Patient risk of contact with respiratory pathogens from inanimate surfaces in a cystic fibrosis outpatient clinic. A prospective study over a four-year period

Acquisition of respiratory pathogens such as Pseudomonas aeruginosa (PA) is associated with increased morbidity and mortality in cystic fibrosis (CF). Research on the prevalence of these pathogens on environmental surfaces of a CF Center is scanty, and so far no study has determined what risk CF patients have of coming in contact with them during their visits to the CF Center. This study is aimed at assessing the prevalence of some respiratory pathogens in samples taken systematically during a 4-year period from inanimate surfaces and sinks in a CF Outpatient Clinic, and to estimate the risk that a non-PA colonized CF patient has of contact with PA when visiting the CF Center. Microbiological samples were taken and cultured from the inanimate surfaces and sinks of the Outpatient clinic of a CF Center once a month from 2001 to 2005. Four hundred and sixty environmental specimens were collected: 36.3% were positive for respiratory pathogens (23% of rooms' inert surfaces, 49.5% of sinks). Achromobacter xylosoxidans was found in 0.8% of surface samples. PA was isolated in 22.8% samples. The estimated risk for each non-colonized patient of coming in contact with PA on the surfaces in the Clinic at each visit was 5.4 per thousand (CI95% 0.9-30.1). Genotyping of a sample of environmental PA strains revealed a genetic relation between environmental and clinical isolates in most cases. Micro-organisms relevant for CF patients can be found on inanimate surfaces of a CF Center, although the risk for patients of coming in contact with PA during their visits to the CF center seems low.

[Influenza vaccination of nurses in an Italian pediatric hospital: effects on absenteeism and on costs, factors associated with vaccine uptake and analysis of personal motivations. A prospective cohort study]

AIMS

To evaluate the effects on absenteeism and on costs for the health care system (HCS) of influenza vaccination offered to nurses in a paediatric hospital; the factors associated with vaccination acceptance and non-acceptance; the motivations of vaccine-recipient and non-recipient nurses.

METHODS

Cohort study. During the 2005-2006 influenza season we observed the entire nurse population of a Paediatric Hospital (n = 327) who were offered influenza vaccination at no cost at the working place. An anonymous questionnaire was also administered.

RESULTS

Vaccination rate was 30.3%. Mean days of sick leave of vaccinated nurses (3.4 per 100 calendar days) and non vaccinated nurses (4.5 per 100 calendar days) differed but not significantly. The saving for HCS due to vaccination of less than 1/3 of nurses was equal to 0.67 nurse-years. Age > or = 40 years (RR 1.47, p = 0.01), length of service > or = 20 years (RR 1.81, p = 0.0003) and working in oncology ward (RR 2.09, p = 0.002) were predictors of adhesion to the vaccination campaign. Among motivations given for vaccination were: not to transmit influenza to hospitalised children (62.8%), to avoid getting sick (55.6%), to protect own family members (49.4%). Only 34% of vaccinated nurses would have made vaccination even if not offered for free. Among non-recipients' main motivations were: vaccination is unnecessary (62.4%), no trust in its efficacy (8.8%). No differences were found in the incidence of influenza symptoms reported by vaccinated and non vaccinated nurses.

DISCUSSION

The utility of influenza vaccination to reduce absenteeism of nurses remains unclear. Strategies for influenza vaccination campaigns should particularly address younger nurses and should take into account the beliefs of each nurse in regards to own health.

[Incidence of nosocomial rotavirus infections in a pediatric hospital over a 3-year period]

AIM

To estimate the incidence rate of hospital-acquired rotavirus infections (HRI) in a paediatric hospital in a 3-year period; the risk of HRI associated to age, sex, ward, season; the cost determined by HRI for the healthcare system.

METHODS

Retrospective epidemiological study, carried out using hospital datasets, with the analysis of some clinical records.

RESULTS

In the 2003-2005 period the HRI incidence rate was 1.9% (mean age 15.2 months, SD 11.8, range 1.5-49), with a decreasing trend over years. Children aged less than 8 months were at higher risk of HRI than others (RR 1.83, CI 95% 1.18-2.85) as well as were children admitted to a 0-18 months pediatric medicine ward (RR=2.84, CI 95% 1.78-4.5) and to an infectious diseases ward (RR=4.9, CI 95% 3.4-7). The incidence of HRI was higher in the winter than in the rest of the year (RR 1.59, CI 95% 1.07-2.36). The hospital stay of children with HRI was prolonged by a mean of 5.2 days compared to age, sex and comorbidity-matched controls. (P=0.02).

CONCLUSIONS

The method used in this study is easily reproducible. Data obtained can be used as internal quality indicators and to evaluate the performance of different hospital wards in infection control. Infection prevention activities should involve mothers and families of hospitalized children, as they perform on them a great deal of basic care and hygiene activities which are at risk for hospital cross-infections.

Isolation measures for prevention of infection with respiratory pathogens in cystic fibrosis: a systematic review

Respiratory infections are the most important cause of morbidity and mortality in patients with cystic fibrosis (CF). These infections are typically caused by a limited number of respiratory pathogens, particularly Burkholderia cepacia complex (BCC) and Pseudomonas aeruginosa (PA). Since the 1980s, several outbreaks of unique strains of PA and BCC among CF patients attending the same CF care centres have been described, leading to a sharp decline in the patients' health. One of the measures adopted in CF centres to interrupt ongoing outbreaks is the separation of patients with a respiratory tract culture that is positive for PA or BCC from patients who are not infected. This type of measure has been implemented routinely in many CF centres to prevent cross-transmission of PA and BCC. The aim of this review was to determine what evidence is available to support the efficacy of isolation (or segregation) practices in preventing, delaying or reducing the risk for CF patients of acquiring PA and BCC. A systematic review of scientific literature from 1980 to 31 December 2004 was performed. Existing guidelines regarding infection control in CF were also analysed. In total, 398 relevant papers were retrieved. Only 10 well-designed studies were found that evaluated the efficacy of isolation practices in preventing the transmission of respiratory pathogens in CF care centres (one prospective controlled study, one retrospective cohort study, five 'before-after' studies and three cross-sectional studies. No systematic reviews or randomized controlled trials exist on this subject. In the absence of studies with an experimental, controlled design, the efficacy of isolation practices in preventing the transmission of respiratory pathogens in CF remains unproven. However, notwithstanding the considerable limits represented by the study designs, which were mainly retrospective, the observational studies reviewed seem to support the implementation of isolation (or segregation) measures to reduce the risk of transmission of BCC and PA in CF patients.

Managing insulin therapy during exercise in type 1 diabetes mellitus

BACKGROUND

Exercise is integral to the life of T1DM subjects. Several factors influence the metabolic response to exercise in these patients. Despite physical and psychological benefits of exercise, its hypo- and hyperglycemic effects may cause discouragement from participation in sports and games.

AIM

To use existing evidence from literature to provide practical indications for the management of insulin therapy in subjects with T1DM who practice sports or physical activities.

METHODS

Bibliographic research was performed on PubMed and the main Systematic Review and Guidelines database were also searched.

RESULTS

Existing guidelines are useful but the exact adjustments of insulin dose must be made on an individual basis and these adjustments can be made only by "trial and error" approach.

CONCLUSIONS

These clinical indications may be a starting point from which health care providers can find practical advices for each patient.

Early eradication therapy againstPseudomonas aeruginosain cystic fibrosis patients

In cystic fibrosis (CF) patients early antibiotic treatment of lung infection has been shown to lead to Pseudomonas aeruginosa eradication. The present study determined: 1) the time period from eradication to new P. aeruginosa acquisition; 2) P. aeruginosa re-growth and new acquisition; and 3) the impact of eradication therapy on lung function, antimicrobial resistance, emergence of other pathogens and treatment costs. Ciprofloxacin and colistin were used to eradicate P. aeruginosa in 47 CF patients. Bacterial pathogens, lung function decline, P. aeruginosa antimicrobial resistance and anti-pseudomonal serum antibodies were assessed quarterly and compared with an age-matched CF control group. Additionally, costs of antibiotic therapy in both groups were assessed. Early antibiotic therapy leads to a P. aeruginosa free-period of a median (range) of 18 (4-80) months. New acquisition with different P. aeruginosa genotypes occurs in 73% of episodes. It also delays the decline of lung function compared with chronically infected patients, prevents the occurrence of antibiotic resistant P. aeruginosa strains, does not lead to emergence of other pathogens, and significantly reduces treatment costs. The treatment substantially lowers P. aeruginosa prevalence in CF. In conclusion, early antibiotic therapy exerts beneficial effects on the patient's clinical status and is cost-effective compared with conventional antibiotic therapy for chronically infected cystic fibrosis patients.

Gestational and neonatal characteristics of children with cystic fibrosis: a cohort study

OBJECTIVE

To examine whether the birth weight (BW) and the risks of being pre-term, low birth weight (LBW), and small for gestational age (SGA) of children with cystic fibrosis (CF) are different from nonaffected children.

STUDY DESIGN

Retrospective cohort study. We examined all the children with CF born in Tuscany, Italy, from 1991 to 2002 (n = 70) comparing them to the entire population of non-CF-affected children born in the same period (n = 290,059).

RESULTS

The mean BW of newborns with CF was 246.2 g lower than the mean BW of the non-CF neonatal population (P = .0003). Children with CF had a higher risk of being born pre-term (RR 2.62, P = .001), LBW (RR 2.66, P = .0009), and SGA (RR = 1.74, P = .04) than the non-CF-affected children. The mean BW of term newborns with CF was 205.7 g lower than that of term non-CF-affected babies (P = .0002).

CONCLUSIONS

Our data show an association between CF and reduced BW and show a greater risk of being pre-term for babies with CF.

[Factors that influence the duration of peripheral venous catheters used to antibiotic therapy in Cystic Fibrosis patients: results of a study]

Antibiotic intravenous (IV) therapy is of paramount importance in the treatment of cystic fibrosis (CF) lung disease. During their life CF patients have to undergo frequent IV antibiotic treatments. Peripheral venous catheters (PVC) -or cannulas- are often used to reduce the number of venepunctures needed to complete a treatment cycle, as well as to provide patients the best possible level of autonomy. The clinical experience in managing IV therapy in CF patients at Meyer Hospital in Florence, suggested that the in situ duration of PVCs varies greatly.

GOAL

To understand which factors influence the duration of PVCs used to administer IVantibiotic in people with CF.

STUDY DESIGN

Cohort prospective study, integrated with retrospective data retrieval. MATERIALS, PATIENTS AND METHODS: We observed all the PVCs inserted during an 8-month period to CF patients followed at the CF Centre of Tuscany (Florence, Italy).

RESULTS

We studied 87 PVCs inserted to 36 patients in 56 IV antibiotic treatment cycles. The mean duration of PVCs was 8.3 days. The mean duration of PVCs used for 3 daily antibiotic administrations was longer than that of PVCs used for 2 daily antibiotic administrations (10.3 days vs. 6.5 days, p=0.001). Moreover, PVCs with a larger gauge (G22) had longer mean duration than smaller (G24) PVCs (9.6 days vs. 7.2 days, p=0.03). No statistically significant association was found between PVCs' duration and, respectively, the place where the treatment was administered (in hospital or at home), the arm used (dominant or non-dominant), the PVC's brand, patient's clinical condition and the concurrent use of either steroidal antinflammatory drugs or NSAIDs per os.

Sweat testing in newborns positive to neonatal screening for cystic fibrosis

Sweat chloride concentrations above 40 mmol/l are unusual in newborns screened for cystic fibrosis and should be followed up. Centiles of sweat chloride concentrations in newborns positive to cystic fibrosis neonatal screening are presented. There are no significant correlations between age at sweat testing and sweat chloride concentration or quantity of sweat collected.

Prevalence of pain in adults with cystic fibrosis

BACKGROUND

Cystic fibrosis (CF) may strongly condition the life of affected people. CF may be associated with relevant painful conditions caused by complications of the illness and also by therapy itself, which may represent an additional load of suffering. This study was aimed at evaluating the prevalence of pain symptoms in adult CF patients, if they are noticed and treated, and the influence of pain symptoms on patients' life.

METHOD

Using a questionnaire, we examined 239 adults with CF (17% of the whole Italian adult CF population).

RESULTS

We found a high prevalence of painful episodes among CF adult patients, as for both intensity and frequency. In a 2 months period 32.6% of patients experienced episodes of pain described as intense to severe, and 29.7% had more than 10 occurrences of pain in the same location. Headache, gastric pain and backache were the most frequently reported kind of pain. 59.8% of subjects perceived pain episodes as the cause of unfavorable effects on their life. Only 42.6% of those with pain asked a CF center physician for help and another 3.5% a general practitioner.

CONCLUSION

Painful symptoms can be the cause of a worsening of the quality of life for adults with CF; the relevance of pain in CF adult patients may often be underestimated; the assessment of pain should be routinely performed as a part of care in CF centers.

[Prevention and control of respiratory tract infections in the network of Italian Centers for Cystic Fibrosis]

Infections caused by respiratory pathogens such as Burkholderia cepacia and Pseudomonas aeruginosa are associated with an increased morbidity and mortality in people affected by cystic fibrosis, the most common lethal genetic disease in Caucasian populations. Preventing the acquisition of these pathogens is paramount for these patients. The goal of this survey was to assess the distribution and the prevalence of the measures adopted for the prevention and control of infections caused by respiratory pathogens in the 28 italian centres for cystic fibrosis. 21 questionnaires were returned and some important differences can be observed in the adoption of segregation measures. Although results may be influenced by other factors, specific segregation policies appear to be more directly associated than other measures (e.g., intensive disinfection; behavioural rules to minimise patient' contacts) with lower prevalence of Pseudomonas aeruginosa (OR 0.36 CI95% 0.31-0.42), of multidrug-resistant Pseudomonas aeruginosa (OR 0.30 CI95% 0.22-0.40), and of methicillin-resistant Staphylococcus aureus (OR 0.67 CI95% 0.48-0.94).