Orazio Claudio Grillo

Prevalence of serum anti-rubella virus antibodies among pregnant women in southern Italy.

To determine the prevalence of anti‐rubella virus antibodies and the level of knowledge about congenital rubella syndrome (CRS) among pregnant women living in southern Italy.

Trends, risk factors and outcomes of healthcare- associated infections within the Italian network SPIN-UTI

BACKGROUND Implementing infection control measures in light of healthcare-associated infection (HAI) surveillance data can prevent HAIs. Surveillance has been associated with a reduction of HAI in intensive care unit (ICU) patients, though the reasons for this improvement remain unclear. AIM To evaluate changes in healthcare-associated infection (HAI) rates during three surveys of the Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) network (SPIN-UTI) six-year project and to explore sources of variation of indicators of HAI in the 65 participating ICUs. METHODS The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance. Cumulative incidence, incidence density, infection rates adjusted for device-days, and device utilization ratios were calculated for each survey and compared. To identify risk factors multiple logistic regression analyses were performed. Crude excess mortality was computed as the difference between the crude overall case-fatality rate of patients with and without HAI. FINDINGS The risk of ICU-acquired infections increased in the third survey compared with previous (relative risk: 1.215; 95% confidence interval: 1.059-1.394). Among risk factors, the number of hospitalized patients requiring ICU admission and the Simplified Acute Physiology Score II increased from 73.7% to 78.1% and from 37.9% to 40.8% respectively. Although mortality rates remained unchanged, HAIs trebled the risk of death. Acinetobacter baumannii was the most frequently reported micro-organism in the third survey (16.9%), whereas in the previous surveys it ranked third (7.6%) and second (14.3%). CONCLUSIONS The study highlighted the increased risk of HAI, at least partially explained by the greater severity and number of hospitalized patients requiring ICU admission. Furthermore, the management of intubation procedures and of ventilated patients was identified as a potential target for infection control interventions to decrease the growing risk of HAI in ICUs.

Knowledge, Attitudes, and Smoking Behaviours among Physicians Specializing in Public Health: A Multicentre Study

Background. Healthcare professionals have an important role to play both as advisers—influencing smoking cessation—and as role models. However, many of them continue to smoke. The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS) approach. Materials and Methods. A multicentre cross-sectional study was carried out in 24 Italian schools of public health. The survey was conducted between January and April 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance), therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors). The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance was P ≤ 0.05. Results. A total of 388 answered the questionnaire on the website (85%), of which 81 (20.9%) declared to be smokers, 309 (79.6%) considered health professionals as behavioural models for patients, and 375 (96.6%) affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7%) heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. Conclusions. The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools.

Influenza vaccination coverage among medical residents: an Italian multicenter survey

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011–2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P < 0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011–2012 season (P < 0.001). “To avoid spreading influenza among patients” was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future.

Congenital rubella syndrome and immunity status of immigrant women living in southern Italy: a cross-sectional, seroepidemiological investigation.

OBJECTIVES A National Programme to eliminate Measles and Congenital Rubella was implemented in Italy in 2003. It aimed to achieve elimination by 2010 in line with the targets set by the World Health Organization (WHO) European Region. The aim of this study was to determine the prevalence of rubella antibodies in samples of immigrant women living in southern Italy. METHOD A seroepidemiologic study was conducted from 1 January 2008 to June 30 2009. 489 immigrant women resident in Messina were enrolled in the study. The detection of rubella antibodies was performed using a microparticle enzyme immunoassay. A questionnaire was used to collect demographic data including age, country of origin, educational level and knowledge about rubella. RESULTS The results of the seroepidemiological survey to detect rubella antibodies showed an overall seropositivity rate of 82.2%. Generally, knowledge about rubella and congenital rubella syndrome was lacking. CONCLUSION Many immigrants are susceptible to rubella and may benefit from vaccination programmes. Additional catch-up vaccination strategies are urgently needed to eliminate the risk of congenital rubella syndrome for future generations.

An Innovative Approach to Hospital Sanitization Using Probiotics: In Vitro and Field Trials

Background: The nosocomial infections continue to be a problem, even in hospitals where meticulous sanitization procedures are in place. The most commonly used methods employ chemical disinfectants which carry some disadvantages. Objective: To investigate the effectiveness of an innovative sanitization procedure using probiotic bacteria based on the principle of biological competition: Probiotic Cleaning Hygiene System (PCHS). Methods: The study included survival tests and in vitro and field trials. The in vitro trials tested three surfaces (washbasin, floor and desk) in the absence of recontamination. Field trials were carried out in order to evaluate the efficacy of probiotics in the presence of contaminants and to study whether probiotics are able to contain pathogens over time. Samples were taken from the floor in a corridor and an inpatient room and the dispensary washbasin twice daily (pre-sanitization and post-sanitization). Results: The in vitro tests on three surfaces, not subject to recontamination, resulted in an average reduction ranging from 92.2% to 99.9% after 24 h. From field trials it emerged that the bacterial count was totally eliminated for Enterococcus faecalis and Candida albicans and almost 100% elimination of Pseudomonas aeruginosa, Acinetobacter baumannii e Klebsiella pneumoniae on all three surfaces after only six hours even when recontaminated. However, less satisfactory results were attained for Staphylococcus aureus. Conclusion: PCHS acts constantly and is durable over time due to the stabilization of a biofilm which is able to reduce and contain the proliferation of pathogenic microorganisms. Probiotics are therefore effective innovative products to sanitize the hospital environment.

Human Papillomavirus Vaccination Coverage among Adolescents Living in Southern Italy

Objective: The aim of this study was to estimate HPV vaccination coverage in the target population residing in Sicily, five years after launch of the vaccination campaign, and to analyze its organization in this region. Methods: Regional data as at 31 December 2013, grouped by province, issued by the Regional Health Authority were used. The organization and information materials of the campaign were also assessed (letters, posters, brochures, etc.). Results: The results for Sicily show uptake rates for three doses of HPV vaccination of 56.5%, 55.8%, 58.2%, 55.3% for cohorts born in 1997, 1998, 1999, 2000 respectively, and 56.4% for cohorts born in 1996. These figures highlight the problems encountered during the promotion campaign and vaccination provision. Conclusions: Vaccine uptake in Sicily was lower than national figures for Italy as a whole for all cohorts and both fall far short of the targets set by the National Immunization Prevention Plan 2012-2014. In order to promote vaccination uptake and improve coverage, at both regional and local level, the quality of information should be improved and more communication campaigns be instigated to increase the involvement of professionals.

The Possible Role of Mobile Phones in Spreading Microorganisms inHospitals

Mobile phones belonging to healthcare workers and inpatients represent a potential source of microorganisms, some being well-known sources of hospital infections. The aim of this study was to determine the extent of contamination of the hands and mobile phones of healthcare workers and inpatients. The study comprised 200 healthcare workers and 100 inpatients of the University Hospital in Messina (Italy) between April 1 and June 31, 2013. Bacterial contamination was detected on 230 mobile phones (76.6%) and on 250 hands (83.3%). The most frequently isolated bacteria belonged to the Staphylococcus genus. For hospital staff, 78% of mobile phones and 86% of hands were found to be contaminated. Similar results were obtained for inpatients whose mobile phones tested positive in 74% of cases, while for hands the rate was 78%. These findings are in line with international literature and demonstrate that routine everyday use of mobile phones by healthcare workers and inpatients represents an important vehicle of contamination since potentially pathogenic agents, capable of causing nosocomial infections, can pass from the telephone to the hands and vice versa.