1. Control and prevention measures for legionellosis in hospitals: A cross-sectional survey in Italy
- Author
-
Maria Valeria Torregrossa, Andrea Patroni, Valeria Teti, Licia Veronesi, Francesco Rose, Claudia Pacifico, Mario Sarti, Giorgio Liguori, Anna Maria Spagnolo, Ida Mura, Luca Arnoldo, Placido Mondello, Giovanni Battista Orsi, Anna Poli, E Martini, Emanuele Torri, Christian Napoli, Andrea Molino, Sandra Savini, Stefano Tardivo, Giusy Diella, Beatrice Casini, Marina Busetti, Francesco Auxilia, L. Sodano, Maurizio Fiorio, Osvalda De Giglio, Antonio Goglio, Maria Teresa Montagna, R. Novati, Francesco Bisetto, Silvio Brusaferro, M. Moro, Antonella Agodi, Antonio Silvestri, Maria Luisa Cristina, Rossano Di Luzio, Andrea Rocchetti, Tatjana Baldovin, Giancarlo Ripabelli, Gaetano Pierpaolo Privitera, Raffaele Zarrilli, Maurizio Formoso, Serafina Rutigliano, Cesira Pasquarella, Gioia Calagreti, Montagna, Maria Teresa, De Giglio, Osvalda, Napoli, Christian, Diella, Giusy, Rutigliano, Serafina, Agodi, Antonella, Auxilia, Francesco, Baldovin, Tatjana, Bisetto, Francesco, Arnoldo, Luca, Brusaferro, Silvio, Busetti, Marina, Calagreti, Gioia, Casini, Beatrice, Cristina, Maria Luisa, Di Luzio, Rossano, Fiorio, Maurizio, Formoso, Maurizio, Liguori, Giorgio, Martini, Enrica, Molino, Andrea, Mondello, Placido, Mura, Ida, Novati, Roberto, Orsi, Giovanni Battista, PATRONI GRIFFI, LUIGI ANDREA, Poli, Anna, Privitera, Gaetano, Ripabelli, Giancarlo, Rocchetti, Andrea, De Rose, Francesco, Sarti, Mario, Savini, Sandra, Silvestri, Antonio, Sodano, Luisa, Spagnolo, Anna Maria, Tardivo, Stefano, Teti, Valeria, Torregrossa, Maria Valeria, Torri, Emanuele, Veronesi, Licia, Zarrilli, Raffaele, Pacifico, Claudia, Goglio, Antonio, Moro, Matteo, and Pasquarella, Cesira
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Cross-sectional study ,Legionella ,media_common.quotation_subject ,030106 microbiology ,Control measures ,Biochemistry ,Hospital ,Legionellosis ,National survey ,Prevention ,2300 ,Legionella pneumophila ,03 medical and health sciences ,0302 clinical medicine ,Cross Infection ,Cross-Sectional Studies ,Disinfection ,Humans ,Infection Control ,Italy ,Surveys and Questionnaires ,Water Microbiology ,Water Supply ,Hygiene ,Legionellosi ,medicine ,control measures ,hospital ,legionellosis ,national survey ,prevention ,Control measures, Hospital, Legionellosis, National survey, Prevention, Biochemistry, 2300 ,030212 general & internal medicine ,Seroconversion ,General Environmental Science ,Preventive healthcare ,media_common ,Response rate (survey) ,biology ,business.industry ,Public health ,Control measure ,biology.organism_classification ,Emergency medicine ,business ,Risk assessment - Abstract
Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2–15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.
- Published
- 2018