Individualized Catheter Surveillance among Neonates: A Prospective, 8-Year, Single-Center Experience

Objective. To monitor trends in central line-associated bloodstream infections and clinical sepsis (CLABICS) among neonates and to determine risk factors for infection, especially dwell time. Design. Prospective, single-center cohort study conducted from 2001 through 2008. Setting. University-affiliated tertiary care center. Methods. Individualized surveillance of catheter use and CLABICS episodes was conducted. Data were obtained via regular on-site visits made 3 times a week. Trends over time were estimated by Poisson regression, and risk factor analysis was conducted using a Cox proportional hazards model and logistic regression. Results. In all, 1,124 neonates were exposed to 2,210 central lines for a total of 12,746 catheter-days and 11,467 catheter-days at risk. The median duration of catheter use was 8 (interquartile range, 5-11) days for peripherally inserted central catheters (PICCs) and 4 (interquartile range, 2-6) days for umbilical catheters; 102 CLABICS episodes were detected. The median time to infection was 7 days. Incidence densities were 8.5 CLABICS episodes per 1,000 catheter-days at risk and 8.0 CLABICS episodes per 1,000 catheter-days. The highest rates were identified among neonates weighing 750 g or lower (14.9 CLABICS episodes per 1,000 catheter days at risk) and for PICCs (13.2 CLABICS episodes per 1,000 catheter days at risk). Catheter dwell time was associated with CLABICS for all umbilical catheters (odds ratio [OR], 1.2 per day of use [95% confidence interval {CI}, 1.1-1.3] P< .001) and for PICCs for up to 7 days (OR, 1.2 [95% CI, 1.1-1.4]; P = .041), but not thereafter (OR, 1.0 [95% CI, 0.9-1.1]; P = .90). Conclusion. Catheter dwell time is a risk factor for CLABICS during the first 7 days, irrespective of catheter type. After 7 days, PICCs are less likely to become infecte

Acceptability of COVID-19 Vaccine Among Hospital Employees in the Department of Paediatrics, Gynaecology and Obstetrics in the University Hospitals of Geneva, Switzerland

BACKGROUND AND AIMS: COVID-19 vaccination has been in the spotlight for almost a year now, both within the scientific community and in the general population. The issue of healthcare workers' (HCWs) hesitancy is particularly salient, given that they are at the forefront of the fight against COVID-19. Not only could unvaccinated HCW spread the disease, but HCWs are also critical messengers in building confidence towards COVID-19 vaccines. The goal of this study was to examine the perception of COVID-19 risk and of its vaccine acceptance among employees (i.e., HCW plus administrative staff) in the Department of Paediatrics, Gynaecology and Obstetrics at the University Hospitals of Geneva, for the purpose of drawing lessons on the determinants of vaccination morale. METHODS: We conducted an anonymous online survey comparing vaccination attitudes among vaccinated and unvaccinated workers in June 2021. It included questions on perception of COVID-19 risks and COVID-19 vaccines. Vaccination was not mandatory in our institution but was strongly recommended. RESULTS: In June 2021, 66% of the 1,800 employees of our department had received two doses of COVID-19 vaccine by the time of the survey. Among the employees, 776 participated (43%) to the survey, and among them 684 (88%) had chosen to be vaccinated. Participants working for longer in a hospital, with a chronic disease and a household contact with chronic disease were more likely to be vaccinated. Doctors were twice as likely to be vaccinated than nurses. Among unvaccinated hospital employees, 48 (52%) responded that they would not change their mind. Further, 35 (38%) were not feeling in danger of contracting severe COVID-19, and 32 (35%) had fears about possible side effects of COVID-19 vaccines that they wanted to discuss with a specialist. CONCLUSION: Our study indicates that, while two-third of the employees had been vaccinated, quite many were still hesitant. The unvaccinated explained their choice by not feeling at risk of complicated COVID-19, and because of fear of possible side effects associated with the vaccine. Investments in COVID-19 vaccine education is a critical component for increasing vaccine acceptance among the unvaccinated

Congenital syphilis in Switzerland: a marker of inequality? A mini-review

Syphilis remains a global public health problem, with growing incidence in most regions of the world, particularly among women of childbearing age. This alarming trend has led to an increase in cases of congenital syphilis, resulting in devastating consequences. While the implementation of measures by the World Health Organization (WHO) and various governments has contributed to a decline in the global incidence of congenital syphilis, many countries are facing an escalating crisis, as incidence continues to rise. This mini-review aims to provide an overview of the current state of this disease in different parts of the world, focusing on the most affected populations and highlighting congenital syphilis as a marker of vulnerability. It also focuses on Switzerland, a country with a robust economy, to identify shortcomings in the healthcare system that contribute to the persistence of congenital syphilis, even though the infection is easily detectable and treatable. In conclusion, this mini-review highlights the persistent risk of congenital syphilis worldwide, regardless of country prevalence or economic status, and underscores the need for sustained efforts to reach underserved women, emphasizing the vital role of comprehensive training for healthcare professionals

Zoonotic Potential of Rotavirus From Swine and Bovine in South of Taiwan

Rotavirus was recognized as the virus that responsible for causing acute gastroenteritis, especially young livestock. Taiwan Center for Disease Control (CDC) confirms the majority cases of acute gastroenteritis in Taiwan on February 2015 were caused by rotavirus. In this study, we report the incidence and zoonotic impact of rotavirus strain from Taiwan. This study examined 90 (swine) and 60 (bovine) fecal samples collected from south of Taiwan in March 2015. Detection of rotavirus using VP6 gene by RT-PCR technique with amplicons 379 bp. Zoonotic potential analysis based on nucleotide sequence and phylogenetic analysis. RT-PCR utilizing the primers specific for VP6 gene detected rotavirus with positive reactions 3/30 (10%) in piglets and 1/20 (5%) in the calf. Based on the nucleotide sequences and phylogenetic analysis indicated that 1 of 3 wild strains from swine rotavirus had 85.0% - 91.1% and 1 wild strain from bovine had 78.7% - 85.9% identity relations with human strains. These findings indicated that the wild strains of swine and bovine rotavirus may broadly spread and contribute to zoonotic transmission

Dynamics of Bacterial Hand Contamination During Routine Neonatal Care

Abstract Objective: To evaluate the dynamics of bacterial contamination of healthcare workers' (HCWs) hands during neonatal care. Setting: The 20-bed neonatal unit of a large acute care teaching hospital in Geneva, Switzerland. Methods: Structured observation sessions were conducted. A sequence of care began when the HCW performed hand hygiene and ended when the activity changed or hand hygiene was performed again. Alcohol-based handrub was the standard procedure for hand hygiene. An imprint of the five fingertips of the dominant hand was obtained before and after hand hygiene and at the end of a sequence of care. Regression methods were used to model the final bacterial count according to the type and duration of care and the use of gloves. Results: One hundred forty-nine sequences of care were observed. Commensal skin flora comprised 72.4% of all culture-positive specimens (n = 360). Other microorganisms identified were Enterobacteriaceae (n = 55, 13.8%); Staphylococcus aureus (n = 10, 2.5%); and fungi (n = 7,1.8%). Skin contact, respiratory care, and diaper change were independently associated with an increased bacterial count; the use of gloves did not fully protect HCWs' hands from bacterial contamination. Conclusions: These data confirm that hands become progressively contaminated with commensal flora and potential pathogens during neonatal care, and identify activities at higher risk for hand contamination. They also reinforce the need for hand hygiene after a sequence of care, before starting a different task, and after glove remova

Comparison of clinical presentation of respiratory tract infections in H1N1/09-positive and H1N1/09-negative patients

The true burden of influenza in children is difficult to assess and is probably underestimated as clinical signs are usually nonspecific, and formal viral identification is rarely searched. In this study, we compare the clinical features of infections related to the new H1N1/09 influenza virus with infections due to other respiratory viruses in children consulting in a tertiary care pediatric hospital in Geneva. Between October 1, 2009 and February 10, 2010, 109 patients were recruited, with a median of age of 7years (range 0.1-18). There were 75 H1N1/09-positive patients (69%), and 32 (43%) had identified risk factors such as asthma or a history of wheezing. Fever (87%), cough (92%), and rhinitis (85%) were the most frequent reported presenting symptoms in both patient groups. H1N1/09-positive patients were significantly older (median of 8.2 vs. 4.6years) and were more likely to have risk factors (43% vs. 24%) and myalgias (41% vs. 20%). H1N1/09-negative patients had more wheezing episodes (29% vs. 9%), higher rates of dyspnea (28% vs. 20%) and of hospital admissions (35% vs. 16%). Conclusion: Clinical signs cannot reliably differentiate H1N1/09-positive and H1N1/09-negative patients, although we found a higher proportion of myalgias in H1N1/09-positive patients. Severity of disease was lower in H1N1/09-positive than in H1N1/09-negative patients, mostly because of a higher proportion of asthma/wheezing episodes among H1N1/09-negative patient

Hand Hygiene and Glove Use Behavior in an Italian Hospital

In an Italian hospital, we observed that hand hygiene was performed in 638 (19.6%) of 3,253 opportunities, whereas gloves were worn in 538 (44.2%) 1,218 of opportunities. We observed an inverse correlation between the intensity of care and the rate of hand hygiene compliance (R2=0.057; P<.001), but no such association was observed for the rate of glove use compliance (R2 = 0.014; P = .078). Rates of compliance with hand hygiene and glove use recommendations follow different behavioral pattern

Response to Treatment and Disease Progression Linked to CD4+ T Cell Surface CC Chemokine Receptor 5 Density in Human Immunodeficiency Virus Type 1 Vertical Infection

The factors governing interindividual variability in disease progression among children vertically infected with human immunodeficiency virus type 1 (HIV-1) remain unclear. Because it has recently been shown in infected adults that the density of CC chemokine receptor 5 (CCR5) molecules at the surface of nonactivated (human leukocyte antigen [HLA]-DR-) CD4+ T cells correlates with disease progression, the same correlation was sought in children. HLA-DR-CD4+ T cell surface CCR5 density was constant over time and correlated with the bioclinical stage and with the CD4 cell slope observed before antiretroviral treatment. In addition, CCR5 density was negatively correlated with the intensity of the decrease in viremia during antiretroviral therapy and was positively correlated with CD4 cell slope since birth. These results are compatible with the hypothesis that CCR5 density is a key factor governing disease progression in pediatric HIV-1 infection and, thereby, an indicator of prognosis. Moreover, they suggest that therapies aimed at reducing CCR5 accessibility should slow down HIV disease evolution in childre

Risk of Vaccine-Preventable Infections in Swiss Adults with Inflammatory Bowel Disease.

BACKGROUND Patients with inflammatory bowel disease (IBD) have a higher risk of infection and are frequently not up to date with their immunizations. OBJECTIVES This study aims to review vaccination status and evaluate whether age, disease type, or treatment regimen could predict the absence of seroprotection against selected vaccine-preventable infection in adults with IBD. METHODS Cross-sectional study using questionnaire, immunization records review, and assessment of tetanus-specific, varicella-specific, and measles-specific immunoglobulin G concentrations. ClinicalTrials.gov: NCT01908283. RESULTS Among the 306 adults assessed (median age 42.7 years old, 70% with Crohn's disease, 78% receiving immunosuppressive treatment), only 33% had an immunization record available. Absence of seroprotection against tetanus (6%) was associated with increasing age and absence of booster dose; absence of seroprotection against varicella (1%) or measles (3%) was exclusively observed in younger patients with Crohn's disease. There was no statistically significant difference in immunoglobulin concentrations among treatment groups. Although vaccinations are strongly recommended in IBD patients, the frequencies of participants with at least 1 dose of vaccine recorded were low for nearly all antigens: tetanus 94%, diphtheria 87%, pertussis 54%, poliovirus 22%, measles-mumps-rubella 47%, varicella-zoster 0%, Streptococcus pneumoniae 5%, Neisseria meningitidis 12%, hepatitis A 41%, hepatitis B 48%, human papillomavirus 5%, and tick-borne encephalitis 6%. CONCLUSIONS Although many guidelines recommend the vaccination of IBD patients, disease prevention through immunization is still often overlooked, including in Switzerland, increasing their risk of vaccine-preventable diseases. Serological testing should be standardized to monitor patients' protection during follow-up as immunity may wane faster in this population