1
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Exner M, Christiansen B, Cocconi R, Friedrich A, Hartemann P, Heeg P, Heudorf U, llschner C, Kramer A, Merkens W, Oltmanns P, Pitten F, Sonntag HG, Steinhauer K, Tsakris A, Valinteliene R, Voynova-Georgieva V. A European approach to infection prevention and control goals. GMS Hyg Infect Control 2021; 16:Doc29. [PMID: 34956821 PMCID: PMC8662745 DOI: 10.3205/dgkh000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The current pandemic caused by COVID-19 has underlined the importance of a joint effort and approach to ensure patient and health care worker safety in medical care throughout Europe. In addition, the recent flood disasters in Germany and other countries called for immediate joint action, in this case with regard to the prevention of water-borne infections. Environmental disasters will increase with consequences for hospitals and nursing homes. Cooperative efforts are needed for preventing and controlling associated infection outbreaks, new pathogens will appear and a geographic shift of infectious diseases previously not detected in certain areas has already been observed. This approach to infection prevention and control must entail structural as well as regulatory aspects. The principle of equal protection against infections in all European countries must be implemented. Prevention and control of infections, including nosocomial infections, infections caused by antibiotic-resistant bacteria as well as pandemics, need to be based on equal standards in all of Europe. Protection against infections and other public health risks in all European countries is the best guarantor for building trust and identification of citizens in our common Europe. Experts in the fields of hygiene, microbiology, infectiology and epidemiology have to pool the expertise on the prevention and control of infections from different European countries and define key targets for achieving a high standard of hygiene measures throughout Europe. The participants of the Rudolf Schülke Foundation International Symposium call for immediate action and priority to be given to the realization of the proposed 16-point plan.
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Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University Hospital, Bonn, Germany,*To whom correspondence should be addressed: Martin Exner, Universitätsklinikum Bonn, Präventions- und Ausbruchsmanagement/One Health, Venusberg-Campus 1, Gebäude 63, 53127 Bonn, Germany, E-mail:
| | - Bärbel Christiansen
- Department of Internal Hygiene, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Roberto Cocconi
- Azienda Sanitaria, Universitaria Integrata di Undine, Udine, Italy
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Senior Consultant in Hygiene and Infection Control, Ammerbuch, Germany
| | - Ursel Heudorf
- Public Health Department, City of Frankfurt, Frankfurt, Germany
| | - CaroIa llschner
- Institute of Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | | | - Frank Pitten
- IKI - Institut für Krankenhaushygiene & Infektionskontrolle GmbH, Gießen, Germany
| | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Heidelberg, Germany
| | | | - Athanassios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Rolanda Valinteliene
- Visuomenes sveikatos technologiju centro vadove, Higienos institutas, Vilnius, Lithuania
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2
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Exner M, Bhattacharya S, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Ling ML, Merkens W, Oltmanns P, Pitten F, Rotter M, Schmithausen RM, Sonntag HG, Steinhauer K, Trautmann M. Reply to the letter to the editor by R. Papke. GMS Hyg Infect Control 2021; 16:Doc23. [PMID: 34354902 PMCID: PMC8299058 DOI: 10.3205/dgkh000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Moi Lin Ling
- Infection Prevention & Control, Singapore General Hospital, Singapore
| | | | | | - Frank Pitten
- IKI - Institut für Krankenhaushygiene & Infektionskontrolle GmbH, Gießen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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Exner M, Bhattacharya S, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Ling ML, Merkens W, Oltmanns P, Pitten F, Rotter M, Schmithausen RM, Sonntag HG, Steinhauer K, Trautmann M. Chemical disinfection in healthcare settings: critical aspects for the development of global strategies. GMS Hyg Infect Control 2020; 15:Doc36. [PMID: 33520601 PMCID: PMC7818848 DOI: 10.3205/dgkh000371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chemical disinfection is an indispensable means of preventing infection. This holds true for healthcare settings, but also for all other settings where transmission of pathogens poses a potential health risk to humans and/or animals. Research on how to ensure effectiveness of disinfectants and the process of disinfection, as well as on when, how and where to implement disinfection precautions is an ongoing challenge requiring an interdisciplinary team effort. The valuable resources of active substances used for disinfection must be used wisely and their interaction with the target organisms and the environment should be evaluated and monitored closely, if we are to reliable reap the benefits of disinfection in future generations. In view of the global threat of communicable diseases and emerging and re-emerging pathogens and multidrug-resistant pathogens, the relevance of chemical disinfection is continually increasing. Although this consensus paper pinpoints crucial aspects for strategies of chemical disinfection in terms of the properties of disinfectant agents and disinfection practices in a particularly vulnerable group and setting, i.e., patients in healthcare settings, it takes a comprehensive, holistic approach to do justice to the complexity of the topic of disinfection.
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Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Moi Lin Ling
- Infection Prevention & Control, Singapore General Hospital, Singapore
| | | | | | - Frank Pitten
- IKI – Institut für Krankenhaushygiene & Infektionskontrolle GmbH, Gießen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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4
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Setty K, Loret JF, Courtois S, Hammer CC, Hartemann P, Lafforgue M, Litrico X, Manasfi T, Medema G, Shaheen M, Tesson V, Bartram J. Faster and safer: Research priorities in water and health. Int J Hyg Environ Health 2019; 222:593-606. [PMID: 30910612 PMCID: PMC6545151 DOI: 10.1016/j.ijheh.2019.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 11/22/2022]
Abstract
The United Nations' Sustainable Development Goals initiated in 2016 reiterated the need for safe water and healthy lives across the globe. The tenth anniversary meeting of the International Water and Health Seminar in 2018 brought together experts, students, and practitioners, setting the stage for development of an inclusive and evidence-based research agenda on water and health. Data collection relied on a nominal group technique gathering perceived research priorities as well as underlying drivers and adaptation needs. Under a common driver of public health protection, primary research priorities included the socioeconomy of water, risk assessment and management, and improved monitoring methods and intelligence. Adaptations stemming from these drivers included translating existing knowledge to providing safe and timely services to support the diversity of human water needs. Our findings present a comprehensive agenda of topics at the forefront of water and health research. This information can frame and inform collective efforts of water and health researchers over the coming decades, contributing to improved water services, public health, and socioeconomic outcomes.
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Affiliation(s)
- Karen Setty
- The Water Institute at University of North Carolina at Chapel Hill, Department of Environmental Sciences and Engineering, 166 Rosenau Hall, CB #7431, Chapel Hill, NC, 27599-7431, USA.
| | - Jean-Francois Loret
- Suez, Centre International de Recherche sur l'Eau et l'Environnement (CIRSEE), 38 rue du President Wilson, 78230, Le Pecq, France.
| | - Sophie Courtois
- Suez, Centre International de Recherche sur l'Eau et l'Environnement (CIRSEE), 38 rue du President Wilson, 78230, Le Pecq, France.
| | - Charlotte Christiane Hammer
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, NR4 7TJ, UK.
| | - Philippe Hartemann
- Université de Lorraine, Faculté de Médecine, EA 7298, ERAMBO, DESP, Vandœuvre-lès-Nancy, France.
| | - Michel Lafforgue
- Suez Consulting, Le Bruyère 2000 - Bâtiment 1, Zone du Millénaire, 650 Rue Henri Becquerel, CS79542, 34961, Montpellier Cedex 2, France.
| | - Xavier Litrico
- Suez, Tour CB21, 16 Place de l'Iris, 92040, Paris La Defense Cedex, France.
| | - Tarek Manasfi
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600, Dübendorf, Switzerland.
| | - Gertjan Medema
- KWR Watercycle Research Institute, Groningenhaven 7, 3433, PE, Nieuwegein, the Netherlands; Delft University of Technology, Stevinweg 1, 2628 CN, Delft, the Netherlands.
| | - Mohamed Shaheen
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
| | - Vincent Tesson
- French National Institute for Agricultural Research (INRA), UMR 1114 EMMAH, 228 route de l'Aérodrome, CS 40 509, 84914, Avignon Cedex 9, France.
| | - Jamie Bartram
- The Water Institute at University of North Carolina at Chapel Hill, Department of Environmental Sciences and Engineering, 166 Rosenau Hall, CB #7431, Chapel Hill, NC, 27599-7431, USA.
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5
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Baars EW, Zoen EBV, Breitkreuz T, Martin D, Matthes H, von Schoen-Angerer T, Soldner G, Vagedes J, van Wietmarschen H, Patijn O, Willcox M, von Flotow P, Teut M, von Ammon K, Thangavelu M, Wolf U, Hummelsberger J, Nicolai T, Hartemann P, Szőke H, McIntyre M, van der Werf ET, Huber R. The Contribution of Complementary and Alternative Medicine to Reduce Antibiotic Use: A Narrative Review of Health Concepts, Prevention, and Treatment Strategies. Evid Based Complement Alternat Med 2019; 2019:5365608. [PMID: 30854009 PMCID: PMC6378062 DOI: 10.1155/2019/5365608] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/23/2018] [Indexed: 12/18/2022]
Abstract
AIM The aim of this narrative review was to explore the potential contributions of CAM to reduce antibiotic use. METHODS We searched PubMed, Embase, and Cochrane Database of Systematic Reviews with a specific, limited set of search terms and collected input from a group of expert CAM researchers to answer the question: What is known about the contribution of CAM health and health promotion concepts, infection prevention, and infection treatment strategies to reduce antibiotic use? Results. The worldview-related CAM health concepts enable health promotion oriented infection prevention and treatment aimed at strengthening or supporting the self-regulating ability of the human organism to cope with diseases. There is some evidence that the CAM concepts of health (promotion) are in agreement with current conceptualization of health and that doctors who practice both CAM and conventional medicine prescribe less antibiotics, although selection bias of the presented studies cannot be ruled out. There is some evidence that prevention and some treatment strategies are effective and safe. Many CAM treatment strategies are promising but overall lack high quality evidence. CONCLUSIONS CAM prevention and treatment strategies may contribute to reducing antibiotic use, but more rigorous research is necessary to provide high quality evidence of (cost-)effectiveness.
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Affiliation(s)
- Erik W. Baars
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | - Eefje Belt-van Zoen
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | | | - David Martin
- University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Harald Matthes
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | | | - Georg Soldner
- Medical section of the Goetheanum, Rüttiweg 45 4143 Dornach, Switzerland
| | - Jan Vagedes
- ARCIM institute, Im Haberschlai 7, 70794 Filderstadt, Germany
| | | | - Olga Patijn
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
| | - Merlin Willcox
- University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Paschen von Flotow
- Sustainable Business Institute, Zehnthofstr. 1, 65375 Oestrich-Winkel, Germany
| | - Michael Teut
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | - Klaus von Ammon
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Madan Thangavelu
- European Ayurveda Association e.V., In den Forstwiesen 27, D- 56745 Bell, Germany
| | - Ursula Wolf
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | | | - Ton Nicolai
- Eurocam, Rue du Trône 194, 1050 Brussels, Belgium
| | - Philippe Hartemann
- University of Lorraine, School of Medicine, 7 avenue de la Forêt de Haye, 54500 Vandoeuvre-Nancy, France
| | - Henrik Szőke
- University of Pécs, 7622 Pécs, Vasvári Pál str. 4., Hungary
| | - Michael McIntyre
- Midsummer Clinic, Church Westcote, Chipping Norton, Oxon, Ox7 6SF, UK
| | - Esther T. van der Werf
- Taylor's University, School of Medicine, 1, Jalan Taylor's, 47500 Subang Jaya, Selangor D.E., Malaysia
- University of Bristol, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Roman Huber
- University of Freiburg, Faculty of Medicine, Breisacher Str. 115b, 79106 Freiburg, Germany
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6
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Caicedo C, Rosenwinkel KH, Exner M, Verstraete W, Suchenwirth R, Hartemann P, Nogueira R. Legionella occurrence in municipal and industrial wastewater treatment plants and risks of reclaimed wastewater reuse: Review. Water Res 2019; 149:21-34. [PMID: 30445393 DOI: 10.1016/j.watres.2018.10.080] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/26/2018] [Accepted: 10/27/2018] [Indexed: 05/22/2023]
Abstract
Wastewater treatment plants (WWTPs) have been identified as confirmed but until today underestimated sources of Legionella, playing an important role in local and community cases and outbreaks of Legionnaires' disease. In general, aerobic biological systems provide an optimum environment for the growth of Legionella due to high organic nitrogen and oxygen concentrations, ideal temperatures and the presence of protozoa. However, few studies have investigated the occurrence of Legionella in WWTPs, and many questions in regards to the interacting factors that promote the proliferation and persistence of Legionella in these treatment systems are still unanswered. This critical review summarizes the current knowledge about Legionella in municipal and industrial WWTPs, the conditions that might support their growth, as well as control strategies that have been applied. Furthermore, an overview of current quantification methods, guidelines and health risks associated with Legionella in reclaimed wastewater is also discussed in depth. A better understanding of the conditions promoting the occurrence of Legionella in WWTPs will contribute to the development of improved wastewater treatment technologies and/or innovative mitigation approaches to minimize future Legionella outbreaks.
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Affiliation(s)
- C Caicedo
- Leibniz University Hannover, Institute for Sanitary Engineering and Waste Management, Hannover, 30167, Germany.
| | - K-H Rosenwinkel
- Leibniz University Hannover, Institute for Sanitary Engineering and Waste Management, Hannover, 30167, Germany
| | - M Exner
- University of Bonn, Institute for Hygiene and Public Health, Bonn, Germany
| | - W Verstraete
- Ghent University, CMET, Ghent, and Avecom, Wondelgem, Belgium
| | - R Suchenwirth
- Public Health Office of Lower Saxony, Hannover, Germany
| | - P Hartemann
- Faculty of Medicine, Department of Environment and Public Health, Nancy University-CHU Nancy, Vandoeuvre Les Nancy, France
| | - R Nogueira
- Leibniz University Hannover, Institute for Sanitary Engineering and Waste Management, Hannover, 30167, Germany.
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7
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Vincent M, Duval RE, Hartemann P, Engels-Deutsch M. Contact killing and antimicrobial properties of copper. J Appl Microbiol 2018; 124:1032-1046. [PMID: 29280540 DOI: 10.1111/jam.13681] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/06/2017] [Accepted: 12/20/2017] [Indexed: 12/15/2022]
Abstract
With the emergence of antibiotic resistance, the interest for antimicrobial agents has recently increased again in public health. Copper was recognized in 2008 by the United States Environmental Protection Agency (EPA) as the first metallic antimicrobial agent. This led to many investigations of the various properties of copper as an antibacterial, antifungal and antiviral agent. This review summarizes the latest findings about 'contact killing', the mechanism of action of copper nanoparticles and the different ways micro-organisms develop resistance to copper.
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Affiliation(s)
- M Vincent
- CNRS, LEMTA, UMR 7563, Vandœuvre-lès-Nancy, France.,Université de Lorraine, LEMTA, UMR 7563, Vandœuvre-lès Nancy, France
| | - R E Duval
- CNRS, UMR 7565, SRSMC, Vandœuvre-lès-Nancy, France.,Université de Lorraine, UMR 7565, SRSMC, Nancy, France.,ABC Platform®, Nancy, France
| | - P Hartemann
- Faculté de Médecine, EA 7298, ERAMBO, DESP, Vandœuvre-lès-Nancy, France
| | - M Engels-Deutsch
- CNRS, LEMTA, UMR 7563, Vandœuvre-lès-Nancy, France.,Université de Lorraine, LEMTA, UMR 7563, Vandœuvre-lès Nancy, France.,Faculté de Médecine, EA 7298, ERAMBO, DESP, Vandœuvre-lès-Nancy, France
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8
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Exner M, Bhattacharya S, Christiansen B, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Larson E, Merkens W, Mielke M, Oltmanns P, Ross B, Rotter M, Schmithausen RM, Sonntag HG, Trautmann M. Antibiotic resistance: What is so special about multidrug-resistant Gram-negative bacteria? GMS Hyg Infect Control 2017; 12:Doc05. [PMID: 28451516 PMCID: PMC5388835 DOI: 10.3205/dgkh000290] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the past years infections caused by multidrug-resistant Gram-negative bacteria have dramatically increased in all parts of the world. This consensus paper is based on presentations, subsequent discussions and an appraisal of current literature by a panel of international experts invited by the Rudolf Schülke Stiftung, Hamburg. It deals with the epidemiology and the inherent properties of Gram-negative bacteria, elucidating the patterns of the spread of antibiotic resistance, highlighting reservoirs as well as transmission pathways and risk factors for infection, mortality, treatment and prevention options as well as the consequences of their prevalence in livestock. Following a global, One Health approach and based on the evaluation of the existing knowledge about these pathogens, this paper gives recommendations for prevention and infection control measures as well as proposals for various target groups to tackle the threats posed by Gram-negative bacteria and prevent the spread and emergence of new antibiotic resistances.
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Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Bärbel Christiansen
- Department of Internal Hygiene, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Elaine Larson
- School of Nursing, Columbia University, New York, USA.,Mailman School of Public Health, Columbia University, New York, USA
| | | | | | | | - Birgit Ross
- Hospital Hygiene, Essen University Hospital, Essen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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9
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Edel-Hermann V, Sautour M, Gautheron N, Laurent J, Aho S, Bonnin A, Sixt N, Hartemann P, Dalle F, Steinberg C. A Clonal Lineage of Fusarium oxysporum Circulates in the Tap Water of Different French Hospitals. Appl Environ Microbiol 2016; 82:6483-6489. [PMID: 27663024 PMCID: PMC5066365 DOI: 10.1128/aem.01939-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/23/2016] [Indexed: 01/03/2023] Open
Abstract
Fusarium oxysporum is typically a soilborne fungus but can also be found in aquatic environments. In hospitals, water distribution systems may be reservoirs for the fungi responsible for nosocomial infections. F. oxysporum was previously detected in the water distribution systems of five French hospitals. Sixty-eight isolates from water representative of all hospital units that were previously sampled and characterized by translation elongation factor 1α sequence typing were subjected to microsatellite analysis and full-length ribosomal intergenic spacer (IGS) sequence typing. All but three isolates shared common microsatellite loci and a common two-locus sequence type (ST). This ST has an international geographical distribution in both the water networks of hospitals and among clinical isolates. The ST dominant in water was not detected among 300 isolates of F. oxysporum that originated from surrounding soils. Further characterization of 15 isolates by vegetative compatibility testing allowed us to conclude that a clonal lineage of F. oxysporum circulates in the tap water of the different hospitals. IMPORTANCE We demonstrated that a clonal lineage of Fusarium oxysporum inhabits the water distribution systems of several French hospitals. This clonal lineage, which appears to be particularly adapted to water networks, represents a potential risk for human infection and raises questions about its worldwide distribution.
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Affiliation(s)
| | - Marc Sautour
- Parasitology and Mycology Laboratory, Plateau Technique de Biologie du CHU, Dijon, France UMR PAM A 02.102 Procédés Alimentaires et Microbiologiques, Université de Bourgogne Franche-Comté, AgroSup Dijon, Dijon, France
| | | | | | - Serge Aho
- Hospital Hygiene and Epidemiology Unit, Hôpital du Bocage, Dijon, France
| | - Alain Bonnin
- Parasitology and Mycology Laboratory, Plateau Technique de Biologie du CHU, Dijon, France UMR PAM A 02.102 Procédés Alimentaires et Microbiologiques, Université de Bourgogne Franche-Comté, AgroSup Dijon, Dijon, France
| | - Nathalie Sixt
- Environmental Microbiology, Plateau Technique de Biologie du CHU, Dijon, France
| | - Philippe Hartemann
- Department Environment and Public Health, Nancy University, Hospital Hygiene Unit, Vandoeuvre-Nancy, France
| | - Frédéric Dalle
- Parasitology and Mycology Laboratory, Plateau Technique de Biologie du CHU, Dijon, France UMR PAM A 02.102 Procédés Alimentaires et Microbiologiques, Université de Bourgogne Franche-Comté, AgroSup Dijon, Dijon, France
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10
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Vincent M, Hartemann P, Engels-Deutsch M. Antimicrobial applications of copper. Int J Hyg Environ Health 2016; 219:585-591. [PMID: 27318723 DOI: 10.1016/j.ijheh.2016.06.003] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/16/2016] [Accepted: 06/02/2016] [Indexed: 01/23/2023]
Abstract
Copper has long been known to have antimicrobial activity and is used in drinking water treatment and transportation. It has been recognized by the American Environmental Protection Agency as the first metallic antimicrobial agent in 2008. With ongoing waterborne hospital-acquired infections and antibiotic resistance, research on copper as an antimicrobial agent is again very attractive. Many studies have shown that the use of copper surface and copper particles could significantly reduce the environmental bioburden. This review highlights in its first part all the conditions described in the literature to enhance copper antimicrobial activity. Secondly, the different antimicrobial applications of copper in water treatment, hospital care units and public applications are presented. Finally, the future research needs on copper as an antimicrobial agent are discussed.
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Affiliation(s)
- Marin Vincent
- CNRS, LEMTA, UMR 7563, Vandœuvre-lès-Nancy F-54500, France; Université de Lorraine, LEMTA, UMR 7563, Vandœuvre-lès-Nancy F-54500, France
| | - Philippe Hartemann
- Université de Lorraine, DESP, Faculté de Médecine, INSERM EA 7298, Vandœuvre-lès-Nancy F-54500, France
| | - Marc Engels-Deutsch
- CNRS, LEMTA, UMR 7563, Vandœuvre-lès-Nancy F-54500, France; Université de Lorraine, LEMTA, UMR 7563, Vandœuvre-lès-Nancy F-54500, France; Université de Lorraine, DESP, Faculté de Médecine, INSERM EA 7298, Vandœuvre-lès-Nancy F-54500, France.
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Mauffrey V, Berger T, Hartemann P, Bouillevaux I. Comment les patients Sourds perçoivent-ils leur prise en charge en médecine générale. Enquête qualitative. Santé Publique 2016. [DOI: 10.3917/spub.162.0213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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12
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Mauffrey V, Berger T, Hartemann P, Bouillevaux I. [Qualitative survey of deaf patients concerning perception of their management by general practitioners]. Sante Publique 2016; 28:213-221. [PMID: 27392056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Doctor-patient communication issues affect general practice consultations of deaf patients. The purpose of this study was to obtain the opinions of deaf patients on the care provided by general practitioners and their expectations in order to suggest possible improvements. METHODS Qualitative research based on semi-structured interviews with ten deaf patients who use sign language and who mostly consult private general practitioners. RESULTS Difficulties were encountered to establish a good quality dialogue between deaf patients and general practitioners. Limited exchanges prevent patients and practitioners from creating a relationship based on trust, without bringing the physicians' skills into question. Problems tended to wane over time and depend on the practitioner's awareness of deaf issues. Deaf patients want to receive care in their own language by means of sign language interpreters or by consulting practitioners who use sign language in a Deaf Patient Reception and Care Unit. They also expect their GP to be able to devote more time to them and to more clearly understand the characteristics of their disability in order to improve their health care. CONCLUSION Although general practitioners' skills are not called into question, the doctor-patient relationship is impaired by communication issues, which have a negative impact on deaf patients' care. This could be improved by strengthening deaf patients' information via public health campaigns, by creating a specific fee in the French medical fee classification related to medical procedures on patients with a sensory disability and by developing tools to facilitate medical consultation.
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Testai E, Hartemann P, Rastogi SC, Bernauer U, Piersma A, De Jong W, Gulliksson H, Sharpe R, Schubert D, Rodríguez-Farre E. The safety of medical devices containing DEHP plasticized PVC or other plasticizers on neonates and other groups possibly at risk (2015 update). Regul Toxicol Pharmacol 2016; 76:209-10. [PMID: 26854686 DOI: 10.1016/j.yrtph.2016.01.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Emanuela Testai
- Member of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR), Luxembourg
| | | | - Philippe Hartemann
- Member of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR), Luxembourg
| | | | - Ulrike Bernauer
- Member of the Scientific Committee on Consumer Safety (SCCS), Luxembourg
| | | | - Wim De Jong
- Member of the SCENIHR Working Group on DEHP, Luxembourg
| | | | | | - Dirk Schubert
- Member of the SCENIHR Working Group on DEHP, Luxembourg
| | - Eduardo Rodríguez-Farre
- Member of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR), Luxembourg
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Testai E, Hartemann P, Rodríguez-Farre E, Rastogi SC, Bustos J, Gundert-Remy U, Hensten A, Kopperud HM, Olea N, Piersma A, De Jong W. The safety of the use of bisphenol A in medical devices. Regul Toxicol Pharmacol 2016; 79:106-107. [PMID: 26851507 DOI: 10.1016/j.yrtph.2016.01.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Emanuela Testai
- Member of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR), Luxembourg
| | | | - Philippe Hartemann
- Member of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR), Luxembourg
| | - Eduardo Rodríguez-Farre
- Member of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR), Luxembourg
| | | | - Juana Bustos
- Member of the SCENIHR Working Group on BPA, Luxembourg
| | | | - Arne Hensten
- Member of the SCENIHR Working Group on BPA, Luxembourg
| | | | - Nicolás Olea
- Member of the SCENIHR Working Group on BPA, Luxembourg
| | | | - Wim De Jong
- Member of the SCENIHR Working Group on BPA, Luxembourg
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Ashbolt N, Loret JF, Hartemann P. The Sixth International Water and Health Seminar, Cannes, France, June 16-18, 2014. Int J Hyg Environ Health 2015; 218:675-6. [PMID: 26431868 DOI: 10.1016/j.ijheh.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Nick Ashbolt
- School of Public Health, University of Alberta, Edmonton, Alberta T6G 2G7, Canada
| | - Jean-François Loret
- Suez Environnement - Tour CB21, 16 Place de l'Iris, 78230 Paris La Defense, France.
| | - Philippe Hartemann
- Department Environment and Public, Health Nancy University, Hospital Hygiene Unit, 9 Avenue de la Forêt de Haye, BP154 54505 Vandoeuvre-les-Nancy Cedex, France
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16
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Hunter PR, Risebro H, Yen M, Lefebvre H, Lo C, Hartemann P, Longuet C, Jaquenoud F. Impact of the Provision of Safe Drinking Water on School Absence Rates in Cambodia: A Quasi-Experimental Study. Ann Nutr Metab 2015; 66 Suppl 3:31-7. [PMID: 26088045 DOI: 10.1159/000381244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Education is one of the most important drivers for helping people in developing countries lift themselves out of poverty. However, even when schooling is available absenteeism rates can be high. Recently, focus is being given on whether or not WASH interventions can help reduce absenteeism in developing countries. However, none has focused exclusively on the role of drinking water provision. We report a study on the association between absenteeism and provision of treated water in containers maintained in schools. METHODS AND FINDINGS We undertook a quasi-experimental longitudinal study of absenteeism rates in 8 schools, 4 of which received one 20 l container of treated drinking water per day. The water had been treated by filtration and ultraviolet disinfection. Weekly absenteeism rates were compared across all schools using the negative binomial model in generalized estimating equations. There was a strong association between the provision of free water and reduced absenteeism (Incidence rate ratio = 0.39 (95% confidence intervals 0.27-0.56)). However, there was also a strong association with season (wet versus dry) and a significant interaction between receiving free water and season. In one of the intervention schools, it was discovered that the water supplier was not fulfilling his contract and was not delivering sufficient water each week. In this school, we showed a significant association between the number of water containers delivered each week and absenteeism (IRR = 0.98 95% CI 0.96-1.00). CONCLUSION There appears to be a strong association between providing free and safe drinking water and reduced absenteeism, although only in the dry season. The mechanism for this association is not clear but may be in part due to improved hydration leading to improved school experience for the children.
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Affiliation(s)
- Paul R Hunter
- Norwich School of Medicine, University of East Anglia, Norwich, United Kingdom
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17
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Fouque E, Héchard Y, Hartemann P, Humeau P, Trouilhé MC. Sensitivity of Vermamoeba (Hartmannella) vermiformis cysts to conventional disinfectants and protease. J Water Health 2015; 13:302-310. [PMID: 26042964 DOI: 10.2166/wh.2014.154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Vermamoeba vermiformis is a free-living amoeba (FLA) widely distributed in the environment, known to colonize hot water networks and to be the reservoir of pathogenic bacteria such as Legionella pneumophila. FLA are partly resistant to biocides, especially in their cyst form. The control of V. vermiformis in hot water networks represents an important health issue, but there are very few data on their resistance to disinfection treatments. The sensitivity of cysts of two strains of V. vermiformis to three disinfectants frequently used in hot water networks (chlorine, heat shock, peracetic acid (PAA) mixed with hydrogen peroxide (H2O2)) was investigated. In vitro, several concentrations of biocides, temperatures and exposure times according to the French regulation were tested. Cysts were fully inactivated by the following conditions: 15 mg/L of chlorine for 10 min; 60 °C for 30 min; and 0.5 g/L equivalent H2O2 of PAA mixed with H2O2 for 30 min. For the first time, the strong efficacy of subtilisin (0.625 U/mL for 24 h), a protease, to inactivate the V. vermiformis cysts has been demonstrated. It suggests that novel approaches may be efficient for disinfection processes. Finally, V. vermifomis cysts were sensitive to all the tested treatments and appeared to be more sensitive than Acanthamoeba cysts.
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Affiliation(s)
- Emilie Fouque
- Scientific and Technical Center for Building, AQUASIM, 11 rue Henri Picherit, BP 82341, 44323 Nantes Cedex 3, France E-mail: ; Université de Poitiers, CNRS UMR 7267, Laboratoire Ecologie et Biologie des Interactions, Equipe Microbiologie de l'Eau, 1 rue Georges Bonnet, BP 633, 86073 Poitiers Cedex 9, France
| | - Yann Héchard
- Université de Poitiers, CNRS UMR 7267, Laboratoire Ecologie et Biologie des Interactions, Equipe Microbiologie de l'Eau, 1 rue Georges Bonnet, BP 633, 86073 Poitiers Cedex 9, France
| | - Philippe Hartemann
- Faculty of Medicine, INSERM INGRES EA 7298, Department of Environment and Public Health, 9 avenue de la Forêt de Haye, BP 184, 59505 Vandœuvre-lès-Nancy Cedex, France
| | - Philippe Humeau
- Scientific and Technical Center for Building, AQUASIM, 11 rue Henri Picherit, BP 82341, 44323 Nantes Cedex 3, France E-mail:
| | - Marie-Cécile Trouilhé
- Scientific and Technical Center for Building, AQUASIM, 11 rue Henri Picherit, BP 82341, 44323 Nantes Cedex 3, France E-mail:
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Sautour M, Edel-Hermann V, Steinberg C, Laurent J, Barbezant M, Sixt N, Aho S, Hartemann P, Bonnin A, Dalle F. Contamination des circuits d’alimentation en eau par Fusarium. J Mycol Med 2015. [DOI: 10.1016/j.mycmed.2015.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sartory DP, Pauly D, Garrec N, Bonadonna L, Semproni M, Schell C, Reimann A, Firth SJ, Thom C, Hartemann P, Exner M, Baldauf H, Lee S, Lee JV. Evaluation of an MPN test for the rapid enumeration of Pseudomonas aeruginosa in hospital waters. J Water Health 2015; 13:427-436. [PMID: 26042975 DOI: 10.2166/wh.2014.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this study, the performance of a new most probable number (MPN) test (Pseudalert(®)/Quanti-Tray(®)) for the enumeration of Pseudomonas aeruginosa from hospital waters was compared with both international and national membrane filtration-based culture methods for P. aeruginosa: ISO 16266:2006 and UK The Microbiology of Drinking Water - Part 8 (MoDW Part 8), which both use Pseudomonas CN agar. The comparison based on the calculation of mean relative differences between the two methods was conducted according to ISO 17994:2014. Using both routine hospital water samples (80 from six laboratories) and artificially contaminated samples (192 from five laboratories), paired counts from each sample and the enumeration method were analysed. For routine samples, there were insufficient data for a conclusive assessment, but the data do indicate at least equivalent performance of Pseudalert(®)/Quanti-Tray(®). For the artificially contaminated samples, the data revealed higher counts of P. aeruginosa being recorded by Pseudalert(®)/Quanti-Tray(®). The Pseudalert(®)/Quanti-Tray(®) method does not require confirmation testing for atypical strains of P. aeruginosa, saving up to 6 days of additional analysis, and has the added advantage of providing confirmed counts within 24-28 hours incubation compared to 40-48 hours or longer for the ISO 16266 and MoDW Part 8 methods.
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Affiliation(s)
- David P Sartory
- SWM Consulting, 7 Sunnybank, Little Ness, Shrewsbury SY4 2LQ, UK E-mail:
| | - Danièle Pauly
- Département Environnement et Santé Publique - INSERM EA 7298 INGRES - Faculté de Médecine, Lorraine University Medical School, Vandoeuvre les Nancy, France
| | - Nathalie Garrec
- Centre Scientifique et Technique du Bâtiment, 11 rue Henri Picherit, BP 82341-44323, Nantes Cedex 3, France
| | - Lucia Bonadonna
- Istituto Superiore di Sanità, Reparto di Microbiologia e Virologia Ambientale e Wellness Dipartimento di Ambiente e Connessa Prevenzione Primaria, Viale Regina Elena 299, Rome 00161, Italy
| | - Maurizio Semproni
- Istituto Superiore di Sanità, Reparto di Microbiologia e Virologia Ambientale e Wellness Dipartimento di Ambiente e Connessa Prevenzione Primaria, Viale Regina Elena 299, Rome 00161, Italy
| | - Christiane Schell
- Hygiene-Institut des Ruhrgebiets, Institut für Umwelthygiene und Toxikologie, Rotthauser Str. 21, Gelsenkirchen 45879, Germany
| | - Annika Reimann
- Hygiene-Institut des Ruhrgebiets, Institut für Umwelthygiene und Toxikologie, Rotthauser Str. 21, Gelsenkirchen 45879, Germany
| | - Susan J Firth
- ALcontrol Laboratories, 7 & 8 Aspen Court, Bessemer Way, Rotherham S60 1FB, UK
| | | | - Philippe Hartemann
- Département Environnement et Santé Publique - INSERM EA 7298 INGRES - Faculté de Médecine, Lorraine University Medical School, Vandoeuvre les Nancy, France
| | - Martin Exner
- Universitätsklinikum Bonn, Institut für Hygiene und Öffentliche Gesundheit, Sigmund-Freud-Straße 25, Bonn 53105, Germany
| | | | - Susanne Lee
- Leegionella Ltd, Edgemoor Cottage, Rockford, Ringwood BH24 3NA, UK
| | - John V Lee
- Leegionella Ltd, Edgemoor Cottage, Rockford, Ringwood BH24 3NA, UK
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Steinberg C, Laurent J, Edel-Hermann V, Barbezant M, Sixt N, Dalle F, Aho S, Bonnin A, Hartemann P, Sautour M. Adaptation of Fusarium oxysporum and Fusarium dimerum to the specific aquatic environment provided by the water systems of hospitals. Water Res 2015; 76:53-65. [PMID: 25792434 DOI: 10.1016/j.watres.2015.02.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/29/2015] [Accepted: 02/19/2015] [Indexed: 06/04/2023]
Abstract
Members of the Fusarium group were recently detected in water distribution systems of several hospitals in the world. An epidemiological investigation was conducted over 2 years in hospital buildings in Dijon and Nancy (France) and in non-hospital buildings in Dijon. The fungi were detected only within the water distribution systems of the hospital buildings and also, but at very low concentrations, in the urban water network of Nancy. All fungi were identified as Fusarium oxysporum species complex (FOSC) and Fusarium dimerum species complex (FDSC) by sequencing part of the translation elongation factor 1-alpha (TEF-1α) gene. Very low diversity was found in each complex, suggesting the existence of a clonal population for each. Density and heterogeneous distributions according to buildings and variability over time were explained by episodic detachments of parts of the colony from biofilms in the pipes. Isolates of these waterborne populations as well as soilborne isolates were tested for their ability to grow in liquid medium in the presence of increasing concentrations of sodium hypochlorite, copper sulfate, anti-corrosion pipe coating, at various temperatures (4°-42 °C) and on agar medium with amphotericin B and voriconazole. The waterborne isolates tolerated higher sodium hypochlorite and copper sulfate concentrations and temperatures than did soilborne isolates but did not show any specific resistance to fungicides. In addition, unlike waterborne isolates, soilborne isolates did not survive in water even supplemented with glucose, while the former developed in the soil as well as soilborne isolates. We concluded the existence of homogeneous populations of FOSC and FDSC common to all contaminated hospital sites. These populations are present at very low densities in natural waters, making them difficult to detect, but they are adapted to the specific conditions offered by the complex water systems of public hospitals in Dijon and Nancy and probably other localities in the world.
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Affiliation(s)
| | - Julie Laurent
- INRA, UMR1347 Agroécologie, 17 rue Sully, BP 86510, F-21000 Dijon, France
| | | | - Marie Barbezant
- Department Environment and Public, Health Nancy University, Hospital Hygiene Unit, 9 Avenue de la Forêt de Haye, BP154, F-54505 Vandoeuvre-Nancy Cedex, France
| | - Nathalie Sixt
- Environmental Microbiology, Plateau Technique de Biologie du CHU, 2 rue Angélique Ducoudray, BP 37013, F-21070 Dijon Cedex, France
| | - Frédéric Dalle
- Parasitology and Mycology laboratory, Plateau Technique de Biologie du CHU, 2 rue Angélique Ducoudray, BP 37013, F-21070 Dijon Cedex, France; Université de Bourgogne, UMR1347 Agroécologie, 17 rue Sully, BP 86510, F-21000 Dijon, France
| | - Serge Aho
- Hospital Hygiene and Epidemiology unit, Hôpital du Bocage, BP 77908, F-21079 Dijon Cedex, France
| | - Alain Bonnin
- Parasitology and Mycology laboratory, Plateau Technique de Biologie du CHU, 2 rue Angélique Ducoudray, BP 37013, F-21070 Dijon Cedex, France; Université de Bourgogne, UMR1347 Agroécologie, 17 rue Sully, BP 86510, F-21000 Dijon, France
| | - Philippe Hartemann
- Department Environment and Public, Health Nancy University, Hospital Hygiene Unit, 9 Avenue de la Forêt de Haye, BP154, F-54505 Vandoeuvre-Nancy Cedex, France
| | - Marc Sautour
- Parasitology and Mycology laboratory, Plateau Technique de Biologie du CHU, 2 rue Angélique Ducoudray, BP 37013, F-21070 Dijon Cedex, France; Université de Bourgogne, UMR1347 Agroécologie, 17 rue Sully, BP 86510, F-21000 Dijon, France
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Bloomfield S, Exner M, Flemming HC, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Krämer I, Merkens W, Oltmanns P, Rotter M, Rutala WA, Sonntag HG, Trautmann M. Lesser-known or hidden reservoirs of infection and implications for adequate prevention strategies: Where to look and what to look for. GMS Hyg Infect Control 2015; 10:Doc04. [PMID: 25699227 PMCID: PMC4332272 DOI: 10.3205/dgkh000247] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In developing hygiene strategies, in recent years, the major focus has been on the hands as the key route of infection transmission. However, there is a multitude of lesser-known and underestimated reservoirs for microorganisms which are the triggering sources and vehicles for outbreaks or sporadic cases of infection. Among those are water reservoirs such as sink drains, fixtures, decorative water fountains and waste-water treatment plants, frequently touched textile surfaces such as private curtains in hospitals and laundry, but also transvaginal ultrasound probes, parenteral drug products, and disinfectant wipe dispensers. The review of outbreak reports also reveals Gram-negative and multiple-drug resistant microorganisms to have become an increasingly frequent and severe threat in medical settings. In some instances, the causative organisms are particularly difficult to identify because they are concealed in biofilms or in a state referred to as viable but nonculturable, which eludes conventional culture media-based detection methods. There is an enormous preventative potential in these insights, which has not been fully tapped. New and emerging pathogens, novel pathogen detection methods, and hidden reservoirs of infection should hence be given special consideration when designing the layout of buildings and medical devices, but also when defining the core competencies for medical staff, establishing programmes for patient empowerment and education of the general public, and when implementing protocols for the prevention and control of infections in medical, community and domestic settings.
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Affiliation(s)
- Sally Bloomfield
- London School of Hygiene and Tropical Medicine, International Scientific Forum on Home Hygiene, London, UK
| | - Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | | | - Philippe Hartemann
- Departement Environment et Santé Publique S.E.R.E.S., Faculté de Médicine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Irene Krämer
- Pharmacy Department of Mainz University, Mainz, Germany
| | | | | | | | | | | | - Matthias Trautmann
- Department of Hospital Hygiene at Stuttgart Hospital, Stuttgart, Germany
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Brusaferro S, Arnoldo L, Cattani G, Fabbro E, Cookson B, Gallagher R, Hartemann P, Holt J, Kalenic S, Popp W, Privitera G, Prikazsky V, Velasco C, Suetens C, Varela Santos C. Harmonizing and supporting infection control training in Europe. J Hosp Infect 2015; 89:351-6. [PMID: 25777079 DOI: 10.1016/j.jhin.2014.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/16/2014] [Indexed: 11/18/2022]
Abstract
Healthcare-associated infection (HCAI), patient safety, and the harmonization of related policies and programmes are the focus of increasing attention and activity in Europe. Infection control training for healthcare workers (HCWs) is a cornerstone of all patient safety and HCAI prevention and control programmes. In 2009 the European Centre for Disease Prevention and Control (ECDC) commissioned an assessment of needs for training in infection control in Europe (TRICE), which showed a substantial increase in commitment to HCAI prevention. On the other hand, it also identified obstacles to the harmonization and promotion of training in infection control and hospital hygiene (IC/HH), mostly due to differences between countries in: (i) the required qualifications of HCWs, particularly nurses; (ii) the available resources; and (iii) the sustainability of IC/HH programmes. In 2013, ECDC published core competencies for infection control and hospital hygiene professionals in the European Union and a new project was launched ['Implementation of a training strategy for infection control in the European Union' (TRICE-IS)] that aimed to: define an agreed methodology and standards for the evaluation of IC/HH courses and training programmes; develop a flexible IC/HH taxonomy; and implement an easily accessible web tool in 'Wiki' format for IC/HH professionals. This paper reviews several aspects of the TRICE and the TRICE-IS projects.
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Affiliation(s)
- S Brusaferro
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
| | - L Arnoldo
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - G Cattani
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - E Fabbro
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - B Cookson
- Division of Infection and Immunity, University College London, London, UK
| | - R Gallagher
- Infection Prevention and Control, Royal College of Nursing, London, UK
| | - P Hartemann
- Service d'Hygiène Hospitalière, C.H.U. de Nancy & DESP-SERES, Faculté de Médicine, Vandoeuvre‒Nancy, France
| | - J Holt
- National Center for Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - S Kalenic
- Department of Medical Microbiology, University of Zagreb, Zagreb, Croatia
| | - W Popp
- Hospital Hygiene, University Clinics Essen, Essen, Germany
| | - G Privitera
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, University of Pisa, Pisa, Italy
| | - V Prikazsky
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - C Velasco
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - C Suetens
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - C Varela Santos
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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23
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Brusaferro S, Cookson B, Kalenic S, Cooper T, Fabry J, Gallagher R, Hartemann P, Mannerquist K, Popp W, Privitera G, Ruef C, Viale P, Coiz F, Fabbro E, Suetens C, Varela Santos C. Training infection control and hospital hygiene professionals in Europe, 2010: agreed core competencies among 33 European countries. ACTA ACUST UNITED AC 2014; 19. [PMID: 25523973 DOI: 10.2807/1560-7917.es2014.19.49.20985] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The harmonisation of training programmes for infection control and hospital hygiene (IC/HH) professionals in Europe is a requirement of the Council recommendation on patient safety. The European Centre for Disease Prevention and Control commissioned the 'Training Infection Control in Europe' project to develop a consensus on core competencies for IC/HH professionals in the European Union (EU). Core competencies were drafted on the basis of the Improving Patient Safety in Europe (IPSE) project's core curriculum (CC), evaluated by questionnaire and approved by National Representatives (NRs) for IC/HH training. NRs also re-assessed the status of IC/HH training in European countries in 2010 in comparison with the situation before the IPSE CC in 2006. The IPSE CC had been used to develop or update 28 of 51 IC/HH courses. Only 10 of 33 countries offered training and qualification for IC/HH doctors and nurses. The proposed core competencies are structured in four areas and 16 professional tasks at junior and senior level. They form a reference for standardisation of IC/HH professional competencies and support recognition of training initiatives.
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Affiliation(s)
- S Brusaferro
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
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Brusaferro S, Cookson B, Gallagher R, Hartemann P, Holt J, Kalenic S, Popp W, Privitera G, Arnoldo L, Cattani G, Fabbro E, Varela Santos C, Suetens C. A model for validation of European Professional Infection Control/Hospital Hygiene training courses. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku161.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hunter PR, Risebro H, Yen M, Lefebvre H, Lo C, Hartemann P, Longuet C, Jaquenoud F. Impact of the provision of safe drinking water on school absence rates in Cambodia: a quasi-experimental study. PLoS One 2014; 9:e91847. [PMID: 24632573 PMCID: PMC3954794 DOI: 10.1371/journal.pone.0091847] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 02/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Education is one of the most important drivers behind helping people in developing countries lift themselves out of poverty. However, even when schooling is available absenteeism rates can be high. Recently interest has focussed on whether or not WASH interventions can help reduce absenteeism in developing countries. However, none has focused exclusively on the role of drinking water provision. We report a study of the association between absenteeism and provision of treated water in containers into schools. METHODS AND FINDINGS We undertook a quasi-experimental longitudinal study of absenteeism rates in 8 schools, 4 of which received one 20 L container of treated drinking water per day. The water had been treated by filtration and ultraviolet disinfection. Weekly absenteeism rates were compared across all schools using negative binomial model in generalized estimating equations. There was a strong association with provision of free water and reduced absenteeism (Incidence rate ratio = 0.39 (95% Confidence Intervals 0.27-0.56)). However there was also a strong association with season (wet versus dry) and a significant interaction between receiving free water and season. In one of the intervention schools it was discovered that the water supplier was not fulfilling his contract and was not delivering sufficient water each week. In this school we showed a significant association between the number of water containers delivered each week and absenteeism (IRR = 0.98 95%CI 0.96-1.00). CONCLUSION There appears to be a strong association between providing free safe drinking water and reduced absenteeism, though only in the dry season. The mechanism for this association is not clear but may in part be due to improved hydration leading to improved school experience for the children.
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Affiliation(s)
- Paul R. Hunter
- Norwich School of Medicine, University of East Anglia, Norwich, United Kingdom
- * E-mail:
| | - Helen Risebro
- Norwich School of Medicine, University of East Anglia, Norwich, United Kingdom
| | - Marie Yen
- 1001 fontaines pour demain, Caluire et Cuire, France
| | | | - Chay Lo
- Teuk Saat 1001, Phnom Penh, Cambodia
| | - Philippe Hartemann
- Département Environnement et Santé Publique, Faculté de médecine de Nancy - Université de Lorraine, Nancy, France
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Hunter PR, Risebro H, Yen M, Lefebvre H, Lo C, Hartemann P, Longuet C, Jaquenoud F. Water source and diarrhoeal disease risk in children under 5 years old in Cambodia: a prospective diary based study. BMC Public Health 2013; 13:1145. [PMID: 24321624 PMCID: PMC4029329 DOI: 10.1186/1471-2458-13-1145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/02/2013] [Indexed: 11/24/2022] Open
Abstract
Background Despite claims that the Millennium Development Goals (MDG) targets on access to safe drinking water have been met, many 100 s of millions of people still have no access. The challenge remains how to provide these people and especially young children with safe drinking water. Method We report a longitudinal study designed to assess the effectiveness of an intervention based on provided treated drinking water in containers on self-reported diarrhoea in children. The intervention was “1001 fontaines pour demain” (1001 F) is a non-governmental not for profit organization (created in 2004 and based in Caluire, France) that helps local entrepreneurs treat package, and sell safe drinking water. Cases and controls were chosen at village and household level by propensity score matching Participants were visited twice a month over six months and asked to complete a diarrhoea health diary. Results In total 4275 follow-up visits were completed on 376 participants from 309 homes. Diarrhoea was reported in 20.4% of children on each visit, equating to an incidence rate estimate of 5.32 episodes per child per year (95% confidence interval = 4.97 to 5.69). Compared to those drinking 1001 F water, children drinking surface water were 33% (95% CI -1 to 17%), those drinking protected ground water were 62% (95% CI 19 to 120%) and those drinking other bottled water 57% (95% CI 15 to 114%) more likely to report diarrhoea. Children drinking harvested rainwater had similar rates of diarrhoea to Children drinking 1001 F water. Conclusion Our study suggests that 1001 F water provides a safer alternative to groundwater or surface water. Furthermore, our study raises serious concerns about the validity of assuming protected groundwater to be safe water for the purposes of assessing the MDG targets. By contrast our study provides addition evidence of the relative safety of rainwater harvesting.
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Affiliation(s)
- Paul R Hunter
- Norwich School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK.
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Brusaferro S, Cookson B, Gallagher R, Hartemann P, Holt J, Kalenic S, Popp W, Privitera G, Varela Santos C, Suetens C, Arnoldo L, Cattani G, Fabbro E. Promoting european infection control / hospital hygiene core competencies: a need for training professionals in Europe. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Maillard JY, Bloomfield S, Coelho JR, Collier P, Cookson B, Fanning S, Hill A, Hartemann P, Mcbain AJ, Oggioni M, Sattar S, Schweizer HP, Threlfall J. Does Microbicide Use in Consumer Products Promote Antimicrobial Resistance? A Critical Review and Recommendations for a Cohesive Approach to Risk Assessment. Microb Drug Resist 2013; 19:344-54. [DOI: 10.1089/mdr.2013.0039] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Jean-Yves Maillard
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Sally Bloomfield
- London School of Hygiene and Tropical Medicine, International Scientific Forum on Home Hygiene, London, United Kingdom
| | | | - Phillip Collier
- School of Contemporary Sciences, University of Abertay Dundee, Dundee, United Kingdom
| | - Barry Cookson
- Division of Infection & Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Séamus Fanning
- UCD Centres for Food Safety and Molecular Innovation & Drug Design, School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin, Ireland
| | - Andrew Hill
- Epidemiology, Surveillance and Risk Group, Animal Health and Veterinary Laboratories Agency, Weybridge, United Kingdom
| | - Philippe Hartemann
- Départment Environment et Santé Publique, Faculté de Médecine, Vandoeuvre-les-Nancy, France
| | - Andrew J. Mcbain
- School of Pharmacy and Pharmaceutical Sciences, the University of Manchester, Manchester, United Kingdom
| | - Marco Oggioni
- Laboratory of Molecular Microbiology and Biotechnology, Università degli Studi di Siena, Siena, Italy
| | - Syed Sattar
- Centre for Research on Environmental Microbiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Herbert P. Schweizer
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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Sautour M, Steinberg C, Laurent J, Edel-Hermann V, Barbezant M, Sixt N, Aho S, Hartemann P, Bonnin A, Dalle F. Contamination de réseaux hydriques hospitaliers par une population clonale de Fusarium oxysporum. J Mycol Med 2013. [DOI: 10.1016/j.mycmed.2013.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brusaferro S, Cookson BD, Gallagher R, Hartemann P, Holte J, Kalenic S, Popp W, Privitera GP, Santos CV, Suetens C, Arnoldo L, Cattani G, Fabbro E. P171: Promoting European infection control / hospital hygiene core competencies (EIC/HHCC): a comparative analysis with related disciplines. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688218 DOI: 10.1186/2047-2994-2-s1-p171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Gebel J, Exner M, French G, Chartier Y, Christiansen B, Gemein S, Goroncy-Bermes P, Hartemann P, Heudorf U, Kramer A, Maillard JY, Oltmanns P, Rotter M, Sonntag HG. The role of surface disinfection in infection prevention. GMS Hyg Infect Control 2013; 8:Doc10. [PMID: 23967396 PMCID: PMC3746601 DOI: 10.3205/dgkh000210] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: The Rudolf Schuelke Foundation addresses topics related to hygiene, infection prevention and public health. In this context a panel of scientists from various European countries discussed “The Role of Surface Disinfection in Infection Prevention”. The most important findings and conclusions of this meeting are summarised in the present consensus paper. Aim: Although the relevance of surface disinfection is increasingly being accepted, there are still a number of issues which remain controversial. In particular, the following topics were addressed: Transferral of microbes from surface to patients as a cause of infection, requirements for surface disinfectants, biocidal resistance and toxicity, future challenges. Methods and findings: After discussion and review of current scientific literature the authors agreed that contaminated surfaces contribute to the transmission of pathogens and may thus pose an infection hazard. Targeted surface disinfection based on a risk profile is seen as an indispensable constituent in a multibarrier approach of universal infection control precautions. Resistance and cross-resistance depend on the disinfectant agent as well as on the microbial species. Prudent implementation of surface disinfection regimens tested to be effective can prevent or minimize adverse effects. Conclusions: Disinfection must be viewed as a holistic process. There is a need for defining standard principles for cleaning and disinfection, for ensuring compliance with these principles by measures such as written standard operating procedures, adequate training and suitable audit systems. Also, test procedures must be set up in order to demonstrate the efficacy of disinfectants including new application methods such as pre-soaked wipes for surface disinfection.
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Affiliation(s)
- Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
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Deblonde T, Hartemann P. Environmental impact of medical prescriptions: assessing the risks and hazards of persistence, bioaccumulation and toxicity of pharmaceuticals. Public Health 2013; 127:312-7. [DOI: 10.1016/j.puhe.2013.01.026] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 10/12/2012] [Accepted: 01/30/2013] [Indexed: 11/15/2022]
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Hautemanière A, Ahmed-Lecheheb D, Cunat L, Hartemann P. Assessment of transpulmonary absorption of ethanol from alcohol-based hand rub. Am J Infect Control 2013; 41:e15-9. [PMID: 23332374 DOI: 10.1016/j.ajic.2012.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/24/2012] [Accepted: 09/04/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alcohol-based hand rubs (ABHRs) have been associated with a reduction of nosocomial infections. Despite the worldwide introduction of these products in health care settings, the aim of this study was to assess the transpulmonary absorption of ethanol contains in ABHRs used by health care workers (HCWs) in real conditions of work shift. METHODS Twenty-six HCWs of Nancy University Hospital were included. Research consisted in monitoring participants during 4 hours of work shift to assess their exposure to ethanol. The measurement of ethanol vapors in exhaled breath was performed using a class B ethylometer (Alco-Sensor FST). Ethanol concentration in inhaled breath was measured using Gilian pump LFS-113. Concentration of ethanol, acetaldehyde, and acetate in blood and urine samples were determined using gas chromatography with flame ionization detector. RESULTS Participants were 12% male and 88% female. The mean age was 40 ± 8 years. None of the employees included in the study presented any traces of ethanol or its metabolites in the blood or urine. Ethanol (0.08 ± 0.07 mg/L) was detected in the breath of 10 HCWs at 1 to 2 minutes postexposure. The mean concentration of ethanol in the inhaled air was 46.2 mg/m. CONCLUSION Absorption of ethanol vapor from ABHRs among HCWs during their care activities was not detected. Quantification of ethanol fumes inhaled during 4 hours of work shift was below the regulatory limitations of exposure to ethanol.
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Cunat L, Ahmed-Lecheheb D, Hartemann P, Hunter PR, Hautemanière A. Emergence of hand contamination with Aspergillus during demolition work. Am J Infect Control 2013; 41:83-5. [PMID: 22749129 DOI: 10.1016/j.ajic.2012.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 11/18/2022]
Abstract
Hand rubbing with hydro-alcoholic solutions prevent the exogenous nosocomial infection, but the hydro-alcoholic solutions were not sporicidal. A major program of demolition was organized on the area of the University Hospital of Nancy (France) between 2007 and 2010, and this period is often considered as a possible source of suspending Aspergillus spores. This study shows the emergence of Aspergillus on the hands of the medical students during demolition period despite the same quality of hand hygiene.
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Affiliation(s)
- Lisiane Cunat
- Department of Public Health and Environment, School of Medicine, Lorraine University, Nancy, France
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Hautemanière A, Florentin A, Hunter PR, Bresler L, Hartemann P. Screening for surgical nosocomial infections by crossing databases. J Infect Public Health 2012; 6:89-97. [PMID: 23537821 DOI: 10.1016/j.jiph.2012.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 06/27/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022] Open
Abstract
UNLABELLED Surgical site infection (SSI) is a major cause of morbidity and mortality, and they are the third cause of nosocomial infections. It has been shown that surveillance can reduce the rate of these infections because the publication of the results that introduce a interrogation on her surgical pratices. However, surveillance requires considerable medical resources. Our objective is to validate a computer algorithm that uses microbiological results and the results of a C-reactive protein (CRP) assay and granulocyte count to detect SSIs. MATERIALS AND METHODS All patients who underwent colorectal surgery between the 1st of January and the 30th of June 2009 were included. Administrative, surgical and microbiological data and the appearance of neutrophilia and CRP after surgery and during hospitalization were collected. The algorithm uses four biological variables: CRP, neutrophils, and the bacterium found on the positive sample. The CRP and neutrophil variables were coded in 0 or 1. CRP was coded as 1 if the sample was below 5mg/l at the time of the operation and increased to more than 60mg/l in the 30 days immediately after post-operation. Neutrophils were coded as 1 if the sample was normal at the time of the operation and increased to more than 12,000cells/mm(3) in the 30 days immediately after post-operation. The "type of sample" and "bacterium" variables were coded in categories. For the type of sample, we coded 3 if the sampling site was related to the surgical site, 2 if the sampling site was potentially linked to the surgical site, 1 if the sampling site was not directly or indirectly related to the surgical site and 0 if there was no sample. Regarding the bacteria, we coded 3 for bacteria found in over 5% of SSIs, 2 for bacteria found in 2-5% of SSIs, 1 for bacteria found in less than 2% of SSIs and 0 if there were no bacteria. The algorithm calculates a score from 1 to 5. RESULTS Our study included 195 operations, out of which it was possible to study 168. Following the operations, we found neutrophilia above 12,000cells/mm(3) in 41.5% of cases and CRP above 60mg/l in 64.6% of cases. Thirty-seven operations (22%) were complicated by an SSI. The positive predictive values and the negative predictive values in our algorithm were 74.07% and 87.94%, respectively, and the number of records that remain to be investigated is 27 out of 168. CONCLUSIONS Linking databases from bacteriology and biology with those containing the hospital records of surgical procedures is a simple method for identifying surgical nosocomial infections.
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Affiliation(s)
- Alexis Hautemanière
- Service Hygiène, Centre Hospitalier Universitaire de Nancy, rue du Morvan, 54511 Vandoeuvre les Nancy Cedex, France.
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Hautemanière A, Cunat L, Ahmed-Lecheheb D, Hajjard F, Gerardin F, Morele Y, Hartemann P. Assessment of exposure to ethanol vapors released during use of Alcohol-Based Hand Rubs by healthcare workers. J Infect Public Health 2012; 6:16-26. [PMID: 23290089 DOI: 10.1016/j.jiph.2012.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 09/11/2012] [Accepted: 09/22/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite the increasing use of Alcohol-Based Hand Rub solutions, few studies have quantified the concentrations of inhaled ethanol. OBJECTIVE The aim of this study was to assess ethanol exposure during hygienic and surgical hand disinfection practices. METHOD Ethanol concentrations were measured at the nose level of a wooden dummy and human volunteers. Two systems were used in parallel to determine short-term ethanol vapor exposures: activated charcoal tubes followed by gas chromatography analysis and direct reading on a photoionization detector (PID). Exposure was assessed for 4 different sequences (N=10) reproducing hand rubs for simple surgery, nursing care, intensive care and surgical scrub. RESULTS The ethanol concentrations measured were of a similar order between the dummy and volunteers. The concentrations obtained by PID were higher than the gas chromatography values for the simple care (45%) and nursing care (27%) sequences and reflected specific exposure peaks of ethanol, whereas ethanol concentrations were continuously high for intensive care (440 mg m(-3)) or surgical scrub (650 mg m(-3)). CONCLUSION Ethanol concentrations were similar for these two exposure assessment methods and demonstrated a relationship between handled doses and inhaled doses. However, the ethanol vapors released during hand disinfection were safe for the healthcare workers.
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Abstract
Silver has been used for centuries. Today, silver and silver nanoparticles (AgNPs) are used in a wide range of healthcare, food industry, domiciliary applications, and are commonly found in hard surface materials and textiles. Such an extensive use raises questions about its safety, environmental toxicity and the risks associated with microbial resistance and cross-resistance. If the mechanisms of antimicrobial action of ionic silver (Ag+) have been studied, there is little understanding of AgNPs interactions with microorganisms. There have been excellent reviews on the bacterial resistance mechanisms to silver, but there is a paucity of information on resistance to AgNPs. Silver toxicity and accumulation in the environment has been studied and there is a better understanding of silver concentration and species in different environmental compartments. However, owing to the increased applications of silver and AgNPs, questions remain about the presence and consequences of AgNPs in the environment. This review provides an historical perspective of silver usage, an overview of applications, and combined information of microbial resistance and toxicity. Owing the evidence provided in this review, a call for a better understanding and control of silver usage, and for tighter regulations of silver and AgNPs usage is proposed.
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Affiliation(s)
- Jean-Yves Maillard
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University , Cardiff , UK
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Pichery C, Bellanger M, Zmirou-Navier D, Fréry N, Cordier S, Roue-LeGall A, Hartemann P, Grandjean P. Economic evaluation of health consequences of prenatal methylmercury exposure in France. Environ Health 2012; 11:53. [PMID: 22883022 PMCID: PMC3533723 DOI: 10.1186/1476-069x-11-53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 07/09/2012] [Indexed: 05/05/2023]
Abstract
BACKGROUND Evidence of a dose-response relationship between prenatal exposure to methylmercury (MeHg) and neurodevelopmental consequences in terms of IQ reduction, makes it possible to evaluate the economic consequences of MeHg exposures. OBJECTIVE To perform an economic evaluation of annual national benefits of reduction of the prenatal MeHg exposure in France. METHODS We used data on hair-Hg concentrations in French women of childbearing age (18-45 years) from a national sample of 126 women and from two studies conducted in coastal regions (n = 161and n = 503). A linear dose response function with a slope of 0.465 IQ point reduction per μg/g increase in hair-Hg concentration was used, along with a log transformation of the exposure scale, where a doubling of exposure was associated with a loss of 1.5 IQ points. The costs calculations utilized an updated estimate of €2008 17,363 per IQ point decrement, with three hypothetical exposure cut-off points (hair-Hg of 0.58, 1.0, and 2.5 μg/g). RESULTS Because of higher exposure levels of women in coastal communities, the annual economic impacts based on these data were greater than those using the national data, i.e., € 1.62 billion (national), and € 3.02 billion and € 2.51 billion (regional), respectively, with the linear model, and € 5.46 billion (national), and € 9.13 billion and € 8.17 billion (regional), with the log model, for exposures above 0.58 μg/g. CONCLUSIONS These results emphasize that efforts to reduce MeHg exposures would have high social benefits by preventing the serious and lifelong consequences of neurodevelopmental deficits in children.
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Affiliation(s)
- Céline Pichery
- EHESP School of Public Health, Rennes Cedex 35043, France
| | | | - Denis Zmirou-Navier
- EHESP School of Public Health, Rennes Cedex 35043, France
- Lorraine University Medical School, Public Health department, Vandoeuvre-les-Nancy cedex, France
- INSERM U 1085-IRSET (Institut de Recherche Santé Environnement Travail), Rennes 1 University, Rennes cedex 35042, France
| | - Nadine Fréry
- Institut de veille sanitaire, Département Santé Environnement, Saint Maurice cedex 94415, France
| | - Sylvaine Cordier
- INSERM U 1085-IRSET (Institut de Recherche Santé Environnement Travail), Rennes 1 University, Rennes cedex 35042, France
| | | | - Philippe Hartemann
- Lorraine University Medical School, Public Health department, Vandoeuvre-les-Nancy cedex, France
- INSERM U 954 "Nutrition, genetics and environmental risks”, Medical School, Vandoeuvre-les-Nancy cedex 54505, France
| | - Philippe Grandjean
- Institute of Public Health, University of Southern Denmark,Odense DK-5000, Denmark
- Department of Environmental Health, Harvard School of Public Health, Boston, MA 02215, USA
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Ferrari L, Pecson-Laribi O, Hartemann P, Kerautet MA, Sari-Minodier I, Tiberguent A, Paris C, Zmirou-Navier D. Corrélation de données de multiexposition atmosphérique avec des tests génotoxiques : le cas des égoutiers de la ville de Paris. ARCH MAL PROF ENVIRO 2012. [DOI: 10.1016/j.admp.2012.03.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Sautour M, Edel-Hermann V, Steinberg C, Sixt N, Laurent J, Dalle F, Aho S, Hartemann P, L’Ollivier C, Goyer M, Bonnin A. Fusarium species recovered from the water distribution system of a French university hospital. Int J Hyg Environ Health 2012; 215:286-92. [DOI: 10.1016/j.ijheh.2011.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 11/03/2011] [Accepted: 11/13/2011] [Indexed: 12/26/2022]
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Ahmed-Lecheheb D, Cunat L, Hartemann P, Hautemanière A. Dermal and pulmonary absorption of ethanol from alcohol-based hand rub. J Hosp Infect 2012; 81:31-5. [PMID: 22445089 DOI: 10.1016/j.jhin.2012.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Ethanol intoxication of healthcare workers (HCWs) using alcohol-based hand rubs (ABHRs) in the workplace is a potentially serious issue. This study quantified the level of ethanol absorption among HCWs after hygienic hand disinfection. METHODS Eighty-six HCWs from Nancy University Hospital were tested before and after a 4-h shift. Participants used ABHR containing 70% ethanol. Levels of ethanol, acetaldehyde and acetate in blood and urine were determined using gas chromatography. A breathalyzer was used to measure the level of ethanol in expired air. RESULTS Ethanol [mean concentration 0.076 (standard deviation 0.05) mg/L] was detected in the expired air of 28 HCWs 1-2 min post exposure. Ethanol, acetaldehyde and acetate were undetectable in blood after a 4-h shift, and urine tests were negative in all participants. CONCLUSION Ethanol exposure from ABHR, particularly inhalation of vapours, resulted in positive breathalyzer readings 1-2 min after exposure. Dermal absorption of ethanol was not detected. Pulmonary absorption was detected but was below toxic levels.
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Affiliation(s)
- D Ahmed-Lecheheb
- Department of Environment and Public Health, Faculty of Medicine, Nancy University, Nancy, France.
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Laurent J, Sautour M, Edel-Hermann V, Steinberg C, Sixt N, Dalle F, Aho S, Hartemann P, Vagner O, Bonnin A. Détection et identification de Fusarium spp. dans le réseau hydrique d’un centre hospitalier universitaire. J Mycol Med 2012. [DOI: 10.1016/j.mycmed.2011.12.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ahmed-Lecheheb D, Cunat L, Hartemann P, Hautemanière A. Prospective observational study to assess hand skin condition after application of alcohol-based hand rub solutions. Am J Infect Control 2012; 40:160-4. [PMID: 21839542 DOI: 10.1016/j.ajic.2011.04.323] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 04/19/2011] [Accepted: 04/19/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND The use of alcohol-based hand rub solutions (ABHRSs) in health care settings has been associated with increased hand hygiene compliance and reduced rates of nosocomial infection. Deterioration in hand skin condition leads to impaired barrier function, changes in skin flora, and increased bacterial shedding. Thus, poor skin condition can increase the risk of infection. This study evaluated the hand skin condition and dermal tolerance among health care workers (HCWs) after ABHRS application. METHODS The study group comprised 231 HCWs (34% nurses, 22% nurse assistants, and 15% hospital cleaners). The mean participant age was 40 years. Stratum corneum hydration and superficial sebum content and surface pH of the skin were measured on the back and palm of each participant's dominant hand before and after ABHRS use. A self-assessment questionnaire was administered to collect information about the participants, their skin problems, and their perception of the ABHRS. RESULTS The study group was 83% females. Skin hydration at the 2 assessment sites was markedly increased after ABHRS use (P < .0001). The mean pH value did not change significantly on the back of the hand, but did change significantly on the palm (P = .012). The superficial sebum content decreased significantly on the palm (P < .0001), but not on the back of the hand. HCWs reported excellent or good skin tolerance of ABHRS in 73% of cases. CONCLUSION ABHRSs are well tolerated and do not dry the skin. pH and superficial sebum values decreased slightly, but these decreases did not affect skin barrier function. Values remained within the physiological range.
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Exner M, Hartemann P, Hunter PR, Levi Y, Loret JF, Mathys W, Villesot D, Wilhelm M. Consensus report: E. coli O104:H4 (HUSEC041) and the potential threat to European water supplies. Int J Hyg Environ Health 2011; 214:500-1. [PMID: 22206100 DOI: 10.1016/j.ijheh.2011.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Among the 3rd Seminar for PhD students working on Water and Health which was held in Cannes on 27–29 June 2011, experts from a number of universities and research institutes took the opportunity to discuss the emergence of Escherichia coli O104:H4 in Europe. Especially, possible threats for European water suppliers were considered. The consensus is summarized in this report. The main conclusion was that E. coli O104:H4 would not pose a substantial risk to well managed water supplies, especially where regular monitoring of indicator E. coli is negative. However, this may not apply for small and very small water systems which are quite common in Europe. New strategies like the Water Safety Plan approach are needed to protect also small scale drinking water systems and private wells in Europe. Water used in the processing of foods likely to be eaten raw, especially sprouts, should be of drinking water quality.
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Affiliation(s)
- Martin Exner
- Institute for Hygiene and Public Health, University of Bonn, Germany.
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Ahmed Lecheheb D, Cunat L, Hartemann P, Hautemaniere A. Prospective observational study to assess hand skin condition after application of alcohol-based hand rubs solutions. BMC Proc 2011. [PMCID: PMC3239702 DOI: 10.1186/1753-6561-5-s6-p272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Florentin A, Hautemanière A, Hartemann P. Health effects of disinfection by-products in chlorinated swimming pools. Int J Hyg Environ Health 2011; 214:461-9. [PMID: 21885333 DOI: 10.1016/j.ijheh.2011.07.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 07/17/2011] [Accepted: 07/28/2011] [Indexed: 11/24/2022]
Abstract
Increased attendance at swimming pools is correlated with higher input of organic and minerals pollutants introduced by swimmers in the swimming pool water. In most swimming pools, microbiological control is performed by disinfection with the addition of chlorine. Chlorine is now well-known to lead to the formation of many disinfection by-products (DBPs) including trihalomethanes and chloramines. The hypothesis of a link between the presence of eye and skin irritation syndromes in swimmers and contact with swimming pool water treated with chlorine was initially proposed by Mood (1953). During recent decades many epidemiological studies have described the importance of DBPs generated with natural or imported organic matter present in water. Many of these DBPs are suspected to be toxic or even carcinogenic. Trihalomethanes and haloacetic acid families are the most studied but others DBPs, like chloral hydrate, haloacetonitriles, N-nitrosodimethylamine and the bromate ion, are emerging compounds of interest. Epidemiological data about the risk of cancer are still controversial. However, numerous publications highlight a toxic risk especially the risk of allergy and respiratory symptoms for babies and elite swimmers. The few publications dedicated to risk assessment do not suggest increased risk, other than for elite swimmers. These publications are likely to underestimate the risk associated with DBPs because of the lack of data in the literature precludes the calculation of risk associated with certain compounds or certain pathways. Thus for regulations, the need to take into account the risks associated with disinfection by-products is now important without forgetting the need of the control of microbiological hazards in swimming pools.
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Affiliation(s)
- Arnaud Florentin
- DESP, Nancy Université - Faculté de Médecine de Nancy, 9 Avenue de la forêt de Haye BP 184, 54 505 Vandœuvre-lès-Nancy Cedex, France.
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Deblonde T, Cossu-Leguille C, Hartemann P. Emerging pollutants in wastewater: a review of the literature. Int J Hyg Environ Health 2011; 214:442-8. [PMID: 21885335 DOI: 10.1016/j.ijheh.2011.08.002] [Citation(s) in RCA: 557] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 07/13/2011] [Accepted: 08/09/2011] [Indexed: 11/26/2022]
Abstract
For 20 years, many articles report the presence of new compounds, called "emerging compounds", in wastewater and aquatic environments. The US EPA (United States - Environmental Protection Agency) defines emerging pollutants as new chemicals without regulatory status and which impact on environment and human health are poorly understood. The objective of this work was to identify data on emerging pollutants concentrations in wastewater, in influent and effluent from wastewater treatment plants (WWTPs) and to determine the performance of sewage disposal. We collected 44 publications in our database. We sought especially for data on phthalates, Bisphenol A and pharmaceuticals (including drugs for human health and disinfectants). We gathered concentration data and chose 50 pharmaceutical molecules, six phthalates and Bisphenol A. The concentrations measured in the influent ranged from 0.007 to 56.63 μg per liter and the removal rates ranges from 0% (contrast media) to 97% (psychostimulant). Caffeine is the molecule whose concentration in influent was highest among the molecules investigated (in means 56.63 μg per liter) with a removal rate around 97%, leading to a concentration in the effluent that did not exceed 1.77 μg per liter. The concentrations of ofloxacin were the lowest and varied between 0.007 and 2.275 μg per liter in the influent treatment plant and 0.007 and 0.816 μg per liter in the effluent. Among phthalates, DEHP is the most widely used, and quantified by the authors in wastewater, and the rate of removal of phthalates is greater than 90% for most of the studied compounds. The removal rate for antibiotics is about 50% and 71% for Bisphenol A. Analgesics, anti inflammatories and beta-blockers are the most resistant to treatment (30-40% of removal rate). Some pharmaceutical molecules for which we have not collected many data and which concentrations seem high as Tetracycline, Codeine and contrast products deserve further research.
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Affiliation(s)
- Tiphanie Deblonde
- DESP - SERES (Département Environnement et Santé Publique - Service d'Etudes et de Recherche en Environnement et Santé), Inserm U954, Faculté de Médecine, 9 avenue de la forêt de Haye, 54500 Vandoeuvre les Nancy, France.
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Hartemann P, Loret JF. The second European PhD students workshop: water and health - Cannes 2010. Int J Hyg Environ Health 2011; 214:415-6. [PMID: 21839680 DOI: 10.1016/j.ijheh.2011.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hautemaniere A, Remen T, Mathieu L, Deloge-Abarkan M, Hartemann P, Zmirou-Navier D. Pontiac fever among retirement home nurses associated with airborne legionella. J Hosp Infect 2011; 78:269-73. [DOI: 10.1016/j.jhin.2011.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 03/29/2011] [Indexed: 11/26/2022]
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Florentin A, Deblonde T, Diguio N, Hautemaniere A, Hartemann P. Impacts of two perfluorinated compounds (PFOS and PFOA) on human hepatoma cells: cytotoxicity but no genotoxicity? Int J Hyg Environ Health 2011; 214:493-9. [PMID: 21676652 DOI: 10.1016/j.ijheh.2011.05.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 05/13/2011] [Accepted: 05/24/2011] [Indexed: 11/13/2022]
Abstract
Perfluorinated compounds (PFCs) and particularly two of them, perfluoroctanoate (PFOA) and perfluorooctanesulfonate (PFOS), have been widely produced and used since 1950. They both persist in the environment and accumulate in wildlife and humans. The toxicity of PFOS and PFOA has been studied extensively in rodents with several adverse effects mainly a hepatocarcinogenic potential. Carcinogenic effects are not highlighted in humans' studies. In this study, we investigated the cytotoxic and genotoxic effects of PFOA and PFOS using human HepG2 cells after 1 or 24h of exposure. The cytotoxic and genotoxic potential was evaluated by MTT assay, single cell gel electrophoresis (SCGE) assay and micronucleus assay respectively. We measured the intracellular generation of reactive oxygen species (ROS) using dichlorofluorescein diacetate to identify a potential mechanism of toxicity. We observed a cytotoxic effect of PFOA and PFOS after 24h of exposure starting from a concentration of 200 μM (MTT: -14.6%) and 300 μM (MTT: -51.2%) respectively. We did not observe an increase of DNA damage with the comet assay or micronucleus with the micronucleus assay after exposure to the two PFCs. After 24h of exposure, both PFOA and PFOS highlight a decrease of ROS generation (-5.9% to -23%). We did not find an effect after an hour of exposure. Our findings show that PFOA and PFOS exert a cytotoxic effect on the human cells line HepG2 but nor PFOA or PFOS could induce an increase of DNA damage (DNA strand breaks and micronucleus) or reactive oxygen species at the range concentration tested. Our results do not support that oxidative stress and DNA damage are relevant for potential adverse effects of PFOA and PFOS. These results tend to support epidemiological studies that do not show evidence of carcinogenicity.
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Affiliation(s)
- Arnaud Florentin
- DESP, Nancy Université - Faculté de Médecine de Nancy, 9 Avenue de la forêt de Haye BP 184, 54 505 Vandœuvre-lès-Nancy cedex, France.
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