Proposal of model for personalized early adapted cancer screening in people living with HIV: experience of "Gaetano Martino" Hospital University of Messina

Human immunodeficiency virus (HIV) infection has historically been related to the development of specific cancers, some of which are so closely linked to the infection, such as Kaposi's Sarcoma (KS), that they have earned the name Acquired Immuno-Deficiency Syndrome (AIDS)-defining cancers (ADCs). While the development of antiretroviral therapy (ART) has decreased the incidence of AIDS-defining cancers, the resulting aging of people living with HIV (PLWH) highlighted an increased occurrence of other forms of cancer. At the "Gaetano Martino" hospital in Messina, we developed a multidisciplinary approach by creating a bridge between the Oncology Unit and the Infectious Diseases Unit to carry out screening and a more rapid diagnostic and therapeutic journey for cancers in PLWH. The goal is to improve the diagnosis of various types of cancer by involving other professionals, such as gastroenterologists and gynecologists, to ensure faster access to treatment and, therefore, a greater chance of survival. In addition, our multidisciplinary approach has also included vaccine screening, offered by the "Gaetano Martino" hospital and useful for preventing the development of specific forms of cancer in the entire population and particularly in PLWH.

A Southern addiction evaluation project: investigating the impact of addiction through a survey HBSC based

Background

Adolescence is a critical phase of development characterized by numerous physical, psychological and social changes. During this stage, individuals may engage in experimentation and risky behavior, leading to increased vulnerability to addiction. This article aims to present the results of a survey based on the HBSC (Health Behavior in School-aged Children) surveillance model in a province of Southern Italy for primary and secondary school students.

Methods

We conducted a prospective study from March 2020 to April 2023 through the administration of a questionnaire to students of the healthcare faculties of the University of Messina and primary and secondary school students, composed of 19 items and based on HBSC surveillance.

Results

We collected a total of 664 questionnaires. We found that smoking habits increase with age: approximately 31% of secondary school students declare they are real smokers compared to 40% of HCP students. At least once, in the three study groups, students experienced alcohol consumption at different rates, with younger students having a greater propensity to drink than older students. Fortunately, in our sample, no middle school students had tried cannabis. At the same time there is a surprising decrease in gambling in all categories compared to national data.

Conclusions

The presence of addictive behaviors in our sample was found to be widespread despite being in line with the national trend. Furthermore, we have observed a reduction in recent years which needs to be investigated to assess the reasons. Primary prevention is probably the main weapon in the hands of politicians and must be applied early in school and community settings to reduce prevalence.

Study-related stress, perceived stress and quality of life among healthcare university students

Background

Many studies have shown that the stress level among healthcare university students is often as high as in workers who experience burnout. Our study investigated if it is possible to observe the burnout syndrome in these kind of students, able to significantly alter the quality of life, their approach to daily activities and relationship life.

Methods

The study was conducted through the administration of an anonymous questionnaire, distributed online through messaging apps, during the breaks between lessons. It was formulated using the perceived stress scale (PSS) in its short formula in order to evaluate feelings and thoughts and the WHOQOL-AGE, in order to evaluate the quality of life.

Results

The sample consisted of 292 university students aged between 18 and 49, with an average age of 22,42 ± 4,65. 16.4% does not often feel able to control the important things in life, 42.8% is often unable to manage personal problems. The PSS score of all our university students showed a high stress level in 6.2%, an average stress level in 57.2% and low stress level in 36.6%. The WHOQOL score shows that 42% had a high quality of life and only 4% had a poor quality of life, 54% had an intermediate quality of life and half of the sample was unsatisfied with the way he felt every day.

Conclusions

Many students (63.4%) are subjected to stress study-related, even if does not affect their quality of live, therefore not perceiving it as negative. There is a gender difference: females have a higher level of stress than men. Two thirds of the sample has an average or high stress level; only a third has a low grade. Stress prevention in young university students must begin through a new way of teaching, even if a certain amount of stress study-related is stimulant.

Impact of the COVID-19 pandemic on HPV vaccination coverage in the general population and in PLWHs

OBJECTIVE

On March 11, 2020, the World Health Organization (WHO) has declared the novel coronavirus (COVID-19) outbreak as a global pandemic. COVID-19 pandemic has impacted health services, including immunization programs, with a consequent reduction in vaccination coverage in those categories for which the prevention of vaccine-preventable diseases is strongly recommended.

SUBJECTS AND METHODS

We conducted a retrospective cross-sectional study on the general population and on PLWHs, comparing anti-human papillomavirus (HPV) vaccination coverage data in 2019, before COVID-19 pandemic, and the 2020 data, after the announcement of the pandemic state and the lockdown and the implementation of restrictive measures to contain the contagion.

RESULTS

Compared to 2019, 2020 data show a 42% reduction in HPV vaccine coverage in the general population and 36% in PLWHs. The greatest reduction in anti-HPV vaccination coverage occurred during periods of greatest restriction and mainly concerned the general population.

CONCLUSIONS

The prevention of vaccine-preventable diseases remains essential. Above all, it is essential to increase and recover the anti-HPV vaccine coverage, in consideration of the data that show its preventive oncological efficacy.

The Clean Care Contest: promoting hand hygiene among healthcare and medical students

INTRODUCTION

Despite continuing efforts, compliance rates and knowledge of best practices in hand hygiene remain disappointing. Recognizing that conventional educational tools seem out of touch with young people and that the med and messages contents need refreshing, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health devised a novel approach to promote the creation of innovative educational tools for improving knowledge of, and compliance with, hand hygiene rules among healthcare and medical students.

METHODS

A contest in creating educational material on hand hygiene practices involved university students of nursing and medicine, and of other healthcare degrees. Students from the universities of the GISIO network were invited to create educational material (e.g., videos, posters, presentations, leaflets, and screensavers) to be presented by May 5th 2019 during the World Hand Hygiene Day / Save Lives: Clean Your Hands Global Annual Initiative of the World Health Organization). A local and a national winners were awarded.

RESULTS

Three different local and national contests were performed during 2016, 2017 and 2018. During the three-year period, more than 270 educational tools have been developed: 130 (48%) were judged useful for hand hygiene promotion campaigns. The most frequent projects participating in the contests were videos (39%), posters (29%), leaflets (14%), and others (18%) submitted by more than 1,500 students of nursing (40%), medicine (31%), dentistry (7%), and of other healthcare courses in 14 universities. Products were evaluated by a local committee and, subsequently, local winners represented their University in a national contest.

CONCLUSIONS

The contest provided a framework for the creation of innovative and potentially effective educational tools via an engaging approach that leveraged student creativity. Given the need to improve compliance rates, this study suggests that new ways can be advantageously explored to teach hand hygiene procedures and increase awareness of the importance of their consistent use among healthcare and medical students.

"Vaccinate your child for best protection": attitude towards vaccination in a group of pregnant women

BACKGROUND

Although the benefits and importance of vaccination before and right after pregnancy, are well known, vaccination coverage among pregnant women remains very low. The aim of our study was to evaluate pregnant women's knowledge and attitude towards vaccination.

STUDY DESIGN

A cross sectional study was performed from October 2018 to June 2019 at the University of Messina.

METHODS

We gave pregnant women >18 years old a non-self-compiling paper questionnaire. We stratified the sample according to age (<30 and >30 years old), marital status (single/divorced, in a relationship and married) and level of education (<8 and >8 years of school attendance). All possible correlations between collected data were analysed using software R.

RESULTS

The sample included 156 women (mean age 32±0.49 years old). Only 1.4% of the subjects were aware of all the vaccines indicated for children. Luckily, 86.7% of the sample had a positive attitude, believing in the effectiveness and safety of immunization, despite a limited lack of confidence and a belief in false myths was expressed by some of the subjects. Interestingly, results showed that information about vaccination were more frequently obtained from family/friends (52.6%), mass media (49.1%), blogs/forums (19.3%), rather than from medical institutions (only 17.5%) or the family physician (only 35.0%), reflecting the quality of the information obtained.

CONCLUSIONS

Our results proved that a general positive attitude emerged among our sample towards vaccination, however, correct information was not always provided to women, making it a crucial issue for public health in the future.

Adherence to the three Italian screening in a sample of women (and men) in the Southern Italy

INTRODUCTION

Although scientific evidence shows the numerous benefits of screening programs, in Italy. There is a great disparity between the regional coverage of the North and South despite the screening programs have been activated for several years in all regions even with territorial differences.

OBJECTIVE

The aim of our study was to evaluate the knowledge and adherence to different screenings in the population, the influence exercised by the local health authority the role of the general practitioner in advising and referring patients to screening tests and the main causes of refuse.

MATERIAL AND METHODS

The study was carried out, from December 2019 to May 2020, through the administration of anonymous self-filled "ad hoc" questionnaires to women and men over 26 years old.

RESULTS

in our sample 36% have never performed a breast check and 39% of the interviewees never had a mammogram; for cervical cancer 25% did not ever perform screening and 65% did not have an indication by GP. The worst result was found for colorectal cancer (only 27% of the sample performed the screening). The role of GP was fundamental for and similar to other studies, was fundamental in fact,similar to other studies the most frequent reported reasons for the non-execution of screening were the lack of physicians' advice, follwed by lack of time, the most frequent reported reasons for the non-execution of screening were the lack of physicians' advice, a lack of time, fear of cancer and embarrassment at visiting a gynaecologist.

DISCUSSION AND CONCLUSIONS

the study carried out found that despite the knowledge of the oncological disease and the possibilities of prevention is fairly rooted in the population, adherence to the screening is quite inadequate, especially as regards colorectal cancer.

Susceptibility to measles among health workers in a university hospital in southern Italy

OBJECTIVES

Measles still has a high impact on the health of the population in Italy and therefore requires a strong commitment to prevention at national level. In addition to Italy, measles outbreaks have also been reported in other EU countries, with a high number of cases and a rapid spread of the disease even in the nosocomial context between patients and health personnel. The aim of this study is to evaluate the prevalence of measles in a group of health workers working at a university hospital in southern Italy.

MATERIALS AND METHODS

A seroepidemiological study was conducted on 458 health workers. Measles antibody IgG and IgM levels were evaluated by immunoenzymatic testing.

RESULTS

The highest percentage of susceptible subjects was ≤30 years old, with a statistically significant difference compared to the age group ≥51 years. With regard to gender, susceptibility to measles in males was significantly higher than in females (p<0.05). Additional statistically significant differences were found in the different age groups in both genders.

CONCLUSIONS

Although the results show that most health workers are immune to measles, a 20% susceptibility certainly represents a risk for the spread of the disease among operators and patients. Vaccination and control of suspected cases, especially in community settings such as the hospital environment, are the main measures to prevent the transmission and spread of the disease.

The new era of vaccines: the "nanovaccinology"

Vaccinations are the most effective preventive methods against infectious diseases and represent one of the most relevant successes of medicine. Vaccine development is constantly evolving; therefore, the number of vaccine candidates is progressively increasing. However, most of new potential vaccines are characterized by a lower immunogenicity, with the inability to stimulate powerful and long-lasting immune responses. Hence, to get modern and effective vaccines, we need adjuvants and innovative delivery systems that increase their immunogenicity. The use of nanotechnology in vaccinology is providing the opportunity to contrast these difficulties and develop effective vaccines. Particularly, nanoparticles used as vehicles of vaccine components, are able to increase the host's immune responses and, due to their size, to reach specific cellular districts. To date, a certain number of nanovaccines has been approved for human health and many are studied in clinical or pre-clinical trials. There are several types of nanoparticles considered as possible delivers of vaccine antigens. These nanoparticles-based synthetic delivery systems, in the size range of 20-200 nm, protect antigen from degradation, enhance its presentation and facilitate its uptake by professional antigen-presenting cells. Virus-like particles, self-assembled proteins, micelles, liposomes, inorganic nanoparticles, and polymers are the most studied of these systems. In this review, we provide a general overview of different types, methods of synthesis, characterizations, properties and applications of nanoparticles in vaccine production.

Mediterranean diet: knowledge and adherence in Italian young people

INTRODUCTION

In November 2010 the Mediterranean Diet was recognized by the UNESCO as Intangible Cultural Heritage of Humanity. It is an heritage that brings together the dietary habits of the peoples of the Mediterranean countries, consolidated over the centuries remained almost unchanged until the 1950s. Numerous scientific studies have also shown that the Mediterranean Diet is an healthy diet that helps to prevent the main chronic diseases such as cardiovascular diseases, diabetes, bulimia and obesity and thanks to the antioxidant power of olive oil combined with vegetables consumption, an important means of cancer prevention. The aim of our study was to investigate the knowledge and the adherence to the Mediterranean diet of young people living in the Mediterranean area.

MATERIALS AND METHODS

The survey was carried out by administering a web-based anonymous questionnaire from March to May 2019 to Italian young people. In this survey we asked for socio-economic conditions, knowledge, awareness and adherence to the Mediterranean diet (through the KIDMED test) both in childhood and at present time. Parental educational status and family income were used as indicators of socio-economic status (SES).

RESULT

The sample was made up by 507 Italian young people between the ages of 17 and 35 (123 males and 384 females), with an average age of 22.88 years (DS 7.02). Only 11.4% knew the Mediterranean diet. During childhood 70.8% of respondents had breakfast and 58% ate fruit and vegetables daily. Today they have maintained the correct eating habits, in fact, 71.2% had breakfast, 60.2% ate fruit and 64.7% ate vegetables. In addition, only 48.3% eat fish and the majority of respondents consume carbohydrates (76.9%). To a lesser extent they consume junk foods like candy and various snacks (18.1%) or fast food meals (9.1%). Moreover, we asked for physical activity and we found that 48.9% did it. We found age, exercise and sex high significant variables (p<0.01). Higher adherence to MD was found in older interviewees.

CONCLUSION

Our study we found high knowledge to a Mediterranean diet into 90.5% of the sample and poor adherence into 23.5% of them, medium into 53.4% while higher only in 23.1% of the interviewees. Lower adherence was found among those who do not engage in physical activity and the two regressor with higher weight on the adherence to MD were "eat at home "and "eat fruit and vegetables". Furthermore, in our sample more increased the age more increased adherence to traditional diet models.

Definition of a novel vaccination pathway in PLWHA: experience of a Southern University Hospital

Background

At the end of 2018 across the globe there are ∼37.9 million people with HIV/AIDS also thanks to the use of HAART which led to an increase in life expectancy. The Italy Immunization Plan 2017-19 recommend vaccines to these patients but a protocol still isn't present. Moreover, despite the availability of effective vaccines, coverage remained very low for many reasons including problems with privacy. The objectives of this study were a) the appliance of a shared clinical pathway between the “Immunization Center of Hospital Hygiene Operating Unit” and the “HIV/AIDS Disease Prevention, Diagnosis and Treatment Center of Infectious Diseases Operating Unit” b) the increase in vaccination coverage and the evaluation of side effects.

Methods

A prospective study was conducted from Oct 2019 to Feb 2020 at the G. Martino University Hospital of Messina. In particular, of the 138 patients followed by the Infectious Diseases OU, after evaluation of their immune status, 62% were enrolled in this study. Following the acquisition of informed consent, we collected socio-anagraphical data and we started the free administration of vaccines by providing an hoc calendar in the Immunization Center. Statistical analysis was performed with R software.

Results

The sample was represented by 86 patients (74% males and 26% females, 21% foreigners and 79% Italian, mean age=40±13.6 SD). We didn't observe drop out and no differences were observed for local/systemic AEs generally reported. We obtained an increase of vaccination coverage with a total of 74 doses administered for flu (+164%) and 240 for other vaccines (+172%). In particular, we immunized a total of 74% of patients for HPV (2% in 2018), 42% for HAV (28% in 2018), 37% for HBV (28% in 2018), 58% for pneumococcal (21% in 2018), 54% for meningococcal ACWY and B (0% in 2018).

Conclusions

The undertook clinical pathway showed the relevance of specific management of these patients and the need to increase the vaccination offer.

Key messages

The immunization in people living with HIV is priority to reduce the risk of infectious disease. It’s important to implement a shared clinical pathway to increase vaccination rates of these patients. The application of the protocol had an high impact in patients' adhesion to vaccination also thanks to the chance of accessing to the service in a comfortable setting and suitable to protect privacy.

The role of water distribution system in HCAIs

Introduction

The water distribution system in hospitals may constitute a source of healthcare-associated infections. Understanding the means of acquisition, sources and reservoirs of nosocomial pathogens is crucial for developing methods to reduce the incidence of nosocomial infections. The aim of our study was to evaluate the microbiological contamination by Pseudomonas aeruginosa in the water system of the University Hospital “G. Martino” in Messina over a period of nine years, in order to a) clarify possible relationship between the presence of aerators and contamination, b) to highlight the presence of a yearly variation and c) to verify the statistical difference between microbiological contamination of taps with and without filters.

Materials and

Methods

We carried out a retrospective study for nine year through the collection of water samples that were analysed for total bacteria count and Pseudomonas aeruginosa. The differences between the results recorded over the nine-year study period were evaluated using variance analysis. P values of &lt; 0.05 were considered statistically significant. Software R was used for statistical assessment.

Results

We analysed a total of 6168 samples with a positive rate of 9.31% and a decreasing trend over the nine years to a value of 2.44% (p &lt; 0.001), due to the elimination of the aerators of taps without filters and also to the introduction of filters in taps of high-risk wards and surgical rooms. We found statistical difference between taps with or without filter (p &lt; 0.001) and a higher positive rate during the summer season compared to the other months. Also, an increase of the positivity rate was detected in some year due to the lack of monthly replacement of the filter.

Conclusions

These results reveal a high level of contamination of taps by opportunistic bacteria with severe implications especially for high-risk settings and therefore, the need to improve the management of these devices.

Key messages

Particular attention must be reserved to the water distribution systems in hospitals in order to prevent the spread of healthcare associated infections. The continued application and strengthening of guidelines and procedures is essential to limit the spread of multidrug resistant pathogens.

Pregnant women and risk factors: a cross-sectional study

Background

Many investigations have shown the important role played by risk factors such as tobacco and alcohol in the development of congenital anomalies.

Methods

Through the administration of an hoc questionnaire, we evaluated the attitude towards smoking and alcohol of a sample of 200 pregnant women at the University Hospital of Messina. The questionnaire was structured to collect information about socio-demographic characteristics, type of gynaecological assistance and their lifestyles (smoking and alcohol). Statistical analysis was performed using version 10 of StatSoftVR software.

Results

14% of the women continued to smoke despite pregnancy; the majority of these were young adults, divorced, employed and with a high educational level. Correlating the smoking habit with the socio-demographic characteristics of the studied women, we found a statistically significant difference for the marital status, with a higher number of smokers among the single women (p &lt; 0.05).Moreover, we found a statistically significant difference also for the profession with a higher number of smokers in the worker women (p &lt; 0.05). About the drinking habit, the 4.3% declared to be moderate drinkers (occasional use of alcohol equal to 2-3 glasses a week) despite pregnancy, the 34.4% stated they do not drink alcohol during pregnancy and the 56% stated do not usually drink alcohol. Particularly, about the drinkers' socio-demographic characteristics, the 50% of them were 24-25 years old and the 75% were married. About the type of alcoholic beverages consumed, 86% stated they usually drink bier during the weekend.

Conclusions

Our study shows that the awareness of the women about the importance of these risk factors is still rather poor. In order to improve the awareness of pregnant women on the importance of avoiding these risk factors and prevent CAs, health education campaigns at various levels surely represent the public health cornerstone.

Key messages

In our sample 14% of the pregnant women continued to smoke and 4.3% to drink despite pregnancy and they generally were young or young adults and with a high educational level. Our results highlight the importance of continuous health education about the risk to smoke and drink during pregnancy.

Risk perception, knowledge, prevention, information sources and efficacy beliefs related to Covid-19

Background

Sars-Cov-2 is one of the latest examples of an emerging infectious disease challenging the world and it is the third case, in just two decades, of “spillover”. In light of the recent outbreak (Italy is in 2nd position), it is important to evaluate people risk perception and to support the Health Authority with effective communicative actions to avoid the spread of “infodemia”/alarmism. The aim of this study is a) to study levels of perceived threat, risk perception, severity and comparative vulnerability b) to compare risk perception with other communicable/not communicable diseases; c) provide information to increase awareness/ knowledge of the disease.

Methods

We performed an Italian multicentre study from 11 February 2020 and it is still in progress. The subjects in study (general population, HCWs and university students) were enrolled through the administration of a standardized questionnaire based on Health Belief Model through CAPI and CAWI methods. The summary and inferential statistical analyses will be carried out using the R software.

Results

We enrolled 2495 people from 11 February until 4 March 2020. All the respondents had heard of COVID19. Only 2% didn't know any symptoms and 3% answered to all the questions correctly (mean knowledge score of 13). 48% thought that he/she could acquired COVID 19 in the next 12 months and 70% stated that their concern of the disease was high(score5). Perceived capability to avoid it was rated as good/very good by 62%. The correct mask use (WHO) was reported by 64% of the sample and 47% stated all preventive actions (2% no one). Only 22% of the sample stated all actions to be taken in case of suspected acquisition of COVID19.

Conclusions

Italy is facing an epidemic that could have the potential to affect the entire national health system. It's so important to implement public health activities and surveillance systems in order to limit the spread of the disease and bad/disinformation.

Key messages

This study is the first to report on public perception of Sars-Cov-2 in all the Italy. The results indicated that the Italian population is aware of the outbreak and it is concerned about their risk. On the other hand, only half of the sample is aware about all preventive actions and not everybody knows all procedures to be taken in case of COVID 19 suspect.

The role of the hospital environment in the healthcare-associated infections: a general review of the literature

Healthcare-associated infections (HAIs) are one of the most relevant public health problems worldwide. The role of the hospital environment as a reservoir of pathogens causing HAIs is still debated. These pathogens are common in several hospital environments, where they are able to persist from hours to months and their circulation is favored by healthcare workers (HCWs). Hospital surfaces at close contact with patients such as bed bars and header, bedside table, taps, and handles in wards ("high-touched surfaces"), are considered easily contaminable and at risk to transfer pathogens to patients. However, some studies showed the possible role played by "non-classical" surfaces such as healthcare workers' (HCWs) mobile phones and personal computers as well as oxygen humidifiers and protective lead garments used in operating rooms. HCWs' hands play a fundamental role in patient-to-patient transmission by touching contaminated surfaces or patients during care activities. The aim of this review is to evaluate the role of the hospital environment in the transmission of nosocomial pathogens, focusing on single pathogens causing HAIs and the importance of hospital surfaces as reservoirs.

Nine years of microbiological air monitoring in the operating theatres of a university hospital in Southern Italy

INTRODUCTION

Surgical site infections are among the most frequent Health Care Associated Infections with severe impact on mortality and high economic costs; the role of air microbiological contamination in surgical site infections was amply discussed in the scientific literature, highlighting differences in air contamination rates between different ventilation systems, number of people present and door opening rates.

MATERIAL AND METHODS

The aim of our study was to monitor the presence of bacterial air contamination in operating theaters and its relationship with number of people and type of airflow over a period of nine years (January 2010-November 2018) at Messina's University Hospital. The Rho of Spearman test was used to evaluate differences in microbial contamination between empty and working theaters. The impact of the number of people on colony-forming unit values was assessed by performing a stepwise multiple regression analysis. The differences between the results recorded over the nine-year study period were evaluated using the variance analysis. Software R was used for the statistical assessment.

RESULTS

Air samples were taken in each operating theater over nine years. A total of 1,425 samples were collected with a positivity rate of 37.3%. The median bacterial contamination rate was 30 cfu/m3 in empty theaters, while this rate was significantly higher (P < 0.001) in working theaters, where it reached 85 cfu/m3. A statistically significant difference was identified between laminar and turbulent airflow systems, with higher bacterial contamination rates with the latter (p<0.001); in these cases, the value of bacterial contamination (microbial count) was higher in the presence of a higher number of individuals in the operating theater (p<0.001).

CONCLUSION

Our study demonstrates the complexity of the Operating Theatres environment, in which a good ventilation system is, indeed, only one prerequisite for clean air, but other factors, such as the behavior of healthcare professionals and environmental conditions, can influenced the bacterial count.

Perception of rubella risk in pregnancy: an epidemiological survey on a sample of pregnant women

BACKGROUND

Rubella is a common exanthematous viral disease all over the world. The disease can be prevented by administering a safe and effective vaccine, and in Italy it is subject to reporting obligations. A national plan for the elimination of measles and congenital rubella (in Italian "PNEMoRC") was approved in 2003 and updated in 2010. This plan originally aimed at reducing the susceptible target population (women in fertile age, 15-49 years old) to below 5% and at eliminating the congenital form of rubella by 2015, a goal which has not been achieved yet.

STUDY DESIGN

Our research work was focused on a convenience sample of pregnant women attending the antenatal classes at the two main hospitals in Messina, Sicily (Italy).

METHODS

After we obtained an informed consent, we administered to 200 Italian and foreign pregnant women an anonymous questionnaire reporting socio-demographic characteristics, type of gynaecological assistance and information received about Rubella serological statu.

RESULTS

The mean age was 30.6 years ± 5.45. The majority of these women were married, at work and with a high educational level. Most of them (75.3%) reported to be assisted by a private gynaecologist, while only 24.7% used a public facility. A remarkable percentage (62.8%) of these women reported to be serologically negative at the anti-rubella antibodies test, but, only 7.5% of them reported to have passed the anti-rubella antibody test before the conception.

CONCLUSION

Our results clearly show that we are still far from achieving the elimination of rubella risk in pregnancy. We are facing a cultural gap perhaps also due to a generalized loss of "historical memory" about the impact that infectious diseases have had in the past in terms of mortality and morbidity. In fact, alongside the considerable drop in vaccination coverage in the recent years, our research also reveals a reduced focus on pre-conceptional testing and limited awareness of associated risks. Furthermore, we correlated the serological status with the sociodemographic characteristics of these women and found a statistically significant correlation with their age and their educational level (P<0.05). A lot still needs to be done to improve the situation; in particular, better education at various levels could considerably increase the awareness among women about this relevant public health issue.

Evaluation of Vaccination Coverages in the Health Care Workers of a University Hospital in Southern Italy

INTRODUCTION

An adequate immunization of the health care workers is essential for infection prevention and control, to avoid consequences not only for them, but for all patients that the health care workers could infect causing serious damage and / or death. Unfortunately, to date, despite the presence of international and national guidelines (Law Decree 119/2017), the vaccination coverage was low, also because of the "vaccine hesitancy" spread among the same health care workers. In light of the above, the aim of our study was to investigate the vaccination coverage of healthcare workers of all the operational units present in our hospital and to evaluate differences between sex, age, professional profile and area of work.

MATERIALS AND METHODS

A study was conducted from March to June 2018 to investigate the vaccination coverage of healthcare workers at the University hospital "G. Martino" of Messina; data were collected using a self-completion questionnaire based on Attachment 3 of Ministerial Circular 25233 of 18 August 2017. We verified any possible association between physicians and pediatricians and between age classes by the chi square method. Also, a logistic regression was used for each vaccination, considering the vaccination as the variable and the following covariates: type of operative unit, sex, age and area) in order to predict the probability of vaccination.

RESULTS

We analyzed a sample of 822 health care workers (324 males and 498 females with an age of 49.5 ± 10.5 SD). The sample was made up of physicians (36%), nurses (21%) and other professional categories (43%). Analyzing the data we obtained vaccination coverages lower than the target required to guarantee "herd immunity"; higher vaccination coverages were found for females, physicians and the clinical area and - for influenza vaccination - in the older age groups and - for all the other vaccinations - in the younger groups.

CONCLUSION

Data analysis revealed a lax attitude towards vaccinations by health care workers and the need for measures aimed at increasing vaccination their coverage to prevent them from becoming a source of dangerous outbreaks.

An observational study of university students of healthcare area: knowledge, attitudes and behaviour towards vaccinations

INTRODUCTION

Despite vaccines are the most successful public health interventions for prevention of infectious diseases "vaccine hesitancy" spreads today across the world. Despite attitudes of future generations of HCWs is fundamental, these aren't much analysed in the literature. The aim of our research was a) to evaluate attitudes and behaviours reported towards vaccinations among a sample of university students in the health area, b) to know their vaccination status and intention to get vaccines and c) investigate their propensity to vaccinate (who and with which vaccines).

MATERIALS AND METHODS

We evaluated a sample of university students of the health area of University of Messina through an anonymous face to face questionnaires based on HProimmune survey appropriately modified, analysing presence of statistical difference between gender. All analyses were carried out using EPI INFO software.

RESULTS

Our study showed a general lack of confidence and insecurity towards vaccination by future HCWs and absent perception of the risk of acquire a vaccine preventable disease as they also demonstrate low vaccination coverage in our sample. Their opinion about awareness of recommended vaccines for HCWs also was low, however, they thought that vaccinations should be a prerequisite for healthcare professionals to work in healthcare area. Also, we observed that 96% of respondents would recommend vaccinations to their patients, with a greater propensity of women.

CONCLUSIONS

The motivations of vaccine hesitancy are many and maybe other studies would help policymakers and stake-holders to shape programs to improve vaccination coverage among students and HCWs.

The evolution of vaccines for early childhood: the MMRV

Measles, mumps, rubella and varicella vaccines have greatly reduced the incidence of these four childhood diseases, which in the past caused a considerable burden of morbidity and lethality to the population. Vaccines against MMR, varicella and a tetravalent MMRV vaccine are currently available on the market to provide immunization against measles-mumps-rubella and varicella. A recently passed Italian Law (L 119/2017) on vaccinations increased the number of free of charge but compulsory vaccinations from four to ten, including MMR and varicella, as a requirement for admission to nursery schools and kindergartens; fines may be levied for non compliance, in the attempt to increase vaccination coverage. The Italian National Immunization Program 2017-19 allows immunization to be administered either by: the trivalent anti-measles-mumps-rubella plus the monovalent anti-varicella vaccine, administered in different anatomic sites at the same session, or by a quadrivalent MMRV combined vaccine.

A multicentre study on epidemiology and prevention of needle stick injuries among students of nursing schools

INTRODUCTION

Among the health professions with a long period of training, the students of the Nursing Bachelor's Degree are the most exposed to biological risk resulting from accidents, in particular with needles and cutting edges. The aim of the study was to estimate the frequency and the circumstances for the occurrence of needle stick injuries, as a knowledge base for targeted prevention interventions.

METHODS

The study was carried out between May and July 2017 in 11 Universities in Italy and 1 in Albania (associated with the "Tor Vergata" University of Rome). An anonymous semi-structured questionnaire was proposed to 1st (second semester), 2nd and 3rd year students of Nursing Bachelor's Degree.

RESULTS

A total of 2742 questionnaires were collected. The average age of participants was 22.9 years (median 22, range 19-60 years), 73% of whom were females. A total of 381 injuries were reported. Three hundred and sixteen students (11.8%) underwent at least 1 injury (12.7% among females, 9.7% among males); 41 students declared two or more injuries; four students did not report the number of injuries occurred. The first injury occurred, as an average, 17 days after the start of the internship (median 15 days) and, in 25% of the cases, during the first 9 days. The highest percentage of accidents occurred during the first internship (25.3% of the total) and decreased with the progress of the training path. The injuries occurred in 38% of cases during drug preparation, 24% when disposing of sharp devices, 15% while re-capping needles, 13% during blood sampling and 10% in other circumstances. In 51.2% of cases, the needle was not sterile. Among the nursing students who suffered a needle stick injury, 58.1% declared that they had performed the post-exposure prophylaxis. 96% of students stated to be vaccinated against Hepatitis B virus. Amongst the students who had their serological status checked (74%), 18% stated the antibody titre was not protective. 49.8% of students answered to have been trained in advance on the correct procedures to avoid needle stick and cutting edges injuries in each clinical ward attended, 41.2% referred that this occurred only in some wards and 10% in no ward at all.

CONCLUSION

The results of this study show a high percentage of needle stick injuries in students of the Nursing Bachelor's Degree. Therefore, there is a need for careful reflection on the most effective methods of targeted training acquisition of knowledge, skills and behavioural models useful for the exercise of the profession.

Knowledge, experiences, and attitudes toward Mantoux test among medical and health professional students in Italy: a cross-sectional study

BACKGROUND

The World Health Organization's Action Framework for tuberculosis elimination in low-tuberculosis incidence countries includes the screening for active and latent tuberculosis in selected high-risk groups, including health care workers. In this context, medical and health profession students, exposed to nosocomial tuberculosis transmission during training and clinical rotations, are target populations for tuberculosis screening. No updated data are available on tuberculosis screening practice and knowledge of medical and health profession students in Italy.

METHODS

Within the activities Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health, we carried out a multicentre cross-sectional study to assess knowledge, attitude and practices on tuberculosis prevention and control among Medical, Dentistry, Nursing and other health professions' students. Students were enrolled in the study on a voluntary basis and were administered a previously piloted structured questionnaire. Logistic regression models were applied to explore knowledge on tuberculosis prevention by selected socio-demographic variables and University-based tuberculosis prevention practice.

RESULTS

Students of seventeen Universities across Italy participated in the study, and 58.2% of them received compulsory tuberculin skin test either at enrollment or while attending clinical practice. A total of 5,209 students filled the questionnaire. 37.7% were medicine and dentistry students (Group 1), 44.9% were nursing students (Group 2) and 17.4% were other health professions' students (Group 3). Age and gender had different distributions by groups, as well as knowledge and practice on tuberculin skin test. 84.4% of the study population (95% CI = 83.3-85.3) was aware of the existence of the tuberculin skin test, 74.4% (95% CI = 73.2-75.6) knew what is the first-level screening test for latent tuberculosis and only 22.5% (95% CI = 21.4-23.6) knew how to proceed after a positive tuberculin skin test result. Overall, knowledge on tuberculosis prevention was higher in Group 2 and lower Group 3, as compared to Group 1.

CONCLUSION

In Italy, the knowledge on tuberculosis screening among University students is generally good. To reduce some of the criticalities found among the different study courses, it would be appropriate to harmonize both the regulations on tuberculosis screening practices for admission to University courses, and the educational activities on the topic of tuberculosis, to be extended to all workers involved in health care setting.

Epidemiology of intensive care unit-acquired sepsis in Italy: results of the SPIN-UTI network

BACKGROUND

Sepsis is the major cause of mortality from any infectious disease worldwide. Sepsis may be the result of a healthcare associated infection (HAI): the most frequent adverse events during care delivery especially in Intensive Care Units (ICUs). The main aim of the present study was to describe the epidemiology of ICU-acquired sepsis and related outcomes among patients enrolled in the framework of the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project.

STUDY DESIGN

Prospective multicenter study.

METHODS

The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance.

RESULTS

During the five editions of the SPIN-UTI project, from 2008 to 2017, 47.0% of HAIs has led to sepsis in 832 patients. Overall, 57.0% episodes were classified as sepsis, 20.5% as severe sepsis and 22.5% as septic shock. The most common isolated microorganisms from sepsis episodes were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. The case fatality rate increased with the severity of sepsis and the mean length of ICU-stay was significantly higher in patients with ICU-acquired sepsis than in patients without.

CONCLUSION

Our study provides evidence that ICU-acquired sepsis occurs frequently in Italian ICU patients and is associated with a high case fatality rate and increased length of stay. However, in order to explain these findings further analyses are needed in this population of ICU patients.

Effects of aerators, filters and chlorination on contamination of water samples: a nine years study in a Southern University Hospital

OBJECTIVES

The aim of our study was to evaluate the microbiological contamination by Pseudomonas aeruginosa in the water system of the University Hospital "G. Martino" in Messina over a period of nine years, in order to a) clarify possible relationship between the presence of aerators and contamination, b) to highlight the presence of a yearly variation and c) to verify the statistical difference between microbiological contamination of taps with and without filters.

MATERIAL AND METHODS

We carried out our study between January 2010 and December 2018 through the collection of water samples that were analysed for total bacteria count and Pseudomonas aeruginosa. The differences between the results recorded over the nine-year study period were evaluated using variance analysis. P values of <0.05 were considered statistically significant. Software R was used for statistical assessment.

RESULTS

We analysed a total of 6168 samples with a positive rate of 9.31% and a decreasing trend over the years to a value of 2.44% (p<0.001), due to the elimination of the aerators of taps without filters and also to the introduction of filters in taps of high-risk wards and surgical rooms. We found statistical difference between taps with or without filter (p<0.001) and a higher positive rate during the summer season compared to the other months.

CONCLUSIONS

These results reveal a high level of contamination of taps by opportunistic bacteria with severe implications especially for high-risk settings and therefore, the need to improve the management of these devices.

Drug-resistant bacteria on hands of healthcare workers and in the patient area: an environmental survey in Southern Italy's hospital

OBJECTIVE

Drug-resistant bacteria on hands of healthcare workers and in the patient area: an environmental survey in Southern Italy's hospital.

METHODS

The study was conducted from June 2017 to May 2018 using contact slides for surfaces and active sampling for air. We used automated biochemical methods to identify microorganisms; antibiograms were performed in compliance with the EUCAST expert rules.

RESULTS

We analyzed 3,760 samples, 16.17% were found positive and 34 % of these were antimicrobial-resistant. On analyzing the isolated Staphylococci, 39% were multidrug-resistant and 5% extensively drug-resistant. A 30% of the Enterococcus faecalis isolates were resistant to gentamycin and vancomycin. We found Klebsiella pneumoniae isolates resistant to ceftriaxone, cefoxitin, mecillinam and imipenem. A 7% and 8% of the Acinetobacter baumannii and Pseudomonas aeruginosa isolates, respectively, were resistant to gentamicin, imipenem, and ceftazidime.

CONCLUSIONS

These findings are in line with the international literature, confirming that antimicrobial resistance is also steadily growing in Italy with rates varied for the different pathogens.

"Clean care is safer care": correct handwashing in the prevention of healthcare associated infections

BACKGROUND

In 2005, WHO developed the campaign "Clean care is safer care", aiming at the reduction of Healthcare Associated Infections (HCAI) through the worldwide promotion of appropriate hand hygiene practices. Adherence to these practices presently ranges from 5 to 81% (average 40%).

METHODS

Aim of the study was the evaluation of healthcare workers (HCWs) adherence to the application of WHO guidelines on the hand hygiene and the possible impact on HCAI reduction. First, some wards at highest HCAI risk were identified. Then, direct observational survey was conducted to evaluate the behaviour of the different HCW categories.

RESULTS

Six-hundred-twenty-eight HCWs were observed: 519 nurses (68 in training), 109 physicians (63 in training). Survey analysis highlighted that compliance with handwashing was higher in post care practices (59.6%) than before (55.1%). Some HCWs performed handwashing in both cases. Only in 30.6% of cases HCWs observed the handwashing technique suggested by the guidelines. In 70.4% they wore gloves during procedures in which it was possible to have contact with potentially infectious material, but they did not change them before caring for a new patient in 64% of cases.

CONCLUSIONS

The survey confirms the international data, showing a low compliance with hand hygiene practices by the HCWs and the need to promote a correct handwashing based on respect of the international guidelines.

An evaluation of attitude toward vaccines among healthcare workers of a University Hospital in Southern Italy

BACKGROUND

Vaccination is an effective and safe health technology. Despite this vaccine coverage falls short of national and international targets. Study design. The aim of the study was to evaluate the views of medical staff at Messina University Hospital regarding vaccinations, their current and future vaccination status and whether they recommend it to their patients.

METHODS

The study was conducted from April 2016 to March 2017 by an anonymous face-to-face questionnaire submitted to HCWs.

RESULTS

A general lack of confidence and insecurity about vaccination was shown by a substantial proportion of physicians analyzed while pediatricians showed a positive attitude to vaccines. However, many physicians had not been immunized with the recommended vaccines for HCWs and therefore represent a potential source of infection for both patients and the general population.

CONCLUSIONS

Despite the evidence of the effectiveness and safety of vaccines, compliance by HCWs remains very low for a variety of reasons. A range of measures are therefore needed to ensure their use, not only by the general population, but also by doctors who should be their major promoters.

Attitudes towards compulsory vaccination in Italy: Results from the NAVIDAD multicentre study

BACKGROUND

Vaccine hesitancy is a considerable issue in European countries and leads to low coverage rates. After a long debate, Italy has made vaccination mandatory for admission to its schools.

METHODS

In the NAVIDAD study (a cross-sectional multicentre study), a 63-item questionnaire was administered to 1820 pregnant women from 15 Italian cities. The questionnaire assessed the interviewee's opinion on mandatory vaccines, as well as their socioeconomic status, sources of information about vaccines, confidence in the Italian National Healthcare Service (NHS), and intention to vaccinate their newborn.

RESULTS

Information sources play a key role in determining the opinion on restoration of mandatory vaccines; in particular, women who obtained information from anti-vaccination movements are less likely to accept the vaccines (OR: 0.35, 95% CI: 0.21-0.58, p < 0.001). Women who had confidence in healthcare professional information agreed more on mandatory vaccination than did the other women (OR: 2.66, 95% CI: 1.62-4.36, p < 0.001); those who perceived that healthcare professionals have economic interest in child immunization and who declared that healthcare providers inform only on vaccinations benefits not on risks were less likely to agree on compulsory vaccination (OR: 0.66, CI 95%: 0.46-0.96, p = 0.03; OR: 0.66, CI 95%: 0.46-0.95, p = 0.03, respectively).

CONCLUSION

Information sources and confidence towards health professionals are the main determinants of acceptance of mandatory vaccine restoration. To increase the acceptability of the restoration and reduce vaccine hesitancy, these aspects need to be strengthened.

Surveillance of microbiological contamination and correct use of protective lead garments

BACKGROUND

Healthcare associated infections are an important threat of Public Health. Several studies investigated the possible role played by the hospital environment in the transmission of nosocomial pathogens. In addition to the "classic" nosocomial surfaces, some researches focused their attention on "alternative" surfaces. Little is known about the protective lead garments used in operating rooms.

STUDY DESIGN

This study was conducted in three phases to investigate the microbiological contamination and the normal use of these garments. In the first step, we administered a questionnaire to know the frequency and the type of sanitation. Then, in the second step, we conducted the microbiological samplings and, finally, in the third step, we carried out a surveillance on the use of these garments during the surgical procedures.

METHODS

In the first step, we administered the questionnaire through direct interview. For microbiological sampling we used sterile swabs, the normal growth media and the API Identification System (bioMérieux).

RESULTS

The study showed that the garments are sanitized only in 66.7% of the cases with a non-defined frequency. Moreover, a bacterial contamination was found on 88 garments with a positivity of 80.7% and the units with the higher rate of contamination were Urology, Orthopedics, Neuroradiology and Intensive Cardiac Care. Finally, 100% of the surgical team members wore sterile disposable shirts above the protective lead garments while this was never true for the rest of the nursing and anaesthesia team.

CONCLUSIONS

To prevent the contamination of these garments, it is important to develop appropriate sanitation procedures and to store them in special cabinets also subjected to sanitation. Finally, it is necessary to focus on the correct use of the protective lead garments.

Humidifiers for oxygen therapy: what risk for reusable and disposable devices?

INTRODUCTION

Nosocomial pneumonia accounts for the vast majority of healthcare-associated infections (HAI). Although numerous medical devices have been discussed as potential vehicles for microorganisms, very little is known about the role played by oxygen humidifiers as potential sources of nosocomial pathogens. The purpose of this research was to evaluate the safety of the reuse of humidifiers by analysing the rate of microbial contamination in reusable and disposable oxygen humidifiers used during therapy, and then discuss their potential role in the transmission of respiratory pathogens.

METHODS

Water samples from reusable and disposable oxygen humidifiers were collected from different wards of the University Hospital of Messina, Italy, where nosocomial pneumonia has a higher incidence rate due to the "critical" clinical conditions of inpatients. In particular, we monitored the Internal Medicine and Pulmonology wards for the medical area; the General Surgery and Thoracic and Cardiovascular Surgery wards for the surgical area and the Intensive Care Unit and Neonatal Intensive Care Unit for the emergency area. The samples were always collected after a period of 5 days from initial use for both types of humidifiers. Samples were processed using standard bacteriological techniques and microbial colonies were identified using manual and automated methods.

RESULTS

High rates of microbial contamination were observed in samples from reusable oxygen humidifiers employed in medical (83%), surgical (77%) and emergency (50%) areas. The most relevant pathogens were Pseudomonas aeruginosa, amongst the Gram-negative bacteria, and Staphylococcus aureus, amongst the Gram-positive bacteria. Other pathogens were detected in lower percentage. The disposable oxygen humidifier samples showed no contamination.

CONCLUSIONS

This research presents evidence of the high rate and type of microbial contamination of reusable humidifiers employed for oxygen therapy. These devices may thus be involved in the transmission of potential pathogens. It could be important, for the prevention of nosocomial pneumonia, to replace them with singleuse humidifiers for which the absence of microbial contamination has been confirmed.

Management of two influenza vaccination campaign in health care workers of a university hospital in the south Italy

BACKGROUND

In Europe, flu remains one of the major public health problems. Healthcare workers (HCWs) are a category at high-risk of contracting the infection and infecting their patients; consequently, for this category, vaccination is highly recommended. Unfortuntely, coverage levels remain insufficient with rates ranging between 4 and 40.

STUDY DESIGN

The purpose of our work was to evaluate the adherence of HCWs to the influenza vaccination and to carry out a combination of educational and motivational interventions in order to increase the rate of adherence to the vaccination in this workers' category.

METHODS

We conducted two different influenza vaccination campaigns, 2014-2015 and 2015-2016. The study was divided in two steps. In the first, preliminary step, an anonymous questionnaire was administered to HCWs containing a set of questions in order to gain information about the number of subjects willing to undergo the vaccination and the reasons that led others toits rejection. In the second step, vaccination campaigns were carried out preparing an appropriate vaccination calendar that was communicated to all interested Units and vaccination points located in various wards.

RESULTS

We found a slightly improved compliance trend, from an average of 2.3% in the previous years to 3.3% in 2014 and 7.4% in 2015.

CONCLUSIONS

Despite the observed increase, the adherence remains very low. We found that the main causes of this result are the fear of adverse effects, the negligence and indolence of the same workers and a lack of risk perception of contracting the disease and transmitting it to patients. Our work stressed the importance of offering correct information and of meeting the needs of HCWs, often unable to leave their ward for the excess workload. This could be, in future years, one of the possible solutions to increase vaccination adherence.

Seroprevalence of hev antibodies in a sample of pregnant women in the city of Messina

BACKGROUND

Hepatitis E virus (HEV) is widespread in developing countries and the disease is also increasing in the developed ones. This infection in pregnancy can cause spontaneous abortion and neonatal death in 56% of newborns.

STUDY DESIGN

The study was conducted on a sample of 352 pregnant women, 326 Italian and 26 foreign, in order to confirm the presence of HEV in our territory, to analyze wrong habits of the population and to suggest preventive actions against the risk to contract the infection during pregnancy.

METHODS

We asked all women under study to fill an anonymous questionnaire immediately before taking a venous blood samples to determine the presence of anti-HEV antibodies. The questionnaire contained a set of questions to gain information about lifestyles and risk factors to contract HEV.

RESULTS

The questionnaire revealed that a portion of the tested women have risk behaviours, as consumption of raw or undercooked food, eating unwashed food and traveling to endemic areas. The percentage of women positive for HEV antibodies was 3.4%, in agreement with national data; all the women were Italian.

CONCLUSIONS

This study confirms the circulation of HEV in the city of Messina. For this reason, it is highly recommended to disseminate hygienic and appropriate behaviours and feeding habits in order to prevent the risk to contract the infection.

Response to anti-HBV vaccine and 10-year follow-up of antibody levels in healthcare workers

BACKGROUND

Despite improvements in public health and antiviral treatments, vaccination is still the most effective means of prevention of hepatitis B virus (HBV) infection. However, little is known about the duration of protection given by the anti-HBV vaccine. Healthcare workers represent a category at risk not only of contracting infection but also of being a source of contagion to patients.

OBJECTIVES

To assess individual responses to the anti-HBV vaccine and duration of protection 10 years after its administration in a cohort of healthcare workers employed by the University Hospital 'G. Martino' in Messina, Italy.

METHODS

One hundred and seventy medical staff who had been vaccinated following an incident carrying risk of HBV infection were included in this study. The group was followed over a 10-year period, and HBV antibody levels were assessed using an automated microparticle enzyme immunoassay.

RESULTS

Protective antibody levels (≥10 mIU/ml) were found in 65% of subjects who had completed the full vaccine schedule (three doses) and in 35% of subjects who had only received one or two doses of anti-HBV vaccine. Moreover, 10 years after vaccination, HBV antibody levels were inversely related to age at vaccination (P < 0.001). No differences were found between males and females.

CONCLUSIONS

This study, in line with the literature, shows the importance of completing the full vaccine schedule (three doses). Moreover, in order to have an effective and durable antibody response and avoid the risk of contracting HBV after an injury at work, it is important to recommend anti-HBV vaccination at a young age, ideally during childhood in accordance with the national vaccination policy.

Surveillance and evidence of contamination in hospital environment from meticillin and vancomycin-resistant microbial agents

INTRODUCTION

Direct contact is undoubtedly the main means of transmission of hospital infections. An investigative study was therefore conducted to assess workplace surfaces at risk from microbial contamination.

METHODS

The study was conducted using swabs and contact slides placed on the palms of healthcare workers during their routine patient care and on workplace surfaces (e.g. telephones, computers, medication trolleys, taps) in treatment rooms, operating theatres and wards. Disposable swabs were used for rapid screening and read with a bioluminometer. At the same time, a sample was taken from those testing positive using a contact slide. The samples testing positive for Staphylococci underwent identification to assess resistance to meticillin-resistant Staphylococcus aureus (MRS/MRSA) and to vancomycin (VISA/VRSA).

RESULTS

Meticillin-resistant Staphylococcus strains were found on 14.7% (20/136) of samples taken from the hands of workers and 35.7% (15/42) of those from hospital surfaces. An even higher resistance to meticillin and/or vancomycin than that found for S. aureus was identified in nosocomial strains of coagulase negative staphylococci, including S. epidermidis and S. haemolyticus.

CONCLUSION

The study concludes that there is thus a need for greater care in complying with procedures designed and support for surveillance to reduce the risk of infection.

Hepatitis E virus (HEV) in sewage from treatment plants of Messina University Hospital and of Messina City Council

Samples of sewage from treatment plants at the "G. Martino" University Hospital of Messina (AOU) and that of Messina City Council were analysed to detect the hepatits E virus. Samples were taken on sewage entering and exiting the treatment plants on a monthly basis over a one-year period from both the hospital plant (24 samples) and the municipal plant (22 samples). All sewage samples were pretreated by ultrafiltraton and concentration and finally processed by the PCR method to amplify gene material. A total of three samples tested positive: two (8.33%) entering the AOU treatment plant and one (4.5%) entering the municipal plant while no cases of HEV were detected in samples of treated sewage. These findings confirm the presence of the virus in the city of Messina and showed that the two treatment plants to be working efficiently when tested.

Eliminating congenital rubella: a seroepidemiological study on women of childbearing age and MMR vaccine coverage in newborns

INTRODUCTION

Rubella can have particularly serious effects on the product of conception if contracted during pregnancy. Thus, the main aim of rubella vaccination programmes is to prevent infection during pregnancy.

MATERIALS AND METHODS

A seroepidemiological study was conducted from July 2006 to December 2007 on 1000 women of childbearing age, 15 to 45 years old, using specific rubivirus antibody assays, IgG and IgM. A questionnaire administered at the same time allowed us to survey how much women knew about this disease. In addition, MMR vaccine coverage rates were analysed for cohorts born in the local health districts of Messina for the period 1993-2006.

RESULTS

An analysis of the replies given to the questionnaire showed an estimated 42.8% of the women to have immunity from rubella, while the serological study showed an immunity coverage rate of80.6%. Vaccination coverage in the local health districts regarding the first dose of MMR was 81% (cohorts 1993-2005), while the rate was only 24% for the second dose (cohorts 1993-2002).

CONCLUSIONS

Both immunity coverage in women of childbearing age and that for newborns (for the cohort considered)fall below the 95% target set by the National Elimination Plan for Measles and Congenital Rubella (PNEM). It is therefore necessary to provide women with adequate information about the risks of rubella during pregnancy and about the benefits of vaccination, as well as to recoup subjects at risk or those whose immune status is unknown. Public health authorities also need to make continued efforts to increase the number of MMR vaccinations throughout the region.

Comparison between a conventional subunit vaccine and the MF59-adjuvanted subunit influenza vaccine in the elderly: an evaluation of the safety, tolerability and immunogenicity

The objective of this study was to evaluate and compare the safety, tolerability and immunogenicity for two seasonal influenza subunit vaccines, one with MF59 adjuvant (Fluad) and one without an adjuvant (Agrippal). A total of 195 subjects aged > or = 65 years were enrolled to receive one dose of vaccine intramuscularly, 96 were vaccinated with Fluad, 99 received Agrippal. Blood samples were taken from all subjects in order to assess their antibody titre by the haemagglutination inhibition assay (HI), before (Time 0) and after (Time 1: 28 +/- 7 days) vaccination, against the A/H3N2 (A/Moscow/10/99), A/H1N1 (A/New Caledonia/20/99) and B/Shandong/7/97 antigens contained in the influenza vaccine in the 2002/2003 influenza season for the northern hemisphere. A good humoral antibody response was detected for both vaccines, meeting all the criteria of EMEA. The number of subjects in whom > or = 4-fold increase in antibody titre was recorded, in comparison with the pre-vaccination value, proved to be lower in the group vaccinated with AgrippaPl than in those vaccinated with the adjuvated preparation. Fluad" exhibited better immunogenicity than Agrippal. This difference was probably linked to the potentiated immune stimulation exerted by the adjuvant molecules. These results take on a particular importance if we consider that the immune system is weaker in the elderly; the administration of an adjuvated vaccine in such subjects is clearly preferable in that it provides greater and more prolonged protection. Both vaccines were generally well tolerated; no severe adverse events occurred in any of the subjects vaccinated, confirming the excellent safety profile of Fluad and Agrippal.

Identification of the microorganisms responsible for periodontopathy by Multiplex RT-PCR

The aim of our research was to identify by bacterial genomic DNA analysis the prevalence of five different species of periodontopathogenic bacteria present in the subgingival biofilm, specifically: Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Bacterioides forsytus (Bf), Treponema denticola (Td). For the analysis we used the systematic Multiplex-PCR-microdent kit with species-specific primers. We studied a group of 48 subjects, 18 males and 30 females, from 18 to 78 years of age. The initial clinical screening enabled us to select, among the group analysed, 24 subjects with signs of active periodontopathy (Group A) and 24 patients without identifiable clinical evidence of the disease used as the control group (Group B). Within the two experimental groups (A and B), the test was found to be positive in 75% of subjects from group A, whereas the test was found to be negative in all the subjects from group B. Our research shows that the Multiplex-PCR system is reliable. Furthermore, the sensitivity and simplicity of this technique, as well as the decrease in working times and the possibility of identifying non-culturable bacteria, since the presence of viable organisms is not essential, make this technique indicated for the simultaneous identification of periodontopathogenic bacteria and might, in perspective, provide a more effective clinical alternative to the techniques of bacterial typing of the subgingival plaque.

Study on hepatitis B and C serologic status among municipal solid waste workers in Messina (Italy)

A study on hepatitis B and C virus seroprevalence was carried out on blood samples from 327 municipal solid waste workers in Messina (Italy) to verify the hypothesis that this category of workers is at high risk for such diseases. The fact that 32.41% of all the subjects showed previous exposure to hepatitis B virus (HBV) substantiates the need to proceed with compulsory HBV vaccine prophylaxis in this category of workers, also in anticipation of possible medical legal litigations.

[Retrospective survey on epidemiologic monitoring of accidents due to professional exposure to biological agents in A.O.U. "G. Martino" of Messina, Italy)]

The management of healthcare professionals exposed to biological material which may potentially be contaminated with HIV HBVand HCV viruses, is of vital importance in acquiring precise epidemiological data regarding the type and means of exposure, and the efficacy or failure to apply recommended preventive measures. This will make it possible to assess over time which measures need to be implemented or improved. For these reasons we decided to analyze cases of occupational exposure to biological risk occurring in the University Hospital in Messina between 1998 and 2002. Our study highlighted in particular that the most frequently affected category was that of professional nurses (46.74%) and that only 31.72% of the healthcare workers who tested negative for HBsAb were administered vaccine prophylaxis also after the accident. Moreover, it emerged that there is the need to increase the amount and quality of information made available, by changing report forms, with the aim of identifying problems and risky behavior and procedures, and thus make ways to ensure the continued improvement of the accident prevention and management programmes. In fact, in the accident reporting procedure used, it was not possible to specify the precise way in which the accidents happened.

The presence of anti-Borrelia burgdorferi antibodies in a group of multiple sclerosis patients in eastern Sicily. Preliminary data

The authors evaluate the presence of anti-Borrelia burgdorferi antibodies in a group of polysclerotic patients of Eastern Sicily, in order to verify or dismiss a correlation between Borrelia infection and demyelinizing syndrome. 460 samples of serum were examined, of which 60 belonged to patients affected by definite multiple sclerosis; the other 400 were taken from a group of apparently healthy subjects. From the analysis of the data obtained it can be seen that of the 60 polysclerotic subjects examined, 12 equal to 20% were found to be positive for the presence of IgG anti-Borrelia burgdorferi, while in the control group 30 subjects were found to be positive, equal 7.5%.