Environmental Surveillance of Legionella spp. in an Italian University Hospital Results of 10 Years of Analysis

One World, One Health: Zoonotic Diseases, Parasitic Diseases, and Infectious Diseases

When we take into account how the boundaries between human, animal, and environmental health are inextricably linked and increasingly intertwined, it comes as no surprise that the One Health approach has assumed an unprecedented level of importance over the past decade [...].

Family Medicine and Primary Healthcare: The Past, Present and Future

As defined by the World Health Organisation in the conference held in Alma Ata, Kazakhstan, in 1978, "Primary health care is essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination" [...].

Environmental Monitoring of Legionella in Hospitals in the Campania Region: A 5-Year Study

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.

Impact of the COVID-19 Pandemic on the Prevalence of HAIs and the Use of Antibiotics in an Italian University Hospital

The COVID-19 pandemic has massively affected healthcare systems globally, causing a possible reduction in attention to traditional infection prevention programs. The objective of this study was to estimate the prevalence of healthcare-associated infections (HAIs) and the use of antimicrobials in an Italian University Hospital and to investigate whether the intensification of hospital infection control measures during the COVID-19 pandemic has affected the prevalence of bacterial HAIs. A point prevalence survey was conducted according to the simplified ECDC protocol. The survey identified a local HAI prevalence of 9.0%, revealing an increase compared to pre-pandemic values (7.3%). The survey also identified an antimicrobial exposure of 40.8%, revealing a decrease in their use compared to the study carried out in the pre-pandemic era (44.6%). Among the organizational challenges experienced during the COVID-19 pandemic, despite the greater attention paid to infection prevention measures aimed at reducing SARS-CoV-2, many healthcare facilities had to contend with the controlled availability of personnel, physical space limitations and a large number of patients. Active surveillance in hospital wards and the consequent reporting by personnel specialized in infection control is fundamental for hospitals to recognize gaps in prevention and report any observed increases in HAIs.

The revised European Directive 2020/2184 on the quality of water intended for human consumption. A step forward in risk assessment, consumer safety and informative communication

Water is an indispensable element for humankind and indeed all living beings; as such it is essential that it be supplied in adherence with safety and security criteria so as to fulfill its primordial role in community development. Therefore, the European Union has issued a new Directive on drinking water, updating the previous one (98/83/EC). The main new features of the updated Directive issued on January 12, 2021 include: • The adoption of a risk-based approach, in accordance with the principles of the Water Safety Plan, along the entire supply chain including the domestic system from the meter to the tap; • The updating of some quality standards, mainly related to the introduction of new parameters and the modification of parameter values for some in a more restrictive sense and for others in more permissive terms; • The identification of possible emerging pollutants present in supply sources (catchment areas); • The demand for effective and transparent communication to citizens on the quality of the water supplied, necessary to foster consumer confidence in the mains water supply. The Directive is the first European legislation adopted following a European Citizens' Initiative (ECI), a European Union participatory democracy tool launched through the "Right2Water" initiative aiming to positively affect the environment. Indeed, the increased consumer confidence in tap water resulting from the desired improvement in communication to citizens should lead to a gradual reduction in the use of plastic water bottles. In addition, the Directive confirms what WHO has been reporting for some time through its Water Safety Plans. It is not limited to monitoring activities but also reproposes and promotes a generalised safety approach based on risk identification and management along the entire drinking water supply chain (from the catchment area to extraction, treatment, storage including distribution). The revised Directive will become the reference standard for the quality of water intended for human consumption in EU countries, and its entry into force will make it possible to minimise the harmful impacts of pollution on human health.

Controlling Infectious Risk in Transfusion: Assessing the Effectiveness of Skin Disinfection in Blood Donors

Bacterial infectious risk is a major problem in transfusion medicine. The type of micro-organisms isolated during bacterial contamination of blood products indicates that the donor’s skin is its main source. In this context, the primary measures to reduce this risk are: (a) optimal disinfection of the donor’s arm and (b) satellite bag diversion of the initial volume of blood collected. This work aimed to verify the effectiveness of skin disinfection of the blood donor’s venipuncture site. Two methodological approaches were used: (a) qualitative and quantitative microbiological testing of the skin at the collection site, before and post-disinfection; (b) qualitative microbiological testing of the first deviated blood. Pre-disinfection testing showed skin microbial load values between 3 and >200 CFU/plate. More than two-thirds of the isolates were Gram-positive bacteria (77.8%) of which 57.7% were staphylococci. Among Gram-negative bacteria, Pseudomonadaceae, Enterobacteriaceae, and Acinetobacter spp. were isolated from the blood donors (BDs). Post-disinfection, a 100% reduction in microbial load was observed in 84.4% of BDs. Microbiological testing of the first blood diverted sample revealed the presence of microbial flora in 1.9% samples; of the isolates, 83.3% were non-aureus staphylococci. This study highlights the importance of the correct application of skin disinfection procedures in order to ensure blood safety.