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Tuvo B, Totaro M, Cristina ML, Spagnolo AM, Di Cave D, Profeti S, Baggiani A, Privitera G, Casini B. Prevention and Control of Legionella and Pseudomonas spp. Colonization in Dental Units. Pathogens 2020; 9:E305. [PMID: 32326140 PMCID: PMC7238104 DOI: 10.3390/pathogens9040305] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Dental Unit Waterlines (DUWLs) have shown to be a source of Legionella infection. We report the experience of different dental healthcare settings where a risk management plan was implemented. Materials and methods: In a Hospital Odontostomatology Clinic (HOC) and three Private Dental Clinics (PDCs) housing 13 and six dental units (DUs), respectively, an assessment checklist was applied to evaluate staff compliance with guideline recommendations. DUWLs microbial parameters were investigated before and after the application of corrective actions. Results: In the HOC a poor adherence to good practices was demonstrated, whereas protocols were carefully applied in PDCs. L. pneumophila sg 2-15 was isolated in 31% (4/13) and 33% (2/6) of DUs in HOC and PDCs, respectively, mainly from handpieces (32%, 6/19) with counts >102 colony-forming units per milliliter (CFU/L), often associated with P. aeruginosa (68%, 13/19). The shock disinfection with 3% v/v hydrogen peroxide (HP) showed a limited effect, with a recolonization period of about 4 weeks. Legionella was eradicated only after 6% v/v HP shock disinfection and filters-installation, whilst P. aeruginosa after the third shock disinfection with a solution of 4% v/v HP and biodegradable surfactants. Conclusions: Our data demonstrate the presence and persistence of microbial contamination within the DUWLs, which required strict adherence to control measures and the choice of effective disinfectants.
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Affiliation(s)
- Benedetta Tuvo
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Michele Totaro
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (A.M.S.)
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy; (M.L.C.); (A.M.S.)
| | - David Di Cave
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Sara Profeti
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Angelo Baggiani
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Gaetano Privitera
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
| | - Beatrice Casini
- Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy; (B.T.); (M.T.); (S.P.); (A.B.); (G.P.)
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Totaro M, Vaselli O, Nisi B, Frendo L, Cabassi J, Profeti S, Valentini P, Casini B, Privitera G, Baggiani A. Assessment, control, and prevention of microbiological and chemical hazards in seasonal swimming pools of the Versilia district (Tuscany, central Italy). J Water Health 2019; 17:490-498. [PMID: 31095523 DOI: 10.2166/wh.2019.208] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although in Europe the quality of swimming pools (SPs) is dictated by regulations, microbiological and chemical hazards are described in the literature. Environmental bacteria or toxic disinfection by-product (DBP) compounds may indeed be recovered in waters even after disinfection. We evaluated the water quality from 26 outdoor seasonal SPs of the Versilia district, according to requirements of Regional Decree 54R/2015. In spring 2017, supply and reinstatement waters were collected after shock hyperchlorination (10 mg/L) while in summertime, a second sampling of waters before entering the pools, as well as in the pools, was performed after SPs were open to the public. In all samples, microbiological and chemical parameters were determined as defined by Directive 98/83/EC and the Italian Health Ministry. Microbiological data were within suggested limits. The first chemical analyses showed that in 35% of the feeding-pool seawater samples, the halogenated organic compounds were higher than the maximum permissible concentrations (30 μg/L). Pool waters were then dechlorinated and re-treated with hydrogen peroxide (10 mg/L) to ensure the abatement of DBPs (from 164 ± 107 to 0.9 ± 0.8 μg/L; p = 0.002). Results highlighted the need of self-controlled procedures for the SPs waters to prevent waterborne diseases and suggested hydrogen peroxide as the most appropriate disinfection method.
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Affiliation(s)
- Michele Totaro
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56100 Pisa, Italy E-mail:
| | - Orlando Vaselli
- Department of Earth Sciences, University of Florence, Via G. La Pira 4, 50121 Florence, Italy; CNR-IGG Institute of Geosciences and Earth Resources, Via G. La Pira 4, 50121 Florence, Italy
| | - Barbara Nisi
- CNR-IGG Institute of Geosciences and Earth Resources, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Lorenzo Frendo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56100 Pisa, Italy E-mail:
| | - Jacopo Cabassi
- CNR-IGG Institute of Geosciences and Earth Resources, Via G. La Pira 4, 50121 Florence, Italy
| | - Sara Profeti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56100 Pisa, Italy E-mail:
| | - Paola Valentini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56100 Pisa, Italy E-mail:
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56100 Pisa, Italy E-mail:
| | - Gaetano Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56100 Pisa, Italy E-mail:
| | - Angelo Baggiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56100 Pisa, Italy E-mail:
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Totaro M, Costa AL, Casini B, Profeti S, Gallo A, Frendo L, Porretta A, Valentini P, Privitera G, Baggiani A. Microbiological Air Quality in Heating, Ventilation and Air Conditioning Systems of Surgical and Intensive Care Areas: The Application of a Disinfection Procedure for Dehumidification Devices. Pathogens 2019; 8:pathogens8010008. [PMID: 30650590 PMCID: PMC6472009 DOI: 10.3390/pathogens8010008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/07/2019] [Accepted: 01/11/2019] [Indexed: 12/17/2022] Open
Abstract
International literature data report that the increase of infectious risk may be due to heating, ventilation and air conditioning (HVAC) systems contaminated by airborne pathogens. Moreover, the presence of complex rotating dehumidification wheels (RDWs) may complicate the cleaning and disinfection procedures of the HVAC systems. We evaluated the efficacy of a disinfection strategy applied to the RDW of two hospitals’ HVAC systems. Hospitals have four RDW systems related to the surgical areas (SA1 and SA2) and to the intensive and sub-intensive care (IC and sIC) units. Microbiological air and surface analyses were performed in HVAC systems, before and after the disinfection treatment. Hydrogen peroxide (12%) with silver ions (10 mg/L) was aerosolized in all the air sampling points, located close to the RDW device. After the air disinfection procedure, reductions of total microbial counts at 22 °C and molds were achieved in SA2 and IC HVAC systems. An Aspergillus fumigatus contamination (6 CFU/500 L), detected in one air sample collected in the IC HVAC system, was eradicated after the disinfection. The surface samples proved to be of good microbiological quality. The results suggest the need for a disinfection procedure to improve the microbiological quality of the complex HVAC systems, mostly in surgical and intensive care areas.
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Affiliation(s)
- Michele Totaro
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Anna Laura Costa
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Sara Profeti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Antonio Gallo
- Department of Public Health and Hygiene, Azienda USL Toscana Nord Ovest, 56100 Pisa, Italy.
| | - Lorenzo Frendo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Andrea Porretta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Paola Valentini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Gaetano Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
| | - Angelo Baggiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35-39, 56123 Pisa, Italy.
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