Nowadays nosocomial infection are still a significant issue, an almost real social, health and economic emergency that affects not only Europe, but also other parts of the world. In particular, hospitals must adopt standardized protocols in order to avoid this risk during prolonged hospitalization. One of the major cornerstones of these protocols is the monitoring of the procedures of the prevention of the infection. In my thesis, two of the fundamental prevention procedures are analyzed, in particular the correct use of disinfectants and hand washing. As regards to the use of disinfectant, it is very challenging to find out the so-called ideal disinfectant, which should be characterized by a broad-spectrum of action, a prolonged efficacy over time and absence of unpleasant odor. Actually, there are different types of disinfectants on the market, classified according to their harmlessness, simplicity of use, costs, and based on the results that should be obtained in terms of reducing microbial contamination and the type of microorganism. Beside the use of disinfectants, environmental hygiene also plays an extremely important role in ensuring the maintenance of adequate levels of safety in health facilities. For this reason, hospital environment have been classified into low, medium and high-risk environments, taking into consideration not only the use of the room, but also other parameters, including crowding and number of objects contained inside. A similar approach is used for healthcare devices which have been divided into critical, semi-critical and non-critical items. Another important prevention strategy can be represented by washing hands in any context, from domestic to healthcare environment. This is related to the fact that it is possible to detect multiple potential pathogenic microorganisms on our skin in every single layer, from the most superficial to the deepest one. This is a problem since the hands of healthcare workers represent one on the most frequently involved vehicle in the transmission of nosocomial pathogens. Therefore, the CDC (Center for Disease control and Prevention), classifies hand washing as the most important measure in the control of hospital infections, since it is able to reduce alone the rate of infections and to prevent about 40% of all nosocomial infections. A few years ago, the WHO, which is one of the most important organizations that issue guidelines, launched the initiative "Save lives: clean your hands", proposing five moments of hands hygiene. Nowadays, this initiative takes significance if we think about the current global pandemic caused by the viral agent SARS-CoV-2, known worldwide as Covid-19 and responsible for acute respiratory syndrome. If the infected person has contaminated hands, he possibly spread the hands of another person, who can in turn become infected by bringing a hand to his mouth, eyes or nose. In addition to hand washing, medical surgical devices can also be used in order to disinfect skin and/or surfaces: these are available on the national territory and they are based on active ingredients such as: sodium hypochlorite, ethanol, quaternary ammonium, chlorhexidine digluconate and many others. To conclude, as regards the issue of healthcare-related infections, some studies are focusing on the impact of advanced or alternative hygiene practices compared to current practice including the Probiotic Cleaning Hygiene System (PCHS), based on ecologically sustainable detergents which contain spores of probiotics of the genus Bacillus. These are able to reduce surface pathogens up to 90% more than conventional disinfectants, without inducing the selection of drug resistant strains. Indeed, it is desirable that this new methodology is able to reduce the frequency of nosocomial infections and it may represent an additional important prevention system, together with disinfection and hand washing.
Ancora oggi le infezioni nosocomiali sono un problema rilevante e per evitare questo rischio durante i ricoveri prolungati, gli ospedali devono adottare protocolli standardizzati in cui il monitoraggio delle procedure di prevenzione delle infezioni è uno dei punti cardini. Nella mia tesi vengono analizzate due tra le procedure di prevenzione fondamentali come il corretto uso dei disinfettanti e il lavaggio delle mani. Nel caso dei disinfettanti, è molto difficile trovare il cosiddetto disinfettante ideale caratterizzato da un ampio spettro d’azione, un’efficacia prolungata nel tempo e l’assenza di odore sgradevole ma esistono in commercio diversi tipi di disinfettanti scelti in base all’innocuità, semplicità di impiego, costo, e tenendo conto del risultato che si vuole ottenere in termini di abbattimento della contaminazione microbica e del tipo di microrganismo. Oltre all’uso dei disinfettanti, anche l’igiene dell’ambiente riveste un ruolo estremamente importante per poter garantire il mantenimento di adeguati livelli di sicurezza nelle strutture sanitarie. Per questo motivo gli ambienti ospedalieri sono stati suddivisi in ambienti a basso, medio e ad alto rischio valutando insieme all’uso del locale anche parametri come affollamento e numero di oggetti contenuti all’interno. Un approccio analogo è stato utilizzato per i dispositivi sanitari che sono stati divisi in articoli critici, semicritici e non critici. Un’altra importante strategia di prevenzione è il lavaggio delle mani da adottare in qualsiasi contesto da quello domestico a quello sanitario. Sulle nostre mani, dagli strati superficiali a quelli più profondi della cute, sono rilevabili molteplici microrganismi potenzialmente patogeni e questo è un problema se pensiamo che il veicolo più frequentemente implicato nella trasmissione dei patogeni nosocomiali sono le mani del personale ospedaliero. Pertanto i CDC (Center for Desease control and Prevention), classificano il lavaggio delle mani come la misura più importante nel controllo delle infezioni ospedaliere in grado da sola di ridurre il tasso delle infezioni e di prevenire circa il 40% di tutte le infezioni nosocomiali. Qualche anno fa, una delle più importanti organizzazioni coinvolte nell’emissione di linee guida, l’OMS ha lanciato l’iniziativa “Save lives: clean your hands (salva le vite, lava le tue mani)” indicando cinque momenti per l’igiene delle mani. Questa iniziativa oggi assume un significato rilevante se pensiamo a questo periodo di pandemia globale causato dall’agente virale SARS-CoV-2, conosciuto al mondo come Covid-19 e responsabile della sindrome respiratoria acuta. Se il soggetto infetto ha le mani contaminate può trasferire il virus sulle mani di un altro che può a sua volta infettarsi portando una mano alla bocca, agli occhi o al naso). Oltre il lavaggio delle mani, si possono usare anche presidi medico chirurgici per la disinfezione della cute e/o delle superfici disponibili sul territorio nazionale a base di principi attivi come: ipoclorito di sodio, etanolo, ammoni quaternari, clorexidina digluconato e molti altri. Infine, riguardo sempre il problema delle infezioni correlate all’assistenza sanitaria, alcuni studi si stanno concentrando sull’impatto di pratiche di igiene avanzata o alternativa rispetto alla pratica corrente tra cui il Probiotic Cleaning Hygiene System (PCHS), basato su detergenti ecologicamente sostenibili contenenti spore di probiotici del genere Bacillus, in grado di ridurre i patogeni di superficie fino al 90% in più rispetto ai disinfettanti convenzionali senza indurre la selezioni di ceppi resistenti ai farmaci. E’ auspicabile che questa nuova metodologia riesca a ridurre frequenze d’ infezioni nosocomiali e possa costituire un ulteriore importante sistema di prevenzione insieme alla disinfezione e al lavaggio delle mani.
Antisettici e disinfettanti in ambito nosocomiale.
CALABRESE, LUDOVICA
2019/2020
Abstract
Nowadays nosocomial infection are still a significant issue, an almost real social, health and economic emergency that affects not only Europe, but also other parts of the world. In particular, hospitals must adopt standardized protocols in order to avoid this risk during prolonged hospitalization. One of the major cornerstones of these protocols is the monitoring of the procedures of the prevention of the infection. In my thesis, two of the fundamental prevention procedures are analyzed, in particular the correct use of disinfectants and hand washing. As regards to the use of disinfectant, it is very challenging to find out the so-called ideal disinfectant, which should be characterized by a broad-spectrum of action, a prolonged efficacy over time and absence of unpleasant odor. Actually, there are different types of disinfectants on the market, classified according to their harmlessness, simplicity of use, costs, and based on the results that should be obtained in terms of reducing microbial contamination and the type of microorganism. Beside the use of disinfectants, environmental hygiene also plays an extremely important role in ensuring the maintenance of adequate levels of safety in health facilities. For this reason, hospital environment have been classified into low, medium and high-risk environments, taking into consideration not only the use of the room, but also other parameters, including crowding and number of objects contained inside. A similar approach is used for healthcare devices which have been divided into critical, semi-critical and non-critical items. Another important prevention strategy can be represented by washing hands in any context, from domestic to healthcare environment. This is related to the fact that it is possible to detect multiple potential pathogenic microorganisms on our skin in every single layer, from the most superficial to the deepest one. This is a problem since the hands of healthcare workers represent one on the most frequently involved vehicle in the transmission of nosocomial pathogens. Therefore, the CDC (Center for Disease control and Prevention), classifies hand washing as the most important measure in the control of hospital infections, since it is able to reduce alone the rate of infections and to prevent about 40% of all nosocomial infections. A few years ago, the WHO, which is one of the most important organizations that issue guidelines, launched the initiative "Save lives: clean your hands", proposing five moments of hands hygiene. Nowadays, this initiative takes significance if we think about the current global pandemic caused by the viral agent SARS-CoV-2, known worldwide as Covid-19 and responsible for acute respiratory syndrome. If the infected person has contaminated hands, he possibly spread the hands of another person, who can in turn become infected by bringing a hand to his mouth, eyes or nose. In addition to hand washing, medical surgical devices can also be used in order to disinfect skin and/or surfaces: these are available on the national territory and they are based on active ingredients such as: sodium hypochlorite, ethanol, quaternary ammonium, chlorhexidine digluconate and many others. To conclude, as regards the issue of healthcare-related infections, some studies are focusing on the impact of advanced or alternative hygiene practices compared to current practice including the Probiotic Cleaning Hygiene System (PCHS), based on ecologically sustainable detergents which contain spores of probiotics of the genus Bacillus. These are able to reduce surface pathogens up to 90% more than conventional disinfectants, without inducing the selection of drug resistant strains. Indeed, it is desirable that this new methodology is able to reduce the frequency of nosocomial infections and it may represent an additional important prevention system, together with disinfection and hand washing.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/12500