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Sponselli S, De Maria L, Caputi A, Stefanizzi P, Bianchi FP, Delvecchio G, Foti C, Romita P, Ambrogio F, Zagaria S, Giannelli G, Tafuri S, Vimercati L. Infection Control among Healthcare Workers and Management of a Scabies Outbreak in a Large Italian University Hospital. J Clin Med 2023; 12:jcm12113830. [PMID: 37298025 DOI: 10.3390/jcm12113830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
This retrospective observational study describes the results of an ad-hoc designated prevention protocol aimed at containing the spread of the scabies infestation among healthcare workers (HCWs) of a large University Hospital in Italy. The outbreak started on October 2022 and a preventive protocol was set up thanks to a multidisciplinary approach. HCWs at high scabies risk were defined as subjects working in Operative Units with a scabies prevalence higher than 2%, close contacts of a confirmed case of scabies, or HCWs with signs and symptoms of the disease. All cases at high scabies risk underwent a dermatological examination, and the infested HCWs were suspended from work until definitive healing. Mass drug administration was established for all HCWs working in Operative Units with a scabies prevalence higher than 2%. Until March 2023, out of 183 screening dermatological examinations, 21 (11.5%) were diagnostic for scabies. Between 11 October 2022 (date of the first diagnosed scabies case) and 6 March 2023 (the end of incubation period related to the last case detected), the frequency of scabies was 0.35% (21 scabies cases/6000 HCWs). The duration of the outbreak in our hospital was 14.7 weeks. Statistical analysis shows a significant association between scabies and being a nurse and having an allergy to dust mites. We obtained a low frequency of scabies infection, limiting the duration of the outbreak and the related economic burden.
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Affiliation(s)
- Stefania Sponselli
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Antonio Caputi
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy
| | | | - Giuseppe Delvecchio
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, University of Bari, 70124 Bari, Italy
| | - Paolo Romita
- Department of Biomedical Science and Human Oncology, University of Bari, 70124 Bari, Italy
| | - Francesca Ambrogio
- Department of Biomedical Science and Human Oncology, University of Bari, 70124 Bari, Italy
| | - Silvia Zagaria
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Gianmarco Giannelli
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy
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Xu T, Durst M, Keck T, Dixon H, Yassin MH. A Scabies Outbreak in an Inpatient Rehabilitation Setting. Am J Infect Control 2022; 51:705-709. [DOI: 10.1016/j.ajic.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022]
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3
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Lee JB. Commentary: Instrumentation in dermatology. Clin Dermatol 2021; 39:553-554. [PMID: 34809760 DOI: 10.1016/j.clindermatol.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jason B Lee
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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4
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Sunderkötter C, Wohlrab J, Hamm H. Scabies: Epidemiology, Diagnosis, and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:695-704. [PMID: 34615594 DOI: 10.3238/arztebl.m2021.0296] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/26/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Scabies is a skin infestation whose incidence is apparently rising. METHODS This review is based on pertinent articles retrieved by a selective search of PubMed on diagnosis and treatment strategies. RESULTS Thread-like papules (burrows), new, intense pruritus, and dermatitis guide the suspected diagnosis which is confirmed by the microscopic or dermatoscopic demonstration of scabies mites. The first line therapy is topical application of permethrin, in accordance with the current recommendations for its use. Other treatment options include systemic ivermectin and topical crotamiton or benzyl benzoate. A combination of permethrin and ivermectin is used to treat otherwise intractable cases and is generally indicated for the treatment of crusted scabies. Known causes of treatment failure include improper application of the external agents, failure of repeated treatment with ivermectin, incomplete decontamination of furnishings and clothes, failure to simultaneously treat contact persons, absence of written documents explaining treatment modalities, and the patient's belonging to a risk group. Even though there has not yet been any direct proof of resistance of scabies mites to permethrin, there is a rising number of welldocumented cases of poor response to this agent. Moxidectin is a new substance now undergoing clinical testing. CONCLUSION Treatment of scabies according to the guidelines and the additional recommendations reported here should result in effective curing, even in cases that are thought to be intractable.
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Affiliation(s)
- Cord Sunderkötter
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale); Institute of Applied Dermatopharmacy, Martin Luther University Halle-Wittenberg, Halle (Saale); Department of Dermatology, Venereology and Allergology, University Hospital Würzburg
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5
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Consonni D, Bordini L, Nava C, Todaro A, Lunghi G, Lombardi A, Magioni D, De Palo F, Guerrieri L, Gatti M, Serra D, Polonioli M, Pratò S, Muscatello A, Bandera A, Auxilia F, Castaldi S. COVID-19: What happened to the healthcare workers of a research and teaching hospital in Milan, Italy? ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020016. [PMID: 32921712 PMCID: PMC7716960 DOI: 10.23750/abm.v91i3.10361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023]
Abstract
The paper wants to present the data of infection of the Health Care Workers of a research and teaching hospital in Milan, Italy. The majority (2554, 55.9%) of 4572 HCWs were tested for SARS-CoV-2 and 8.8% were found positive. Most of the tested workers were women, but we found higher relative frequency of positivity for men, even after adjustment for age, working area, and occupation. The higher frequency of positive tests in the medicine area is probably explained by the higher concentration in that area of COVID-19 patients. Conversely, the low frequency of positive HCWs in intensive care units is probably explained by the diffuse and continuous use of PPD. Our results show that HCWs in a research and teaching hospital in the most hit Region in Italy had a similar pattern of infection as all other HCWs all over the world. The problem of SARS-CoV-2 infections among the hospital personnel HCWs should remind us the concerns about hospital acquired infections both for patients and HCWs.
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Affiliation(s)
- Dario Consonni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Lorenzo Bordini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Carlo Nava
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Aldo Todaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giovanna Lunghi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Andrea Lombardi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Davide Magioni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Francesco De Palo
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Lidia Guerrieri
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Michele Gatti
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Daniele Serra
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Marco Polonioli
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Simone Pratò
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Antonio Muscatello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alessandra Bandera
- Centre for Multidisciplinary Research in Health Sciences (MACH), University of Milan, Italy.
| | - Francesco Auxilia
- Dept Biomedical Sciences for Health, University of Milan, Italy and ASST Fatebenefratelli e Sacco, Milan, Italy.
| | - Silvana Castaldi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Dept Biomedical Sciences for Health, University of Milan, Italy.
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Castaldi S, Luconi E, Marano G, Auxilia F, Maraschini A, Bono P, Ungaro R, Bandera A, Boracchi P, Biganzoli E. Hospital Acquired Infections in COVID-19 patients in sub intensive care unit. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020017. [PMID: 32921713 PMCID: PMC7717023 DOI: 10.23750/abm.v91i3.10376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 01/28/2023]
Abstract
The aim of this study is to assess the association among species of bacteria and to identify the presence of clusters of patients in sub intensive care unit with different profiles of infection, and to study the relationship between such profiles and patient demographics (gender, age), kind of investigations and material used to detect the infection. The findings need to analyse a bigger amount of data in the same setting to make evident that it is constant the infection only with Escherichia coli and Staphylocossus epidemidis and a third case in which more bacteria are inlvolved.
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Affiliation(s)
- Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Hospital, Milan, Italy.
| | - Ester Luconi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Italia.
| | - Giuseppe Marano
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
| | | | - Anna Maraschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Italia.
| | - Patrizia Bono
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Policlinico Milano Italia.
| | - Riccardo Ungaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Italia.
| | - Alessandra Bandera
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti University of Milan Italy .
| | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
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Hosoi H, Nishikawa S, Kida Y, Kishi T, Murata S, Iwamoto M, Toyoda Y, Yamada Y, Ikeda T, Sonoki T. Susceptibility of patients receiving chemotherapy for haematological malignancies to scabies. J Hosp Infect 2020; 106:594-599. [PMID: 32866631 DOI: 10.1016/j.jhin.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Scabies is a contagious dermatosis. The risk factors for its transmission remain unclear. A scabies outbreak, involving patients who were receiving chemotherapy for haematological malignancies, occurred at our hospital. METHODS The outbreak population was analysed to determine whether the incidence of scabies was higher among contact patients receiving chemotherapy for haematological malignancies. RESULTS A patient with crusted scabies was the index case, and 18 of 78 contact healthcare workers (HCWs) and 22 of 135 contact patients were diagnosed with classical scabies. Ten of 17 contact patients with haematological malignancies and 12 of 118 contact patients with other diseases were infected with scabies. The incidence rate was significantly higher among the patients with haematological malignancies (P<0.001). The patients with haematological malignancies had a significantly lower mean minimum neutrophil count than those with other diseases (1159/μL vs 3761/μL, P=0.0012). Most haematological patients did not require special nursing assistance, suggesting that the higher incidence of scabies among these patients resulted from their immunodeficiency rather than greater skin-to-skin contact with infected HCWs. CONCLUSION Our study suggests that patients receiving chemotherapy for haematological malignancies are more susceptible to scabies than patients with other diseases, and require stricter protection.
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Affiliation(s)
- H Hosoi
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan; Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan.
| | - S Nishikawa
- Department of Nursing, Kainan Municipal Medical Center, Wakayama, Japan; Infection Control Team, Kainan Municipal Medical Center, Wakayama, Japan
| | - Y Kida
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan
| | - T Kishi
- Department of Dermatology, Kainan Municipal Medical Center, Wakayama, Japan
| | - S Murata
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - M Iwamoto
- Infection Control Team, Kainan Municipal Medical Center, Wakayama, Japan; Department of Pediatrics, Kainan Municipal Medical Center, Wakayama, Japan
| | - Y Toyoda
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan
| | - Y Yamada
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan
| | - T Ikeda
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan
| | - T Sonoki
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
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8
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Capolongo S, Gola M, Brambilla A, Morganti A, Mosca EI, Barach P. COVID-19 and Healthcare Facilities: a Decalogue of Design Strategies for Resilient Hospitals. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:50-60. [PMID: 32701917 PMCID: PMC8023092 DOI: 10.23750/abm.v91i9-s.10117] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM The COVID-19 pandemic has upended the global healthcare systems. The surge in infections and sick critically ill patients has tested the resilience of healthcare infrastructures and facilities forcing organizations to quickly adapt and embrace emergency solutions. The paper proposes a decalogue of design strategies applicable both to new hospitals and to the refurbishment of existing hospitals. METHODS The authors conducted observations at hospitals, during public health webinars and through experts working groups from March to May 2020. RESULTS In this commentary, the authors present a list of strategies for creating critical care surge capacity and exploring design strategies for healthcare design for resilient hospital facilities. The strategies are organized into two tiers: I) design and II) operations. The (I) Design phase strategies are: 1) Strategic Site Location; 2) Typology Configuration; 3) Flexibility; 4) Functional program; 5) User-centerdness. The (II) Operation phase strategies are: 6) Healthcare network on the territory; 7) Patient safety; 8) HVAC and indoor air quality; 9) Innovative finishing materials and furniture; 10) Healthcare digital innovation. CONCLUSIONS Hospitals, health care systems, and institutions urgently need to assess their resources, identify potential bottlenecks, and create strategies for increasing critical care surge capacity. The COVID-19 pandemic disrupted healthcare operations and accelerated the processes of innovation and transformation. The design and operational strategies can enable the achievement of resilient hospital facilities. Further multidisciplinary researches is needed to validate the strategies empirically.
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Affiliation(s)
- Stefano Capolongo
- Politecnico di Milano, Department of Architecture, Built environment and Construction engineering (DABC), Design and Health LAB, Italy .
| | - Marco Gola
- Politecnico di Milano, Department of Architecture, Built environment and Construction engineering (DABC), Design and Health LAB, Italy .
| | - Andrea Brambilla
- Politecnico di Milano, Department of Architecture, Built environment and Construction engineering (DABC), Design and Health LAB, Italy .
| | - Alessandro Morganti
- Politecnico di Milano, Department of Architecture, Built environment and Construction engineering (DABC), Design and Health LAB, Italy .
| | - Erica Isa Mosca
- Politecnico di Milano, Department of Architecture, Built environment and Construction engineering (DABC), Design and Health LAB, Italy .
| | - Paul Barach
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, United States of America; Jefferson College of Population Health, Philadelphia, PA, United States of America; Sigmund Freud University, Wien, Austria.
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9
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Squeri R, Levita A, Intelisano R, Costa GB, Mancuso G, Grasso L, D'Amato S, Mazzitelli F, Squeri A, Midiri A, Biondo C, Alesci D, Bonaccorso V, Bitto A, Genovese C. Correct management and low rate of contagiousness of healthcare workers in a University Hospital in Southern Italy: from contact tracing to serological investigation. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:79-86. [PMID: 32701920 PMCID: PMC8023094 DOI: 10.23750/abm.v91i9-s.10118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
The COVID-19 epidemic, which began in Wuhan in December 2019, quickly spread all over the world, leading in a few months to a high number of deaths also in healthcare workers. The purpose of the study is to a) describe the importance of a correct management of SARS-CoV-2 infections; b) report the number of positive healthcare workers after the epidemic phase and to describe their socio-characteristics data, the main methods of transmission and the symptoms; c) to report the seroconversion rate of healthcare workers (HCWs). The study was conducted from March 9, 2020 to June 19, 2020 in three phases:1) in a first phase, we implemented the guidelines to be followed for patient care in our hospital; 2) in a second phase, we provided the epidemiological investigation/contact tracing of HCWs; 3) we collected swabs on all healthcare workers and we also performed serological investigation. The number of healthcare workers under surveillance is of 2611 subjects and, of these, only 0.65% contracted COVID-19. In particular, 70.6% of these have been infected in the healthcare setting, 11, 8% in the family and 17.6% returning from high risk areas. Ultimately, only 0.1% of HCWs dedicated to the treatment of COVID-19 patients contracted the infection (one was asymptomatic). Only 2% of HCWS were positive for serological investigation.
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Affiliation(s)
- Raffaele Squeri
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.
| | | | | | - Gaetano Bruno Costa
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Giuseppe Mancuso
- Department of Human Pathology of the adult and developmental age Gaetano Barresi, University of Messina, Messina, Italy.
| | - Loredana Grasso
- Department of Human Pathology of the adult and developmental age Gaetano Barresi, University of Messina, Messina, Italy.
| | - Smeralda D'Amato
- Postgraduate Medical School in Hygiene and Preventive Medicine, University of Messina, Italy.
| | - Francesco Mazzitelli
- Postgraduate Medical School in Hygiene and Preventive Medicine, University of Messina, Italy.
| | - Andrea Squeri
- Department of Human Pathology of the adult and developmental age Gaetano Barresi, University of Messina, Messina, Italy.
| | - Angelina Midiri
- Department of Human Pathology of the adult and developmental age Gaetano Barresi, University of Messina, Messina, Italy.
| | - Carmelo Biondo
- Department of Human Pathology of the adult and developmental age Gaetano Barresi, University of Messina, Messina, Italy.
| | - Domenica Alesci
- Department of Human Pathology of the adult and developmental age Gaetano Barresi, University of Messina, Messina, Italy.
| | - Vincen Bonaccorso
- Department of Human Pathology of the adult and developmental age Gaetano Barresi, University of Messina, Messina, Italy.
| | - Alessandra Bitto
- Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, Messina, 98125, Italy.
| | - Cristina Genovese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
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10
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Auxilia F, Maraschini A, Bono P, Ungaro R, Luconi E, Biganzoli E, Castaldi S. COVID-19: new scenario old problems. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:90-91. [PMID: 32701922 PMCID: PMC8023089 DOI: 10.23750/abm.v91i9-s.10119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022]
Abstract
The short paper present the problem of hospital acquired infection in subintensive units og a research and teaching hospital.
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Affiliation(s)
- Francesco Auxilia
- Department of Biomedical Sciences for Health University of Milan, Italy.
| | - Anna Maraschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Patrizia Bono
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Riccardo Ungaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Ester Luconi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
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11
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Thomas C, Coates SJ, Engelman D, Chosidow O, Chang AY. Ectoparasites: Scabies. J Am Acad Dermatol 2019; 82:533-548. [PMID: 31310840 DOI: 10.1016/j.jaad.2019.05.109] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 12/26/2022]
Abstract
Scabies is an ectoparasitic dermatosis caused by Sarcoptes scabiei var. hominis and is a public health issue in all countries regardless of socioeconomic status. In high-income countries, delays in diagnosis can lead to institutional outbreaks; in low- and middle-income countries, poor access to health care contributes to disease undertreatment and long-term systemic sequelae. With scabies now recognized as a neglected tropical disease by the World Health Organization, increased awareness and systematic efforts are addressing gaps in diagnosis and treatment that impede scabies control. This review summarizes the available data and provides an update on scabies epidemiology, clinical features, diagnosis, management, and public health considerations.
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Affiliation(s)
- Cristina Thomas
- Departments of Dermatology and Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah J Coates
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Daniel Engelman
- International Alliance for the Control of Scabies, Parkville, Australia; Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Olivier Chosidow
- International Alliance for the Control of Scabies, Parkville, Australia; Department of Dermatology, Assistance Publique - Hôpitaux de Paris, University Paris-Est Créteil, Créteil, France
| | - Aileen Y Chang
- Department of Dermatology, University of California, San Francisco, San Francisco, California; International Alliance for the Control of Scabies, Parkville, Australia.
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12
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Mueller SM, Gysin S, Schweitzer M, Schwegler S, Haeusermann P, Itin P, Bart T, Denz RS, Steffen T, Kuehl R, Widmer AF, Brandt O. Implementation and evaluation of an algorithm for the management of scabies outbreaks. BMC Infect Dis 2019; 19:200. [PMID: 30819115 PMCID: PMC6394030 DOI: 10.1186/s12879-019-3818-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/13/2019] [Indexed: 11/28/2022] Open
Abstract
Background Infestations with scabies mites are a global burden affecting individuals of all ages, classes and ethnicities. As poor sanitation and overcrowding favor the transmission of this highly contagious disease, epidemic outbreaks are frequently observed among displaced persons and asylum seekers. Due to the growing influx of refugees during the last years, public health authorities in host countries are frequently confronted with the challenge to treat individuals with diagnosed or suspected scabies promptly and effectively to avoid further spreading of the infestation. This study aimed to establish a straightforward and efficient algorithm for rapid screening and treatment of large numbers of patients with confirmed or suspected scabies infestations. Methods Forty-eight individuals (58% males, mean age 22.4 yrs.) from Syria with suspected scabies infestation were allocated to 3 colour-coded groups: (1) no signs or symptoms of infestation, (2) itch only, and (3) itch and typical skin lesions. Patients were treated with a single (group 1) or two doses of oral ivermectin at an interval of 7 days (group 2), or with a combination of 2 doses of ivermectin plus 2 applications of permethrin ointment at an interval of 7 days (group 3). Follow-ups were performed 4 weeks after initial treatments. Results All individuals with signs and/or symptoms of infestation had improved skin lesion; in 10/11 (90.9%) lesion had completely resolved. All individuals with initial itch only (n = 32) reported improvement of its intensity or complete resolution. None of the patients of group 1 developed itch or skin lesions. The algorithm was reapplied in 4 individuals (8.3%) after 4 weeks and the outbreak was completely controlled after 8 weeks. Colour-coding ensured fast flow of information between health-care providers at the interfaces of the algorithm. Conclusions Our algorithm proved to be both highly efficient for treatment of large numbers of patients with suspected or diagnosed scabies infestation as well as for prevention of spreading of the disease. Hence, this algorithm is well suited for the management of scabies mass outbreaks.
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Affiliation(s)
- Simon M Mueller
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland.
| | - Stefan Gysin
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Michael Schweitzer
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Simon Schwegler
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Peter Haeusermann
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Peter Itin
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Thomas Bart
- Department of Health, Medical Services, Social Medicine, 4056, Basel, Canton of Basel-City, Switzerland
| | - Ruth Spieler Denz
- Department of Health, Medical Services, Social Medicine, 4056, Basel, Canton of Basel-City, Switzerland
| | - Thomas Steffen
- Department of Health, Medical Services, Social Medicine, 4056, Basel, Canton of Basel-City, Switzerland
| | - Richard Kuehl
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, 4056, Basel, Switzerland
| | - Andreas F Widmer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, 4056, Basel, Switzerland
| | - Oliver Brandt
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
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13
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Marotta M, Toni F, Dallolio L, Toni G, Leoni E. Management of a family outbreak of scabies with high risk of spread to other community and hospital facilities. Am J Infect Control 2018; 46:808-813. [PMID: 29397231 DOI: 10.1016/j.ajic.2017.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND In developed countries, scabies is observed sporadically or as institutional outbreaks in hospitals and other health facilities. In the family context, outbreaks generally involve a limited number of cases. METHODS A local health authority in Emilia-Romagna (Northern Italy) carried out an epidemiologic investigation on a family outbreak of scabies that included an unusually high number of cases. Its possible connection with a nosocomial case in a long-term care facility (LTCF) and outbreak management are discussed. RESULTS Among the household members, 8 confirmed cases occurred (attack rate, 87.5%). Another case was reported in a patient of an LTCF where one of the family cases worked as a sociosanitary operator. In total, 244 contacts were placed under surveillance. The control strategy focused on a mass information campaign addressed to all contacts and the training of health care personnel. In addition, specific prophylaxis (permethrin 5%) was performed in 108 high-risk contacts and LTCF patients and staff. CONCLUSIONS The control measures were successful in preventing the spread of the outbreak. However, misdiagnosis and the tendency of people to hide the symptoms caused the late recognition and underestimation of the cases, contributing to delayed control measures and increasing the economic and human resources required for outbreak management.
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Affiliation(s)
- Manfredo Marotta
- Unit of Hygiene and Public Health, Local Health Authority of Romagna, Rimini, Italy
| | - Francesco Toni
- Unit of Hygiene and Public Health, Local Health Authority of Romagna, Rimini, Italy
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, Bologna, Italy.
| | - Greta Toni
- Unit of Hygiene and Public Health, Local Health Authority of Romagna, Rimini, Italy
| | - Erica Leoni
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, Bologna, Italy
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14
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Adler N, Tay J, McLellan S, Klintworth G, Cheng A, Aung A. Nosocomial crusted scabies outbreak: Important infection prevention lessons learned from a small case series. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Kouotou EA, Nansseu JRN, Sangare A, Moguieu Bogne LL, Sieleunou I, Adegbidi H, Tameyi Tatsa J, Moyou Somo R. Burden of human scabies in sub-Saharan African prisons: Evidence from the west region of Cameroon. Australas J Dermatol 2017; 59:e6-e10. [DOI: 10.1111/ajd.12540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/12/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Emmanuel Armand Kouotou
- Internal Medicine Unit; Yaoundé University Teaching Hospital; Yaoundé Cameroon
- Internal Medicine Unit; Biyem-Assi District Hospital; Yaoundé Cameroon
- Department of Internal Medicine and Specialties; Faculty of Medicine and Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
| | - Jobert Richie N Nansseu
- Department of Public Health; Faculty of Medicine and Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
| | - Abdoulaye Sangare
- Dermatology Unit; Treichville University Teaching Hospital; Treichville Ivory Coast
| | - Léonnelle-Lynda Moguieu Bogne
- Internal Medicine Unit; Yaoundé University Teaching Hospital; Yaoundé Cameroon
- Department of Medicine; Faculty of Health Sciences; University of Mountains; Bangangté Cameroon
| | - Isidore Sieleunou
- School of Public Health; University of Montréal; Montréal Québec Canada
| | - Hugues Adegbidi
- Dermatology Unit; University Hospital National Centre of Cotonou; Cotonou Benin
| | - Joël Tameyi Tatsa
- Department of Internal Medicine and Specialties; Faculty of Medicine and Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
| | - Roger Moyou Somo
- Department of Parasitology and Mycology; Faculty of Medicine and Biomedical Sciences; University of Yaoundé I; Yaoundé Cameroon
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16
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Furuya K, Nakajima H, Sasaki Y, Ishiko A, Urita Y. A scabies outbreak in a diabetic and collagen disease ward: Management and prevention. Exp Ther Med 2016; 12:3711-3715. [PMID: 28105102 DOI: 10.3892/etm.2016.3845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/05/2016] [Indexed: 11/05/2022] Open
Abstract
Scabies is an infection caused by Sarcoptes scabiei. In developed countries, scabies remains an important public health problem in hospitals and care facilities among elderly or immunocompromised patients. There are a number of medical providers who have not experienced scabies and there has been confusion surrounding its management and prevention. Therefore, the aim of the present study was to identify the optimal approach for the management and prevention of scabies. A scabies outbreak occurred between June 2014 and October 2014 in the Toho University School of Medicine, Omori Hospital (Tokyo, Japan), and the current study investigates factors concerning the outbreak, such as disease recognition, diagnostic strategy, medical staff experience and correspondence after the outbreak occurred. Six patients were newly diagnosed with scabies including patients, medical staff and family of the medical staff. An infection control committee was implemented and required a follow-up survey of 181 people (144 patients and 37 medical staff). It took ~4 months to resolve the outbreak. Scabies is highly infectious, and sufficient knowledge is required to care for the patients and prevent the infection of healthy people. In this example, the spread of infection was controlled by prompt action.
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Affiliation(s)
- Kenta Furuya
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital, Ota-ku, Tokyo 143-8541, Japan
| | - Hitoshi Nakajima
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital, Ota-ku, Tokyo 143-8541, Japan
| | - Yousuke Sasaki
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital, Ota-ku, Tokyo 143-8541, Japan
| | - Akira Ishiko
- Department of Dermatology, Toho University School of Medicine, Omori Hospital, Ota-ku, Tokyo 143-8541, Japan
| | - Yoshihisa Urita
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital, Ota-ku, Tokyo 143-8541, Japan
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17
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Chuang S, Howley PP, Lin SH. Implementing systems thinking for infection prevention: The cessation of repeated scabies outbreaks in a respiratory care ward. Am J Infect Control 2015; 43:499-505. [PMID: 25798774 DOI: 10.1016/j.ajic.2015.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Root cause analysis (RCA) is often adopted to complement epidemiologic investigation for outbreaks and infection-related adverse events in hospitals; however, RCA has been argued to have limited effectiveness in preventing such events. We describe how an innovative systems analysis approach halted repeated scabies outbreaks, and highlight the importance of systems thinking for outbreaks analysis and sustaining effective infection prevention and control. METHODS Following RCA for a third successive outbreak of scabies over a 17-month period in a 60-bed respiratory care ward of a Taiwan hospital, a systems-oriented event analysis (SOEA) model was used to reanalyze the outbreak. Both approaches and the recommendations were compared. RESULTS No nosocomial scabies have been reported for more than 1975 days since implementation of the SOEA. Previous intervals between seeming eradication and repeat outbreaks following RCA were 270 days and 180 days. Achieving a sustainable positive resolution relied on applying systems thinking and the holistic analysis of the system, not merely looking for root causes of events. CONCLUSION To improve the effectiveness of outbreaks analysis and infection control, an emphasis on systems thinking is critical, along with a practical approach to ensure its effective implementation. The SOEA model provides the necessary framework and is a viable complementary approach, or alternative, to RCA.
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18
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Development of Conventional and Real-Time Quantitative PCR Assays for Diagnosis and Monitoring of Scabies. J Clin Microbiol 2015; 53:2095-102. [PMID: 25903566 DOI: 10.1128/jcm.00073-15] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/13/2015] [Indexed: 11/20/2022] Open
Abstract
Scabies remains the most prevalent, endemic, and neglected ectoparasitic infestation globally and can cause institutional outbreaks. The sensitivity of routine microscopy for demonstration of Sarcoptes scabiei mites or eggs in skin scrapings is only about 50%. Except for three studies using conventional or two-tube nested PCR on a small number of cases, no systematic study has been performed to improve the laboratory diagnosis of this important infection. We developed a conventional and a real-time quantitative PCR (qPCR) assay based on the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene of S. scabiei. The cox1 gene is relatively well conserved, with its sequence having no high levels of similarity to the sequences of other human skin mites, pathogenic zoonotic mites, or common house dust mite species. This mitochondrial gene is also present in large quantities in arthropod cells, potentially improving the sensitivity of a PCR-based assay. In our study, both assays were specific and were more sensitive than microscopy in diagnosing scabies, with positive and negative predictive values of 100%. The S. scabiei DNA copy number in the microscopy-positive specimens was significantly higher than that in the microscopy-negative specimens (median S. scabiei DNA copy number, 3.604 versus 2.457 log10 copies per reaction; P = 0.0213). In the patient with crusted scabies, the qPCR assay performed on lesional skin swabs instead of scrapings revealed that the parasite DNA load took about 2 weeks to become negative after treatment. The utility of using lesional skin swabs as an alternative sample for diagnosis of scabies by PCR should be further evaluated.
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Bader MS, Brooks AA, Srigley JA. Postexposure management of healthcare personnel to infectious diseases. Hosp Pract (1995) 2015; 43:107-27. [PMID: 25728206 PMCID: PMC7103705 DOI: 10.1080/21548331.2015.1018091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 02/09/2015] [Indexed: 11/16/2022]
Abstract
Healthcare personnel (HCP) are at risk of exposure to various pathogens through their daily tasks and may serve as a reservoir for ongoing disease transmission in the healthcare setting. Management of HCP exposed to infectious agents can be disruptive to patient care, time-consuming, and costly. Exposure of HCP to an infectious source should be considered an urgent medical concern to ensure timely management and administration of postexposure prophylaxis, if available and indicated. Infection control and occupational health departments should be notified for management of exposed HCP, identification of all contacts of the index case, and application of immediate infection control measures for the index case and exposed HCP, if indicated. This article reviews the main principles of postexposure management of HCP to infectious diseases, in general, and to certain common infections, in particular, categorized by their route of transmission, in addition to primary prevention of these infections.
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Affiliation(s)
- Mazen S. Bader
- Department of Medicine, Hamilton Health sciences, Juravinski hospital and Cancer Centre, Hamilton, Ontario, Canada
| | - Annie A. Brooks
- Department of Pharmacy, Hamilton Health Sciences, Juravinski hospital and Cancer Centre, Hamilton, Ontario, Canada
| | - Jocelyn A. Srigley
- Department of Medicine, Infection Prevention and Control, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Abstract
Scabies and bedbugs are two emerging ectoparasitic infections reported in crowded areas, including hospitals. Skin involvement is the main presenting initial manifestation for both infections, and the diagnosis is yet challenging for both. Topical permethrin is considered the first-line therapy for scabies except for crusted scabies which is mainly treated with oral ivermectin. To the contrary, treatment of bedbugs is mainly symptomatic. Avoiding close contact, early diagnosis and treatment of infected persons as well as decontamination of the involved environment play an essential role in controlling outbreaks in healthcare settings.
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Affiliation(s)
- Maroun Sfeir
- Department of Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA,
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