Post-exposure rate of tuberculosis infection among health care workers measured with tuberculin skin test conversion after unprotected exposure to patients with pulmonary tuberculosis: 6-year experience in an Italian teaching hospital

BACKGROUND: This study assesses the risk of LTBI at our Hospital among HCWs who have been exposed to TB patients with a delayed diagnosis and respiratory protection measures were not implemented. METHODS: All HCWs exposed to a patient with cultural confirmed pulmonary TB and respiratory protection measures were not implemented were included. Data on TST results performed in the past (defined as T0) were recorded. TST was performed twice: first, immediately after exposure to an index patient (T1) and three months later (T2). The period of time between T0 and T1 was used to calculate he annual rate of tuberculosis infection (ARTI), while le period of time between T1 and T2 was used to calculate the post exposure annual rate of tuberculosis infection (PEARTI). RESULTS: Fourteen index patients were admitted; sputum smear was positive in 7 (58.3%), 4 (28.6%) were non-Italian born patients. 388 HCWs were exposed to index patients, a median of 27 (12-39) HCW per each index patient. One hundred eighty (46.4%) HCWs received BCG in the past. One hundred twenty two HCWs (31%) were TST positive at a previous routine screening and not evaluated in this subset. Among the remaining 255 HCWs with negative TST test in the past, TST at T1 was positive in 11 (4.3%). ARTI was 1.6 (95% CI 0.9-2.9) per 100 PY. TST at T2 was positive in 9 (3.7%) HCWs, that were TST negative at T1. PEARTI was 26 (95% CI 13.6-50) per 100 PY. At univariate analysis, older age was associated with post exposure latent tuberculosis infection (HR 1.12; 95% CI 1.03-1.22, p=0.01). CONCLUSIONS: PEARTI was considerably higher among HCWs exposed to index patients than ARTI. These data underscore the overwhelming importance of performing a rapid diagnosis, as well as implementing adequate respiratory protection measures when TB is suspected

Occupational risk of scabies among healthcare workers: problem focus and personal experience

Background: scabies (causative agent: Sarcoptes scabiei var. hominis) is a contagious parasitic disease, widespread in the general population, which can cause hospital outbreaks, with possible involvement of sanitary staff, and considerable economic and managerial implications. The Policlinico San Matteo of Pavia (Italy) adopts (since 2005) a protocol for the management of index cases, based on early patient isolation, identification of close contacts, and their prophylactic treatment (with temporary removal from duty). Objectives: acquiring descriptive data on reported cases of scabies in the hospital under study, and on the preventive effectiveness of the operative protocol adopted for their management. Methods: retrospective study (2005-2014) of the index cases, collected in ad hoc computer archive. For each case, personal and clinical data were collected, as well as information on the healthcare workers who had dealt with the patient within the 6 weeks (maximum scabies incubation period) preceding the diagnosis. Results: 30 index cases were identified: 11 females and 19 males; mean age 60 years; range: 2 months - 92 years. 9 patients had been transferred to the Policlinico from other health facilities. 11 were immunosuppressed: of these, 3 were suffering from Norwegian scabies (or crusted scabies: a highly contagious variant, difficult to diagnose, in which the number of mites on the patient’s skin is very high, up to several millions). Close contacts included 894 health professionals, mainly nurses, physicians and students; of these, 158 had provided assistance to cases of Norwegian scabies: 15 (1.7% of the entire sample) were infected. This percentage is below the rates of infection (sometimes > 30%) reported in other case series. Almost all involved personnel received (prophylactic or therapeutic) acaricide treatment. Conclusions: scabies is a major occupational hazard in hospitals, especially for nursing staff, including students in training. Caution is particularly needed for immunocompromised patients, since they develop with greater frequency Norwegian scabies. The operative protocol adopted by the Policlinico San Matteo is effective for risk containment

Scabbia occupazionale in ambito ospedaliero: studio retrospettivo

Introduzione: la scabbia (agente eziologico: Sarcoptes scabiei var. hominis) è una malattia parassitaria contagiosa, diffusa nella popolazione generale, che può essere all’origine di focolai epidemici in ambito ospedaliero, con possibile coinvolgimento del personale e notevoli ripercussioni economiche e gestionali. Il Policlinico San Matteo di Pavia adotta (dal 2005, con revisioni triennali) un protocollo operativo per la gestione dei casi indice, basato sul precoce isolamento del paziente infestato, sull’identificazione dei contatti stretti e sul loro trattamento profilattico, con temporaneo allontanamento dalla mansione. Obiettivi: acquisizione di dati descrittivi sui casi di scabbia riscontrati nell’ospedale oggetto dello studio e verifica dell’efficacia preventiva del protocollo adottato per la loro gestione. Metodi: studio retrospettivo (2005-2014) dei casi indice, raccolti in apposito archivio informatico. Per ognuno di essi, sono stati raccolti i dati anagrafici e clinici, e informazioni sugli operatori sanitari che erano venuti in contatto con il paziente nelle 6 settimane precedenti la diagnosi (periodo massimo d’incubazione della malattia). Risultati: sono stati identificati 30 casi di scabbia tra i ricoverati (11 femmine e 19 maschi; età media 60 anni; range: 2 mesi – 92 anni); 9 di loro risultavano trasferiti da altre strutture sanitarie; 11 pazienti erano immunodepressi: di questi, 3 erano affetti da scabbia norvegese (o scabbia crostosa: variante clinica ad alta contagiosità, di difficile diagnosi, nella quale il numero di acari sulla cute dell’ammalato è assai elevato, fino ad alcuni milioni). I contatti comprendevano 894 operatori sanitari, in prevalenza infermieri, ausiliari e studenti infermieri; tra questi, 158 avevano prestato assistenza ai casi di scabbia norvegese: 15 (1,7% dell’intero campione) risultavano contagiati. Questa percentuale è molto inferiore ai tassi di contagio (talora > 30%) riportati in altre casistiche. Tutti gli operatori identificati come contatti stretti sono stati sottoposti a trattamento (profilattico o terapeutico) con permetrina crema al 5% o ivermectina per os (200 µg/kg), ad eccezione di 6 che -a un’indagine più approfondita- sono stati riclassificati come contatti occasionali con casi di scabbia classica, a rischio di contagio trascurabile. La compliance al trattamento è stata totale. Conclusione: la scabbia continua a essere un importante rischio professionale in ambito ospedaliero, soprattutto per il personale infermieristico, compresi gli studenti in formazione. Particolarmente pericolosi, sotto questo punto di vista, sono i pazienti immunocompromessi, nei quali può con maggior frequenza manifestarsi la scabbia norvegese. Il protocollo operativo adottato dal Policlinico San Matteo risulta efficace per il contenimento del rischio

Rischio di malattie a trasmissione ematica nel personale ostetrico: aggiornamento della casistica pavese

Lo studio esamina la frequenza e le modalità degli infortuni a rischio di malattie ematogene occorsi al personale ostetrico del Policlinico San Matteo di Pavia dal 1997 al 2010. In questo periodo sono stati segnalati 74 incidenti (47 esposizioni percutanee e 27 mucocutanee), irregolarmente distribuiti nel corso degli anni, coinvolgenti 52 ostetriche strutturate e 22 studentesse. Tali infortuni sono avvenuti prevalentemente di giorno (turno 8-16), nella stanza della paziente o in sala parto, interessando mani e volto (soprattutto gli occhi). La manipolazione impropria di aghi e taglienti, e il non corretto uso dei mezzi di protezione individuale, sono risultati fattori causali assai frequenti. Nonostante 23 delle 74 pazienti fon e fossero potenzialmente infettanti (e 10 tra le operatrici infortunate non avessero copertura vaccinale contro l’epatite B), non si è verificata alcuna sieroconversione. Il personale ostetrico si conferma categoria professionale ad alto rischio biologico. Tuttavia, la casistica offre aspetti incoraggianti circa l’efficacia delle strategie preventive recentemente introdotte nell’ospedale (anche per effetto del D.Lgs. 81/2008), comprendenti valutazione del rischio, formazione e informazione, gestione razionale dei rifiuti, uso di protezioni personali, follow-up e profilassi farmacologica post-esposizione

Infortuni a rischio di malattie a trasmissione ematica nel personale ostetrico: analisi di una casistica ospedaliera

Health care workers (HCW) are at high risk of accidental contact with biological fluids. In spite of extensive recom mendations concerning HCW accidents continue to be frequent and seem to be related to specific factors. To evaluate the factors influencing risk of blood-borne infections in a particular category of HCW--obstetricians, and obtain information useful for prevention guidelines. Data were obtained from the exposure registers of nursing and of the Emergency Ward staff where HCWfirst report after accidental contact with biological fluids. Accidents with risk of blood-borne diseases were more frequent in obstetricians with lower job seniority. They usually occurred between 8 a.m. and 4p. m., in the patient's room. The hands and face (particularly the eyes) were the body parts more often involved In almost half of the accidents, the worker was not wearing any personal protective device. Although some contacts were with infected blood, no seroconversion occurred. Obstetricians are at high risk of contact with biological fluids. Prevention requires a global strategy including the availability of protective and safety devices, as well as worker education, especially concerning the use of such devices, the application of the universal rules of prevention and the improvement of risk awareness. An adequate post-exposure management of accidents in also required

Outcome of hepatic amebic abscesses managed with three different therapeutic strategies

Abstract: Three different approaches to hepatic abscesses due to Entamoeba histolytica were compared in 51 patients. The three modes of therapy utilized were: medical therapy with nitroimidazoles (N = 11 patients), open surgical drainage (N = 9 patients), and percutaneous drainage using ultrasound guidance followed by intralesional nitroimidazole administration (N = 31 patients). The results with each form of therapy were assessed clinically and by abdominal ultrasound. Patients receiving combined US-guided drainage and intralesional chemotherapy experienced a faster and overall better clinical response, which was confirmed also by sonographic follow-up of the hepatic lesions. This better response was associated with faster resolution, fewer relapses, and less residual hepatic scarring than either with medical therapy alone or open surgical drainage combined with medical therap