Papers by anna maria spagnolo
Antibiotics, Dec 7, 2021
According to the WHO, P. aeruginosa is one of the antibiotic-resistant bacteria that represent th... more According to the WHO, P. aeruginosa is one of the antibiotic-resistant bacteria that represent the biggest threat to public health. The aim of the study was to establish the prevalence of antibioticresistant P. aeruginosa in the water systems of various healthcare facilities over the course of nine years. A total of 4500 tap water system samples were taken from seventeen healthcare facilities. The culture method was used to detect P. aeruginosa, and the isolates were then tested for antibiotic resistance using the standardised disc diffusion method. Eleven antibiotics from five different classes were tested. P. aeruginosa was found to have contaminated 2.07% (no. 93) of the water samples. The majority of positive samples came from the dental units (30.11%) and the ward kitchens (23.66%). Considering the total isolates, 56.99% (no. 3) were resistant to at least one of the antibiotics tested. A total of 71.43% of P. aeruginosa isolated from water emerging from dental unit handpieces was antibiotic-resistant, with 45% of it resistant to ≥3 classes of antibiotics. Out of the total isolates, 19.35% showed resistance to carbapenems. It would be advisable to systematically screen tap water for opportunistic micro-organisms such as P. aeruginosa, as many countries already do, including this in the Water Safety Plan.
Journal of Preventive Medicine and Hygiene, 2013
Summary An experimental study was conducted in a hospital in Liguria (northern Italy) on two grou... more Summary An experimental study was conducted in a hospital in Liguria (northern Italy) on two groups of patients with the same disease severity who were undergoing the same type of surgery (primary hemiarthroplasty). Our aim was to assessing the results of a quality- improvement scheme implemented in the operating room. The quality-improvement protocol involved analyzing a set of parameters concerning the operating team's behavior and environmental conditions that could be attributed to the operating team itself. A program of training and sanitary education was carried to rectify any improper behavior of the operating staff. Two hundred and six hip-joint replacement operations (primary hip hemiarthroplasty - ICD9-CM 81.51) all conducted in the same operating room were studied: 103 patients, i.e. operations performed before the quality-improvement scheme and 103 patients, i.e. operations performed after the quality improvement scheme; all were comparable in terms of type of surger...
Journal of preventive medicine and hygiene, 2009
Aspergillus species (Fig. 1) are conidia-forming fungi that are responsible for a wide spectrum o... more Aspergillus species (Fig. 1) are conidia-forming fungi that are responsible for a wide spectrum of human illnesses. About 19 species of Aspergillus have been documented as agents of human disease, but the majority of infections are caused by Aspergillus fumigates (Fresenius, 1850), Aspergillus flavus (Link,1809), Aspergillus niger (Van Tieghem, 1867), and Aspergillus terreus (Thom, 1918) [1, 2]. Clinical syndromes and diseases associated to Aspergillus spp. can be: “cutaneous” (primary skin and burnwound infections, especially in neonates and children); “hypersensity” (allergic bronchopulmonary aspergillosis); “acute invasive” (pneumonia, ulcerative tracheobronchitis, osteomyelitis,..);“chronic invasive” (chronic pneumonitis) [3-5]. The primary route of acquiring Aspergillus infections is by the inhalation of conidia [6]. The respiratory tract is therefore the most common portal of entry of Aspergillus spp. conidia [7]. Conidia of the most commonly involved pathogenic Aspergillus sp...
Journal of Preventive Medicine and Hygiene, 2013
Summary Surgical site infections (SSI) account for 14% to 17% of all hospital-acquired infections... more Summary Surgical site infections (SSI) account for 14% to 17% of all hospital-acquired infections and 38% of nosocomial infections in surgical patients. SSI remain a substantial cause of morbidity and death, possibly because of the larger numbers of elderly surgical patients or those with a variety of chronic and immunocompromising conditions, and emergence of antibiotic-resistant microorganisms. Factors causing surgical site infection are multifarious. Several studies have identified the main patient-related (endogenous risk factors) and procedure-related (external risk factors) factors that influence the risk of SSI. The rate of surgical wound infections is strongly influenced by operating theatre quality, too. A safe and salubrious operating theatre is an environment in which all sources of pollution and any micro-environmental alterations are kept strictly under control. This can be achieved only through careful planning, maintenance and periodic checks, as well as proper ongoin...
Journal of preventive medicine and hygiene, 2010
INTRODUCTION Recent discoveries in cell therapy research present new opportunities for cellular p... more INTRODUCTION Recent discoveries in cell therapy research present new opportunities for cellular products to be used to treat severe, and as yet incurable, diseases. It is therefore essential to implement a quality control programme in order to ensure that safe cells and tissues are provided. METHODS In a preliminary phase of the setting up of a the cellfactory, monitoring was carried out monthly over a 6-month period in one out of three cell therapy laboratories and filter rooms in order to evaluate the microbial contamination of air and surfaces and the presence of airborne particulates. RESULTS The mean total bacterial and fungal loads measured in the air in the centre of the filter room were 20.7 +/1 28.9 colony-forming units (cfu)/m3 and 9.2 +/- 15.4 cfu/m3, respectively, and 5.2 +/- 4.1 cfu/m3 and 6.8 +/- 13.4 cfu/m3, respectively, in the laboratory. The mean fungal load values recorded on the surfaces sampled in the laboratory were in 6 out of 18 cases higher than the referenc...
Journal of Preventive Medicine and Hygiene, 2016
Summary Objective. To describe the occurrence of CRKP infections in a tertiary care hospital and ... more Summary Objective. To describe the occurrence of CRKP infections in a tertiary care hospital and to analyse the allelic profiles of the clinical strains involved and the most frequent carbapenemases. Design. The study analyzed cases of infection due to CRKP in the period 2013-2014; 147 cases were recorded, most of which (82.31%) were in-hospital infections. Setting. A hospital in northern Italy. Methods. We retrospectively collected: data on patient characteristics and the microbiological characteristics of CRKP. Isolates from 72 of the in-hospital cases underwent molecular typing (MLST); in addition, in each isolate, a procedure for the detection of the blaKPC gene was carried out. Results. The in-hospital death rate was 24.0% in 2013 and 37.5% in 2014. However, the difference between these two values did not prove statistically significant (P > .05). Analysis of mortality revealed that bloodstream infections were more frequently associated with death than other infections (χ2 =...
Journal of preventive medicine and hygiene, 2018
Introduction We described an outbreak of C. difficile that occurred in the Internal Medicine depa... more Introduction We described an outbreak of C. difficile that occurred in the Internal Medicine department of an Italian hospital and assessed the efficacy of the measures adopted to manage the outbreak. Methods The outbreak involved 15 patients and was identified by means of continuous integrated microbiological surveillance, starting with laboratory data (alert organism surveillance). Diarrheal fecal samples from patients with suspected infection by C. difficile underwent rapid membrane immuno-enzymatic testing, which detects both the presence of the glutamate dehydrogenase antigen and the presence of the A and B toxins. Extensive microbiological sampling was carried out both before and after sanitation of the environment, in order to assess the efficacy of the sanitation procedure. Results The outbreak lasted one and a half month, during which time the Committee for the Prevention of Hospital Infections ordered the implementation of multiple interventions, which enabled the outbreak...
Journal of preventive medicine and hygiene, 2009
INTRODUCTION In dentistry, as in surgery, there is a risk of cross-infection for both patients an... more INTRODUCTION In dentistry, as in surgery, there is a risk of cross-infection for both patients and staff The aim of this research was to evaluate procedures and behaviors enacted by dental staff which might engender a risk for themselves and their patients. METHODS A questionnaire was administered to 106 dental workers in Genoa (Italy), both public and private. Whenever personal interviews were conducted, the facilities involved were also inspected and the activities of the dental staff were observed directly. RESULTS This research highlighted some critical points in both structural and organizational features and in the management of infective hazards in the sample considered. In some cases, inadequacies were noted with regard to the prevention of cross-infections, such as the lack of disinfection of work surfaces and the handles of chair-set accessories. DISCUSSION AND CONCLUSIONS The particular nature of dental work, in which aerosols of blood and saliva may be produced by rotati...
International Journal of Environmental Research and Public Health, 2021
Demographic studies show that life expectancy is increasing in developed countries; increased lon... more Demographic studies show that life expectancy is increasing in developed countries; increased longevity has also increased the share of the older population with often concomitant chronic conditions. An ageing population and increased comorbidities lead to more complex pharmacological therapies (polypharmacy). The particular picture provided by chronic conditions and polypharmacy can lead to longer hospital stays and a greater need for healthcare. Elderly patients are identified as being in the high-risk group for the development of healthcare-associated infections (HAIs) due to the age-related decline of the immune system, known as immunosenescence. Comorbid conditions can often complicate infections, diminishing our ability to treat them effectively. Respiratory tract infections are the most common healthcare-associated infections, followed by urinary tract infections. HAIs in geriatric patients are responsible for longer hospital stays, extended antibiotic therapy, significant mo...
International Journal of Environmental Research and Public Health, 2021
Multiple studies have demonstrated the presence of microorganisms commonly associated with surgic... more Multiple studies have demonstrated the presence of microorganisms commonly associated with surgical site infections (SSIs), in the air within the operating theatre (OT). In some countries such Italy, the limit of microbial concentration in the air for OT with turbulent airflows is 35 CFU/m3 for an empty OT and 180 CFU/m3 during activity. This study aims to hypothesize new benchmarks for the airborne microbial load in turbulent airflow operating theatres in operational and at rest conditions using the percentile distribution of data through a 17-year environmental monitoring campaign in various Italian hospitals that implemented a continuous quality improvement policy. The quartile distribution analysis has shown how in operational and at rest conditions, 75% of the values were below 110 CFU/m3 and 18 CFU/m3, respectively, which can be considered a new benchmark for the monitored OTs. During the initial stages of the monitoring campaign, 28.14% of the concentration values in operatio...
European Journal of Public Health, 2020
Background Failure in reprocessing of endoscopes has been reported as one of the top ten most imp... more Background Failure in reprocessing of endoscopes has been reported as one of the top ten most important threats to patient health. Materials/Methods The study was conducted in two digestive endoscopy centres of a teaching hospital (29,000 endoscopies/year, of which 550 endoscopic retrograde cholangiopancreatography (ERCP). Following two cases of bacteremia due to KPC-producing Klebsiella pneumoniae temporally related to ERCP and 89% of non-compliance detected on endoscopes subjected to microbiological surveillance, the reprocessing activities were audited and implemented to ensure guideline compliance. Clinical and microbiological surveillance were reinforced and all responsibilities for each phase identified according to UNI/TR11662. Microbiological surveillance was performed according to the 'Duodenoscope Surveillance Sampling and Culturing Protocols' protocol, CDC, 2018. Results In the 11 months of surveillance, 47 endoscopes were sampled (13 colonoscopes, 9 gastroscopes,...
International Journal of Environmental Research and Public Health, 2020
Liguria is a northwestern region of Italy that, since the WHO has declared COVID-19 as a pandemic... more Liguria is a northwestern region of Italy that, since the WHO has declared COVID-19 as a pandemic (11 March 2020), presented 108 patients hospitalized, 34 of which were in the intensive care unit. Due to this serious epidemiological emergency, the transformation of a long-distance ferry ship into a hospital ship for COVID-19 patients who were still positive after the acute phase of the illness was carried out to free up hospital beds for patients in the acute phase. The ship was moored in the port of Genoa, the capital of Liguria. The conversion was localized to a single deck, where designated healthcare areas were identified. From 23 March to 18 June 2020, 191 patients were admitted onto the ship; they were provided with high-level healthcare guaranteed by the multi-disciplinary nature of clinical competencies available. Patients had a favorable outcome in all cases, confirmed by their recovery and negative swab results. Moreover, no cases of voluntary discharge were recorded. To t...
International Journal of Environmental Research and Public Health, 2019
Background: The use of a contaminated endoscope may lead to infections due to the transmission of... more Background: The use of a contaminated endoscope may lead to infections due to the transmission of potential pathogens from patient to patient. Methods: Post-reprocessing microbiological surveillance of four duodenoscopes was carried out over a three-year period in the Digestive Endoscopy Unit of an Italian hospital. Sampling of duodenoscopes was performed after the devices have been reprocessed. The initial phase of surveillance involved the contemporary evaluation of the four duodenoscopes; afterwards, microbiological surveillance proceeded at monthly intervals. Results: The initial phase of surveillance revealed that three duodenoscopes presented a high level of contamination with “high-concern” micro-organisms, some of which were multi-drug-resistant. The highest values of contamination regarded the species P. aeruginosa (2500 CFU/duodenoscope), K. pneumoniae (2580 CFU/duodenoscope), and A. baumannii (2600 CFU/duodenoscope). Since the cultures were repeatedly positive on three su...
Annali di igiene : medicina preventiva e di comunita
The high diffusion of endoscopes worldwide and the need for effective reprocessing methods reques... more The high diffusion of endoscopes worldwide and the need for effective reprocessing methods requested the development of guidelines and implementation of surveillance procedures at local level. In order to collect data on everyday's practice and adherence to available guidelines, endoscopy units from different public institutions were surveyed using a dedicated questionnaire. Between July and November 2015 a survey was carried in 12 main hospitals from 10 different Italian regions, involving 22 endoscopy units. The state of the art of national and international guidelines was investigated to compare the protocols adopted at local level. In all the surveyed hospitals, the reprocessing activity is based on pre-established protocols in adherence with principal guidelines. Enzymatic detergents, which are recommended by the international guidelines, are used in 55.6% of units and peracetic acid is currently the most widely used chemical disinfectant. Discrepancies were observed in the...
Journal of infection and public health, Jan 28, 2017
In the last decade, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become endemic in seve... more In the last decade, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become endemic in several countries, including Italy. In the present study, we assessed the differences in epidemiology, management, and mortality of CR-Kp bloodstream infection (BSI) in the three main adult acute-care hospitals of the metropolitan area of Genoa, Italy. From January 2013 to December 2014, all patients with CR-Kp BSI were identified through the computerized microbiology laboratory databases of the three hospitals. The primary endpoints of the study were incidence and characteristics of CR-Kp BSI in hospitals within the same endemic metropolitan area. Secondary endpoints were characteristics of CR-Kp BSI in hospitals with and without internal infectious diseases consultants (IDCs) and 15-day mortality. During the study period, the incidence of healthcare-associated CR-Kp BSI in the entire study population was 1.35 episodes per 10,000 patient-days, with substantial differences between the three ...
International journal of environmental research and public health, Jan 13, 2015
Exposure to the particulate matter produced in underground railway systems is arousing increasing... more Exposure to the particulate matter produced in underground railway systems is arousing increasing scientific interest because of its health effects. The aim of our study was to evaluate the airborne concentrations of PM10 and three sub-fractions of PM2.5 in an underground railway system environment in proximity to platforms and in underground commercial areas within the system, and to compare these with the outdoor airborne concentrations. We also evaluated the metal components, the cytotoxic properties of the various fractions of particulate matter (PM) and their capacity to induce oxidative stress. We collected the coarse fraction (5-10 µm) and the fine fractions (1-2.5 µm; 0.5-1 µm; 0.25-0.5 µm). Chemical characterisation was determined by means of spectrometry. Cytotoxicity and oxidative stress were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and Reactive Oxygen Species (ROS) assessment. The concentrations of both PM10 and PM2.5 proved t...
Infection Control & Hospital Epidemiology, 2014
Objective.Our aim was to evaluate the impact of aerators on water microbiological contamination i... more Objective.Our aim was to evaluate the impact of aerators on water microbiological contamination in at-risk hospital departments, with a view to quantifying the possible risk of patient exposure to waterborne microorganisms.Design.We analyzed the microbiological and chemical-physical characteristics of hot and cold water in some critical hospital departments.Setting.Two hospitals in northern Italy.Methods.We took 304 water samples over a 1-year period, at 3-month intervals, from taps used by healthcare personnel for handwashing, surgical washing, and the washing of medical equipment. We analyzed heterotrophic plate counts (HPCs) at 36°C and 22°C, nonfastidious gram-negative bacteria (GNB-NE), andLegionella pneumophila.Results.The percentages of positivity and mean values of HPCs at 22°C, HPCs at 36°C, and GNB-NE loads were significantly higher at outlet points than in the plumbing system. In particular, GNB-NE positivity was higher at outlet points than in the plumbing system in both...
Acta Neurochirurgica, 2009
Acinetobacter baumannii has emerged as an important nosocomial pathogen that can cause a multitud... more Acinetobacter baumannii has emerged as an important nosocomial pathogen that can cause a multitude of severe infections. In neurosurgical patients the usual presentation is ventriculitis associated with external ventricular drainage. Carbapenems have been considered the gold standard for the treatment of Acinetobacter baumannii ventriculitis, but resistant isolates are increasing worldwide, reducing the therapeutic options. In many cases polymyxins are the only possible alternative, but their poor blood-brain barrier penetration could require them to be directly administered intraventricularly and clinical experience with this route is limited. We review the literature concerning intraventricular use of colistin (polymyxin E) for A. baumannii ventriculitis and add three cases successfully treated with this method. Our experience suggests that intraventricular colistin is a potentially effective and safe therapy for the treatment of multidrug-resistant A. baumannii central nervous system infections.
International Journal of Environmental Research and Public Health, 2019
Studies conducted over the last 40 years have demonstrated that the water output from dental unit... more Studies conducted over the last 40 years have demonstrated that the water output from dental unit waterlines (DUWLs) is often contaminated with high densities of microorganisms. It has been monitored the microbiological quality of the water in 30 public dental facilities in northern Italy in order to assess the health risk for patients and dental staff. In each facility, samples of water both from taps and from DUWLs were analyzed in order to evaluate heterotrophic plate counts (HPCs) at 22 °C and 36 °C, and to detect coliform bacteria, Pseudomonas aeruginosa, Legionella pneumophila and amoebae. In 100% of the samples taken from the DUWLs, the concentration of HPCs was above the threshold as determined by the Ministère de la Santé et des Solidarités (2007). The concentration of P. aeruginosa was greater than the indicated threshold in 16.67% of the hand-pieces analyzed. A total of 78.33% of samples were contaminated by L. pneumophila, while in the samples taken from the DUWLs alone,...
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Papers by anna maria spagnolo