Fear of HIV infection and impact of training on the attitudes of surgical and emergency nurses toward inpatient HIV testing

This study evaluates the association between the degree of fear of human immunodeficiency virus (HIV) infection and support for different HIV testing policies. A strong fear of acquiring HIV infection at work was widespread among a sample of 601 Polish surgical and emergency nurses. Most favored inappropriate HIV testing of all surgical patients and inpatients. Previous training about HIV and acquired immunodeficiency syndrome (AIDS) and experience caring for HIV‐positive patients had a significant impact on reducing support for testing of all inpatients but not for testing of surgical patients

Maria Ganczak, Peter Barss: Nosocomial HIV Infection: Epidemiology and Prevention -A Global Perspective Nosocomial HIV Infection: Epidemiology and Prevention -A Global Perspective

Abstract Because, globally, HIV is transmitted mainly by sexual practices and intravenous drug use and because of a long asymptomatic period, healthcare-associated HIV transmission receives little attention even though an estimated 5.4% of global HIV infections result from contaminated injections alone. It is an important personal issue for healthcare workers, especially those who work with unsafe equipment or have insufficient training. They may acquire HIV occupationally or find themselves before courts, facing severe penalties for causing HIV infections. Prevention of blood-borne nosocomial infections such as HIV differs from traditional infection control measures such as hand washing and isolation and requires a multidisciplinary approach. Since there has not been a review of healthcare-associated HIV contrasting circumstances in poor and rich regions of the world, the aim of this article is to review and compare the epidemiology of HIV in healthcare facilities in such settings, followed by a consideration of general approaches to prevention, specific countermeasures, and a synthesis of approaches used in infection control, injury prevention, and occupational safety. These actions concentrated on identifying research on specific modes of healthcare-associated HIV transmission and on methods of prevention. Searches included studies in English and Russian cited in PubMed and citations in Google Scholar in any language. MeSH keywords such as nosocomial, hospital-acquired, iatrogenic, healthcare associated, occupationally acquired infection and HIV were used together with mode of transmission, such as "HIV and hemodialysis". References of relevant articles were also reviewed. The evidence indicates that while occasional incidents of healthcare-related HIV infection in high-income countries continue to be reported, the situation in many low-income countries is alarming, with transmission ranging from frequent to endemic. Viral transmission in health facilities occurs by unexpected and unusual as well as more frequent modes. HIV can be transmitted to patients and to donors of blood products by specific vehicles and vectors during blood transfusion, plasma donation, and artificial insemination, by improperly sterilized sharps, by medical equipment during activities such as dialysis and organ transplantation, and by healthcare workers infected by occupational exposure to hazards such as blood-contaminated sharps. Personal, equipment, and environmental factors predispose to acquisition of nosocomial HIV and all are pertinent for prevention. For infection and injury control, poverty is often an underlying determinant. While sophisticated new tests offer improved HIV detection, increasingly higher marginal costs limit their feasibility in many settings. Modest investment in safer equipment and appropriate integrated training in infection control, injury prevention, and occupational safety should provide greater benefit. (AIDS Rev. 2008;10:-61) Corresponding author: Peter Barss, [email protected]

Vacinação contra hepatite B e exposição ocupacional no setor saúde em Belo Horizonte, Minas Gerais

OBJETIVO: Identificar fatores associados à vacinação contra hepatite B em trabalhadores da saúde. MÉTODOS: Estudo transversal com 1.808 trabalhadores da saúde do setor público de Belo Horizonte, MG, em 2009. Questionário autoadministrado foi usado e a situação vacinal foi analisada considerando características sociodemográficas, estilo de vida, características e condições de trabalho. Análises estatísticas univariada (p < 0,20) e múltipla foram realizadas utilizando regressão de Poisson (p < 0,05) para avaliação de fatores associados à vacinação. RESULTADOS: Declararam ter sido vacinados 85,6% dos trabalhadores, 74,9% dos quais receberam esquema completo da vacina. Não ter sido vacinado associou-se a não ter companheiro, a escolaridade em nível médio/técnico ou superior incompleto e a características do trabalho, como atuar na vigilância ou setor administrativo/serviços gerais e não utilizar equipamentos de proteção individual. CONCLUSÕES: Foram identificados grupos com menor cobertura vacinal. São necessários esforços para garantir o acesso e a adesão à vacinação a todos os grupos ocupacionais.OBJECTIVE: To identify factors associated with vaccination against hepatitis B among healthcare workers. METHODS: This was a cross-sectional study on 1,808 public-sector healthcare workers in Belo Horizonte, Southeastern Brazil, in 2009. A self-administered questionnaire was used and the vaccination situation was analyzed taking sociodemographic characteristics, lifestyle and working conditions and characteristics into consideration. Univariate (p < 0.20) and multiple (p < 0.05) statistical analyses were performed using Poisson regression to evaluate factors associated with vaccination. RESULTS: Of the workers, 85.6% declared that they had been vaccinated, although only 74.9% of the vaccinated professionals had received a complete imunization schedule. Not having been vaccinated was associated with not having a partner; having high school, technical or incomplete higher education level; work characteristics such as working in surveillance or the administrative/general services sector; and not using personal protection equipment. CONCLUSIONS: Groups with lower vaccination coverage were identified. Efforts are required to ensure access and adherence to vaccination among healthcare workers, such as awareness-raising mechanisms.OBJETIVO: Identificar factores asociados con la vacunación contra hepatitis B en trabajadores de la salud. MÉTODOS: Estudio transversal con 1.808 trabajadores de la salud del sector público de Belo Horizonte, Sudeste de Brasil, en 2009. Se usó cuestionario auto-administrado y se analizó la situación de la vacunación considerando características sociodemográficas, estilo de vida, características y condiciones de trabajo. Se realizaron análisis estadísticos univariado (p< 0,20) y múltiple utilizando regresión de Poisson (p< 0,05) para evaluación de factores asociados con la vacunación. RESULTADOS: Declararon haber sido vacunados 85,6% de los trabajadores, 74,9% recibieron esquema completo de vacunación. No haber sido vacunado se asoció a no tener compañero, a la escolaridad en nivel medio/técnico o superior incompleto y a características de trabajo, como actuar en la vigilancia o sector administrativo/servicios generales y no utilizar equipamientos de protección individual. CONCLUSIONES: Se identificaron grupos con menor cobertura de vacunación. Son necesarios esfuerzos para garantizar el acceso y la adhesión a la vacunación entre los trabajadores de la salud, como ejemplo de mecanismos de sensibilización

Predictors of a Change and Correlation in Activities of Daily Living after Hip Fracture in Elderly Patients in a Community Hospital in Poland: A Six-Month Prospective Cohort Study

Objectives: The consequences of hip fractures (HFs) in elderly persons include a deterioration in functional capacity to perform activities that enable independent living. Since prior research into this issue in Central Europe is rather scant, this study sought to assess the change in activities and instrumental activities of daily living (ADL/IADL) after HF surgery among Polish patients, to study predictors of regaining pre-fracture functional status three and six months later, and to evaluate the correlation between ADL and IADL limitations over time. Methods: A prospective study was conducted between 2011 and 2013 in a tertiary hospital in Western Poland. ADL/IADL were evaluated using the Katz index and Lawton scale, respectively. Results: About half (50.8%) of 120 patients (mean age 80.1 ± SD 7.59) had cognitive impairment (CI). Patients with CI were older (p = 0.002) and had lower scores for pre-fracture ADL/IADL (p = 0.001 and p &lt; 0.001, respectively). Six months after HF, 33.3% of patients failed to return to their pre-fracture ADL and 62.5% failed to return to pre-fracture IADL; 20% of those who could walk before HF were unable to walk after six months. The pre-fracture Spearman correlation coefficient between ADL and IADL summary scores was 0.46; it increased to 0.70 at three months after HF surgery and 0.77 at six months (p &lt; 0.0001). Regaining ADL after six months was more likely in patients with pre-fracture intact intellectual function and independence in pre-fracture ADL; regaining IADL, in younger patients and those with higher pre-fracture IADL scores. Conclusions: Impairment in functional performance is common after HF surgery. ADL and IADL were strongly correlated in these patients, with this increasing over time. Functional outcomes after HF were more dependent on patient characteristics than treatment-related factors. Therefore, more emphasis should be directed towards the pre-fracture period and, in particular, maintaining cognitive function and preserving functional capacity in older persons at high risk of HF

Does Vaccinating against Influenza in a Given Epidemic Season Have an Impact on Vaccination in the Next Season: A Follow-Up Study

To improve the uptake of influenza vaccine in the elderly, it is important to understand the factors that predict vaccination. The study objective was to explain influenza vaccination uptake in the next season (2019/2020) in a sample of primary care clinic patients from Gryfino, Poland, vaccinated in 2018/2019 with the free-of-charge quadrivalent vaccine. A baseline and a follow-up survey assessed respondent intentions to receive a vaccine (2018), then (2020) vaccine uptake and its predictors. Patients (n = 108, 54.6% males, Mage = 66.7 &plusmn; 6.7) filled in a researcher-administered questionnaire. A majority (69.3%) intended to get vaccinated in the next season, with 25.9% receipt. Of those willing to be immunized, only 31.9% were vaccinated in the next season; of those whose decision was dependent on reimbursement, none received influenza vaccine; of undecided patients, 23.1% were vaccinated. Multivariable analysis indicated that living with a partner (OR 6.22, p = 0.01), being employed (OR = 4.55, p = 0.05) and past vaccination behavior (OR 4.12; p = 0.04) were predictors of vaccine uptake. The findings show limited follow-through on initial influenza vaccination plans for the nearest season in previously vaccinated elderly patients. Future interventions should additionally focus on unanticipated barriers to vaccination, such as those revealed in this study, to increase vaccination coverage rates

Quadrivalent Influenza Vaccine-Induced Antibody Response and Influencing Determinants in Patients ≥ 55 Years of Age in the 2018/2019 Season

The effects of immunization with subunit inactivated quadrivalent influenza vaccine (QIV) are not generally well assessed in the elderly Polish population. Therefore, this study evaluated vaccine-induced antibody response and its determinants. Methods: Consecutive patients &ge; 55 years old, attending a Primary Care Clinic in Gryfino, Poland, received QIV (A/Michigan/ 45/2015(H1N1)pdm09, A/Singapore/INFIMH-16-0019/2016 (H3N2), B/Colorado/06/2017, B/Phuket/ 3073/2013) between October-December 2018. Hemagglutination inhibition assays measured antibody response to vaccine strains from pre/postvaccination serum samples. Geometric mean titer ratio (GMTR), protection rate (PR) and seroconversion rate (SR) were also calculated. Results: For 108 patients (54.6% males, mean age: 66.7 years) the highest GMTR (61.5-fold) was observed for A/H3N2/, then B/Colorado/06/2017 (10.3-fold), A/H1N1/pdm09 (8.4-fold) and B/Phuket/ 3073/2013 (3.0-fold). Most patients had post-vaccination protection for A/H3N2/ and B/Phuket/3073/ 2013 (64.8% and 70.4%, respectively); lower PRs were observed for A/H1N1/pdm09 (41.8%) and B/Colorado/06/ 2017 (57.4%). The SRs for A/H3N2/, A/H1N1/pdm09, B Victoria and B Yamagata were 64.8%, 38.0%, 46.8%, and 48.2%, respectively. Patients who received QIV vaccination in the previous season presented lower (p &lt; 0.001 and p = 0.03, respectively) response to B Victoria and B Yamagata. Conclusions: QIV was immunogenic against the additional B lineage strain (B Victoria) without significantly compromising the immunogenicity of the other three vaccine strains, therefore, adding a second B lineage strain in QIV could broaden protection against influenza B infection in this age group. As the QIV immunogenicity differed regarding the four antigens, formulation adjustments to increase the antigen concentration of the serotypes that have lower immunogenicity could increase effectiveness. Prior season vaccination was associated with lower antibody response to a new vaccine, although not consistent through the vaccine strains

Nosocomial HIV infection: Epidemiology and prevention - A global perspective

Because, globally, HIV is transmitted mainly by sexual practices and intravenous drug use and because of a long asymptomatic period, healthcare-associated HIV transmission receives little attention even though an estimated 5.4% of global HIV infections result from contaminated injections alone. It is an important personal issue for healthcare workers, especially those who work with unsafe equipment or have insufficient training. They may acquire HIV occupationally or find themselves before courts, facing severe penalties for causing HIV infections. Prevention of blood-borne nosocomial infections such as HIV differs from traditional infection control measures such as hand washing and isolation and requires a multidisciplinary approach. Since there has not been a review of healthcare-associated HIV contrasting circumstances in poor and rich regions of the world, the aim of this article is to review and compare the epidemiology of HIV in healthcare facilities in such settings, followed by a consideration of general approaches to prevention, specific countermeasures, and a synthesis of approaches used in infection control, injury prevention, and occupational safety. These actions concentrated on identifying research on specific modes of healthcare-associated HIV transmission and on methods of prevention. Searches included studies in English and Russian cited in PubMed and citations in Google Scholar in any language. MeSH keywords such as nosocomial, hospital-acquired, iatrogenic, healthcare associated, occupationally acquired infection and HIV were used together with mode of transmission, such as “HIV and hemodialysis”. References of relevant articles were also reviewed. The evidence indicates that while occasional incidents of healthcare-related HIV infection in high-income countries continue to be reported, the situation in many low-income countries is alarming, with transmission ranging from frequent to endemic. Viral transmission in health facilities occurs by unexpected and unusual as well as more frequent modes. HIV can be transmitted to patients and to donors of blood products by specific vehicles and vectors during blood transfusion, plasma donation, and artificial insemination, by improperly sterilized sharps, by medical equipment during activities such as dialysis and organ transplantation, and by healthcare workers infected by occupational exposure to hazards such as blood-contaminated sharps. Personal, equipment, and environmental factors predispose to acquisition of nosocomial HIV and all are pertinent for prevention. For infection and injury control, poverty is often an underlying determinant. While sophisticated new tests offer improved HIV detection, increasingly higher marginal costs limit their feasibility in many settings. Modest investment in safer equipment and appropriate integrated training in infection control, injury prevention, and occupational safety should provide greater benefit. (AIDS Rev. 2008;10:47 -61) Corresponding author: Peter Barss, [email protected]