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In the context of the recent re-emergence of mpox worldwide, the French Society for Hospital Hygiene (SF2H) performed a literature review of the transmission paths and proposed specific recommendations for healthcare workers (HCWs) caring for patients with suspected or confirmed MPXV. In developed countries, the risk of contamination among HCWs in healthcare facilities seemed to be very low, limited to contamination through needle stick injuries. Two additional contamination cases were reported and not fully explained. Beyond healthcare settings, the analysis of the literature highlighted (i) a main contamination route during sexual intercourse, mainly among men who have sex with men, and (ii) a very low secondary attack rate in other contexts, such as schools or jails. Numerous studies have reported molecular or virus identification on surfaces or in the air surrounding patients, without any association with the low secondary case incidence; moreover, the minimum infectious dose through air or mucosal exposure is still unknown. Owing to the lack of evidence of MPXV respiratory transmission in the healthcare setting, the SF2H recommends the implementation of standard and contact precautions combined with medical/surgical mask use. Owing to the lack of evidence of transcutaneous contamination, the SF2H recommends the use of gloves only if contact with cutaneous lesions or mucous membranes occurs. Regarding the risk of contamination from the environment in healthcare facilities, additional studies must be conducted to investigate this. [ABSTRACT FROM AUTHOR]

Healthcare workers treating SARS-CoV-2 patients are at risk of infection by respiratory exposure to patient-emitted, virus-laden aerosols. Source control devices such as ventilated patient isolation hoods have been shown to limit the dissemination of non-infectious airborne particles in laboratory tests, but data on their performance in mitigating the airborne transmission risk of infectious viruses are lacking. We used an infectious airborne virus to quantify the ability of a ventilated hood to reduce infectious virus exposure in indoor environments. We nebulized 109 plaque forming units (pfu) of bacteriophage PhiX174 virus into a ∼30-m3 room when the hood was active or inactive. The airborne concentration of infectious virus was measured by BioSpot-VIVAS and settle plates using plaque assay quantification on the bacterial host Escherichia coli C. The airborne particle number concentration (PNC) was also monitored continuously using an optical particle sizer. The median airborne viral concentration in the room reached 1.41 × 105 pfu/m3 with the hood inactive. When active, the hood reduced infectious virus concentration in air samples by 374-fold. The deposition of infectious virus on the surface of settle plates was reduced by 87-fold. This was associated with a 109-fold reduction in total airborne particle number escape rate. A personal ventilation hood significantly reduced airborne particle escape, considerably lowering infectious virus contamination in an indoor environment. Our findings support the further development of source control devices to mitigate nosocomial infection risk among healthcare workers exposed to airborne viruses in clinical settings. [ABSTRACT FROM AUTHOR]

Background: The source of transmission of Clostridioides difficile in healthcare institutions is frequently unknown. The aim of this prospective cohort study was to assess the association between strains cultured from patients and shoe soles of healthcare workers (HCWs), as already shown in the operating theatre, but not on general hospital wards in an acute-care institution.Methods: We conducted a study at a university tertiary care centre in Switzerland. From October 2019 to July 2020, shoe soles of HCWs were cultured for C. difficile twice per shift while taking care of a patient infected with toxigenic C. difficile. Additional risk factors were assessed by interviewing involved HCWs. Patients' faecal samples were processed by routine microbiological methods. Similarity of the HCWs' and patients' strains was determined by whole-genome sequencing (WGS).Results: A total of 103 HCWs exposed to 42 hospitalized patients participated in the study, providing 206 samples. Contamination of shoe soles with C. difficile was detected in 37 samples (17.8%) of HCWs taking care of patients infected with C. difficile. Overall, transmission was suspected by epidemiological link and matching strains demonstrated by WGS in 74%.Conclusions: HCWs' shoe soles were positive in 17.8% with C. difficile strains linked epidemiologically and confirmed by WGS to infected patients suggesting potential transmission by HCWs' shoe soles. This pilot study provides sufficient evidence to further evaluate this potential mode of healthcare-associated transmission of C. difficile by a larger clinical trial. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers (HCWs) are at risk for coronavirus disease 2019 (COVID-19), and for spreading severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) amongst colleagues and patients.Aim: To study the presence of SARS-CoV-2 RNA and possible onward transmission by HCWs upon return to work after COVID-19, and association with disease severity and development of antibodies over time.Methods: Unvaccinated HCWs with positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) were recruited prospectively. Data on symptoms were collected via telephone questionnaires on days 2, 7, 14 and 21 after a positive test. Upon return to work, repeat SARS-CoV-2 RT-PCR was performed and serum was collected. Repeat serum samples were collected at weeks 4, 8, 12 and 16 to determine antibody dynamics over time. Phylogenetic analysis was conducted to investigate possible transmission events originating from HCWs with a positive repeat RT-PCR.Findings: Sixty-one (84.7%) participants with mild/moderate COVID-19 had a repeat SARS-CoV-2 RT-PCR performed upon return to work (median 13 days after symptom onset), of which 30 (49.1%) were positive with a median cycle threshold (Ct) value of 29.2 (IQR 26.9-29.9). All HCWs developed antibodies against SARS-CoV-2. No significant differences in symptomatology and presence of antibodies were found between repeat RT-PCR-positive and -negative HCWs. Eleven direct colleagues of six participants with a repeat RT-PCR Ct value <30 tested positive after the HCW returned to work. Phylogenetic and epidemiologic analysis did not indicate onward transmission through HCWs who were SARS-CoV-2 RNA positive upon return to work.Conclusions: HCWs regularly return to work with substantial SARS-CoV-2 RNA loads. However, this study found no evidence for subsequent in-hospital transmission. [ABSTRACT FROM AUTHOR]

Personal protective equipment (PPE) is essential for healthcare worker (HCW) safety. Conservation of PPE for clinical use during the COVID-19 pandemic reduced its availability for training, necessitating an innovative approach to sourcing high physical resemblance PPE (HPR-PPE). We present a case study of crowd-sourcing of HPR-PPE to train HCWs. Survey results indicated that HPR-PPE enabled high-fidelity practise of PPE application and removal, aided procedure recall, improved user confidence and was sufficiently similar to medical-grade PPE. HPR-PPE provided a novel and cost-effective alternative. We also demonstrated that medical-grade PPE can be sourced from non-medical institutions and businesses during a pandemic. [ABSTRACT FROM AUTHOR]

Background: There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers.Aim: This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcare-associated infections using hand hygiene.Methods: CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria.Findings: Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multi-modal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the 'Five Moments'. However, recording of hand hygiene technique was not common.Conclusion: Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers. [ABSTRACT FROM AUTHOR]

Aim: To investigate the sources of infection among healthcare workers (HCWs) and patients in a teaching hospital in the Netherlands during the early stages of the coronavirus disease 2019 (COVID-19) pandemic using epidemiological and whole-genome sequencing data.Methods: From 3rd April to 11th May 2020, 88 HCWs and 215 patients were diagnosed with COVID-19. Whole-genome sequences were obtained for 30 HCWs and 20 patients.Results: Seven and 11 sequence types were identified in HCWs and patients, respectively. Cluster A was the most common sequence type, detected in 23 (77%) HCWs; of these, 14 (61%) had direct patient contact and nine (39%) had indirect patient contact. In addition, seven patients who were not hospitalized in the COVID-19 cohort isolation ward who became positive during their admission were infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) cluster A. Following universal masking of all HCWs and emphasis on physical distancing during meals and breaks, no further evidence was found for patient-to-HCW or HCW-to-HCW transmission or vice versa.Conclusion: The finding that patients and HCWs were infected with SARS-CoV-2 cluster A suggests both HCW-to-HCW and HCW-to-patient transmission. [ABSTRACT FROM AUTHOR]

Background: Streptococcus pyogenes is a well-known cause of postpartum infections and is causing significant morbidity and mortality.Aim: To describe measures taken to control an outbreak of postpartum infections caused by S. pyogenes emm75 on a maternity ward.Methods: Patients presenting postpartum with signs and symptoms of infection were cultured for β-haemolytic streptococci with cervical swabs and blood cultures, and bacterial isolates were species-determined with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and emm-typed. Pharyngeal swabs were taken from healthcare workers (HCWs) at the ward. Bacterial isolates were subjected to whole-genome sequencing (WGS). The multi-locus sequence type and the number of single nucleotide polymorphisms (SNPs) compared to an index genome were determined.Findings: During a three-month period, six cases of postpartum infection with S. pyogenes emm75 were identified on the maternity ward. By comparing delivery dates with duty rotas, one HCW was identified as a possible source of infection in five cases. After repeated pharyngeal swabs from this individual, an S. pyogenes emm75 was isolated. The five isolates from patients epidemiologically linked to the HCW and the two isolates of the family members had an identical sequence type (ST49) and 0-2 SNPs difference compared to the HCW isolate, whereas the sixth patient had an unrelated isolate. Eradication antibiotic therapy with clindamycin and rifampicin was given to the carrier. All patients received intravenous antibiotic treatment and recovered.Conclusion: A three-month outbreak was stopped when a carrier was identified and treated. Source identification and WGS proved vital for outbreak control. [ABSTRACT FROM AUTHOR]

Background: Viral respiratory illnesses are common causes of outbreaks and can be fatal to some patients.Aim: To investigate the association between laboratory-confirmed viral respiratory infections and potential sources of exposure during the previous 7 days.Methods: In this nested case-control analysis, healthcare personnel from nine Canadian hospitals who developed acute respiratory illnesses during the winters of 2010/11-2013/14 submitted swabs that were tested for viral pathogens. Associated illness diaries and the weekly diaries of non-ill participants provided information on contact with people displaying symptoms of acute respiratory illness in the previous week. Conditional logistic regression assessed the association between cases, who were matched by study week and site with controls with no respiratory symptoms.Findings: There were 814 laboratory-confirmed viral respiratory illnesses. The adjusted odds ratio (aOR) of a viral illness was higher for healthcare personnel reporting exposures to ill household members [7.0, 95% confidence interval (CI) 5.4-9.1], co-workers (3.4, 95% CI 2.4-4.7) or other social contacts (5.1, 95% CI 3.6-7.1). Exposures to patients with respiratory illness were not associated with infection (aOR 0.9, 95% CI 0.7-1.2); however, healthcare personnel with direct patient contact did have higher odds (aOR 1.3, 95% CI 1.1-1.6). The aORs for exposure and for direct patient contact were similar for illnesses caused by influenza.Conclusion: Community and co-worker contacts are important sources of viral respiratory illness in healthcare personnel, while exposure to patients with recognized respiratory infections is not associated. The comparatively low risk associated with direct patient contact may reflect transmission related to asymptomatic patients or unrecognized infections. [ABSTRACT FROM AUTHOR]

This article reports the observed rate of infection with severe acute respiratory syndrome coronavirus-2 in healthcare workers (HCWs) who worked on wards dedicated to care of patients with coronavirus disease 2019 (COVID-19) compared with HCWs who worked on non-COVID-19 wards. The infection rate was significantly higher among HCWs who worked on non-COVID-19 wards (odds ratio 2.3, P=0.005), illustrating the need to strengthen social distancing measures and training. [ABSTRACT FROM AUTHOR]

An effective post-exposure prophylaxis (PEP) strategy may limit the spread of infection. However, there is no consensus regarding PEP for Middle East respiratory syndrome coronavirus (MERS-CoV) infection. This study assessed the efficacy of ribavirin and lopinavir/ritonavir as PEP for healthcare workers (HCWs) exposed to patients with severe MERS-CoV pre-isolation pneumonia. The safety of the PEP regimen was assessed. HCWs with high-risk exposure to MERS-CoV pre-isolation pneumonia were retrospectively enrolled. HCWs who received PEP therapy were classified into the PEP group. PEP therapy was associated with a 40% decrease in the risk of infection. There were no severe adverse events during PEP therapy. [ABSTRACT FROM AUTHOR]

Background: Hand hygiene compliance among healthcare workers (HCWs) in intensive care units (ICUs) is disconcertingly low.Aim: To identify the effective intervention(s) for increasing HH compliance among HCWs in adult ICUs.Methods: Two major electronic databases, OVID Medline and CINAHL, were searched by using a combination of MeSH terms and text words (e.g. hand hygiene, hand washing, compliance, adher*, improve*, develop* and intensive care unit) for relevant articles. This was supplemented by Google Scholar and hand searching of included bibliographies. Data from identified articles were then abstracted, quality-assessed, and combined into a summary effect.Findings: Of 89 titles and abstracts that were identified, 14 articles were finally included. Overall study quality was good. However, variations in design, setting, sample size, and intervention(s) tested precluded a meta-analysis; hence a narrative synthesis was conducted. The interventions included education, observation, provision of supplies, improving access and directive support; tested singly or in combination; resulted in positive outcomes in all but one study. A combination of administrative support, 'supplies', education and training, reminders, surveillance, and performance feedback raised the compliance from a baseline of 51.5% to a record 80.1%; but no set of intervention(s) could improve the compliance to the desired near-100% level.Conclusion: Available data suggest that multi-modal interventions are effective in raising the compliance to a 'plateau' level but not up to the desired standard. Methodologically appropriate trials of combined interventions could enhance the evidence about interventions to improve hand hygiene compliance among ICU staff. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers (HCWs) face specific challenges in infectious disease outbreaks, which provide unusual, new events with exposure risk. The fear of infection or new, unknown tasks in an unfamiliar setting, for example, may complicate outbreak management.Aim: To gain insight into how healthcare organizations can prepare to meet the needs of their HCWs by capturing the experiences of HCWs with patients with suspected Ebola virus disease.Methods: We conducted 23 in-depth interviews with HCWs, of whom 20 worked in a Dutch university hospital and three worked in a regional ambulance service. We invited HCWs who cared for patients with suspected Ebola or who were on the team preparing for admission of such patients in the period 2014-2015.Findings: The HCWs were stressed and anxious, but most rated their overall experience as positive. We categorized the reported experiences in three main themes, namely, experiences related to: (i) the novelty of the threat, (ii) the risk of infection and fear of transmission, and (iii) the excessive attention. Our results underline the importance of a supportive working environment suitable for crises.Conclusion: The experiences of HCWs dealing with patients with suspected Ebola can direct improvements in generic preparedness for highly transmissible diseases. [ABSTRACT FROM AUTHOR]

Background: Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions.Aim: To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy.Methods: The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities.Findings: More than 96% of facilities had 'improved' water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78-92% of handwashing locations for doctors and nurses, but just 4-30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%).Conclusion: Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi healthcare facilities. [ABSTRACT FROM AUTHOR]

Background: Operating theatres and surgical clothing are designed to protect the patient from surgical site infections. However, there is still a risk of infection of the surgical team with blood-borne pathogens via ocular or mucocutaneous exposure. Whereas conventional surgical clothing provides some protection against contamination, surgical helmet systems (SHS) are intended to provide a high level of protection by forming a barrier for particles, aerosols and fluids between surgeon and surgical field of work.Aim: The aim of this study was to quantify the contamination of the surgeon by droplets during orthopaedic procedures by an in-vitro simulation of hip and knee arthroplasty while wearing SHS versus conventional surgical clothing.Methods: Hip and knee arthroplasty procedures were performed on artificial foam bone, which was continuously kept wet with a marker fluid. Each of the procedures was carried out by ten subjects wearing conventional surgical clothing or wearing SHS with integrated toga. After the simulated operation, pictures of the subjects were taken under ultraviolet illumination. Images wearing the full gown, and after removal of the gown, were evaluated for stained areas.Findings: The contamination risk was 30% while wearing conventional clothing. In none of the 20 subjects using the SHS stains could staining be detected after removal of the protective clothing.Conclusion: This study has demonstrated that the protective properties of the SHS are superior to conventional surgical clothing. Using SHS in high-risk procedures could reduce occupational exposure to blood-borne infections in surgeons. [ABSTRACT FROM AUTHOR]

Summary Background Tuberculosis (TB) is one of the important occupationally acquired infectious diseases in low-incidence countries. Delays in TB diagnosis and treatment among healthcare workers (HCWs) result in costly large-scale TB contact screening among patients and other HCWs. Aim To assess the cost-effectiveness of TB screening for HCWs using interferon-gamma release assays (IGRAs) compared with tuberculin skin test (TST) and chest x ray (CXR). Methods Markov models were constructed using a hospital payer perspective. The target populations were a hypothetical cohort of 30-year-old HCWs at the time of employment, and a hypothetical cohort of HCWs working on a high-risk ward until 60 years of age. Six strategies were modelled: TST, QuantiFERON-TB Gold In-Tube (QFT), T-SPOT.TB (T-SPOT), TST followed by QFT, TST followed by T-SPOT, and CXR. The main outcome measure of effectiveness was quality-adjusted life-years (QALYs). Costs and QALYs gained per person screened were calculated. Findings QFT was the most cost-effective strategy at the ‘willingness to pay’ level of US$ 50,000/QALYs gained (at the time of employment: US$ 334.91, 21.071 QALYs; on a high-risk ward: US$ 1050.32, 20.968 QALYs; values for 2012). Cost-effectiveness was sensitive to latent TB infection (LTBI) rate and bacillus Calmette-Guérin vaccination rate. TST followed by QFT was more cost-effective than QFT when the LTBI rate was <0.026 at the time of employment and <0.08 on a high-risk ward. Conclusion Systematic TB screening using QFT is cost-effective for screening HCWs, and is recommended in low-incidence countries. [ABSTRACT FROM AUTHOR]

Summary: Background: Healthcare workers (HCWs) have the potential for increased exposure to infectious disease resulting from the provision of patient care. Pregnancy can confer specific problems in some infections for the mother and her unborn child. Aims: To discuss the viral infections encountered in the UK that constitute a particular risk to the pregnant HCW: human immunodeficiency virus, hepatitis B virus, hepatitis C virus, varicella-zoster virus, herpes simplex virus, human parvovirus B19, cytomegalovirus, rubella, measles, enteroviruses, mumps and influenza. Evidence for nosocomial transmission, clinical aspects specific to pregnancy, and recommendations to protect the pregnant HCW at work are included. Methods: Medline, EMBASE and Pubmed were searched using a list of keywords specific to each viral infection, including ‘nosocomial’, ‘occupational’ and ‘healthcare workers’. References from the bibliographies of articles identified were reviewed for relevant material. Findings: The evidence for increased risk in the healthcare setting for many of these infections, outside of outbreaks, is weak, possibly because of the application of standard protective infection control measures or because risk of community exposure is greater. The pregnant HCW should be advised on protective behaviour in both settings. Potential interventions include vaccination and reducing the likelihood of exposure through universal precautions, infection control and redeployment. Conclusion: Protection of the pregnant HCW is the responsibility of the individual, antenatal care provider and employer, and is made possible through awareness of the risks and potential interventions both before and after exposure. If exposure occurs or if the HCW develops an infective illness, urgent specialist advice is required. [Copyright &y& Elsevier]

Summary: Background: Influenza presents a life-threatening infection for hospitalized geriatric patients, who might be nosocomially infected via healthcare workers (HCWs), other patients or visitors. In the 2011/2012 influenza season an influenza A(H3N2) outbreak occurred in the geriatric department at the Hôpital Edouard Herriot, Lyon. Aim: To clarify the transmission chain for this influenza A(H3N2) outbreak by sequence analysis and to identify preventive measures. Methods: Laboratory testing of patients with influenza-like illness in the acute care geriatric department revealed 22 cases of influenza between 19th February and 15th March 2012. Incidences for patients and HCWs were calculated and possible epidemiological links were analysed using a questionnaire. Neuraminidase and haemagglutinin genes of culture-positive samples and community influenza samples were sequenced and clustered to detect patients with identical viral strains. Findings: Sixteen patients and six HCWs were affected, resulting in an attack rate of 24% and 11% respectively. Six nosocomial infections were recorded. The sequence analysis confirmed three independent influenza clusters on three different sections of the geriatric ward. For at least two clusters, an HCW source was determined. Conclusion: Epidemiological and microbiological results confirm influenza transmission from HCWs to patients. A higher vaccination rate, isolation measures and better hand hygiene are recommended in order to prevent outbreaks in future influenza seasons. [Copyright &y& Elsevier]

Summary: Background: Healthcare-associated infections (HCAIs) are the most frequent adverse consequences of healthcare worldwide, threatening the health of both patients and healthcare workers (HCWs). The impact of HCAI is particularly felt in resource-poor countries, with an already overstretched health workforce and a high burden of community-acquired infection. Aim: To provide an overview of the current situation in sub-Saharan Africa with regards to the spectrum of HCAI, antimicrobial resistance, occupational exposure and infection prevention. Methods: We reviewed the literature published between 1995 and 2013 and from other sources such as national and international agencies. Findings: Sparse data suggest that HCAIs are widespread in sub-Saharan Africa, with surgical site being the dominant focus of infection. Nosocomial transmission of multidrug-resistant tuberculosis is a considerable concern, as is the prevalence of meticillin-resistant S. aureus and resistant Enterobacteriaceae. In HCWs, vaccination rates against vaccine-preventable occupational hazards are low, as is reporting and subsequent human immunodeficiency virus-testing after occupational exposure. HCWs have an increased risk of tuberculosis relative to the general population. Compliance with hand hygiene is highly variable within the region. Injection safety in immunization programmes has improved over the past decade, mainly due to the introduction of autodestruct syringes. Conclusions: Despite the scarcity of data, the burden of HCAI in sub-Saharan Africa appears to be high. There is evidence of some improvement in infection prevention and control, though widespread surveillance data are lacking. Overall, measures of infection prevention and occupational safety are scarce. [Copyright &y& Elsevier]

Summary: Background: Varicella zoster infection can be spread by infected healthcare workers (HCWs) to coworkers and patients. A self-reported history of chickenpox infection is sometimes taken as proof of immunity. Aim: To establish the relationship between positive recall history and serological immunity against varicella zoster virus (VZV) amongst healthcare workers in a tertiary hospital in Taiwan. Methods: Between May 2008 and April 2009, all HCWs in a Taiwanese tertiary care hospital were tested for VZV immunoglobulin G (IgG), and completed a self-administered questionnaire to determine their history of varicella infection or vaccination. Those who were seronegative were vaccinated. Findings: All HCWs (N =3733) at the hospital participated in this study. Their mean age was 34.6 years, and the seroprevalence of VZV was 91.1%. Sensitivity, specificity, and positive and negative predictive values of a self-reported history of varicella infection were 82.3%, 48.6%, 96.3% and 14.4%, respectively. Corresponding figures for a history of varicella vaccination were 23.4%, 69.4%, 90.9% and 6.5%, respectively. The recall history of younger HCWs and medical professionals (doctors, nurses and paramedical staff) to varicella had higher sensitivity. However, only the recall history of medical professionals had a significantly higher positive predictive value. Conclusion: A positive recall history of varicella infection and vaccination did not ensure the presence of protective VZV IgG, and a negative history was not predictive of a lack of immunity. For effective prevention of nosocomial infection, VZV IgG status should be documented for all HCWs, and susceptible HCWs should be vaccinated. [Copyright &y& Elsevier]

Summary: In the UK, infections due to Panton–Valentine leucocidin-positive community-associated meticillin-resistant Staphylococcus aureus (PVL-MRSA) have been reported sporadically. In September 2006, a fatal PVL-MRSA infection occurred in a Filipino healthcare worker (HCW) after she underwent caesarean section. Throat and nasal swabs were obtained from contacts of cases in community and hospital. MRSA with an antibiogram similar to the PVL-MRSA strain were characterised including toxin gene profiling, polymerase chain reaction- and sequence-based typing. Carriers underwent decolonisation treatment, and HCWs were restricted from patient care until they and their household members were considered negative for PVL-MRSA. The PVL-MRSA belonged to ST30, was protein A gene (spa) type t019, SCCmec IVc, agr 3, and resistant only to β-lactam antibiotics. Representatives of the same lineage were identified among a further 16 individuals in community and hospital. Infections likely to be caused by PVL-MRSA had occurred in 12 cases, and were likely to be hospital-acquired in two patients (one fatal) and occupationally acquired in one HCW. Nine cases worked as nursing staff in the hospital. Eight of these had emigrated from the Philippines in the previous five years and were linked socially. Thus, PVL-MRSA-ST30 was detected in a HCW community in the UK. This is the first report of nosocomial transmission of this pandemic clone in the UK associated with a fatality. Increased vigilance in healthcare and community is needed in response to this emerging threat. [Copyright &y& Elsevier]

Summary: To increase local influenza vaccination uptake among healthcare workers (HCWs), a co-ordinated, area-wide influenza vaccination campaign was undertaken in 2008 for five hospitals in the South Metropolitan Area Health Service of Perth, Western Australia (WA). The programme included standardised marketing and data collection, with a consent form completed by each recipient. Denominator data were obtained from the WA Department of Health''s staff database. Vaccination coverage at each hospital was calculated and compared with that of 2007, with predictors for vaccination determined using a follow-up cross-sectional survey. A total of 6387 influenza vaccinations were administered. The coverage rate was above 55% in all but one hospital (range: 48.8–76.5%) whereas in 2007 no hospital achieved 55% (range: 29–51%). Allied health professionals attained the highest coverage (57.7%), followed by doctors (51.9%), nurses (49.6%) and patient support staff (48.6%). Of HCWs who worked half-time or more, 58.8% were vaccinated. The main reasons for vaccination were to prevent influenza, limit spread, and the programme''s availability. The survey revealed that HCWs who perceived that they were susceptible to influenza, that it was a serious disease and that immunisation was effective and important were significantly more likely to be vaccinated. An area-wide approach to HCW influenza vaccination can substantially improve uptake. Regular working party meetings, consistent marketing, standardised data collection and analysis, and senior management support were key elements and could be used by others to attain good vaccination coverage among HCWs. [Copyright &y& Elsevier]

Summary: The advent of interferon-gamma release assays (IGRAs) provides new options for detection of latent tuberculosis infection (LTBI). This is particularly relevant to healthcare workers (HCWs), who are at higher risk of infection, but who have often also been vaccinated. In this article, we discuss the role of IGRAs for the diagnosis of LTBI in various healthcare settings. A search was performed for studies that reported data on IGRAs in HCWs in the last 18 years. Twenty-two studies met the inclusion criteria. IGRAs showed poor agreement with the tuberculin skin test (TST), except in countries with high incidences of tuberculosis (TB), but generally correlated better with markers of exposure to TB including during contact investigation. The T-SPOT®.TB assay has not been adequately assessed in HCWs; the few studies available showed enhanced specificity of T-SPOT.TB when compared to TST. This review confirms the utility of IGRAs as important tools in the prevention and control of tuberculosis in healthcare settings. [Copyright &y& Elsevier]

Summary: Healthcare workers have an increased risk of tuberculosis infection compared with the general population. There have been few attempts to quantify the prevalence of latent tuberculosis infection amongst German healthcare workers, due to inadequacy of the current tuberculin skin test (TST). Therefore, it was our aim to investigate the prevalence of latent tuberculosis in this cohort using a tuberculosis-specific ELISpot (T-SPOT®.TB) test and to compare the performance of this test to that of the TST. Ninety-five healthy participants working in departments of radiology were examined by ELISpot, lymphocyte transformation test and TST. For cellular in-vitro tests, tuberculosis-specific peptides and purified protein derivate (PPD) were used as antigens. These tests were combined with a questionnaire on prior tuberculosis exposure. Out of 95 healthcare workers, only one (1%) was defined as positive by T-SPOT.TB, 92 (97%) by PPD–ELISpot, 78 (82%) by PPD–lymphocyte transformation test and 32 (34%) by TST. Multivariate analysis showed that the TST was significantly affected (P <0.0001 and P =0.001, respectively) by foreign birth and prior skin testing. The T-SPOT.TB test results were independent of foreign birth, prior skin testing and prior vaccination against tuberculosis. In contrast to the TST, T-SPOT.TB appears to be an accurate and useful tool to track tuberculosis infection in this at-risk group. With only one of 95 participants having acquired latent tuberculosis, these preliminary results argue for a low incidence of latent tuberculosis in German radiologists. [Copyright &y& Elsevier]

Summary: An outbreak of staphylococcal bullous impetigo occurred over a period of five months in a maternity ward involving seven infected and two colonised neonates. The skin lesions were due to epidermolytic toxin A-producing Staphylococcus aureus. Infection control measures were implemented and a retrospective case–control study performed. Contact with an auxiliary nurse was the only risk factor for cases of bullous impetigo (P <0.01). The nurse cared for all seven cases and was an asymptomatic nasal carrier of the epidemic strain. Repeated courses of decontamination treatment failed to eradicate carriage. Nine months after the last case, another neonate developed a more severe form of bullous impetigo and the auxiliary nurse was reassigned to an adult ward. [Copyright &y& Elsevier]

Summary: Healthcare workers in China have a high risk of tuberculosis infection. This study measured the prevalence of latent tuberculosis infection in 210 healthcare workers in a chest hospital in Harbin using two interferon-gamma release assays (IGRAs) [QuantiFERON®-TB Gold In-Tube (QFT-GIT) and A.TB] and the tuberculin skin test. Results from the IGRAs had moderate agreement with positivity rates of 76.5% (QFT-GIT) and 65.7% (A.TB) but <50% of subjects returned for tuberculin skin test readings. Risk of infection increased with patient exposure. IGRAs may be more useful than tuberculin skin test in monitoring tuberculosis infections in high risk environments. [Copyright &y& Elsevier]