Covid-19 vaccine management (Comirnaty and mrna-1273 Moderna) in a teaching hospital in Italy: a short report on the vaccination campaign.

OBJECTIVES: In this article, we aim to share our experience in the hospital reorganization made to conduct the SARS-CoV-2 vaccination campaign, based on the principles of flexibility and adaptability. STUDY DESIGN: A descriptive study. METHODS: The data concerning the organization of the vaccination campaign were taken from the operative protocol developed by the hospital dedicated task force, composed by experts in hygiene, public health, occupational medicine, pharmacists, nurses, hospital quality, and disaster managers. Data about the numbers of vaccine administered daily were collected by the Innovation and Development Operative Unit database. RESULTS: Vaccinations against COVID-19 started across the EU on the 27th of December 2020. The first phase of the vaccination campaign carried out in our hospital was directed to healthcare workers immunization including medical residents, social care operators, administrative staff and technicians, students of medicine, and health professions trainees. The second phase was enlarged to the coverage of extremely fragile subjects. Thanks to the massive employment of healthcare workers and the establishment of dynamic pathways, it was possible to achieve short turnaround times and a large number of doses administered daily, with peaks of 870 vaccines per day. From the 27th of December up to the 14th of March a total of 26,341 doses of Pfizer have been administered. 13,584 were first doses and 12,757 were second doses. From the 4th to the 14th of March, 296 first doses of Moderna were dispensed. It was necessary to implement adequate spaces and areas adopting anti-contagion safety measures: waiting area for subjects to be vaccinated, working rooms for the dilution of the vaccine and the storage of the material, vaccination rooms, post-vaccination observation areas, room for observation, and treatment of any adverse reactions, with an emergency cart available in each working area. CONCLUSIONS: The teaching hospital of Pisa faced the beginning of the immunization campaign readjusting its spaces, planning an adequate hospital vaccination area and providing an organization plan to ensure the achievement of the targets of the campaign. This represented a challenge due to limited vaccine doses supplied and the multisectoral teams of professionals to coordinate in the shortest time and the safest way possible. The organizational model adopted proved to be adequate and therefore exploited also for the second phase aimed to extremely fragile subjects.

Prolonged outbreak of New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE), Tuscany, Italy, 2018 to 2019.

In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) have increased since November 2018. Between November 2018 and October 2019, 1,645 samples were NDM-CRE-positive: 1,270 (77.2%) cases of intestinal carriage, 129 (7.8%) bloodstream infections and 246 (14.9%) infections/colonisations at other sites. Klebsiella pneumoniae were prevalent (1,495; 90.9%), with ST147/NDM-1 the dominant clone. Delayed outbreak identification and response resulted in sustained NDM-CRE transmission in the North-West area of Tuscany, but successfully contained spread within the region.

Detection and decontamination of Mycobacterium chimaera and other non-tuberculosis mycobacteria in heater-cooler devices used in cardiopulmonary bypass: a Manufacturer and National guidelines summary, and a potential resolution to the problem requiring further investigation.

Since 2011, invasive infections due to Mycobacterium chimaera have been diagnosed in patients with previous cardiac surgery. The use of heating/cooling devices (heater-cooler units), necessary to regulate the blood temperature in extra-corporeal circulation, has been identified as a source of contaminated aerosol. Adhering to a strict maintenance program according to the manufacturer's instructions for use including sanitizing is essential to reduce the risk. Current manufacturer guidelines and national recommendations for detection and decontamination of Mycobacterium chimaera and other non-tuberculosis mycobacteria should organically update units' policies and protocols as they are published.

Collection, transport and storage procedures for blood culture specimens in adult patients: recommendations from a board of Italian experts.

Bloodstream infections (BSIs) remain a potentially life-threatening condition. The gold standard for the diagnosis of BSI is still blood cultures (BCs), and the diagnostic yield depends on clinical and technical factors that have an impact on collection and transportation. Hence, monitoring of the entire pre-analytical process from blood collection to transportation to the microbiology laboratory is critical. To optimize the clinical impact of the diagnostic and therapeutic procedures, a multidisciplinary approach and univocal protocols are mandatory. A board of specialists discussed the available evidence on the pre-analytical process and produced the present document to guide physicians and nurses on the ideal execution of BC: (1) timing and preparation for blood collection; (2) skin antisepsis; (3) blood volume; (4) sampling method and safety; (5) medium to be used; (6) time to BC transportation; and (7) quality assurance and quality management.

Assessment, control, and prevention of microbiological and chemical hazards in seasonal swimming pools of the Versilia district (Tuscany, central Italy).

Although in Europe the quality of swimming pools (SPs) is dictated by regulations, microbiological and chemical hazards are described in the literature. Environmental bacteria or toxic disinfection by-product (DBP) compounds may indeed be recovered in waters even after disinfection. We evaluated the water quality from 26 outdoor seasonal SPs of the Versilia district, according to requirements of Regional Decree 54R/2015. In spring 2017, supply and reinstatement waters were collected after shock hyperchlorination (10 mg/L) while in summertime, a second sampling of waters before entering the pools, as well as in the pools, was performed after SPs were open to the public. In all samples, microbiological and chemical parameters were determined as defined by Directive 98/83/EC and the Italian Health Ministry. Microbiological data were within suggested limits. The first chemical analyses showed that in 35% of the feeding-pool seawater samples, the halogenated organic compounds were higher than the maximum permissible concentrations (30 µg/L). Pool waters were then dechlorinated and re-treated with hydrogen peroxide (10 mg/L) to ensure the abatement of DBPs (from 164 ± 107 to 0.9 ± 0.8 µg/L; p = 0.002). Results highlighted the need of self-controlled procedures for the SPs waters to prevent waterborne diseases and suggested hydrogen peroxide as the most appropriate disinfection method.

[Asbestos in drinking water and hazards to human health: a narrative synthesis]. / L'amianto nell'acqua potabile e i pericoli per la salute umana: una sintesi narrativa.

The term asbestos refers to six unique fibrous minerals mostly used in the production of asbestos cement sheets and pipes. According to the World Health Organization and the International Agency for Research on Cancer (IARC), there exists at least "sufficient evidence" that all types of asbestos may cause cancer in humans (mesothelioma, lung cancer, laryngeal tumor and ovarian cancer). The only asbestos limit in drinking water is 7 million fiber/liter. This study is a narrative synthesis about the possible hazards to human health related to the presence of asbestos in drinking water. The various scientific studies and epidemiological reports examined highlight that there is an ongoing debate on the possible carcinogenic risk associated with asbestos exposure through ingestion. Nevertheless, considering the latency with which diseases caused by asbestos may emerge, control measures should be adopted.

Control and prevention measures for legionellosis in hospitals: A cross-sectional survey in Italy.

Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2-15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.

Higher adherence to the Mediterranean diet is inversely associated with having hypertension: is low salt intake a mediating factor?

Blood pressure (BP) is a major risk factor for population health worldwide and a preventable disease through lifestyle modification. The aim of this study was to assess the association between adherence to the Mediterranean diet (MD) and occurrence of hypertension in a Mediterranean cohort. Demographic and dietary data of 1937 adults were collected in 2014-2015 from the general population of Catania, Sicily (Italy). Food frequency questionnaires and a MD adherence score were used to assess exposure variables. Higher adherence to the MD was inversely associated with hypertension. However, this association was no more significant after adjustment for sodium and potassium intake. These results suggest that salt may exert a mediating effect of high adherence to the MD towards hypertension.

Unplanned readmissions within 30 days after discharge: improving quality through easy prediction.

OBJECTIVE: To propose an easy predictive model for the risk of rehospitalization, built from hospital administrative data, in order to prevent repeated admissions and to improve transitional care. DESIGN: Retrospective cohort study. SETTING: Azienda Ospedaliero Universitaria Pisana (Pisa University Hospital). PARTICIPANTS: Patients residing in the territory of the province of Pisa (Tuscany Region) with at least one unplanned hospital admission leading to a medical Diagnosis-Related Group (DRG) in the calendar year 2012. INTERVENTION: We compared two groups of patients: patients coded as 'RA30' (readmitted within 30 days after the previous discharge) and patients coded as 'NRA30' (either admitted only once or readmitted after 30 days since the latest discharge). MAIN OUTCOME MEASURES: The effect of age, sex, length of stay, number of diagnoses, normalized number of admissions and presence of diseases on the probability of rehospitalization within 30 days after discharge was evaluated. RESULTS: The significant variables included in the predictive model were: age, odds ratio (OR) = 1.018, 95% confidence interval (CI) = 1.011-1.026; normalized number of admissions, OR = 1.257, CI = 1.225-1.290; number of diagnoses, OR = 1.306, CI = 1.174-1.452 and presence of cancer diagnosis, OR = 1.479, CI = 1.088-2.011. CONCLUSIONS: The model can be easily applied when discharging patients who have been hospitalized after an access to the Emergency Department to predict the risk of rehospitalization within 30 days. The prediction can be used to activate focused hospital-primary care transitional interventions. The model has to be validated first in order to be implemented in clinical practice.

A nosocomial measles outbreak in Italy, February-April 2017.

We describe a nosocomial outbreak of measles that occurred in an Italian hospital during the first months of 2017, involving 35 persons and including healthcare workers, support personnel working in the hospital, visitors and community contacts. Late diagnosis of the first case, support personnel not being promptly recognised as hospital workers and diffusion of the infection in the emergency department had a major role in sustaining this outbreak.

[Employment opportunities and job satisfaction in the field of Public Health: a survey among recent graduates of the Hygiene and Preventive Medicine residency in Italy]. / Sbocchi professionali, aspettative e gratificazioni dei neo-specialisti in Igiene e Medicina Preventiva: risultati di un'indagine nazionale.

We conducted an on-line survey among 255 specialists in Hygiene and Preventive Medicine in Italy who completed their training between October 2014 and July 2016, to assess their training experience, employment opportunities and current job satisfaction. Response rate was 49%. Mean age was 35 years. A high employment rate within two years from obtaining specialist qualification was reported by the 125 specialists who completed the questionnaire (76% are currently employed). The three main work settings of the participating specialists are hospital health directions (37%), universities (19%) and local Prevention Departments (16%). Two thirds (66%) have temporary positions and only 6% permanent positions. Job, pay, and training satisfaction are often below expectations with geographical differences that would need to be further investigated.

Clinical Assessment of Risk Management: an INtegrated Approach (CARMINA).

Purpose - The European Union recommendations for patient safety calls for shared clinical risk management (CRM) safety standards able to guide organizations in CRM implementation. The purpose of this paper is to develop a self-evaluation tool to measure healthcare organization performance on CRM and guide improvements over time. Design/methodology/approach - A multi-step approach was implemented including: a systematic literature review; consensus meetings with an expert panel from eight Italian leader organizations to get to an agreement on the first version; field testing to test instrument feasibility and flexibility; Delphi strategy with a second expert panel for content validation and balanced scoring system development. Findings - The self-assessment tool - Clinical Assessment of Risk Management: an INtegrated Approach includes seven areas (governance, communication, knowledge and skills, safe environment, care processes, adverse event management, learning from experience) and 52 standards. Each standard is evaluated according to four performance levels: minimum; monitoring; outcomes; and improvement actions, which resulted in a feasible, flexible and valid instrument to be used throughout different organizations. Practical implications - This tool allows practitioners to assess their CRM activities compared to minimum levels, monitor performance, benchmarking with other institutions and spreading results to different stakeholders. Originality/value - The multi-step approach allowed us to identify core minimum CRM levels in a field where no consensus has been reached. Most standards may be easily adopted in other countries.

[Correction: Adverse events and preventable consequences: retrospective study in five large Italian hospitals]. / Correzione: Eventi avversi e conseguenze prevenibili: studio retrospettivo in cinque grandi ospedali italiani.

[This corrects the Table 4 of the article: pmid: 22828228].

[The key role of public health medical resident education for future public health challenges]. / La formazione del giovane igienista per le nuove sfide della sanità pubblica.

INTRODUCTION: The Italian Committee of medical residents in Hygiene, Preventive Medicine and Public Health is a member of the Italian Society of Hygiene, Preventive Medicine and Public Health with the aim of developing a network among Italian resident in public health and promoting the educational path improvement through comparisons and debates between postgraduate medical schools. In this perspective, during last years account has been taken of some essential topics concerning education of public health medical residents, which represent future health-care and public health experts. METHODS: Cross-sectional researches were conducted among Italian public health medical residents (PHMRs) through self-administered and web-based questionnaires. Each questionnaire was previously validated by pilot studies conducted during the 46th National Conference of the Italian Society of Hygiene, Preventive Medicine and Public Health. RESULTS: Seventy percent of Italian PHMRs considered the actual length of Public Health postgraduate medical school excessively long, with regard to predetermined educational goals. Confirming this statement, 90% of respondents were inclined to a reduction from 5 to 4 years of postgraduate medical school length, established by Law Decree 104/2013. Seventy seven percent of surveyed PHMRs stand up for a rearrangement on a national setting of the access contest to postgraduate medical schools. Moreover 1/3 of Italian schools performed less than 75%of learning and qualifying activities specified in Ministerial Decree of August 2005. In particular, data analysis showed considerable differences among Italian postgraduate schools. Finally, in 2015 only four Italian Universities (Napoli Federico II, Palermo, Pavia, Roma Tor Vergata) provide for the Second Level Master qualify for the functions of occupational doctor. This offer makes available 60 positions against a request of over 200 future Public Health medical doctors who have shown interest in the Master. CONCLUSIONS: In Italy, after the introduction of Ministerial Decree 285/2005, the educational course of PHMRs was significantly improved. The standardization of learning and qualifying activities allowed for the first time the attendance at medical directions or Local Health Units. Nevertheless, the excessive lenght of postgradute schools and the differences about training among Italian Universities are critical and actual issue. Moreover, the remarkable interest shown by PHMRs in the Master could suggest a poor job replacement prospect for young medical specialist in Hygiene, Preventive Medicine and Public Health.

Exploring the Possible Use of AI Chatbots in Public Health Education: Feasibility Study.

BACKGROUND: Artificial intelligence (AI) is a rapidly developing field with the potential to transform various aspects of health care and public health, including medical training. During the "Hygiene and Public Health" course for fifth-year medical students, a practical training session was conducted on vaccination using AI chatbots as an educational supportive tool. Before receiving specific training on vaccination, the students were given a web-based test extracted from the Italian National Medical Residency Test. After completing the test, a critical correction of each question was performed assisted by AI chatbots. OBJECTIVE: The main aim of this study was to identify whether AI chatbots can be considered educational support tools for training in public health. The secondary objective was to assess the performance of different AI chatbots on complex multiple-choice medical questions in the Italian language. METHODS: A test composed of 15 multiple-choice questions on vaccination was extracted from the Italian National Medical Residency Test using targeted keywords and administered to medical students via Google Forms and to different AI chatbot models (Bing Chat, ChatGPT, Chatsonic, Google Bard, and YouChat). The correction of the test was conducted in the classroom, focusing on the critical evaluation of the explanations provided by the chatbot. A Mann-Whitney U test was conducted to compare the performances of medical students and AI chatbots. Student feedback was collected anonymously at the end of the training experience. RESULTS: In total, 36 medical students and 5 AI chatbot models completed the test. The students achieved an average score of 8.22 (SD 2.65) out of 15, while the AI chatbots scored an average of 12.22 (SD 2.77). The results indicated a statistically significant difference in performance between the 2 groups (U=49.5, P<.001), with a large effect size (r=0.69). When divided by question type (direct, scenario-based, and negative), significant differences were observed in direct (P<.001) and scenario-based (P<.001) questions, but not in negative questions (P=.48). The students reported a high level of satisfaction (7.9/10) with the educational experience, expressing a strong desire to repeat the experience (7.6/10). CONCLUSIONS: This study demonstrated the efficacy of AI chatbots in answering complex medical questions related to vaccination and providing valuable educational support. Their performance significantly surpassed that of medical students in direct and scenario-based questions. The responsible and critical use of AI chatbots can enhance medical education, making it an essential aspect to integrate into the educational system.

ChatGPT and the rise of large language models: the new AI-driven infodemic threat in public health.

Large Language Models (LLMs) have recently gathered attention with the release of ChatGPT, a user-centered chatbot released by OpenAI. In this perspective article, we retrace the evolution of LLMs to understand the revolution brought by ChatGPT in the artificial intelligence (AI) field. The opportunities offered by LLMs in supporting scientific research are multiple and various models have already been tested in Natural Language Processing (NLP) tasks in this domain. The impact of ChatGPT has been huge for the general public and the research community, with many authors using the chatbot to write part of their articles and some papers even listing ChatGPT as an author. Alarming ethical and practical challenges emerge from the use of LLMs, particularly in the medical field for the potential impact on public health. Infodemic is a trending topic in public health and the ability of LLMs to rapidly produce vast amounts of text could leverage misinformation spread at an unprecedented scale, this could create an "AI-driven infodemic," a novel public health threat. Policies to contrast this phenomenon need to be rapidly elaborated, the inability to accurately detect artificial-intelligence-produced text is an unresolved issue.

Assessing vaccine hesitancy and health literacy using a new Italian vaccine confidence index and a modified Italian medical term recognition test: A cross-sectional survey on Italian parents.

The decline in children's vaccination coverage and the resurgence of preventable infectious diseases draw attention to parents' vaccine hesitancy. Our study introduces two validated tools to independently assess vaccine hesitancy and health literacy among parents with school-age children. We developed a Vaccine Confidence Index (VCI) from 10 Likert items, exploring their relationships through exploratory and confirmatory factor analyses. We modified the IMETER (Italian medical term recognition test) to measure health literacy. We assessed the internal consistency of the modified IMETER and the 10 Likert items using Cronbach's alpha test (α) and McDonald's omega total coefficient (ω) with good results (ω = 0.92, α = 0.90; ω = 0.87, α = 0.82 respectively). We used these tools within a questionnaire conducted on 743 parents recruited from pediatric clinic waiting rooms in Italy, collecting demographic data, information sources on vaccines and vaccine-preventable diseases knowledge. The VCI resulting from factor analyses consisted of six items on a ten-point Likert scale, reflecting the ratio of positive to negative items. The survey revealed significant variations in the VCI according to individual features such as education, use of social networks, or Health institutions as sources of information. Multivariate logistic regression identified an association between vaccine intention and the VCI. Health literacy was functional for 91.2% of participants, but knowledge about vaccine-preventable diseases was generally low. The VCI showed no significant association with health literacy and vaccine-preventable diseases knowledge. The VCI and the modified IMETER effectively assess vaccination attitude and health literacy, offering valuable public health tools for tailoring vaccination campaigns to hesitant population subgroups.

[Adverse events and preventable consequences: retrospective study in five large Italian hospitals]. / Eventi avversi e conseguenze prevenibili: studio retrospettivo in cinque grandi ospedali italiani.

OBJECTIVE: To define the incidence of adverse events and their preventability in a representative sample of patients in five acute hospitals located in the North, the Centre and the South of Italy. Other objectives include the evaluation of the consequences of adverse events and their distribution according to specialties. DESIGN: Retrospective and multicentre study. The methodology is focused on the review of clinical records related to hospital admissions in the year 2008 with a sample of 5 hospitals belonging to the national healthcare system selected according to criteria of location (North, Centre and South of Italy) and complexity (regional reference hospitals). The clinical records included in the study were selected in a random way starting from the electronic archives of the hospital discharges of each participating centre. SETTING AND PARTICIPANTS: 7,573 clinical records were reviewed with a process of two stages managed by two reviewers each. The first stage of the review process involved 7 physicians, 1 nurse, 1 pharmacist and 1 biologist with skills and experiences in clinical risk management and in analysis of clinical documentation. The second stage was realized by 10 physicians (5 specialists, 3 experts in public health and 2 forensic physicians), also for the second stage every person involved had specific training in clinical risk management. The reviewers attended a 20-hour training course. MAIN OUTCOME MEASURES: Study of the incidence of adverse events identified during the admissions included. In the case of more than one adverse event for each admission, it is calculated the cumulative incidence of adverse events for each patient. We also considered the percentage of re-admitted patients for each adverse event, the percentage of adverse events which occurred in the phase of pre hospitalization and the degree of preventability of adverse events. A description of the identified adverse events was realized. The sample of the data included in the study was described in terms of included and excluded subjects with respect to the planned research design. Different products and results were tested and validated in the study and could be reused in the future research products. RESULTS: The overall average of the incidences of adverse events was 5.2%, the median was 5.5% and it is consistent with the expected results mentioned in the protocol of the study. The identified incidence of adverse events is lower than the median rate of international studies (9.2%). The distribution of adverse events for specialties underlines the majority of adverse events in the medical area (37.5%), in opposition to the results of other studies; the surgery is the second specialty for number of adverse events (30.1%), followed by the emergency room (6.2%) and obstetrics (4.4%). The study identified 56.7% of adverse events as preventable. The consequences of adverse events were classified in different typologies: the prolonged stay was the most frequent consequence, followed by the disability at discharge. The death of the patient had a median occurrence of 9.45%. The concordance between the two reviewers in the evaluation of the clinical records was very high (higher than 95%) except for two centres. CONCLUSIONS: The results were consistent with the results of other international studies similar in scope in terms of type of study (definition of the rate of adverse events) and epidemiological study design (retrospective study). The incidence rate, previously mentioned as 5.2%, coincides with the unfavorable rates of events determined in varied countries. The preventability resulted in an average of 56.7%. The variability of the results obtained in our inquiry are likely attributable to varied factors occurred during the study.

Healthcare Workers Attitudes, Practices and Sources of Information for COVID-19 Vaccination: An Italian National Survey.

Background: Vaccination of healthcare workers (HCWs) is a crucial element to overcome the COVID-19 pandemic. The aim of this survey was to assess attitudes, sources of information and practices among Italian Healthcare workers (HCWs) in relation to COVID-19 vaccination. Methods: From 19 February to 23 April 2021, an anonymous voluntary questionnaire was sent to the mailing list of the main National Health Service structures. Data were collected through the SurveyMonkey platform. Results: A total of 2137 HCWs answered. Hesitancy towards COVID-19 vaccination was more frequent in females, in those with lower concern about COVID-19, and in nurses, auxiliary nurses (AN) and healthcare assistants. Hesitant professionals were more likely to not recommend vaccination to their patients or relatives, while a high concern about COVID-19 was related to an increased rate of recommendation to family members. HCWs were mostly in favor of mandatory vaccination (61.22%). Female sex, a lower education level, greater hesitancy and refusal to adhere to flu vaccination campaigns were predictors influencing the aversion to mandatory vaccination. All categories of HCWs referred mainly to institutional sources of information, while scientific literature was more used by professionals working in the northern regions of Italy and in infection control, infectious diseases, emergencies and critical areas. HCWs working in south-central regions, nurses, AN, healthcare technicians, administrators and HCWs with a lower education level were more likely to rely on internet, television, newspapers, and the opinions of family and friends. Conclusions: Communication in support of COVID-19 immunization campaigns should consider the differences between the various HCWs professional categories in order to efficiently reach all professionals, including the most hesitant ones.

Screening for antimicrobial-resistant Gram-negative bacteria in hospitalised patients, and risk of progression from colonisation to infection: Systematic review.

BACKGROUND: Transmission of antimicrobial-resistant Gram-negative bacteria (AMR-GNB) amongst hospitalised patients can lead to new cases of carriage, infection and outbreaks, hence the need for early carrier identification. We aim to explore two key elements that may guide control policies for colonisation/infection in hospital settings: screening practices on admission to hospital wards and risk of developing infection from colonisation. METHODS: We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to 2021 reporting on adult patients hospitalised in high-income countries. RESULTS: The search retrieved 11,853 articles. After screening, 100 studies were included. Combining target patient groups and setting type, we identified six screening approaches. The most reported approach was all admitted patients to high-risk (HR) wards (49.4%). The overall prevalence of AMR-GNB was 13.8% (95%CI 9.3-19.0) with significant differences across regions and time. Risk of progression to infection amongst colonised patients was 11.0% (95%CI 8.0-14.3) and varied according to setting and pathogens' group (p value<0.0001), with higher values reported for Klebsiella species (18.1%; 95%CI 8.9-29.3). CONCLUSIONS: While providing a comprehensive overview of the screening approaches, our study underlines the considerable burden of AMR-GNB colonisation and risk of progression to infection in hospitals by pathogen, setting and time.