Search

In Tuscany, Italy, colonisation or infection by New Delhi metallo- beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) in hospitalised patients has increasingly been observed since 2018, leading in 2019 to the introduction of enhanced control measures successfully reducing transmission. We describe here the impact of the COVID epidemic on the underlying NDM-CRE prolonged outbreak in Tuscany. Data on patients colonised or infected by NDM-CRE reported by Tuscan laboratory surveillance among hospitalised patients in four Tuscan hospitals were collected from 07/2019 to 10/2020. Since February 2020 COVID-19 diagnosis was recorded. Monthly rates of NDM-CRE cases on hospital days in medical and critical care wards were calculated. In March-October 2020 NDM-CRE rates were calculated and stratified by COVID-19 diagnosis. The number of NDM-CRE cases/hospital days in 2019 decreased due to control interventions, however since March 2020 an increase was observed, temporally associated with COVID-19 admissions. In March-October 2020, compared to previous period, NDM-CRE cases had lower median age (73 yrs vs 75), were less likely to have previous hospitalisation episodes (59% vs 75%) and more likely to be admitted to ICU (32% vs 20%). We observed, in the period March-October 2020 a significantly higher rate of NDM-CRE cases per hospital days (256.71/100,000) in COVID-19 patients, compared to non-COVID-19 ones (452.9/100,000). Our data suggest a resurgence in NDM-CRE spread among hospitalised patients in Tuscany during COVID pandemic, despite evidence of effective control measures in 2019. Risk of NDM-CRE transmission was significantly higher among COVID patients. Several factors may have contributed to this occurrence, including patients case mix, performance of risk-prone procedures (including antibiotic prescriptions), extended length of stay, availability and usage of personal protective equipment and compliance with infection prevention procedures. Key messages We observed a relation between admission for COVID-19 and the risk of a hospital acquisition of NDM-CRE. There is the need to conciliate Health Care Associated Infections control measured with COVID-19 protection ones.

Objectives In this article, we aim to share our experience in the hospital reorganization made to conduct the SARS-CoV-2 vaccination campaign, based on the principles of flexibility and adaptability. Study design A descriptive study. Methods The data concerning the organization of the vaccination campaign were taken from the operative protocol developed by the hospital dedicated task force, composed by experts in hygiene, public health, occupational medicine, pharmacists, nurses, hospital quality, and disaster managers. Data about the numbers of vaccine administered daily were collected by the Innovation and Development Operative Unit database. Results Vaccinations against COVID-19 started across the EU on the 27th of December 2020. The first phase of the vaccination campaign carried out in our hospital was directed to healthcare workers immunization including medical residents, social care operators, administrative staff and technicians, students of medicine, and health professions trainees. The second phase was enlarged to the coverage of extremely fragile subjects. Thanks to the massive employment of healthcare workers and the establishment of dynamic pathways, it was possible to achieve short turnaround times and a large number of doses administered daily, with peaks of 870 vaccines per day. From the 27th of December up to the 14th of March a total of 26,341 doses of Pfizer have been administered. 13,584 were first doses and 12,757 were second doses. From the 4th to the 14th of March, 296 first doses of Moderna were dispensed. It was necessary to implement adequate spaces and areas adopting anti-contagion safety measures: waiting area for subjects to be vaccinated, working rooms for the dilution of the vaccine and the storage of the material, vaccination rooms, post-vaccination observation areas, room for observation, and treatment of any adverse reactions, with an emergency cart available in each working area. Conclusions The teaching hospital of Pisa faced the beginning of the immunization campaign readjusting its spaces, planning an adequate hospital vaccination area and providing an organization plan to ensure the achievement of the targets of the campaign. This represented a challenge due to limited vaccine doses supplied and the multisectoral teams of professionals to coordinate in the shortest time and the safest way possible. The organizational model adopted proved to be adequate and therefore exploited also for the second phase aimed to extremely fragile subjects.

Transmission of antimicrobial-resistant Gram-negative bacteria (AMR-GNB) amongst hospitalised patients can lead to new cases of carriage, infection and outbreaks, hence the need for early carrier identification. We aim to explore two key elements that may guide control policies for colonisation/infection in hospital settings: screening practices on admission to hospital wards and risk of developing infection from colonisation.We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to 2021 reporting on adult patients hospitalised in high-income countries.The search retrieved 11,853 articles. After screening, 100 studies were included. Combining target patient groups and setting type, we identified six screening approaches. The most reported approach was all admitted patients to high-risk (HR) wards (49.4%). The overall prevalence of AMR-GNB was 13.8% (95%CI 9.3-19.0) with significant differences across regions and time. Risk of progression to infection amongst colonised patients was 11.0% (95%CI 8.0-14.3) and varied according to setting and pathogens' group (p value0.0001), with higher values reported for Klebsiella species (18.1%; 95%CI 8.9-29.3).While providing a comprehensive overview of the screening approaches, our study underlines the considerable burden of AMR-GNB colonisation and risk of progression to infection in hospitals by pathogen, setting and time.

Worldwide epidemiological reports assert that drinking water is a source for infections and Legionella control represents a critical issue in healthcare settings. Chemical disinfections of water networks are control measures that need to be fine-tuned to obtain satisfactory results in large buildings over prolonged time periods. Aim of study is the evaluation of the effect of anolyte and chlorine dioxide, applied in two different hot water networks of a nursing home to manage Legionella risk. Nursing home has two buildings (A and B), with the same point of aqueduct water entrance. From June 2016, following a shock chlorination, the continuous disinfections with chlorine dioxide and anolyte were applied in hot networks of building A and B, respectively. Hot water was sampled at the central heating system and at two points of use for Legionella research, while chemical tests of manganese (Mn), iron (Fe), zinc (Zn) and trihalomethanes compounds (THM) were implemented to evaluate the disinfection by-products presence. Before chlorination Legionella pneumophila sg1 was recovered with a mean count of 2.4 × 104 CFU/L, while chemical compounds concentrations were within the law limits (Directive 98/83/EC). Then the disinfections Legionella was not recovered in both hot water plants. After the disinfection with chlorine dioxide (from June 2016 to May 2018), a statistically significant increase of iron, zinc and THM concentrations was detected in building A (p = 0.012; p = 0.004; p = 0.008). Both disinfectants appear effective against Legionella spp. growth in water network, but anolyte ensures a lower disinfection by-products release.

Summary Background Patients receiving haemodialysis are exposed to a large volume of dialysis fluid. The Italian Society of Nephrology (ISN) has published guidelines and microbial quality standards on dialysis water (DW) and solutions to ensure patient safety. Aim To identify microbial and chemical hazards, and evaluate the quality of disinfection treatment in DW plants. Methods In 2015 and 2016, water networks and DW plants (closed loop and online monitors) of nine dialysis wards of Italian hospitals, hosting 162 dialysis beds overall, were sampled on a monthly basis to determine the parameters provided by ISN guidelines. Chlorinated drinking water was desalinated by reverse osmosis and distributed to the closed loop which feeds all online monitors. Disinfection with peracetic acid was performed in all DW plants on a monthly basis. Findings Over the 24-month study period, seven out of nine DW plants (78%) recorded negative results for all investigated parameters. Closed loop contamination with Burkholderia cepacia was detected in a DW plant from January 2015 to March 2015. Pseudomonas aeruginosa was isolated from March 2016 to May 2016 in the closed loop of another DW plant. These microbial contaminations were eradicated by shock disinfection with sodium hypochlorite and peracetic acid, followed by water flushing. Conclusion These results highlight the importance of chemical and physical methods of DW disinfection. The maintenance of control measures in water plants hosted in dialysis wards ensures a microbial risk reduction for all dialysis patients.

In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) have increased since November 2018. Between November 2018 and October 2019, 1,645 samples were NDM-CRE-positive: 1,270 (77.2%) cases of intestinal carriage, 129 (7.8%) bloodstream infections and 246 (14.9%) infections/colonisations at other sites. Klebsiella pneumoniae were prevalent (1,495; 90.9%), with ST147/NDM-1 the dominant clone. Delayed outbreak identification and response resulted in sustained NDM-CRE transmission in the North-West area of Tuscany, but successfully contained spread within the region.

We describe the epidemiology of New Delhi Metallo-Beta-Lactamase-Producing Carbapenem-Resistant Enterobacterales (NDM-CRE) colonization/infection in a cohort of COVID-19 patients in an Italian teaching hospital. These patients had an increased risk of NDM-CRE acquisition versus the usual patients (75.9 vs. 25.3 cases/10,000 patient days). The co-infection significantly increased the duration of hospital stay (32.9 vs. 15.8 days).

In Italy, the coronavirus disease 2019 (COVID-19) emergency took hold in Lombardy and Veneto at the end of February 2020 and spread unevenly among the other regions in the following weeks. In Tuscany, the progressive increase of hospitalized COVID-19 patients required the set-up of a regional task force to prepare for and effectively respond to the emergency. In this case report, we aim to describe the key elements that have been identified and implemented in our center, a 1082-bed hospital located in the Pisa district, to rapidly respond to the COVID-19 outbreak in order to guarantee safety of patients and healthcare workers.

International literature data report that the increase of infectious risk may be due to heating, ventilation and air conditioning (HVAC) systems contaminated by airborne pathogens. Moreover, the presence of complex rotating dehumidification wheels (RDWs) may complicate the cleaning and disinfection procedures of the HVAC systems. We evaluated the efficacy of a disinfection strategy applied to the RDW of two hospitals&rsquo, HVAC systems. Hospitals have four RDW systems related to the surgical areas (SA1 and SA2) and to the intensive and sub-intensive care (IC and sIC) units. Microbiological air and surface analyses were performed in HVAC systems, before and after the disinfection treatment. Hydrogen peroxide (12%) with silver ions (10 mg/L) was aerosolized in all the air sampling points, located close to the RDW device. After the air disinfection procedure, reductions of total microbial counts at 22 &deg, C and molds were achieved in SA2 and IC HVAC systems. An Aspergillus fumigatus contamination (6 CFU/500 L), detected in one air sample collected in the IC HVAC system, was eradicated after the disinfection. The surface samples proved to be of good microbiological quality. The results suggest the need for a disinfection procedure to improve the microbiological quality of the complex HVAC systems, mostly in surgical and intensive care areas.

International literature data report that the increase of infectious risk may be due to heating, ventilation and air conditioning (HVAC) systems contaminated by airborne pathogens. Moreover, the presence of complex rotating dehumidification wheels (RDWs) may complicate the cleaning and disinfection procedures of the HVAC systems. We evaluated the efficacy of a disinfection strategy applied to the RDW of two hospitals HVAC systems. Hospitals have 4 RDW systems related to the surgical areas (SA1 and SA2) and to the intensive and sub-intensive cares (IC and sIC). Microbiological air and surfaces analysis were performed in HVAC systems, before and after the disinfection treatment. Hydrogen peroxide (12%) with silver ions (10 mg/L) was aerosolized in all the air sampling points, located close to the RDW device. After the air disinfection procedure, reductions of total microbial counts at 22°C and fungi were achieved in SA2 and IC HVAC systems. An Aspergillus fumigatus contamination (6 CFU/500L), detected in one air sample collected in the IC HVAC system, was eradicated after the disinfection. Surface samples proved a good microbiological quality. Results suggest the need of a disinfection procedure aimed to improve the microbiological quality of the complex HVAC systems, mostly in surgical and intensive care areas.

We describe a nosocomial outbreak of measles that occurred in an Italian hospital during the first months of 2017, involving 35 persons and including healthcare workers, support personnel working in the hospital, visitors and community contacts. Late diagnosis of the first case, support personnel not being promptly recognised as hospital workers and diffusion of the infection in the emergency department had a major role in sustaining this outbreak.

A prospective multi-centre study was conducted to assess the microbiological pattern and prognostic factors of bacteraemia and their impact on clinical outcome. All patients admitted to 41 Italian hospitals over 2 months, from whom one or more clinically significant organisms were isolated from blood culture, were studied according to a standardized protocol and case definition. A total of 156 episodes of bacteraemia were identified in 20601 patients. There were 3·9 episodes of nosocomially acquired bacteraemia and 3·7 episodes of community-acquired bacteraemia per 1000 admissions. The most frequent pathogens isolated were Gram-negative bacteria (44·9%) but Gram-positive species accounted for 40·4% of episodes. Fungal infections due to Candida spp. were found in 3·8% of episodes, and multiple pathogens were recovered from 9·6% of episodes. The clinical response to bacteraemia was classified as sepsis in 90 episodes (57·7%), severe sepsis in 21 (13·5%) and septic shock in 26 (16·7%); 19 episodes (12·2%) showed no clinical response. The total in-hospital mortality was 25·0%. By multivariate logistic regression, the variables which independently predicted mortality were increasing age, the presence of septic shock, infection with Gram-positive bacteria or fungi and nosocomial acquisition.

A one-day survey was carried out in 88 out of 113 public hospitals in Lombardy to obtain prevalence rates of hospital-acquired infections (HAIs) by hospital departments and to identify the pathogens more frequently involved. In total 18 667 patients were surveyed, representing 72% of the average daily total of occupied beds in public hospitals in Lombardy. The overall prevalence of HAI was 4.9%. The highest prevalence was observed in intensive care units and in spinal units. The prevalence of bloodstream infections was 0.6%; pneumonia 1.1%; urinary tract infections 1.6% and gastrointestinal infections 0.4%. In surgical patients the prevalence of surgical site infections was 2.7%. The most frequently isolated pathogen from all sites of infections was Escherichia coli (16.8%), followed by Staphylococcus aureus (15.0%), Pseudomonas aeruginosa (13.2%) and Candida spp. (8.7%). Methicillin-resistant S. aureus accounted for 23% of all isolated S. aureus. The results provide baseline data for rational priorities in allocation of resources, for further studies and for infection control activities.

We studied the extent to which hospitals can expect to receive reimbursement for costs relating to nosocomial infections (NI) under the diagnosis-related groups (DRG) system of clinical claims and calculated the loss of reimbursement due to missed or incorrect registration of infective complications on hospital discharge records (HDR). We calculated clinical claim reimbursement in three scenarios: the good, in which all NI are recorded on HDR; the bad, in which a proportion of NI recorded on HDR observed at the 41 participating hospitals; the ugly, in which none of the NI are recorded on HDR. We analysed in which patients the recording of infective complications changed the DRG clinical claim and the economic consequences on reimbursements. Compared with the ugly scenario, the bad scenario, which is closest to what actually occurs, with only 55.9% of NI (180/322) properly recorded, produced an increased DRG clinical claim in 30 cases, of on average 403 for every NI. Compared with the ugly scenario, the good scenario, produced an increased DRG clinical claim in 45 cases with an average reimbursement of 618. The difference between the bad and the good scenarios shows an average loss of 215 for every case. Our calculated good scenario could cover only 3.8% of direct costs per case attributable to NI. Real, tangible benefits in health, both social and economic, will only accrue from the monitoring and control of NI in hospitals.