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.

Infectious risk for healthcare workers: evaluation and prevention.

Exposure to pathogenic agents is a major occupational risk factor in healthcare facilities. The most common pathogenic agents are human immunodeficiency virus, hepatitis B and C viruses, and Mycobacterium tuberculosis. In Italy, about 70-80% of all cases of exposure to biological agents result from injuries caused by needles or other sharp instruments used during healthcare procedures. These accidents place a high economic burden on healthcare facilities. Indeed, each event is estimated to cost around € 375. Various studies have shown that the adoption of needlestick-prevention devices reduces occupational exposure to biological risk. At regulatory level, Italian Legislative Decrees 81/08 and 19/14 provide for measures to protect healthcare professionals from biological exposure to pathogenic agents.

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.

Sporadic isolation of sabin-like polioviruses and high-level detection of non-polio enteroviruses during sewage surveillance in seven Italian cities, after several years of inactivated poliovirus vaccination.

Sewage surveillance in seven Italian cities between 2005 and 2008, after the introduction of inactivated poliovirus vaccination (IPV) in 2002, showed rare polioviruses, none that were wild-type or circulating vaccine-derived poliovirus (cVDPV), and many other enteroviruses among 1,392 samples analyzed. Two of five polioviruses (PV) detected were Sabin-like PV2 and three PV3, based on enzyme-linked immunosorbent assay (ELISA) and PCR results. Neurovirulence-related mutations were found in the 5'noncoding region (5'NCR) of all strains and, for a PV2, also in VP1 region 143 (Ile>Thr). Intertypic recombination in the 3D region was detected in a second PV2 (Sabin 2/Sabin 1) and a PV3 (Sabin 3/Sabin 2). The low mutation rate in VP1 for all PVs suggests limited interhuman virus passages, consistent with efficient polio immunization in Italy. Nonetheless, these findings highlight the risk of wild or Sabin poliovirus reintroduction from abroad. Non-polio enteroviruses (NPEVs) were detected, 448 of which were coxsackievirus B (CVB) and 294 of which were echoviruses (Echo). Fifty-six NPEVs failing serological typing were characterized by sequencing the VP1 region (nucleotides [nt] 2628 to 2976). A total of 448 CVB and 294 Echo strains were identified; among those strains, CVB2, CVB5, and Echo 11 predominated. Environmental CVB5 and CVB2 strains from this study showed high sequence identity with GenBank global strains. The high similarity between environmental NPEVs and clinical strains from the same areas of Italy and the same periods indicates that environmental strains reflect the viruses circulating in the population and highlights the potential risk of inefficient wastewater treatments. This study confirmed that sewage surveillance can be more sensitive than acute flaccid paralysis (AFP) surveillance in monitoring silent poliovirus circulation in the population as well as the suitability of molecular approaches to enterovirus typing.

Legionella contamination in hospitals of the Campania Region: five years of environmental surveillance results.

OBJECTIVE: The purpose of this study was to assess the presence and the distribution of Legionella serotypes in 50 hospital facilities in the Campania Region (Italy) through the sampling of their waters. METHODS: From January 2008 to December 2012, in compliance with the Italian Monitoring Guidelines for Legionellosis, 4.842 water samples were collected from the end points of hot water distribution networks, air conditioning systems, boilers and cooling towers. RESULTS: 1.426 (29.4%) of the 4.842 samples resulted positive for Legionella spp, with a bacterial average of 3.40 log10 cfu/L. The frequency of Legionella isolation in the specimens progressively decreased during the study (43.8% in 2008 vs 22.9% in 2012). Samples from cooling towers (32.7%), showers and taps (31.9%) revealed a more frequent presence of the microorganism, although considerable bacterial concentration variability was found in all examined points. A bacterial average of 3.33 + 0.88 log10 cfu/L was detected in cooling towers, whereas the lowest values (2.89 + 0.92 cfu/L) were found in ACSs. The most frequently isolated species were L. pneumophila 2-14, detected in 60.6% of positive samples. Within serotypes, types 6 (23.8%), 8 (21.9%) and 3 (21.4%) resulted as being the most representative. CONCLUSIONS: A significant contamination was found in examined centers. It is therefore advisable to systematically implement currently available surveillance and monitoring strategies through the scrupulous monitoring of systems as well as through the application of validated and effective procedures.

[The surveillance of Candida spp. infections related to health care in the Neonatal Intensive Care of University Hospital Federico II of Naples, Italy]. / La sorveglianza delle infezioni da Candida spp. nella terapia intensiva neonatale dell'AOU Federico II di Napoli.

BACKGROUND: In neonatal intensive care unit (NICU) invasive fungal infections are predominantly supported by Candida species, with an increasing frequency of C. non-albicans. This work aims to demonstrate the need for monitoring of these infections for the purposes of a more effective prevention strategy. METHODS: This study, conducted for 15 months on 365 patients admitted to the NICU of the University Hospital "Federico II" of Naples, examines the colonization and nosocomial infections by Candida species in relation to the most significant risk factors such as prematurity, low birth weight and the application of relief devices. RESULTS: It was detected a statistically significant association between infections and pharyngeal colonization (p = 0.002), gestational age <28 weeks (p = 0.001) and central venous catheterization (p = 0.01). 12% of the 336 patients cared for more than 48 hours had pharyngeal colonization by Candida spp, especially C. albicans, while 2% develops sepsis due to C. parapsilosis. CONCLUSIONS: The results demonstrate the importance and validity of the procedures used for the surveillance of infections in NICU.

[Epidemiologic situation of viral hepatitis type A in Campania: perspectives of prevention and control of infections at the local level]. / Quadro epidemiologico dell'epatite virale di tipo A in Campania: prospettive di prevenzione e di controllo dell'infezione a livello locale.

In the Region Campania (South Italy) the Hepatitis A infection reveals to be very present, despite of worldwide decreasing trend. Particularly Naples has a high incidence pathology as compared with other regional districts: the propose of this work is analysing the reasons by analysis of small but representative sample of this pathology. Health District of ASL Napoli 1 Center provides us with the notifications of this disease. The cases disease are attributable to consumption of contaminated shellfish purchased from mainly non-authorized dealers present on all city territory. A properly educational, of the population, increased repression control of dealers, careful monitoring of illegal dumping, can reduce the incidence of EVA in city live Naples.

Prevalence of anti-legionella antibodies among Italian hospital workers.

This study evaluated the prevalence of anti-legionella antibodies in workers at hospitals with a long-term history of legionella contamination. The hospitals are located in Milan and Turin, northern Italy, and in Naples and Bari, southern Italy. Antibody prevalence and titres of healthcare workers, medical and dental students and blood donors were assessed. In total 28.5% of subjects were antibody positive, most frequently to L. pneumophila serogroups 7-14. Major differences were observed in seroprevalence and type of legionella antibody in persons from different geographic areas. Healthcare workers had a significantly higher frequency of antibodies compared with blood donors in Milan (35.4 vs 15.9%, P<0.001), whereas in Naples both groups exhibited high antibody frequency (48.8 vs 44.0%) and had a higher proportion of antibodies to legionella serogroups 1-6. Dental workers had a higher seroprevalence than office staff in Bari, but not in Turin, where daily disinfecting procedures had been adopted to avoid contamination of dental unit water. No association was found between the presence of antibodies and the presence of risk factors for legionellosis, nor with the occurrence of pneumonia and/or flu-like symptoms. In conclusion, the presence of legionella antibodies may be associated with occupational exposure in the hospital environment, but there was no evidence of any association with disease.

[Microbiological verification of a self control plan for a hospital food service]. / Verifica microbiologica di un piano di autocontrollo in un servizio di ristorazione ospedaliera.

During the past years, it has been an increment of food related infectious diseases. In order to avoid micro biological food contamination, adherence to good manufacturing is required through control measures of food safety practices. Updated national and European regulations underline the need to apply the HACCP system, overcoming the old concept of sample control on the end user product. This work shows results of microbiological controls made along the whole productive chain. Measurements are made using biomolecular techniques (PFGE) in order to assess the management of the micro biological risk of the self control plan applied to a hospital food service of Naples. The use of the PFGE applied on some micro-organisms gram negative potentially pathogen, underlines the circulation, continued in time, of these micro-organisms within the cooking area. In addition, cross contamination between several matrixes of samples has been detected.