Trends in hospital acquired New Delhi metallo-beta-lactamase-producing Enterobacterales in Tuscany (Italy) from 2019 to 2021: impact of the COVID-19 pandemic.

OBJECTIVES: In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) in hospitalized patients has increasingly been observed since 2018, leading in 2019 to the implementation of enhanced control measures successfully reducing transmission. We describe the NDM-CRE epidemiology during the COVID-19 pandemic in Tuscany. METHODS: Data on NDM-CRE patients hospitalized in five Tuscan hospitals were collected from January 2019 to December 2021. Weekly rates of NDM-CRE cases on hospital days in medical and critical-care wards were calculated. In March-December 2020, NDM-CRE rates were stratified by COVID-19 diagnosis. Multi-variate regression analysis was performed to assess outcomes' differences among two periods analysed and between COVID-19 populations. RESULTS: Since March 2020, an increase in NDM-CRE cases was observed, associated with COVID-19 admissions. COVID-19 patients differed significantly from non-COVID-19 ones by several variables, including patient features (age, Charlson index) and clinical history and outcomes (NDM-CRE infection/colonization, intensive care unit stay, length of stay, mortality). During the pandemic, we observed a higher rate of NDM-CRE cases per hospital day in both non-COVID-19 patients (273/100,000) and COVID-19 patients (370/100,00) when compared with pre-pandemic period cases (187/100,00). CONCLUSIONS: Our data suggest a resurgence in NDM-CRE spread among hospitalized patients in Tuscany during the COVID-19 pandemic, as well as a change in patients' case-mix. The observed increase in hospital transmission of NDM-CRE could be related to changes in infection prevention and control procedures, aimed mainly at COVID-19 management, leading to new challenges in hospital preparedness and crisis management planning.

Flu vaccination coverage in healthcare workers during a 3-year period in the context of the pandemic : Giuditta Scardina

Background Vaccination of healthcare workers (HCWs) against seasonal influenza is considered the most effective way to protect HCWs and maintain essential healthcare services during influenza epidemics. With the present study we aimed to evaluate the efficacy of measures implemented during the three flu campaigns of 2018/19, 2019/20 and 2020/21 in a university hospital in Pisa, Italy, through the assessment of vaccination coverage (VC) in HCWs and to assess attitudes toward flu vaccination. Methods Flu VC was stratified according to sex, age, job and vaccination status for each season and the association between each variable and vaccination status was explored. In 2020, a survey collecting data on knowledge and attitudes on flu vaccination was distributed. Results Starting from the 2018/19 campaign, an increasing flu VC rate was registered: contained in 2019/20 (from 11.6% to 14.3%, Δ%=23.1) and significant (VC = 39.6%, Δ%=177.6) in 2020/21 as compared with the previous year. Physicians were the professionals most willing to get vaccinated during all seasons. Considering age the situation changed greatly over the study period, with VC rising in 2020/21 in those age groups marked by low VC in previous years (<30 and 41-50 years old, Δ%=293). Having been vaccinated in the previous year represented the most important variable to predict likelihood of accepting flu jab. However, while previously vaccinated HCWs were 13 times more likely to get the flu jab in 2019/20 compared with the others;in 2020/21 they were only 3 times. Only half of HCWS considered themselves at higher risk of contracting influenza compared to the general population, while 71% totally agreed that receiving the flu jab in 2020/21 was more important than the previous years due to COVID. Conclusions A significant increase in VC was observed in 2020/21, especially among those sub-groups with consistently lower uptake in previous years, due to the COVID pandemic that positively influenced vaccination uptake. Key messages • This study evaluates the impact of subsequent flu vaccination campaigns implemented in a large university hospital in Italy through the assessment of flu VC among HCWs. • A significant increase in flu VC among HCWs was observed in 2020/21, especially in those categories characterized by lower VC rates in the previous years, more likely due to the COVID-19 pandemic.

“Laboratorium Repository”: a training tool for the Healthcare Workforce : Guglielmo Arzilli

Background The COVID-19 pandemic highlighted the need to redefine the healthcare workforce (HCW) competencies to face future emergencies linked to emerging infectious diseases, environmental, climate and social crises. As recently stated by WHO, there is a need to identify standards for education and competencies training for HCW in emergency and preparedness (E&P). The Italian National Institute of Health, in agreement with the deliberation of the G20 Health Ministers under the Italian Presidency, is developing an educational program named “Laboratorium” which includes a free access digital repository aimed to share selected documents and tools at the International Public HCW (PHCW) to increase the competencies in E&P response. Objectives A range of web domains selected according to their reliability was monitored using a keyword search tool for any relevant material published from February 14th up to April 28th, 2022. We included any publications, training materials, epidemiological data, initiatives, and communication items that addressed the topic of interest. Each item was submitted for approval by a scientific board and, if appropriate, classified by typology, language, topic, and country before publication. Results To date, out of 6197 items, 418 fulfilled the inclusion criteria. For the type of content, we included guidelines/recommendations (75), epidemiological data (58), websites (34), online courses (15) and books (16). PHCW was the most representative target group (361), followed by other stakeholders (127), hospital practitioners (90), primary care (87). The most represented topic was infectious diseases/SARS-CoV-2 (277) followed by vaccines (88), emergency interventions (34), emerging diseases (17), policies (26), public health preparedness (32). Conclusions Future training for PHCW should be designed with a modular approach with different levels of usability. The Laboratorium Repository provides a core of items for learning according to one's training needs Key messages The Laboratorium repository offers to PHCW a tool for updating their emergency and preparedness competencies. This repository has a user-friendly interface, accessible also through mobile devices.

Need for a competency-based approach for the Public Health Workforce training: the ISS proposal : Guglielmo Arzilli

Issue The COVID-19 pandemic acted as a catalyst for a reconsidering health care professional workforce (HCPW) competency needed to face future public health challenges, in line with the recent WHO “Global Competency and Outcomes Framework for UHC” document. In this context, in the Italian G20 Presidency framework, the Italian National Institute of Health (ISS), launched a program named “Laboratorium” - recognised in the G20 Declarations of Ministers of Health and Leaders - aimed to the development of training tools suitable for distance learning in whatever context they are placed. Description of the problem Common competencies and needs of the HCPW have to be fulfilled through cross-sectional and multilevel training, to overcome the current emergency and be able to face future challenges. The aim is to provide a modular educational approach that is finalized to actively involve the participant: health professionals step in their training pathway according to their knowledge gaps, identify their specific learning objectives and, through a problem-based learning approach, acquire the proper skills for their function and tasks. Results We propose a two-tiered approach to training: the development of competence based courses oriented to active learning. A pilot course on Epidemic Intelligence design according to this model is ready to be released. At the same time, a repository of everything available on the web systematically selected from authorised sources by a scientific committee was created to support the training objective. It is characterised by a detailed multilevel tagging that allows an effective modularisation to reach only the content useful for its user. Lessons Accessibility to health-related training materials is a required necessity at every level of HCPW. Profiles within healthcare are increasingly heterogeneous and there is a need to focus on disseminating tools that can provide knowledge to address different healthcare scenarios and common purposes. Key messages • Future public health challenges underline a need for a competencies-based learning approach in Healthcare Workforce training. • Italian National Institute of Health propose two methods within the ‘Laboratorium’ project to enable this type of learning: specifically designed courses and a structured document repository.

COMBINATION OF ADVANCED THERAPIES IN PATIENTS WITH COMPLEX INFLAMMATORY BOWEL DISEASE

Background and aim: Dual Targeted Therapy (DTT) is a novel therapeutic strategy proposed for the management of patients with complex inflammatory bowel disease (IBD). Our aim was to evaluate the safety and effectiveness of this approach in a real-life setting Materials and methods: In this single centre retrospective cohort study, we collected data on IBD patients receiving DTT from 2017 to 2022. Baseline characteristics, clinical activity of intestinal and extraintestinal disease, C-reactive protein (CRP) levels, endoscopic assessment and adverse events (AEs) were recorded. Clinical remission, CRP normalization, endoscopic remission and occurrence of AEs were investigated at baseline and during follow up Results: Sixteen patients were identified;indications for DTT were: uncontrolled IBD (11 patients), uncontrolled extraintestinal manifestations (EIMs) (6 patients: 4 spondyloarthritis, 2 psoriatic disease). Patients received vedolizumab (VDZ, 14, 87.5%), ustekinumab (UST, 8, 50%), anti-TNFα (7, 43.8%), sekukinumab (2, 12.5%), tofacitinib (1, 6.3%). The most common combinations were: VDZ+UST (6 patients, 37.5%) and adalimumab+VDZ (3, 18.8%). At baseline, 15/16 (93.8%) and 4/6 (66.6%) patients had active intestinal and EI symptoms, respectively;14 (87.5%) patients had positive CRP and 5 (31.3%) were receiving oral steroids. Median follow-up duration on DTT was 15 months (IQR 11-22). Clinical intestinal remission was reported by 6/16 (37.5%) and 3/11 (27.3%) patients at 6 and 12 months, respectively. Clinical remission of EIMs was reported by 3/7 (42.9%) at 6 and 5/7 (71.4%) patients at 12 months, respectively. CRP normalization was observed in 3/16 (18.8%) and 6/11 (54.5%) patients at 6 and 12 months, respectively. 80% of patients on steroid therapy at baseline discontinued them within 6 months. Endoscopic assessments were available for 8 patients, with endoscopic remission in 2, endoscopic improvement in 3 and no improvement in 3. Four patients (25%) experienced an AE (1 COVID-19 and reactivation of perianal disease;1 mild pneumonitis and reactivation of perianal disease;1 drug-induced pneumonitis;1 arthralgia and COVID-19). Finally, 1 patient underwent colectomy due to uncontrolled disease. Three patients discontinued DTT: 2 because of treatment failure, 1 because of an AE (drug-induced pneumonitis) Conclusions: DTT can be considered a reasonably safe and effective treatment in complex IBD patients, either with uncontrolled intestinal inflammation or with concomitant EIMs, when other therapeutic options have failed

Attitudes, Practices and Sources of Information Towards COVID-19 Vaccination in a Sample of Italian Healthcare Workers

Introduction: Vaccination of Healthcare workers (HCWs) is a crucial element of the strategy against COVID-19 to conduct an effective immunization campaign among general population. Objectives: A cross-sectional survey was conducted to assess attitudes, sources of information and practices among HCWs in relation to COVID-19 vaccination. Methods: From February 19th to April 23rd 2021 an anonymous voluntary questionnaire was sent to the mailing list of SIMPIOS and to the main National Health Service structures. Data collected through the Survey-Monkey platform was subjected to univariate and multivariate analysis to identify factors significantly and independently associated with the variables of interest. Results: 2137 HCWs answered. Hesitancy is greater in females, in those with lower concern about COVID-19, in nurses, auxiliary nurses (AN) and healthcare assistants. The most hesitant professionals are more likely not to recommend vaccination to either their patients or their relatives, while concern about COVID-19 increases the practice of recommending vaccination to family members, but not to patients. HCWs are mostly in favor of mandatory vaccination (61.22%). Female sex, a lower education level, greater hesitancy and refusal to adhere to flu vaccination campaigns are factors influencing the aversion to mandatory vaccination. Institutional source of information (eg. World Health Organization) are the most used by all categories. Scientific literature is more used by professionals working in the northern regions of Italy and by those dealing with infection control and hospital hygiene, infectious diseases, emergencies and critical area. HCWs working in south-central regions, nurses, AN, healthcare technicians, administrators and HCWs with a lower education level are more likely to choose internet, television, newspapers, family and friends' advice as sources of information. Conclusion: Communication in support of COVID-19 immunization campaigns should consider the differences between the various HCWs professional categories, to reach all professionals in a homogeneous way, involving even the most hesitant ones.

The educational role of IBD nurses in Italy in vaccinations: do not miss the moment for COVID-19.

OBJECTIVE: The role of nurses has great educational-scientific potential in COVID-19 vaccination. The aim of this work is to clarify whether the educational role of IBD nurses in vaccination is perceived by IBD patients. MATERIALS AND METHODS: A cross-sectional study was carried out, through a questionnaire, to evaluate how many IBD patients received health education about vaccinations from the dedicated nurses (IBD nurses). RESULTS: There were four hundred questionnaires, 310 patients (77.5%) answered all questions. The nurse does not appear to help educate patients on influenza vaccination (66.1%) or pneumococcal vaccination (81.6%). Disclosed patients have many doubts about the new COVID-19 vaccination (74.4%) and many seek information (74.8%) and think that the nurse can provide the necessary information (70%). CONCLUSIONS: IBD nurses do not seem very active in the vaccination education role, and they do not meet patients' expectations, which are conversely very high.