains supplementary material, which is available to authorized users.
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Kadaifciler DG, Cotuk A. Microbial contamination of dental unit waterlines and effect on quality of indoor air. ENVIRONMENTAL MONITORING AND ASSESSMENT 2014; 186:3431-3444. [PMID: 24469014 DOI: 10.1007/s10661-014-3628-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 01/09/2014] [Indexed: 06/03/2023]
Abstract
The microbiological quality in dental unit waterlines (DUWLs) is considered to be important because patients and dental staff with suppressed immune systems are regularly exposed to water and aerosols generated from dental units (DUs). Opportunistic pathogens like Pseudomonas, Legionella, Candida, and Aspergillus can be present in DUWLs, while during consultations, bioaerosols can be dispersed in the air, thus resulting in effects on microbiological quality of indoor air. This present study represents microbiological air and water quality in dental offices (DOs) and also concerns the relationship between the quality of DO air and dental unit water. This study aimed to assess both the microbial quality of dental unit water and the indoor air in 20 DOs and to survey the effect on the quality of the indoor air with the existing microorganisms in dental unit water. Fourteen out of 20 (70 %) DUWLs were found to be contaminated with a high number of aerobic mesophilic heterotrophic bacteria. In terms of bacterial air contamination levels, in 90 % of DOs, a medium level (<500 colony-forming units (CFU)/m(3)) of contamination was determined, while in terms of microfungal air contamination, in all DOs, a low level (<100 CFU/m(3)) of contamination was determined. Potential infection or allergen agents, such as Pseudomonas, Micrococcus, Staphylococcus, Alternaria, Cladosporium, Penicillium, Aspergillus, and Paecilomyces were isolated from water and air samples. This study's determination of contamination sources and evaluation of microbial load in DOs could contribute to the development of quality control methods in the future.
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Affiliation(s)
- Duygu Göksay Kadaifciler
- Department of Biology, Faculty of Science, Istanbul University, Vezneciler, 34134, Istanbul, Turkey,
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Napoli C, Marcotrigiano V, Montagna MT. Air sampling procedures to evaluate microbial contamination: a comparison between active and passive methods in operating theatres. BMC Public Health 2012; 12:594. [PMID: 22853006 PMCID: PMC3444341 DOI: 10.1186/1471-2458-12-594] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 07/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since air can play a central role as a reservoir for microorganisms, in controlled environments such as operating theatres regular microbial monitoring is useful to measure air quality and identify critical situations. The aim of this study is to assess microbial contamination levels in operating theatres using both an active and a passive sampling method and then to assess if there is a correlation between the results of the two different sampling methods. METHODS The study was performed in 32 turbulent air flow operating theatres of a University Hospital in Southern Italy. Active sampling was carried out using the Surface Air System and passive sampling with settle plates, in accordance with ISO 14698. The Total Viable Count (TVC) was evaluated at rest (in the morning before the beginning of surgical activity) and in operational (during surgery). RESULTS The mean TVC at rest was 12.4 CFU/m3 and 722.5 CFU/m2/h for active and passive samplings respectively. The mean in operational TVC was 93.8 CFU/m3 (SD = 52.69; range = 22-256) and 10496.5 CFU/m2/h (SD = 7460.5; range = 1415.5-25479.7) for active and passive samplings respectively. Statistical analysis confirmed that the two methods correlate in a comparable way with the quality of air. CONCLUSION It is possible to conclude that both methods can be used for general monitoring of air contamination, such as routine surveillance programs. However, the choice must be made between one or the other to obtain specific information.
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Affiliation(s)
- Christian Napoli
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Piazza G, Cesare, 11, 70124, Bari, Italy.
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Pasquarella C, Veronesi L, Napoli C, Castiglia P, Liguori G, Rizzetto R, Torre I, Righi E, Farruggia P, Tesauro M, Torregrossa MV, Montagna MT, Colucci ME, Gallè F, Masia MD, Strohmenger L, Bergomi M, Tinteri C, Panico M, Pennino F, Cannova L, Tanzi M. Microbial environmental contamination in Italian dental clinics: A multicenter study yielding recommendations for standardized sampling methods and threshold values. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 420:289-299. [PMID: 22335883 DOI: 10.1016/j.scitotenv.2012.01.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/06/2012] [Accepted: 01/12/2012] [Indexed: 05/31/2023]
Abstract
A microbiological environmental investigation was carried out in ten dental clinics in Italy. Microbial contamination of water, air and surfaces was assessed in each clinic during the five working days, for one week per month, for a three-month period. Water and surfaces were sampled before and after clinical activity; air was sampled before, after, and during clinical activity. A wide variation was found in microbial environmental contamination, both within the participating clinics and for the different sampling times. Before clinical activity, microbial water contamination in tap water reached 51,200cfu/mL (colony forming units per milliliter), and that in Dental Unit Water Systems (DUWSs) reached 872,000cfu/mL. After clinical activity, there was a significant decrease in the Total Viable Count (TVC) in tap water and in DUWSs. Pseudomonas aeruginosa was found in 2.38% (7/294) of tap water samples and in 20.06% (59/294) of DUWS samples; Legionella spp. was found in 29.96% (89/297) of tap water samples and 15.82% (47/297) of DUWS samples, with no significant difference between pre- and post-clinical activity. Microbial air contamination was highest during dental treatments, and decreased significantly at the end of the working activity (p<0.05). The microbial buildup on surfaces increased significantly during the working hours. This study provides data for the establishment of standardized sampling methods, and threshold values for contamination monitoring in dentistry. Some very critical situations have been observed which require urgent intervention. Furthermore, the study emphasizes the need for research aimed at defining effective managing strategies for dental clinics.
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Affiliation(s)
- Cesira Pasquarella
- Dipartimento di Sanità Pubblica, Università degli Studi di Parma, Italy.
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O’Donnell MJ, Boyle MA, Russell RJ, Coleman DC. Management of dental unit waterline biofilms in the 21st century. Future Microbiol 2011; 6:1209-26. [DOI: 10.2217/fmb.11.104] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Dental chair units (DCUs) use water to cool and irrigate DCU-supplied instruments and tooth surfaces, and provide rinsewater during dental treatment. A complex network of interconnected plastic dental unit waterlines (DUWLs) supply water to these instruments. DUWLs are universally prone to microbial biofilm contamination seeded predominantly from microorganisms in supply water. Consequently, DUWL output water invariably becomes contaminated by high densities of microorganisms, principally Gram-negative environmental bacteria including Pseudomonas aeruginosa and Legionella species, but sometimes contain human-derived pathogens such as Staphylococcus aureus. Patients and staff are exposed to microorganisms from DUWL output water and to contaminated aerosols generated by DCU instruments. A wide variety of approaches, many unsuccessful, have been proposed to control DUWL biofilm. More recently, advances in biofilm science, chemical DUWL biofilm treatment agents, DCU design, supply water treatment and development of automated DUWL biofilm control systems have provided effective long-term solutions to DUWL biofilm control.
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Affiliation(s)
- Mary J O’Donnell
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin 2, Republic of Ireland
| | - Maria A Boyle
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin 2, Republic of Ireland
| | - Ronnie J Russell
- The Department of Microbiology, The Moyne Institute of Preventive Medicine, University of Dublin, Trinity College Dublin, Dublin 2, Republic of Ireland
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Liguori G, Bagattini M, Gallè F, Negrone M, Di Onofrio V, Triassi M. Automated cleaning of fan coil units with a natural detergent-disinfectant product. Ann Clin Microbiol Antimicrob 2010; 9:29. [PMID: 20939877 PMCID: PMC2964557 DOI: 10.1186/1476-0711-9-29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 10/12/2010] [Indexed: 11/10/2022] Open
Abstract
Background Air conditioning systems represent one important source of microbial pollutants for indoor air. In the past few years, numerous strategies have been conceived to reduce the contamination of air conditioners, mainly in hospital settings. The biocidal detergent BATT2 represents a natural product obtained through extraction from brown seaweeds, that has been tested previously on multidrug-resistant microorganisms. Methods BATT2 has been utilized for the disinfection of fan coil units from four air conditioning systems located in hospital environments with a mean degree of risk. Samples were collected from the air supplied by the conditioning systems and from the surfaces of fan coil units, before and after sanitization procedures. Total microbial counts at 37°C and 22°C and mycotic count at 32°C were evaluated. Staphylococci and Pseudomonas aeruginosa were also detected on surfaces samples. Results The biodetergent was able to reduce up 50% of the microbial pollution of fan coil units surfaces and air supplied by the air conditioners. Conclusions BATT2 could be considered for cleaning/disinfection of air conditioning systems, that should be performed on the basis of accurate and verifiable sanitization protocols.
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Affiliation(s)
- Giorgio Liguori
- Cattedra di Igiene ed Epidemiologia, Università degli studi di Napoli Parthenope, Napoli, Italy
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