Effectiveness of anti-epidemic measures on ensuring indoor air quality of cleanrooms in a tertiary care hospital.

OBJECTIVES: Maintaining cleanrooms in a hospital is a key part of preventing healthcare-associated infections (HAIs). The aim of this work was to verify the effectiveness of anti-epidemic measures to ensure air quality in cleanrooms in a tertiary care hospital. METHODS: The study was based on the application of anti-epidemic measures and verification of their effectiveness by regular indoor air monitoring between the years 2014-2019. Monitoring was performed according to a recommended procedure based on European standards for cleanrooms. RESULTS: The results demonstrate a reduction in the number of airborne particles and the number of colonies, as well as the elimination of fungi and conditioned pathogens in air samples. CONCLUSIONS: The authors emphasize the importance of established anti-epidemic measures and regular monitoring for the prevention of HAIs.

[Prevalence of diphtheria, tetanus and pertussis in the world].

Diphtheria, tetanus and pertussis are very serious diseases threatening the lives of children and adults. However, these diseases are preventable by vaccination. After the World Health Organization was founded in 1946, its experts rapidly developed a vaccination schedule for the pediatric population. The former Czechoslovakia, a founding member of this organization, actively participated in the implementation of vaccination against many infectious diseases, including vaccinations against tetanus, diphtheria and pertussis. Mass vaccination of children could not be implemented in all countries of the European Region. The main problem was differences in the economic situation since the mass vaccination of the pediatric population represents a significant financial burden. It was only in the early 1970´s that the pediatric immunization program was initiated in developing countries. The article compares the impact of vaccination in different continents (Europe, Asia, Africa) since 1980. High immunization coverge is essential for a reduction in the incidence of the above infectious diseases. Cases of the diseases reported between 1980 and 2016 are cited in the article. Trends in these infectious diseases are related to the economic and political changes that occurred at the turn of the millennium.

Monitoring of Microscopic Filamentous Fungi in Indoor Air of Transplant Unit.

AIM: The aim of the study was to control the microbial contamination of indoor air monitored monthly at the Transplant Unit of the University Hospital Olomouc from August 2010 to July 2011. METHODS: The unit is equipped with a three-stage air filtration system with HEPA filters. The MAS-100 air sampler (Merck, GER) was used. Twenty locations were singled out for the purposes of collecting a total of 720 samplings of the indoor air. Swabs of the HVAC diffusers at the sampling locations were always carried out after the sampling of the indoor air. RESULTS: In total, 480 samples of the indoor air were taken for Sabouraud chloramphenicol agar. In 11 cases (2.29%) the cultivation verified the presence of microscopic filamentous fungi. Only two cases involved the sanitary facilities of a patient isolation box; the other positive findings were from the facilities. The most frequent established genus was Aspergillus spp. (4x), followed by Trichoderma spp. (2x) and Penicillium spp. (2x), Paecilomyces spp., Eurotium spp., and Chrysonilia spp. (1x each). In 2 cases the cultivation established sterile aerial mycelium, unfortunately no further identification was possible. A total of 726 swabs of HVAC diffusers were collected (2 positive-0.28%). The study results demonstrated the efficacy of the HVAC equipment. CONCLUSIONS: With the continuing increase in the number of severely immunocompromised patients, hospitals are faced with the growing problem of invasive aspergillosis and other opportunistic infections. Preventive monitoring of microbial air contaminants is of major importance for the control of invasive aspergillosis.

Monitoring of the environment at the transplant unit-hemato-oncology clinic.

AIMS: Aim of this study was to monitor the environment at the Transplant Unit-Hemato-Oncology Clinic, University Hospital Olomouc (Olomouc, Czech Republic) and identify risks for the patients. METHODS AND RESULTS: Microorganisms were cultivated under standard aerobic conditions. Strains were biochemically identified using the BD Phoenix™ PID Panel (USA). Legionella pneumophila was identified by DNA sequencing. From the air, the most frequently isolated strains were coagulase-negative staphylococci (94.3%), Micrococcus spp. and Bacillus spp. No Gram-negative strains were isolated from the air. From the surfaces, the most frequently isolated Gram-positive strains were coagulase-negative staphylococci (67.4%), Bacillus spp., enterococci (5.5%), Staphylococcus aureus (2.3%) and Micrococcus spp. (1.7%). From the surfaces, the most frequently isolated Gram-negative strains were from genera Pseudomonas (28%), Enterobacter (28%), E. coli (6%), and Klebsiella spp. (5%). From the personnel, the most frequently isolated Gram-positive strains were coagulase-negative staphylococci (59.6%), Bacillus spp. (24.1%) and Staphylococcus aureus (9.8%). From the personnel, the most frequently isolated Gram-negative strains were Enterobacter spp. (61%), Klebsiella oxytoca (18%), and E. coli (11%). Microscopic filamentous fungi were isolated in 13 cases (2.71%). Isolated strains were Aspergillus spp. (4), Trichoderma spp. (2), Penicillium spp. (2), one case of the strains Paecilomyces spp., Eurotium spp., Monilia spp. CONCLUSIONS: The study found no significant deviations in the microbial contamination of the cleanroom air. The personnel entrance of the Transplant Unit represent a high risk area, an extreme value (7270 CFU/m3) was recorded. Regime measures are fully effective, no other deficiencies were found. SIGNIFICANCE AND IMPACT OF THE STUDY: This epidemiological study, which was held for the duration of one year at the Transplant Unit-Hemato-Oncology Clinic, University Hospital Olomouc. The study monitored microbial contamination of the cleanroom air, surfaces, water, colonization of the personnel by bacterial strains of epidemiological consequence.

[Bacterial contamination of the indoor air in a transplant unit]. / Bakteriální kontaminace vnitrního vzduchu transplantacní jednotky.

For one year (August 2010 to July 2011), microbial contamination of the indoor air in the Transplant Unit of the Haemato-Oncology Clinic, Olomouc University Hospital was monitored monthly. Twenty sampling sites were singled out and a total of 240 indoor air samples were collected. An MAS-100 air sampler (Merck, GER) was used, air flow rate of 100 liters per minute, 1 minute. The measured values of indoor air temperature were stable. The relative air humidity ranged from 17% to 68%. The highest average value of microbial air contamination was found in the "staff entry room" (1170 CFU/m3). The lowest microbial air contamination (150-250 CFU/m3) was measured in the patient isolation units. The most frequently isolated bacterial strains were coagulase-negative staphylococci (94.3%), followed by Micrococcus spp. (67%) and Bacillus subtilis (11%). It can be assumed that the -source of these airborne bacterial strains are both patients and medical staff. They are classified as -opportunistic pathogens and as such can cause hospital infections among haemato-oncology patients.

[The incidence of gram-negative bacteria in the environment of the Transplant Unit, Department of Hemato-oncology, University Hospital --Olomouc]. / Výskyt gramnegativních bakterií v prostredí transplantacní jednotky Hemato-onkologické kliniky FN Olomouc.

A study entitled "Surveillance of Infectious Complications in Hemato-oncological Patients", was conducted at the Department of Hemato-Oncology, University Hospital Olomouc from 1 July 2010 to 31 August 2011. During the study period, a total of 96 patients were hospitalized at that department and 63 stem cell transplants were performed, 43 autologous and 23 allogeneic. Microbial contamination was monitored in indoor air, on selected surfaces, and in health care providers (right hand smear, left and right nostril swabs and scalp hair smear). Opportunistic Gram-negative bacterial strains were selected from the cultures.

[The incidence of nonfermentative gram-negative bacilli in the environment of the transplant unit, department of hemato-oncology, university hospital Olomouc]. / Výskyt gramnegativních nefermentujících bakterií v prostredí transplantacní jednotky Hemato-onkologické kliniky FN Olomouc.

A study entitled "Surveillance of Infectious Complications in Hemato-oncological Patients" was conducted at the Department of Hemato-Oncology, University Hospital Olomouc from 1 July 2010 to 31 August 2011. During the study period, a total of 63 patients were hospitalized at that department and 33 stem cell transplants were performed, 21 autologous and 12 allogeneic. Microbial contamination was monitored in indoor air, on selected surfaces, and in health care providers (right hand smear, left and right nostril swabs and scalp hair smear). Gram-negative bacteria detected by culture were identified biochemically. Special attention was paid to nonfermentative Gram-negative bacilli which, based on the recent literature, should be considered as emerging causative agents of hospital infections.

The importance of cleanrooms for the treatment of haemato-oncological patients.

The main purpose of cleanrooms in health care centres is to prevent hospital infections or leakage of a highly infectious agent (the source of haemorrhagic fevers, SARS, etc.) into the ambient environment and subsequently possibly threatening other individuals. Patients with haematological malignancies or after autologous or allogeneic haematopoietic stem cell transplantation (HSCT) rank among immunosuppressed individuals. Prolonged and deep neutropenia is considered a key risk factor of the occurrence of an exogenous infection. One of the possibilities of preventing an exogenous infection in these patients is to place them in a "cleanroom" for the crucial period of time. Cleanrooms are intensive care units with reverse isolation. The final part of the general article below provides an overview of the technology and types of cleanrooms for immunosuppressed patients in compliance with the current recommendations and technical standards.

[Bacteriospermia and the production of reactive oxygen species in the semen of males from infertile couples]. / Bacteriospermie a produkce of reaktivních kyslíkových cástic v ejakulátu muzu z neplodných páru.

OBJECTIVE: To estimate the incidence of bacteriospermia, the representation of specific micro-organisms and the generation of reactive oxygen species (ROS) in the semen of males from infertile couples in comparison with the semen of fertile volunteers. MATERIAL AND METHODS: Males from infertile couples were divided according to WHO criteria of their spermiogram results into those with normospermia (Group A, n = 65) and those with semen abnormalities (Group B, n = 116). The control group consisted of 44 fertile volunteers (Group C, n = 44). Aerobic culture was performed to ascertain the genus and species of the present microorganisms. ROS production was estimated by the chemiluminescence method. Statistical analysis was performed using the Mann-Whitney test. RESULTS: The incidence of positive cultures in the semen between Groups A, B and C (69 %, 74 % and 66 %, respectively) did not differ significantly, with Staphylococcus and Streptococcus species being most frequently identified. A significant difference was found only between the occurrence of microorganism Escherichia coli in the groups A, B and C (11.1 %, 9.3 % and 3.2 %). There were no statistically significant differences between ROS production in semen with positive or negative culture in any of the studied groups. CONCLUSIONS: In all the studied groups, the incidence of bacteriospermia as well as ROS production in the semen were similar. Staphylococcus and Streptococcus species were found in all groups. A significantly higher frequency of Escherichia coli in the semen samples of males from infertile couples in comparison with those from fertile volunteers was observed. No differences in ROS production in semen samples with positive and negative culture results were found in any of the studied groups.

Current knowledge of methicillin-resistant Staphylococcus aureus and community-associated methicillin-resistant Staphylococcus aureus.

BACKGROUND: Bacterial strains that are oxacillin and methicillin-resistant, historically termed methicillin-resistant Staphylococcus aureus (MRSA) are resistant to all beta-lactam agents, including cephalosporins and carbapenems. MRSA are pathogenic and have a number of virulence factors that enable them to result in disease. They are transmissible and important causes of nosocomial infections worldwide. An MRSA outbreak can occur when one strain is transmitted to other patients or through close contacts of infected persons in the community. Hospital-associated MRSA (HA-MRSA) isolates are also frequent causes of healthcare-associated bloodstream and catheter-related infections. Community-associated MRSA (CA-MRSA) isolates are often only resistant to beta-lactam agents and erythromycin but they are an emerging cause of community-associated infections, especially skin and soft tissue infections (SSTI) and necrotizing pneumonia. METHODS: Current possibilities for detecting MRSA strains in the laboratory are reviewed and discussed in the context of the recent literature. RESULTS AND CONCLUSION: The active surveillance and prevention of MRSA occurrence and spreading in hospitals are discussed in the context of recent literature.

Protection against tetanus in the aged people in the Czech Republic--cross-sectional study.

The aged people belong to most vulnerable group for tetanus infection in terms of their vaccination history, frequency of injuries, which may serve as gate of entry for this infection and declared decrease of general as well as specific immunity. The examinations of the aged people for antitetanus antibodies have been done to assess the immunity against tetanus in this particular group of people in the Czech republic. Blood samples were collected from people living in hostels for senior citizens on the bases of signed informed consent. The study focused on people older than 60 years of age. TETANUS ELISA Genzyme Virotech GmbH kit was used for detection of IgG antibodies against tetanus. The level of >0.1 IU/ml was used as protective level of antibodies. Total number of 341 samples was investigated for antibodies against tetanus. Nonprotective (<0.1 IU/ml) titer of antibodies was found in 9.1% of subjects and 90.9% of people possessed protective titers of antibodies against tetanus. The interval between the last vaccination (or revaccination) against tetanus and collection of blood sample was ascertained in 257 subjects and this interval was 10 years or less in 89.9% of subjects. Geometric mean of titers was calculated for different intervals between the last vaccination and collection of blood sample. There was an increasing trend of geometric mean values found with decreasing interval from the last vaccination. But there were also good values of geometric mean of titers found in subjects vaccinated long before collection of blood (intervals up to 27 years). Due to completely different situation in the Czech Republic, where adult people were repeatedly revaccinated in military service (males), in the employment with higher risk of tetanus infection, in context with treatment of injuries and finally during mass vaccination campaigns, organized in the Czech Republic for all adult people in 1974-1976 and in 1984-1986, even the aged people can reach acceptable immunity against tetanus.