Staphylococcus aureus nasal carriage in the community: a survey from central Italy

Recently, concern has increased regarding the spread of methicillin-resistant Staphylococcus aureus (MRSA) in the community. We studied 812 subjects from central Italy to establish the rates of nasal carriage of S. aureus, and antibiotic susceptibility patterns, in the community. The prevalence of S. aureus nasal carriage was 30.5%. Only one subject, with predisposing risk factors for acquisition, was identified as carrier of MRSA (prevalence of 0.12%). The presence of MRSA in the community of our area still appears to be a rare event. Among methicillin-susceptible S. aureus (MSSA) isolates, a surprisingly high rate (18%) of resistance to rifampin was observed.     

Prevention of hepatitis B in Italy: lessons from surveillance of type-specific acute viral hepatitis. SEIEVA Collaborating Group

The relative contribution of various risk factors to the incidence of acute hepatitis B in Italy was estimated using a special surveillance system (SEIEVA) for type-specific acute viral hepatitis. At present 146 health departments (USLs) which contain 21% of the Italian population participate in SEIEVA out of the total of 650. Data on 2460 hepatitis B cases and 708 hepatitis A cases were compared. Hospitalization, surgical intervention, dental therapy, other percutaneous exposures, barber shop shaving, i.v. drug abuse and household contact with HBsAg carriers were associated with acute hepatitis B and a large number of cases were attributable to these risk factors. Because the control programme based on vaccination will not be effective in the short term at reducing hepatitis B incidence, other additional interventions are recommended.     

Risk factors in overweight: a survey among female hospital personnel

The purpose of this study was to explore the eventual relationship between the working conditions, and overweight women working in hospitals. The sample comprised 594 women working in hospitals in Lyon; 34% of them were overweight which is 10% above the theoretical weight. The rate of overweight hospital staff increased with the woman's age, the number of children and when the social level decreased. The analysis showed that being overweight was more frequent in women working in cleaning staff (56%) and in nursing auxiliaries (36%) than in nurses and administrative staff (24% and 27% respectively). After taking the above personal risk factors into account, this relationship remained the same. However, the night work and the length of service in hospitals are not found to be risk factors, after adjustment for the personal risk factors and type of work. Considering the women who were not overweight at the time of commencing employment, the relationship between being overweight and the type of working conditions in the hospitals disappeared.     

Musculoskeletal injuries among operating room nurses: results from a multicenter survey in Rome,Italy

Aim  

Chronic disorders of the musculoskeletal system, particularly low back pain (LBP), are increasing and represent a social and economic problem of growing importance, especially if correlated with working conditions. Health care workers are at higher risk of developing LBP during work shifts in the hospital. The aim of this study was to assess the prevalence of LBP among operating room nurses and to investigate the risk factors for musculoskeletal injuries in the operating room.     

Smoking in the workplace. Study at a hospital in central Italy

Smoking is the leading preventable cause of death and the source of numerous problems in the workplace. This study assessed the smoking in health care workers in a general hospital in Central Italy. As part of the health surveillance required by Law No. 626/1994, 2743 employers (40.8% males, 59.2% females; mean age 42.0 ys, SD 9.6 ys) were interviewed. The prevalence of smokers was very high: 36.0% in men and 36.7% in women. When the population was stratified according to occupation, the highest prevalence of smokers was found in ward orderlies (45.2%) and nurses (38.9%) and the lowest in doctors (26.3%). The prevalence of smoking was similar in all occupational divisions--clinical, surgery, diagnostics and administration. This study shows that smoking is more widespread in hospital workers than in an age-matched section of the general population (27.5%). As all health workers should set a positive example in combatting smoking, occupational physicians in charge of health surveillance in hospitals should actively collaborate in smoking dissuasion programmes.     

Hepatitis B antigen in a leprosy hospital

A survey of hospital patients with lepromatous and with tuberculoid leprosy showed 5% of the former and 6.3% of the latter to be carriers of hepatitis B antigen. These findings contradict the hypothesis of a genetically determined predisposition; opportunity for infection appears rather to be the determining factor. It was also found that (1) the number of carriers was higher among patients staying longer in hospital; (2) titres of antigen in patients with lepromatous leprosy were higher than in those with tuberculoid leprosy or in controls; and (3) antigen titres measured twice at an interval of 4 months indicated that the carrying of hepatitis B antigen in patients with leprosy is stable and persistent.     

Home from hospital: a survey of hospital discharge arrangements in Northamptonshire.

The timeliness and adequacy of inpatient discharge communication between hospitals and general practitioners (GPs) in Northamptonshire was examined by a postal questionnaire survey of GPs of patients recently discharged from hospital, with the aim of improving the co-ordination of discharge procedures, and hence improving continuity of care. The questionnaire measured when and how the GP was informed of the discharge, and examined the adequacy of medical, therapeutic and social details in the discharge documents sent out by the hospital. It was found that 67 per cent of discharges had been notified to the GP by the hospital within five days of discharge. With notable exceptions the discharge documents were considered timely. General practitioners were less satisfied with the adequacy of discharge communication in terms of 'social' topics such as transport needs, social services back-up, and whether a patient with a malignancy knew about his or her diagnosis. The GPs of patients under geriatricians were more satisfied with the quality of discharge documents. Comparison with an earlier study suggested that the speed of communication and involvement of GPs in discharge in Northamptonshire is not as satisfactory as that found in Oxford in 1986. It was concluded that within the county there appear to be models of good practice in terms of discharge communication with GPs. These standards should be adopted by other specialties to match or improve on existing good practice.     

Childhood vaccination coverage in Italy: results of a seven-region survey. The Italian Vaccine Coverage Survey Working Group.

In Italy few data exist on vaccination coverage and timeliness. We therefore carried out cluster surveys on 12-23-month-olds in nine Italian cities and regions using standard Expanded Programme on Immunization methodology. The study areas accounted for 40% of all live births in Italy in 1991. Coverage levels for the third dose of diphtheria and tetanus toxoids and for oral poliovirus vaccine, which are mandatory, exceeded 90% in all but one area. However, less than two-thirds of the children had completed the primary vaccine series by their first birthday. The commonest reason for failure to complete the series in time was that the child had been sick and was not brought for vaccination. For the two optional vaccines (pertussis and measles) coverage was much poorer, ranging from 8% to 71% for pertussis and from 9% to 53% for measles. The commonest reason given by the mothers for pertussis non-vaccination was that they had been advised against it, while for measles the commonest reasons were that the child was sick and that they had been advised against it. These findings suggest that although coverage for the mandatory vaccines is high, coverage for pertussis and measles is very low. Additional education of physicians and mothers is needed concerning the true contraindications for vaccination. Also, in the absence of legislation making pertussis and measles vaccines mandatory, greater efforts are needed to convince physicians and the public about the benefits of their use.     

Hunger: a hospital survey.

Patients at a New York City municipal hospital were surveyed in 1985 and 1989 to ascertain the extent of hunger and its possible correlates. Twenty-two percent (22%) of the 382 subjects in 1985 and 23% of the 332 subjects in 1989 experienced hunger. Hunger was related significantly to homelessness, social isolation and the physical inability to buy and/or prepare food. Between 1985 and 1989, there was a large increase in the use of institutional resources for food; a decline in reliance on Food Stamps; and an increase in household density. Inpatients were found to be poorer than outpatients, and to rely more heavily upon soup kitchens. Practice, policy and research implications are noted.     

Prevalence of hepatitis B serologic markers in community hospital personnel.

The seroprevalence of hepatitis B markers among predominantly high-risk staff members and personnel of 31 community hospitals located throughout the United States was 8.4 per cent (greater than or equal to 5 per cent in 25 hospitals and greater than or equal to 10 per cent in 13 hospitals). Only two hospitals had seroprevalence rates less than or equal to 3 per cent. The institutional seroprevalence ranged from 0 per cent to 16.7 per cent, with a median of 8.2 per cent. Although there are limitations to this survey, the results suggest that the well established increased risk of contracting HBV infection among certain groups of health-care workers in urban teaching medical centers may also hold true for personnel in similar occupational and professional categories in community hospitals.     

Hepatitis B in children in Italy: Incidence and risk factors

The objectives of the present report were to give a baseline picture of hepatitis B notification incidence rates in children before the campaign of mass vaccination for newborns and adolescents (12–13 years old), and to study the role of different risk factors. Data from a specific national surveillance system of acute viral hepatitis (SEIEVA, Sistema Epidemiologico Integrato dell'Epatite Virale Acuta) were used and acute hepatitis B cases were compared to acute hepatitis A patients with the case-control study method to estimate the associations with the considered risk factors. Since the system began, one hundred and sixty-three local health departments have joined SEIEVA covering 30% of the Italian population. The incidence of acute hepatitis B notifications among 0–14 aged children was 9 per 100,000 in 1985 and 1 per 100,000 in 1990. Such decline in incidence was observed in both the North and the South of Italy. Surgical interventions, dental therapy and household contacts with a HBsAg chronic carrier were found to be associated with acute hepatitis B. The point estimate of the odds ratio was 10 for the latter risk factor. Other preventive measures in addition to vaccination are needed to control the risk of hepatitis B infection and other parenteral diseases due to surgical intervention and dental therapy.     

Hepatitis B in ward and clinical laboratory employees of a general hospital.

After a sharp increase in viral hepatitis cases, mostly type B, among the 2000 employees of a general hospital during three years, we conducted an investigation which consisted of obtaining data on employee cases and surveying many current employees. Of the 38 cases, 22 occurred in non-physician, ward employees. Of 189 current ward employees, 8% had antibody to hepatitis B surface antigen (anti-HBS) and 1% had hepatitis B surface antigen (HBSAg). Hepatitis B virus (HBV) seropositivity was highest for employees who worked closely with hemodialysis and renal transplant patients and for those who claimed that their ward was understaffed. Nine of the 38 cases occurred in clinical lab workers. Of 70 current lab employees, 17% were positive for anti-HBS and none for HBSAg. HBV seropositivity was highest for those working in the chemistry section (highest there among those performing blood-gas determinations and those working with the multi-channel autoanalyzers) and those who routinely got blood on their skin and clothes at work. All seropositive employees worked routinely with blood. These data support the hypotheses that many hospital employees contract hepatitis B from exposure to HBSAg-positive patients and many clinical laboratory employees contract it from exposure to HBV-contaminated blood.     

Hepatitis B vaccination programs for health care personnel in U.S. hospitals

A random sample of 232 U.S. hospitals was surveyed. Of those hospitals, 75 percent had hepatitis B vaccination programs. The presence of a program was associated with hospital size (60 percent of those with 100 beds, 75 percent with 100-499 beds, 90 percent with 500 or more beds; P = 0.0013) and hospital location (urban 86 percent; rural 57 percent; P less than 0.001). The frequency of needlestick exposures per month among hospital personnel and hospital location were directly related to and best predicted the existence of hepatitis B vaccination programs. All hospitals with programs offered vaccine to high-risk personnel (as defined by the hospital). Seventy-seven percent of hospitals paid all costs for vaccinating high-risk personnel; 19 percent paid for any employee to be vaccinated regardless of risk status. Forty-six percent of hospitals with programs were estimated to have vaccinated more than 10 percent of all eligible personnel, and 13 percent to have vaccinated more than 25 percent of eligible personnel. The highest compliance rates were associated with hospitals paying for the vaccine and requiring vaccination of high-risk personnel. Fifty-four percent of hospitals attributed noncompliance to concern regarding vaccine safety and effectiveness. The reasons why there was no vaccination program in 58 hospitals were (a) low incidence of hepatitis B virus infections among personnel, (b) cost of vaccine, and (c) vaccination being offered as part of a needlestick protocol. Full utilization of hepatitis B vaccine could eliminate the occupational hazard that hepatitis B virus presents to health care personnel.     

Hepatitis B antigen and antibody in the U.S. Army: prevalence in health care personnel.

The prevalence of Hepatitis B surface antigen (HB(S)Ag) and antibody (anti-HB(S)) seropositivity and the association of seropositivity with demographic, personal health, and professional experiences were studied in a cohort of Army Medical Department officer personnel. Serologic evidence of Hepatitis B infection was found in 5.0 per cent of personnel and was associated with age, sex, place of birth, history of hepatitis, history of blood transfusion, and previous overseas assignments. Seropositivity rates were higher for patient care oriented officer personnel, especially for those in surgical specialties, and rose with increasing professional experience. These data present a composite of risk factors operative in the acquisition of Hepatitis B seropositivity and identify a cohort for prospective study.     

The incidence of cryptosporidiosis: a two-year prospective survey in a children's hospital.

A two-year prospective survey of patients with diarrhoea at a children''s hospital detected 65 cases of cryptosporidiosis; 56 were index cases representing 1.4% of patients examined. There was a marked seasonal variation with fewer index cases in July-September (0.4-0.6%) than February-April (3-5%). All four adult cases were contacts of infected children and 21 (32%) of the patients were 12 months old or younger. Cryptosporidium was the fourth commonest diagnosed cause of gastroenteritis, the second most common non-viral cause, was responsible for 7.2% of all cases, and 14.7% of non-viral cases where a cause was identified. As such it should be sought routinely in cases of gastroenteritis in children.