Health inequalities and inadequate housing. The case of exceptions to hygienic requirements for dwellings in Italy

Negli ultimi decenni, i requisiti igienici italiani per le abitazioni sono stati modificati da più deroghe. Scopo del presente lavoro è analizzare le deroghe introdotte a livello nazionale, regionale e locale. Le deroghe più importanti riguardavano l'uso abitativo di seminterrati e sotterranei e il restauro di edifici. Il documento descrive anche le norme in materia di indennità per violazione degli abusi nell'edilizia. Gli autori sottolineano la necessità di maggiore uniformità e chiarezza nella determinazione degli standard sanitari delle abitazioni, nonché di una semplificazione della legislazione esistente.In the past decades, Italian hygienic requirements for dwellings have been modified by multiple derogations. Aim of the present work is to analyse the derogations introduced at a national, regional, and local level. The most important derogations were related to the habitable use of semi-basements and garrets, and building restoration. The paper also describes the regulations regarding indemnity for infringement of building abuses. The authors underline the need for more uniformity and clarity in the determination of health standards of dwellings, as well as for a simplification of the existing legislation

Are liquids an efficient vehicle of healthcare associated infections? A review of reported cases in Italy (2000- 2014)

INTRODUCTION: In the field of healthcare-associated infections (HCAIs), one of the most reported, studied and discussed sources of infections is water, partly due to its controllability, but also because healthcare facilities, especially hospitals, require a significant quantity of water per day. In addition to water, during healthcare procedures, other liquids can serve as source of infections. The present study reports a review of those HCAIs associated to liquid vehicles occurred in Italy during the period 2000-2014. METHOD: The review focused on cases of liquid-associated HCAIs in both sporadic cases and outbreaks according to the definition provided by both Word Health Organization and United States' Centers for Disease Control and Preventions in 2011. The review included all original papers published in peer-reviewed journals, in which the association between the infection and the exposure to contaminated water/other fluid was demonstrated by epidemiological and/or molecular methods. Articles describing cases due to parenteral transmitted pathogens (by blood or blood-derived fluids) were excluded. RESULTS: During the period 2000-2014, 34 episodes have been described for a total of about 400 cases of infection. Isolations included genus Legionella, Pseudomonas, Serratia, Ralstonia, Burkolderia, Klebsiella and other pseudomonadaceae. The results confirm that HCAIs can be associated also to liquids other than piped water. The large majority of articles refers to hospital wards where patients with high risk of infections are usually admitted. DISCUSSION: The review highlights a great number of HCAIs, but if we consider that the large part of HCAIs are not reported in literature, it is clear that the burden of this phenomenon is by far higher. Many cases of HCAI were identified in the context of local surveillance systems, demonstrating their role in HCAI control. With regard to diagnosis, the isolation and identification of the etiological agent is critical to reach the source of infection and to plan the necessary disinfection measures. Therefore, it is possible to conclude that, through a multiple approach of engineering and hygiene measures, as well as surveillance ad management of hospital liquids, the risk for contracting "water born" HCAIs may be controlled

Development of an innovative method for the evaluation of fungal contamination of surfaces

The objective of this technical report is to compare the ability to capture fungal spores through samples performed with three different methods: Rodac contact plates, cotton pad and a pad prepared with a dusting cloth (DC pads) selected from those available on the market. The tests were conducted using a suspension of Aspergillus niger conidia equal to 0.5 MacFarland diluted 1/30, 1/40, 1/50, 1/100. With each of these dilutions 3 sterile tiles of stainless steel were contaminated, each divided into 16 small squares, in the center of which 0.1 ml of the dilution chosen was placed and left to dry (for a total of 12 sheets). In addition, we have used other 6 tiles to repeat the experience with dilutions 1/40 and 1/50. A total of 288 squared surfaces were contaminated: 96 of these were sampled with Rodac contact plates, 96 with cotton pads and 96 with DC and then inseminated in Petri plates. Sabouraud dextrose agar was used as culture medium for the first 12 plates, while, for the other 6 plates Sabouraud dextrose agar added with lecithin and polysorbate 80 was used. All plates were incubated at 37 degrees for 18 hours. To estimate the differences among the sampling methods and the dilutions tested, multiple linear regression was used. The analysis showed that the number of colonies harvested at dilution 1/40 is 13% higher (P = 0.09) than the number harvested at dilution 1/50 and the number of colonies harvested at dilution 1/30 is 6% higher than dilution 1/50 (P = 0.52). With regard to the comparison between the number of colonies harvested with Rodac contact plates, with cotton pads and DC pads, regression analysis shows that cotton pads harvest a number of fungal cfu 5 times higher than those detected with Rodac plates, while DC pads harvest a number of fungal ufc 6 times higher than those detected with Rodac plates (P < 0.00005). These results, although preliminary, indicate that DC pads are a sensitive and simple approach for the environmental control of fungal contamination

Human tularemia in Italy. Is it a re-emerging disease?

In order to evaluate whether tularemia is re-emerging in Italy, data on mortality and morbidity (obtained by the National Institute of Statistics; ISTAT), Italian cases described in the scientific literature and data concerning hospitalizations for tularemia (obtained by the National Hospital Discharge Database) were analysed. From 1979 to 2010, ISTAT reported 474 cases and no deaths. The overall number of cases obtained from the literature review was at least 31% higher than that reported by ISTAT. Moreover, the number of cases reported by ISTAT was 3·5 times smaller than hospitalized cases. The real frequency of the disease should be carefully investigated and taken into account in order to implement specific prevention measures.Tularemia is a contagious infectious disease due to Francisiella tularensis that can cause serious clinical manifestations and significant mortality if untreated. Although the frequency and significance of the disease has diminished over the last decades in Central Europe, over the past few years, there is new evidence suggesting that tularemia has re-emerged worldwide. To know the real epidemiology of the disease is at the root of correct control measures. In order to evaluate whether tularemia is re-emerging in Italy, data on mortality and morbidity (obtained by the National Institute of Statistics; ISTAT), Italian cases described in the scientific literature and data concerning hospitalizations for tularemia (obtained by the National Hospital Discharge Database) were analysed. From 1979 to 2010, ISTAT reported 474 cases and no deaths. The overall number of cases obtained from the literature review was at least 31% higher than that reported by ISTAT. Moreover, the number of cases reported by ISTAT was 3·5 times smaller than hospitalized cases. In Italy tularemia is sporadic, rarely endemic and self-limiting; but, although the trend of reported tularemia does not support the hypothesis of a re-emerging disease, the study demonstrates a wide underreporting of the disease. The real frequency of the disease should be carefully investigated and taken into account in order to implement specific prevention measures

Adeguare le risposte ai nuovi problemi dell'abitare in una società che cambia

Il lavoro focalizza l’attenzione sulle conseguenze sanitarie delle recenti trasformazioni sociali ed economiche e pone l’accento soprattutto sul problema dell’emergenza abitativa, sia in termini quantitativi che qualitativi. Ne emerge un quadro preoccupante, soprattutto nelle periferie delle grandi città, con problematiche igienico-sanitarie sovrapponibili a quelle dell’epoca dell’Unità d’Italia. Gli autori analizzano quindi le evidenze di rischio correlato al degrado abitativo e presentano alcuni esempi che quantificano l’efficacia sanitaria del risanamento ambientale. Il lavoro si conclude sottolineando la necessità di porre tale problematica di nuovo al centro dell’agenda della Sanità Pubblica, sia in termini di valutazione dell’impatto sanitario, sia in termini di formazione e sensibilizzazione dei diversi attori sociali coinvolti, recuperando anche quel ruolo politico enfatizzato da Rudolf Virchow già alla fine del diciannovesimo secolo

Riuso delle acque grigie in ambiente domestico: implicazioni per la sanità pubblica

The Authors describe the main microbiological characteristics of gray and rain waters, the evidence of infections related to the reuse of such waters and the main Italian and international standards and guidelines in this regard. In light of the review, the authors conclude that the limits defined by the Italian regulations are very precautionary and should ensure a very low risk of bacterial and/or viral infection (< 10.5 and 10.9 cases/year). It remains an open problem the risk of parasitic infections, for which the evidences to draw final conclusions are not sufficient yet

Field validation of a dusting cloth for mycological surveillance of surfaces

Efficient monitoring of surfaces for spores of filamentous fungi is essential for detecting minor contamination even when air samples test negative for fungi. This study evaluates and compares a pad prepared using a dusting cloth with Rodac contact plates and humidified swabs for detecting mycological contamination, and concludes that the new method is superior and cheaper

A Simulation Model for Logical and Operative Clash Detection

The introduction of the Building Information Modeling (BIM) approach has facilitated the management process of documents produced by different kinds of professionals involved in the design and/or renovation of a building, through identification and subsequent management of geometrical interferences (Clash Detection). The methodology of this research proposes a tool to support Clash Detection, introducing the logical-operative dimension, that may occur with the presence of a construction site within a hospital structure, through the integration of a BIM model within a Game Engine environment, to preserve the continuity of daily hospital activities and trying to reduce negative impacts, times and costs due to construction activities

Indagine sull'inquinamento acustico nel quartiere Nomentano di Roma e sulla sua percezione da parte dei residenti

The Authors describe the results of an investigation, carried out in the Nomentano quarter of Rome, to evaluate noise pollution level by road traffic and the annoyance in a resident sample. The measurement places have been subdivided according to three categories of streets ("flowing ", "quarter" and "local" streets); the LAeq (equivalent continuous level of noise) was taken during the day (from 7 am to 19 pm), the evening (from 19 pm to 23 pm) and the night (from 23 pm to 7 am). The results have been compared with previous study's data taken in 1988 and with the prescribed noise's limit values of the current national regulations. Lden values, the Community recommended acoustic parameter were also calculated. At the same time an interview was carried out to investigate resident's annoyance level; the results are discussed in relationship with registered noise levels

Stato dell’arte dei Piani di Emergenza per il Massiccio Afflusso di Feriti (PEMAF) negli ospedali italiani. Studio pilota

Aim of this study is to assess the level of implementation of plans for the massive influx of injured (PEMAF) in Italian hospitals. An anonymous questionnaire was administered to a sample of 100 hospitals selected through the network of the Italian Society of Emergency Medicine (SIMEU). Each answer of the questionnaire was assigned a score, then reported on a scale of compliance (maximum 65 points, threshold 35 points). The average scores were analyzed by hospital’s venue, level of activity and previous experience of managing a real emergency. Student’s t-test was used to compare means. Thirty-two hospitals sent the questionnaire, representing 33% of those selected. Five were excluded for incomplete data. The data analyzed refers to 27 hospitals of various levels of complexity, from all around the country: 55.6% from the Northern Section, 22.2% from the Centre and 22.2% from the Southern section and the Islands; and only 55.6% are above the minimum threshold of compliance. The weakest PEMAF’s area is the one related to the specific training of health workers, therefore the percentage of hospitals complying the requirements in this field is down to 37%. Ten hospitals (37%) had managed a real maxi-emergence in the past: belonging to such group of hospitals is associated with an average level of compliance significantly higher than the others (p<0,005). Due to a limited percentage of responders, the study involved so far a too small amount of hospitals; happily, they were evenly distributed in the different sections of the Country; therefore it will be appropriate to obtain a larger compliance before reaching clear-cut conclusions, but it already appears that the most critical point is the lack of specific education to maxi-emergencies in the hospital personnel