The structure of chemical vapor deposited graphene substrates for graphene-enhanced Raman spectroscopy

Defects and nanocrystalline grain structures play a critical role in graphene-enhanced Raman spectroscopy (GERS). In this study, we selected three types of few-layer, polycrystalline graphene films produced by chemical vapor deposition (CVD), and we tested them as GERS substrates. The graphene structure was controlled by decreasing the CVD temperature, thus obtaining (i) polycrystalline with negligible defect density, (ii) polycrystalline with high defect density, (iii) nanocrystalline. We applied rhodamine 6G as a probe molecule to investigate the Raman enhancement. Our results show that nanocrystalline graphene is the most sensitive GERS substrate, indicating that the GERS effect is primarily connected to the nanocrystalline structure, rather than to the presence of defects.

The endogenous oxytocin after manipulative osteopathic treatment in full-term pregnant women

OBJECTIVE

The aim of this study is to assess whether the touch of osteopathic manipulative treatment (OMT) can affect the endogenous production of oxytocin in full-term pregnant women and the assessment of well-being following the treatment.

PATIENTS AND METHODS

In this study have been enrolled 57 pregnant women at full-term pregnancy (37th-41st week) for evaluation of the concentration of salivary oxytocin 2 minutes before and 2 minutes after a single session of OMT by an osteopath lasting for 30 minutes. Pre-OMT and post-OMT saliva samples were collected with the use of Salivette® salivary swabs. 7 salivary swabs were excluded from the analysis. 50 samples were analyzed with an appropriate ELISA kit.

RESULTS

The mean OT salivary concentration pre-OMT was 89.98±16.39, and post-OMT was 100.60±19.13 tends to increase with p=0.0000051. In multivariate analysis, two subgroups show interesting data in the mean difference in OT salivary concentration post-OMT: women with painful contractions (p=0.06) and women under 35 years (p=0.09).

CONCLUSIONS

The results of this study demonstrate that the effectiveness of OMT-increasing endogenous oxytocin is statistically significant in full-term pregnant women. The sensation of well-being found in most women indicates that there has been a predominantly central rather than peripheral oxytocin release after OMT.

Severe Hypernatremia as Presentation of Netherton Syndrome

Netherton syndrome is a rare, multisystem, autosomal recessive genodermatosis characterized by a triad of manifestations: congenital ichthyosis, immune dysregulation, and scalp anomalies. We report the case of a 1-month-old male infant evaluated for failure to thrive and feeding difficulties. At birth, the infant was admitted to intensive care for severe hypernatremia (natremia 186 mg/dL). Upon entering the ward, the general conditions were poor. He presented with diffuse erythrodermia. A dermatological evaluation showed evidence of "invaginated trichuriasis," a typical sign of Netherton syndrome. Netherton syndrome is caused by a genetic mutation causing loss of function of the SPINK5 gene it encodes for the LEKTI protein, normally expressed in epithelia. Loss of LEKTI induces severe skin barrier defect. The history of the disease is characterized by serious potential complications in the first months of life, such as the risk of hypernatremic dehydration induced by high skin permeability, recurrent and/or severe infections, and growth retardation.

Intramuscular migration of calcium deposits into the deltoid muscle: two cases of a rare complication of rotator cuff calcific tendinopathy

Rotator cuff calcific tendinopathy is a common non-traumatic shoulder pain condition that occurs predominantly in the supraspinatus tendon. Ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) is a valid treatment in the resorptive phase. A complication of calcific tendinopathy is migration of calcium deposits outside the tendon. The most common site of migration is the subacromialsubdeltoid bursa (SASD). Another, but not frequent, type of migration is the intramuscular migration which mostly affects the supraspinatus, the infraspinatus and the biceps brachii muscles. This paper reports two cases of migration of calcification from the supraspinatus tendon to the deltoid muscle. The aforementioned site of migration has so far never been described in literature. Both patients presented calcification in the resorptive phase and therefore were treated by US-PICT.

Evaluating the effect of COVID-19 incidence on Emergency Departments admissions. Results from a retrospective study in Central Italy during the first year of pandemic

Introduction

The COVID-19 pandemic has had a major impact on the Healthcare System, changing the patterns of Emergency Department access. In fact, accesses for trauma and less severe cases decreased significantly. This decline has generally been attributed to both the effects of the lockdown, imposed by the government, and the fear of being infected by SARS-CoV-2 in the hospital. However, the correlation between these elements is not yet clear, since the accesses to the Emergency Department did not increase either at the end of the lockdown or in the summer when the epidemiological situation was more favorable. Aim: To evaluate the association between trends of Emergency Department accesses and COVID-19 incidence in 2020.

Methods

Data on Emergency Department accesses, by month and severity triage code, from 14 hospitals in southeastern Tuscany (Italy) were obtained from hospitals' data warehouse. Official data on new cases of COVID-19 infection were used to calculate incidence. Hospitals were classified into 4 categories. Differences in Emergency Department access by month, triage code, and hospital type were investigated using Kruskal-Wallis analysis. Association between Emergency Department accesses and COVID-19 incidence was evaluated using a random-effect panel data analysis, adjusting for hospital type and triage code.

Results

The trend of 268,072 Emergency Department accesses decreases substantially at the first pandemic peak; thereafter, it increased and decreased again until the minimum peak in November 2020. COVID-19 incidence appeared to be overlapping with an inverse direction. Monthly differences were significant (p<0.01) except for most severe codes. There was a significant inverse association between Emergency Department accesses and COVID-19 incidence (Coef. =-0.074, p<0.001) except for most severe cases (triage code 1: Coef. =-0.028, p=0.154).

Conclusion

Emergency Department admissions trend followed the COVID-19 incidence, except for the most severe cases. Fear of infection seems to discourage patients from accessing Emergency Department for illnesses perceived as not serious.

The role of peritoneal lavage in benign gynecologic laparoscopic surgery

OBJECTIVE

Laparoscopic surgery offers many advantages compared to invasive surgery but one of the main problems is postoperative pain, partially resulting from the peritoneal inflammatory process mediated by inflammatory cytokines. The rationale of this study is that intraperitoneal washing could remove inflammatory mediators that are the cause of postoperative pain and could help in the removal of CO2 from the abdominal cavity. This article aims to analyze the effects of peritoneal lavage in the reduction of postoperative shoulder pain.

PATIENTS AND METHODS

277 patients enrolled to undergo laparoscopic gynecologic surgery were included in the study. Women are randomized into two groups, according to the use or non-use of peritoneal lavage with saline solution at the end of laparoscopic gynecological major procedures.

RESULTS

Data show that the peritoneal lavage can significantly reduce postoperative pain in the first 36 hours after surgery, as well as patients' requests for analgesics: during the first 3 postoperative days, requests for paracetamol were lower in the YW (Yes Washing) group than the NW (No Washing) group (77 vs. 101; p<0.05); similar results are obtained considering ketorolac administration (62 vs. 71; p<0.05).

CONCLUSIONS

Peritoneal lavage after gynecological laparoscopic procedures may be effective in the reduction of postoperative pain and use of analgesics.

Disinfecting Slush Machines by an Innovative Near Ultraviolet Light Emitting Diode (UV LED) Technological System

Background

Microbial contamination of food and beverages is a topic of great interest. The most innovative technologies take advantage from UV light. This study aimed to evaluate a possible configuration of a nUV LED device at a wavelength of 405 nm installed on slush machines in order to reduce the microbial contamination.

Study Design and Methods

Study Design and Methods. The study was conducted in the Department of Molecular and Developmental Medicine, University of Siena, Italy. A nUV LED device with 408 nm wavelength was installed and used on the slush machines. The inner walls of the machine tanks were fouled with contaminated slush, to evaluate the effectiveness of nUV radiation in reducing microbial contamination over time.

Results

Experiment results on the slush machine showed a statistically significant logarithmic microbial reduction, in relation with the distance from the nUV LED light source. It has also been shown that the reduction of microbes is possible with a proper management of some parameters: the exposure time, the power and wavelength of the light source, the distance and the obstacles between the light source and the target to be irradiated.

Conclusion

To reduce the incidence of foodborne diseases it is necessary to take all necessary precautionary measures, and the use of nUV technology has proved to be a crucial element in achieving this goal.

Effectiveness of near-UVA in SARS-CoV-2 inactivation

This experimental study aimed to determine the activity of a near-UVA (405 nm) LED ceiling system against the SARS-CoV-2 virus. The ceiling system comprised 17 near-UVA LED lights with a radiant power of 1.1 W/each centred at 405 nm wavelength. A 96-multiwell plate, fixed to a wooden base, was inoculated with suspensions of VERO E6 cell cultures infected with SARS-CoV-2 virus and irradiated at a distance of 40 cm with a dose of 20.2 J/cm² for 120 min. The collected suspensions were transferred to VERO cell culture plates and incubated for 3 days. The maximum measurable log reduction obtained, starting from a concentration of 10^7.2 TCID50/mL, was 3.0 log₁₀ and indicated inhibition of SARS-CoV-2 replication by the near-UVA LED ceiling system. Near-UVA light at a 405-nm wavelength is emerging as a potential alternative treatment for localised infections and environmental decontamination because it is far less harmful to living organisms' cells than UV-C irradiation.

Safer school with near-UV technology: novel applications for environmental hygiene

Systems capable of disinfecting air and surfaces could reduce the risk of infectious diseases transmission. Aim: to evaluate the effectiveness of near-UV LED ceiling lamps, with a wavelength of 405 nm, in improving environmental hygiene. Between November and December 2020, we conducted an experimental study having a pre-post design in a kindergarten room in Siena where 4 ceiling lamps with 405 nm LED technology were installed. Twice per day, sampling was performed before (T0) and after treatment with near-UV (T1). We used between 8 and 12 pairs of contact plates to sample at various random spots each day. Air samplings were also performed. The plates were incubated at 22 and 36 °C. Significance was set at 95% (p < 0.05). The mean level of Colony Forming Unit (CFU) at T(0) was 249 (95% CI 193.1 - 305.0) at 36 °C and 535.2 (374.3 - 696.1) at 22 °C. The reduction was significant at T(1): by 65% at 36 °C and, 72% at 22 °C. Also, for air contamination: 95.3% (98.4-92.3). A dose threshold of about 5 J/cm² was identified to have an 80% CFU abatement and remains nearly constant. The advantage of being able to use this technology in the presence of people is very important in the context of controlling environmental contamination.

Graphical abstract

Wind of change: Better air for microbial environmental control

Background

The COVID19 epidemic highlighted the importance of air in the transmission of pathogens. Air disinfection is one of the key points to reduce the risk of transmission both in the health sector and in public, civil and industrial environments. All bacteria and viruses tested to date can be inactivated by UV-C rays. Laboratory tested UV-C systems are increasingly popular and proposed as effective technologies for air purification; few studies have evaluated their performance in populated indoor environments. The aim of this investigation was to evaluate the effectiveness of a UV-C disinfection system for air in a real working context.

Methods

This experimental study was conducted between December 2020 and February 2021 in an office of the Department of Molecular and Developmental Medicine of the University of Siena, Italy. A pre-final version air purifier (Cleaning Air T12), capable of treating 210 m³/h of air, was first tested for its ability to filter particulates and reduce microbial air contamination in the absence of people. Subsequently, the experiments were conducted in the presence of 3-5 subjects who worked for several hours in an office. During the tests, microbiological samples of air were collected in real time, switching the system on and off periodically. Air samples were collected and incubated on Petri dishes at 36 °C and 22 °C. Statistical analysis was performed with Stata 16 software assuming a significance level of 95%. An interpolating model was identified to describe the dynamics of contamination reduction when the device operates.

Results

Preliminary tests showed a significant 62.5% reduction in Colony-Forming Units (CFUs) with 36 °C incubation. Reductions in the particulate component were also observed. In the main test, comparison of CFU data, between the device-on phase (90 min) and the subsequent device-off phase (60 min), showed statistically significant increase (p = 0.001) of environmental contamination passing from a mean of 86.6 (65.8-107.4) to 171.1 (143.9-198.3) CFU/m³, that is a rise of about 100%. The interpolating model exhibited a good fit of CFU reduction trend with the device on.

Conclusions

The system, which mainly uses UV-C lamps for disinfection, was able to significantly reduce environmental and human contamination in real time. Experimental tests have shown that as soon as the device is switched off, after at least half an hour of operation, the healthiness of the air decreases drastically within 10 minutes, bringing the airborne microbial contamination (induced by the presence of operators in the environment) to levels even higher than 150% of the last value with the device on. Re-engineering strategies for system improvement were also discussed.

Reducing waiting times of elective surgical procedures: effectiveness evaluation of a multi-interventions approach

BACKGROUND

Increasing waiting times for elective surgery is a major concern for policymakers and healthcare staff in many countries, due to its effect on health, patient satisfaction and the perceived quality of health-care. Many organizational models to reduce surgical waiting times have been studied, but the international literature indicates that multidimensional interventions on different aspects of the surgical pathway can be more effective in reducing waiting times than interventions focused on optimizing a single aspect.

AIM

The aim of the study is to evaluate the effectiveness of a multidimensional intervention in reducing waiting times for elective surgery.

STUDY DESIGN

We used a pre-post approach to evaluate the effect of a multidimensional project to reduce waiting times and lists.

METHODS

In a district general hospital (Italy) with three elective surgery operating rooms open 6 hours/day, 5 days/week (surgery specialties: general surgery, orthopaedics, gynaecology and urology), a project for reducing surgery waiting times was implemented in October 2018. The project focused on three aspects: i) separation of the flow of day surgery from that of ordinary surgery; ii) increasing available operating time by reorganizing the staff; iii) allocation of operating sessions flexibly in proportion to the waiting list. Waiting times for surgery in the periods 1/10/2019-31/12/2019 and 1/10/2018-31/12/2018 were compared by t test.

RESULTS

Waiting times for non-high-priority cases shortened significantly for all specialities (p<0.01), ex-cept for urology. For general surgery, orthopaedics and gynaecology, mean waiting times for day surgery decreased from 198 to 100 days (-50%) and for ordinary operations from 213 to 134 days (-37%). Waiting times for high-priority cases also shortened.

CONCLUSIONS

Our multidimensional project based on reorganization of staff and facilities and on improved scheduling proved effective in reducing waiting times for elective surgery.

Factors influencing the first thousand days of life

Background

The first 1000 days are crucial for the health of the baby and the well-being of the mother-baby dyad, which forms a single complex organism with its co-metabolism expressed through sophisticated neurobiological, epigenetic and microbiome development mechanisms. This study aims to investigate how much social support can influence the path of pregnancy and motherhood.

Methods

The retrospective observational study was conducted on a sample of mothers enrolled through social networks who were administered a questionnaire from July to September 2021. The questionnaire consisted of 37 questions: 11 analyzed sociodemographic variables, 20 were on current / any previous pregnancies and breastfeeding, and 6 were used to calculate the Maternity Social Support Scale (MSSS-Webster et al.). STATA 14 was used for statistical analysis.

Results

Our sample consisted of 3447 women. 88.0% wanted the pregnancy, and 63.5% planned it. The average of the Maternity Social Support Scale (MSSS) was 23.91 points. A low MSSS score correlates with a higher risk of cessation of breastfeeding before 6 months of age, a higher risk of not having spontaneous labour, a higher risk of cesarean section and a higher risk of not having a spontaneous birth. On the other hand, a higher MSSS total score is a protective factor concerning breastfeeding duration, which is more likely to be longer-lasting (>6 months), to have spontaneous onset labour with a higher probability of spontaneous delivery.

Conclusions

The results showed that most of our sample have good friends who support them, can often count on their family, and receive help from their partner/husband. The outcomes of pregnancy, childbirth and motherhood are strongly influenced and conditioned by the social context in which they occur and the support the woman can receive. The presence or lack of this support can affect the health of newborns.

Key messages

• The first 1,000 days is a vulnerable phase in which parents, institutions and health professionals should create early interventions for the proper development and promotion of good health.

• the outcomes of pregnancy, birth and motherhood are strongly influenced and conditioned by the social context, but especially by the presence or lack of support that can affect the health of newborns.

Is it really possible to leave sars-cov-2 outside the door?

Background

In this historical period, it has become very important to live in healthy environments. By using everyday objects, cross-contamination is possible because of prolonged microbial persistence on surfaces. UV-C irradiation is an environmentally friendly method to disinfect objects as no harmful chemicals or heat are involved. This study aims to determine the virucidal activity, against SARS-CoV-2, of UV-C irradiation occurring in a designed UV device, ‘Purity Capsule'.

Methods

An experimental study was performed in September 2020. The ‘Purity capsule’ has an 11 W lamp (3.5W UV-C) positioned in the centre of the device. The lamp has a dome covered with a reflective, protective coating. Three metal carriers were placed at the maximum distance from the UV-C lamp in three different positions and tested at 30 and 60 seconds 3 times. The carriers were inoculated with 100 µL of SARS-CoV-2 viral suspension with a concentration of 106.5 TCID50 /mL. After treatment, laboratory procedures were used to transfer the treated virus from carriers to multiwell plates. The samples were compared with positive controls (not exposed to UV-C light) after incubation, at 37 °C in 5% COÕ · in a humidified atmosphere, for 3 days. The residual viral activity was tested by assessing the 50% infectious dose per tissue culture (TCID50%).

Results

Tests performed at 30 seconds of UV-C irradiation show an average viral reduction of 4.0 Log10 (99.99%). All three tests performed at 60 seconds reached the maximum measurable log10 viral reduction: 5.0 Log10 (99.999%).

Conclusions

The study assessed the effectiveness of the device in significantly reducing the viral load on all carriers regardless exposure time and distance from the UV-C light source, with no impact on the level of environmental pollution.

Key messages

• UV-C light has the property of inactivating viral growth; its physical approach is considered a good compromise between cost and effectiveness.

• The device was effective in disinfecting all small everyday objects tested.

Emergency Department: Analysis of Patient Flow and Length of Stay Variations

Background

Crowding in Emergency Departments(ED)is a severe public health issue.Length of stay(LOS)is not a direct measure of crowding,but it is an essential indicator for monitoring emergency care quality.LOS in ED can be associated with delays in treatment,decreased patient satisfaction and adverse outcomes.The aim of this study is to analyze ED LOS in the Teaching Hospital of Siena for further strategies.

Methods

A retrospective observational study was conducted between January 1,2019, and December 31,2021.To manage admissions and discharges, all patients’ data admitted to ED of the University Hospital of Siena were accessed by Aurora,the IT system.In addition,a descriptive analysis was performed, collecting the following variables:sex,age,arrival mode,ED visit reasons,triage code,discharge mode,hospital admission area and LOS(cut-off>8hours).The analysis was carried out using STATA 17:variables were analyzed with ANOVA test.

Results

Our sample consisted of 152.393 patients (F49.47% M50.53%),and the average age was 50.51(SD ± 26.07).During the years total ED visits decreased:65.426(2019);40.318(2020); 46.649(2021),and there was a significant increase (p < 0.001) of patients with LOS>8 hours:13.96%(2019); 21.51%(2020); 23.10%(2021).In the years 2019,2020 and 2021, admissions of patients with LOS>8 hours were respectively: 25.92%; 43.95% and 37.09%, with the following percentage in medical areas:69.96% in 2019;70.51% in 2020;64.55% in 2021.A progressive increase of admissions in COVID area resulted since 2020(2.23%-2020;6.07%-2021).

Conclusions

The spread of COVID-19 and the containment measures,such as lockdown,caused a significant decrease in ED access.The increase LOS>8h could be primarily due to the time needed to perform laboratory investigations for the search for SARS-CoV-2 but also to the overflow of SARS-CoV-2-infected patients rapidly saturating the ED boxes and hospital bed capacity,with the need sometimes to dedicate other medical areas to manage COVID patients.

Key messages

• ED-LOS is a proxy indicator to monitor emergency care quality.

• Further investigations should be performed to analyze the leading causes of ED LOS increase during the pandemic period.

Promote equal access to COVID19 vaccination: strategies of the Local Authority Toscana SudEst, Italy

Background

In the area of the Local Health Authority Toscana Sud-Est (LHA) 13,5% of residents are foreigners. We aim to assess the impact of our intervention to COVID-19 vaccination coverage.

Methods

Since summer 2021, LHA has promoted vaccination sessions dedicated to foreign residents with free walk-in access, multilingual forms, flyers and TV interventions, cultural mediators and trained healthcare workers. We collected data about vaccination status of residents (28 December 2020-31 January 2022) and we analysed them using the software STATA to assess vaccine coverage by nationality and the effectiveness of our intervention. The results were adjusted for age and sex. We set significance level at p &lt; 0.05.

Results

On 31 July 2021, 78% of Italian residents (N = 685289) had received the first dose of vaccine, compared to only 43% of foreign residents (N = 106370). There was a 35% gap. On 31 January 2022, after our intervention, 89% of Italian residents and 71% of foreign residents had received the first dose of the vaccine. The gap was 18%. On 31 January 2022, 50% of residents of all nationalities had received two doses of the vaccine. A significant difference between Italian and foreign residents is still observed after adjustment for age and sex (OR 0.41 95% IC 0.40-0.41). Vaccination adherence is lower in females than males, for both Italian (OR 0.90 0.89-0.91) and foreign residents (OR 0.82 0.79-0.84). This is accentuated within some ethnic groups: Macedonians, Kosovars, Pakistanis.

Conclusions

The creation of dedicated service guaranteed to reach a high vaccination coverage in all the nationalities and to reduce the gap between host and foreign residents. In foreigners it is lower than in the hosts, so it is necessary to investigate possible cultural factors that may influence hesitancy. A lower vaccination coverage in females, especially in foreigners, may be due to an inferior participation in social and working life as a consequence of the gender gap.

Key messages

• The creation of dedicated interventions guaranteed to achieve high vaccination coverage in all nationalities.

• A lower vaccination adherence in females than males, especially in foreigners, may be due to an inferior participation in social and working life as a consequence of the gender gap.

Patients’ migration for orthopaedic intensive rehabilitation among Italian Regions

Background

Interregional patients’ migration, according to Italian Law, can be considered an expression of the (inviolable?) right to health and freedom of choice regarding place of care. It contributing, albeit perversely, to guaranteeing equity in the Italian National Health Service allowing citizens to overcome territorial inequalities in the distribution of healthcare services. The aim of our study was to analyze fulfilment of needs for orthopaedic intensive rehabilitation hospital services on site and interregional patients’ migration trends.

Methods

We conducted an observational cross sectional study on Hospital Discharge Cards provided by the Ministry of Health, upon specific request, from 2011 to 2019. The study of interregional patients’ migration, for orthopaedic intensive rehabilitation, relative to single Italian regions was carried out from data of Residents, Attractions and Escapes, which were graphically developed through Gandy’s Nomogram. Trend analysis (Cuzick’s Test) was performed through STATA. Were considered statistically significant at level of 95% (p &lt; 0.05).

Results

In our studied period, Gandy’s Nomogram showed that only Piedmont, Lombardy, A.P. of Trento, E. Romagna, Umbria and Abruzzo had a good public hospital planning for orthopaedic intensive rehabilitation. Attractions increased significantly for Lombardy, A.P. of Trento, Veneto and Basilicata, while they decreased significantly for A.P. of Bolzano, Veneto, F.V. Giulia, Abruzzo, Calabria and Sicily. Escapes increased significantly for Veneto, F.V. Giulia, E. Romagna, Tuscany, Molise, Puglia and Basilicata, while they decreased significantly for Piedmont, Aosta Valley, A.P. of Trento, Umbria, Abruzzo and Sicily.

Conclusions

Only six regions (4 in the North, 1 in the Centre and 1 in the South) satisfied care needs of their Residents, with an Attractions minus Escapes positive balance. Only A.P. of Trento appears to have been able to reduce Escapes and increase Attractions at the same time.

Key messages

• Studying patients’ migration by type of health benefit makes it possible to identify specific situations of lack of supply.

• Patients’ migration is an indirect Index of a region’s health policy.

Which one to choose? A cost-effectiveness analysis between different technologies of air purifiers

Introduction

CoViD19 pandemic highlighted the importance of air purifiers and, in commercialization, their performance and price influence the choice. Since primary focus concerns only performance in terms of CADR (Clean Air Delivery Rate), this study aims to compare: I) levels of declared air purifications according to different types of air purification technologies; II) price of them to evaluate if, with similar group-mean CADR (within +/- 1 SD), there are significant differences in selling prices.

Methods

A review of several devices was carried out, collecting data in January-April 2022. Four different types of air purifiers were considered, divided into as many groups: those equipped with HEPA filters + UV lamps, only with HEPA filters, only with UV lamps and those using other technologies. We applied Kruskal-Wallis test to evaluate statistical differences among prices normalized by CADR, at significant level of 0.05.

Results

Analysis was carried out on 186 devices: I) 37 had HEPA filters + UV lamps, II) 117 only HEPA filters, III) 11 only UV lamps and IV) 21 other technologies. Eight system had HEPA H11 (95% reduction of particle matter 0.5 μm), 8 had HEPA H12 (99.5%), 70 had HEPA H13 (99.95%), 11 had HEPA H14 (99.995%). The mean normalized costs of each group devices, in Euros/CADR were I) 1.22 (SD 2), II) 1.49 (SD 1.4), III) 7.63 (SD 7.38), IV) 1.22 (SD 0.99), respectively. Statistical comparison of four-group selling prices show significant differences (p &lt; 0.05) due to the devices equipped with only UV lamps.

Conclusions

Comparison between technologies analyzed by mean price normalized to CADR showed significant differences between those that used only UV lamps compared to all the others. This is reasonably due to the fact that the use of only UV lamps requires radiant powers considerably greater than all the others, therefore also higher costs (about 5-6 times). In all cases, the level of disinfection reached, as declared, was always &gt; 95%.

Key messages

• With the same mean price normalized to CADR, the selling price is significanly different only for devices equipped with UV lamps compared to all the others.

• Choice of devices with a certain level of declared air purifications can be directed towards those with HEPA+UV/HEPA/other without the mean price normalized to CADR undergoing significant differences.

Invisible mother-daughter heredity

Background

The type of maternal caregiving impacts children’s growth and can lead to heritable changes in gene expression. When women become mothers, they adopt parents’ behaviours similar to those received in the family of origin. The study investigates if a birth’s social and cultural content can be seen as heredity transmitted from mother to daughter.

Materials and methods

A retrospective study was conducted on a group of mothers recruited across Italy through the social network Facebook. The study was carried out using a questionnaire administered from July to September 2021. The survey consisted of 21 questions. The analysis was carried out using STATA 14.

Results

Our sample consisted of 6051 mothers; the mean age was 37.7 years. Womens born by spontaneous birth has 2.1 times higher risk of having a spontaneous birth for their first child. Those born by operative labour have 2.7 times higher risk of having an operative delivery for their first child. Finally, those born by caesarean section are 2.3 times more likely to have a caesarean section for their first child. On the other hand, those born by preterm labour have 1.8 times higher risk of delivering their first child preterm. Those who were breastfed have 2 times higher risk of breastfeeding their first child. Women who have been told their birth is an extraordinary event are 2 times more likely to consider the birth of their first child as a problematic but still extraordinary event. Those who received a description of childbirth from their mother as a problematic event are twice as likely to consider the birth of their first child as a traumatic event overall.

Conclusions

The results show that transmission, written in the psyche, in preverbal and in internalisations derived from the relationship with one’s mother, is true and strongly present. Also, the ways of one’s own birth are so strong as to have repercussions on the daughter’s own and subsequently also on her children.

Key messages

• The unconscious objects, which are projected onto the children, can also take the form of both physical and psychic somatisations, which are repeated cyclically between generations.

• The way in which birth is cared for and the quality of care provided at this unique time in a woman’s life will leave an imprint not only on the woman herself, but also on future generations.

Stylish UV-C lamp for disinfecting household objects

Background

Considering the current pandemic situation, the growing problem of antibiotic resistance and the increase in healthcare costs, attention to daily disinfection is becoming increasingly important. This study aimed to evaluate the bactericidal efficacy of a modern and stylish UV-C device designed for the home environment.

Methods

The experimental study was conducted between July-August 2020 on four bacterial strains: Staphylococcus aureus, Salmonella typhymurium, Klebsiella pneumoniae and Escherichia coli. The UV-C device consist of a protective dome with a reflective coating, a UV-C lamp (placed in the device base) and three reflective holders. Different positions and exposure times were tested using two different carriers holder for the bacterial inoculum (plastic and stainless steel) to estimate the germicidal efficency related to UV-C lamp exposure, with direct and reflected (from the dome coating) light.

Results

The experiment showed that the higher bacterial inactivation effect (3.5 to 7 log10) was achieved for all four strains at 3 minutes, but even at 1 minute, there is a marked reduction in the bacterial load with the only exception of Klebsiella pneumoniae. After 45 and 30 seconds, steel carriers contaminated by Escherichia coli and Staphylococcus aureus on the opposite side of the UV-C source showed significant reductions in the range between 99 and 99,9%.

Conclusions

The device has proven to be effective for the disinfection of various everyday objects placed into the lamp and introduces beauty to the household environment.

Key messages

• In this study, UV-C device proved to be a valuable tool for disinfecting household items and enhancing safety for everyday health.

• UV-C device proved to be a valuable tool for disinfecting household items and enhancing safety for everyday health.

A novel technology for disinfecting surfaces infested with Candida auris: the UVC chip

Background

The fungal pathogen Candida Auris is increasingly associated with multidrug-resistant infections that are highly expensive for the Health Care System. The spreading of this pathogen can occur, among others, through contact with infected surfaces or medical instruments. This study evaluated the efficacy of a novel UVC chip, novel alternative to UVC LEDs and lamps, in inactivating Candida auris strain.

Methods

This experimental study was carried out between July and September 2020 at the University of Siena. Candida auris (ATCC 12372) at two known concentrations (1.5X107 and 1.5x106 CFU/ml) at a fixed distance (7,5 cm) from the chip (5.1mW radiant power) was tested, in triplicates, with three exposure times (5, 10 and 15 minutes). Potato Dextrose Agar (PDA) plates without the plate lid and containing Candida auris were exposed to UVC light. Subsequently, the plates were incubated at 36 °C for 48 h. Log reduction between treated and positive control (not exposed to UVC light) samples was calculated.

Results

At 15 minutes, we had the highest inactivation result, mean 4.43 log10, starting from a 1.5x106 CFU/mL concentration. At a higher concentration, 1.5X107 CFU/mL, the reduction had a mean of 3.51 log10.

Conclusions

The results of the experiments showed a significant microbial reduction in relation to the exposure time. The highest level of reduction was reached after 15 minutes of exposure. UVC chip had a relevant biocidal effect on Candida auris and may represent a valuable tool in the prevention of infections caused by this pathogen, which is becoming increasingly prevalent and persistent globally.

Key messages

• The use of UVC Chip decreases surface contamination.

• New technology against healthcare-associated infections.

Improving the quality of medical records

Background

Medical record is an essential tool both in patients’ diagnostic and therapeutic pathways and communication between different care providers. It also has an economic-administrative, medical-legal and epidemiological function. From an economic-administrative point of view, a medical record allows an evaluation and review of services to better manage the corporate health budget. In addition, it allows traceability and complete transparency of the health activities carried out. The study evaluates the formal quality of medical records compiled in an Italian private clinic before and after a training intervention.

Methods

In June 2019, a retrospective study was carried out to assess a private clinic’s quality of medical records. One month later, healthcare providers were trained on the appropriate compilation of medical records, whose pre-printed format was structurally improved. In March 2020, we verified the quality of medical records produced after that training intervention. Statistical analysis (Wilcoxon test) was carried out through Stata.

Results

A total of 149 medical records were reviewed. Statistically significant improvements (p &lt; 0,05), between before and after training intervention, were for overall readability (33.3% vs 74.7%), completeness of admission and discharge dates (33.3% vs 74.40%), for completeness of anamnesis (13.6% vs 63.9%), for completeness of therapeutic card (53% vs 85.5%), in the reduction of non-compliance corrections (22.7% vs 4.8%), signature presence of physical examination (34.9% vs 71.1%) and for signature presence in the hospital discharge card (86.4% vs 96.4%).

Conclusions

The results show that simple measures, such as staff training and restructuring of the format, are effective in improving the quality of medical records.

Key messages

• Healthcare providers should perceive the proper completion of medical records as a common goal.

• Well-completed medical records contribute to better health care.

Don’t be scared to touch! Effectiveness of a new disinfection technology based on Ag ions & Zeolite

Background

Disinfection of contact surfaces has become common practice since the two-year Covid-19 pandemic. The transmission of microbial agents has long been the focus of public health and hygiene awareness campaigns. Indeed, the development of new disinfection technologies and approaches is attracting considerable interest in the scientific community. Mixed plastic powders with antimicrobial properties and silver ions that compromise the metabolism of microorganisms could reduce the contamination of the contact surfaces. We aimed to evaluate an inorganic antimicrobial agent (IAA) based on Ag ions and zeolite mixed in a resin.

Methods

This experimental study was carried out at the University of Siena, Italy. Different objects were produced in two versions: i) with an IAA mixed in plastic resin; ii) with a standard plastic mixture. To the eye, the two versions were indistinguishable and were randomly contaminated with the hands of several operators. After the hand contamination, T0, we sampled the objects using RODAC plates at T1 (1h) and T2 (6h), incubating at 36 °C for 48 hours. Comparisons of the biocidal effect were made at T1 and T2. Statistical analysis was carried out with Stata.

Results

The mean level of contamination of the objects made with standard plastic were, respectively 50 CFU (SD 36.5) at T1 and 20 CFU (SD 13.6) at T2. In comparison, the objects made with IAA resin showed a mean level of contamination of 10 CFU (SD 5.9) at T1 and 6 CFU (SD3.6) at T2. The objects made with IAA resin have shown a mean percentage reduction of contamination of 79.5% at T1 and 78.3% at T2.

Conclusions

IAA resin reduced contamination on objects that came into contact with hands. Antimicrobial plastic blends, are a valuable aid in counteracting the spread of infection related to contact with surfaces and fomites. The public health system could support and raise awareness for using these innovative materials for everyday applications and in healthcare facilities.

Key messages

• Inorganic antimicrobial agent based on Ag ions and Zeolite mixed in a resin are efficient in reducing the contamination on different items in a real-life context.

• Public health system have to support and sensitize to production with inorganic materials with proven antimicrobial properties.

Air purifiers, comparison between real and declared surface for use: fake it or make it?

Introduction

Air pollution has been recognized as one of the major risk factors for the global burden of disease. In modern society, most exposure occurs indoors, and air quality may be improved with air purifiers utilizing various cleaning techniques. This analysis aims to evaluate whether recommended room surface in which to use these devices as declared by producers is actually in line with their real effective area of activity.

Methods

A review of devices for the purification of the air was carried out between January-April 2022. Four different types of air purifiers were considered based on the adopted technologies: I) HEPA filters and UV lamps; II) only with HEPA filters; III) only UV lamps and IV) those using other technologies. For each group, based on the CADR (Clean Air Delivery Rate) provided by the producers, the optimal real surface area of the room to use the device was calculated, referring to the standard EN779:2012. This value was compared with the recommended area of the room declared by the producers. Descriptive statistics and Wilcoxon matched pair test used for comparisons. The significance level was set at p &lt; 0.05.

Results

The analysis was carried out on 252 devices; I) 52 had HEPA filters + UV lamps, with a recommended mean room area of 40 m2 (IQR 49.75), II) 142 devices had only HEPA filters with 52.5 m2 (IQR 46.75), III) 27 devices only UV lamps, 40 m2 (IQR 105), IV) 31 devices with other technologies, 54 m2 (IQR 84.2). As required by EN779:2012, the effective area of activity was calculated using CADR x 0.075: the medians of the 4 groups were I) 12 m2 (IQR 16.5), II) 15.83 m2 (IQR 26.4), III) 4.5 m2 (IQR 22.5), IV) 7.5 m2 (IQR 21.53), respectively. Comparing declared and calculated CADR values, all the groups showed significant differences (p &lt; 0.05).

Conclusions

Results show that recommended surfaces derived from CADR declared by producers largely overestimate the real volume of the room that devices can purify, whatever the technology used.

Key messages

• There’s no correspondence between recommended area of room to be sanitized indicated by producers of air purifiers and area that they are actually able to sanitize, which is significantly lower.

• It is necessary to be aware of the difference between data indicated by producers and real data, in order to purchase a device that actually corresponds to dimensional needs of the environment itself.

Flu and Covid-19: is there adherence to vaccination in target groups?

Background

In Italy, the flu vaccine is recommended and free for target groups (adults≥60 years old, fragile people, healthcare workers, pregnant women). During the 2020/2021 flu season, an increased vaccination coverage (+6,9%) was observed compared to the previous season, also due to the Covid-19 pandemic. We aimed to investigate how strong the adherence to the flu vaccine was by the vulnerable groups and assess if the Covid-19 vaccination campaign may have influenced the rate of flu vaccines.

Methods

At the beginning of autumn 2021 we conducted an online survey among the population of Tuscany. We collected data on demographics, health status (pregnancy, vulnerable), flu and COVID-19 vaccinations coverage and health information sources. In addition, we performed a descriptive and a risk factors analysis to assess correlation between our variables with R v 4.0.0. Significance level was set at p < 0.05.

Results

Among 408 participants, 248 (61%) belong to a vulnerable group and are recommended to receive the flu vaccine, 229 (56%) usually get the flu vaccine, 386 (95%) got the Covid-19 vaccine, 267 (65%) choose and trust the general practitioner (GP) as their health information source. There is a statistically significant association between being part of a vulnerable group and getting the seasonal flu vaccine (OR 6.63 95% CI 4.26-10.3 p < 0.001). In addition, getting the Covid-19 vaccine increases the likelihood of receiving the flu vaccine (2.90 95% CI 1.16-7.28 p = 0.018). Moreover, participants who trust their GP as their health information source (OR 1.63 CI 1.08-2.46 p = 0.019) are more likely to receive the flu vaccine; other information sources (TV, newspaper, social media) are not associated with the flu vaccine.

Conclusions

Our research shows that vulnerable groups get vaccinated against the flu. The increase in flu vaccine coverage may be due to the COVID-19 vaccines campaign. GPs play a crucial role in the health promotion, prevention and health literacy of patients.

Key messages

Impact of lockdown on football players’ injuries

Background

The global outbreak of COVID-19 has resulted in the closure of stadiums and the interruption of Serie A for three months. Many studies have evaluated the effects of COVID on population health, but few have evaluated the effects of containment measures on the health of football players. With this study, we evaluated the impact of this break on Serie A football players.

Methods

This cross-sectional study was conducted considering a timespan of three Serie A seasons (2018-19; 2019-20; 2020-21). The information was obtained from the German website Transfermarkt. All the players who had played at least one match during each of the Serie A season were identified. For each of the players, data concerning the number of days lost due to injury, both before and after the stop in the championship due to Covid, were collected. Statistical analysis was performed using Stata 17 Software.

Results

According to the selection criteria, 264 players were selected. This group was subsequently skimmed to 256 players after eliminating all players who did not suffer physical injuries over the timespan considered (non-purely orthopedic surgery; COVID; Intestinal problems; Infections). 256 players were analysed, 228 had skipped at least one day for pre-lockdown due to physical injury (median=37,5), while 227 missed a day for post-lockdown (median=27). Wilcoxon signed-rank test between days lost due to injuries before and after lockdown highlighted significant differences (p < 0.05).

Conclusions

Comparing pre-lockdown and post-lockdown periods, we noticed that there were fewer days skipped due to physical injury post lockdown. Statistical evidence suggests that the same players were more susceptible to suffer physical injuries in the pre-lockdown period. This is probably because some players have worked with home coaching by spending more time in the gym and less time on the field. Also tapis roulant and cyclettes were often delivered to football players’ homes.

Key messages

A time-varying SIRD model for dynamic vaccination strategies against COVID-19

Introduction

The COVID-19 pandemic has demonstrated how the optimal allocation of the limited doses of vaccine available represents one of the main useful measures to mitigate the transmission of the infection and reduce the mortality associated with it, especially at an early stage of the pandemic. The use of a compartmental model allows us to understand which population groups to vaccinate and to what extent to act depending on the type of health or social objective to be achieved.

Methods

A time-varying susceptible-infected-recovered-deceased (SIRD) compartmental model, stratified into ten age groups, was developed on Italian data. Simulations were performed every 15 days from December 2020 to April 2021. An optimal vaccination strategy was achieved by minimizing deaths or infected, considering the total vaccine doses available.

Results

We showed how the effects of a vaccination campaign can be planned in a way that maximizes lives saved and/or minimizes infections. Regarding the minimization of deaths, the model prioritizes the elderly (&gt;80 years) and then those between 60 and 80 years, in all simulations. Regarding the cost function of new infections, the first simulation assigns all available doses to those over 90 years of age. In the later simulations, the doses are assigned mainly to the 20-29-year-old and the 89+ year old.

Conclusions

Optimal allocation of available vaccine doses is useful in mitigating transmission of infection and reducing mortality. Application of the mathematical model can be useful at the beginning of an epidemic caused by a new pathogen, when data are scarce, and it is therefore necessary to introduce a standardized approach. This kind of simulation is useful to understand whether the implemented vaccination strategy needs to be recalibrated, too.

Key messages

• Time-varying compartmentalised models can be used both to continuously inform decision-makers about changes in epidemic traits and to simulate the effects of targeted pandemic containment strategies.

• The application of compartmental models can be very useful at the onset of an epidemic to more successfully contain it and structure the health, political, and economic plan.

Safer school with near-UVA technology: novel applications for Environmental Hygiene

Background

Schools are crowded places where outbreaks can occur. Systems capable of disinfecting air and surfaces could reduce the risk of transmission of infectious diseases.

Aim

to evaluate the effectiveness of a near-UVA (nUVA) LED ceiling lamp in improving environmental hygiene.

Methods

This cross-sectional study was conducted for 2 weeks between November and December 2020 in a kindergarten in Siena, Italy. Four ceiling lamps with LED wavelength of 405 nm were mounted on the room ceiling. The distance of the lamps from the floor was 2.70 m and 2.0 m from the desks. We preliminary selected 12 points in different sites of the room by measuring their irradiance values. We randomly sampled between 8 and 12 pairs of Petri Dishes (PD) daily during the study, incubated at 22 and 36C°, at different irradiation times: 8, 12 or 36 hours. Paired controls were used before using the lamps (at time T0), which were automatically switched ON overnight and compared with treatment (at time T1). Air sampling was also performed at T0 and T1. Statistical analysis was performed with Stata 14. Significance was set at 95% (p &lt; 0.05).

Results

520 PDs were used in the study: 130 PDs at T0 matched at T1 incubated at 36 °C and as many at 22 °C. The mean level of contamination at T0 was respectively 249 CFU (95 % CI 193.1 - 305.0) at 36 °C and 535.2 CFU (374.3 - 696.1) at 22 °C. The reduction was significant (p &lt; 0.05) at T1: we had 87.4 CFU (56.3 - 118.6), equal to 65%, at 36C° and 149.6 CFU (83.7 - 215.4), equal to 72%, at 22C°. Different values were recorded stratifying for dose (irradiance per exposition time). A significant mean percentage reduction of air contamination was 95.3% (98.4 - 92.3).

Conclusions

The system was able to improve the environmental hygiene of the kindergarten. The advantage of using this technology in the presence of people is very important in the context of controlling environmental contamination.

Key messages

• Near-UVA are efficient in reducing the contamination level significantly in a real-life context, on the surfaces and of the air.

• Crowded places favour germ outbreaks. Hygiene control is essential to reduce the risk of transmission of infectious diseases.

COVID-19 incidence on Emergency Departments accesses. Health need and fear of infection, what wins?

Introduction

The COVID-19 pandemic has changed the patterns of access to the Emergency Department (ED), but it is unclear whether this change was due to COVID-19 incidence or the lockdown imposed by law.

Aim

To evaluate the association between trends of ED accesses and COVID-19 incidence in the period 1 January - 31 December 2020.

Material and methods

The data of accesses to the ED per month and severity triage code of 14 hospitals in the Southeast Tuscany (Italy, Provinces of Siena, Arezzo, Grosseto) were obtained from hospitals data warehouses. Data on new cases of COVID-19 infection (obtained by the Ministry of Health) for the 3 provinces were used to calculate the incidence of infection. Hospitals were classified in 4 categories based on beds number, medical specialties offered, services provided. Differences in ED accesses by month, triage code and hospital type were investigated by a Kruskal-Wallis analysis of variance. Association between ED accesses and COVID-19 incidence was evaluated using a random effect panel data analysis adjusting for hospital type and triage code.

Results

A total of 268,072 ED accesses have been studied. Their trends saw a strong decrease in correspondence of the first pandemic peak, subsequently they are increased and then decreased again until the minimum peak in November 2020. COVID-19 incidence appeared to overlap, but in the reverse direction, with ED admissions trends. Monthly differences of the ED accesses were significant (p &lt; 0.01) except for most severity code. There is a statistically significant inverse association between ED accesses and COVID-19 incidence (Coef. = -0.074, p &lt; 0.001) except for most severe cases (triage code 1: Coef. = -0.028, p = 0.154).

Conclusions

ED admissions trends followed the COVID-19 incidence independently from the period of lockdown except for the most severe cases. The fear to contract the infection seemed to discourage patients to access ED for diseases that were perceived as not serious.

Key messages

• The pandemic has changed the lifestyle of people worldwide, modifying even the perception that the patient has of own state of health and their access to Emergency Department.

• The decrease in accesses involved less severe cases. Reflect on both the adequacy of accesses in the pre-pandemic period and on what is the best setting to manage these cases in the pandemic period.

Improvement and standardization of disinfection in Hospital Theatre with UV-C technology

BACKGROUND

The level of disinfection between operating sessions is important to prevent cross-contamination risk in Operating Theatres (OTs). The aim was to assess the difference in microbial contamination between different disinfection levels (DLs), before T(0) and after T(1) application of a UVC Device (UVC-D).

METHODS

A cross-sectional study was conducted between December 2019 and August 2020 in a Clinic. Three DLs: no disinfection after surgery (DL0), after in-between cleaning (DL1), and after terminal cleaning (DL2), were compared to assess the reduction of microbial presence before T(0) and after T(1), the use of UVC-D that was used for 5-3 minutes per bedside. 260 Petri dishes (PD), divided into a preliminary phase followed by a probabilistic model-driven experiment, were used in 3 OTs, and Colony Forming Units (CFU) were counted. The Mann-Whitney test was performed in the preliminary phase to establish UVC exposure time. Using the probabilistic model, we calculated descriptive statistics and % and log₁₀ reduction. The MANOVA analysis for repeated measure was performed to verify the 95% statistical difference between T(0) and T(1), combined with the DLs and different OTs.

RESULTS

The Mann-Whitney showed no CFU difference between 3-5 minutes of UVC exposure time; the MANOVA test for showed no significant difference between DLs in T(0)-T(1) CFU reduction with a mean CFU reduction of 72% (CI95% 61.7 - 84.9%) regardless of the DL applied before.

CONCLUSION

UVC-D enhanced environmental disinfection under any initial conditions. In concert with sainting procedures improves and standardizes the level of environmental hygiene.

Nitrogen dioxide pollution increases vulnerability to COVID-19 through altered immune function

Previous ecological studies suggest the existence of possible interplays between the exposure to air pollutants and SARS-CoV-2 infection. Confirmations at individual level, however, are lacking. To explore the relationships between previous exposure to particulate matter < 10 μm (PM₁₀) and nitrogen dioxide (NO₂), the clinical outcome following hospital admittance, and lymphocyte subsets in COVID-19 patients with pneumonia. In 147 geocoded patients, we assessed the individual exposure to PM₁₀ and NO₂ in the 2 weeks before hospital admittance. We divided subjects according to the clinical outcome (i.e., discharge at home vs in-hospital death), and explored the lymphocyte-related immune function as an index possibly affecting individual vulnerability to the infection. As compared with discharged subjects, patients who underwent in-hospital death presented neutrophilia, lymphopenia, lower number of T CD45, CD3, CD4, CD16/56 + CD3 + , and B CD19 + cells, and higher previous exposure to NO₂, but not PM₁₀. Age and previous NO₂ exposure were independent predictors for mortality. NO₂ concentrations were also negatively related with the number of CD45, CD3, and CD4 cells. Previous NO₂ exposure is a co-factor independently affecting the mortality risk in infected individuals, through negative immune effects. Lymphopenia and altered lymphocyte subsets might precede viral infection due to nonmodifiable (i.e., age) and external (i.e., air pollution) factors. Thus, decreasing the burden of air pollutants should be a valuable primary prevention measure to reduce individual susceptibility to SARS-CoV-2 infection and mortality.

An age grouped time-varying compartmental model for CoViD-19 vaccination strategy

Background

Compartmental models are the simplest in the mathematical study of infectious disease dynamics. Using an age-stratified compartmental model allows us to understand which population groups to target and to what extent to act, in order to achieve predefined goals in line with policy and/or health choices. In fact, the vaccination strategies of most countries are age dependent. With this study we want to show that the optimal vaccination strategy should be different depending on the type of health or social objective to be achieved.

Methods

A time varying susceptible-infected-recovered-deceased (SIRD) compartmental models, stratified into ten age groups of ten years was developed on Italian data. An optimal vaccination strategy was obtained minimizing deaths or infectious starting from April 11, 2021, considering the total doses due to Italy by the European contract for each type of vaccine from April to June. The efficacy of each vaccine and the days between administration and the beginning of immunization were also considered.

Results

On April 11, about 75% of over-80 Italian population have received at least the first dose of vaccine. Concerning the minimization of death, the model gives the priority to the older people (>60-year-old). This confirms the Italian vaccination strategy by completing the remaining vaccinations of over-80s and then vaccinating those between 60 and 80. Instead, if the priority were to reduce the infected, the model would recommend vaccinating the most of over-80s and the classes aged 20-30 and 40-60.

Conclusions

In conclusion, the use of this model can help to vary vaccine strategies by adopting targeted approaches to effectively achieve specific objective. For example, given the different age destination of some vaccine types, a good vaccination strategy might have been to vaccinate the over 90s with one type of vaccine to protect them from high risk of death while simultaneously vaccinating younger people to contain the spread.

Key messages

The modelling approach is an excellent decision support tool for pandemic containment.

The compartmentalized model stratified by age allows to act more efficiently on subpopulations.

Can a UV-C box help cinema industry by hygienizing video-cameras?

Background

UV-C has proven to be an effective microbiocide method for disinfecting objects in domestic and work environments. Aim of this study was to test the biocidal efficiency of an UVC box on a real video-camera.

Methods

In February 2021, a descriptive study on a parallelepiped-shaped UVC box, produced by Cartoni S.p.a., was conducted at the University of Siena. The box has 10 UV-C lamps (254 nm at 0.9 Watt/each) and all six mirrored reflective walls. It was specifically engineered for disinfecting equipments for film makers. A real professional camera was used to assess the level of disinfection. Contamination was obtained inoculating 1.5x107CFU/mL of S. Aureus ATCC 43300 on five 20 cm2 plastic carriers positioned in five different spots (referred as spots A, B, C, D, E), both directly (spot A), and indirectly (by reflected light, spots B, C, D, E) exposed to a UV-C light source. After a cycle of 3 minutes' exposition to UV-C: all carriers were transferred on empty Petri dishes; 10 mL D/E medium was added, transferred into a 50 ml Falcon and spun for 40 minutes at 4500 rpm; the supernatant was then removed and 100 µl of it was incubated into a Petri dish (with a generic growth medium) at 36 °C for 48 h. The experiment was run in triplicate. The mean logarithmic reduction and its 95% confidence interval were calculated from the replicates data and compared with positive controls (1.5x107CFU/mL).

Results

Mean logarithmic reduction compared to positive control was in spot A: 6.33 log10(C.I. 5.90-6.75), spot B: 4.74 log10(C.I. 4.11-5.33), spot C: 4.83 log10(C.I. 4.75-4.91), spot D: 4.89 log10(C.I. 4.12-5.65), spot E: 5.00 log10(C.I. 4.79-5.21).

Conclusions

These experiments showed that after 3 minutes of UV-C exposure there is a significant reduction in the bacterial load, 4 to 6 log10 (99.99% to 99.9999% reduction), on the carriers. The results also highlight the ability of the UV-C box to disinfect all infected spots, including those irradiated by reflected light.

Key messages

UV-C Box devices are effective in decreasing bacterial contamination on shared work tools in cinema industries, regardless of the direct or indirect exposition to the UV-C source. UV-C box's speed in hygienizing shared work tools can help cinema industry professionals to work in a safer and cleaner environment.

An emerging innovative UV disinfection technology: virucide activity on SARS-CoV-2

Background

Surface sanitation is one of the key points to reduce the risk of transmission both in healthcare and other public spaces. UV-C is already used in hospital and laboratory's disinfection procedure furthermore some recent studies show effectiveness on SARS-CoV-2. UV-C may be generated by Lamps and Light Emitting Diode, but novel sources are emerging. The aim of the study was to test a device having UV chips for inactivating SARS-CoV2.

Methods

The descriptive study was conducted in the period between June and July 2019, in laboratories of the University of Siena and of the scientific park of Toscana life sciences. The device, shaped in a rectangular box, contained six UV chips (10 mW each, with a peak at 264nm nm ranging from 260 to 350 nm) placed in the bottom. Central and short side long positions were tested expecting different dose levels. Each experiment was conducted in triplicate, with and without the device lid, at 3, 6 and 10 minutes. All repetitions were tested for SARS-CoV-2 having a virus suspension of 10^7.2.

Results

The zones with the higher value of irradiance (max 187.9 µW/cm2) were near the corners of the box, while the lowest (min 61.9 µW/cm2) near one of the long sides. The light distribution was almost symmetrical. The tests revealed a viral charge reduction from an initial concentration of virus suspension of 10^7.2 TCID50/mL, of more than 99.9% after 3 minutes of UV exposure; at 6 minutes, the minimum Log10 attenuation value was over 5 Log10(99,999%); the maximum detectable attenuation value of Log10 = 5.7 was measured at 10 minutes.

Conclusions

This device is the first one which introduces this novel UV chip source, similarly it is the first time it was tested against the SARS-CoV-2. Objects that need to be disinfected may benefit of such devices according a proper exposition time for homogeneous disinfections of the surfaces.

Key messages

Implementation of cleaning and disinfection devices has been shown to reduce Sars-cov-2 infection incidence. In the hospital sanitation field, but also in public places and homes, using viable alternatives as UV-C can contribute to the reduction of pandemic spread.

Hospital Patients’ migration among Italian Regions

Background

At the beginning of the 2000s the federalization of the Italian National Health Service gave to the Regions greater financial and political responsibility: 21 Regional Health Services were set up with administrative and planning independence. They are in a potential competitive regime, since the citizens are free to choose their place of treatment. The aim of our research was to analyze fulfillment of needs for hospital services on site and Patients' migration to hospitals of other Regions.

Methods

We conducted an observational cross sectional study on Hospital Discharge Cards provided by the Ministry of Health, upon specific request, from 2013 to 2017. The subjects of the analysis (catchment areas) were the hospital networks of Italian Regions. Interregional flows were carried out from data of Residents, Attractions and Escapes, which were developed through Attraction and Escape Indexes. Graphic representation was produced with Gandy's Nomogram.

Results

In the studied period, we observed an important decrease in hospitalizations and a simultaneous increase in interregional mobility. At the same time, admissions to hospital managed by Local Health Authorities and to Private Clinics increased. According to the Major Diagnostic Categories the main causes of hospitalizations in mobility were Musculoskeletal System And Connective Tissue Diseases (MDC 8), Cardiovascular System Diseases (MDC 5), Nervous System Diseases (MDC 1) and Digestive System Diseases (MDC 6). There were discrepancies between the Regions of Northern/Central Italy (higher Attraction Indexes) and Southern Italy (higher Escape Indexes). According to Gandy's Nomogram only nine Regions showed a good public hospital planning: Lombardy, A.P. of Bolzano, Veneto, Friuli V.G., E. Romagna, Tuscany, Umbria, Latium and Molise.

Conclusions

The North/Centre Regions have a public hospital planning able to be better to meet the care needs of their citizens and to attract Patients than the South ones.

Key messages

The study of Patients’ mobility is relevant in order to evaluate equity and quality of care provided by different Italian Regions. Patients' mobility has also an important economic implications.

Economic crisis, epidemiology and resilience in Italian Regions

Introduction

Avoidable Mortality is an indicator of the effectiveness of Health Services. We know that Gross Domestic Product (GDP) and other macroeconomic indicators are related to health indicators. The aim was to study the impact of economic indicators on Avoidable Mortality, in Italy, with attention to the periods following the economic crisis and COVID-19 epidemic.

Methods

GDP, Gini Coefficient (GC) and other economic and epidemiologic data were collected from the beginning of the Century up to the present from the Italian National Institute of Statistics database (ISTAT) and the Italian National Institute of Health (ISS). Mortality data (597 causes coded by ICD-9) was divided in Preventable, Amenable and Avoidable categories. Spearman's rank Correlation Coefficient was carried out with STATA software. The analysis was performed, also using JOINPOINT software, on the entire Italian territory and then specifically on the 20 Regions.

Results

GDP trend showed two decreasing phases occurred between 2008-2009 and 2012-2013. A negative correlation (p.<0.05) has been demonstrated in 7 Regions between GDP values and Avoidable Mortality, 5 Regions for Preventable and Amenable Mortality. GC showed a fluctuating but growing trend without any correlation with all categories of Avoidable Mortality. In 2020, after the start of the COVID-19 pandemic (in February 2020 in Italy), GDP and Employment Rate (ER) declined rapidly, but not always homogeneously.

Conclusions

The upward trend of the GC reflects an increase in inequality in the period following the economic crisis. GDP trend reflects the phases of the economic crisis impacting on epidemiological indicators with a latency of about 4 years. The negative correlation between GDP and Avoidable Mortality can not be observed in all Regions. This may be explained by heterogeneous administrative policies and different levels of resilience among Regions: another description of the “european microcosm” represented by Italy.

Key messages

The impact of the economic crisis on Avoidable Mortality has about 4 years of latency. COVID-19 pandemic has a faster impact on GDP and ER.

Italian Regions show different levels of resilience.

Food and lifestyle education in Tuscan schoolchildren: 2018-2019 follow-up of a long-term campaign

Background

Nutritional profile, physical activity level and sedentary behaviours, in preteen age, are determinants able to influence both short and long-term state of health, therefore succeeding in health education campaigns addressed to this age group is critical for the interested population. Is currently underway the multiannual follow-up of the Italian “sCOOL FOOD - Per un Futuro di tutto Rispetto” project of Monte dei Paschi Foundation of Siena, Tuscany, which offers year-round cycles of classes and workshops about the themes listed above. Our objective was to assess whether this intervention could significantly influence over time healthy, and unhealthy, behaviours of the participants.

Methods

We structured the follow-up as a prospective cohort study with one-group pretest-posttest design. We used the CAWI technique, building a questionnaire based on the Italian “OKkio alla Salute” survey, and collected data from the whole population of students enrolled in the project (in the school year 2018-2019 they were 3787, aged from 7 to 12) before and after the intervention. Afterwards, we conducted paired data analysis on the frequencies of specific behaviours.

Results

We analysed paired data from 310 respondents. Improvements were gained in: afternoon TV watching (OR 0.54; 0.34 - 0.84; p &lt; 0.01), consumption of sweet (OR 0.39; 0.16 - 0.88; p &lt; 0.05) and salty (0.42; 0.18 - 0.90; p &lt; 0.05) snacks, attitude to play outdoors after school (OR 2.6; 1.21 - 6.04; p &lt; 0.01), sedentary behaviour in leisure time (OR 0.27; 0.16 - 0.44; p &lt; 0.0001), mean weekly sport activity (+0.14 days; +0.02 - +0.27; p &lt; 0.05). No variable has deteriorated.

Conclusions

The improved compliance with healthy behaviours in the participants at this project suggests its viability as a health promotion campaign. Further parallel surveys on control groups are pending, in order to control potential confounders such as the seasonality of some habits and the awareness of the participants on the addressed subjects.

Key messages

A coordinated and cross-disciplinary food and lifestyle year-round education campaign at school can affect health determinants of children. School can correct unfavourable eating and lifestyle behaviours determined by family habits.

Efficacy of nearuv-a to inactive microbial growth

Background

Microbes are less able to develop resistance towards antimicrobial blue light (aBL), at 405nm, towards disinfectants/antibiotics. In addition, Near UV-A light (nUV) is less harmful to host cell compared to UV-C irradiation. This study aimed to assess the efficiency aBL in reducing microbial growth on surfaces.

Methods

This cross-sectional study, run between July-October 2020. Petri dishes were contaminated with P. Aeruginosa, E. Coli, S. Aureus, S. Typhimurium, K. Pneumoniae at a concentration of 1.5x104 CFU/mL and were placed at 2 and 3m of distances from the light source having an irradiance of 967,39 and 497,33 µW/cm2 for 12 hours. The air confined the room was sampled for two weeks with two air samplers (SAS), before and after the exposition to the nUV light source to estimate the reduction of the environmental microbial contamination. The analysis was conducted using Stata software. Final results were expressed as logarithmic reduction mean with 95% confidence interval.

Results

The highest microbial reduction was reached 2m directly under the light. Significant (p &lt; 0.05) log-reduction were achieved for S. Typhimurium, 2.93 (IC 2.44-3.40), K.Pneumoniae, 2.30 (IC 2.14-2.46), S.Aureus, 3.98 (IC 3.78-4.12), E.Coli, 3.83 (IC 3.17-4.50), P. Aeruginosa, 3.86 (IC 3.22-4.48). At 3m of distance from the light source, it was observed a significant logarithmic reduction for S. Aureus, 3.49 (IC 3.34-3.65), and P. Aeruginosa, 3.80 (IC 3.11-4.47). In the air tests, we observed a mean percentage microbial reduction of about 70% after 12 h of exposure to nUV light.

Conclusions

nUV has proven to contrast microbial growth on the plates. It is possible to implement this technology in the environment for controlling microbial presence in “ad hoc” scenario but also in common areas. Mitigating the energy, it is possible to use this technology in presence of persons.

Key messages

In this experimental study, nearUV-A has proven to be efficient to reduce the microbial growth and to disinfect air and surface. NearUV light (nUV) can be use as an innovative technology for decreasing bacterial contamination, also in presence of people.

There is no planet B: masks UVC disinfection to rise to the environmental challenge during COVID-19

Background

Since the outbreak of Sars-CoV-2 public health measures have been adopted globally, most notably the use of face masks has become essential and often mandatory. As a result, about 3.4 billion single-use face masks are estimated to be discarded daily worldwide. Due to waste mismanagement, the COVID-19 pandemic is severely impacting the environment, the ecosystem and therefore human health. We aimed to assess if UV-C light is an efficient tool for proper mask disinfection, to guarantee their safe reuse and reduce their waste.

Methods

In October 2020 we conducted a cross sectional study on KN95 masks. Various operators wore the masks during their shift in the laboratory for 8, 16 and 24h. Contact plates were used to measure microbial contamination on both surfaces of the masks at time T(0). Then, masks were placed into a UV-C box (volume of 0.012 m3, 40 UVC LED at 270nm at 3mW) for a treatment of 3 minutes. We repeated the sampling at time T(1). We incubated all plates at 36 °C and read them after 48h. We performed descriptive and inferential (Wilcoxon matched pair test) analysis with Stata. Significance level was set at p < 0.05.

Results

We always observed greater contamination on internal surfaces than external ones. At T(0) the medians of CFU on samples of internal surface were 212.7 (CI 95% 0-480.2) at 8h, 311.7 (0-683.1) at 16h and 404.7 (0-736.1) at 24h; at T(1), CFU reduced (p < 0.05) and were respectively 3.2 (0-6.2), 2 (0-5.9) and 50.6 (0-164.7). At T(0) the medians of CFU on external surface were 23.7 (0-48.4), 53.2 (0-143) and 24.3 (0-71.8); at T(1) they respectively reduced (p < 0.05) to 8.7 (0-25.2), 18.2 (0-70), 2.3 (0-6.1).

Conclusions

Results showed that UV-C is effective in mask disinfection although an uncomplete abatement of the microbial load. It could be due to the limited UV-C dose or to its difficulty to penetrate among the meshes of the mask. Further investigation is needed to find a sustainable solution for mask use.

Key messages

UV-C seems a valid disinfection tool for used KN95 masks.

The development of strategies for proper disinfection of masks should be carried out to guarantee reusability and reduce waste production.

Wind of change: better air for microbial environmental control

Background

COVID19 outbreak highlighted air disinfection's importance. All bacteria and viruses tested to date (including various coronaviruses) respond to UV-C disinfection. This study aims to assess the effectiveness of an UVC disinfection system for air in a real working context.

Methods

This descriptive study was carried out in November 2020 in an office of the Department of Molecular and Developmental Medicine at the University of Siena. The disinfecting air system, Cleaning Air T12, produced by Italia Iso Group, has 12 lamps of 6.9 Watt of UVC/each, two inlet grills in its bottom and 2 outlet grills in the superior part. The volume of air that the system treat is of 210m3/h. The experiments were run over several days during the activities of 3-5 subjects working for several hours. Real time microbial air samplings were run during the tests switching the system ON and OFF. To verify microbial time variation, initial samplings (phase 1) had the system OFF, then ON (phase 2) and finally OFF again (phase 3). Petri dishes were incubated at 36 and 22 C°. Statistical analysis was executed with Stata 16. Significance level was set at p &lt; 0.05.

Results

The longest test highlighted that during phase 2, after 8 minutes from the end of phase 1, the system acted significantly (p = 0.001) on the reduction of environmental contamination up to a mean of 70 (95% C.I. 64 - 77) CFU/500 liters (about 70% at 22 °C) and 50% at 36 °C. In phase 3 the mean values became 171 (144 - 198) CFU/500 liters at 22C° and 259 (228-291) at 36 °C.

Conclusions

The system was able to significantly reduce the environmental contamination in real time. The experimental tests show how, as soon as the device is turned OFF after at least half an hour of operation, air healthiness drops dramatically within 10 minutes, bringing the levels of microbial contamination (induced by the presence of the operators in the room) to levels even higher than 150%.

Key messages

In order to convey a correct and truthful message about the disinfection capabilities of an air purification system, testing the device under real operating would be necessary. Testing the device under real operating conditions, with and without the presence of people in controlled environments, would be necessary before the final product is placed on the market.

[Permanent environmental disinfection techniques in hospital settings with infectious risk]

While the world's economies avoid the COVID-19 pandemic blockade, there is an urgent need for technologies aimed at reducing the transmission of COVID-19 in confined spaces such as hospital environments. Although the cleaning and disinfection procedures now have rather complex and sophisticated weapons, they do not seem to be sufficient to continuously maintain low levels of environmental microbiological contamination. This result can now be achieved through the cross-use, in space and time, of improved, more efficient and effective technologies. This result can now be achieved through the cross-use, in space and time, of improved technologies. This work highlights the possibility of crossing and cooperation of different disinfection techniques, such as to keep the microbial and viral load low over time.

[An integrated approach for better contamination control in hospital settings]

Disinfection of hospital environments is a cornerstone of intervention strategies to reduce the risk of hospital-associated infections. Many studies show that standard cleaning procedures are not sufficient for proper disinfection of hospital environments and that the addition of no-touch technologies, such us ultraviolet light, can provide deeper sanitisation. This study aims to test whether the application of ultraviolet light after standard procedures improves hygiene levels in the shortest possible time and shows the degree of contamination before and after irradiation. A cross-sectional study was conducted in a real clinical setting in rehabilitation rooms of a contracted clinic "Rugani Hospital" in Monteriggioni (SI), Italy, between December 2019 and August 2020.the study was carried out according to the following protocol: i) quantization of contamination of 12 selected target points in room; ii) attribution to the points of a probability of contamination risk; iii) sampling of a subset of 6 points with probabilistic assignment; iv) evaluation of the pre-post disinfection environmental hygiene using a UV-C system. For the pre-post statistical analysis the non-parametric Wilcoxon test was used; the multivariate MANOVA was used to verify the role of different confounders, with post hoc Bonferroni test. Probabilistic calculations minimised the samplings required to conclude that the application of the ultraviolet light device reduced the level of contamination in a statistically significant manner (p &lt; 0.01) when comparing pre- and post-exposure, with less irradiation time than indicated by the manufacturer.

Natural Radioactivity of the Crystalline Basement Rocks of the Peloritani Mountains (North-Eastern Sicily, Italy): Measurements and Radiological Hazard

Crystalline rocks can produce dangerous radiation levels on the basis of their content in radioisotopes. Here, we report radiological data from 10 metamorphic and igneous rock samples collected from the crystalline basement of the Peloritani Mountains (southern Italy). In order to evaluate the radiological properties of these rocks, the gamma radiation and the radon emanation have been measured. Moreover, since some of these rocks are employed as building materials, we assess the potential hazard for population connected to their use. Gamma spectroscopy was used to measure the 226Ra, 232Th and 40K activity concentration, whereas the radon emanation was investigated by using a RAD 7 detector. The results show 226Ra, 232Th and 40K activity concentration values ranging from (17 ± 4) to (56 ± 8) Bq kg-1, (14 ± 3) to (77 ± 14) Bq kg-1 and (167 ± 84) to (1760 ± 242) Bq kg-1, respectively. Values of the annual effective dose equivalent outdoor range from 0.035 to 0.152 mSv y-1, whereas the gamma index is in the range of 0.22-0.98. The 222Rn emanation coefficient and the 222Rn surface exhalation rate vary from (0.63 ± 0.3) to (8.27 ± 1.6)% and from (0.12 ± 0.03) to (2.75 ± 0.17) Bq m-2 h-1, respectively. The indoor radon derived from the building use of these rocks induces an approximate contribution to the annual effective dose ranging from 8 to 176 μSv y-1. All the obtained results suggest that the crystalline rocks from the Peloritani Mountains are not harmful for the residential population, even though they induce annual effective doses due to terrestrial gamma radiation above the worldwide average values. Moreover, their use as building materials does not produce significant health hazards connected to the indoor radon exposure.

Rapid detection of Legionella spp in water samples by ScanVIT method: comparison of acid vs heat treatment

BACKGROUND

A rapid detection of Legionella bacteria in water samples is crucial to minimize the risk of acquiring infections, especially in health care facilities. Different detection methods and different decontamination procedures have been reported to affect the recovery of Legionella spp. Our goal was to test the recovery of Legionella pneumophila and Legionella non-pneumophila species using a kit based on non-specific and species-specific probes to treat water samples after two different decontamination procedures.

METHODS

The study was conducted with samples collected in the teaching hospital "Le Scotte" of Siena (Italy). Waters samples were analyzed by: i) ScanVIT method after treatment with acids; ii) ScanVIT method after heating; and iii) cultural standard method after heating. The results of the decontamination procedures and the detection methods were evaluated by comparing the number of Legionella-positive and -negative samples, and the recovery rates (CFU l-1) obtained by ScanVIT and the standard method.

RESULTS

We find that ScanVIT method is highly sensitive with both decontamination treatments, yielding a higher recovery of L. pneumophila compared to the standard method. Conversely, ScanVIT associated with the acid-treatment yielded the highest recovery of L. non-pneumophila.

CONCLUSIONS

The acid-treatment combined to the ScanVIT method increases the recovery of L. non-pneumophila in water samples compared to both ScanVIT associated with heat-treatment and standard culture method. Thus, this method may represent the best choice to detect L. non-pneumophila in water samples and reduce the risk of infection due to underestimation of Legionella loads.

Carbapenem-resistant enterobacteriaceae: don’t trust your neighbour

Background

The spread of carbapenem-resistant enterobacteriaceae (CRE) outbreaks consists not only of germs producing KPC and OXA-48, endemic already, but also metallo-beta-lactamase such as NDM or VIM. In Tuscany, Italy, a multidisciplinary regional task force has extended, since NDM alert spread out, from 1st Oct 2019 the CRE screening programme, via molecular testing, to newly admitted patients in high risk settings (medical, intensive care, oncology, transplant, infectious diseases, cardiac surgery units) to fight cross-contamination. The aim of the study is to assess levels and types of CRE in an italian teaching hospital (615 beds) after the programme became effective.

Methods

The surveillance team began recording daily all the CRE positive cases, defined as laboratory confirmed colonizations/infections with CRE. Our retrospective, descriptive study covers the time span between 30th Sep - 16th Dec 2019. Cases were classified by infected apparatus and by resistance phenotype, and we calculated descriptive statistics.

Results

In total we identified 97 cases (male 60.82%, mean (+/-SD) age 71.58+/-17.34 years, 74.23% in medical wards); 5 patients had two body districts infected and 9 carried two different phenotypes. Out of 102 positive samples, 92.16% were bowel colonization, 1.96% BSI, 3.92% urinary and 1.96% respiratory. Among these, 21 were NDM (19.81%), 29 KPC (27.36%), 4 OXA-48 (3.77%), 52 VIM (49.06%). The most detected germ was Klebsiella pneumoniae (30.19%), followed by Escherichia coli (2.83%), Enterobacter cloacae (2.83%), Citrobacter freundii and braakii (2.83%), Klebsiella oxytoca (1.89%). 61 agents were unspecified (57.55%). Among the 21 NDM, 76.19% were K. pneumoniae, only one was a BSI.

Conclusions

CREs continue to be present despite constant surveillance. Although high levels of KPC-producing agents persist, the new spread of VIM phenotype is significant, highlighting, however, that the pathogen wasn't detected in over 50% of the samples.

Key messages

Despite increased surveillance, there is still a consistent portion of patients colonized with unidentified CRE. A surveillance mainly focused on NDM-producing CREs had incidentally highlighted an unexpected spread of VIM phenotype.

Six ultraviolet minutes for cleaner operating theatres

Background

Sanitizing the operating theatres (OT) is important to minimize risk of post-operative infections. Disinfection procedures between one operation and another is less aggressive than final cleaning procedures, at the end of the day. Aim was assessing the difference of contamination: i) between different levels of disinfection; ii) before and after the use of a UVC Device (UVC-D).

Methods

Between December 2019/February 2020 a cross sectional study was conducted in OT in a real clinical context. 94 Petri dishes (PD) were used in 3 OT. Three different sanitation levels (SL1-3) were compared pre- and post-use of UVC-D: i) No cleaning after surgery (SL1); ii) after in-between cleaning (SL2); iii) after terminal cleaning (SL3). UVC-D was employed for 6 minutes, 3 minutes per bed side. PD were incubated at 36 °C and colony forming unit (CFU) counted at 48h. Descriptive statistic, Wilcoxon and Mann-Whitney tests were performed to assess the contamination levels in total, pre/post use of UVC-D, and between different sanitation levels, respectively.

Results

In total we had a mean of 3.39 CFU/PD (C.I. 2.05 - 4.74) and a median of 1 CFU/PD (Min. 0 - Max. 39), after UVC-D use we had a mean of 2.20 CFU/PD (C.I. 0.69 - 5.09) and a median of 0 CFU/PD (Min. 0 - Max. 133). The UVC-D led to a significant reduction of CFU (p &lt; 0.001). Without UVC-D we had a significant CFU drop (p &lt; 0.05) between SL1 and SL3. Using UVC-D, we observed significant reductions of contamination (p &lt; 0.05) between SL3 and SL1. Comparing SL1 (median 0) post UVC-D use vs SL2 pre UVC-D use (median 0.5), and SL2 post UVC-D use (median 0) vs SL3 pre UVC-D use (median 1) we had a significant reduction of contamination (p &lt; 0.05).

Conclusions

UVC-D improved environmental contamination in any of the three sanitation levels. Furthermore, the use of UVC-D alone was better than in-between and terminal cleaning. Although these encouraging results, the cleaning procedures executed by dedicated staff has to be considered.

Key messages

UVC are efficient to decrease contamination in operating theatres regardless of sanitation levels. The additional use of UVC technology to standard cleaning procedures significantly improves sanitation levels.

Sliding doors: how their opening affects particulate matter levels?

Background

The operating theatres (OTs) have adequate conditions to perform safe operations and to prevent surgical site infections. Opening doors can compromise these situations. Measurement of particulate contamination is a key point to check the effectiveness of preventive measures in the OTs. We analysed how openings impact in different type of OTs.

Methods

Between January/February 2020 a transversal study was conducted in 5 different types of OTs in a university hospital. Two had laminar flows, with 55 and 60 air changes/h; three had turbulent flows: OT-A (18 air changes/h, with 4 inlets from the ceiling), OT-B (23 air changes/h and air flow from the ceiling plenum), OT-C (16 air changes/h, air flow directed from one wall to the opposite wall and the main door laterally to the flow). Particulate matter (PM) measurements were carried out in 7 different points in each OT, alternating two conditions: a) doors closed; b) opening/closing the main door twice per minute. For each spot, in each condition, we recorded for several minutes the following parameters: particles (0.3, 0.5, 1, 3, 5, 10µ), room temperature (Ta), Relative Humidity (Rh), airspeed (Va). Comparison with the Wilcoxon test were made using STATA 14.

Results

In laminar flow, classified with better ISO levels (4), opening and closing the door the PM, for any size, increased not significantly (p &gt; 0.05). The OTs with turbulent flows (ISO 5-6) had a higher particulate level than the laminar ones and greater variations with door openings. OT-A worsened significantly for all particles (p &lt; 0.05) closing/opening the door. In contrast, OT-B and OT-C had a significant reduction of PM (p &lt; 0.05). All 5 OTs had pressure falling to 0 at door opening; Ta, Rh and Va may be affected by different type air flows and design.

Conclusions

OTs parameters during door openings are influenced by different ventilation systems and room design. Laminar flows OTs are less affected, but innovative turbulent flows OTs can be just as effective.

Key messages

The operating rooms are affected by the door opening. Laminar flows operating rooms are less influenced by door openings than turbulent flows ones. Turbulent flow rooms have different performance depending on their construction characteristics.

Tuning a UV-C device to challenge new threats in the sanitization setting of healthcare facilities

Background

Environmental hospital hygiene plays a role in healthcare-associated infections emergency caused by resistant multi-drug organisms. The implementation of new and effective disinfection procedures is now more than ever important to prevent the cross-transmission of pathogens in the hospital facilities. In combination with common chemicals biocides, UV technology is a realistic option for environmental disinfection. In this study, we evaluate a UV device for its effectiveness on an emerging pathogen.

Methods

A laboratory cross section experiment was performed between August and October 2019. Two different strains of Candida auris (CBS 10913 and CBS 12372) were tested on 20 cm2 stainless steel carriers inoculated with 10 µl of bacterial culture at a concentration of 1x105 CFU/mL. The inoculum was spread until dry in aseptic condition. Carriers were placed parallel to the UV device, having 4 UV-C lamps that emit 325 W, at a fixed distance of 2.44 m. Biocidal tests were carried out in triple at three different light exposure times (5, 10 and 20 minutes). After treatment, laboratories procedures were used to detach and transfer the remaining microorganisms from the carriers to plates and compared them to controls after incubation at 37 °C for 48 h.

Results

A significant inactivation of C. auris already occurred at 5 minutes, reaching 3-4 log10 reduction at 20 minutes of UV-C exposure. No substantial differences were identified by analyzing the results between the two strains.

Conclusions

The chosen distance of 2.44 m from the target allows to ideally sanitize an entire hospital room. However, to avoid the limit of shaded areas due to the presence of non-movable objects, a couple of positions are recommended, so that shorter distances can reduce the exposure time or increase the average irradiance level of exposed surfaces.

Key messages

In sanitation of hospital environments, the use of viable alternatives as UV-C can contribute to the reduction of infections caused by multidrug-resistant microorganisms. Accurate testing of different space-time irradiation configurations allows to achieve important results related to the biocidal effects of UV devices.

A simulation model of microbe overlapping for the correct estimation of UV-C device log-reduction

Background

Candida auris is an emerging pathogen responsible for several outbreaks within healthcare facilities. It can be found on hospital surfaces and patient care devices. UV- C sanitisation may constitute an effective adjunct to routine room cleaning to prevent the spreading of this yeast. Previous findings with this technology suggest to investigate different sources of variability in the study of the biocidal effect of UV devices on C. auris. In this study we develop a computer simulation of surface distribution of microorganisms on a stainless steel carrier, to optimize UV-device experiments.

Methods

Based on the literature about C. auris studies and its estimated average size (about 5 μm diameter), several Matlab simulations have been performed to include as many microorganisms as possible to be ideally placed on a 20 cm2 stainless steel support, avoiding cell overlapping. This was done in order to maximize the effectiveness of UV exposure.

Results

Two initial simulations were performed to evaluate a random arrangement of a very large number of microorganisms (8x107 CFU) on the steel support, widely overlapped. In this case, due to the poor UV-C penetrability, we would not exceed two log10 reduction. By randomly distributing 1x106 CFU, the probability of overlapping was about 1.3%, but even a partial overlap limits the log10 reduction. By randomly distributing 1x105 CFU, the overlaps were at least 10 times less likely.

Conclusions

The simulation results allowed us to evaluate the most appropriate microorganism distribution model able to optimize the biocidal effects of UV-C devices. The overlapping of microorganisms reduces UV-C penetrability. Our simulated study is consistent with literature results where we observed a lower log-reduction by increasing the concentration of microorganisms and therefore the probability of overlapping. The resulting model would simulate any log-reduction scenario, at any distance and any concentration, with and without overlapping.

Key messages

The complete or partial microorganism overlapping plays a relevant role in the outcome of UV-C biocidal experiments. To identify the exponential CFU reduction curve and estimate accurately the inactivation rate constant, simulated experiments should be performed to assess the real effectiveness of UV devices.

Simulated operating room aerodynamics to improve air quality and prevent surgical site infections

Background

Proper operating room (OR) ventilation and air filtration are important measures to prevent infection of the surgical site and consequently reduce hospital stay and healthcare costs. In order to identify how changes in the air system can affect air quality, tailor-made researches need to be conducted in ORs. The aim of the study is to verify how a mobile air filtration system can affect the air quality of ORs when placed in different positions.

Methods

This is a descriptive study conducted during April and May 2018 in the University Hospital of Siena, Italy. We measured air flows through the vents of both the OR air system and a mobile novel air system unit, which includes a patented crystalline ultraviolet C reactor and an HEPA filter. Using a CAD 3D simulation software (SolidWorks 2017) the air flows interactions were simulated in the replicated OR.

Results

The device influenced the original airflows generated by the integrated OR ventilation system. Simulations have shown that when the device is positioned close to the wall with its intake beside the entrance and its outlet towards the operating table, air from outside can enter the room because the air intake from the device prevails over the internal pressure of the OR, increasing contamination. If the device is placed near the OR centre with its suction towards the operating table and its outlet towards the OR entrance, if the door is opened, airflows towards the outside of the room prevail, improving ability to retain outgoing contaminants.

Conclusions

The different positioning of mobile devices that generate clean air flows within ORs can have a significant impact on aerodynamics, which can turn can affect critical aspects of the surgical outcome. In order to achieve an effective device placement and orientation, OR-specific environmental measurements should be carried out.

Key messages

Movable devices may help boosting the performance of air systems in operating rooms. Every operating room needs a specific study in order to obtain the best profit.