Central-line associated bloodstream infections in a tertiary care children's University hospital: a prospective study.

BACKGROUND: The central-line associated bloodstream infections (CLABSI) are the most common healthcare-associated infections in childhood. Despite the international data available on healthcare-associated infections in selected groups of patients, there is a lack of large and good quality studies. The present survey is the first prospective study monitoring for 6 months the occurrence of central-line associated bloodstream infections in all departments of an Italian tertiary care children's university hospital. METHODS: The study involved all children aged less than 18 years admitted to Meyer Children's University Hospital, Florence, Italy who had a central line access between the October 15th, 2014 and the April 14th, 2015. CLABSI were defined according to the Center for Disease Control and Prevention criteria. CLABSI incidence rates with 95% confidence limits were calculated and stratified for the study variables. For each factor the relative risk and 95% confidence intervals were evaluated. Statistical analysis was performed using the statistical software SPSS for Windows, version 22.0 (SPSS Inc., Chicago, IL), p < 0.05 was considered statistically significant. RESULTS: CLABSI rate was 3.73/1000 (95% CI: 2.54-5.28) central line-days. A higher CLABSI incidence was seen with female gender (p = 0.045) and underlying medical conditions (excepting prematurity, surgical diseases and malignancy) (p = 0.06). In our study 5 infections, were caused by extended-spectrum ß-lactamase producing organisms and in one case by carbapenem-resistant Klebsiella pneumoniae. CONCLUSIONS: Our study confirms the spreading of multi-resistant pathogens as causes of healthcare associated infections in children. An increased incidence rate of CLABSI in our study was related to underlying medical conditions. Pediatric studies focusing on healthcare infections in this type of patients should be done in order to deepen our understanding on associated risk factors and possible intervention areas.

Consensus conference on the appropriateness of palivizumab prophylaxis in respiratory syncytial virus disease.

Respiratory syncytial virus infection represents a clinical burden among young children under 24 months. Palivizumab is the only drug licensed in Italy for the prevention of serious lower respiratory tract disease requiring hospitalization caused by respiratory syncytial virus in children at high risk. However recommendations for palivizumab prophylaxis are heterogeneous. Not all the published documents agree about the clinical indications of palivizumab; this could lead to different clinical practices and concerns about the appropriateness of prophylaxis. These issues and the lack of evidence about palivizumab prophylaxis efficacy in specific medical conditions brought on the idea of a consensus conference on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications. The goal was to perform a review of the evidence regarding the efficacy and the safety of palivizumab and give recommendations in order to harmonize its use. A structured and validated method to conduct the consensus process was adopted. The consensus conference recommends palivizumab prophylaxis in infants born before 29 weeks and younger than 12 months at the start of the epidemic season. According to evidence from literature and experts' opinion, palivizumab prophylaxis is not recommended in preterm infants of gestational age ≥29 weeks, without co-morbidity (i.e., cardiac, bronchopulmonary diseases). The experts identified some clinical rare conditions for which the decision of prophylaxis should be entrusted to the specialists. The evaluation of the appropriateness of palivizumab prophylaxis in the single patient should be documented by the specialists. Pediatr Pulmonol. 2016;51:1088-1096. © 2016 Wiley Periodicals, Inc.

Serratia marcescens outbreak in a neonatal intensive care unit: crucial role of implementing hand hygiene among external consultants.

BACKGROUND: Serratia marcescens represents an important pathogen involved in hospital acquired infections. Outbreaks are frequently reported and are difficult to eradicate. The aim of this study is to describe an outbreak of Serratia marcescens occurred from May to November 2012 in a neonatal intensive care unit, to discuss the control measures adopted, addressing the role of molecular biology in routine investigations during the outbreak. METHODS: After an outbreak of Serratia marcescens involving 14 neonates, all admitted patients were screened for rectal and ocular carriage every two weeks. Extensive environmental sampling procedure and hand sampling of the staff were performed. Antimicrobial susceptibility pattern and molecular analysis of isolates were carried out. Effective hand hygiene measures involving all the external consultants has been implemented. Colonized and infected babies were cohorted. Dedicated staff was established to care for the colonized or infected babies. RESULTS: During the surveillance, 65 newborns were sampled obtaining 297 ocular and rectal swabs in five times. Thirty-four Serratia marcescens isolates were collected: 11 out of 34 strains were isolated from eyes, being the remaining 23 isolated from rectal swabs. Two patients presented symptomatic conjunctivitis. Environmental and hand sampling resulted negative. During the fifth sampling procedure no colonized or infected patients have been identified. Two different clones have been identified. CONCLUSIONS: Ocular and rectal colonization played an important role in spread of infections. Implementation of infection control measures, involving also external specialists, allowed to control a serious Serratia marcescens outbreak in a neonatal intensive care unit.

[Influenza vaccination of nurses in an Italian pediatric hospital: effects on absenteeism and on costs, factors associated with vaccine uptake and analysis of personal motivations. A prospective cohort study]. / Una campagna di vaccinazione antinfluenzale gratuita tra gli infermieri in un ospedale pediatrico: fattori associati all'adesione, analisi delle motivazioni, effetti sulle assenze ed analisi dei costi. Studio di coorte prospettico.

AIMS: To evaluate the effects on absenteeism and on costs for the health care system (HCS) of influenza vaccination offered to nurses in a paediatric hospital; the factors associated with vaccination acceptance and non-acceptance; the motivations of vaccine-recipient and non-recipient nurses. METHODS: Cohort study. During the 2005-2006 influenza season we observed the entire nurse population of a Paediatric Hospital (n = 327) who were offered influenza vaccination at no cost at the working place. An anonymous questionnaire was also administered. RESULTS: Vaccination rate was 30.3%. Mean days of sick leave of vaccinated nurses (3.4 per 100 calendar days) and non vaccinated nurses (4.5 per 100 calendar days) differed but not significantly. The saving for HCS due to vaccination of less than 1/3 of nurses was equal to 0.67 nurse-years. Age > or = 40 years (RR 1.47, p = 0.01), length of service > or = 20 years (RR 1.81, p = 0.0003) and working in oncology ward (RR 2.09, p = 0.002) were predictors of adhesion to the vaccination campaign. Among motivations given for vaccination were: not to transmit influenza to hospitalised children (62.8%), to avoid getting sick (55.6%), to protect own family members (49.4%). Only 34% of vaccinated nurses would have made vaccination even if not offered for free. Among non-recipients' main motivations were: vaccination is unnecessary (62.4%), no trust in its efficacy (8.8%). No differences were found in the incidence of influenza symptoms reported by vaccinated and non vaccinated nurses. DISCUSSION: The utility of influenza vaccination to reduce absenteeism of nurses remains unclear. Strategies for influenza vaccination campaigns should particularly address younger nurses and should take into account the beliefs of each nurse in regards to own health.