Mobile laminar air flow screen for additional operating room ventilation: reduction of intraoperative bacterial contamination during total knee arthroplasty

Background Surgical site infections are important complications in orthopedic surgery. A mobile laminar air flow (LAF) screen could represent a useful addition to an operating room (OR) with conventional turbulent air ventilation (12.5 air changes/h), as it could decrease the bacterial count near the operating field. The purpose of this study was to evaluate LAF efficacy at reducing bacterial contamination in the surgical area during 34 total knee arthroplasties (TKAs). Materials and methods The additional unit was used in 17 operations; the LAF was positioned beside the operating table between two of the surgeons, with the air flow directed towards the surgical area (wound). The whole team wore conventional OR clothing and the correct hygiene procedures and rituals were used. Bacterial air contamination (CFU/m3) was evaluated in the wound area in 17 operations with the LAF unit and 17 without the LAF unit. Results The LAF unit reduced the mean bacterial count in the wound area from 23.5 CFU/m3 without the LAF to 3.5 CFU/m3 with the LAF (P<0.0001), which is below the suggested limit for anORwith ultraclean laminar ventilation. There were no significant differences in the mean bacterial count in the instrument table area: 28.6 CFU/m3 were recorded with the LAF (N = 6) unit and 30.8 CFU/m3 (N = 6) without the LAF unit (P = 0.631). During six operations with LAF and six without LAF, particle counts were performed and the number of 0.5 lm particles was analyzed. The particle counts decreased significantly when the LAF unit was used (P = 0.003). Conclusion When a mobile LAF unit was added to the standard OR ventilation, bacterial contamination of the wound area significantly decreased to below the accepted level for an ultraclean OR, preventing SSI infections

Prevention of healthcare-associated infections: knowledge among dental students in seven Italian universities

Background: Lack of knowledge is the major reason for non-compliance with correct healthcare-associated infections (HAI) prevention procedures. The aim of this study was to evaluate knowledge of the Dental School (DSS) and Dental Hygiene (DHS) students with regard to the prevention of HAI, as basic knowledge for improving and harmonizing the educational content in the different Italian Universities. Methods: A cross-sectional study was carried out using an anonymous questionnaire that was completed by DSS (I, II, III, IV, and V year) in seven Universities and DHS (I, II, and III year) in three Universities. The questions dealt with three specific areas: healthcare-associated infections, standard recautions and hand hygiene. Factors associated with an unacceptable level of knowledge (score <17.5) were analyzed using a logistic regression model. A p value <0.05 was considered to be significant. Results: Five hundred and four questionnaires were collected: 81.5% for DSS and 18.5% for DHS. Mean overall score (\ub1DS) achieved by the total number of students was 18.2\ub12.93 on an overall perfect score of 25; 18.2\ub13.04 for DSS and 17.8\ub12.31 for DHS. Stratifying by area, the average score 2.7\ub11.07 (53%) for HAI, 10.3\ub11.61 (85.9%) for standard precautions, and 5.2\ub11.44 (64.8%) for hand hygiene was observed. A significantly different level of knowledge (p<0.001) between DSS and DHS was observed only for HAI (2.8\ub11.07 for DSS vs 2.1\ub10.96 for DHS). Significant differences among the academic years were found only for DSS concerning HAI and standard precautions. The logistic regression model showed that an age <23 years was a risk factor for lack of knowledge on HAI, but a protective factor for lack of knowledge about standard precautions and hand hygiene; attending DH degree course was associated with lack of knowledge on HAI

Legionella spp. contamination in indoor air: preliminary results of an Italian multicenter study

AbstractOBJECTIVE: To propose a standardized protocol for the evaluation of Legionella contamination in air.DESIGN: A bathroom having a Legionella contamination in water >1,000 cfu/l was selected in 10 different healthcare facilities. Air contamination was assessed by active (Surface Air System, SAS) and passive (Index of Microbial Air, IMA) sampling for 8 hours, about 1 m away from the floor and 50 cm from the tap water. Two hundred liters of air were sampled by SAS every 12 min, after flushing water for 2 min. The IMA value was calculated as the mean value of colony forming units/16 plates exposed during sampling (2 plates/hour). Water contamination was evaluated at T0, after 4 and 8 hours, according to the standard methods.RESULTS: Air contamination by Legionella was found in three healthcare facilities (one with active and two with passive sampling), showing a concomitant tap water contamination (median=40,000; range 1,100-43,000 cfu/l). The remaining seven hospitals isolated Legionella spp. exclusively from water samples (median=8,000; range 1,200-70,000 cfu/l).CONCLUSIONS: Our data suggest that environmental Legionella contamination cannot be assessed only through the air sampling, even in the presence of an important water contaminatio

[Health promotion 25 years after the Ottawa Charter]

Twenty-five years have passed since the Ottawa Charter for Health Promotion was signed at the First International Conference on Health Promotion, organized by the World Health Organization. This article traces the evolution of the definition of health, the introduction of the "salutogenesis" approach to health, the evolution of educational processes in community health, and defines the concept of health promotion, describing its application needs

Microbial monitoring of water in a dental clinic as a useful tool to device preventive measures

Background Microorganisms found in the water used for dental procedures may represent a considerable health hazard for dental staff and patients, particularly immunocompromised ones. Aim To monitor the microbial contamination of tap water and the dental unit water system (DUWS) in a dental clinic at the University Hospital of Parma, providing a picture of contamination levels, highlighting any variation between different sampling points and sampling times, and providing useful advice on microbial monitoring procedures and preventive measures. Methods Water microbial contamination was assessed during the five working days for one week per month, over a three month period. Tap water and DUWS were sampled before (T0) and after (T1) clinical activity to determine the Total Viable Count (TVC) at 22°C and 36°C, and the presence of Legionella spp. and P. aeruginosa. Results 80% of samples from tap water and more than 90% from the DUWS exceeded the TVC recommended values (Directive 98/83/EC; CDC, 2003). Microbial contamination decreased significantly during clinical activity. TVC median values (cfu/mL) for tap water decreased from 2,304 to 140 at 22°C and from 1,072 to 114 at 36°C; DUWS values went from 48,400 to 16,800 at 22°C and from 12,430 to 6,150 at 36°C. The most contaminated handpiece was the air-water syringe, with a maximum value of 872,000. Differing levels of contamination were observed among the different days, weeks and months. The day with the highest contamination was Monday, both for tap water and the DUWS. No Legionella spp. nor P. aeruginosa were found in tap water. Legionella spp. was found in one sample and P. aeruginosa in 66.6% of samplesfrom the DUWS. Conclusion In the light of our results a global renovation of the dental clinic is being carried out and a microbial monitoring programme that includes tap water and the DUWS is being planned. Special attention will be devoted to monitorings performed on Mondays, which turned out to be “the worst day”