Search

This study analyzed the performances of a hybrid membrane aerated biofilm reactor (MABR) pilot plant in terms of nutrients removal of the attached growth and suspended biomass in comparison with a conventional activated sludge (CAS) system at different sludge retention time (SRT) (20−3) days. Overall, the MABR showed better performances than the CAS in terms of TSS (86% vs 79%), COD (89% vs 85%) and total nitrogen (80% vs 65%). The minimum SRT for achieving complete nitrification in the MABR was close to 3 days, corresponding to a SRT in the aerobic compartment of 1.9 days, whereas in the CAS it was equal to 8 days (aerobic SRT of 4.8 days). Nitrification rate in biofilm was on average equal to 0.40 gNH4-N h−1 (2.40 gNH4-N m−2d−1). Its contribution to the overall nitrification in the MABR plant was 25–30% on average, although it increased when the SRT was decreased. Particle size distribution and microscopic analyses showed particles of biofilm detached from the membrane of the MABR. The seeding effect allowed sustaining nitrification of the suspend biomass at very low SRT. The nitrification rate observed in the suspended biomass in the MABR slightly decreased from 3.42 mgNH4-N gVSS−1 h−1 to 2.87 mgNH4-N gVSS−1 h−1 when the SRT was decreased from 20 days and 3 days, whereas in the CAS it collapsed from 2.33 mgNH4-N gVSS−1 h−1 to 0.47 mgNH4-N gVSS−1 h−1, because of nitrifying washout. Moreover, the biofilm detachment involved a positive effect in settling properties of the suspended biomass.

The aerobic granular sludge (AGS) process has attracted significant interest over the last decade and is one of the most promising wastewater treatment technologies. AGS offers several advantages over conventional activated sludge (CAS) including excellent settling, and higher volumetric loading capacity. Because of porosity, concentration gradients develop and stratified aerobic, anoxic, and anaerobic layers develop throughout granule depth. This is the reason for simultaneous nutrient removal in a single tank. Aerobic granulation is influenced by many parameters including wastewater characteristics and operating conditions. Among these, the anaerobic upflow feeding strategy and a properly balanced feast/famine regime have most significantly influenced granule stability and nutrient removal efficiency. Hydraulic shear forces can improve the physical characteristics of the granules, whereas selective wasting also allows undesirable biomass with low density to be washed out. Implementation of AGS in full-scale requires some important retrofitting, including adequate grit and particulate organics removal from the wastewater. Furthermore, aerobic granular sludge cycles should be designed with flexibility to address variable influent loads. Considerations include equalization and flow balancing, dissolved oxygen control strategies, multiple draw points for selective wasting and swing-capabilities. Several studies and full-scale implementations have demonstrated that AGS is suited for the treatment of a wide variety of industrial wastewaters, as well as municipal wastewater. Full-scale implementations of AGS treating municipal wastewater have improved process stability, attained more stringent effluent quality (i.e., total nitrogen (TN)

Background. Sepsis is the major cause of mortality from any infectious disease worldwide. Sepsis may be the result of a healthcare associated infection (HAI): the most frequent adverse events during care delivery especially in Intensive Care Units (ICUs). The main aim of the present study was to describe the epidemiology of ICU-acquired sepsis and related outcomes among patients enrolled in the framework of the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project. Study design. Prospective multicenter study. Methods. The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance. Results. During the five editions of the SPIN-UTI project, from 2008 to 2017, 47.0% of HAIs has led to sepsis in 832 patients. Overall, 57.0% episodes were classified as sepsis, 20.5% as severe sepsis and 22.5% as septic shock. The most common isolated microorganisms from sepsis episodes were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. The case fatality rate increased with the severity of sepsis and the mean length of ICU-stay was significantly higher in patients with ICU-acquired sepsis than in patients without. Conclusions. Our study provides evidence that ICU-acquired sepsis occurs frequently in Italian ICU patients and is associated with a high case fatality rate and increased length of stay. However, in order to explain these findings further analyses are needed in this population of ICU patients.

Small and medium breweries discharging to municipal sewers without treatment generate significant loads with typical concentrations reported by Valta et al. (2014) as 2-6 g COD L-1, 25-80 mg TN L-1, 10-50 mg TP L-1, with pH between 4.5 and 12. Treatment of the high-strength wastewater requires specialized low footprint processes, such as aerobic granular sludge (AGS), capable of high-rate degradation, as well as simultaneous nitrogen and phosphorous removal (Wang et al., 2007). The objective of this study was to evaluate the start-up period of AGS receiving brewery wastewater after initial anaerobic pre-treatment.

Natural water resources are becoming increasingly limited due to global-scale climate change and water availability issues have become so severe that they must be addressed. Given these issues, reuse of wastewater and rainwater provides a promising way to cope with water shortages. This paper describes an investigation into the efficiency of rainwater usage systems. A conceptual model was built to assess the behaviour of rainwater tanks and their effectiveness in coping with water shortages. The study is based on a long-term simulation (12 years) of different rainwater reuse tank schemes. The associated reductions in residential freshwater demand (water reuse efficiency) and wetweather runoff delivered to the sewer system (sewer discharge efficiency) were surveyed. The results clearly show that rainwater usage systems can significantly reduce drinking water consumption. The specific volumes required for the reuse of rainwater are high; however, for local scale application, the specific volumes necessary are comparable to the reservoir volumes already used to store freshwater resources during potable water shortage.

Il biogas prodotto dalla digestione anaerobica (AD) a partire da matrici organiche, sia in reattori controllati (digestori) che da discariche controllate, è costituito principalmente da metano, CH4 (50÷70%) e anidride carbonica, CO2 (30÷50%). Il contenuto relativo di CH4 e CO2 nel biogas dipende principalmente dalla natura del substrato e dal pH nella massa in digestione. Oltre a questi due, il biogas contiene, inoltre, quantità minori di altri composti, come l'azoto (0÷3%), il vapore acqueo (5÷10%), l’ossigeno (0÷1%), l’idrogeno solforato (0÷10.000 ppmv), che è prodotto dalla riduzione del solfato contenuto in alcuni rifiuti, l’ammoniaca, proveniente prevalentemente da idrolisi di materiali proteici, gli idrocarburi (0÷200 mg·m-3) e i silossani (0÷41 mg·m-3), ossia composti silico-organici. Oltre al CH4, tutti gli altri gas contenuti nel biogas sono indesiderati e sono considerati inquinanti del biogas stesso; alcuni di questi si ritengono addirittura dannosi al punto da scoraggiare l'utilizzo del biogas nei motori a combustione, come gli idrocarburi alogenati e i silossani, poiché producono acidi alogenati e silice che, a lungo termine, corrodono le superfici metalliche dei motori, ricoprono le candele, abradono le superfici e ostacolano il funzionamento delle valvole. Il contenuto energetico del metano descritto dal potere calorifico inferiore (PCI) è 50,4 MJ·kg-1CH4 o 36 MJ·Nm-3CH4 (in condizioni standard di temperatura e pressione). Tale valore risulta tanto minore quanto maggiore è il contenuto di CO2 o di N2 nel biogas. Per il biogas con contenuto di metano nell'intervallo 60-65%, Il PCI è di circa 20-25 MJ·m-3biogas. H2S e NH3 sono tossici ed estremamente corrosivi, danneggiando l'unità combinata di calore e potenza (CHP) e le parti metalliche attraverso l'emissione di SO2 dalla combustione. A ciò contribuisce anche la presenza di silossani come già accennato. In virtù delle sue proprietà energetiche, oggi sono sempre più proposte ed applicate tecnologie di miglioramento qualitativo delle caratteristiche del biogas allo scopo di poterne attuare lo sfruttamento per alimentazione/integrazione di reti di distribuzione di gas naturali, per autotrazione, per produzione energia elettrica e per teleriscaldamento (Fig. 1.1). Gli impianti di trattamento del biogas finalizzati al miglioramento delle sue potenzialità energetiche sono configurati, normalmente, in due stadi di trattamento: il primo stadio), denominato "biogas cleaning", ha l’obiettivo di rimuovere i composti nocivi e/o tossici (come H2S, Si, composti organici volatili (VOC), silossani, CO e NH3. All’atto pratico tale stadio è praticamente costituito solo dall'unità di rimozione dell’H2S, comunemente basata sull'ossidazione biologica dell'H2S da parte di batteri solfo-ossidanti. Il secondo stadio di trattamento è denominato "upgrading del biogas" e mira ad aumentare il potere calorifico basso del biogas e, quindi, a convertirlo in standard di combustibile più elevato (Sun et al., 2015). Nel processo di “upgrading” la CO2 contenuta nel biogas grezzo viene rimosso o convertito in CH4 mediante reazione con H2 (Kougias et al., 2017). Nel caso in cui il biogas trattato sia purificato fino ad assumere composizione simile a quella del gas naturale, il prodotto finale del gas è chiamato biometano (Kougias et al., 2017). Attualmente, le specifiche della composizione del gas naturale sono fissate dalle normative nazionali e in alcuni paesi è richiesto che il contenuto metano sia maggiore del 95%. Tuttavia, la Commissione Europea ha come obiettivo quello di determinare norme per armonizzare la qualità del gas in tutti gli stati membri (Angelidaki et al., 2018). Oggi sono disponibili numerose tecnologie commerciali per effettuare l’upgrading del biogas e, pertanto, negli ultimi anni è crescente in Europa, soprattutto in quella del nord, il numero di impianti a questo finalizzati (Fig. 1.2). Ciò anche in virtù del fatto che, come si può notare nella Figura 1.3, il biometano produce un quantitativo di GHG, in termini di CO2eq. emessa, nettamente inferiore rispetto i comuni combustibili applicati negli autoveicoli, e, in particolare, meno di 2432 volte la quantità emessa per uso di combustibili fossili. Ciò rende il biometano un combustibile “sostenibile”.

Introduction. Healthcare workers are continuously exposed to the risk of being infected by influenza viruses during their work, thus representing a threat especially for fragile patients. Although the Italian Ministry of Health strongly recommends influenza vaccination for all HCWs, coverage levels in Italy are still far from the expected. Several studies report that one of the preferred strategies to improve vaccination coverage among Healthcare Workers is improving vaccination knowledge through specific multidisciplinary courses. To assess the effectiveness of an educational intervention on influenza vaccination coverage among Healthcare Workers a study was conducted at "Paolo Giaccone" University Hospital of Palermo, in the occasion of the 2016/2017 seasonal influenza vaccination campaign. Material and methods. Educational interventions on influenza infection and vaccination were organized involving personnel of the hospital units in which patients were more fragile. The Healthcare Workers who volunteered attend the course were considered as the intervention group, while two controls for each case, composed by Healthcare Workers not attending it, were randomly selected from the same unit. For both groups, a questionnaire was used to investigate attitude and behaviors toward influenza vaccination, while vaccination coverage data were obtained throughout the Hospital informational data system. Results. Overall, out of the 125 participants, 38 (30.4%) followed the course (intervention group) and 87 (69.6%), not attending the course, represented the control group; later, only 43 Healthcare Workers out of 125 (34.4%) underwent vaccination during the season considered. In particular, after the educational intervention, 42% of the attending Healthcare Workers got vaccinated, while vaccination prevalence in the control group was 31%. The Healthcare Workers who underwent vaccination reported, before the intervention, a higher risk perception for contracting (transmitting) influenza compared to those not vaccinated (p < 0.05), while no significant difference in risk perception of transmitting influenza to their patients was reported between the two groups. Discussion. Despite the training provided, and an improvement in vaccination adherence by the Healthcare Workers involved, coverage obtained was lower than recommended to reduce influenza spread in hospital contexts. In conclusion, our data suggest that specific training alone may play a role in the improvement of influenza vaccination adherence, but it should be integrated by a wider range of public health measures, including mandatory vaccination.

In Italy there are no rules concerning the establishment of a hospital hygiene structure in hospitals and other healthcare settings, and the hospital organization plans vary widely. The aim of the survey, carried out by the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive medicine and Public health, was to evaluate the presence in the hospital organization plan of a structure referred to as Hospital hygiene, or including in its denomination the words "hygiene" or "hospital hygiene", the activities carried out, the relation to other areas, like patient safety, the type and quantity of professionals involved, the strengths and the critical aspects.A semi-structured questionnaire was administered to Healthcare Trusts representing all Italian Regions through the members of the above Study Group.35 Trusts, 13 in Northern, 8 in Central, 14 in Southern Italy (including Sicily and Sardinia), completed the questionnaire. In 19 Trusts (54.3%) a structure whose denomination included the words "hospital hygiene" or "hygiene" was present. The activities related to the management of infectious risk were most represented, carried out autonomously or in collaboration, but many other activities were covered. In all hospitals the activities of the Hospital Hygiene Unit inter-linked with those of the clinical risk, with different forms of collaboration.This survey, even though on a limited sample, provided a picture of hospital hygiene at a national level, showing a considerable heterogeneity and highlighting critical issues but also strengths. It is essential to share organizational and management models that enhance and promote hospital hygiene, to ensure the appropriateness of healthcare practices offered in a safe and comfortable environment to patients, operators, and visitors.

Vengono discussi alcuni aspetti della progettazione degli impianti MBR, come la scelta della configurazione, la scelta delle membrane, delle dotazioni elettromeccaniche e delle opere accessorie degli impianti MBR. Inoltre sono riportati dei cenni sulle soluzioni tecnologiche più innovative atte a minimizzare le disfunzioni dei sistemi MBR e di conseguenza dei costi operativi. La scelta di sistemi con flusso a pistone in impianti MBR ha impatti negativi sia sulla per quanto concerne il fenomeno del foaming che quello del fouling. Per la scelta delle membrane risulta che quelle piane siano utilizzate sia per applicazioni industriali che civili, quasi esclusivamente in impianti a configurazione sommersa a servizio di comunità medio-piccole, mentre quelle a fibre cave sono utilizzate anch’esse in impianti a configurazione sommersa, vengono maggiormente utilizzate per installazioni di grandi dimensioni. Le tipologie di griglie vanno scelte in maniera opportuna in funzione della tipologia di membrana installata. In particolare, i costruttori suggeriscono di adottare una grigliatura grossolana a coclea a monte di quella fine o dell’unità di stacciatura, indicata se sono installate membrane a fibre cave. Come sistema di miscelazione si adottano mixer compatti dotati di anello convogliatore orientati in modo da evitare la formazione di zone morte e di innescare dei moti rotatori che consentono di ottenere un'adeguata miscelazione, contenendo al contempo i costi energetici. Il sistema di aerazione deve avere il duplice ruolo di fornire l'ossigeno necessario alla biomassa per ossidare la sostanza organica e l'azoto ammoniacale, nonché di garantire una sufficiente turbolenza in corrispondenza delle fibre della membrana (scouring) per attenuare il fenomeno del fouling. L'ottimizzazione dei costi di aerazione tuttavia, passa necessariamente anche attraverso la scelta di macchine elettriche altamente efficienti. In particolare alcuni costruttori di membrane suggeriscono l'utilizzo di compressori centrifughi che consentono un maggiore controllo delle portate erogate anche al variare della viscosità della miscela aerata. Nella progettazione dei reattori, si consiglia sempre di prevedere dispositivi di evacuazione superficiale della schiuma, utilizzando stramazzi laterali a livello di sfioro regolabile o mediante inghiottitoi dotati di galleggiante. La scelta di soluzioni tecnologicamente avanzate, quali membrane con flusso elicoidale, i sistemi pulsanti e le membrane rotative, consentono un’efficace minimizzazione del fenomeno del fouling consentendo di ottenere notevoli vantaggi in termini di qualità dell'effluente rispetto ai sistemi convenzionali. La progettazione degli impianti MBR deve essere effettuata attuando delle soluzioni volte alla minimizzazione dei costi, sia di investimento che operativi, attraverso scelte progettuali oculate, che vanno dalla scelta della configurazione dei reattori all'impiantistica di processo.

Il rischio biologico (RB) in ambito sanitario è universalmente riconosciuto per tutti gli operatori sanitari (OS) esposti al contatto con materiale biologico o strumenti medici potenzialmente contaminati da agenti biologici. In Italia, le esposizioni a RB negli OS sono molto frequenti e rappresentano la prima causa di infortunio (40% di tutti gli infortuni denunciati). MATERIALI E METODI: Un’indagine descrittiva retrospettiva degli incidenti a RB è stata condotta presso l’A.O.U.P. “P. Giaccone” di Palermo analizzando le schede di segnalazione degli incidenti pervenute presso l’U.O. di Prevenzione e Sorveglianza delle Infezioni Ospedaliere negli anni 2005-2016. RISULTATI: Sono stati registrati 765 incidenti a RB (range 43-81/anno, media 65) che hanno coinvolto infermieri (35.1%), medici (9.6%), tecnici (8.2%) con una frequenza maggiore nell’area chirurgica (42.1%). Le cause più frequenti sono risultate: prelievo ematico (14.2%), somministrazione di terapie iniettive (11.4%), gestione dei cateteri (10.6%). La modalità di esposizione più frequente è stata la puntura (75.7%), seguita dalla contaminazione muco cutanea (15.8%) e dal taglio (8.1%). Tali risultati sono stati messi in relazione con l’uso dei dispositivi di protezione individuale (DPI) tra gli OS (64.9% per il camice, 62.7% per i guanti, 18.7% per il filtrante facciale con un trend d’uso crescente negli anni). È stato valutato, inoltre, il volume di attività ospedaliere come i ricoveri ordinari e le prestazioni erogate in relazione alla quantità di personale impiegato. La copertura vaccinale osservata tra gli OS è stata: 79.6% per anti epatite B, 13.0% per antitubercolare, 15,0% per antitetanica e 2.5% per antitifica, con trend crescente negli ultimi anni. Non è stata registrata nessuna sieroconversione. CONCLUSIONI: Negli anni si è registrato un trend negativo (-9.2%) di accadimento d’incidenti a RB in relazione alla diminuzione degli OS in servizio (-12.2%), all’aumento delle prestazioni sanitarie erogate (+39.8% dal 2010) e alla diminuzione dei ricoveri ordinari (–39.1%). I fattori determinanti la riduzione degli incidenti potrebbero essere la continua sensibilizzazione nei reparti alle buone prassi di lavoro, alla pratica delle vaccinazioni, all’uso di adeguati DPI e all’incremento dei programmi di formazione sulla sicurezza aziendale e sulla prevenzione del RB.

Nonostante la tecnologia MBR mostri un grande trend di crescita nel numero di applicazioni in piena scala, rimane ancora poco studiato il fenomeno della formazione di schiume all’interno dei reattori biologici che può provocare non pochi problemi gestionali degli impianti. Quest’aspetto fa sì che il fenomeno è oggi di crescente interesse scientifico, anche a seguito d’ipotesi secondo cui i fenomeni di foaming e fouling potrebbero reciprocamente influenzarsi, considerando i fattori comuni di influenza (EPS, microrganismi filamentosi idrofobici, fisiologia del fango). A tal riguardo viene anche mostrato che la ricerca scientifica condotta in Italia sull’argomento è molto ben avviata, stante l’elevata incidenza percentuale del numero di pubblicazioni prodotte rispetto a quello complessivo su scala mondiale. Infine, in questo capitolo sono analizzati le possibili cause del fenomeno e i metodi per valutarne l’entità, a fenomeno avvenuto, o da usare a scopo previsionale. Inoltre, è riportato un particolare caso di studio concernente l’esercizio di un impianto pilota IA-MBR (Intermittent Aeration Membrane BioReactor) in cui, mediante una specifica analisi del foaming determinatosi, è stato possibile accertare il contestuale ruolo delle sostanze polimeriche extracellulari (EPS) e dei microrganismi filamentosi idrofobici nella formazione della schiuma

Traditionally the activated sludge process is treated as two stage process. The first stage (aeration basin) is described in terms of biological processes while the description of the second stage concentrates on processes of biomass separation and thickening. The modern approach to the activated sludge process looks at both the biological and the separation stage as one system. The aim of this chapter is to explain the interactions between the two parts of the activated sludge system.

The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health promoted and conducted a study on teaching hospital hygiene, with particular reference to the prevention and control of healthcare-associated infections, with the aim of developing effective educational material starting from the results collected.First of all, a survey was carried out, targeting lecturers in hospital hygiene, with the purpose of investigating their perceptions regarding this issue. The available scientific literature was also reviewed in order to identify effective educational/teaching strategies for the prevention of healthcare-associated infections, so that valid training interventions could be subsequently developed. Finally, a trial-training intervention was implemented, and specific audio-visual teaching material was also tested.The overall response rate to the survey was 42%, with good country-wide representativeness. The level of awareness of hospital hygiene issues by students resulted higher among trainee nurses (65%) than among medical students (44%). The teaching staff identified alternative educational methodologies to substitute the classical lecture (e.g.: case discussions) and, in most cases, the alternative solution appeared to be preferable. The teaching of hospital hygiene was better integrated with other disciplines and professional training activities in the degree courses for nurses than in those for doctors; the total number of hours assigned to such teaching was variable. The literature review highlighted that various educational approaches are used. The most common are presentations or lectures, but videos, posters, questionnaires and e-learning strategies are also used. Combining different instruments when designing an educational programme has proven to be an effective strategy. The training activity tested was positively evaluated by the participants; the possibility of multidisciplinary exchange of knowledge was particularly appreciated.Having considered the issue of teaching hospital hygiene from the points of view of the different protagonists involved (educators and students), this enabled us to develop useful training material and a proposal for a shared educational intervention. The subject of hospital hygiene, in particular the one related to the prevention of healthcare-associated infections, is addressed in various courses and with different modalities; it is, therefore, important to standardize course contents and teaching methods, in order to facilitate multidisciplinary debate, especially starting from case studies.

Surveillance of Healthcare-Associated Infections (HAIs) is essential to improve the quality of health services. The aim of this paper is to report the commitment of the Italian Study Group of Hospital Hygiene (GISIO) of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI) describing some experiences to contrast HAIs and antimicrobial resistance. Particularly, the commitment to contrast HAIs in intensive care with the SPIN-UTI project - Italian Nosocomial Infections Surveillance in ICUs, and in surgery with the ISCHIA project - Infections of Surgical Site in Arthroplasty Interventions - were described. Furthermore, some activities conducted in Sicily using repeated prevalence studies were reported. The experiences reported confirmed that surveillance is essential to provide health services with information, guidance and tools to manage effectively the risk of HAI and antimicrobial resistance and to monitor the level of achievement of control programmes

Recent studies have questioned the role of unidirectional airflow ventilation system in reducing surgical site infection (SSI) in prosthetic implant surgery. The aim of the ISChIA study ("Infezioni del Sito Chirurgico in Interventi di Artroprotesi" which means "Surgical site infections in arthroplasty surgery") was to evaluate, as a contribution to this debate, the association between heating, ventilation and air conditioning systems, microbial air contamination and surgical site infection in hip and knee arthroplasty.The study was performed from March 2010 to February 2012 in 14 hospitals, for a total of 28 operating theatres: 16 were equipped with vertical unidirectional airflow ventilation (U-OTs), 6 with mixed airflow ventilation (M-OTs), 6 with turbulent airflow ventilation (T-OTs). Microbial air contamination in the operating theatre was evaluated by means of passive (Index of Microbial Air contamination, IMA) and active (Colony Forming Units per cubic metre, cfu/m3) sampling. SSI surveillance was carried out according to the Hospitals in Europe Link for Infection Control through Surveillance protocol.A total of 1,285 elective prosthesis procedures (61.1% hip and 38.9% knee) were included in the study. The results showed a wide variability of the air microbial contamination in operating theatres equipped with unidirectional airflow. The recommended values of ≤2 IMA and ≤10 cfu/m3 were exceeded, respectively, by 58.9% and 46.4% of samples from U-OTs and by 87.6% and 100% of samples from M-OTs. No significant difference was observed between SSI cumulative incidence in surgical procedures performed in U-OTs compared with those performed in T-OTs. A lower risk of SSI, even though not statistically significant, was shown in surgical procedures performed in U-OTs with a microbial air contamination within the recommended values (≤2 IMA and ≤10 cfu/m3) compared with those performed in U-OTs where these limits were exceeded, and compared with those performed in T-OTs with microbial air contamination within the recommended values for this type of OTs (≤25 IMA, ≤180 cfu/m3.ISChIA study did not show a protective effect of unidirectional airflow compared with turbulent airflow in arthroplasty surgery. However, the frequent exceeding of recommended air microbial contamination values in OTs equipped with unidirectional airflow, and the lower SSI risk in surgical procedures performed in compliant U-OTs compared with those performed in non-compliant U-OTs and with those performed in compliant T-OTs, suggest the need of further studies, which should consider air microbial contamination and other aspects of SSI prevention that may negate the potential benefits of the ventilation system; differences in intrinsic and extrinsic risk factors, medical treatment and surgical technique are also to be considered. Training interventions aimed at improving the behaviour of operators are essential.

In 2014, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health (GISIO-SItI), in collaboration with the National Association of Medical Hospital Managers (ANMDO), conducted a survey on the availability of procedures for cleaning and disinfecting ambulances in order to assess the practices in use.An online questionnaire was prepared through the Survey Monkey® platform and a web link access was sent to a convenience sample of ANMDO doctors working in healthcare management in public and private healthcare facilities.Ninety-six questionnaires were collected (26% response rate). In 73% of cases there was a procedure for cleaning and disinfecting ambulances, which had been produced at a company level (67%) and involved various professionals. In 21% of cases the procedure had been prepared in expectation of an epidemic or following an epidemic (5%). The recommendations had been presented to the staff (90%), in 28% of cases through training events with verification of the knowledge acquired. Monitoring of the implementation of the procedure is planned in the majority of cases (88%), mainly through direct observation (92%). In 67% of cases the tender specifications for ambulance services did not include a section dedicated to cleaning and disinfection and, in the absence of a procedure, this was provided by the hospital in only 51% of case.This survey represented a first step towards the development of guidelines for standardising procedures and providing indications useful for their evaluation and monitoring their implementation.

Healthcare-Associated Infections are a great concern for worldwide healthcare systems and represent a considerable threat to patient safety, leading to adverse clinical outcomes. A defined panel of indicators represents a key element to guide Healthcare Organizations towards identification of main gaps, implementation of effective actions and continuous improvements on Healthcare-Associated Infections prevention and control activities. A review on accreditation systems conducted by the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene Preventive Medicine and Public Health revealed a substantial heterogeneity of implemented standards and led to the development of a core set of indicators and requirements for Healthcare-Associated Infections' prevention and control within the hospital setting. The main aim of the study was to test the feasibility of the Healthcare-Associated Infections' prevention and control within the hospital setting tool to calculate performance scores on a sample of Italian Healthcare Organizations and to identify major critical issues. The potential benefits of the possibility of future implementation of the tool within Institutional Accreditation Programs is discussed.Cross sectional pilot survey.The Healthcare-Associated Infections' prevention and control within the hospital setting included 96 criteria and 20 key areas including an area for outcomes indicators. For applicable criteria, standards fulfilment was evaluated according to a 4 point Likert scale. A composite score was calculated for each Healthcare Organization and five performance levels were identified. Data were further analysed by computing performance scores at the level of each area and requirement.20 Healthcare Organizations agreed to take part in this pilot study including two rehabilitative Healthcare Organizations. Among the whole sample a mean of 12.20% of requirements resulted not fulfilled, leaving space for further improvements. Critical areas were easily identified and the instrument was able to capture substantial differences between Healthcare Organizations. Only a few number of standards resulted "Not Applicable" (Mean = 4.71%) and most of them regarded Rehabilitative Healthcare Organizations. Mean composite performance index resulted 74.06% (SD = 16.96, range 36.30 - 94.27%); area of outcome indicators obtained a mean score of 56.17.The Healthcare-Associated Infections' prevention and control within the hospital setting resulted an useful tool to assess Healthcare Organizations' performance in the field of Healthcare-Associated Infections prevention and control and to identify necessary actions for further improvements. The distribution of total scores by Healthcare Organizations showed a high heterogeneity. Implementation of the Healthcare-Associated Infections' prevention and control within the hospital setting tool as an institutional accreditation tool may help to drive the required harmonization at a national level of Healthcare-Associated Infections management and control strategies and overcome current substantial regional differences.

Background. It is necessary to implement current teaching in the healthcare and university sector by promoting new tools for the enhancement of public health, bearing in mind that some health determinants seek to create a context in which to present their own idea of innovative Startup, can represent the opportunity to give your professional contribution to the development of another's idea or to propose an improved solution to the private business. On the other hand, networking with companies and networking between training participants will allow us to recognize the importance of demonstrating their diverse skills as a key element to create a successful Startup or to implement the activities of a reality already consolidated. Methods. This paper describes the research protocol of a Hackathon Public Health (HPH) teaching methodology aimed at: a) increasing public health knowledge; b) changing the proactive approach of the healthcare provider, especially by increasing the sectoral training activity; c) to promote educational and training activities in Italian regions. The subjects involved will be healthcare professionals (doctors, nurses, health professions, psychologists, biologists, assistants in training) who are selected to receive or not the intervention through the implementation of a HPH which also includes training activity. Conclusion. HPH is an innovation in the national health landscape, with the aim of creating environments and training policies aimed at promoting proper clinical risk management as part of the continuous improvement of the quality of healthcare organizations and proper training activities.

I processi di digestione anaerobica di matrici organiche, seppure necessitino di una impiantistica complessa e di una elevata competenza degli operatori, contrariamente ai processi aerobici, notoriamente energivori, offrono la concreta possibilità di ottenere un consistente ritorno economico mediante il recupero energetico dal biogas che in essi viene prodotto. Le tecnologie disponibili consentono di utilizzare il biogas, dopo una preliminare depurazione, a scopo cogenerativo, ossia per la produzione di energia elettrica e termica contemporaneamente, con rese tali da potere soddisfare gli autoconsumi dell’impianto di produzione stesso e tali da consentire una commercializzazione all’esterno dell’energia cogenerata. Oggi, mentre da una parte vengono proposte soluzioni che consentono di ottimizzare i convenzionali motori endotermici da decenni utilizzati a scopo cogenerativo, dall’altra viene prospettato l’uso di sistemi assai più evoluti che, seppure ancora applicabili a campi ristretti di potenze prodotte, consentono di ottenere benefici economici ed ambientali di non trascurabile entità. Particolari forme di incentivazione recentemente attivate promuovono, inoltre, prima della trasformazione energetica del biogas, la valorizzazione per conversione a biometano, avente maggiore potere calorifico del biogas, e il successivo utilizzo diretto di quest’ultimo come combustibile per autotrazione o per successiva cogenerazione, comportando tale pratica elevati benefici economici ed ambientali.

Objectives Leukaemia is the most common cancer in children, but its aetiology is still poorly understood. We tested the hypothesis that traffic-related air pollution is associated with paediatric leukaemia because of chronic exposure to several potential carcinogens. Methods The Italian SETIL study (Study on the aetiology of lymphohematopoietic malignancies in children) was conducted in 14 Italian regions. All incident cases of leukaemia in children aged ≤10 years from these regions (period 1998–2001) were eligible for enrolment. Two controls per case, matched on birth date, gender and region of residence were randomly selected from the local population registries. Exposure assessment at birth residence included traffic indicators (distance to main roads and length of main roads within 100 m) and estimates of pollutants concentrations (particulate matter -PM 2.5 and PM 10 - and gases -NO 2 and O 3 -) from national dispersion model and land use regression models. The association between the exposure variables and leukaemia was assessed by logistic regression analyses. Results Participation rates were 91.4% among cases and 69.2% in controls; 620 cases (544 acute lymphocytic and 76 acute non-lymphocytic leukaemia) and 957 controls were included. Overall, when considering the residence at birth, 35.6% of cases and 42.4% of controls lived along busy roads, and the mean annual PM 10 levels were 33.3 (SD=6.3) and 33.4 µg/m 3 (SD=6.5), respectively. No association was found, and all ORs, independent of the method of assessment and the exposure windows, were close to the null value. Conclusions Using various exposure assessment strategies, air pollution appears not to affect the incidence of childhood leukaemia.

The treatment of municipal landfill leachate by means of aerobic granular sequencing batch reactors (GSBRs) was investigated. The paper reports the results from an experimental campaign lasted 100 days, which has been divided into three periods: cultivation of granular sludge (70 days), operation with semi-fresh (15 day) and diluted landfill leachate (15 day). Two different GSBR configurations were used: a Sequencing Batch Bubble Column reactor and a Sequencing Batch Airlift Reactor. All reactors were operated at Volume Loading Rates (VLRs) between 4.8 and 7.2 g COD /(m 3 ·d). The Chemical Oxygen Demand (COD) removal efficiency varied between 80% and 90% under operation with synthetic wastewater feeding. On the other hand, the COD removal performance decreased to 40-50 % with semi-fresh leachate and to 50-60% with diluted leachate. Regarding nitrogen removal, after granules formation, the performance were satisfactory only when the reactors were fed with synthetic wastewater. Contrarily, the obtained results underline that a specific pre-treatment of ammonium must be applied in order to optimize nitrogen removal. However, the observed results indicate that the landfill leachate can be potentially treated in GSBR bioreactors.