Prevention of nosocomial legionellosis by best water management: comparison of three decontamination methods.

BACKGROUND: Since 2000, the National Health System has adopted international guidelines for assessing Legionella spp. in hospital water systems. The control of water contamination by Legionella spp. is still a matter of research concerning the most effective method in preventing nosocomial infections. AIM: To compare three different decontamination methods by monitoring colony-forming unit count and number of hospital-acquired legionellosis cases. A secondary objective was to evaluate the long-term effects of the preventive measures on the water pipes. METHODS: A protocol was developed for the selection of high-risk sampling sites and for the testing of three disinfection methods over the course of 19 years: hyperchlorination and thermal shock (period A, 2000-2005); copper-silver ionization (period B, 2006-2010); and integration of pre-filtering, filtering, pipe-protecting products, and remote control with chlorine dioxide (ClO2) (period C, 2011-2018). FINDINGS: The use of shock disinfection and hyperchlorination led to a decrease in contamination level immediately after the procedure, but then it rose again to the previous level in two months. Both copper-silver ionization and ClO2 disinfection showed a stable and durable decrease in contamination level. Throughout these three phases, six cases of Legionella spp. occurred during period A, six cases during period B, and three cases during period C. With regard to the damage of water pipes, effective copper-silver levels caused corrosion and calcification in water pipes. CONCLUSION: Both copper-silver ionization and ClO2 properly controlled Legionella spp. contamination. ClO2 significantly reduced the number of positive sites (P < 0.001) without damaging the pipelines.

Evaluation of a model to improve collection of blood cultures in patients with sepsis in the emergency room.

Sepsis begins outside of the hospital for nearly 80% of patients and the emergency room (ER) represents the first contact with the health care system. This study evaluates a project to improve collection of blood cultures (BCs) in patients with sepsis in the ER consisting of staff education and completion of the appropriate BC pre-analytical phase. A retrospective observational study performed to analyse the data on BC collection in the ER before and after a three-phase project. The first phase (1 January to 30 June 2015) before the intervention consisted of evaluation of data on BCs routinely collected in the ER. The second phase (1 July to 31 December 2015) was the intervention phase in which educational courses on sepsis recognition and on pre-analytical phase procedures (including direct incubation) were provided to ER staff. The third phase (1 January to 30 June 2016; after the intervention) again consisted of evaluation. Before the intervention, out of 24,738 admissions to the ER, 103 patients (0.4%) were identified as septic and had BCs drawn (359 BC bottles); 19 out of 103 patients (18.4%) had positive BCs. After the intervention, out of 24,702 admissions, 313 patients (1.3%) had BCs drawn (1,242 bottles); of these, 96 (30.7%) had positive BCs. Comparing the first and third periods, an increase in the percentage of patients with BCs collected (from 0.4% to 1.3% respectively, p < 0.0001) and an increase in the percentages of patients with true-positive BCs (from 0.08% to 0.39% of all patients evaluated respectively, p < 0.0001) were observed. The isolation of bacteria by BCs increased 3.25-fold after project implementation. These results can be principally ascribed to an improved awareness of sepsis in the staff associated with improved pre-analytical phase procedures in BC collection.

[Accidents due to biological risk in health personnel: descriptive epidemiological analysis of the decade 1994-2003]. / Infortuni a rischio biologico nel personale sanitario: analisi epidemiologica descrittiva nel decennio 1994-2003.

The study evaluates the body fluid exposure among health care workers (HCW) at IRCCS Policlinico San Matteo of Pavia from the 1994 through 2003 years. Our data showed that all HCW for less than 5 years of employment, nurses, mid-wifes and surgeons are the most exposed occupational groups. Some variables were compared with a previous study performed from 1983 to 1994 at the same Institution. The study documented 1 case of seroconversion to hepatitis C virus among a physician after percutaneous exposure. In order to reduce the body fluid exposure among the HCW, the authors underline the importance of the administrative and educational interventions carried out in collaboration with the Infection Control Committee and Occupational Medicine Service.

[Monitoring air dispersed concentrations of aldehydes during the use of ortho-phthalaldehyde and glutaraldehyde for high disinfection of endoscopes]. / Monitoraggio delle concentrazioni aerodisperse di aldeidi durante l'utilizzo di orto-ftalaldeide e glutaraldeide per l'alta disinfezione degli endoscopi.

Solutions of glutaraldehyde (GTA) and ortho-phthalaldehyde (OPA) can both be used for low-temperature disinfection of endoscopes. Currently, GTA is being replaced by OPA (an aromatic dialdehyde) at the San Matteo Hospital, as OPA is less dangerous for health care workers than GTA, but has a similar capacity to kill viruses, bacteria and spores. The aim of the study was to compare air levels of GTA and OPA in several endoscopy units at our hospital. The air samples were analysed by means of both Infrared Spectroscopy (IR) and HPLC-UV (High Performance Liquid Chromatography with UV detection). The HPLC method gave a much lower aldehyde value when using OPA (8.4 micrograms/m3) compared to that obtained when GTA was used to disinfect endoscopes (21.279.3 micrograms/m3). Both HPLC and IR methods detected low levels of OPA in air, the mean values being below 10 micrograms/m3. In addition, we studied the resistance of various types of gloves to OPA. Tests showed that OPA permeated vinyl gloves more rapidly (26,628 ng/cm2 per hour) than nitrile gloves (13.9 ng/cm2 per hour).

Incidence of, and risk factors for, nosocomial infections among hematopoietic stem cell transplantation recipients, with impact on procedure-related mortality.

OBJECTIVES: To determine the incidence of, and risk factors for, nosocomial infections (NIs) occurring among hematopoietic stem cell transplantation (HSCT) recipients during hospitalization and to evaluate the impact of these NIs on patient outcome. DESIGN: A two-year prospective observational study in two HSCT units. PATIENTS: All patients admitted to the HSCT units between February 1997 and March 1999. SETTING: A teaching hospital. METHODS: After admission to the HSCT units, the patients were followed prospectively on a daily basis to collect all pertinent variables for the development of NIs. RESULTS: 49 NIs were identified in 34 of the 143 patients screened. The incidence of NIs and infected patients was 34.2% and 23.7%, respectively. The incidence density of NI was 8.96 per 1,000 patient-days. The most frequent NIs were bloodstream infections ([BSIs], 42.8%) and respiratory tract infections (28.6%). Other sites involved were as follows: eye (8.2%), urinary tract (6.1%), gastrointestinal tract (6.1%), skin (4.1%), ear (2%), and central venous catheter ([CVC], 2%). Because of the predominance and clinical relevance of BSIs, we examined both intrinsic and extrinsic risk factors associated with these infections. Independent risk factors for BSIs were allograft from matched unrelated or partially matched family donor, graft-versus-host disease (GVHD) prophylaxis without methotrexate (MTX), type of CVC, and duration of total parenteral nutrition. Four variables were independently associated with mortality occurring during hospitalization: culture-proven BSIs, advanced disease phase at transplant, type of transplant, and absence of MTX for GVHD prophylaxis. CONCLUSIONS: The study identified several factors associated with increased risk of BSIs among HSCT patients. Because BSIs are life-threatening complications for HSCT recipients, preventive measures aimed at reducing the incidence of these infections among patients given HSCT should be adopted.

[Epidemiologic study on the prevalence of low back pain in health personnel exposed to manual handling tasks]. / Studio epidemiologico sulla prevalenza della lombalgia nel personale sanitario esposto a movimentazione manuale dei carichi.

An epidemiological study on the prevalence rate of low back pain among health care workers exposed to manual handling tasks and physical work load was performed. A representative sample (n. 1053) of nursing staff working at the San Matteo Hospital in Pavia was studied using a questionnaire with the purpose of evaluating the prevalence rate of low back pain and related risk factors. 86.4% of the subjects admitted having suffered from back pain at some stage in their life and 71.0% complained of back pain in the 3 months prior to answering the questionnaire. Multivariate logistic regression analysis revealed a significant correlation between low back pain, female gender and specific nursing activities. A significant correlation was found between smoking (> 20 cigarettes per day) and the presence of low back pain, due to intervertebral disk pathology. A statistically significant difference (p < 0.0001) was found in the average degree of disability between healthy nurses (1.3), those with low back pain taking analgesic drugs (5.9) and nurses suffering from low back pain without taking drugs (3.8).

Seroprevalence of hepatitis B virus markers and risk factors in patients and staff of an Italian residential institution for the mentally disabled.

We conducted a cross-sectional study to evaluate the prevalence rate and risk factors for hepatitis B virus (HBV) infection among residents and staff at the Fatebenefratelli Institute in San Colombano in the province of Milan. We tested serum from 510 patients and 165 staff members. In addition, a medical record and a completed questionnaire were obtained from each patient. A total of 338 (66.5%) residents were found to have markers of HBV infection, including 29 (5.7%) who were identified as carriers. Thirty-nine members of staff (24.1%) showed evidence of HBV infection but only 1 (0.6%) was identified as a carrier. Among patients the prevalence rate of HBV was significantly associated with length of stay and age at admission, as it was with length of employment among staff members. The hepatitis B vaccine was offered to all patients and staff in the institution during 1994. A total of 143 (84%) patients and 111 (90%) members of the staff were vaccinated in the same year. To prevent the further spread of HBV infection in this institution, all current and future residents and staff members should be screened for serological markers for HBV and subjects identified as being susceptible should be vaccinated according to a compulsory routine policy.

Effects of 3'-hydroxyfarrerol (IdB 1031), a novel flavonoid agent, on phagocyte products.

The novel flavonoid compound 3'-hydroxyfarrerol (IdB 1031) was tested in a number of in vitro experiments in order to ascertain its effects on some functions and products of human phagocytes. We found that IdB 1031 did not depress neutrophil phagocytosis and chemotaxis, whereas at a concentration of 10(-4) M it significantly (p < 0.05) reduced the fMLP-triggered neutrophil production of superoxide anion. At the same concentration, the compound decreased the release of neutrophil elastase and myeloperoxidase from neutrophils (p < 0.05). We also found evidence that IdB 1031 is a non competitive, reversible inhibitor of human neutrophil elastase (Ki 200 microns). Finally, IdB 1031 at the concentration of 10(-5) M significantly reduced the release of tumor necrosis factor-alpha and interleukin-8 from monocytes (p < 0.05). We conclude that, in spite of the moderate activity displayed by IdB 1031, these findings add to our current knowledge on the spectrum of the antiinflammatory activities of flavonoids.

A pilot study on the liver protective effect of silybin-phosphatidylcholine complex (IdB1016) in chronic active hepatitis.

In order to assess the liver protective activity and the antioxidant properties of a new silybin complex (IdB1016), we carried out a short-term pilot study on 20 patients with chronic active hepatitis (CAH), randomly assigned to 240 mg of silybin b.i.d. (10 patients, 4 m/6 f, mean age: 50 years) or placebo (10 patients, 2 m/8 f, mean age: 55 years). Blood samples were collected before and after 7 days of treatment for liver function tests (LFTs), malonaldehyde (MDA) as an index of lipid peroxidation, and copper (Cu) and zinc (Zn), two trace elements involved in protecting cells against free radical-mediated lipid peroxidation. In the treated group, there was a statistically significant reduction of mean (+/- SEM) serum concentrations of aspartate aminotransferase (AST) from 88.0 (+/- 13.3) to 65.9 (+/- 7.5) u/l, (p < 0.01), of alanine aminotransferase (ALT) from 115.9 (+/- 12.9) to 82.5 (+/- 10.6) u/l (p < 0.01), of gamma-glutamyltranspeptidase (gamma-GT) from 51.4 (+/- 9.3) to 41.3 (+/- 4.2) u/l (p < 0.02) and of total bilirubin (TB) from 0.76 (+/- 0.08) to 0.53 (+/- 0.04) mg/dl (p < 0.05). Alkaline phosphatase (AP) fell slightly from 143.4 (+/- 6.4) to 137.5 (+/- 7.8) u/l. There were no significant changes in MDA, Cu or Zn serum concentrations. These results show that IdB1016 may improve LFTs related to hepatocellular necrosis and/or increases membrane permeability in patients affected by CAH.

Seroepidemiology, morbidity and vaccination strategies against rubella infection. Eight years experience in Oltrepò Pavese.

Selective rubella vaccination of schoolgirls in Italy started 14 years ago following the United Kingdom strategy that was adopted in 1970. The aims of this program were to eliminate the risk of rubella among women of childbearing age, encourage the acquisition of immunity by natural infection during early childhood and allow the vaccine-induced antibody production by the circulating virus. On the basis of this program, between 1982 to 1990, a prospective serosurvey for rubella antibody in the province of Pavia was performed. The results showed a decline in the overall seropositivity rate for rubella antibodies from 57.7% in 1982 to 41.9% in 1984 followed by a remarkable increase in 1985 (53.3%) and in 1987 (56.5%). This trend was confirmed by the number of cases reported to the local Public Health Service. The results of this study provide further evidence of the need to change the current selective immunization policy in order to obtain a significant reduction of risk of the infection in the population.

Sarcoidosis of the thyroid: report of a case and a review of the literature.

A case of sarcoidosis involving the thyroid gland in a 75 year-old woman and a review of the literature are described. Fine-needle aspiration of the thyroid and a cervical lymph node was performed. Histological examination confirmed the cytological diagnosis.

Hashimoto's thyroiditis in association with Tolosa Hunt syndrome: a case report.

Tolosa Hunt syndrome (THS) is a painful ophthalmoplegia due to a nonspecific inflammatory process in the cavernous sinus or to parasellar neoplasms. Although the cause of the disease is unknown, previous observations support the hypothesis that THS may be only one manifestation of a generalized vasculitis. The diagnosis is based on findings of painful ophthalmoplegia, excellent response to corticosteroids, and exclusion of other causes including aneurysm, diabetes mellitus, paranasal mucocele, and carotid cavernous fistula. We report the case of a 24-year-old woman with THS who had undergone thyroidectomy 4 years before admission for goiter with histologic diagnosis of Hashimoto's thyroiditis. This case shows the unusual association between Hashimoto's thyroiditis and THS and supports the autoimmune origin of both diseases.

Primary Hodgkin's disease of the thyroid: report of a case and a review of the literature.

A case of primary and exclusive Hodgkin's disease of the thyroid gland in a 29-year-old woman and a review of the literature are described. Diagnosis with fine-needle aspiration biopsy (FNAB) was performed before surgery. The patient underwent subtotal thyroidectomy, followed by a radiotherapy dose of 46 Gy. Post-operative histological examination confirmed the cytological diagnosis without evidence of thyroiditis or lymphadenopathy. Five months after thyroidectomy, surgical staging confirmed the exclusive localization of the disease in the thyroid. The patient is followed up on an out-patient basis and is still in good health, 24 months after treatment.

[Survey on goiter in elementary school children in the Bisagno and Trebbia valleys (Liguro-Emilian Apennines)]. / Inchiesta sul gozzismo in età scolare primaria nelle valli Bisagno e Trebbia (Appennino Ligure-Emiliano).

The authors have made an inquiry about school-children of two villages of Northern Appennines: Bargagli and Ottone, formerly seats of endemic goiter. The disappearance of endemic goiter in the younger generations of these villages, is in accordance with previous observations by one of the writers suggesting that sheep represent an important ecologic factor in endemic areas.