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Tomazin R, Matos T. Mycological Methods for Routine Air Sampling and Interpretation of Results in Operating Theaters. Diagnostics (Basel) 2024; 14:288. [PMID: 38337804 PMCID: PMC10855394 DOI: 10.3390/diagnostics14030288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Many infectious diseases are transmitted via the air and are, therefore, particularly difficult to combat. These infections include various invasive mycoses caused by molds. The usual route of infection is the inhalation of conidia. In hospitals, infection can also occur through the deposition of conidia in otherwise sterile anatomical sites during surgical and other invasive procedures. Therefore, knowledge of airborne mold concentrations can lead to measures to protect patients from fungal infections. The literature on this topic contains insufficient and sometimes ambiguous information. This is evidenced by the fact that there are no international recommendations or guidelines defining the methodology of air sampling and the interpretation of the results obtained. Surgical departments, intensive care units and medical mycology laboratories are, therefore, left to their own devices, leading to significant differences in the implementation of mycological surveillance in hospitals. The aim of this mini-review is to provide an overview of the current methods of air sampling and interpretation of results used in medical mycology laboratories.
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Affiliation(s)
| | - Tadeja Matos
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
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2
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Stålfelt F, Svensson Malchau K, Björn C, Mohaddes M, Erichsen Andersson A. Can particle counting replace conventional surveillance for airborne bacterial contamination assessments? A systematic review using narrative synthesis. Am J Infect Control 2023; 51:1417-1424. [PMID: 37182760 DOI: 10.1016/j.ajic.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Bacterial airborne contamination in the operating room during surgery indicates an increased risk for surgical site infection. The conventional surveillance method for bacteria in the air is by air sampling, plating, and counting of colony-forming units (CFU). Particle counting measures particles in the air, typically in sizes of 1-20 µm, and has been suggested as an alternative to CFU measurements. The primary aim was to investigate the correlation between the number of airborne CFU and particles during surgery. The secondary aim was to explore whether different ventilation settings influence the correlation between CFU and particles. METHODS The databases Cochrane, Embase, and Medline were searched for relevant publications. Due to the heterogeneity of the data, meta-analysis was not possible and a narrative analysis was performed instead. RESULTS The review included 11 studies. Two of the studies (n = 2) reported strong correlation between particles and CFU (Rp = 0.76 and Rc = 0.74). The remaining studies observed moderate correlation (n = 3), low correlation (n = 3), or no correlation (n = 3). Based on the primary results from this study, ventilation attribution to distinguish the correlation between particles and CFU had no or little contribution. CONCLUSIONS Due to the lack of convincing evidence of correlation and lack of high-quality studies performing measurements in a standardized way, the studies could not provide the necessary evidence that show that particle counting could be used as a substitution for conventional air bacterial assessment. Further studies are warranted to strengthen the conclusion.
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Affiliation(s)
- Frans Stålfelt
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Karin Svensson Malchau
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Camilla Björn
- RISE Research Institutes of Sweden, Division Materials and Production, Methodology, Textiles and Medical Technology, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annette Erichsen Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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3
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Miner MA. Clinical Issues - July 2023. AORN J 2023; 118:54-59. [PMID: 37368534 DOI: 10.1002/aorn.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/29/2023]
Abstract
Use of clean versus sterile pneumatic tourniquet cuffs Key words: clean, sterile, pneumatic tourniquet, incision site, cuff placement. Active shooter crisis preparedness Key words: active shooter preparedness, emergency response, active shooter event, evacuate, barricade. Heating, ventilation, and air-conditioning parameters Key words: laminar airflow (LAF); unidirectional ultraclean air-delivery system; unidirectional downward airflow; turbulent; heating, ventilation, and air-conditioning (HVAC) system. Modifying directional air pressure settings Key words: directional air pressure, negative-pressure room, positive-pressure room, bronchoscopy, parameters.
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Chisari E, Largoza G, Clarkson S, Krueger CA, Kirschman D, Parvizi J. Many Common Pathogens are Present in the Operative Room Air During Surgery. J Arthroplasty 2022; 37:2427-30. [PMID: 35843378 DOI: 10.1016/j.arth.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The main objective of this study was to assess the sanitary measures of operating theaters using next-generation sequencing. METHODS Air was sampled from the operating room for the whole duration of 10 surgical days of "clean" (no infection cases) procedures (6 hip/knee arthroplasty and 4 spine cases). Controls consisted of samples at the beginning of the day (1 hour before the surgery started) and at the end of the day after terminal cleaning. One additional control sample, consisting of a culture swab that was opened and exposed to the air for 5 seconds, was collected at each time point. All samples were sent for next-generation sequencing analysis (16S rRNA sequencing) for bacterial identification. RESULTS Overall, 306 samples were collected (159 controls and 147 experimental). Microbial DNA was detected in only 1 control sample, while 18 (12.2%) experimental samples were positive for microbial DNA. The most common organisms retrieved were Escherichia coli (6/18, 30%), Cutibacterium acnes (3/18, 15%), and Pseudomonas aeruginosa (2/18, 11.1%). There was no difference in positive samples between arthroplasty and spine cases (P > .05). CONCLUSION Microbial organisms are not uncommonly present in the operating room air during hip and knee arthroplasties and spine procedures.
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Bolten A, Kringos DS, Spijkerman IJB, Sperna Weiland NH. The carbon footprint of the operating room related to infection prevention measures: a scoping review. J Hosp Infect 2022; 128:64-73. [PMID: 35850380 DOI: 10.1016/j.jhin.2022.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. AIM To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. METHODS A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. FINDINGS Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. CONCLUSION Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.
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Affiliation(s)
- A Bolten
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - I J B Spijkerman
- Department of Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N H Sperna Weiland
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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Abstract
Bioaerosols consist of airborne particles of biological origin. They play an important role in our environment and may cause negative health effects. The presence of biological aerosol is typically determined using active samplers. While passive bioaerosol samplers are used much less frequently in bioaerosol investigations, they offer certain advantages, such as simple design, low cost, and long sampling duration. This review discusses different types of passive bioaerosol samplers, including their collection mechanisms, advantages and disadvantages, applicability in different sampling environments, and available sample elution and analysis methods. Most passive samplers are based on gravitational settling and electrostatic capture mechanism or their combination. We discuss the agar settle plate, dustfall collector, Personal Aeroallergen Sampler (PAAS), and settling filters among the gravity-based samplers. The described electrostatics-based samplers include electrostatic dust cloths (EDC) and Rutgers Electrostatic Passive Sampler (REPS). In addition, the review also discusses passive opportunity samplers using preexisting airflow, such as filters in HVAC systems. Overall, passive bioaerosol sampling technologies are inexpensive, easy to operate, and can continuously sample for days and even weeks which is not easily accomplished by active sampling devices. Although passive sampling devices are usually treated as qualitative tools, they still provide information about bioaerosol presence and diversity, especially over longer time scales. Overall, this review suggests that the use of passive bioaerosol samplers alongside active collection devices can aid researchers in developing a more comprehensive understanding of biological presence and dynamics, especially over extended time scales and multiple locations.
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Affiliation(s)
| | - Gediminas Mainelis
- Corresponding author: Gediminas Mainelis, Phone: 848-932-5707, Fax: 732-932-8644
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Caggiano G, Lopuzzo M, Spagnuolo V, Diella G, Triggiano F, D’Ambrosio M, Trerotoli P, Marcotrigiano V, Barbuti G, Sorrenti GT, Magarelli P, Sorrenti DP, Napoli C, Montagna MT. Investigations on the Efficacy of Ozone as an Environmental Sanitizer in Large Supermarkets. Pathogens 2022; 11:pathogens11050608. [PMID: 35631128 PMCID: PMC9147425 DOI: 10.3390/pathogens11050608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
Awareness of the importance of the microbial contamination of air and surfaces has increased significantly during the COVID-19 pandemic. The aim of this study was to evaluate the presence of bacteria and fungi in the air and on surfaces within some critical areas of large supermarkets with and without an ozonation system. Surveys were conducted in four supermarkets belonging to the same commercial chain of an Apulian city in June 2021, of which two (A and B) were equipped with an ozonation system, and two (C and D) did not have any air-diffused remediation treatment. There was a statistically significant difference in the total bacterial count (TBC) and total fungal count (TFC) in the air between A/B and C/D supermarkets (p = 0.0042 and p = 0.0002, respectively). Regarding surfaces, a statistically significant difference in TBC emerged between A/B and C/D supermarkets (p = 0.0101). To the best of our knowledge, this is the first study evaluating the effect of ozone on commercial structures in Italy. Future investigations, supported by a multidisciplinary approach, will make it possible to deepen the knowledge on this method of sanitation, in light of any other epidemic/pandemic waves.
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Affiliation(s)
- Giuseppina Caggiano
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (P.T.); (M.T.M.)
- Correspondence: ; Tel.: +39-(0)-80-5478-475
| | - Marco Lopuzzo
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.L.); (V.S.); (F.T.); (M.D.); (G.B.)
| | - Valentina Spagnuolo
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.L.); (V.S.); (F.T.); (M.D.); (G.B.)
| | - Giusy Diella
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (P.T.); (M.T.M.)
| | - Francesco Triggiano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.L.); (V.S.); (F.T.); (M.D.); (G.B.)
| | - Marilena D’Ambrosio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.L.); (V.S.); (F.T.); (M.D.); (G.B.)
| | - Paolo Trerotoli
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (P.T.); (M.T.M.)
| | - Vincenzo Marcotrigiano
- Department of Prevention, Food Hygiene and Nutrition Service, Local Health Unit BT, Barletta-Andria-Trani, 76125 Trani, Italy; (V.M.); (G.T.S.); (P.M.); (D.P.S.)
| | - Giovanna Barbuti
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (M.L.); (V.S.); (F.T.); (M.D.); (G.B.)
| | - Giovanni Trifone Sorrenti
- Department of Prevention, Food Hygiene and Nutrition Service, Local Health Unit BT, Barletta-Andria-Trani, 76125 Trani, Italy; (V.M.); (G.T.S.); (P.M.); (D.P.S.)
| | - Pantaleo Magarelli
- Department of Prevention, Food Hygiene and Nutrition Service, Local Health Unit BT, Barletta-Andria-Trani, 76125 Trani, Italy; (V.M.); (G.T.S.); (P.M.); (D.P.S.)
| | - Domenico Pio Sorrenti
- Department of Prevention, Food Hygiene and Nutrition Service, Local Health Unit BT, Barletta-Andria-Trani, 76125 Trani, Italy; (V.M.); (G.T.S.); (P.M.); (D.P.S.)
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Maria Teresa Montagna
- Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (P.T.); (M.T.M.)
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Masia MD, Dettori M. Antimicrobial Resistance, Healthcare-Associated Infections, and Environmental Microbial Contamination. Healthcare (Basel) 2022; 10:242. [PMID: 35206857 PMCID: PMC8872406 DOI: 10.3390/healthcare10020242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 01/27/2023] Open
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Ting Wu H, Shuang Li Q, Chen Dai R, Liu S, Wu L, Mao W, Hua Ji C. Effects of air-conditioning systems in the public areas of hospitals: A scoping review. Epidemiol Infect 2021; 149. [DOI: 10.1017/s0950268821001990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Almost all hospitals are equipped with air-conditioning systems to provide a comfortable environment for patients and staff. However, the accumulation of dust and moisture within these systems increases the risk of transmission of microbes and have on occasion been associated with outbreaks of infection. Nevertheless, the impact of air-conditioning on the transmission of microorganisms leading to infection remains largely uncertain. We conducted a scoping review to screen systematically the evidence for such an association in the face of the coronavirus disease 2019 epidemic. PubMed, Embase and Web of Science databases were explored for relevant studies addressing microbial contamination of the air, their transmission and association with infectious diseases. The review process yielded 21 publications, 17 of which were cross-sectional studies, three were cohort studies and one case−control study. Our analysis showed that, compared with naturally ventilated areas, microbial loads were significantly lower in air-conditioned areas, but the incidence of infections increased if not properly managed. The use of high-efficiency particulate air (HEPA) filtration not only decreased transmission of airborne bioaerosols and various microorganisms, but also reduced the risk of infections. By contrast, contaminated air-conditioning systems in hospital rooms were associated with a higher risk of patient infection. Cleaning and maintenance of such systems to recommended standards should be performed regularly and where appropriate, the installation of HEPA filters can effectively mitigate microbial contamination in the public areas of hospitals.
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Zaman SU, Yesmin M, Pavel MRS, Jeba F, Salam A. Indoor air quality indicators and toxicity potential at the hospitals' environment in Dhaka, Bangladesh. Environ Sci Pollut Res Int 2021; 28:37727-37740. [PMID: 33723779 DOI: 10.1007/s11356-021-13162-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Indoor air quality (IAQ) is a leading apprehension currently especially in the perilous atmosphere, like hospitals. Clean and fresh air is very crucial for the patients and healthcare professionals in the hospitals. Therefore, we examined IAQ indicators (PM1.0, PM2.5, PM10, NO2, CO2, and TVOC) at sixteen locations of three hospitals with an emphasis on seasonal variations, indoor/outdoor correlation, and concomitant toxicity potential (TP) of human exposure between October 2019 and January 2020. For the measurement of trace gases (NO2, CO2, and TVOC), Aeroqual 500 series (New Zealand) sampler was used; particulate matter (PM1.0, PM2.5, and PM10) concentrations and relative humidity (RH) were measured using the IGERESS air quality monitoring device (WP6930S, China). The total average concentration of IAQ indicators were 104.1 ± 67.6 (PM1.0), 137.4 ± 89.2 (PM2.5), and 159.0 ± 103.3 (PM10) μgm-3; 0.11 ± 0.02 (NO2), 1047.1 ± 234.2 (CO2), and 176.5 ± 117.7 (TVOC) ppm. Significant variations of IAQ indicators were observed between different locations of the hospitals. Winter IAQ indicators were much higher than post-monsoon season. Indoor particulate matter (PM) levels were lower than outdoor, but gaseous pollutants were higher in indoor than outdoor except NO2. Indoor TVOC was about two times higher than outdoor and also higher in post-monsoon than winter. A good positive correlation was observed between indoor and outdoor particulate matter during winter. A strong positive correlation was obtained between NO2 and RH with PM in winter. Very high (> 10) indoor toxicity potential (TP) values of PM2.5 and PM10 were determined during winter. Extremely high TP values indicated potential severe health consequences of the healthcare professionals and patients in indoor hospitals' environment.
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Affiliation(s)
- Shahid Uz Zaman
- Department of Chemistry, University of Dhaka, Dhaka-1000, Bangladesh
| | - Mahbuba Yesmin
- Enam Medical College and Hospital, Savar, Dhaka, Bangladesh
| | | | - Farah Jeba
- Department of Chemistry, University of Dhaka, Dhaka-1000, Bangladesh
| | - Abdus Salam
- Department of Chemistry, University of Dhaka, Dhaka-1000, Bangladesh.
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Rufino de Sousa N, Shen L, Silcott D, Call CJ, Rothfuchs AG. Operative and Technical Modifications to the Coriolis® µ Air Sampler That Improve Sample Recovery and Biosafety During Microbiological Air Sampling. Ann Work Expo Health 2021; 64:852-865. [PMID: 32469054 PMCID: PMC7544001 DOI: 10.1093/annweh/wxaa053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
Detecting infectious aerosols is central for gauging and countering airborne threats. In this regard, the Coriolis® µ cyclonic air sampler is a practical, commercial collector that can be used with various analysis methods to monitor pathogens in air. However, information on how to operate this unit under optimal sampling and biosafety conditions is limited. We investigated Coriolis performance in aerosol dispersal experiments with polystyrene microspheres and Bacillus globigii spores. We report inconsistent sample recovery from the collector cone due to loss of material when sampling continuously for more than 30 min. Introducing a new collector cone every 10 min improved this shortcoming. Moreover, we found that several surfaces on the device become contaminated during sampling. Adapting a high efficiency particulate air-filter system to the Coriolis prevented contamination without altering collection efficiency or tactical deployment. A Coriolis modified with these operative and technical improvements was used to collect aerosols carrying microspheres released inside a Biosafety Level-3 laboratory during simulations of microbiological spills and aerosol dispersals. In summary, we provide operative and technical solutions to the Coriolis that optimize microbiological air sampling and improve biosafety.
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Affiliation(s)
- Nuno Rufino de Sousa
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Solnavägen, SE-171 77 Stockholm, Sweden
| | - Lei Shen
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Solnavägen, SE-171 77 Stockholm, Sweden
| | | | | | - Antonio Gigliotti Rothfuchs
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Solnavägen, SE-171 77 Stockholm, Sweden
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Romano F, Milani S, Ricci R, Joppolo CM. Operating Theatre Ventilation Systems and Their Performance in Contamination Control: "At Rest" and "In Operation" Particle and Microbial Measurements Made in an Italian Large and Multi-Year Inspection Campaign. Int J Environ Res Public Health 2020; 17:E7275. [PMID: 33027963 DOI: 10.3390/ijerph17197275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
In Operating Theatres (OT), the ventilation system plays an important role in controlling airborne contamination and reducing the risks of Surgical Site Infections (SSIs). The air cleanliness is really crucial in this field and different measurements are used in order to characterize the situation in terms of both airborne microbiological pollutants and particle size and concentration. Although the ventilation systems and airborne contamination are strictly linked, different air diffusion schemes (in particular, the Partial Unidirectional Airflow, P-UDAF, and the Mixing Airflow, MAF) and various design parameters are used, and there is still no consensus on real performance and optimum solutions. This study presents measurements procedures and results obtained during Inspection and Periodic Performance Testing (1228 observations) in a large sample of Italian OTs (175 OTs in 31 Italian hospitals) in their operative life (period from 2010 to 2018). The inspections were made after a cleaning procedure, both in “at-rest” conditions and “in operation” state. Inert and microbial contamination data (in air and on surfaces) are analyzed and commented according to four relevant air diffusion schemes and design classes. Related data on Recovery Time (RT) and personnel presence were picked up and are commented. The results confirm that the ventilation systems are able to maintain the targeted performance levels in the OT operative life. However, they attest that significant differences in real OT contamination control capabilities do exist and could be ascribed to various design choices and to different operation and maintenance practices. The study shows and confirms that the air diffusion scheme and the design airflow rate are critical factors. Beside large variations in measurements, the performance values, in terms of control of airborne particle and microbial contamination (in air and on surfaces), for P-UDAF systems are better than those that were assessed for the MAF air diffusion solution. The average performances do increase with increasing airflows, and the results offer a better insight on this relationship leading to some possible optimization.
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13
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Caggiano G, Diella G, Triggiano F, Bartolomeo N, Apollonio F, Campanale C, Lopuzzo M, Montagna MT. Occurrence of Fungi in the Potable Water of Hospitals: A Public Health Threat. Pathogens 2020; 9:E783. [PMID: 32987845 PMCID: PMC7601515 DOI: 10.3390/pathogens9100783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 01/24/2023] Open
Abstract
Since the last decade, attention towards the occurrence of fungi in potable water has increased. Commensal and saprophytic microorganisms widely distributed in nature are also responsible for causing public health problems. Fungi can contaminate hospital environments, surviving and proliferating in moist and unsterile conditions. According to Italian regulations, the absence of fungi is not a mandatory parameter to define potable water, as a threshold value for the fungal occurrence has not been defined. This study evaluated the occurrence of fungi in potable water distribution systems in hospitals. The frequency of samples positive for the presence of fungi was 56.9%; among them, filamentous fungi and yeasts were isolated from 94.2% and 9.2% of the samples, respectively. The intensive care unit (87.1%) had the highest frequency of positive samples. Multivariable model (p < 0.0001), the variables of the period of the year (p < 0.0001) and type of department (p = 0.0002) were found to be statistically significant, suggesting a high distribution of filamentous fungi in the potable water of hospitals. Further studies are necessary to validate these results and identify the threshold values of fungi levels for different types of water used for various purposes to ensure the water is safe for consumption and protect public health.
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Affiliation(s)
- Giuseppina Caggiano
- Department of Biomedical Science and Human Oncology-Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; (G.D.); (F.T.); (N.B.); (F.A.); (C.C.); (M.L.); (M.T.M.)
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Romano F, Milani S, Gustén J, Joppolo CM. Surgical Smoke and Airborne Microbial Contamination in Operating Theatres: Influence of Ventilation and Surgical Phases. Int J Environ Res Public Health 2020; 17:ijerph17155395. [PMID: 32727035 PMCID: PMC7432766 DOI: 10.3390/ijerph17155395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/23/2023]
Abstract
Air cleanliness is a crucial factor in operating theatres (OTs), where the health of patients and staff must be preserved by controlling air contamination. Particular attention must be paid to ultrafine particles (UFPs) size range, generated for instance by electrosurgical instruments (ESTs). OT contamination is also affected by ventilation systems, medical staff and their gowning system, staff routines, instruments, etc. This comparative study is based on experimental measurements of airborne microbial contamination and UFPs carried out during real ongoing surgeries in two OTs equipped with upward displacement ventilation (UWD) and hybrid ventilation, with unidirectional airflow on the operating table and peripheral mixing (UDAF+Mixing) ventilation systems. Airborne contamination concentration at the exit grilles has been analyzed as function of four different surgical phases normally performed during an operation. Results highlight that airborne contamination is influenced by the activities carried out during the surgical phases. EST usage affects the contamination level more than staff size during operation observed. Colony forming unit (CFU) values in the protected area close to the patient’s wound are influenced more by the type of ventilation system than by surgical phases. CFU values decrease by 18 to 50 times from the UWD system to the hybrid one. The large airflow volumes supply together with high air velocities in OTs equipped with UDAF+Mixing systems guarantee a better and a safer airborne contamination control for patients and medical team in comparison with UWD systems.
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Affiliation(s)
- Francesco Romano
- Dipartimento di Energia, Politecnico di Milano, 20125 Milan, Italy; (S.M.); (C.M.J.)
- Correspondence: ; Tel.: +39-02-2399-3876
| | - Samanta Milani
- Dipartimento di Energia, Politecnico di Milano, 20125 Milan, Italy; (S.M.); (C.M.J.)
| | - Jan Gustén
- Building Services Engineering, Chalmers University of Technology, SE-41296 Gothenburg, Sweden;
| | - Cesare Maria Joppolo
- Dipartimento di Energia, Politecnico di Milano, 20125 Milan, Italy; (S.M.); (C.M.J.)
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15
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Pasquarella C, Balocco C, Colucci ME, Saccani E, Paroni S, Albertini L, Vitali P, Albertini R. The Influence of Surgical Staff Behavior on Air Quality in a Conventionally Ventilated Operating Theatre during a Simulated Arthroplasty: A Case Study at the University Hospital of Parma. Int J Environ Res Public Health 2020; 17:E452. [PMID: 31936699 PMCID: PMC7013425 DOI: 10.3390/ijerph17020452] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/28/2022]
Abstract
Surgical staff behavior in operating theatres is one of the factors associated with indoor air quality and surgical site infection risk. The aim of this study was to apply an approach including microbiological, particle, and microclimate parameters during two simulated surgical hip arthroplasties to evaluate the influence of staff behavior on indoor air quality. During the first hip arthroplasty, the surgical team behaved correctly, but in the second operation, behavioral recommendations were not respected. Microbiological contamination was evaluated by active and passive methods. The air velocity, humidity, temperature, and CO2 concentration were also monitored. The highest levels of microbial and particle contamination, as well as the highest variation in the microclimate parameter, were recorded during the surgical operation where the surgical team behaved "incorrectly". Turbulent air flow ventilation systems appeared more efficient than in the past and very low air microbial contamination was reached when behavior was correct. Therefore, adherence to behavioral recommendations in operating theatres is essential to not undermine the effectiveness of the heating, ventilation, and air conditioning systems and employed resources.
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Affiliation(s)
- Cesira Pasquarella
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | - Carla Balocco
- Department of Industrial Engineering, University of Florence, via S. Marta 3, 50139 Firenze, Italy;
| | - Maria Eugenia Colucci
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | - Elisa Saccani
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | - Samuel Paroni
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | | | - Pietro Vitali
- Hygiene Unit, University Hospital of Parma, Parma, via Gramsci 14, 43126 Parma, Italy;
| | - Roberto Albertini
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
- Clinical Immunology Unit, University Hospital of Parma, Parma, via Gramsci 14, 43126 Parma, Italy
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