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Discussion on effect of material on UV reflection and its disinfection with focus on Japanese Stucco for interior wall. Sci Rep 2021; 11:21840. [PMID: 34750445 PMCID: PMC8575928 DOI: 10.1038/s41598-021-01315-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/26/2021] [Indexed: 11/08/2022] Open
Abstract
Research has previously shown that ultraviolet light C (UV-C) can inactivate unexpected infection. However, this type of potential disinfection is dramatically reduced for the shadow area such as under desk or medical equipment. Because the UV-C reflectance ratio is low on the general wall surfaces. We compared Stucco against the other materials to investigate whether we could improve disinfection for the shadow area. The reflectance ratios of UV-C irradiation of each material were examined, with particular attention to the rates for the author’s Modified Stucco. To evaluate the disinfection effects of the UV-C reflective lighting, colonies of E. coli and of Staphylococcus hominis were cultured in an agar media and counted over a certain time period after applying UV-C irradiation from a sterilizing lamp onto the investigation materials. The author’s Modified Stucco, produced reflectance ratios that was 11 times that of white wallpaper. This demonstrated that the UV-C reflected on the Stucco wall having optimum components and their compositions inhibited the number of E. coli and S. hominis, resulting in significantly disinfection effects on white wallpapers. The space with Modified Stucco and then irradiated by a UV-C may give a strong disinfection effect.
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Tanner WD, Leecaster MK, Zhang Y, Stratford KM, Mayer J, Visnovsky LD, Alhmidi H, Cadnum JL, Jencson AL, Koganti S, Bennett CP, Donskey CJ, Noble-Wang J, Reddy SC, Rose LJ, Watson L, Ide E, Wipperfurth T, Safdar N, Arasim M, Macke C, Roman P, Krein SL, Loc-Carrillo C, Samore MH. Environmental Contamination of Contact Precaution and Non-Contact Precaution Patient Rooms in Six Acute Care Facilities. Clin Infect Dis 2021; 72:S8-S16. [PMID: 33512527 DOI: 10.1093/cid/ciaa1602] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Environmental contamination is an important source of hospital multidrug-resistant organism (MDRO) transmission. Factors such as patient MDRO contact precautions (CP) status, patient proximity to surfaces, and unit type likely influence MDRO contamination and bacterial bioburden levels on patient room surfaces. Identifying factors associated with environmental contamination in patient rooms and on shared unit surfaces could help identify important environmental MDRO transmission routes. METHODS Surfaces were sampled from MDRO CP and non-CP rooms, nursing stations, and mobile equipment in acute care, intensive care, and transplant units within 6 acute care hospitals using a convenience sampling approach blinded to cleaning events. Precaution rooms had patients with clinical or surveillance tests positive for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae or Acinetobacter within the previous 6 months, or Clostridioides difficile toxin within the past 30 days. Rooms not meeting this definition were considered non-CP rooms. Samples were cultured for the above MDROs and total bioburden. RESULTS Overall, an estimated 13% of rooms were contaminated with at least 1 MDRO. MDROs were detected more frequently in CP rooms (32% of 209 room-sample events) than non-CP rooms (12% of 234 room-sample events). Surface bioburden did not differ significantly between CP and non-CP rooms or MDRO-positive and MDRO-negative rooms. CONCLUSIONS CP room surfaces are contaminated more frequently than non-CP room surfaces; however, contamination of non-CP room surfaces is not uncommon and may be an important reservoir for ongoing MDRO transmission. MDRO contamination of non-CP rooms may indicate asymptomatic patient MDRO carriage, inadequate terminal cleaning, or cross-contamination of room surfaces via healthcare personnel hands.
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Affiliation(s)
- Windy D Tanner
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA.,IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Molly K Leecaster
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA.,IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Yue Zhang
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Kristina M Stratford
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA.,IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Jeanmarie Mayer
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA.,IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Lindsay D Visnovsky
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA.,IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Heba Alhmidi
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Annette L Jencson
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Sreelatha Koganti
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Christina P Bennett
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Curtis J Donskey
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | | | - Sujan C Reddy
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura J Rose
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren Watson
- William S. Middleton Veterans Hospital, Madison, Wisconsin, USA
| | - Emma Ide
- William S. Middleton Veterans Hospital, Madison, Wisconsin, USA
| | | | - Nasia Safdar
- William S. Middleton Veterans Hospital, Madison, Wisconsin, USA.,University of Wisconsin, Madison, Madison, Wisconsin, USA
| | - Maria Arasim
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Colleen Macke
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Patti Roman
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Sarah L Krein
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Catherine Loc-Carrillo
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA.,IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Matthew H Samore
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA.,IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
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Boyle MA, Kearney A, Carling PC, Humphreys H. 'Off the rails': hospital bed rail design, contamination, and the evaluation of their microbial ecology. J Hosp Infect 2019; 103:e16-e22. [PMID: 31229570 DOI: 10.1016/j.jhin.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022]
Abstract
Microbial contamination of the near-patient environment is an acknowledged reservoir for nosocomial pathogens. The hospital bed and specifically bed rails have been shown to be frequently and heavily contaminated in observational and interventional studies. Whereas the complexity of bed rail design has evolved over the years, the microbial contamination of these surfaces has been incompletely evaluated. In many published studies, key design variables are not described, compromising the extrapolation of results to other settings. This report reviews the evolving structure of hospital beds and bed rails, the possible impact of different design elements on microbial contamination and their role in pathogen transmission. Our findings support the need for clearly defined standardized assessment protocols to accurately assess bed rail and similar patient zone surface levels of contamination, as part of environmental hygiene investigations.
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Affiliation(s)
- M A Boyle
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - A Kearney
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P C Carling
- Department of Infectious Diseases, Carney Hospital and Boston University School of Medicine, Boston, USA
| | - H Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
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Haig CW, Mackay WG, Walker JT, Williams C. Bioaerosol sampling: sampling mechanisms, bioefficiency and field studies. J Hosp Infect 2016; 93:242-55. [PMID: 27112048 PMCID: PMC7124364 DOI: 10.1016/j.jhin.2016.03.017] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 03/15/2016] [Indexed: 11/21/2022]
Abstract
Investigations into the suspected airborne transmission of pathogens in healthcare environments have posed a challenge to researchers for more than a century. With each pathogen demonstrating a unique response to environmental conditions and the mechanical stresses it experiences, the choice of sampling device is not obvious. Our aim was to review bioaerosol sampling, sampling equipment, and methodology. A comprehensive literature search was performed, using electronic databases to retrieve English language papers on bioaerosol sampling. The review describes the mechanisms of popular bioaerosol sampling devices such as impingers, cyclones, impactors, and filters, explaining both their strengths and weaknesses, and the consequences for microbial bioefficiency. Numerous successful studies are described that point to best practice in bioaerosol sampling, from the use of small personal samplers to monitor workers' pathogen exposure through to large static samplers collecting airborne microbes in various healthcare settings. Of primary importance is the requirement that studies should commence by determining the bioefficiency of the chosen sampler and the pathogen under investigation within laboratory conditions. From such foundations, sampling for bioaerosol material in the complexity of the field holds greater certainty of successful capture of low-concentration airborne pathogens. From the laboratory to use in the field, this review enables the investigator to make informed decisions about the choice of bioaerosol sampler and its application.
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Affiliation(s)
- C W Haig
- Institute of Healthcare Associated Infection, University of the West of Scotland, Paisley, UK.
| | - W G Mackay
- Institute of Healthcare Associated Infection, University of the West of Scotland, Paisley, UK
| | - J T Walker
- Public Health England, National Infection Service, Biosafety Unit, Porton Down, UK
| | - C Williams
- Institute of Healthcare Associated Infection, University of the West of Scotland, Paisley, UK
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Maben J, Griffiths P, Penfold C, Simon M, Anderson JE, Robert G, Pizzo E, Hughes J, Murrells T, Barlow J. One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs. BMJ Qual Saf 2016; 25:241-56. [PMID: 26408568 PMCID: PMC4819646 DOI: 10.1136/bmjqs-2015-004265] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. METHODS Mixed methods pre/post 'move' comparison within four nested case study wards in a single acute hospital with 100% single rooms; quasi-experimental before-and-after study with two control hospitals; analysis of capital and operational costs associated with single rooms. RESULTS Two-thirds of patients expressed a preference for single rooms with comfort and control outweighing any disadvantages (sense of isolation) felt by some. Patients appreciated privacy, confidentiality and flexibility for visitors afforded by single rooms. Staff perceived improvements (patient comfort and confidentiality), but single rooms were worse for visibility, surveillance, teamwork, monitoring and keeping patients safe. Staff walking distances increased significantly post move. A temporary increase of falls and medication errors in one ward was likely to be associated with the need to adjust work patterns rather than associated with single rooms per se. We found no evidence that single rooms reduced infection rates. Building an all single-room hospital can cost 5% more with higher housekeeping and cleaning costs but the difference is marginal over time. CONCLUSIONS Staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms.
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Affiliation(s)
- Jill Maben
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Clarissa Penfold
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- Directorate of Nursing/AHP, Inselspital Bern University Hospital, Bern, Switzerland
| | - Janet E Anderson
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Elena Pizzo
- Faculty of Population Health Sciences, Institute of Epidemiology & Health, UCL,London, UK
| | | | - Trevor Murrells
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Maben J, Griffiths P, Penfold C, Simon M, Pizzo E, Anderson J, Robert G, Hughes J, Murrells T, Brearley S, Barlow J. Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jill Maben
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Peter Griffiths
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Clarissa Penfold
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Michael Simon
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Elena Pizzo
- Imperial College Business School, London, UK
| | - Janet Anderson
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Glenn Robert
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Jane Hughes
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Trevor Murrells
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Sally Brearley
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
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Vandini A, Temmerman R, Frabetti A, Caselli E, Antonioli P, Balboni PG, Platano D, Branchini A, Mazzacane S. Hard surface biocontrol in hospitals using microbial-based cleaning products. PLoS One 2014; 9:e108598. [PMID: 25259528 PMCID: PMC4178175 DOI: 10.1371/journal.pone.0108598] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/23/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Healthcare-Associated Infections (HAIs) are one of the most frequent complications occurring in healthcare facilities. Contaminated environmental surfaces provide an important potential source for transmission of many healthcare-associated pathogens, thus indicating the need for new and sustainable strategies. AIM This study aims to evaluate the effect of a novel cleaning procedure based on the mechanism of biocontrol, on the presence and survival of several microorganisms responsible for HAIs (i.e. coliforms, Staphyloccus aureus, Clostridium difficile, and Candida albicans) on hard surfaces in a hospital setting. METHODS The effect of microbial cleaning, containing spores of food grade Bacillus subtilis, Bacillus pumilus and Bacillus megaterium, in comparison with conventional cleaning protocols, was evaluated for 24 weeks in three independent hospitals (one in Belgium and two in Italy) and approximately 20000 microbial surface samples were collected. RESULTS Microbial cleaning, as part of the daily cleaning protocol, resulted in a reduction of HAI-related pathogens by 50 to 89%. This effect was achieved after 3-4 weeks and the reduction in the pathogen load was stable over time. Moreover, by using microbial or conventional cleaning alternatively, we found that this effect was directly related to the new procedure, as indicated by the raise in CFU/m2 when microbial cleaning was replaced by the conventional procedure. Although many questions remain regarding the actual mechanisms involved, this study demonstrates that microbial cleaning is a more effective and sustainable alternative to chemical cleaning and non-specific disinfection in healthcare facilities. CONCLUSIONS This study indicates microbial cleaning as an effective strategy in continuously lowering the number of HAI-related microorganisms on surfaces. The first indications on the actual level of HAIs in the trial hospitals monitored on a continuous basis are very promising, and may pave the way for a novel and cost-effective strategy to counteract or (bio)control healthcare-associated pathogens.
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Affiliation(s)
- Alberta Vandini
- CIAS Laboratory, Centre for the Study of physical, chemical and microbiological Contamination of Highly Sterile Environments, Department of Architecture, University of Ferrara, Ferrara, Italy
| | - Robin Temmerman
- Laboratory of Microbial Ecology and Technology, Ghent University, Ghent, Belgium
- Chrisal R & D Department, Lommel, Belgium
| | - Alessia Frabetti
- CIAS Laboratory, Centre for the Study of physical, chemical and microbiological Contamination of Highly Sterile Environments, Department of Architecture, University of Ferrara, Ferrara, Italy
| | - Elisabetta Caselli
- Department of Medical Sciences, Microbiology Section, University of Ferrara, Ferrara, Italy
| | - Paola Antonioli
- Department of Infection Prevention Control and Risk Management, Ferrara University Hospital, Ferrara, Italy
| | - Pier Giorgio Balboni
- Department of Medical Sciences, Microbiology Section, University of Ferrara, Ferrara, Italy
| | - Daniela Platano
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alessio Branchini
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Sante Mazzacane
- CIAS Laboratory, Centre for the Study of physical, chemical and microbiological Contamination of Highly Sterile Environments, Department of Architecture, University of Ferrara, Ferrara, Italy
- * E-mail:
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