Measurement of IFN-γ and IL-2 for the assessment of the cellular immunity against SARS-CoV-2.

The study of specific T-cell responses against SARS-CoV-2 is important for understanding long-term immunity and infection management. The aim of this study was to assess the dual IFN-γ and IL-2 detection, using a SARS-CoV-2 specific fluorescence ELISPOT, in patients undergoing acute disease, during convalescence, and after vaccination. We also evaluated humoral response and compared with T-cells with the aim of correlating both types of responses, and increase the number of specific response detection. Blood samples were drawn from acute COVID-19 patients and convalescent individuals classified according to disease severity; and from unvaccinated and vaccinated uninfected individuals. IgGs against Spike and nucleocapsid, IgMs against nucleocapsid, and neutralizing antibodies were also analyzed. Our results show that IFN-γ in combination with IL-2 increases response detection in acute and convalescent individuals (p = 0.023). In addition, IFN-γ detection can be a useful biomarker for monitoring severe acute patients, as our results indicate that those individuals with a poor outcome have lower levels of this cytokine. In some cases, the lack of cellular immunity is compensated by antibodies, confirming the role of both types of immune responses in infection, and confirming that their dual detection can increase the number of specific response detections. In summary, IFN-γ/IL-2 dual detection is promising for characterizing and assessing the immunization status, and helping in the patient management.

Hygiene with wet wipes in bedridden patients to prevent catheter-associated urinary tract infection in cardiac surgery: A randomized controlled trial.

We assessed hygiene with wet wipes in bedridden patients with urinary catheters for catheter-associated urinary tract infection (CAUTI) prevention. CAUTIs occurred in 16.5% of the control group compared to 5.9% of the intervention group (P = .035). Hygiene with wet wipes can substitute for conventional hygiene for preventing CAUTI.

Correction: Influenza vaccination coverage and factors associated with severe laboratory-confirmed influenza-related illness in patients receiving care at a tertiary hospital in Catalonia (Spain) during the 2018-2019 epidemic season.

[This corrects the article DOI: 10.1371/journal.pone.0260397.].

Intervention to reduce the incidence of non-ventilator-associated hospital-acquired pneumonia: A pilot study.

BACKGROUND: Our aim was to evaluate the effectiveness of an intervention to reduce the incidence of non-ventilator-associated hospital-acquired pneumonia (NV-HAP) and determine compliance with preventive measures. METHODS: This was a quasi-experimental before-after study involving patients in the 53-bed Internal Medicine ward in a university hospital in Spain. The preventive measures included hand hygiene, dysphagia detection, head-of-bed elevation, withdrawal of sedatives in the event of confusion, oral care, and sterile or bottled water use. A prospective post-intervention study of the incidence of NV-HAP was carried out from February 2017 to January 2018 and compared with baseline incidence (May 2014 to April 2015). Compliance with preventive measures was analyzed with 3-point-prevalence studies (December 2015, October 2016, and June 2017). RESULTS: The rate of NV-HAP decreased from 0.45 cases (95% confidence interval 0.24-0.77) in the pre-intervention period to 0.18 cases per 1,000 patient-days (95% confidence interval 0.07-0.39) in the post-intervention period (P = .07). Compliance with most preventive measures improved after intervention and remained stable over time. CONCLUSIONS: The strategy improved the adherence to most of the preventive measures, with a decrease in the incidence of NV-HAP. Efforts to enhance adherence to such fundamental preventive measures are critical to lowering the incidence of NV-HAP.

Análisis de la calidad de vida relacionada con salud oral en adultos con maloclusión / Analysis of the Oral Health-Related Quality of Life in Adults with Malocclusion / Análise da qualidade de vida relacionada à saúde bucal em adultos com má oclusão

aquellos pacientes que requirieron tratamiento de ortodoncia informaron impactos negativos en su calidad de vida relacionada con salud oral, en comparación con aquellos pacientes conclusión normal. El objetivo fue analizar la calidad de vida relacionada con la salud oral en pacientes con diferentes niveles de severidad de maloclusión que acudieron a consultorios odontológicos públicos de Paraguay durante el 2017. Materiales y métodos: estudio transversal. Se midieron variables sociodemográficas (como sexo, edad, residencia y nivel de estudios) y variables clínicas (como diastema, máxima irregularidad anterior maxilar y mandibular, resalte incisal y mordida cruzada anterior). Se utilizó el cuestionario Perfil de Impacto de Salud Oral en su versión paraguaya (ohip-14Py) y el Índice de Estética Dental (IED). Resultados: formaron parte del estudio 269 pacientes, la mayoría mujeres (75.1 %). El puntaje IED fue de 31.6 ± 11.6. Se observó resalte incisal aumentado (>2 mm) en poco más de la mitad (52.4 %) y una baja frecuencia de mordida cruzada anterior (5.9 %) y mordida abierta (10.0 %). Al evaluar por dimensiones, la incapacidad psicológica (p = 0.028), social (p = 0.034) y la minusvalía (p = 0.552) aumentaron conforme el nivel de severidad de maloclusión, por lo que fueron estadísticamente significativas las dos primeras. Conclusión: conforme aumenta la gravedad de la maloclusión, disminuye significativamente la calidad de vida oral para las dimensiones incapacidad psicológica e incapacidad social.

Patients requiring orthodontic treatment reported negative impacts on oral health-related qual-ity of life compared to patients with normal occlusion. Objective: To analyze the oral health-related quality of life in patients with different levels of severity of malocclusion attending public dental offices in Paraguay in 2017. Methodology: This was a cross-sectional study. Both, the sociodemographic variables, like sex, age, res-idence, and educational level, and the clinical variables, like diastema, maximum anterior maxillary, and mandibular irregularity, incisal overhang, and anterior crossbite were measured. The Oral Health Impact Profile questionnaire was used in its Paraguayan version (ohip-14Py) and the Dental Aesthetic Index (ied) scale. Results: A total of 269 patients were a part of the study. Moreover, 75.1 % of them were women. The ied score was 31.4 ± 11.6. An increase in the incisal protrusion (>2 mm) was seen in 52.4 % of the patients. Whereas a low frequency of anterior crossbite and open bite were seen in 5.9 % and 10.0 % of the population, respec-tively. While conducting an evaluation based on the dimensions, the psychological disability (p = 0.028), social disability (p = 0.034), and handicap (p = 0.552) increased according to the level of severity of malocclusion, being statistically significant in the first two. Conclusion: As the severity of the level of malocclusion increases, the oral quality of life decreases for the psychological disability and social disability dimensions.

os pacientes que necessitaram de tratamento ortodôntico relataram impactos negativos na qualidade de vida relacionada à saúde bucal em comparação aos pacientes com oclusão normal. Objetivo:analisar a qualidade de vida relacionada à saúde bucal em pacientes com diferentes graus de severi-dade da má oclusão que compareceram a consultórios odontológicos públicos no Paraguai durante o ano de 2017. Metodologia: estudo transversal. Foram mensuradas variáveis sociodemográficas como sexo, idade, residência e escolaridade e variáveis clínicas como diastema, irregularidade anterior maxilar e mandibular máxima, sobressaliência incisal e mordida cruzada anterior. Foram utilizados o questioná-rio Perfil de Impacto em Saúde Bucal em sua versão paraguaia (ohip-14Py) e o Índice de Estética Dental (ied). Resultados: fizeram parte do estudo 269 pacientes, sendo a maioria mulheres (75,1 %). A pontuação do ied foi de 31,6 ± 11,6. Observou-se aumento da saliência incisal (>2 mm) em pouco mais da metade (52,4 %) dos pacientes, além de baixa frequência de mordida cruzada anterior (5,9 %) e mordida aberta (10,0 %). Ao avaliar por dimensões, a incapacidade psicológica (p = 0,028), incapacidade social (p = 0,034) e desvantagem (p = 0,552) aumentaram de acordo com o grau de severidade da má oclusão, sendo as duas primeiras estatisticamente significativas. Conclusão: à medida que a gravidade da má oclusão aumenta, a qualidade de vida oral diminui significativamente para as dimensões de incapacidade psicológica e incapacidade social.

Correlation between Clinical and Immunological Variables and Humoral Response to SARS-CoV-2 Vaccination in Adult Patients with Antibody Deficiency Disorders.

BACKGROUND: Prophylactic vaccination has proven to be the most effective strategy to fight the COVID-19 pandemic. METHODS: This was a prospective observational cohort study involving 30 predominantly antibody deficiency disorders (ADD)-afflicted adult patients on immunoglobulin replacement therapy vaccinated with three doses of the mRNA-1273 COVID-19 vaccine, and 10 healthy controls. Anti-RBD IgG antibodies were determined in plasma samples collected just before the first dose of mRNA-based COVID-19 vaccine and on weeks 4, 8, 24, and 28 following the first vaccination. Patients were categorized based on the levels of anti-RBD antibodies determined on w8 as non-, low-, and responders. Chi-square and Kruskal-Wallis tests were used to see if any variables correlated with humoral response levels. Any adverse effects of the mRNA-based vaccine were also noted. RESULTS: The COVID-19 vaccine was safe and well-tolerated. The humoral response elicited at w8 after vaccination depended on the type of ADD, the type of immunoglobulin deficiency, the presence of granulomatous lymphocytic interstitial lung disease, recent use of immunosuppressive drugs, and the switched memory B cells counts. The third vaccine dose boosted humoral response in previous responders to second dose but seldom in non-responders. CONCLUSIONS: The humoral response of patients with predominant ADD depends mostly on the type of immunodeficiency and on the frequency of B and T cell populations.

Impacto de una intervención multimodal en el cumplimiento de higiene de manos en los profesionales sanitarios de un hospital de tercer nivel / Impact of a multimodal intervention on compliance with hand hygiene among health care workers of a tertiary hospital

Antecedente y objetivo: La higiene de manos (HM) es la medida más sencilla y eficaz para la prevención de la infección relacionada con la asistencia sanitaria. A pesar de ello, el cumplimiento en los profesionales sanitarios continúa siendo subóptimo. El objetivo de este estudio es evaluar el impacto de una estrategia multimodal de la Organización Mundial de la Salud (OMS) ampliada en el cumplimiento de la HM en el personal sanitario.Material y métodosSe diseñó un estudio cuasiexperimental pretest-postest, llevando a cabo durante 2018 la estrategia multimodal de la OMS ampliada y dirigida a los profesionales de un hospital de tercer nivel. En esta estrategia, aparte de aplicar los 5 pilares de la OMS, se realizó un vídeo, la administración del cuestionario de percepciones de la OMS y un incentivo al servicio/unidad con mejor cumplimiento, añadiendo a la formación una modalidad de talleres prácticos. Se compararon los porcentajes de cumplimiento del año 2017 y 2018.ResultadosEn el año 2017 se observaron 1.056 oportunidades, registrándose 631 acciones de HM, siendo el cumplimiento global del 60% (IC 95% 56,7-62,7). En el año 2018, con 1.481 oportunidades observadas y 1.111 acciones de HM, el cumplimiento fue del 75% (IC 95% 72,7-77,2) (p<0,001). Este cumplimiento se incrementó en todos los estamentos y en todas las indicaciones.ConclusionesLa aplicación de una estrategia multimodal ampliada tiene un impacto positivo en el cumplimiento de HM. Se deben dirigir estrategias a los estamentos con peor cumplimiento y de forma continuada en el tiempo. (AU)

Background and objective: Hand hygiene (HH) is the simplest and most effective measure for the prevention of infection related to healthcare. Despite this, compliance in healthcare professionals continues to be suboptimal. The aim of this study is to assess the impact of an expanded World Health Organization (WHO) multimodal strategy on HH compliance in healthcare personnel.Material and methodsA quasi-experimental before-after study was designed, carrying out the expanded WHO multimodal strategy in 2018, aimed at professionals in a tertiary hospital. In this strategy, apart from applying the 5 pillars of the WHO, a video was made, the administration of the WHO perceptions questionnaire and an incentive to the service/unit with better compliance, adding to the training a modality of practical workshops. The compliance percentages for 2017 and 2018 were compared.ResultsIn 2017, 1056 opportunities were observed, registering 631 HH actions, with global compliance of 60% (95% CI 56.7-62.7). In 2018, with 1481 opportunities observed and 1111 HH actions, compliance was 75% (95% CI 72.7-77.2) (P<.001). This compliance increased in all professional categories and in all indications.ConclusionsThe application of an expanded multimodal strategy has a positive impact on HH compliance. Strategies should be directed to the categories with the worst compliance and continuously over time. (AU)

Measuring T-Cell Responses against SARS-CoV-2 Is of Utility for Disease and Vaccination Management.

The measurement of specific T-cell responses can be a useful tool for COVID-19 diagnostics and clinical management. In this study, we evaluated the IFN-γ T-cell response against the main SARS-CoV-2 antigens (spike, nucleocapsid and membrane) in acute and convalescent individuals classified according to severity, and in vaccinated and unvaccinated controls. IgG against spike and nucleocapsid were also measured. Spike antigen triggered the highest number of T-cell responses. Acute patients showed a low percentage of positive responses when compared to convalescent (71.6% vs. 91.7%, respectively), but increased during hospitalization and with severity. Some convalescent patients showed an IFN-γ T-cell response more than 200 days after diagnosis. Only half of the vaccinated individuals displayed an IFN-γ T-cell response after the second dose. IgG response was found in a higher percentage of individuals compared to IFN-γ T-cell responses, and moderate correlations between both responses were seen. However, in some acute COVID-19 patients specific T-cell response was detected, but not IgG production. We found that the chances of an IFN-γ T-cell response against SARS-CoV-2 is low during acute phase, but may increase over time, and that only half of the vaccinated individuals had an IFN-γ T-cell response after the second dose.

Evaluation of Fourier Transform Infrared Spectroscopy as a First-Line Typing Tool for the Identification of Extended-Spectrum ß-Lactamase-Producing Klebsiella pneumoniae Outbreaks in the Hospital Setting.

Early detection of pathogen cross-transmission events and environmental reservoirs is needed to control derived nosocomial outbreaks. Whole-genome sequencing (WGS) is considered the gold standard for outbreak confirmation, but, in most cases, it is time-consuming and has elevated costs. Consequently, the timely incorporation of WGS results to conventional epidemiology (CE) investigations for rapid outbreak detection is scarce. Fourier transform infrared spectroscopy (FTIR) is a rapid technique that establishes similarity among bacteria based on the comparison of infrared light absorption patterns of bacterial polysaccharides and has been used as a typing tool in recent studies. The aim of the present study was to evaluate the performance of the FTIR as a first-line typing tool for the identification of extended-spectrum ß-lactamase-producing Klebsiella pneumoniae (ESBL-Kp) outbreaks in the hospital setting in comparison with CE investigations using WGS as the gold standard method. Sixty-three isolates of ESBL-Kp collected from 2018 to 2021 and classified according to CE were typed by both FTIR and WGS. Concordance was measured using the Adjusted Rand index (AR) and the Adjusted Wallace coefficient (AW) for both CE and FTIR clustering considering WGS as the reference method. Both AR and AW were significantly higher for FTIR clustering than CE clustering (0.475 vs. 0.134, p = 0.01, and 0.521 vs. 0.134, p = 0.009, respectively). Accordingly, FTIR inferred more true clustering relationships than CE (38/42 vs. 24/42, p = 0.001). However, a similar proportion of genomic singletons was detected by both FTIR and CE (13/21 vs. 12/21, p = 1). This study demonstrates the utility of the FTIR method as a quick, low-cost, first-line tool for the detection of ESBL-Kp outbreaks, while WGS analyses are being performed for outbreak confirmation and isolate characterization. Thus, clinical microbiology laboratories would benefit from integrating the FTIR method into CE investigations for infection control measures in the hospital setting.

Impact of the Introduction of a Two-Step Laboratory Diagnostic Algorithm in the Incidence and Earlier Diagnosis of Clostridioides difficile Infection.

Our aim was to determine changes in the incidence of CD infection (CDI) following the introduction of a two-step diagnostic algorithm and to analyze CDI cases diagnosed in the study period. We retrospectively studied CDI (January 2009 to July 2018) in adults diagnosed by toxin enzyme immunoassay (EIA) (2009−2012) or toxin-EIA + polymerase chain reaction (PCR) algorithm (2013 onwards). A total of 443 patients with a first episode of CDI were included, 297 (67.1%) toxin-EIA-positive and 146 (32.9%) toxin-EIA-negative/PCR-positive were only identified through the two-step algorithm including the PCR test. The incidence of CDI increased from 0.9 to 4.7/10,000 patient-days (p < 0.01) and 146 (32.9%) toxin-negative CDI were diagnosed. Testing rate increased from 24.4 to 59.5/10,000 patient-days (p < 0.01) and the percentage of positive stools rose from 3.9% to 12.5% (p < 0.01). CD toxin-positive patients had a higher frequency of severe presentation and a lower rate of immunosuppressive drugs and inflammatory bowel disease. Mortality (16.3%) was significantly higher in patients with hematological neoplasm, intensive care unit admission and complicated disease. Recurrences (14.9%) were significantly higher with proton pump inhibitor exposure. The two-step diagnostic algorithm facilitates earlier diagnosis, potentially impacting patient outcomes and nosocomial spread. CD-toxin-positive patients had a more severe clinical presentation, probably due to increased CD bacterial load with higher toxin concentration. This early and easy marker should alert clinicians of potentially more severe outcomes.

Cultural adaptation, translation and validation of the Spanish version Debriefing Experience Scale.

Clinical simulation as a teaching methodology allows the student to train and learn technical abilities and/or non-technical abilities. One of the key elements of this teaching methodology is the debriefing, which consists of a conversation between several people, in which the participants go over a real or simulated event in order to analyze their actions and reflect on the role that thought processes, psychomotor skills and emotional states can play in maintaining, or improving their performance in the future. The Debriefing Experience Scale allows the experience of students in debriefing to be measured. The objective of this study is to translate the Debriefing Experience Scale (DES) into Spanish and analyze its reliability and validity to measure the experience of nursing students during the debriefing. The study was developed in two phases: One: the adaption of the instrument to Spanish, two: a transversal study carried out in a sample of 290 nursing students. The psychometric properties were analyzed in terms of reliability and construct validity using confirmatory factorial analysis (CFA). Cronbach's alpha was adequate for all the scales and for each one of the dimensions. The confirmatory factorial analysis showed that the 4-dimensional model is acceptable for both scales (experience and opinion). The Spanish version Debriefing Experience Scale questionnaire is useful, valid and reliable for use to measure the debriefing experience of university students in a simulation activity.

Effectiveness of Mental Health Literacy Programs in Primary and Secondary Schools: A Systematic Review with Meta-Analysis.

In recent years, there has been an increase in studies evaluating the effectiveness of mental health literacy programs within the context of education as a universal, preventive intervention. A systematic review and meta-analysis regarding the effectiveness of mental health literacy interventions in schools, from 2013 to the present, on mental health knowledge, stigma, and help-seeking is conducted. Of the 795 identified references, 15 studies met the inclusion criteria. Mental health knowledge increased after the interventions (standardized mean difference: SMD = 0.61; 95% CI (0.05, 0.74)), at two months (SMD = 0.60; 95% CI (0.4, 1.07)) and six months (SMD = 0.39; 95% CI (0.27, 0.51)). No significant differences were observed between stigma and improving help-seeking. Mental health literacy interventions are effective in augmenting mental health knowledge, but not in reducing stigma or improving help-seeking behavior.

Autopercepción en salud y calidad de vida relacionada con salud oral

RESUMEN Las enfermedades bucales están asociadas con factores de riesgo que son comunes a enfermedades no transmisibles. La salud bucal tiene implicaciones sistémicas potencialmente multiorgánicas, que van desde una resistencia a la insulina producida por la presencia de enfermedad periodontal hasta complicaciones sistémicas multiorgánicas más complejas que involucran al sistema cardiovascular o incluso patología neurodegenerativa. El objetivo fue correlacionar la calidad de vida relacionada con salud oral y la calidad de vida relacionada con salud general en un grupo de adultos paraguayos. Estudio transversal donde participaron adultos paraguayos de ambos sexos. Se utilizaron los cuestionarios de la EuroQol (EQ-5D-3L) para medir la autopercepción en salud y el Perfil de Impacto de la Salud Oral (OHIP-14Py) para medir la calidad de vida relacionada con salud oral. Se utilizó el análisis de correlación de Pearson con un nivel de confianza del 95%. La muestra quedó conformada por 333 adultos, siendo 77,48% mujeres. El promedio del OHIP-14Py fue de 5,53±5,19. El EQ EVA promedio fue de 78,25±19,74. El 21,62% presentó angustia y/o depresión moderada y el 16,52% presentó dolor y/o malestar moderado. El 11111 correspondió al 56,46% y en el 33333 se encontró el 0,30% de la muestra. La correlación entre OHIP-14Py y EQ EVA fue negativo (Rho=-0,29; p<0,01), mientras que con el EQ-5D-3L fue positiva (Rho=0,21; p<0,01). Se reportaron niveles moderados y severos de angustia/depresión, dolor/malestar y alteración de actividades diarias por problemas con su salud. El OHIP-14Py se correlacionó significativamente con el EQ-5D-3L.

ABSTRACT Oral diseases are associated with risk factors that are common to non-transmissible diseases. Oral health has potentially multi-organ systemic implications, ranging from insulin resistance produced by the presence of periodontal disease to more complex multi-organ systemic complications involving the cardiovascular system or even neurodegenerative pathology. The objective was to correlate the quality of life related to oral health and the quality of life related to general health in a group of Paraguayan adults. Cross-sectional study in which Paraguayan adult men and women participated. The EuroQol questionnaires (EQ-5D-3L) were used to measure self-perception of health and the Oral Health Impact Profile (OHIP-14Py) to measure the quality of life related to oral health. Pearson's correlation analysis was used with a confidence level of 95%. The sample consisted of 333 adults and 77.48% of them were women. The mean OHIP-14Py was 5.53±5.19. The mean EQ EVA was 78.25±19-74. The 21.62% showed moderate distress and/or depression and 16.52% showed moderate pain and/or discomfort. The 11111 corresponded to 56.46% and the 0.30% of the sample was in the 33333. The correlation between OHIP-14Py and EQ EVA was negative (Rho=-0.29; p<0.01), while it was positive with EQ-5D-3L (Rho=0.21; p<0.01). Moderate and severe levels of distress/depression, pain/discomfort, and disruption of daily activities due to health problems were reported. The OHIP-14Py correlated meaningfully with the EQ-5D-3L.

Psychological impact of the COVID-19 pandemic on nursing students in the first wave: A cross-sectional survey.

AIM: The aim of the study was to evaluate the psychological impact on nursing students at the end of period of confinement during the first wave of the COVID-19 outbreak in Spain. DESIGN: A cross-sectional study reported in line with the STROBE guidelines. METHODS: Nursing students were invited to complete an online questionnaire at the end of the 2019-2020 academic year using convenience sampling. The questionnaire collected data on sociodemographic factors, work, and life experiences in relation to COVID-19, habits and lifestyle using the World Health Organization Five Well-Being Index (WHO-5) and the Generalized Anxiety disorder-7 scale. Variables related to anxiety were analysed using multiple lineal regression analysis, RESULTS: The prevalence of low psychological well-being in the 203 students was 44.3% and of anxiety 55.7%. In the multivariate analysis the variables associated with anxiety were having worked in the pandemic, having had symptoms of COVID-19 and having been afraid of getting infected. CONCLUSIONS: The levels of anxiety due to the COVID-19 pandemic in nursing students have been high, and levels of psychological well-being have been low. The fact of having worked during the pandemic, having had symptoms compatible with COVID-19 or being afraid of getting infected are associated with the highest scores for anxiety. RELEVANCE TO CLINICAL PRACTICE: This study gives more evidence on the psychological impact on nursing students during the first wave of the pandemic in Spain. This can be used to design anxiety management programmes for inclusion into teaching syllabuses. It also gives arguments for the setting up of psychological and emotional support services for these students and other healthcare professionals working during the pandemic.

Impact of a multimodal intervention on compliance with hand hygiene among health care workers of a tertiary hospital. / Impacto de una intervención multimodal en el cumplimiento de higiene de manos en los profesionales sanitarios de un hospital de tercer nivel.

BACKGROUND AND OBJECTIVE: Hand hygiene (HH) is the simplest and most effective measure for the prevention of infection related to healthcare. Despite this, compliance in healthcare professionals continues to be suboptimal. The aim of this study is to assess the impact of an expanded World Health Organization (WHO) multimodal strategy on HH compliance in healthcare personnel. MATERIAL AND METHODS: A quasi-experimental before-after study was designed, carrying out the expanded WHO multimodal strategy in 2018, aimed at professionals in a tertiary hospital. In this strategy, apart from applying the 5 pillars of the WHO, a video was made, the administration of the WHO perceptions questionnaire and an incentive to the service/unit with better compliance, adding to the training a modality of practical workshops. The compliance percentages for 2017 and 2018 were compared. RESULTS: In 2017, 1056 opportunities were observed, registering 631 HH actions, with global compliance of 60% (95% CI 56.7-62.7). In 2018, with 1481 opportunities observed and 1111 HH actions, compliance was 75% (95% CI 72.7-77.2) (P<.001). This compliance increased in all professional categories and in all indications. CONCLUSIONS: The application of an expanded multimodal strategy has a positive impact on HH compliance. Strategies should be directed to the categories with the worst compliance and continuously over time.

Influenza vaccination coverage and factors associated with severe laboratory-confirmed influenza-related illness in patients receiving care at a tertiary hospital in Catalonia (Spain) during the 2018-2019 epidemic season.

INTRODUCTION: Influenza vaccination rates in risk groups remain suboptimal. Evidence supporting a significant association between influenza vaccination and severe illness is limited. METHODS: We retrospectively analyzed the epidemiological characteristics of out- and inpatients with laboratory-confirmed influenza infection attended during the 2018-19 epidemic season. Influenza vaccination coverage by indication was analyzed. Logistic regression was used to compare the odds of vaccination between severe and non-severe influenza-positive patients. Severe cases were defined as presenting pneumonia, admission to critical care units and/or death. RESULTS: The overall vaccination coverage among influenza-positive patients was 30.4%. In subjects with ≥ 1 indication for vaccination, the vaccination coverage was 42.4%. By indication, coverage rates were: 52.5% in patients aged ≥ 59 years, 42.2% in obese patients, 29.2% in immunosuppressed subjects and 6.5% in pregnant women. In patients with underlying chronic diseases, a higher coverage was found in patients with cognitive impairment (77%), muscular dystrophy (63.6%) and renal disease (60.4%). The multivariate logistic regression model showed severe influenza-related illness was associated with a lack of influenza vaccination before seeking care during the 2018-2019 season [0.59 (95%CI 0.36-0.97); p = 0.038], older age [1.01 (95%CI 1.00-1.02); p = 0.009] and current or former smoking status [1.63 (95%CI 0.84-3.18) and 2.03 (95%CI 1.16-3.57); p = 0.031], adjusted by underlying disease. CONCLUSION: Adjusting by age, smoking status and underlying disease, a moderate association between the influenza vaccine and severe laboratory-confirmed influenza-related illness was found in an epidemic season in which there was matching between the vaccine and circulating strains. Protection against complications, especially in older subjects and in those with underlying disease is postulated as one of the strengths of annual influenza vaccination. However, influenza vaccination is a pending issue in these groups, especially in pregnant women and obese people. To avoid suboptimal vaccination coverages, health professionals should recommend the seasonal influenza vaccination according to the annual instructions of the health authorities.

Attitudes of Spanish hospital staff towards COVID-19 vaccination and vaccination rates.

BACKGROUND: COVID-19 vaccine hesitancy seems to be universal across countries and subgroups, and so are its determinants. We studied the willingness and factors associated with the decision to be vaccinated against COVID-19 in healthcare workers (HCW) in a Spanish tertiary hospital. Furthermore, we compared the percentage of willingness to vaccinate against COVID with actual vaccination rates among HCW in our hospital. METHODS: From December 21, 2020 to January 4, 2021, before initiation of the COVID-19 HCW vaccination campaign at Germans Trias i Pujol University Hospital (HUGTiP), an anonymous self-administered questionnaire was administered to HCW. Univariate and multivariate logistic regression of the association of variables with the outcome "intention to receive the COVID-19 vaccine as soon as possible" was conducted. Vaccination rates were extracted from the hospital information systems. RESULTS: Forty-four percent of HCW included in the study declared a willingness to be vaccinated against COVID-19 as soon as possible. This was associated with male sex [1.66 (95%CI 1.13-2.43); p = 0.009], older age [1.02 (95%CI 1.00-1.03); p = 0.014], belonging to the occupational groups "physician" or "other" [5.76 (95%CI 3.44-9.63) and 2.15 (95%CI 1.25-3.70); p<0.001], respectively, and reporting influenza vaccination during the last three seasons or at least one of the last three seasons [3.84 (95%CI 2.56-5.75) and 2.49 (95%CI 1.71-3.63); p<0.001]. One in ten hospital workers reported they were unwilling to receive COVID-19 vaccination. Actual COVID-19 vaccination uptake among HCW was higher (80.4%) than the percentage of willingness to vaccinate estimated from the questionnaire. Physicians not only had the highest vaccination rate, but also the highest correlation between the reported intention to vaccinate and the final decision to receive COVID-19 vaccination. CONCLUSIONS: COVID-19 vaccination uptake was higher than previously estimated according to the stated intentions of HCW. Doubts and fears must be addressed, particularly in persons less inclined to be vaccinated: females, younger people and those not vaccinated against influenza in recent seasons. The study of barriers and strategies aimed at promoting COVID-19 vaccination must be adapted in relation to occupational groups' attitudes, understanding their idiosyncrasies with respect to this and other vaccines.