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Hospital Outdoor and Indoor Environmental Impact: Control Measures

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Science and Engineering".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 27820

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Prof. Dr. Nicola Nante

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Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
Interests: public health; epidemiology; preventive medicine; hospital hygiene and organization; primary health care; outcome research

Special Issue Information

Dear Colleagues,

Hospitals, a “health producer” by definition, are one of the main polluting industries (Eckelman 2016). Pursuing the medical imperative "primun non nocere", hospital hygiene deals not only with the prevention and control of indoor risks for patients, operators and visitors, but also the risks to the external environment. It is estimated that hospitals produce about 15 kilos of solid waste (including lots of PVC) per bed. In the United States, hospitals produce more than 30 pounds of CO2 emissions per square foot (Lopez, 2017). The drugs administered to patients and their entry into waste water becomes a source of unknowm pollution, which is possible to reduce (Lupoli, 2012). In addition, the optimization of hospital construction and management techniques can reduce their environmental impact (Riedel, 2011). With regard to the indoor hospital environment, the greatest hygienic attention is directed to avoiding cross-contamination, and hand washing represents a cornerstone of hygienic practices, although it is disregarded. The introduction of new disinfection technologies is becoming more popular (Messina, 2017). An emerging problem is hospitals’ production of a new microbiological contamination: infections contracted inside the wards and projected outside. It is known that Staphylococcus Aureus Meticillin Resistant, born in the hospital, is spreading rapidly in the open community (Hawkes M, 2007). The problem, which also concerns other "drug resistant superbugs" (Escherichia Coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecium, etc.) is increasing. Potential sources of the infectious risks produced by hospitals for the external environment, including liquid and solid waste, have been kept under control for long time (WHO, 2019). Less manageable carriers of the emerging infectious risk in the greater community posed by superbugs, in addition to health care workers, are patients infected during hospitalization and not cleared before discharge (Verheyen, 2019). Little is known of the impact of this issue on health outcomes and costs at the territorial level, but stricter action is required (Wozniak TM, 2018). Quantifying the environmental impact of hospitals is important to determine the potential value of mitigation and harm associated with health care delivery. Reducing the environmental impact of health care may be considered an extension of efforts to improve health care quality by reducing unintended consequences (Chung, 2009).

To develop knowledge on the abovementioned themes, we are launching a call for contributions for the next Special Issue of IJERPH. In agreement with the mission of the journal, we therefore want to develop research on the impact of antropogenic factors on the quality of our environment, on the interaction between environmental health and the quality of human life, and on environmental stewardship and public health. Contributions from epidemiologists, ecologists, engineers, economists, etc., will be welcomed and we also encourage the submission of interdisciplinary and multicentric research.

Prof. Nicola Nante
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Hospital hygiene
Outdoor and indoor hospital environment
Environmental and health impact assessment
Emerging infections/antibiotic resistant bacteria/cross-contamination
Disinfection techniques
Decontamination

Published Papers (7 papers)

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Research

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18 pages, 4336 KiB

Open AccessArticle

Disinfecting Action of Gaseous Ozone on OXA-48-Producing Klebsiella pneumoniae Biofilm In Vitro

by Kaća Piletić, Bruno Kovač, Marko Perčić, Jure Žigon, Dalibor Broznić, Ljerka Karleuša, Sanja Lučić Blagojević, Martina Oder and Ivana Gobin

Int. J. Environ. Res. Public Health 2022, 19(10), 6177; https://doi.org/10.3390/ijerph19106177 - 19 May 2022

Cited by 11 | Viewed by 2868

Abstract

Klebsiella pneumoniae is an emerging multidrug-resistant pathogen that can contaminate hospital surfaces in the form of a biofilm which is hard to remove with standard disinfectants. Because of biofilm resistance to conservative disinfectants, the application of new disinfection technologies is becoming more frequent. Ozone gas has antimicrobial activity but there is lack of data on its action against K. pneumoniae biofilm. The aim of this study was to investigate the effects and mechanisms of action of gaseous ozone on the OXA-48-procuding K. pneumoniae biofilm. A 24 h biofilm of K. pneumoniae formed on ceramic tiles was subsequently exposed to different concentrations of ozone during one and two hours to determine the optimal ozone concentration. Afterwards, the total bacteria count, total biomass and oxidative stress levels were monitored. A total of 25 ppm of gaseous ozone was determined to be optimal ozone concentration and caused reduction in total bacteria number in all strains of K. pneumoniae for 2.0 log₁₀ CFU/cm², followed by reduction in total biomass up to 88.15%. Reactive oxygen species levels significantly increased after the ozone treatment at 182% for the representative K. pneumoniae NCTC 13442 strain. Ozone gas in the concentration of 25 ppm caused significant biofilm reduction but did not completely eradicate the K. pneumoniae biofilm formed on ceramics. In conclusion, ozone gas has great potential to be used as an additional hygiene measure in joint combat against biofilm in hospital environments. Full article

(This article belongs to the Special Issue Hospital Outdoor and Indoor Environmental Impact: Control Measures)

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7 pages, 312 KiB

Open AccessArticle

The Environmental Footprint of Neurosurgery Operations: An Assessment of Waste Streams and the Carbon Footprint

by Sayed Samed Talibi, Teresa Scott and Rahim A. Hussain

Int. J. Environ. Res. Public Health 2022, 19(10), 5995; https://doi.org/10.3390/ijerph19105995 - 15 May 2022

Cited by 14 | Viewed by 2433

Abstract

Healthcare in England generates 24.9 million tonnes of carbon dioxide equivalents (CO₂e), equating to approximately 4% of the total national output of greenhouse gases (GHG), and of this, 10% is from the manufacturing of medical equipment. Operating theatres are a major contributor of biomedical waste, especially consumables, and are three-to-six times more energy intensive than the rest of the hospital. This study seeks to quantify and evaluate the carbon cost, or footprint, of neurosurgery at a single institution in England. A single neurosurgical operation generates, on average, 8.91 kg of waste per case, equivalent to 24.5 CO₂e kg per case, mostly from single-use equipment. Per annum, 1300 neurosurgical operative cases are performed with total waste generation of 11,584.4 kg/year and a carbon footprint of 31,859 (kg) CO₂e. The challenge of achieving net zero GHG presents an opportunity to catalyse innovation and sustainability in neurosurgery, from how care is delivered, through to equipment use and surgical methodologies. This should improve the quality of healthcare provision to patients and yield potential cost savings. Full article

(This article belongs to the Special Issue Hospital Outdoor and Indoor Environmental Impact: Control Measures)

15 pages, 1668 KiB

Open AccessArticle

Improving the Reprocessing Quality of Flexible Thermolabile Endoscopes: How to Learn from Mistakes

by Beatrice Casini, Benedetta Tuvo, Emanuele Marciano, Giuliana Del Magro, Giulia Gemignani, Grazia Luchini, Maria Luisa Cristina, Anna Laura Costa, Guglielmo Arzilli, Michele Totaro, Angelo Baggiani and Gaetano Privitera

Int. J. Environ. Res. Public Health 2021, 18(5), 2482; https://doi.org/10.3390/ijerph18052482 - 3 Mar 2021

Cited by 5 | Viewed by 3246

Abstract

Background: Failure in the reprocessing of thermolabile flexible endoscopes has been reported as one of the most important threats to patient health. Method: A case report and observational study was conducted, from August 2014 to December 2019, in the Digestive Endoscopy Unit of a University Hospital in Italy, where two cases of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae infections in patients undergoing endoscopic retrograde cholangio-pancreatography were observed. Following the risk/safety management practices, an epidemiological investigation was started, duodenoscopes were removed from use and the reprocessing practices reviewed. Moreover, microbiological surveillance of endoscopes was carried out according to the CDC guidelines. Results: In the first phase of sampling, 10/10 (100%) endoscopes were found to be non-compliant, of which 7 showed results for high-concern organisms (HCOs), such as KPC-K. pneumoniae, P. aeruginosa and E. coli. After implementing corrective actions, 12 out of 17 endoscopes were found to be non-compliant (70.5%), of which 8 showed results for HCOs, such as KPC-K. oxytoca and P. aeruginosa. During the last year of regular microbiological surveillance, only 23% of endoscopes (35/152) were found to be non-compliant, of which 7 showed results for HCOs, such as NDM-K. pneumoniae, P. aeruginosa and A. baumannii. The crucial issues were related to samples collected from the internal channels of duodenoscopes. Conclusion: Managing the risk associated with the reprocessing of digestive endoscopes, through risk assessment at every stage of the process, is important for the prevention of infections associated with the use of these device. Full article

(This article belongs to the Special Issue Hospital Outdoor and Indoor Environmental Impact: Control Measures)

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10 pages, 906 KiB

Open AccessArticle

No-Touch Automated Disinfection System for Decontamination of Surfaces in Hospitals

by Patryk Tarka and Aneta Nitsch-Osuch

Int. J. Environ. Res. Public Health 2020, 17(14), 5131; https://doi.org/10.3390/ijerph17145131 - 16 Jul 2020

Cited by 7 | Viewed by 4706

Abstract

Background: Hospital-acquired infections (HAIs) remain a common problem, which suggests that standard decontamination procedures are insufficient. Thus, new methods of decontamination are needed in hospitals. Methods: We assessed the effectiveness of a no-touch automated disinfection (NTD) system in the decontamination of 50 surfaces in 10 hospital rooms. Contamination of surfaces was assessed with a microbiological assay and an ATP bioluminescence assay. Unacceptable contamination was defined as > 100 colony forming units/100 cm² in the microbiological assay, and as ≥ 250 relative light units in the ATP assay. Results: When measured with the microbiological assay, 11 of 50 surfaces had unacceptable contamination before NTD, and none of the surfaces had unacceptable contamination after NTD (p < 0.001). On the ATP bioluminescence assay, NTD decreased the number of surfaces with unacceptable contamination from 28 to 13, but this effect was non-significant (p = 0.176). On the microbiological assay taken before NTD, the greatest contamination exceeded the acceptable level by more than 11-fold (lamp holder, 1150 CFU/100 cm²). On the ATP bioluminescence assay taken before NTD, the greatest contamination exceeded the acceptable level by more than 43-fold (Ambu bag, 10,874 RLU). Conclusion: NTD effectively reduced microbiological contamination in all hospital rooms. However, when measured with the ATP bioluminescence assay, the reduction of contamination was not significant. Full article

(This article belongs to the Special Issue Hospital Outdoor and Indoor Environmental Impact: Control Measures)

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15 pages, 338 KiB

Open AccessArticle

Chemical Pollution in Healing Spaces: The Decalogue of the Best Practices for Adequate Indoor Air Quality in Inpatient Rooms

by Marco Gola, Gaetano Settimo and Stefano Capolongo

Int. J. Environ. Res. Public Health 2019, 16(22), 4388; https://doi.org/10.3390/ijerph16224388 - 10 Nov 2019

Cited by 17 | Viewed by 3133

Abstract

Indoor air quality (IAQ) is one of the main topics in which governments are focusing. In healthcare facilities, several studies have reported data analysis and case studies to improve users’ health. Nowadays, although many studies have been conducted related to the biological and physical risks, the chemical risks have been less investigated and only in some specific functional areas of the hospitals. Starting from some systematic reviews and research works, this paper aims to list the best healthy practices for an adequate IAQ in inpatient wards. In particular, the decalogue lists the strategies related to chemical pollution, starting from design and management, with a focus on (a) localization of hospitals and inpatient rooms, (b) hospital room, (c) microclimatic parameters, (d) ventilation systems, (e) materials and finishing, (f) furniture and equipment, (g) cleaning products and activities, (h) maintenance and (i) management activities, and (l) users and workers. The multidisciplinary approach emphasizes the need for interdisciplinary knowledge and skills aimed to find solutions able to protect users’ health status. The design and management decision-making, ranging from the adequate choices of construction site and hospital exposure, finishing materials, cleaning and maintenance activities, etc., which can affect the IAQ must be carried out based on scientific research and data analysis. Full article

(This article belongs to the Special Issue Hospital Outdoor and Indoor Environmental Impact: Control Measures)

16 pages, 2467 KiB

Open AccessArticle

Assessment of Overheating Risk in Gynaecology Scanning Rooms during Near-Heatwave Conditions: A Case Study of the Royal Berkshire Hospital in the UK

by Hannah Gough, Samuel Faulknall-Mills, Marco-Felipe King and Zhiwen Luo

Int. J. Environ. Res. Public Health 2019, 16(18), 3347; https://doi.org/10.3390/ijerph16183347 - 11 Sep 2019

Cited by 8 | Viewed by 4162

Abstract

Hospital buildings in the UK are at particular risk to rising summer temperatures associated with climate change. Balancing the thermal needs of patients, staff, and visitors is a challenging, complex endeavour. A case study of the ultrasound area of the Royal Berkshire Hospital’s Maternity and Gynaecology building is presented, where temperatures were measured for 35 days in waiting areas, staff offices, and ultrasound scanning rooms, aiming to assess the overheating risk posed to occupants. Local external temperature measurements were used for comparison whereby determining the indoor-outdoor environmental connection. Results show that most rooms had already breached standard overheating thresholds within the study period. Anthropogenic and waste heat from equipment has a noticeable effect on indoor temperatures. Local air-conditioning helped reduce the peaks in temperature seen between 14:00 and 17:00 for similar scanning rooms but is in contradiction to the National Health Service’s sustainability plans. Several low-level solutions such as improved signage, access to water, and the allocation of vulnerable patients to morning clinics are suggested. Barriers to solutions are also discussed and the requirement of sufficient maintenance plans for cooling equipment is empathised. These solutions are likely to be applicable to other hospital buildings experiencing similar conditions. Full article

(This article belongs to the Special Issue Hospital Outdoor and Indoor Environmental Impact: Control Measures)

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Review

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14 pages, 456 KiB

Open AccessReview

Methods of Disinfecting Stethoscopes: Systematic Review

by Margherita Napolitani, Daiana Bezzini, Fulvio Moirano, Corrado Bedogni and Gabriele Messina

Int. J. Environ. Res. Public Health 2020, 17(6), 1856; https://doi.org/10.3390/ijerph17061856 - 13 Mar 2020

Cited by 14 | Viewed by 5925

Abstract

The aim of this systematic review was to investigate the effectiveness of various disinfection methods available for stethoscopes. In March 2019, we performed a search in PubMed and Scopus using the search terms: “reducing stethoscopes contamination” and “disinfection stethoscopes”; the Mesh terms used in PubMed were “Decontamination/methods” or “Disinfection/methods” and “Stethoscopes/microbiology”. Selection criteria were: English language; at least one disinfection method tested. A total of 253 publications were screened. After title, abstract, and full-text analysis, 17 papers were included in the systematic review. Ethanol at 90%, Ethanol-Based Hands Sanitizer (EBHS), triclosan, chlorhexidine, isopropyl alcohol, 66% ethyl alcohol, sodium hypochlorite, and benzalkonium chloride have been proven to lower the presence of bacteria on stethoscopes’ surfaces. In addition, alcohol wipes show effective results. A wearable device emitting ultraviolet C by Light-Emitting Diode (LED) resulted efficacious against common microorganisms involved in Healthcare Associated Infections. The cover impregnated with silver ions seemed to be associated with significantly higher colony counts. Instead, copper stethoscopes surface reduced bacterial load. The disinfection of stethoscopes appears to be essential. There are many valid methods available; the choice depends on various factors, such as the cost, availability, and practicality. Full article

(This article belongs to the Special Issue Hospital Outdoor and Indoor Environmental Impact: Control Measures)

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