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Karia K, Ali S. The need for in-house efficacy testing and assessment of the antimicrobial properties of silver nanoparticle (Ag +)-impregnated showerheads against Pseudomonas aeruginosa intended for healthcare waters in high-risk patient settings. J Hosp Infect 2024; 151:29-32. [PMID: 38851326 DOI: 10.1016/j.jhin.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Pseudomonas aeruginosa is a Gram-negative water-borne opportunistic pathogen. Reservoirs of bacteria can infect vulnerable populations. Mitigation of this risk in health care includes regular microbiology monitoring and chemical/thermal disinfection of outlets. Where contamination is persistent, point-of-use filters/antimicrobial showers may be used to reduce the bioburden. This study tested the efficacy of a silver nanoparticle (Ag+)-impregnated antimicrobial showerhead against P. aeruginosa under simulated conditions. METHODS Test (excised from Ag+-impregnated showerhead) and control (stainless steel) coupons (∼1 cm2; N=108) were inoculated with 10 μL [∼103 colony-forming units (CFU)] P. aeruginosa (NCTC 10662 and wild-types) and overlaid with coverslips. Coupons were incubated at ambient temperature (∼40% relative humidity) for 0 min, 30 min, 2 h, 4 h and 24 h. Coupons and coverslips were transferred to neutralizer solution, followed by bead washing for bacterial recovery and enumeration. RESULTS Contamination ranged from ∼2.90 log10 CFU (±0.14 log10; type strain) to ∼3.02 log10 CFU (±0.16 log10; wild-types). No significant reductions in the P. aeruginosa bioburden were observed for any of the three strains (P>0.05). Analogous bacterial decline was noted between the test and control coupons (falling to below the detection limit) between 4 and 24 h, possibly due to desiccation. SUMMARY Whilst being an economically and environmentally friendly option, antimicrobial showers may not be appropriate to reduce the bioburden in healthcare waters. Previous research has demonstrated the bactericidal effects of Ag+; however, this was not established in the present study. Although the concentration of silver in the test materials was unknown, these findings suggest that antimicrobial showerheads may require higher concentrations of Ag+ to display antimicrobial activity. Further testing is required to determine efficacy against biofilms.
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Affiliation(s)
- K Karia
- Environmental Research Laboratory, University College London Hospitals NHS Foundation Trust, London, UK.
| | - S Ali
- Environmental Research Laboratory, University College London Hospitals NHS Foundation Trust, London, UK
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Baudet A, Lizon J, Florentin A, Mortier É. Initial waterline contamination by Pseudomonas aeruginosa in newly installed dental chairs. Microbiol Spectr 2024; 12:e0396223. [PMID: 38652098 DOI: 10.1128/spectrum.03962-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
Water contamination in dental unit waterlines (DUWLs) is a potential source of healthcare-associated infection during dental care. The aim of this study was to evaluate the microbiological quality of DUWLs water from newly installed dental chairs in a French University Hospital. The microbiological quality of water from 24 new DUWLs initially disinfected by ICX Renew-prior to use of the dental units for patient treatment-was assessed for total culturable aerobic bacteria at 22°C and 36°C, Legionella sp., Pseudomonas aeruginosa, and total coliforms. Among the 24 samples analyzed, 21 were compliant with the water quality levels: 19 had no bacteria, and 2 contained only 4 and 1 CFU/mL for total culturable aerobic bacteria at 22°C and 36°C, respectively. Three samples were non-compliant due to contamination by P. aeruginosa (4, 2, and 2 CFU/100 mL). Controlling and preventing the microbiological contamination of DUWLs, especially by pathogenic bacteria, at the time of the installation of the new dental chairs are crucial to prevent healthcare-associated infection in dentistry. IMPORTANCE Dental unit waterlines (DUWLs) of new dental chairs may be contaminated before their first clinical use, so an initial shock disinfection is crucial at the time of their installation. The microbiological analyses are crucial to control the water quality of DUWLs before their first clinical use because their disinfection does not guarantee the elimination of all bacteria.
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Affiliation(s)
- Alexandre Baudet
- Faculté d'odontologie, Université de Lorraine, Nancy, France
- CHRU-Nancy, Service d'odontologie, Nancy, France
- Université de Lorraine, Inserm, INSPIIRE, Nancy, France
| | - Julie Lizon
- Département territorial d'hygiène et prévention du risque infectieux (DTPRI), CHRU-Nancy, Nancy, France
| | - Arnaud Florentin
- Université de Lorraine, Inserm, INSPIIRE, Nancy, France
- Département territorial d'hygiène et prévention du risque infectieux (DTPRI), CHRU-Nancy, Nancy, France
- Département d'hygiène, des risques environnementaux et associés aux soins (DHREAS), Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Éric Mortier
- Faculté d'odontologie, Université de Lorraine, Nancy, France
- CHRU-Nancy, Service d'odontologie, Nancy, France
- CNRS, IJL, Université de Lorraine, Nancy, France
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Albertini P, Mainardi P, Bagattini M, Lombardi A, Riccio P, Ragosta M, Pennino F, Bruzzese D, Triassi M. Risk Influence of Some Environmental and Behavioral Factors on Air Contamination in the Operating Room: An Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6592. [PMID: 37623177 PMCID: PMC10454192 DOI: 10.3390/ijerph20166592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
Air contamination in operating rooms (ORs) depends on the conditions of the room and on activities therein performed. Methodologies of air quality assessment in ORs are often inadequately described in the scientific literature, and the time required for a change in status in air quality is never taken into account. The purpose of this study was to determine the influence of the state and the presence of human operators on air quality by implementing a precise measurement protocol that also took into account the time required for changes in the room to affect air pollution. As the main indicators of air pollution, bacterial load and concentration of airborne dust were measured. The results showed that: the use of surgical masks by operators in the OR did not significantly affect bacterial load within a distance of 2 m; keeping OR doors open did not induce a significant increase in bacterial load and of 5 μm particles while 10 μm particles concentration was positively affected; and air pollution measured with open doors was not significantly different from that due to the presence of two staff members, whether or not they were wearing masks. The results clarified the role of some factors on air pollution in ORs.
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Affiliation(s)
- Prospero Albertini
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Pierangela Mainardi
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Maria Bagattini
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Annalisa Lombardi
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Patrizia Riccio
- Department of Molecular Medicine and Medical Biotechnology, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy;
| | - Maria Ragosta
- School of Engineering, University of Basilicata, V.le dell’Ateneo Lucano N° 10, 85100 Potenza, Italy;
| | - Francesca Pennino
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Dario Bruzzese
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
| | - Maria Triassi
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy; (P.A.); (P.M.); (M.B.); (A.L.); (D.B.); (M.T.)
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Lombardi A, Borriello T, De Rosa E, Di Duca F, Sorrentino M, Torre I, Montuori P, Trama U, Pennino F. Environmental Monitoring of Legionella in Hospitals in the Campania Region: A 5-Year Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085526. [PMID: 37107807 PMCID: PMC10138562 DOI: 10.3390/ijerph20085526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
Legionella is a pathogen that colonizes soils, freshwater, and building water systems. People who are most affected are those with immunodeficiencies, so it is necessary to monitor its presence in hospitals. The purpose of this study was to evaluate the presence of Legionella in water samples collected from hospitals in the Campania region, Southern Italy. A total of 3365 water samples were collected from January 2018 to December 2022 twice a year in hospital wards from taps and showers, tank bottoms, and air-treatment units. Microbiological analysis was conducted in accordance with the UNI EN ISO 11731:2017, and the correlations between the presence of Legionella and water temperature and residual chlorine were investigated. In total, 708 samples (21.0%) tested positive. The most represented species was L. pneumophila 2-14 (70.9%). The serogroups isolated were 1 (27.7%), 6 (24.5%), 8 (23.3%), 3 (18.9%), 5 (3.1%), and 10 (1.1%). Non-pneumophila Legionella spp. represented 1.4% of the total. Regarding temperature, the majority of Legionella positive samples were found in the temperature range of 26.0-40.9 °C. An influence of residual chlorine on the presence of the bacterium was observed, confirming that chlorine disinfection is effective for controlling contamination. The positivity for serogroups other than serogroup 1 suggested the need to continue environmental monitoring of Legionella and to focus on the clinical diagnosis of other serogroups.
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Affiliation(s)
- Annalisa Lombardi
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Tonia Borriello
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Elvira De Rosa
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Fabiana Di Duca
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Michele Sorrentino
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Ida Torre
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Paolo Montuori
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Ugo Trama
- General Directorate of Health, Campania Region, Centro Direzionale C3, 80143 Naples, Italy
| | - Francesca Pennino
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
- Correspondence:
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Dey S, Tunio M, Boryc LC, Hodgson BD, Garcia GJM. Quantifying strategies to minimize aerosol dispersion in dental clinics. EXPERIMENTAL AND COMPUTATIONAL MULTIPHASE FLOW 2023; 5:290-303. [PMID: 37305074 PMCID: PMC10042415 DOI: 10.1007/s42757-022-0157-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/12/2022] [Accepted: 12/25/2022] [Indexed: 03/29/2023]
Abstract
Many dental procedures are aerosol-generating and pose a risk for the spread of airborne diseases, including COVID-19. Several aerosol mitigation strategies are available to reduce aerosol dispersion in dental clinics, such as increasing room ventilation and using extra-oral suction devices and high-efficiency particulate air (HEPA) filtration units. However, many questions remain unanswered, including what the optimal device flow rate is and how long after a patient exits the room it is safe to start treatment of the next patient. This study used computational fluid dynamics (CFD) to quantify the effectiveness of room ventilation, an HEPA filtration unit, and two extra-oral suction devices to reduce aerosols in a dental clinic. Aerosol concentration was quantified as the particulate matter under 10 µm (PM10) using the particle size distribution generated during dental drilling. The simulations considered a 15 min procedure followed by a 30 min resting period. The efficiency of aerosol mitigation strategies was quantified by the scrubbing time, defined as the amount of time required to remove 95% of the aerosol released during the dental procedure. When no aerosol mitigation strategy was applied, PM10 reached 30 µg/m3 after 15 min of dental drilling, and then declined gradually to 0.2 µg/m3 at the end of the resting period. The scrubbing time decreased from 20 to 5 min when the room ventilation increased from 6.3 to 18 air changes per hour (ACH), and decreased from 10 to 1 min when the flow rate of the HEPA filtration unit increased from 8 to 20 ACH. The CFD simulations also predicted that the extra-oral suction devices would capture 100% of the particles emanating from the patient's mouth for device flow rates above 400 L/min. In summary, this study demonstrates that aerosol mitigation strategies can effectively reduce aerosol concentrations in dental clinics, which is expected to reduce the risk of spreading COVID-19 and other airborne diseases.
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Affiliation(s)
- Shamudra Dey
- Joint Department of Biomedical Engineering, Marquette University, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Maryam Tunio
- School of Dentistry, Marquette University, Milwaukee, 53233 USA
| | - Louis C. Boryc
- School of Dentistry, Marquette University, Milwaukee, 53233 USA
| | | | - Guilherme J. M. Garcia
- Joint Department of Biomedical Engineering, Marquette University, Medical College of Wisconsin, Milwaukee, 53226 USA
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Bayani M, Raisolvaezin K, Almasi-Hashiani A, Mirhoseini SH. Bacterial biofilm prevalence in dental unit waterlines: a systematic review and meta-analysis. BMC Oral Health 2023; 23:158. [PMID: 36934281 PMCID: PMC10024400 DOI: 10.1186/s12903-023-02885-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 03/14/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUNDS Numerous studies have shown that dental unit water lines (DUWLs) are often contaminated by a wide range of micro-organisms (bacteria, fungi, protozoa) and various prevalence have been reported for it in previous studies. Therefore, this review study aims to describe the prevalence of bacterial biofilm contamination of DUWLs. METHODS This is a systematic review and meta-analysis in which the related keywords in different international databases, including Medline (via PubMed) and Scopus were searched. The retrieved studies were screened and the required data were extracted from the included studies. Three standard methods including American Dental Association (ADA), The Center for Disease Control and Prevention (CDC) and contaminated > 100 CFU/ml(C-100) standards were used to assess the bacterial biofilm contamination of DUWLs. All studies that calculated the prevalence of bacterial biofilm contamination of DUWLs, and English full-text studies were included in the meta-analysis. Studies that did not have relevant data or used unusual laboratory methods were excluded. Methodological risk of bias was assessed by a related checklist and finally, the data were pooled by fixed or random-effect models. RESULTS Seven hundred and thirty-six studies were identified and screened and 26 related studies were included in the meta-analysis. The oldest included study was published in 1976 and the most recent study was published in 2020. According to the ADA, CDC and C-100 standards, the prevalence of bacterial contamination was estimated to be 85.0% (95% confidence interval (CI): 66.0-94.0%), 77.0% (95%CI: 66.0-85.0%) and 69.0% (95%CI: 67.0-71.0%), respectively. The prevalence of Legionella Pneumophila and Pseudomonas Aeruginosa in DUWLs was estimated to be 12.0% (95%CI: 10.0-14.0%) and 8.0% (95%CI: 2.0-24.0%), respectively. CONCLUSION The results of this review study suggested a high prevalence of bacterial biofilm in DUWLs; therefore, the use of appropriate disinfecting protocol is recommended to reduce the prevalence of contamination and reduce the probable cross-infection.
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Affiliation(s)
- Mojtaba Bayani
- grid.468130.80000 0001 1218 604XDepartment of Periodontics, School of Dentistry, Arak University of Medical Sciences, Arak, Iran
| | - Kiyavash Raisolvaezin
- grid.468130.80000 0001 1218 604XStudent Research Committee, Arak University of Medical Sciences, Arak, Iran
| | - Amir Almasi-Hashiani
- grid.468130.80000 0001 1218 604XDepartment of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Seyed Hamed Mirhoseini
- grid.468130.80000 0001 1218 604XDepartment of Environmental Health Engineering, School of Health, Arak University of Medical Sciences, Arak, Iran
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Liu Z, Zhang P, Liu H, He J, Li Y, Yao G, Liu J, Lv M, Yang W. Estimating the restraint of SARS-CoV-2 spread using a conventional medical air-cleaning device: Based on an experiment in a typical dental clinical setting. Int J Hyg Environ Health 2023; 248:114120. [PMID: 36709744 PMCID: PMC9883001 DOI: 10.1016/j.ijheh.2023.114120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/14/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Droplets or aerosols loaded with SARS-CoV-2 can be released during breathing, coughing, or sneezing from COVID-19-infected persons. To investigate whether the most commonly applied air-cleaning device in dental clinics, the oral spray suction machine (OSSM), can provide protection to healthcare providers working in clinics against exposure to bioaerosols during dental treatment. METHOD In this study, we measured and characterized the temporal and spatial variations in bioaerosol concentration and deposition with and without the use of the OSSM using an experimental design in a dental clinic setting. Serratia marcescens (a bacterium) and ΦX174 phage (a virus) were used as tracers. The air sampling points were sampled using an Anderson six-stage sampler, and the surface-deposition sampling points were sampled using the natural sedimentation method. The Computational Fluid Dynamics method was adopted to simulate and visualize the effect of the OSSM on the concentration spatial distribution. RESULTS During dental treatment, the peak exposure concentration increased by up to 2-3 orders of magnitude (PFU/m3) for healthcare workers. Meanwhile, OSSM could lower the mean bioaerosol exposure concentration from 58.84 PFU/m3 to 4.10 PFU/m3 for a healthcare worker, thereby inhibiting droplet and airborne transmission. In terms of deposition, OSSM significantly reduced the bioaerosol surface concentration from 28.1 PFU/m3 to 2.5 PFU/m3 for a surface, effectively preventing fomite transmission. CONCLUSION The use of OSSM showed the potential to restraint the spread of bioaerosols in clinical settings. Our study demonstrates that OSSM use in dental clinics can reduce the exposure concentrations of bioaerosols for healthcare workers during dental treatment and is beneficial for minimizing the risk of infectious diseases such as COVID-19.
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Affiliation(s)
- Zhijian Liu
- Department of Power Engineering, North China Electric Power University, Baoding, Hebei, 071003, PR China.
| | - Peiwen Zhang
- Department of Power Engineering, North China Electric Power University, Baoding, Hebei, 071003, PR China
| | - Haiyang Liu
- Department of Power Engineering, North China Electric Power University, Baoding, Hebei, 071003, PR China
| | - Junzhou He
- Department of Power Engineering, North China Electric Power University, Baoding, Hebei, 071003, PR China
| | - Yabin Li
- The Fifth Medical Center of People's Liberation Army of China General Hospital, Beijing, 100039, China
| | - Guangpeng Yao
- Department of Power Engineering, North China Electric Power University, Baoding, Hebei, 071003, PR China
| | - Jia Liu
- The Fifth Medical Center of People's Liberation Army of China General Hospital, Beijing, 100039, China
| | - Meng Lv
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Wenhui Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China.
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Tesauro M, Consonni M, Grappasonni I, Lodi G, Mattina R. Dental unit water content and antibiotic resistance of Pseudomonas aeruginosa and Pseudomonas species: a case study. J Oral Microbiol 2022; 14:2107316. [PMID: 36034883 PMCID: PMC9415447 DOI: 10.1080/20002297.2022.2107316] [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] [Indexed: 11/23/2022] Open
Abstract
Background Many studies consider the contamination of dental unit waterlines (DUWLs), but few of them have studied the possible presence of antibiotic resistant Pseudomonas aeruginosa in the DUWLs. Aims Investigation of the presence of P. aeruginosa and Pseudomonas spp. strains in DUWLs and evaluation of their resistance to six antibiotics (ceftazidime, netilmicin, piperacillin/tazobactam, meropenem, levofloxacin, colistin sulfate) at a public dental clinic in Milan, Italy. Results Dental units were contaminated by P. aeruginosa with loads of 2–1,000 CFU/L and were mainly located on the mezzanine floor, with a range of 46–54%, while Pseudomonas spp. were primarily found on the first and second floors, ranging from 50 to 91%. P. aeruginosa was antibiotic resistant in 30% of the strains tested, andPseudomonas spp. in 31.8% . Cold water from controls was also contaminated by these microorganisms. Conclusion Monitoring antibiotic resistance in the water and adopting disinfection procedures on DUs are suggested within the Water Safety Plan.
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Affiliation(s)
- M. Tesauro
- Department of Biomedical, Surgical and Dental Sciences, Laboratory of Environmental Hygiene, Coordinating Research Centres Episomi University of Milan, University of Milan, Milan, Italy
| | - M. Consonni
- Department of Biomedical, Surgical and Dental Sciences, Laboratory of Environmental Hygiene, Coordinating Research Centres Episomi University of Milan, University of Milan, Milan, Italy
| | - I. Grappasonni
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - G. Lodi
- Department of Biomedical, Surgical and Dental Sciences, Laboratory of Environmental Hygiene, Coordinating Research Centres Episomi University of Milan, University of Milan, Milan, Italy
| | - R. Mattina
- Department of Biomedical, Surgical and Dental Sciences, Laboratory of Environmental Hygiene, Coordinating Research Centres Episomi University of Milan, University of Milan, Milan, Italy
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Al-Moraissi EA, Kaur A, Günther F, Neff A, Christidis N. Can aerosols-generating dental, oral and maxillofacial, and orthopedic surgical procedures lead to disease transmission? An implication on the current COVID-19 pandemic. FRONTIERS IN ORAL HEALTH 2022; 3:974644. [PMID: 35979536 PMCID: PMC9376374 DOI: 10.3389/froh.2022.974644] [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: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 12/01/2022] Open
Abstract
Various dental, maxillofacial, and orthopedic surgical procedures (DMOSP) have been known to produce bioaerosols, that can lead to the transmission of various infectious diseases. Hence, a systematic review (SR) aimed at generating evidence of aerosols generating DMOSP that can result in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), further investigating their infectivity and assessing the role of enhanced personal protective equipment (PPE) an essential to preventing the spreading of SARS-CoV-2 during aerosol-generating procedures (AGPs). This SR was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) guidelines based on a well-designed Population, Intervention, Comparison, Outcomes and Study (PICOS) framework, and various databases were searched to retrieve the studies which assessed potential aerosolization during DMOSP. This SR included 80 studies (59 dental and 21 orthopedic) with 7 SR, 47 humans, 5 cadaveric, 16 experimental, and 5 animal studies that confirmed the generation of small-sized < 5 μm particles in DMOSP. One study confirmed that HIV could be transmitted by aerosolized blood generated by an electric saw and bur. There is sufficient evidence that DMOSP generates an ample amount of bioaerosols, but the infectivity of these bioaerosols to transmit diseases like SARS-CoV-2 generates very weak evidence but still, this should be considered. Confirmation through isolation and culture of viable virus in the clinical environment should be pursued. An evidence provided by the current review was gathered by extrapolation from available experimental and empirical evidence not based on SARS-CoV-2. The results of the present review, therefore, should be interpreted with great caution.
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Affiliation(s)
- Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Dhamar, Yemen
- *Correspondence: Essam Ahmed Al-Moraissi ;
| | - Amanjot Kaur
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Frank Günther
- Medical Microbiology and Hygiene, Marburg University Hospital, Marburg, Germany
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg Universitätsklinikum Giessen und Marburg GmbH, Marburg, Germany
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Nóbrega MTC, Bastos RTDRM, Mecenas P, de Toledo IP, Richardson-Lozano R, Altabtbaei K, Flores-Mir C. Aerosol generated by dental procedures: A scoping review. J Evid Based Med 2021; 14:303-312. [PMID: 34936216 DOI: 10.1111/jebm.12461] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/30/2021] [Accepted: 11/15/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The current pandemic has raised awareness of aerosol dispersion in dental offices. This scoping review was conducted to assess the amount and spread of aerosol generated by dental procedures. METHODS This scoping review followed the PRISMA-ScR protocol and was conducted by searching multiple databases adopting a core search structure for each database. Detailed eligibility criteria were applied. The authors placed no restrictions on study design, year of publication, and study location. The literature search was updated on September 15, 2021. RESULTS A total of 51 papers were included in this scoping review. The risk of bias assessment was not conducted as per guidelines. The majority of studies found microorganisms, bloodstains, splatters of aerosol, and particles in the air part of the search strategy. Publication dates ranged from 1969 to 2021. Data came from different dental settings locations. Several factors were identified that have an effect on the amount and spread of the aerosol and spatter. CONCLUSION Although it is clear that the microbial contamination occurred mainly during aerosol-generating dental procedures, our understanding of the contamination level, spread, and half-life are limited.
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Affiliation(s)
| | | | - Paulo Mecenas
- Department of Orthodontics, Federal University of Pará, Belém, Pará, Brazil
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Baudet A, Guillaso M, Grimmer L, Regad M, Florentin A. Microbiological Contamination of the Office Environment in Dental and Medical Practice. Antibiotics (Basel) 2021; 10:antibiotics10111375. [PMID: 34827313 PMCID: PMC8614722 DOI: 10.3390/antibiotics10111375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 12/19/2022] Open
Abstract
The microbiological contamination of the environment in independent healthcare facilities such as dental and general practitioner offices was poorly studied. The aims of this study were to describe qualitatively and quantitatively the bacterial and fungal contamination in these healthcare facilities and to analyze the antibiotic resistance of bacterial pathogens identified. Microbiological samples were taken from the surfaces of waiting, consulting, and sterilization rooms and from the air of waiting room of ten dental and general practitioner offices. Six surface samples were collected in each sampled room using agar contact plates and swabs. Indoor air samples were collected in waiting rooms using a single-stage impactor. Bacteria and fungi were cultured, then counted and identified. Antibiograms were performed to test the antibiotic susceptibility of bacterial pathogens. On the surfaces, median concentrations of bacteria and fungi were 126 (range: 0–1280) and 26 (range: 0–188) CFU/100 cm2, respectively. In indoor air, those concentrations were 403 (range: 118–732) and 327 (range: 32–806) CFU/m3, respectively. The main micro-organisms identified were Gram-positive cocci and filamentous fungi, including six ubiquitous genera: Micrococcus, Staphylococcus, Cladosporium, Penicillium, Aspergillus, and Alternaria. Some antibiotic-resistant bacteria were identified in general practitioner offices (penicillin- and erythromycin-resistant Staphylococcus aureus), but none in dental offices. The dental and general practitioner offices present a poor microbiological contamination with rare pathogenic micro-organisms.
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Affiliation(s)
- Alexandre Baudet
- Faculté d’Odontologie, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France
- Service d’Odontologie, CHRU-Nancy, F-54000 Nancy, France
- APEMAC, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France;
- Correspondence:
| | - Monique Guillaso
- Département d’Hygiène, des Risques Environnementaux et Associés aux Soins, Faculté de Médecine, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France; (M.G.); (L.G.); (M.R.)
| | - Léonie Grimmer
- Département d’Hygiène, des Risques Environnementaux et Associés aux Soins, Faculté de Médecine, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France; (M.G.); (L.G.); (M.R.)
| | | | - Marie Regad
- Département d’Hygiène, des Risques Environnementaux et Associés aux Soins, Faculté de Médecine, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France; (M.G.); (L.G.); (M.R.)
- Département Territorial d’Hygiène et de Prévention du Risque Infectieux, CHRU-Nancy, F-54505 Vandœuvre-lès-Nancy, France
| | - Arnaud Florentin
- APEMAC, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France;
- Département d’Hygiène, des Risques Environnementaux et Associés aux Soins, Faculté de Médecine, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France; (M.G.); (L.G.); (M.R.)
- Département Territorial d’Hygiène et de Prévention du Risque Infectieux, CHRU-Nancy, F-54505 Vandœuvre-lès-Nancy, France
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Alsing-Johansson T, Pedersen A, Bergström K, Sternberg-Lewerin S, Penell J, Bergh A. Bacterial Contamination of Equine Dentistry Equipment-Effect of Cleaning and Disinfection. Animals (Basel) 2021; 11:ani11082320. [PMID: 34438777 PMCID: PMC8388488 DOI: 10.3390/ani11082320] [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: 06/29/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Some of the equipment used in equine dentistry is difficult to clean and disinfect. Since it is vital to avoid the spread of infections in equine healthcare it is important to develop practical and easy-to-follow methods for cleaning and disinfecting dental equipment. The aim of this study was to investigate hygiene in equine dentistry. Dental equipment and the head support, where horses rest their head during dental care, were sampled for the amount of bacteria between each patient before and after dental care as well as after cleaning and/or disinfecting. The amount of bacteria was, in general, high on dental equipment and the head support after dental procedures. Bacteria were found in different amounts on most of the dental equipment after cleaning or disinfecting, which indicates a risk for spreading infections when using the equipment. For the head support, cleaning and/or disinfecting generally resulted in a reduced amount of bacteria, indicating a lowered risk for spreading infections. There is a great need for evidence-based guidelines on hygiene in equine dentistry to decrease the risk of transmitting infections between patients, facilities, and stables. Abstract Equine dentistry has developed immensely and human dental equipment, such as handpieces, are often used. Measures to avoid the spread of infectious microorganisms are important, but this is challenging since handpieces are difficult to decontaminate. Thus, it is necessary to develop effective IPC measures in equine dentistry. The aim of this study was to contribute to the evidence needed for future evidence-based guidelines on IPC by investigating hygiene in equine dentistry. Used handpieces and dummies (i.e., handpieces not used during dental procedure, reflecting environmental bacterial contamination) and the head support were sampled each day before the first patient, for each patient after treatment, and after decontamination. All equipment was sampled with 3M TM Swab Samplers and the head support additionally sampled with dip slides. After dental procedures, the detected bacterial load was often high on used handpieces, dummies, and the head support. After decontamination, handpieces did not meet the criteria for high-level disinfected equipment. In all but one case decontamination of the head support resulted in a lowered bacterial load. There is a great need for evidence-based guidelines on hygiene in equine dentistry, including IPC measures, to decrease the risk of spreading infectious microorganisms between patients, facilities, and stables.
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Affiliation(s)
- Todd Alsing-Johansson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, 750 07 Uppsala, Sweden; (A.P.); (J.P.); (A.B.)
- Correspondence:
| | - Anja Pedersen
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, 750 07 Uppsala, Sweden; (A.P.); (J.P.); (A.B.)
| | - Karin Bergström
- Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute, 751 89 Uppsala, Sweden;
| | - Susanna Sternberg-Lewerin
- Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, 750 07 Uppsala, Sweden;
| | - Johanna Penell
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, 750 07 Uppsala, Sweden; (A.P.); (J.P.); (A.B.)
| | - Anna Bergh
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, 750 07 Uppsala, Sweden; (A.P.); (J.P.); (A.B.)
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Hoogenkamp MA, Brandt BW, Laheij AMGA, de Soet JJ, Crielaard W. The microbiological load and microbiome of the Dutch dental unit; 'please, hold your breath'. WATER RESEARCH 2021; 200:117205. [PMID: 34058484 DOI: 10.1016/j.watres.2021.117205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
Dental unit water systems are prone to biofilm formation. During use of the dental unit, clumps of biofilm slough off and can subsequently be aerosolized and inhaled by both patient and staff, potentially causing infections. The aim of this study was to determine the microbial load and microbiome of dental unit water, in the Netherlands, and the factors influencing these parameters. In total, 226 dental units were sampled and heterotrophic plate counts (HPC) were determined on the traditional effluent sample. Of all dental units, 61% exceeded the recommended microbiological guidelines of 100 colony forming units per milliliter. In addition, the microbiome, with additional q-PCR analysis for specific species, was determined on an effluent sample taken immediately after an overnight stagnancy period, in which the biofilm is in its relaxed state. These relaxed biofilm samples showed that each dental unit had a unique microbiome. Legionella spp., amoeba and fungi were found in 71%, 43% and 98% of all units, respectively. The presence of amoeba was positively associated with nine bacterial biomarkers and correlated positively with bacterial and fungal DNA and Legionella spp. concentrations, but not with HPC. Only when adhering to disinfection protocols, statistically significant effects on the microbial load and microbiome were seen. The relaxed biofilm sample, in combination with molecular techniques gives better insight in the presence of opportunistic pathogens when compared to the heterotrophic plate counts. Infection control measures should focus on biofilm analysis and control in order to guarantee patient safety.
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Affiliation(s)
- Michel A Hoogenkamp
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Bernd W Brandt
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alexa M G A Laheij
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Johannes J de Soet
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Wim Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Offner D, Musset AM. An Evaluation of Two Systems for the Management of the Microbiological Quality of Water in Dental Unit Waterlines: Hygowater ® and IGN Calbénium ®. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5477. [PMID: 34065424 PMCID: PMC8161129 DOI: 10.3390/ijerph18105477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/27/2022]
Abstract
Water in dental unit waterlines (DUWL) represents a risk for vulnerable patients if its microbiological quality is not controlled. The aim of this prospective study was to evaluate two systems for its management under real conditions: Hygowater® and IGN Calbenium®. Samples of the output water of DUWL were obtained for 5 previously contaminated units connected to Hygowater®, and 5 non-contaminated units connected to IGN Calbenium®, which was already effective for more than 1 year, as a control group. Samples were regularly collected up to 6 months after the implementation of Hygowater®, and were then cultured and analyzed. With IGN Calbenium®, except for a technical problem and a sample result in one unit at 6 months (Heterotrophic Plate Count (HPC) at 37 °C of 66 colony forming units (cfu)/mL), the results showed an absence of contamination. Hygowater® took a couple of weeks to be effective on initially contaminated DUWL (over 200 cfu/mL for all the units), then showed its efficacy for 2 months (HPC at 37 °C with a mean of 40.2 ufc/mL, and HPC at 22 °C with a mean of 0.2 ufc/mL). At 6 months, results were satisfactory for HPC at 22 °C (mean of 12 ufc/mL), but HPC at 37 °C gave non-satisfactory results for 4 of the 5 units (mean of 92.2 ufc/mL). Both systems have an effect on the microbiological quality of DUWL. IGN Calbenium® appears to be more reliable on a long-term basis.
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Affiliation(s)
- Damien Offner
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, F-67000 Strasbourg, France;
- Faculté de Chirurgie Dentaire, Université de Strasbourg, 8 rue Ste Elisabeth, F-67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg (HUS), 1 Place de l’Hôpital, F-67000 Strasbourg, France
| | - Anne-Marie Musset
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, F-67000 Strasbourg, France;
- Faculté de Chirurgie Dentaire, Université de Strasbourg, 8 rue Ste Elisabeth, F-67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg (HUS), 1 Place de l’Hôpital, F-67000 Strasbourg, France
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15
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Pandora's box in the dental clinic. Infect Control Hosp Epidemiol 2021; 43:742-746. [PMID: 34011423 DOI: 10.1017/ice.2021.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In June 2018, the Ministry of Health received notification from 2 hospitals about 2 patients who presented with overwhelming Enterobacter kobei sepsis that developed within 24 hours after a dental procedure. We describe the investigation of this outbreak. METHODS The epidemiologic investigation included site visits in 2 dental clinics and interviews with all involved healthcare workers. Chart reviews were conducted for case and control subjects. Samples were taken from medications and antiseptics, environmental surfaces, dental water systems, and from the involved healthcare professionals. Isolate similarity was assessed using repetitive element sequence-based polymerase chain reaction (REP-PCR). RESULTS The 2 procedures were conducted in different dental clinics by different surgeons and dental technicians. A single anesthesiologist administered the systemic anesthetic in both cases. Cultures from medications, fluids and healthcare workers' hands were negative, but E. kobei was detected from the anesthesiologist's portable medication cart. The 2 human isolates and the environmental isolate shared the same REP-PCR fingerprinting profile. None of the 21 patients treated by the anesthesiologist in a general hospital during the same period, using the hospital's medications, developed infection following surgery. CONCLUSIONS An outbreak of post-dental-procedure sepsis was linked to a contaminated medication cart, emphasizing the importance of medication storage standards and strict aseptic technique when preparing intravenous drugs during anesthesia. Immediate reporting of sepsis following these outpatient procedures enabled early identification and termination of the outbreak.
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Scarano A, Inchingolo F, Lorusso F. Environmental Disinfection of a Dental Clinic during the Covid-19 Pandemic: A Narrative Insight. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8896812. [PMID: 33145359 PMCID: PMC7596431 DOI: 10.1155/2020/8896812] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/27/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The control of biological hazard risk in health care and dental clinic environments represents a critical point in relation to the Covid-19 infection outbreak and international public health emergency. The purpose of the present review was to evaluate the scientific literature on the no-touch disinfection procedures in dental clinics aiming to limit transmission via airborne particles or fomites using no-touch procedures for environmental decontamination of dental clinics. METHODS An electronic database literature search was performed to retrieve research papers about Covid-19 and no-touch disinfection topics including full-length articles, editorials, commentaries, and outbreak studies. A total of 86 papers were retrieved by the electronic research. RESULTS No clinical article about the decontamination of a dental clinic during the Covid-19 pandemic was detected. About the topic of hospital decontamination, we found different no-touch disinfection procedures used in hospital against highly resistant organisms, but no data were found in the search for such procedures with respect to SARS-CoV-2: (1) aerosolized hydrogen peroxide, (2) H2O2 vapor, (3) ultraviolet C light, (4) pulsed xenon, and (5) gaseous ozone. One paper was retrieved concerning SARS-CoV-2; 32 documents focused on SARS and MERS. The cleaning and disinfection protocol of health care and dental clinic environment surfaces are essential elements of infection prevention programs, especially during the SARS-CoV-2 pandemic. CONCLUSION The decontamination technique that best suits the needs of the dental clinic is peroxide and hypochlorous which can be sprayed via a device at high turbine speed with the ability of producing small aerosol particles, recommendable also for their low cost.
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Affiliation(s)
- Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Felice Lorusso
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
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Tuvo B, Totaro M, Cristina ML, Spagnolo AM, Di Cave D, Profeti S, Baggiani A, Privitera G, Casini B. Prevention and Control of Legionella and Pseudomonas spp. Colonization in Dental Units. Pathogens 2020; 9:E305. [PMID: 32326140 PMCID: PMC7238104 DOI: 10.3390/pathogens9040305] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Dental Unit Waterlines (DUWLs) have shown to be a source of Legionella infection. We report the experience of different dental healthcare settings where a risk management plan was implemented. Materials and methods: In a Hospital Odontostomatology Clinic (HOC) and three Private Dental Clinics (PDCs) housing 13 and six dental units (DUs), respectively, an assessment checklist was applied to evaluate staff compliance with guideline recommendations. DUWLs microbial parameters were investigated before and after the application of corrective actions. Results: In the HOC a poor adherence to good practices was demonstrated, whereas protocols were carefully applied in PDCs. L. pneumophila sg 2-15 was isolated in 31% (4/13) and 33% (2/6) of DUs in HOC and PDCs, respectively, mainly from handpieces (32%, 6/19) with counts >102 colony-forming units per milliliter (CFU/L), often associated with P. aeruginosa (68%, 13/19). The shock disinfection with 3% v/v hydrogen peroxide (HP) showed a limited effect, with a recolonization period of about 4 weeks. Legionella was eradicated only after 6% v/v HP shock disinfection and filters-installation, whilst P. aeruginosa after the third shock disinfection with a solution of 4% v/v HP and biodegradable surfactants. Conclusions: Our data demonstrate the presence and persistence of microbial contamination within the DUWLs, which required strict adherence to control measures and the choice of effective disinfectants.
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Affiliation(s)
- Benedetta Tuvo
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Michele Totaro
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (A.M.S.)
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (A.M.S.)
| | - David Di Cave
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Sara Profeti
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Angelo Baggiani
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Gaetano Privitera
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Beatrice Casini
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
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Efficacy of BRS ® and Alpron ®/Bilpron ® Disinfectants for Dental Unit Waterlines: A Six-Year Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082634. [PMID: 32290533 PMCID: PMC7215904 DOI: 10.3390/ijerph17082634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/07/2020] [Accepted: 04/10/2020] [Indexed: 01/26/2023]
Abstract
Biofilms in dental unit waterlines (DUWL) are a potentially significant source of contamination posing a significant health risk as these may come into contact with patients and dental staff during treatment. The aim of this study was to evaluate the microbiological quality of DUWL water treated by Biofilm-Removing-System® (BRS®) and Alpron®/Bilpron® disinfectant solutions for six years in a French university hospital. The microbiological quality of water supplied by 68 dental units—initially shock treated with BRS®, then continuously treated by Alpron® with sterile water during working days and Bilpron® during inactivity period, and combined with purging every morning and after each patient—was assessed biannually during six years for total culturable aerobic bacteria at 22 °C and 36 °C, Legionella sp., Pseudomonas aeruginosa, and total coliforms. A total of 628 samples were analyzed, 99.8% were compliant with extended microbiological levels, and we never detected pathogen bacteria like Legionella sp. and P. aeruginosa. Only one sample (0.2%) was noncompliant with the level of total culturable aerobic bacteria at 36 °C, which exceeded 140 colony forming units per mL. The protocol implemented in our university hospital gives excellent results and enables control of the microbiological quality of DUWL water in the long term.
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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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20
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Jovanović M. Bioaerosol in dental prosthodontics. ACTA STOMATOLOGICA NAISSI 2020. [DOI: 10.5937/asn2082106j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introdution: During many dental interventions, performed using handpiece instruments and pusters, an aerosol is created,which is converted into a bioaerosol (BIOA) by mixing with the particles of various organic components from the patient's oral cavity.When the high-speed mashine is started, the air becomes instantly contaminated and practically covers the entire room. Pollution is registered all the times, as well as after prosthetic treatment. BIOA created during prosthetic workcontains various bacteria, fungi and viruses from the patient's oral cavity. These microorganisms pose a real hazard to health workers and are a potential risk for infection. The most common pathogens include influenza viruses, herpes viruses, as well as pathogenic streptococci and staphylococci. Infectious diseases, biosynosis, acute toxic reactions, allergies, atopic diseases, conjunctivitis, contact dermatitis, infections of the respiratory system, and even some types of cancer, are possible manifestations of side effects of BIOA. Conclusion:BIOA poses a potential danger to contamination of air, work surfaces and objects in dental offices. Direct and indirect exposure of dental staff and patients to BIOA is especially pronounced in the conditions of COVID 19. Although it is impossible to completely eliminate the risk of adverse effects of BIOA, it is important to pay attention to all prevention measures that can reduce the likelihood of contamination.
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Baudet A, Lizon J, Martrette JM, Camelot F, Florentin A, Clément C. Dental Unit Waterlines: A Survey of Practices in Eastern France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4242. [PMID: 31683783 PMCID: PMC6862618 DOI: 10.3390/ijerph16214242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/24/2019] [Accepted: 10/30/2019] [Indexed: 11/16/2022]
Abstract
Water is essential during dental care. Physical and chemical techniques should be used to maintain a good water quality with respect to bacteria, and to ensure the safety of exposed patients and dental staff. The aim of this survey was to assess the modalities used by dental practitioners in Eastern France to maintain the water quality of their dental unit waterlines (DUWLs). A questionnaire about water quality maintenance practices was sent to 870 dental offices in 2016. The questionnaires were completed by 153 dental offices, covering about 223 dental care units. The majority of units were fed by mains water (91.0%), which is generally unfiltered (71.3%). One-third (33.6%) of the units had an independent water bottle reservoir. Flushing, a basic physical technique to improve the quality of units' outflow water, was practiced in 65.4% of dental offices. Concerning the chemical treatment of water, it was used for 62.1% of the units. An analysis of the microbiological quality of the DUWL water was only carried out in 2.6% of the offices. In conclusion, providing better training to dental staff seems necessary to improve their practices and to generalize procedures that improve the microbiological quality of the water used.
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Affiliation(s)
- Alexandre Baudet
- Faculty of Dentistry, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France.
- Department of Dentistry, University Hospital, 54000 Nancy, France.
| | - Julie Lizon
- Department of Hygiene and Environmental Analysis, University Hospital, 54505 Vandœuvre-lès-Nancy, France.
| | - Jean-Marc Martrette
- Faculty of Dentistry, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France.
- Department of Dentistry, University Hospital, 54000 Nancy, France.
- EA 3450 DevAH, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France.
| | | | - Arnaud Florentin
- Department of Hygiene and Environmental Analysis, University Hospital, 54505 Vandœuvre-lès-Nancy, France.
- Faculty of Medicine, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France.
- EA 4360 APEMAC, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France.
| | - Céline Clément
- Faculty of Dentistry, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France.
- Department of Dentistry, University Hospital, 54000 Nancy, France.
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Montagna MT, Rutigliano S, Trerotoli P, Napoli C, Apollonio F, D'Amico A, De Giglio O, Diella G, Lopuzzo M, Marzella A, Mascipinto S, Pousis C, Albertini R, Pasquarella C, D'Alessandro D, Serio G, Caggiano G. Evaluation of Air Contamination in Orthopaedic Operating Theatres in Hospitals in Southern Italy: The IMPACT Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193581. [PMID: 31557819 PMCID: PMC6801961 DOI: 10.3390/ijerph16193581] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/24/2022]
Abstract
Postoperative infections are a concern, especially in total knee and total hip arthroplasty. We evaluated the air quality in orthopaedic operating theatres in southeastern Italy to determine the level of bacterial contamination as a risk factor for postoperative infection. Thirty-five hospitals with operating theatres focused on total knee and total hip arthroplasty participated. We sampled the air passively and actively before surgeries began for the day (at rest) and 15 min after the surgical incision (in operation). We evaluated bacterial counts, particle size, mixed vs turbulent airflow systems, the number of doors, number of door openings during procedures and number of people in the operating theatre. We found no bacterial contamination at rest for all sampling methods, and significantly different contamination levels at rest vs in operation. We found no association between the number of people in the surgical team and bacteria counts for both mixed and turbulent airflow systems, and low bacterial loads, even when doors were always open. Overall, the air quality sampling method and type of ventilation system did not affect air quality.
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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.
| | - Serafina Rutigliano
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Paolo Trerotoli
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Christian Napoli
- Department of Medical and Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, 0189 Rome, Italy.
| | - Francesca Apollonio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Alessandro D'Amico
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
- Department of Civil, Building and Environmental Engineering, "Sapienza" University of Rome, 00184 Rome, Italy.
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Marco Lopuzzo
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Angelo Marzella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Simona Mascipinto
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Chrysovalentinos Pousis
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Roberto Albertini
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy.
| | - Cesira Pasquarella
- Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy.
| | - Daniela D'Alessandro
- Department of Civil, Building and Environmental Engineering, "Sapienza" University of Rome, 00184 Rome, Italy.
| | - Gabriella Serio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Giuseppina Caggiano
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124 Bari, Italy.
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Griciuc A, Patel S, Federico AN, Choi SH, Innes BJ, Oram MK, Cereghetti G, McGinty D, Anselmo A, Sadreyev RI, Hickman SE, El Khoury J, Colonna M, Tanzi RE. TREM2 Acts Downstream of CD33 in Modulating Microglial Pathology in Alzheimer's Disease. Neuron 2019; 103:820-835.e7. [PMID: 31301936 DOI: 10.1016/j.neuron.2019.06.010] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 05/15/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022]
Abstract
The microglial receptors CD33 and TREM2 have been associated with risk for Alzheimer's disease (AD). Here, we investigated crosstalk between CD33 and TREM2. We showed that knockout of CD33 attenuated amyloid beta (Aβ) pathology and improved cognition in 5xFAD mice, both of which were abrogated by additional TREM2 knockout. Knocking out TREM2 in 5xFAD mice exacerbated Aβ pathology and neurodegeneration but reduced Iba1+ cell numbers, all of which could not be rescued by additional CD33 knockout. RNA-seq profiling of microglia revealed that genes related to phagocytosis and signaling (IL-6, IL-8, acute phase response) are upregulated in 5xFAD;CD33-/- and downregulated in 5xFAD;TREM2-/- mice. Differential gene expression in 5xFAD;CD33-/- microglia depended on the presence of TREM2, suggesting TREM2 acts downstream of CD33. Crosstalk between CD33 and TREM2 includes regulation of the IL-1β/IL-1RN axis and a gene set in the "receptor activity chemokine" cluster. Our results should facilitate AD therapeutics targeting these receptors.
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Affiliation(s)
- Ana Griciuc
- Genetics and Aging Research Unit, McCance Center for Brain Health, Mass General Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Shaun Patel
- Genetics and Aging Research Unit, McCance Center for Brain Health, Mass General Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Anthony N Federico
- Genetics and Aging Research Unit, McCance Center for Brain Health, Mass General Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Se Hoon Choi
- Genetics and Aging Research Unit, McCance Center for Brain Health, Mass General Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Brendan J Innes
- Genetics and Aging Research Unit, McCance Center for Brain Health, Mass General Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Mary K Oram
- Genetics and Aging Research Unit, McCance Center for Brain Health, Mass General Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Gea Cereghetti
- Genetics and Aging Research Unit, McCance Center for Brain Health, Mass General Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA; Institute of Biochemistry, Department of Biology, ETH Zürich, 8093 Zürich, Switzerland
| | - Danielle McGinty
- Genetics and Aging Research Unit, McCance Center for Brain Health, Mass General Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Anthony Anselmo
- Department of Molecular Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Ruslan I Sadreyev
- Department of Molecular Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Suzanne E Hickman
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Joseph El Khoury
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Marco Colonna
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rudolph E Tanzi
- Genetics and Aging Research Unit, McCance Center for Brain Health, Mass General Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA.
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Gawish S, Abbass A, Abaza A. Occurrence and biofilm forming ability of Pseudomonas aeruginosa in the water output of dental unit waterlines in a dental center in Alexandria, Egypt. Germs 2019; 9:71-80. [PMID: 31341834 DOI: 10.18683/germs.2019.1160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/13/2019] [Accepted: 05/23/2019] [Indexed: 11/08/2022]
Abstract
Introduction Dental unit waterlines (DUWLs) are notorious for being contaminated with different bacterial species including the opportunistic pathogen Pseudomonas aeruginosa which poses a risk to patients and professionals. This work aimed at studying the occurrence and biofilm-forming ability (BFA) of P. aeruginosa in the output of DUWLs in a dental center in Egypt. Methods Water samples were collected from the outlets of the high-speed hand piece, the air/water syringe and the cup filler waterlines. Bacteriological analysis included heterotrophic plate count (HPC), isolation and identification of P. aeruginosa and determination of the antimicrobial susceptibility and the BFA of the isolates by tissue culture plate (TCP) method and tube method (TM). Results The average concentration of HPC bacteria in the output of the 3 DUWLs was 2.9×104 CFU/μL where 88.3% of the samples exceeded the Egyptian standards for drinking water (<50 CFU L). P. aeruginosa was isolated from nine cup filler samples (which had a water source different from the other waterlines). The isolates were sensitive to all tested antimicrobials. Of these nine isolates, 6, 5 and 4 were positive for BFA by TCP, modified TCP and TM, respectively. Conclusions More stringent measures are required to ensure safer dental water; as the majority of studied samples exceeded the required HPC bacterial limit and P. aeruginosa isolates were detected. P. aeruginosa isolates from DUWLs may not be as resistant to antibiotics as what is reported in the literature about clinical isolates. Some P. aeruginosa isolates can colonize DUWLs despite their inability to form biofilms in experimental testing.
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Affiliation(s)
- Sheref Gawish
- MSc Microbiology, Microbiology Department, High Institute of Public Health, Alexandria University, 165 El Horreya Avenue, Alexandria, Egypt
| | - Aleya Abbass
- PhD, Professor of Microbiology, Microbiology Department, High Institute of Public Health, Alexandria University, 165 El Horreya Avenue, Alexandria, Egypt
| | - Amani Abaza
- PhD, Professor of Microbiology, Microbiology Department, High Institute of Public Health, Alexandria University, 165 El Horreya Avenue, Alexandria, Egypt
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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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26
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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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Torre I, Alfano R, Borriello T, De Giglio O, Iervolino C, Montagna MT, Scamardo MS, Pennino F. Environmental surveillance and in vitro activity of antimicrobial agents against Legionella pneumophila isolated from hospital water systems in Campania, South Italy: a 5-year study. ENVIRONMENTAL RESEARCH 2018; 164:574-579. [PMID: 29625340 DOI: 10.1016/j.envres.2018.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/26/2018] [Accepted: 02/21/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Legionellosis' treatment failures have been recently reported showing the possibility of resistance development to traditional therapy, especially in healthcare related disease cases. Environmental impact of antibiotic residues, especially in hospital waters, may act on the resistome of Legionella resulting in developing resistance mechanisms. OBJECTIVES In this study we investigate the antibiotic susceptibility of environmental Legionella pneumophila (Lpn) strains isolated from hospital water systems in Campania, a region located in Southwest Italy. METHODS 5321 hospital water samples were investigated for the presence of Lpn. Among positive samples, antibiotic susceptibility was tested for a random subset of 125 Lpn strains (25 Lpn isolates from each of the following serogroups: 1, 3, 5, 6, 8). Susceptibility testing was performed, using the E-test on buffered charcoal yeast extract agar supplemented with α-ketoglutarate, for 10 antimicrobial drugs: azithromycin, cefotaxime, clarithromycin, doxycycline, erythromycin, rifampicin, tigecycline, ciprofloxacin, levofloxacin and moxifloxacin. Non parametric tests were used to determine and assess the significant differences in susceptibility to the different antimicrobics between the serogroups. RESULTS Among the isolated strains, none showed resistance to the antibiotics tested. Rifampicin was the most active antibiotic against overall Legionella strains, followed by levofloxacin. Between the macrolides the clarithromycin was overall the most active drug, instead the azithromycin was the less active. Analyzing the different serogroups a significant difference was found between serogroup 1 and non-1 serogroup isolates for doxycycline and tigecycline. CONCLUSIONS Antibiotic susceptibility of environmental isolates of Legionella spp. might be useful for the early detection of resistance to antibiotics that directly impacts on mortality and length of hospital stay.
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Affiliation(s)
- Ida Torre
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy.
| | - Rossella Alfano
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Tonia Borriello
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Italy
| | - Carmela Iervolino
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Italy
| | - Marina Silvia Scamardo
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Francesca Pennino
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
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28
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Petti S, Vitali M. Occupational risk for Legionella infection among dental healthcare workers: meta-analysis in occupational epidemiology. BMJ Open 2017; 7:e015374. [PMID: 28710211 PMCID: PMC5734417 DOI: 10.1136/bmjopen-2016-015374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The occupational risk for Legionella infection among dental healthcare workers (DHCWs) is conjectured because of the risk of routine inhalation of potentially contaminated aerosols produced by the dental instruments. Nevertheless, occupational epidemiology studies are contrasting. This meta-analysis assessed the level of scientific evidence regarding the relative occupational risk for Legionella infection among DHCWs. METHODS Literature search was performed without time and language restrictions, using broad data banks (PubMed, Scopus, Web of Science, GOOGLE Scholar) and generic keywords ('legionella' AND 'dent*'). Analytical cross-sectional studies comparing prevalence of high serum Legionella antibody levels in DHCWs and occupationally unexposed individuals were considered. The relative occupational risk was assessed through prevalence ratio (PR) with 95% CI. Between-study heterogeneity was assessed (Cochran's Q test) and was used to choose the meta-analytic method. Study quality (modified Newcastle-Ottawa Scale) and publication bias (Begg and Mazumdar's test, Egger and colleagues' test, trim and fill R0 method) were assessed formally and considered for the sensitivity analysis. Sensitivity analysis to study inclusion, subgroup analyses (dental staff categories; publication year, before vs after 1998, ie, 5 years after the release by the Centers for Disease Control and Prevention of the infection control guidelines in dental healthcare setting) were performed. RESULTS Seven studies were included (2232 DHCWs, 1172 occupationally unexposed individuals). No evidence of publication bias was detected. The pooled PR estimate was statistically non-significant at 95% level (1.7; 95% CI 0.8 to 3.2), study-quality adjustment did not change the PR considerably (PR, 1.5; 95% CI 0.5 to 4.1). PR was statistically significant before 1998 and no longer significant after 1998. Subgroup analysis according to DHCW categories was inconclusive. CONCLUSIONS There is no scientific evidence that DHCWs are at high occupational risk. The differences between former and recent studies could be due to different characteristics of municipal water systems and the infection control guideline dissemination.
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Affiliation(s)
- Stefano Petti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, 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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Zemouri C, de Soet H, Crielaard W, Laheij A. A scoping review on bio-aerosols in healthcare and the dental environment. PLoS One 2017; 12:e0178007. [PMID: 28531183 PMCID: PMC5439730 DOI: 10.1371/journal.pone.0178007] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/06/2017] [Indexed: 01/16/2023] Open
Abstract
Background Bio-aerosols originate from different sources and their potentially pathogenic nature may form a hazard to healthcare workers and patients. So far no extensive review on existing evidence regarding bio-aerosols is available. Objectives This study aimed to review evidence on bio-aerosols in healthcare and the dental setting. The objectives were 1) What are the sources that generate bio-aerosols?; 2) What is the microbial load and composition of bio-aerosols and how were they measured?; and 3) What is the hazard posed by pathogenic micro-organisms transported via the aerosol route of transmission? Methods Systematic scoping review design. Searched in PubMed and EMBASE from inception to 09-03-2016. References were screened and selected based on abstract and full text according to eligibility criteria. Full text articles were assessed for inclusion and summarized. The results are presented in three separate objectives and summarized for an overview of evidence. Results The search yielded 5,823 studies, of which 62 were included. Dental hand pieces were found to generate aerosols in the dental settings. Another 30 sources from human activities, interventions and daily cleaning performances in the hospital also generate aerosols. Fifty-five bacterial species, 45 fungi genera and ten viruses were identified in a hospital setting and 16 bacterial and 23 fungal species in the dental environment. Patients with certain risk factors had a higher chance to acquire Legionella in hospitals. Such infections can lead to irreversible septic shock and death. Only a few studies found that bio-aerosol generating procedures resulted in transmission of infectious diseases or allergic reactions. Conclusion Bio-aerosols are generated via multiple sources such as different interventions, instruments and human activity. Bio-aerosols compositions reported are heterogeneous in their microbiological composition dependent on the setting and methodology. Legionella species were found to be a bio-aerosol dependent hazard to elderly and patients with respiratory complaints. But all aerosols can be can be hazardous to both patients and healthcare workers.
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Affiliation(s)
- Charifa Zemouri
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Hans de Soet
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wim Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexa Laheij
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Affiliation(s)
- Hajime Kanamori
- Hospital Epidemiology, University of North Carolina Health Care Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill
| | - David J Weber
- Hospital Epidemiology, University of North Carolina Health Care Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill
| | - William A Rutala
- Hospital Epidemiology, University of North Carolina Health Care Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill
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Montagna MT, Cristina ML, De Giglio O, Spagnolo AM, Napoli C, Cannova L, Deriu MG, Delia SA, Giuliano A, Guida M, Laganà P, Liguori G, Mura I, Pennino F, Rossini A, Tardivo S, Torre I, Torregrossa MV, Villafrate MR, Albertini R, Pasquarella C. Serological and molecular identification of Legionella spp. isolated from water and surrounding air samples in Italian healthcare facilities. ENVIRONMENTAL RESEARCH 2016; 146:47-50. [PMID: 26717079 DOI: 10.1016/j.envres.2015.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/13/2015] [Accepted: 12/14/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Legionella is an intracellular microorganism living in natural and artificial aquatic environments. Although its transmission to humans is linked to the inhalation of contaminated aerosols, there is no validated air sampling method for the control and prevention of the disease. The aim of the present study was to provide more information on the distribution of Legionella spp. in indoor environments and to determine whether the same Legionella strains are isolated from air and water samples. METHODS Ten healthcare facilities located in seven regions of Italy were enrolled. The serological typing of Legionella spp. from water samples and the surrounding air by active and passive sampling was assessed using polyvalent and monovalent antisera. Subsequently, the strains identified as Legionella pneumophila (Lpn) underwent molecular typing by sequence-based typing (SBT) using seven genes (flaA, pilE, asd, mip, mompS, proA, and neuA). The allelic profile number was assigned using the European Working Group for Legionella Infections-SBT database. RESULTS Lpn serogroup 6 was the most prevalent serogroup; it was found simultaneously in the air and water samples of three different healthcare facilities. In the remaining seven hospitals, Lpn serogroups 1, 6, 7, 9, and 12 were isolated exclusively from water samples. The molecular investigation showed that Lpn strains in the water and air samples of each positive healthcare facility had the same allelic profile. Strains, identified as sequence types (STs) 728 and ST 1638+ST 1324, were isolated in two respective healthcare facilities, and a new strain, identified as ST 1989, was obtained in one healthcare facility. CONCLUSION The application of the SBT method allowed to verify the homology among Legionella strains from water samples and the surrounding air. The results showed that the same Lpn strains were present in the air and water samples, and a new Legionella strain was identified.
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Affiliation(s)
- Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology - Hygiene Section, University of Bari, Bari, Italy.
| | | | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology - Hygiene Section, University of Bari, Bari, Italy
| | | | - Christian Napoli
- Department of Biomedical Science and Human Oncology - Hygiene Section, University of Bari, Bari, Italy
| | - Lucia Cannova
- Department of Sciences for Health Promotion - Hygiene Section, University of Palermo, Palermo, Italy
| | - Maria Grazia Deriu
- Department of Biomedical Science - Hygiene Section, University of Sassari, Sassari, Italy
| | - Santi Antonino Delia
- Department of Biomedical Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Ada Giuliano
- Department of Prevention Services of Hygiene and Public Health, ASL Salerno, Salerno, Italy
| | - Marco Guida
- Department of Biology, University of Napoli "Federico II", Napoli, Italy
| | - Pasqualina Laganà
- Department of Biomedical Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Giorgio Liguori
- Department of Movement and Health Sciences, University "Parthenope", Napoli, Italy
| | - Ida Mura
- Department of Biomedical Science - Hygiene Section, University of Sassari, Sassari, Italy
| | | | | | - Stefano Tardivo
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Ida Torre
- Department of Public Health, University of Napoli, Napoli, Italy
| | - Maria Valeria Torregrossa
- Department of Sciences for Health Promotion - Hygiene Section, University of Palermo, Palermo, Italy
| | | | - Roberto Albertini
- Department of Clinical and Experimental Medicine, University of Parma, U.O. Medical Immunology, University Hospital of Parma, Italy
| | - Cesira Pasquarella
- Department of Biomedical, Biotechnological and Translation Sciences, University of Parma, 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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De Giglio O, Napoli C, Lovero G, Diella G, Rutigliano S, Caggiano G, Montagna MT. Antibiotic susceptibility of Legionella pneumophila strains isolated from hospital water systems in Southern Italy. ENVIRONMENTAL RESEARCH 2015; 142:586-90. [PMID: 26298602 DOI: 10.1016/j.envres.2015.08.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 05/04/2023]
Abstract
OBJECTIVES The purpose of this study was to describe the susceptibility of environmental strains of Legionella spp. to 10 antimicrobials commonly used for legionellosis therapy. A study of environmental strains could be useful to timely predict the onset of antibiotic resistance in the environment before it is evidenced in clinical specimens. METHODS The minimum inhibitory concentrations (MICs) of 100 environmental Legionella pneumophila (Lpn) strains belonging to serogroups (sgs) 1, 6, 8, and 10 were tested using the E-test methodology on buffered charcoal yeast extract agar supplemented with α-ketoglutarate. The most frequent sgs were selected from those obtained during microbiological surveillance conducted in 2014 in a hospital in Southern Italy. The MICs were read after 2 days of incubation at 35 °C in a humidified atmosphere without CO2. RESULTS All isolates were inhibited by low concentrations of fluoroquinolones and macrolides. Rifampicin was the most active drug against the isolates in vitro. All Lpn isolates were inhibited by the following drugs (in decreasing order of their MICs): doxycycline>tigecycline>cefotaxime. The MICs of azithromycin, ciprofloxacin, levofloxacin, moxifloxacin, and tigecycline were significantly lower for Lpn non-sg 1 than Lpn sg 1 isolates. CONCLUSIONS Susceptibility testing of Legionella strains to appropriate antibiotics should be performed often to evaluate the possible emergence of resistance, to improve the outcomes of patients, and to reduce the direct costs associated with hospitalization.
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Affiliation(s)
- Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Christian Napoli
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Grazia Lovero
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Serafina Rutigliano
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppina Caggiano
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy.
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van Heijnsbergen E, Schalk JAC, Euser SM, Brandsema PS, den Boer JW, de Roda Husman AM. Confirmed and Potential Sources of Legionella Reviewed. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2015; 49:4797-815. [PMID: 25774976 DOI: 10.1021/acs.est.5b00142] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Legionella bacteria are ubiquitous in natural matrices and man-made systems. However, it is not always clear if these reservoirs can act as source of infection resulting in cases of Legionnaires' disease. This review provides an overview of reservoirs of Legionella reported in the literature, other than drinking water distribution systems. Levels of evidence were developed to discriminate between potential and confirmed sources of Legionella. A total of 17 systems and matrices could be classified as confirmed sources of Legionella. Many other man-made systems or natural matrices were not classified as a confirmed source, since either no patients were linked to these reservoirs or the supporting evidence was weak. However, these systems or matrices could play an important role in the transmission of infectious Legionella bacteria; they might not yet be considered in source investigations, resulting in an underestimation of their importance. To optimize source investigations it is important to have knowledge about all the (potential) sources of Legionella. Further research is needed to unravel what the contribution is of each confirmed source, and possibly also potential sources, to the LD disease burden.
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Affiliation(s)
- Eri van Heijnsbergen
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Johanna A C Schalk
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Sjoerd M Euser
- ‡Regional Public Health Laboratory Kennemerland, Haarlem, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
| | - Petra S Brandsema
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Jeroen W den Boer
- ‡Regional Public Health Laboratory Kennemerland, Haarlem, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
| | - Ana Maria de Roda Husman
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
- §Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
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Leoni E, Dallolio L, Stagni F, Sanna T, D'Alessandro G, Piana G. Impact of a risk management plan on Legionella contamination of dental unit water. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:2344-58. [PMID: 25711357 PMCID: PMC4377905 DOI: 10.3390/ijerph120302344] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/13/2015] [Indexed: 11/23/2022]
Abstract
The study aimed to assess the prevalence of Legionella spp. in dental unit waterlines of a dental clinic and to verify whether the microbiological parameters used as indicators of water quality were correlated with Legionella contamination. A risk management plan was subsequently implemented in the dental health care setting, in order to verify whether the adopted disinfection protocols were effective in preventing Legionella colonization. The water delivered from syringes and turbines of 63 dental units operating in a dental clinic, was monitored for counts of the heterotrophic bacteria P. aeruginosa and Legionella spp. (22 °C and 37 °C). At baseline, output water from dental units continuously treated with disinfection products was more compliant with the recommended standards than untreated and periodically treated water. However, continuous disinfection was still not able to prevent contamination by Legionella and P. aeruginosa. Legionella was isolated from 36.4%, 24.3% and 53.3% of samples from untreated, periodically and continuously treated waterlines, respectively. The standard microbiological parameters used as indicators of water quality proved to be unreliable as predictors of the presence of Legionella, whose source was identified as the tap water used to supply the dental units. The adoption of control measures, including the use of deionized water in supplying the dental unit waterlines and the application of a combined protocol of continuous and periodic disinfection, with different active products for the different devices, resulted in good control of Legionella contamination. The efficacy of the measures adopted was mainly linked to the strict adherence to the planned protocols, which placed particular stress on staff training and ongoing environmental monitoring.
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Affiliation(s)
- Erica Leoni
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via San Giacomo 12, 40126, Bologna, Italy.
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via San Giacomo 12, 40126, Bologna, Italy.
| | - Francesca Stagni
- Department of Biomedical and Neuromotor Sciences, Unit of Odontostomatological Sciences, University of Bologna, via San Vitale 59, 40125, Bologna, Italy.
| | - Tiziana Sanna
- Department of Biomedical and Neuromotor Sciences, School of Hygiene and Preventive Medicine, University of Bologna, via San Giacomo 12, 40126, Bologna, Italy.
| | - Giovanni D'Alessandro
- Department of Biomedical and Neuromotor Sciences, Unit of Odontostomatological Sciences, University of Bologna, via San Vitale 59, 40125, Bologna, Italy.
| | - Gabriela Piana
- Department of Biomedical and Neuromotor Sciences, Unit of Odontostomatological Sciences, University of Bologna, via San Vitale 59, 40125, Bologna, Italy.
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Tesauro M, Bollani M, Cesaria M, Ciconali G, Consonni M. Analisi dei requisiti strutturali preventivi e organizzativi delle attività odontoiatriche monospecialistiche (AOM): studio pilota nel territorio milanese. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)30010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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Effect of different disinfection protocols on microbial and biofilm contamination of dental unit waterlines in community dental practices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:2064-76. [PMID: 24552789 PMCID: PMC3945585 DOI: 10.3390/ijerph110202064] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/20/2014] [Accepted: 01/28/2014] [Indexed: 11/17/2022]
Abstract
Output water from dental unit waterlines (DUWLs) may be a potential source of infection for both dental healthcare staff and patients. This study compared the efficacy of different disinfection methods with regard to the water quality and the presence of biofilm in DUWLs. Five dental units operating in a public dental health care setting were selected. The control dental unit had no disinfection system; two were disinfected intermittently with peracetic acid/hydrogen peroxide 0.26% and two underwent continuous disinfection with hydrogen peroxide/silver ions (0.02%) and stabilized chlorine dioxide (0.22%), respectively. After three months of applying the disinfection protocols, continuous disinfection systems were more effective than intermittent systems in reducing the microbial contamination of the water, allowing compliance with the CDC guidelines and the European Council regulatory thresholds for drinking water. P. aeruginosa, Legionella spp, sulphite-reducing Clostridium spores, S. aureus and β-haemolytic streptococci were also absent from units treated with continuous disinfection. The biofilm covering the DUWLs was more extensive, thicker and more friable in the intermittent disinfection dental units than in those with continuous disinfection. Overall, the findings showed that the products used for continuous disinfection of dental unit waterlines showed statistically better results than the intermittent treatment products under the study conditions.
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Evaluation of fungal contamination in operating rooms using a dusting cloth pad: comparison among different sampling methods. Am J Infect Control 2013; 41:658-60. [PMID: 23380381 DOI: 10.1016/j.ajic.2012.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 10/08/2012] [Accepted: 10/09/2012] [Indexed: 11/20/2022]
Abstract
To evaluate microbial contamination in hospitals environments, several methods are available, each one having its limitations. Therefore, the choice of system to use is open. This study compares the ability of a dusting cloth pad (DC pad) with 2 other methods (Rodac contact plate and air sampling) to detect contamination because of filamentous fungi in operating rooms, performing 110 sampling campaigns in hospitals of 3 Italian cities. Overall, 96% of the DC pad samples were positive compared with 51% of Rodac plates (P < .0001) and 35% of air samples (P < .0001). Authors conclude that the DC pad improves the ability to detect an environmental contamination of filamentous fungi.
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