[Strategies for prevention and control of healthcare related infections by Acinetobacter baumannii]. / Strategie di prevenzione e controllo delle infezioni da Acinetobacter baumannii correlate all'assistenza sanitaria.

The frequent development of acquired antibiotics resistance in bacteria represents a challenge for Public Health in terms of healthcare associated infections control. Apart from the appropriate use of drugs, in particular the choice of proper antimicrobial therapy, increasing interest is, therefore, given to the non-pharmacological prevention of these infections. Acinetobacter (A.) baumannii is a micoorganism that commonly causes infections for patients hospitalized in critical hospital wards (intensive care units, burn centers, surgery, neonatology, etc) potentially severe and difficult to treat, because A. baumannii is resistant to many or sometimes all, available antibiotics (PDR - pan drug resistant). The aim of the present paper was to review the available measures for preventing and controlling the contamination and the spread of these types of bacterial infections in health care scenarios, with particular attention to two methods that stand out for efficiency and safety: hand hygiene and environmental disinfection.

[Skin antisepsis in premature infants]. / Problemi di antisepsi nei neonati prematuri.

In some premature newborns, 7 months old and with less than 1 kg of body wheight, total parenteral nutrition is used for weeks, so that good antiseptics can cooperate to the prevention of nosocomial infections, associating the best biocide effects to the best topical tolerability. Details are reported on the biocide cutaneous properties of some chloro-derivates, as sodium hypochlorite and NaDCC, of ethyl and propyl alcohols, of chlorhexidine, of iodophors and also of triclosan and octenidine (even if these latter biocids are not normally available in Italy as cutaneous antiseptics).

[Specific antisepsis and environmental disinfection in preventing "Clostridium difficile associated diarrhea"]. / Antisepsi mirata e disinfezione ambientale per la prevenzione della "'Clostridium difficile associated diarrhea".

In the last years, Clostridium difficile acquired great interest for public health because of constant increase of Clostridium difficile associated diarrhea (CDAD), especially in nosocomial field and as a consequences of its pathogenicity and virulence. Oro-faecal transmission and great environmental persistence of Clostridium difficile indicate hand hygiene of health care workers and environmental disinfection practices as key interventions for prevention and control of nosocomial CDAD. The current indications relative to the hand hygiene suggest the use of soap and water for hand washing and, to achieve a better compliance of health care workers to this treatment, the alternative use of sodium dichloroisocyanurate or alcohol-based solution or gel waterless. Regard to environmental disinfection, to avoid high concentrations of sodium hypochlorite (in the magnitude of 5.000-6.000 ppm), necessary to reduce microbic load of dirty environment, the most appropriate treatment should consist of 2 phases: preliminary cleaning with water and detergents or polyphenol, followed by treatment with solution containing 1.000 ppm available chlorine, obtained from sodium hypochlorite or sodium dichloroisocyanurate.

[Pandemic influenza: rapid sanitary-hygienic measures for initial containment of diffusion]. / Pandemia influenzale: misure igienico-sanitarie di rapida attuazione per il contenimento iniziale della diffusione.

Viral respiratory diseases may be characterized by rapid diffusion in population, that often cause epidemic outbreaks or pandemic. Besides, typical high mutations of involved virus (almost always influenza virus) can reduce the validity of the up to date available vaccine. The achievement of new vaccines can require prolonged period. In addition, the availability and efficacy of antiviral drugs against new viruses should be evaluated before their uses. Influenza virus replication occurs in the epithelial cells of the respiratory system, and viruses, present in contaminated secretions, spread mainly by aerosols generated during sneezing, coughing, and speaking. Direct and indirect contacts with contaminated fomites play a role, in transmission of viral infection, even if they are less relevant than aerosol transmission. In the absence of ready for use vaccines and active drugs, some "non-pharmaceutical" strategies can be considered decisive factors to reduce the diffusion of pandemic influenza. Hand washing and disinfection procedures, isolation of ill persons, different indication for use of surgical masks and respiratory masks have to be carefully considered.

[Antisepsis and disinfection in emerging and re-emerging viral diseases]. / Malattie virali emergenti e riemergenti: antisepsi e disinfezione mirate per prevenirne la diffusione.

Prevention and therapy of emerging and re-emerging viral diseases may be inefficient due the inavailability of specific vaccines, active chemotherapic drugs, acceptable pesticides, and vector control measures. To reduce contact spreading of viral infections, some biocides, as chlorine compounds or phenolic compounds, associated with detergents, may assume a leading position as safe substances with antiviral properties for the environmental decontamination. Detailed instructions on their use may be introduced in future guidelines related to emerging and re-emerging viral diseases.

[SARS: diagnosis, therapy, and especially prevention]. / SARS: diagnostica, terapia e soprattutto prevenzione.

The main purpose of this review is to analyze some aspects of the severe acute respiratory syndrome, SARS, in order to obtain useful data to suggest preventive actions to reduce the spreading of the disease. Many elements have been examined to reach some conclusions and to allow an updated discussion. Surgical masks protect more the patient than the caregiver. Simple or double surgical masks may be useful, as double gloving protects the hands of the surgical personnel against percutaneous transmission of HIV eventually present in contaminated blood. The frequent substitution of the external masks with a new one will improve the filtering activity against droplets produced by cough or sneezes of the patient. The use of respiratory masks may be suggested in hospitals or in restricted ventilated areas where, even if coronavirus variant is considered an environmental contaminant more than a respiratory risk, droplets nuclei may persist in the air and add consistent dangers to the heath-care givers. Considering that large and medium droplets may infect floors and surfaces, in addition to gloves, gowns, masks and eyes protection, the available list of viral and bacterial factors implicated in SARS ethiology suggests a better hand antisepsis using frequently the alcohol based gels (containing an high percentage of emollients substances), if available. A liquid soap with triclosan can also be used, if the health-care workers compliance to hand washing increases, as expected in this explosive situation. On the basis of the results of some experimental data, the environmental disinfection may be effected with ethyl alcohol 70% in water. Disinfection of floors or larger surfaces may be obtained with chlorine compounds solutions, after an accurate pre-cleaning. When corrosion, bleaching or gas production have to be avoided, chlorine compounds may be substituted by phenolic detergent disinfectants.

Iris alteration using mechanical iris retractors.

A 74-year-old woman had a 3-port pars plana vitrectomy for a dropped nucleus after complicated phacoemulsification. Flexible nylon iris retractors were positioned to dilate the small pupil. The patient died of a pulmonary embolus 1 day after surgery. The eyeball was removed at autopsy, and pathology of the iris was investigated. Localized damage to the iris where the retractor hooks were positioned was noted, but no other alterations to the iris were observed. These findings may explain the recovery of pupil function that is common after surgery with mechanical iris retractors.

Effect of phenolic and chlorine disinfectants on hepatitis C virus binding and infectivity.

BACKGROUND: The purpose of this study was to evaluate the inhibitory activity of 2 polyphenolic disinfectants and a chlorine compound (NaDCC) on hepatitis C virus (HCV) binding and infectivity. METHODS: VERO cells (a continuous cell line derived from cynomolgus kidney cells) suitable for analyzing HCV binding and replication, and the competitive reverse transcription (cRT-PCR) technique for HCV RNA molecules quantitative evaluation have been chosen as a methodologic approach for the antiviral activity testing. RESULTS: At their recommended use dilutions, polyphenolic disinfectants inhibited HCV binding and replication. The chlorine compound was ineffective, probably a result of its low concentration in the presence of protein substances in VERO cell cultures. CONCLUSIONS: Inhibition of HCV binding and replication by the tested polyphenolic associations confirm their value in instrument decontamination and environmental disinfection against this clinically important lipid virus.

Spontaneous dislocation into the vitreous of a poly(methyl methacrylate) disc lens 9 years after surgery.

A 76-year-old woman had sudden visual loss 9 years after an extracapsular cataract extraction with implantation of a poly(methyl methacrylate) disc intraocular lens (IOL) in the capsular bag. Slitlamp examination showed the disc IOL had luxated into the vitreous through a linear inferior opening in the capsular bag; the IOL lay on the retinal surface. A pars plana vitrectomy was performed. The vitreous cavity was filled with perfluorocarbon liquid, floating the IOL to behind the iris. The IOL was removed through a limbal incision, then another type of IOL was implanted in the ciliary sulcus using transscleral fixation. Thirty days after surgery, best corrected visual acuity (BCVA) was 20/20. At 2 months, total retinal detachment appeared with a large superior retinal dialysis. Another pars plana vitrectomy was performed and the scleral-fixated IOL removed through a limbal incision. Internal gas tamponade was used. The eye was left aphakic. Final BCVA was 20/25.

[Elements in the evaluation of some disinfectants for hospital use]. / Elementi per la valutazione di alcuni disinfettanti in ambito ospedaliero.

The efficacy of hospital disinfectants may be evaluated on the basis of the available information on their chemical, physical and biological properties: these depend on the interaction of germicides with other components in the formulation, with the diluent (its quality and quantity), with the organic matter and other materials. The Author is giving his contribution with up-dated information on commercial disinfectants based on phenol derivatives.