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Abstract
Surgical handwashing is a mandatory practice to protect both surgeons and patients in order to control Healthcare-Associated Infections (HAIs). The study is focused on Legionella and Pseudomonas aeruginosa contamination in Surgical Handwashing Outlets (SHWOs) provided by sensor-activated faucets with Thermostatic Mixer Valves (TMVs), as correlated to temperature, technologies, and disinfection used. Samples were analyzed by standard culture techniques, comparing hot- and cold-water samples. Legionella isolates were typed by an agglutination test and by mip sequencing. Legionella contamination showed the same distribution between hot and cold samples concerning positive samples and mean concentration: 44.5% and 1.94 Log10 cfu/L vs. 42.6% and 1.81 Log10 cfu/L, respectively. Regarding the distribution of isolates (Legionella pneumophila vs. Legionella non-pneumophila species), significant differences were found between hot- and cold-positive samples. The contamination found in relation to ranges of temperature showed the main positive samples (47.1%) between 45.1–49.6 °C, corresponding to high Legionella concentrations (2.17 Log10 cfu/L). In contrast, an increase of temperature (>49.6 °C) led to a decrease in positive samples (23.2%) and mean concentration (1.64 Log10 cfu/L). A low level of Pseudomonas aeruginosa was found. For SHWOs located in critical areas, lack of consideration of technologies used and uncorrected disinfection protocols may lead to the development of a high-risk environment for both patients and surgeons.
Highlights
Nosocomial infections, known as Healthcare-Associated Infections (HAIs), are defined as infections which were absent at the time of hospital admission that a patient acquires during their stay in a hospital or other healthcare facilities [1]
The results of mean Legionella concentrations found in 52 Surgical Handwashing Outlets (SHWOs) from 11 hospitals are shown of them showed values over the level of risk indicated by Italian Guidelines, that is, at >100 cfu/L
This study reports knowledge acquired during a Legionella environmental surveillance program performed in hospitals, where high Legionella levels were detected in SHWOs with Thermostatic Mixer Valves (TMVs), some of them with concentrations over the risk level (>2 Log cfu/L), suggesting their critical role in bacterial growth and HAI risk
Summary
Nosocomial infections, known as Healthcare-Associated Infections (HAIs), are defined as infections which were absent at the time of hospital admission that a patient acquires during their stay in a hospital or other healthcare facilities [1]. It has been estimated that, in Italy, 5–8% of hospitalized patients contract nosocomial infections every year and 450,000–700,000 HAIs occur in hospitalized patients; these data refer to urinary infections, followed by infections of surgical wounds, pneumonia, and sepsis [2,3]. The water supply system in hospitals may constitute a source of HAIs caused by opportunistic pathogens such as Pseudomonas aeruginosa (P. aeruginosa), Legionella spp., Acinetobacter species, and fungi [4,5]. These organisms are transmitted by direct or indirect contact with water or by inhalation of aerosol generated by a water source [6,7,8]. Legionella is able to survive for long periods in water and even to replicate in the presence of disinfectants and some conditions (e.g., pipeline materials, stagnation and sludge formation, parasitism of amoebas and protozoic cysts, and so on) [9]
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