Gestion des risques infectieux liés aux piscines et bains collectifs à usage médical

Hydrotherapy for Patients With External Fixation: Effect on Infectious Events

BACKGROUND

Surgery to achieve long bone lengthening and deformity correction in skeletally immature patients is traditionally performed through external fixators. The incidence of infection during treatment is high. Hydrotherapy is highly beneficial during external fixation management, but the infection rates may impact its utilization. The objective of this paper is to document the incidence and duration of infection in patients who participated in a full hydrotherapy program when performed under medical supervision and in accordance with strict follow-up protocols.

METHODS

In this retrospective study, we documented the key characteristics of patients who participated in hydrotherapy after lower limb external fixation surgery including age, sex, diagnosis and surgery site, the incidence and duration of pin site infections, and the percentage of cases, which were able to comply with a full hydrotherapy protocol.

RESULTS

The hydrotherapy pool met all daily water quality metrics. Thirty-four children (19 males and 15 females) had a mean±SD age of 10.9±4.6 years. Of the cases, 80% were unilateral and 20% were bilateral. Diagnoses included congenital hereditary (eg, achondroplasia), congenital nonhereditary conditions (eg, fibular hemimelia), and acquired conditions (eg, traumatic). The location of osteotomy site was quite evenly spread between the femur and the tibia/fibula. Three out of the 34 patients were unable to receive hydrotherapy due to continuous secretions; 2 patients did not miss any sessions. The mean number of treatments was 3 per week. During the entire period, a total of 1200 treatments were performed for these patients with only 32 cancellations (about 3%) due to secretions or other signs of infection. Spearman correlation coefficients showed significantly high correlations between the duration of external fixation and the duration of hydrotherapy. There are no significant correlations between infections and other factors (sex, age segment, whether the problem is unilateral or /bilateral, diagnosis, and duration of treatment).

CONCLUSIONS

This is the first report, to our knowledge, that documents the low prevalence of infectious events during hydrotherapy treatment and demonstrates its feasibility.

LEVEL OF EVIDENCE

Level III; retrospective, comparative study.

Monitoring and factors affecting levels of airborne and water bromoform in chlorinated seawater swimming pools

Water and air quality of eight seawater swimming pools using chlorine disinfection was measured during four sampling campaigns, spread on one full-year, and in four thalassotherapy centers located in Southeast of France. Concentrations of trihalomethanes (THMs) in air and in water as well as concentrations of parameters, including nonpurgeable organic carbon (NPOC), free residual chlorine (Cl_f), pH, Kjeldhal Nitrogen (KN), salinity, conductivity, bromide ions and, water and air temperature, were measured. Water and air samples were collected in triplicates morning - at the opening of the pools -, noon and night - at the closing of the pools -, in summer and winter. Data analysis was performed by Principal Component Analysis (PCA) and rotated component matrix, from both data quality and other parameters such as TOC, aromaticity (UV₂₅₄), pH, hygrometry, and free residual chlorine (Cl_f). This statistical analysis demonstrates a high correlation between TOC, Cl_f and UV₂₅₄ and THM levels found in air and water, particularly for the major ones (CHBr₃ in water_: 300.0μg/L mean, 1029.0μg/L maximum; CHBr₃ in air: 266.1μg/m³ mean, 1600.0μg/m³ maximum, and CHClBr₂ in water: 18.9μg/L mean, 81.0μg/L maximum; CHClBr₂ in air: 13.6μg/m³ mean, 150.0μg/m³ maximum). These high levels of bromoform (CHBr₃) are particularly worrisome in such health institutions, even these levels do not exceed the Permissible Exposure Limit (PEL) of 5mg/m³ as an 8hour time-weighted average currently fixed by various administrations, such as Occupational Safety and Health Administration (OSHA).

Microbiological quality of indoor and outdoor swimming pools in Greece: investigation of the antibiotic resistance of the bacterial isolates

During 1997-2005, the microbiological quality and susceptibility of bacterial isolates of swimming pool waters were investigated. A total of 462 water samples were collected from three indoor swimming pools (a teaching pool, a competition public pool, a hydrotherapy pool) and two outdoor swimming pools (a hotel semi-public and a residential private pool) in Northwestern Greece. All water samples were analyzed for the presence of bacteria, protozoa and fungi and susceptibility tests were performed for the bacterial isolates. Sixty-seven percent of the examined water samples conformed to the microbiological standards and 32.9% exceeded at least one of the indicated limits. Out of 107 bacterial isolates, 38 (35.5%) resistant strains were detected. Multi-resistant Pseudomonas alcaligenes, Leuconostoc, and Staphylococcus aureus (isolated from the teaching pool), Staphylococcus wernerii, Chryseobacterium indologenes and Ochrobactrum anthropi (isolated from the competition pool), Pseudomonas aeruginosa, P. fluorescens, Aeromonas hydrophila, Enterobacter cloacae, Klebsiella pneumoniae and S. aureus (isolated from the hydrotherapy pool) and A. hydrophila (isolated from the hotel pool) were detected. The swimming pool with the poorest microbiological quality (THC 500 cfu/ml in 12.1% of the samples, P. aeruginosa counts 1500 cfu/100 ml in 6% of the samples) and the highest prevalence of multi-resistant isolates (73.6%) was the hydrotherapy pool. No Cryptosporidium or Giardia cysts and no Legionella, Mycobacteria and Salmonella were detected, but there were isolations of Candida albicans, Aspergillus spp., Mucor spp., Alternaria spp., Rhizopus spp., Trichophyton spp., and Penicillium spp.