[Selected risk factors for occupational exposures to blood-borne pathogens in cosmetics salons]. / Wybrane czynniki ryzyka ekspozycji zawodowych na patogeny krwiopochodne w salonach kosmetologicznych.

BACKGROUND: Services offered in the esthetic/beauty industry poses the risk of blood-borne infections (BBIs) due to carrying out invasive procedures. The study objective: was to assess the number of sharps injuries, occupational risk factors, and preventive methods used among cosmetologists. MATERIAL AND METHODS: The anonymous survey was conducted (February-April 2017) in randomly selected beauty/esthetic medicine clinics in Szczecin, Poland; 96 cosmetologists were invited. RESULTS: Eighty cosmetologists (83.3%), responded. The mean age of the group was 25 years (range: 20-60 years). The majority of the respondents (95%) used sharps while at work, 41.3% had suffered at least one sharps injury during their occupational career. Clippers were the most common injury-causing instrument (39.4%), and manicure/pedicure was the most common injury-causing procedure (51.5%); 84.8% of injuries were not reported. The number of injuries was associated with age (34.9% in the group of 20-29 years old respondents vs. 64.7% in respondents ≥ 30 years old, p = 0.05), work experience (32.6% in the respondents working for 1-3 years vs. 68.8%, in those working ≥ 7 years, p = 0.03), and working hours/week (28.9% in those working ≤ 40 h vs. 57.1% of those working > 40 h, p = 0.02). Needle recapping was reported by 47.5% of respondents, 13.8% did not dispose used needles into a container, 17.5% did not routinely use gloves. CONCLUSIONS: Cosmetologists are at risk of sharps injuries. Inconsistent use of preventive methods and failure to report incidents may result in contracting BBIs. There is a need to implement education and intervention measures to prevent occupational injuries, particularly with regard to cosmetologists aged over 30 years, with a longer professional experience, working over 40 h/week. Med Pr 2018;69(3):281-290.

A cross-sectional sero-survey on preoperative HBV vaccination policy in Poland.

BACKGROUND: A two-dose preoperative vaccination schedule against HBV has been the widely accepted policy in Poland. However, its effectiveness has not yet been assessed. OBJECTIVE: To evaluate a two-dose preoperative HBV vaccination policy by an assessment of the proportion of patients who don't present a protective level of anti-HBs (<10.0 mIU/ml). METHODS: Consecutive patients from surgical/gynecologic wards of 12 randomly selected hospitals in West Pomerania, Poland, hospitalized between 2010 and 2013, vaccinated against HBV with a two-dose regimen, were asked to complete an anonymous questionnaire. Serum samples were assayed for anti-HBs with the use of third-generation testing methods. To compare sensitivity versus specificity across a range of values for the ability to predict a dichotomous outcome (a protection against HBV infection) a Receiver operating characteristic (ROC) curve was determined. RESULTS: There were 193 patients, 58.5% women, median age 52 years. Almost a half (46.0%) of the patients were operated on within 0-60 days of taking the second vaccine dose, 16.2% - 61-180 days after, 37.8% >180 days after. Anti-HBs titer was below a protective level in 49.2% of participants (0.0 mIU/ml in 17.8%, 0.1-9.9 mIU/ml in 31.4%); none of them were aware of this fact. Age ≤ 52 years (OR = 1.89) and having surgery more than 37.5 days after HBV vaccination (OR = 2.70) were associated with greater odds of being protected against HBV infection through vaccination. For the time frame between the second dose implementation and surgery 23 days, a sensitivity of 84% and specificity of 22% for obtaining protection against HBV infection was found, for the time frame >37.5 days - sensitivity remained high (80%), while specificity increased (41%); there was an apparent peek on the ROC curve between 38 and 60 day. In the group vaccinated 0-37.5 days before surgery, less patients had the protective level of anti-HBs titer than in vaccinated 38-60 days before surgery (32.3% vs 60.0%; p = 0.03). CONCLUSIONS: The success rate in achieving adequate immune protection with two dose HBV vaccination schedule in preoperatively vaccinated patients is relatively low, especially among those vaccinated less than five weeks prior to surgery. In more than a third of cases the standard three-dose regimen could have been implemented, as participants had time to complete a third dose. Current recommendations regarding a preoperative policy with a 2-dose vaccination schedule in Poland should be revised; the best time to perform surgery after the implementation of the second dose of vaccine in the context of patient protection against HBV infection would be between 38 and 60 days.

[HBV, HCV, and HIV infection prevalence among prison staff in the light of occupational risk factors]. / Wystepowanie zakazen HBV, HCV i HIV wsród personelu wieziennego w swietle zawodowych czynników ryzyka.

BACKGROUND: Objectives of the study: to assess the occupational risk for blood-borne infections (BBIs) among prison staff (number/ circumstances of blood exposures and preventive methods used), and to estimate the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). MATERIAL AND METHODS: The survey, which included serological testing with the use of 3-generation enzyme-linked immunosorbent assays (ELISA) was completed on active staff at a correctional facility in Goleniów, Poland, between June-July 2015. RESULTS: Response rate was 38%, 87 participants (aged 22-64 years, median: 34 years) agreed to participate. There were 88.5% males, correctional officers comprised 87.4% of the participants. Having had ≥ 1 blood exposure during professional career was reported by 28.7% respondents, 8% - sustained it in the preceding year. For correctional officers the last blood exposure was caused by a hollow-bore needle/razor blade during cell or manual searches. This was not reported by 83.3%. Participation rate in an infection control training was 85.1%. Hepatitis B virus vaccination uptake was 83.9%. Compliance with glove use was 75.9%, with protective eyewear - 28.7%. Regular use of both was reported by 9.2% of participants. The lack of their availability was the most common reason (79.7%) for non-compliance. Anti-HBc (hepatitis B core antigen) total/anti-HCV/anti-HIV prevalence was 2.3%, 1.1%, and 0%, respectively. CONCLUSIONS: Prison staff are at risk for occupational exposures to blood. Reporting of such incidents is poor, as well as compliance with personal protective equipment use, which place them at risk for acquiring BBIs. Anti-HCV prevalence is similar to that observed in the general population, anti-HBc total prevalence is lower, possibly due to high vaccination uptake, however, poor response rate limits precise prevalence estimates. Med Pr 2017;68(4):507-516.

A Cross-Sectional Study on Selected Correlates of High risk Sexual Behavior in Polish Migrants Resident in the United Kingdom.

Objective: To assess the correlates of the high risk sexual behaviors of Polish migrants in the United Kingdom (UK) after 2004, and to compare such behaviors before/after immigration. Methods: In 2013, a cross-sectional study was conducted through the use of a Computer-assisted web interviewing surveying technique with the use of a self-administered questionnaire. Results: Among 408 respondents (56.9% women), with a median age of 32 years, significantly more admitted to having unprotected sexual contact with a casual partner while in the UK (p < 0.0001) than while in Poland; more were engaged in sex after the use of recreational drugs and alcohol (p < 0.0001 and p = 0.001 respectively). Being a male was associated with greater odds of unprotected sex, sex after the use of alcohol, and having multiple partners. Being single and having only been a resident for a short time in the UK, presenting a lower self-esteem, were predictors of unprotected sex. A total of 19.6% of the respondents admitted to having been tested while in Poland, a lower (p < 0.0001) frequency than while in the UK (49.5%); this referred to both genders; 1.2% (95% CI: 0.79-2.83%) reported that they were HIV positive. Conclusions: Migration can create a vulnerability to STIs, especially for single male migrants with low self-esteem, staying in the UK for less than two years. The results point to strengthening strategies which help reduce high risk sexual behavior among Polish migrants, and to introduce interventions to promote an awareness of HIV sero-status.

Prevalence of HBV Infection and Knowledge of Hepatitis B Among Patients Attending Primary Care Clinics in Poland.

It is well known that community awareness of hepatitis B (HB) can lead to vaccination and testing. The study objectives were to assess the prevalence of HBV infection and knowledge of HB among adult patients attending randomly selected primary care clinics. A cross-sectional sero-survey was conducted in March 2013 in the Zgorzelec region, Poland, with the use of an investigator-developed questionnaire containing 22 questions regarding HB knowledge. Serum samples were assayed for anti-HBc total and anti-HBs with enzyme immunoassay. The prevalence of anti-HBc total among 410 participants (median age 56 years) was 10.3 % (95 % CI 7.6-13.8 %), nobody was aware of an infection. The main sources of HB knowledge were the media and medical staff. The mean knowledge score was 14.8 ± 4.9; 76.7 % of the respondents had scores >50 %. Particular gaps were detected relating to knowledge of unprotected sexual intercourse and MTCT; 45.6 % patients were not aware of the potential asymptomatic course of HBV infection, 41.2 % about chronic HB treatment. A patient's low educational level was negatively associated with a high knowledge level; the willingness for further education on HB and HBV vaccination in the past were independently associated with good knowledge. In conclusion, the HBV infection remains a public health threat in Poland, since the prevalence of infection markers in asymptomatic adult patients was high. Knowledge gaps call for awareness campaigns which may increase testing and diagnosis, audiences representing lower education level should be targeted first. Knowledge on HB might serve as an effective tool in decision making regarding vaccination.

A cross-sectional serosurvey on hepatitis B vaccination uptake among adult patients from GP practices in a region of South-West Poland.

BACKGROUND: Hepatitis B is a significant health burden in Poland with nosocomial transmission being the main source of infection. Therefore, HBV vaccination is widely recommended for those not covered by the national immunisation program. OBJECTIVE: To assess the coverage and influencing determinants of HBV vaccination among adult patients attending GP clinics as well as to establish serological status in terms of HBV infection. METHODS: Patients who were seen consecutively in March 2013 at four randomly selected GP practices located in Zgorzelec county, in south-western part of Poland, were invited to participate and complete questionnaires on socio-demographic data and other factors related to vaccination. A pilot study was done in one urban GP practice in the city of Gryfino (Gryfino county), the results have been included in the study. Patients' immunisation status was assessed basing on vaccination cards and anti-HBs titer with the use of third-generation testing methods. In addition, serum samples were assayed for anti-HBc total. RESULTS: Response rate: 99.3 %. Of 410 participants (66.1 % females, median age 56 years), 55.4 % (95%CI:50.5-60.1 %) were previously vaccinated; in those 11.5 % took 2 doses, 66.1 % - 3 doses,18.1 % - 4 doses. Elective surgery was the main reason (57.7 %) for HBV immunization, 4.8 % - were vaccinated due to recommendations by GPs. The multivariable logistic regression model revealed that living in a city (OR 2.11), and having a surgery in the past (OR 2.73) were each associated with greater odds of being vaccinated. Anti-HBc total prevalence among those unvaccinated was 13.6 % (95%CI:9.3 %-19,5 %), and 7.2 % (95%CI:4.4-11.8 %) among those vaccinated. CONCLUSIONS: Low HBV immunization coverage among adult patients from GP clinics and the presence of serological markers of HBV infection among both - those unvaccinated and vaccinated call for comprehensive preventative measures against infection, including greater involvement of family doctors. Although interventions should cover the whole population, inhabitants living in the rural areas should be a group of special interest. Preoperative immunization for HBV seems to be an efficient public health tool to increase the vaccination uptake.

Concerns of occupational HIV infection among surgical Staff in the light of anti-HIV sero-status and the distribution of Δ32 allele of the CCR5 gene: a cross-sectional study.

UNLABELLED: Surgical staff might be considered at most risk of accidental viral infection due to their higher exposure to blood. AIM: To evaluate surgical staff concerns about occupational HIV infection, to determine contributing factors, to assess their sero-status regarding this pathogen, and the frequency of the Δ32 allele of the CCR5 gene. METHODS: With the use of a self-administered anonymous questionnaire a cross-sectional sero-survey was conducted from February 2009-January 2010 among doctors/nurses from the surgical/ gynaecological wards of 16 randomly selected hospitals in Western Pomerania, Poland. Fear level was measured by the use of the VAS scale (range 0-10). Serum samples were tested by ELISA. Genotyping was performed using a PCR-AFLP assay. RESULTS: Response rate 84.9%; 427 participants, 88.3% females; 84.8% nurses, 15.2% doctors (median age 42 years, range 22-61 years). More than two thirds of respondents (67.2%) overestimated HIV single exposure risk. The median level of occupational HIV fear was 6.67. The prevalence of anti-HIV was 0.0% (95%CI: 0-0.9%); 1.2% (95%CI: 0.5%-2.9%) of participants were homozygotes Δ32/Δ32. The stepwise regression model revealed that job category (nurse) was associated with HIV fear (p<0.001). CONCLUSIONS: The risk of contracting occupational HIV infection remains low; no anti-HIV positive individuals were found among surgical staff, one in one hundred were resistant to HIV infection. Staff members, especially nurses, were much concerned with acquiring an occupational HIV infection, possibly due to the lack of knowledge on single exposure risk. Educational actions and better access to specialists which would help surgical staff in managing anxiety at the workplace is urgently needed.

Determinants influencing self-paid vaccination coverage, in 0-5 years old Polish children.

Immunization is an important and cost-effective public health intervention to protect the population from illness. In Poland, in addition to free of charge vaccines, listed in the national program on immunization, self-paid vaccinations for pneumococcal, meningococcal, rotavirus, varicella, influenza infections and combination vaccines are recommended. The study objective was to measure the coverage and influencing determinants of self-paid vaccinations in 0-5-year-old children seen between June 2009 and January 2010 at 3 randomly selected GP practices located in one region in the south-western part of Poland. Parents of the children who were seen consecutively were invited to participate and complete questionnaires on socio-demographic data and other factors related to paid vaccination. The response rate: 93.3%. Among the 308 parents (18-50 years old, median 31 years) who agreed to participate, 77.9% (95%CI: 73.0-82.2%) had their child vaccinated with at least one paid vaccine. Combination vaccines were most commonly chosen (62.3%), followed by a pneumococcal (36.4%), influenza (14.3%), meningococcal (13.3%), and rotavirus (12.7%) vaccine. Most parents admitted that their decision was based on a healthcare worker's initiative informing them about the topic. The multi-variable regression model revealed that parent's factors: age≥25 years, high socio-economic status, having one child, and health system factor, i.e. practice location were each associated with greater odds of child immunization The high cost of a vaccine was associated with more than five times lower chance to immunize a child. Observed high coverage rate regarding self-paid vaccines among young children was influenced mostly by combination vaccines. As the cost of a vaccine was an important barrier for the immunization, the gradual introduction of some of currently self-paid vaccines in a national program would be of value. Future interventions on self-paid vaccination coverage should be more tailored, focusing especially on young parents with low income who have more than one child.

[Attitudes of medical specialists toward HBV, HCV or HIV infected surgical staff and a sero-survey among staff members]. / Postawy personelu medycznego wobec osób zakazonych HBV, HCV lub HIV pracujacych w oddzialach zabiegowych oraz badania serologiczne pracowników.

BACKGROUND: Issues regarding the transmission of blood-borne viruses from infected medical personnel to patients are controversial to both parties. The aim of this study was to evaluate the attitudes towards disclosure of HBV/HCV/HIV-infected surgeons and the possibility of being forced to give up surgical procedures, as well as to assess the prevalence of anti-HBc total, HBsAg, anti-HCV and anti-HIV in surgical staff. MATERIAL AND METHODS: Using an anonymous questionnaire a cross-sectional sero-survey was conducted among surgeons and nurses of surgical wards in 16 randomly selected hospitals, Western Pomerania, Poland, from January to June 2009. Serum samples were tested for anti-HBc, HBsAg, anti-HCV and anti-HIV by ELISA tests. RESULTS: In the group of 427 participants (232 nurses, 65 doctors; a median age: 42 years), anti-HBc was found in 16.6%, HBsAg in 0.7%, anti-HCV in 1.4% and anti-HIV in 0%. The risk of a single exposure to HBV was correctly defined by 26.5% of participants, to HCV by 19.7%, to HIV by 18.7%. 16.2% participants stated that infected surgeons should disclose their HBV, HCV, or HIV serostatus, 39.8% and 42.6% that those HBV/HCV-infected and HIV-infected, respectively, should discontinue practicing surgery. Participants who correctly assessed the risk of contracting HIV/HBV/HCV after a single exposure were significantly (p = 0.0001; p = 0.03; p = 0.01, respectively) less likely to favor infected staff being forced to discontinue surgical procedures. CONCLUSIONS: A fraction of surgical staff showed detectable markers of HBV/HCV infection, they may be a source of infection for operated patients. Surgical staff's knowledge about occupational blood exposure risk was not satisfactory, which might have influenced the restrictive attitudes to force those infected with HBV/HCV/HIV to give up surgical procedures and a willingness to disclose their serological status.

Endogenous or exogenous origin of vaginal candidiasis in Polish women?

Vaginal candidiasis is a common problem of clinical practice. Many studies have been conducted to explain its origin but only a few have included Polish women. The aim of the study was to determine the prevalence and similarity of oral, anal and vaginal Candida albicans strains isolated from Polish women with vaginal candidiasis. The study involved 20 from 37 recruited women. Swab samples were collected from their vagina, anus, and oral cavity at two-month intervals. All the women were treated with nystatin. Yeast were recovered and identified by the germ-tube test, API /Vitek system, typed by API ZYM and RAPD-PCR. Chi-square test was used to analyze the data. A total of 170 Candida albicans isolates were recovered from 180 samples collected 3 times from 3 sites of 20 women. Positive yeast vaginal cultures were found in all patients before administration of nystatin. Vaginal yeast recovery rate was decreased statistically significant in both follow-up visits (p= 0.001; p= 0.003). The same and different genotypes/biotypes were found concomitantly in a few body sites and/ or repeatedly at time interval from the same body site. The results support the concept of dynamic exchange of yeast within one woman and endogenous or exogenous origin of vaginal candidiasis.

[Model-based estimates of the risk of HCV transmission from infected patients to gynaecologic and obstetric staff]. / Szacowanie ryzyka transmisji HCV od zakazonych pacjentek do personelu ginekologiczno-polozniczego z wykorzystaniem modelu matematycznego.

UNLABELLED: The risk of acquiring the hepatitis C virus (HCV) through percutaneous occupational exposure is dependent on three key variables: number of injuries, probability of a percutaneous injury transmitting HCV and prevalence of HCV infection in the patient population. OBJECTIVE: To estimate the prevalence of HCV infection in the gynaecological/obstetric patient population and thereafter estimate the risk of HCV transmission to personnel through occupational exposure. METHODS: The prevalence of anti-HCV was estimated through an anonymous serosurvey of gynaecological/ obstetric patients in 15 randomly selected hospitals in West Pomerania, Poland, from February 2008 to January 2009. Using own published data on the percutaneous injuries during gynaecological/obstetric surgeries and results obtained from serologic survey, the risk of annual occupational transmission of HCV to personnel was then derived with the use of a mathematical model. RESULTS: The prevalence of anti-HCV infection for 528 gynaecological/obstetric patients, aged 18-83 (median 45), was 0.76% (4/528; 95%CI: 0.29-1.93%). The estimated risk of HCV transmission from an HCV infected patient to an uninfected staff member may vary over a wide range (0.00007-0.1%), being dependent on the type of exposure; the average risk for a midwife was 0.0038% per annum (0.15% risk over a 40 year professional career). The estimated risk for a gynaecologist/obstetrician was 0.0076% and 0.30% respectively. CONCLUSIONS: The risk of an individual member of a gynaecological/obstetric staff acquiring HCV through occupational exposure is low, however a credible hazard still exists. One in 130 patients hospitalized at gynaecological/obstetric wards showed markers of HCV infection. Therefore, staff members should be encouraged to observe standard precautions regarding sharps injury prevention and present themselves for post-exposure management in case of need.

[Assessment of occupational exposure to HBV, HCV and HIV in gynecologic and obstetric staff]. / Ocena zawodowego narazenia na zakazenie HBV, HCV i HIV u personelu oddzialow ginekologii i poloznictwa.

BACKGROUND: The aim of the study was to assess the occupational risk for hepatitis B, C and HIV in gynecologic and obstetric staff in the context of the number of sharps injuries, HBV immunization coverage, compliance with personal protective equipment (PPE) use and reporting of exposures. METHODS: A voluntary anonymous survey was carried out between January-June 2009 in 15 ran domly selected hospitals in West Pomerania, Poland. RESULTS: There were 110 participants (response rate 72%), 88.2% females, 11.8 males (aged 21-60 years; mean, 42 years); 80.9% nurses, 19.1% doctors. Among those 60.9% reported at least one sharps injury in the preceding year (Me = 1, range 1-12), 43.6% worked at least once a year with a recent abrasion or cut on their hands. The respondents reported the most recent injuries being caused by a hollow-bore needle (54.4%), a suture needle (26.5%), and an instrument (19.1%); 82.5% of such incidents went unreported. Compliance with PPE use was high for glove use (92.7%), much lower for protective eyewear (28.7%). Except one participant who reported acute symptomatic hepatitis B in the past (possibly due to previous surgery), all participants reported being immunized with HBV vaccine: 46.8%--took three doses, 48.6%-- a booster and 4.6% ended the regimen on two doses. CONCLUSIONS: Frequent sharps injuries, mostly unreported, work with unprotected recent abrasion or hands' cuts and lack of compliance with PPE use are important risk factors contributing to occupational HBV, HCV and HIV infections among gynecologic and obstetric staff. The risk of HBV infection has been significantly reduced by a complete immunization coverage observed among participants.

Serodiagnosis of borreliosis: indirect immunofluorescence assay, enzyme-linked immunosorbent assay and immunoblotting.

Lyme disease is an infectious, multi-system, tick-borne disease caused by genospecies of Borrelia burgdorferi bacteria sensu lato, characterized by remarkable heterogeneity. In this situation choosing an optimal antigen array for diagnostic tests seems problematic. The serological tests for borrelia routinely done in laboratories often produce ambiguous results, which makes a proper diagnosis rather complicated and thus delays the implementation of an appropriate treatment regimen. Thirty-seven outpatients and eight inpatients with suspected borreliosis diagnosis hospitalized at the Clinics of the Pomeranian Medical University (Szczecin, Poland), participated in the study. In order to detect the antibodies against Borrelia sensu lato three kinds of serological tests were used: indirect immunofluorescence assay (IIFA), enzyme-linked immunosorbent assay (ELISA), and immunoblot. The IIFA and immunoblot tests conducted on 45 patients (100%) produced positive results for both the IgM and IgG antibody types. In the case of ELISA, positive or borderline results were observed in only 24 patients (53.3%). The immunoblot test for IgM most frequently detected antibodies against the outer surface protein C (OspC) antigen (p25), and, in the case of IgG, against the recombinant variable surface antigen (VlsE). The IIFA screening test used for diagnosing Lyme borreliosis produced the highest percentage of positive results, which were then confirmed by immunoblot, but not by ELISA. Therefore using only ELISA as a screening test or for diagnosing Lyme borreliosis seems debatable.

Assessment of quality of life in patients with idiopathic scoliosis treated operatively.

BACKGROUND: A small percentage of patients with idiopathic scoliosis undergo surgery, which is only used in the case of the most extreme deformities of the spine and chest and progression of disease despite conservative treatment. The aim of this study was to assess the quality of life in patients with idiopathic scoliosis treated operatively and to examine the correlations between the quality of life and radiographic and socio-demographic indices. MATERIAL AND METHODS: wo independent groups of patients operated on at the Department of Pediatric Orthopedics of the Pomeranian Medical University in Szczecin were examined using a standardized SRS -22 HRQL instrument. Quality of life was assessed on three occasions in 35 patients from the first group. The second group included 52 patients at least two years post-surgery. RESULTS: The assessment of physical fitness revealed a decrease proportional to the length of time since surgery. Higher pain intensity was reported by patients whose surgery took place more than 2 years prior to the study. The analysis of mental health assessment results indicated a decrease proportional to the length of time since surgery. No statistically significant differences were found with respect to patients' self-assessment of their body image and treatment satisfaction. CONCLUSIONS: 1. Operative correction of scoliosis enhances patients' self-assessment of their body image and contributes to a high assessment score for treatment satisfaction. 2. No correlations were found between the overall quality of life and previous conservative treatment. 3. Deterioration of physical fitness, mental health impairment and increasing pain intensity were observed among patients residing in small towns and rural areas and those experiencing socioeconomic problems 4. The degree of scoliosis correction in the thoracic spine contributes to increasing life quality, especially in late assessment.

[Rationale for the implementation of pre-operative testing for HCV in the light of anti-HCV and HBsAG tests results in surgical patients from a teaching hospital]. / Przeslanki do wdroienia przedoperacyjnego badania pacjentów w kierunku zakazenia HCV w swietle wyników oznaczen anty-HCV i HBsAG w populacji pacjentów klinicznych oddzialow zabiegowych.

UNLABELLED: Many Polish hospitals compel patients admitted for elective surgery to be immunised for HBV; testing for HBsAg is recommended before. We surveyed immunisation coverage for HBV and prevalence of HBsAg and anti-HCV among surgical patients to assess existing pre-operative screening policies. METHODS: questionnaire data and sera were collected anonymously from 400 consecutive adults admitted to 4 surgical wards of a teaching hospital in Szczecin, Poland during October 2006/December 2007. Samples were assayed for HBsAg, and anti-HCV. RESULTS: Serologic evidence for either HBsAg or anti-HCV was 2.3% (9/400; 95% CI: 1.2-4.2%), all in elective cases; 1.5% (6/400; 95% CI: 0.7-3.2%) were positive for anti-HCV, 0.75% (3/400; 95% CI: 0.26-2.18%) for HBsAg. None of anti-HCV positive patients was aware of their infection, as well as 1 in 3 HBsAg carriers. Anti-HCV and HBsAg prevalence in 20131 blood donors which served as controls were 0.08% (95% CI: 0.02-0.15%) and 0.11% (95% CI: 0.04-0.2%) respectively. HBV immunisation coverage was 247/398 (62%), higher (p < 0.0001) in those undergoing elective rather than emergency surgery. CONCLUSIONS: anti-HCV prevalence was double that for HBsAg. These data give evidence for the expansion of the existing screening programme for blood borne infections among elective surgical patients, to also cover those infected with HCV. A third of patients were unimmunised, remaining a potential pool for HBsAg carriers.

Rationale against preoperative screening for HIV in Polish hospitals: a prevalence study of anti-HIV in contrast to anti-hepatitis C virus and hepatitis B surface antigen.

We describe the prevalence of anti-human immunodeficiency virus (anti-HIV) among a sample of 1,652 surgical and gynecologic patients in Polish hospitals, contrasting it with the prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (anti-HCV) to assess the rationale for preoperative testing. No anti-HIV-positive samples were found; the prevalence of anti-HCV was 0.9%, slightly higher than the prevalence of HBsAg of 0.6%. Universal preoperative screening of hospital patients for HIV is currently not warranted according to the Centers for Disease Control and Prevention guidelines. However, the seroprevalence of HIV should be reassessed periodically.

Preoperative vaccination for HBV at Polish hospitals as a possible public health tool to limit the spread of the epidemic: a cross-sectional study.

To determine the immunisation coverage for HBV and the prevalence of HBsAg an anonymous serosurvey of consecutive adult surgical/gynaecologic patients presenting to 16 randomly selected hospitals in West Pomerania, Poland, was conducted. Immunisation rate was 60.4%, of these 69.7% had received the complete course of three doses; 65.2% were immunised at the request of referring surgeons. The multivariable regression model revealed that age <40 years, low educational status, not having a surgery in the past, tattoo application, and emergency procedure were each associated with a greater odds of not being vaccinated. HBsAg prevalence was 0.6%. Authors conclude that the preoperative vaccination policy might be an effective public health tool to limit the spread of the epidemic.

[Markers of hepatitis B, C and HIV among orthopedic patients and staff at a Polish university hospital]. / Markery zakazenia HBV, HCV i HIV u personelu i pacjentów klinicznego oddzialu ortopedii i traumatologii.

OBJECTIVE: to estimate prevalence of immunization for HBV and seroprevalence for HBV, HCV and HIV among orthopedic patients and staff; to verify the proportion of staff genetically resistant to HIV. METHODS: a voluntary anonymous serosurvey together with immunization history were completed at the orthopedic ward of Szczecin University Hospital (37 beds, 30 doctors and nurses and 1118 admissions annually) between November/December 2006. Blood from 100 consecutive patients and all staff agreeing to participate was tested for anti-HIV, anti-HCV and markers of HBV including anti-HBc total and HBs, as well as for alleles of the CCR5 gene mutated variant with 32-bp deletion. RESULTS: All off the first 100 patients (median age 51 years, 63% males) and 20 staff (response 67%, median age 35 years, 45% males) agreed to participate. Among patients 64% reported being immunized (95% CI: 54.2-72.7%), 24% (95% CI:16.7-33.2%), not being immunized, 12% (95% CI: 7-19,8%) did not remember. Prevalence of anti-HCV and anti-HIV was 0% (95% CI 0-3.7%); as for HBV, one was HBsAg positive (1%; 95% CI: 0.2-5.4%). Among tested staff none were positive for anti-HCV and anti-HIV. As for HBV, anti-HBc were detected in 8 (40%), 2 had had symptomatic hepatitis, of whom one (5%) was HBsAg positive. No tested staff reported non-occupational risk factors. Seven of eight anti-HBc positive staff had been unaware of previous hepatitis B and underwent full immunisation with three doses of vaccine. Among tested staff 1 (5%) was a homozygote delta32/delta32 allele of the CCR5 receptor, 4 (21%) were heterozygotes +/delta32. CONCLUSIONS: The main study limitation was the small sample size and the fact that one-third of staff refused testing; nevertheless, the carrier state of HBs detected in one percent of tested patients, and high proportion of tested staff with the markers of HBV infection indicates high occupational risk and emphasizes the need for immunization. Nearly all HBc positive staff unaware of their serological status had undergone immunization, showing the importance of pre-immunization testing. In the light of low single exposure risk, lack of serological markers of infection in the current population of orthopedic patients and staff, and 5% of careers of mutated allele of CCR5 detected among staff, we conclude that an employment at orthopedic ward does not significantly increase the risk of contracting HIV infection.

Infections with HBV, HCV and HIV in patients admitted to the neurosurgical department of a teaching hospital.

BACKGROUND AND PURPOSE: To estimate the prevalence of infection with HBV, HCV, HIV and immunization coverage against HBV among neurosurgical patients. MATERIAL AND METHODS: The study was designed as an anonymous serosurvey conducted at the neurosurgical department of Szczecin University Hospital. Between November and December 2007, blood samples from 100 consecutive patients were tested for anti-HIV, anti-HCV and HBsAg using a third-generation (ELISA) method. RESULTS: Response rate was 100%. Median age of participants was 51 years, 52% were males. The immunization coverage against HBV was 71% (95% CI: 61.5-79%), 24% (95% CI: 16.7-33.2%) were not immunized, and 5% of patients (95% CI: 2.2-11.2%) did not recall the procedure. There were no differences in immunization rates between emergencies and elective procedures. Four patients (4%; 95% CI: 1.6-9.8%) were positive either with HBV or HCV: 2 were HBsAg positive, 2 anti-HCV positive (2%; 95% CI: 0.6-7%). There were no HIV positive cases among patients. CONCLUSIONS: There is a potential risk to staff of contracting a blood-borne infection, as one in 25 patients was infected with HBV or HCV. Even if patients cover the cost of pre-operative immunization against HBV, with previous HBsAg testing, it would not guarantee the detection of all infected patients, as it refers only to some elective cases. Pre-operative screening for HBV, based on HBsAg testing in immunized patients, detected only 1/4 of patients infected with blood-borne hepatotropic viruses; asymptomatic patients infected with HCV remain a problem in the context of occupationally acquired infections. In the light of the low single exposure risk and lack of serological markers of infection among patients we conclude that employment at a neurosurgical department does not significantly increase the risk of contracting HIV infection.

[Evaluation of visual function among patients with exudative AMD treated with an intravitreal injection of triamcinolone acetonide]. / Ocena funkcji wzroku u pacjentów z wysiekowa postacia zwyrodnienia plamki zwiazanego z wiekiem leczonych doszklistkowym podaniem acetonidu triamcinolonu.

AIM: The aim of our study was to evaluate the visual acuity, visual field, retinal bioelectrical function and fluorescein angiography (FA) results of patients with exudative AMD treated with an intravitreal injection of triamcinolone acetonide (IVTA). MATERIAL AND METHODS: Visual acuity (Snellen chart), Humphrey automatic static perimetry (HASP) 30-2 W-W, mfERG were performed before, one month and three months after a single intravitreal injection of about 20 mg triamcinolone acetonide in 17 eyes of 17 patients (that did not meet the criteria for PDT). Fluorescein angiography was evaluated before and 3 months after treatment. RESULTS: There was no significant improvement in visual acuity after a month and three months after treatment when comparing to the initial examination. Although a slight improvement of 1-2 lines on Snellen chart was noted in individual cases. No significant changes were observed in static perimetry results after 3 months follow-up. In mfERG, there was a significant decrease in both, response density and P1 wave amplitude in fifth peripheral ring. In the rest of the rings, in comparison to the initial examination significant changes were not observed. In 76% of the analyzed eyes stabilization of CNV activity was noted in FA. In majority of eyes, the active CNV diameter did not change or was reduced and transformed into a scar. CONCLUSIONS: Three months after an intravitreal injection oftriamcinolone acetonide, no significant improvement of visual functions was noted in the observed group of patients with exudative AMD. A decrease of leakage in FA and a lack of a significant decrease in visual function may lead to a conclusion that IVTA treatment may slow down the natural course of the disease.