Effectiveness of a combined UV-C and ozone treatment in reducing healthcare-associated infections in hospital facilities.

BACKGROUND: Hospital-acquired infections pose an ongoing threat to patient safety due to the presence of multi-drug-resistant organisms (MDROs) and other pathogens such as Clostridioides difficile which are dependent on thorough and effective cleaning and disinfection by personnel. METHODS: This study evaluated the influence of UV-C air treatment: the air in the room was sanitized by UV-C and redirected into the room. In addition, ozone was released into the room to treat actual surfaces in low-risk areas such as hospital gyms, and high- to medium-risk areas such as hospital rooms. To this aim, a portable device designed for treating the environment air was tested against nine bacterial strains including Aspergillus spp. and Clostridioides spp. RESULTS: The use of UV-C air treatment during daily operations and ozone treatment achieved at least a 2-log10 pathogen reduction except for Clostridioides spp. CONCLUSION: Effective prevention of C. difficile normally requires the use of combined approaches that include chemical compounds and disinfection agents whose toxicity can be harmful not only to patients but also to healthcare personnel. Thus, the proposed no-touch device may be evaluated in future research to assess the needed requirements for its possible and full implementation in hospitals.

[Measurement of chemical agents in metallurgy field: electric steel plant]. / Misura degli agenti chimici in ambito metallurgico: acciaieria elettrica.

The steel industry maintains its important position in the context of the Italian production involving thousands of workers. The iron and steel processes are divided into primary steel industry, production of intermediate minerals, and secondary steel, scrap from the production of semi-finished industrial and consumer sector (metal inserted into components and metal used for dissipative uses, primarily coatings) and industrial waste. The paper presents the results of environmental monitoring carried out in some electric steel plant for the measurement of airborne chemicals that characterize the occupational exposure of workers employed in particular area like electric oven, to treatment outside the furnace, continuous casting area. For the sampling of the pollutants were used both personal and in fixed positions samplers. The pollutants measured are those typical of steel processes inhalable dust, metals, respirable dust, crystalline silica, but also Polycyclic Aromatic Hydrocarbons (PAH), polychlorinated dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs).

[Guides to chemical risk assessment in the construction industry]. / Percorsi di valutazione del rischio chimico in edilizia.

The presence of chemical agents in construction is certainly relevant in terms of quality, quantity and toxicity. Their manipulation can result in potential exposure as inhaled and/or through the skin. It is therefore possible and necessary to identify a list of substances to be considered relevant for the risk assessment and the possible environmental monitoring to verify the adequacy of the estimate made. The many variables inherent in construction make it extremely difficult to apply the usual methods of the industrial hygiene because it would not very significant conclusions in terms of space-time representation. SIMLII in one of its guidelines have proposed a "indexes" method that can provide useful information to the figures of prevention for the actions of their competence. The subsequent introduction of the REACH Regulation and exposure scenarios may help to further sharpening the assessment of chemical hazards in construction.

[Experiences of environmental and biological monitoring in the construction industry]. / Esperienze di monitoraggio ambientale e biologico in edilizia.

After emphasizing the characteristics of the sector and the difficulty of applying traditional industrial hygiene methods for assessing exposure to chemical agents in the construction industry, we have reviewed the major experiences of environmental and biological monitoring that can be derived from the literature. Although the determination of exposure through environmental measures should be considered the most appropriate instrument, it should be paid for the study of specific activities, while it is preferable in many situations the use of simplified tools (such as algorithms and databases) that allow the risk estimation and enable the adoption of safe work procedures and environmental and individual protection devices.

[Assessment of exposure to cancerogenic aromatic hydrocarbon during controlled-access highways management activities]. / Valutazione dell'esposizione ad idrocarburi aromatici cancerogeni nell'attività di gestione autostradale.

The purpose of this study was an integrated assessment of exposure to benzene and Polycyclic Aromatic Hydrocarbons (PAH) in 29 workers employed to manage a controlled-access highways. A campaign was performed in summertime by environmental monitoring (active and passive airborne personal sampler), as well as by biological monitoring (urine samples of the beginning and of the end of daily shift, baseline after two days of vacation). The measured environmental levels did not differ from background environmental concentrations found in a metropolitan area (i.e. benzo[a]pyrene < 1 ng/m3; benzene < 5 mcg/m3), and the results of biological monitoring were in agreement and were compatible with extra-professional habits of the investigated subjects (1-hydroxipyrene 50-990 ng/g creatinine; unmetabolized benzene 15-2010 ng/I; t-t muconic acid < 4-222 mcg/g creatinine).

[Exposure assessment to chemical agents: algorithms and measurements; advantage and critical state]. / Valutazione dell'esposizione ad agenti chimici: algoritmi e misurazioni, vantaggi e criticità.

The exposure assessment to chemical agents may be worked out by "preliminary evaluation" on documentary examination to "instrumental measurements" through "algorithms application" or "screening measurements"; in the last years the need of dermal exposure assessment has increased. The application of the procedures has highlighted the need to distinguish between small and great plants, production processes, etc. and to "interpret" the rules. The paper, through the critical examination of the difficulties observed in these years of application of the risk assessment procedures, suggests some reflections upon the best management of the process of exposure assessment to chemical agents: from the preliminary evaluation to the instrumental measurements.

[Characterization of airborne particles and exposure assessment]. / Caratterizzazione degli inquinanti aerodispersi e valutazione dell'esposizione.

The Authors draw the attention on the critical topics of the occupational exposure assessment according to the criteria of the UNI EN 689/1997: air sampling strategy to characterize spatial and time variability of pollutant concentrations. They present a preliminary scheme to identify the sources and the chemical agents in the workplace and lead into discussion of critical topics on sampling strategy, instruments and analysis for the measurement, the particle size distribution and the chemical characterization of inorganic particles (silica, ultrafine particles), organic (wood dusts) and fibers (asbestos, synthetic fibres).

Micro-organisms and dust exposure in an Italian grain mill.

AIMS: In order to assess possible occupational risk for workers in a grain mill, we evaluated aerial microbiological contamination in different areas of the mill and at different points of the production line. We also measured the concentration of aerodispersed dust particles. METHODS AND RESULTS: An assessment of microbiological contamination levels based on a Global Index of Microbial Contamination per cubic metre (GIMC per m3), an Index of Mesophilic Bacterial Contamination, and an Amplification Index is proposed. The indices were obtained from total and fungal counts. The cleaning sector is the most contaminated area of the mill: the mean GIMC per m3 was 17,213.6. In this area, the average microbial contamination was 11.41 times higher than that in the external environment. The highest concentrations of aerodispersed dust (inhalable 2.763 mg m(-3); respirable 1.400 mg m(-3)) were found in the cleaning area. CONCLUSIONS: The proposed microbiological indices and the concentrations of aerodispersed dust particles show that the most hazardous section of the mill is the cleaning area. The large variation in the data does not depend on seasonal factors, but rather on not easily identifiable conditions of the internal environment which facilitate diffusion and/or proliferation of the micro-organisms. SIGNIFICANCE AND IMPACT OF THE STUDY: The proposed microbiological contamination indices and the evaluation of the concentration of dust particles allow the identification of critical positions during the production cycle so that suitable measures to prevent the aerial contamination can be taken.

House dust mites (Der p 1, Der f 1), cat (Fel d 1) and cockroach (Bla g 2) allergens in indoor work-places (offices and archives).

BACKGROUND: Exposure to indoor allergens has already been shown to occur in many public places, including workplaces, in several countries. Aim of this study was to measure the levels of house dust mites, cat and cockroach allergens in indoor workplaces (offices and archives) in Italy and to evaluate the possible relationships between allergen levels and building characteristics, type of ventilation, indoor relative humidity and temperature. METHODS: Der f 1 and Der p 1, Fel d 1, Bla g 2 were measured by ELISA in dust samples collected from floors or upholstered seats of 160 workplaces. RESULTS: Detectable Der p 1 levels were found in 86 (54%) workplaces Der f 1 in 87 (55%), Fel d 1 in 86 (54%) and Bla g 2 in 3 (1.9%). Der p 1 allergen concentrations expressed per weight were higher than the proposed sensitization thresholds in 7 samples, Der f 1 in 5, Fel d 1 in 6 and Bla g 2 in 3. The highest allergen levels were detected in samples from upholstered seats. A significant correlation was found between Der f 1 level on floors, expressed per surface, and indoor temperature (r = 0.39; P < 0.01). CONCLUSIONS: In our study we found that upholstered seats in workplaces in Italy may constitute a significant reservoir both of house dust mites and cat allergens. Exposure to these allergens in workplaces may represent a risk factor for elicitation of symptoms and/or induction/maintenance of inflammation in allergic individuals and might also constitute a risk factor for sensitization.

[Implementation of parliamentary act D. Lgs 25/02 and definition of "moderate risk"]. / Applicazione del D.Lgs 25/02 e definizione di "rischio moderato".

This paper describes the position of the Joint Working Group of the Italian Association of Industrial Hygienists (AIDII), the Italian Society of Occupational Health and Industrial Hygiene (SIMLII) and the Italian Society of Toxicology (SITOX) on "Analysis of Parliamentary Act D.Lgs 25/02 and role of the Scientific Societies in the definition of Limit Values". The positive aspects of the new law which implements the European Directive 98/24 are discussed, including the abolition of the rigid periodicity of medical examinations as stated by the old rule D.P.R. 303/56. The Authors also address various parts of the law which appear to be unclear and controversial and highlight the expected difficulties arising for the employers and the safety and health professionals during the application of this new piece of legislation. Moreover, a number of discrepancies are noted between the new Italian law and the original Directive or other current Italian rules such as i. the translation of the term "slight risk", as from the original Directive, into "moderate risk", and the resulting non compulsoriness of health surveillance and biological monitoring of the workers in presence of a "moderate risk", ii. the concurrent exclusion, under the same circumstances, of the occupational physician from risk assessment procedures and iii. the upward modification of the previously established (D.Lgs 277/91) occupational exposure limits for lead. Moreover, the Authors examine and criticize--both in semantic and in toxicological terms--a recent proposal for the definition of "moderate risk" made by an ad hoc Consulting Committee of the Labour Ministry, in which the term "moderate" has been interpreted either as "low" or as "irrelevant for health effects", clearly two very different meanings. Besides, it would be inappropriate to define the conditions of a moderate risk based only on the level of exposure to the chemical (expressed as a fraction of the corresponding limit value), without considering the two other components of risk assessment for that chemical (hazard and susceptibility). Even worse would be the use of simplified models based on "algorithms", which might be useful in a preliminary phase of risk assessment, but easily could lead to an under- or over-estimation of risk, particularly when used by non professionals. In conclusion, the Working Group recommend that the new law be amended in order to clarify its most controversial aspects, whose misinterpretation could severely jeopardize the protection of the workers' safety and health at work.

[Proposed microbiological indexes for the assessment of air quality in buildings]. / Proposta di indici microbiologici per la valutazione della qualità dell'aria degli edifici.

An assessment of biological risk in the workplace requires the measurement of microorganisms present in the air. Although it is currently difficult to establish a dose-response relationship on the basis of existing epidemiological data, the number and types of microorganisms present offer a useful index when evaluating the quality of the air. Using the results obtained from a study of 226 different offices located in buildings equipped with forced ventilation we propose an assessment of contamination levels based on a Global Index of Microbial Contamination/m3 (GIMC/m3). This index is calculated as the sum of the values of the total microbial count determined for mesophilic bacteria, psychrophilic bacteria and fungi in all sampled areas. GIMC/m3 fluctuates between a minimum value of 23 and a maximum value of 18.069: the mean value varies depending on the ventilation system mode setting, with a value of 145 when operating in the heating mode, 265 in the air-conditioning mode and 258 under simple forced ventilation. 95.5% of the offices under study had a GIMC/m3 value of below 1000: this value is proposed as a threshold limit above which a more extensive assessment of contamination levels based on the measurement of further microbiological indexes should be carried out. To this aim we propose an Index of Mesophilic bacterial Contamination (IMC), obtained by calculating the ratio between the CFU/m3 value measured for mesophilic and psychrophilic bacteria in the same sampling point. The measurement of the Amplification Index (AI) completes the evaluation and this is determined by calculating the ratio between the GICM/m3 values measured inside the building and those measured outside. When considering these observations as a whole we are able to classify the various work areas under study into groups and categories according to the observed values of the proposed microbial contamination indexes.

[Criteria and methods for the study of occupational exposure to antineoplastic agents]. / Criteri e metodi per lo studio dell'esposizione occupazionale a chemioterapici antiblastici.

Risk assessment for occupational exposure to antiblastic chemotherapeutic drugs (ACD) is carried out by means of environmental and biological monitoring. These practices are not widespread and furthermore their results are frequently difficult to interpret. This paper discusses some of the most important aspects of risk assessment for ACD and in particular for their exposure evaluation. The following guidelines are proposed: a) working rooms, working procedures, type and quantity of drugs, and preventive measures must be checked using a standardized scheme for collecting data: an example of a check list experimented in some Italian hospitals is presented; b) cyclophosphamide, 5-fluorouracil, and Pt coordination compounds have been identified as tracers of drug mixtures usually administered, and their determination is recommended both in environmental and biological samples; c) for a correct evaluation of exposure, ACD should be determined firstly on the contaminated surfaces or on work clothes and secondly in urine of workers; the measurement of ACD in air must be limited to well documented conditions of high exposure and the urinary mutagenicity tests should be avoided; d) the biological monitoring practices should be enhanced, in particular the determination of ACD adducts to proteins and nucleic acids as promising indicators of effective dose.

Chewing electric wire coatings: an unusual source of lead poisoning.

This report describes a case of lead poisoning occurring in an electrician as the result of an unusual personal habit, namely, the chewing of lead-containing coatings of electric wires. A coating chewing test showed that a few minutes after beginning chewing, saliva lead concentration increased from 10 micrograms/l to several milligrams per liter. This case is an example of poisoning caused by an occupationally related source (coatings containing lead) as a consequence of a singular and unconventional worker's habit.

Biological monitoring of human exposure to atrazine.

Atrazine exposure was evaluated in six manufacturing workers by personal and biological monitoring. Total atrazine exposure varied from 10 to 700 mumol per workshift and total urinary atrazine excretion accounted for 1-2% of the external dose. The spectrum of the urinary atrazine metabolites comprises bi-dealkylated (80%), deisopropylated (10%), deethylated (8%) and unmodified atrazine (2%). The metabolites are eliminated in urine in slightly longer than 24 h: 50% of the amount is excreted in the first 8 h following the workshift.

Correlation between PAH airborne concentration and PAH-DNA adducts levels in coke-oven workers.

In order to evaluate the correlation between peripheral blood leukocyte DNA adducts as an indicator of exposure to polycyclic aromatic hydrocarbons (PAH) and the airborne contamination of PAH at the work places, a survey of a cohort of coke-oven workers has been carried out. In each workplace, total and specific PAH airborne concentrations were measured. Among the job title groups, the highest proportion of subjects with levels of adducts above the detection limit and the highest mean value were observed in the door-operators. The correlation between median values of environmental benzo(a)pyrene concentration and mean values of adducts concentration support the fact that the maintenance workers group has a higher relative risk (RR) to have detectable level of PAH-adducts, which is estimated to be 1.84 for an increase of 1 micrograms/m3 of benzo(a)pyrene.

Increases in polycyclic aromatic hydrocarbon content and mutagenicity in a cutting fluid as a consequence of its use.

The aim of this study was to evaluate the relationships between the length of time a cutting fluid was used, its content in polycyclic aromatic hydrocarbons (PAHs) and its mutagenic potential. The PAH concentrations were determined by means of a high-resolution gas chromatograph-mass spectrometer in samples of new cutting fluid and in samples used for 3, 6 and 9 months. The following PAHs were measured: phenanthrene, anthracene, fluoranthene, pyrene, benzo[a]anthracene, chrysene+triphenylene, benzo[e]pyrene, benzo[a]pyrene and perylene. Mutagenicity assays were carried out on the aforementioned samples using the Ames test. Salmonella typhimurium TA98 was used as an indicator to show up mutagens capable of inducing frame-shift genetic changes, and Escherichia coli WP2 uvrA was used as an indicator to detect mutagens capable of inducing base pair genetic changes. The mutagenic tests were carried out with and without microsomal activation, using 1:1, 1:10, 1:20 and 1:50 dilutions of cutting fluid samples. An increase in the concentrations of total PAHs over time was observed in the samples of cutting fluid used for 3, 6 and 9 months. The highest percentage increase in PAH concentrations was observed in the 6-month-old sample (10 times the initial concentration, from 45 to 411.8 micrograms of oil). None of the samples were mutagenic to S. typhimurium without metabolic activation or to E. coli with and without metabolic activation. All samples except for the 1:1 diluted sample showed moderate but significant mutagenic activity in the S. typhimurium test with metabolic activation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Assessment of exposure to polycyclic aromatic hydrocarbons in 3 work activities using mineral oils]. / Valutazione dell'esposizione a idrocarburi aromatici policiclici in tre attività lavorative che utilizzano olii minerali.

The exposure to polycyclic aromatic hydrocarbons (PAH) in different industries using cutting, hardening and extruding oils, was investigated determining their concentration in oils and in environmental samples. The following compounds: phenanthrene, anthracene, fluoranthene, pyrene, benzo-a-anthracene, chrysene, triphenylene, benzo-a-pyrene, benzo-e-pyrene and perylene were evaluated by means of gas-chromatography-mass spectrometry. PAH concentrations in oils ranged from 652 to 4461 ng/gr and environmental concentrations from 63.86 to 120.54 ng/mc. In particular the BaP concentrations varied from 0.73 to 1.9 ng/mc. These results, compared with those measured in other environmental surveys and with the limit values proposed in various countries, point out the existence of a very low inhalatory risk of PAH.

[Qualitative and quantitative changes in the polycyclic aromatic hydrocarbons in cutting oils after their use]. / Modificazioni quali-quantitative degli idrocarburi aromatici policilici negli olii da taglio conseguenti al loro utilizzo.

The quantitative and qualitative variations in the mixture of polycyclic aromatic hydrocarbons (PAH) present in different samples of a cutting oil, unused and after 3,6 and 9 months of use, were evaluated by means of gas-chromatography mass spectrometry. Nine of the identified hydrocarbons (phenanthrene, anthracene, fluoranthene, pyrene, benzo-a-anthracene, chrysene, triphenylene, benzo-a-pyrene, benzo-e-pyrene and perylene) were studied. The total PAH concentration increased from 45 (first sample) to 915 ng/gr of oil, even if a different behaviour for various hydrocarbons was shown. In fact some of them, such as phenanthrene and anthracene increased with use, some, such as fluoranthene and pyrene decreased and the other did not exhibit a regular trend. In the light of results, the influence of variations of the PAH mixture in oil on the PAH air concentration and on the preventive measures to be adopted, is discussed.