"Recommendations for periprosthetic joint infections (PJI) prevention: the European Knee Associates (EKA)-International Committee American Association of Hip and Knee Surgeons (AAHKS)-Arthroplasty Society in Asia (ASIA) survey of members".

PURPOSE: Periprosthetic joint infections (PJIs) represent a devastating consequence of total joint arthroplasty. The European Knee Associates (EKA), the American Association of Hip and Knee Surgeons (AAHKS) International Committee, and the Arthroplasty Society in Asia (ASIA) board members were interested in quantifying differences in arthroplasty surgeons' use of various PJI prevention measures to provide clinical recommendations to reduce PJI incidence. METHODS: A prospective Microsoft Forms online survey was distributed among EKA, AAHKS International Committee, and ASIA members and their affiliated arthroplasty surgeons. The survey consisted of 20 single and multiple response questions focused on PJI prevention strategies at three perioperative periods: preoperatively, intraoperatively, and postoperatively. RESULTS: Three hundred and ninety-four arthroplasty surgeons from 6 different continents completed the survey. Preoperative: (A) PJI Risk Stratification: 40.6% routinely set thresholds (e.g., BMI, HgbA1C) to be met to qualify for surgery, 36.5% only review past medical history; 9.1% use machine learning to personalize PJI risk; (B) BMI limit: 36% no limit; 15.4% BMI < 35; 30.9% BMI < 40; 17.2% BMI < 45; (C) Nutritional status: 55.3% do not screen; among those who screen their patients (44.7%), albumin is the single most used marker (86.3%); (D) Hyperglycemia/Diabetes: 83.3% check this comorbidity; 88.1% use HgbA1C as single best screening test; (E) MRSA nasal colonization: 63.7% do not test; 28.9% test all patients; 7.4% test selectively. Intraoperative: (A) Antibiotic prophylaxis in high-risk patients: 43.4% use single antibiotic for 24 h; 21.3% use double antibiotic for 24 h; 14.2% use single/double antibiotic for 7 days postoperatively; (B) Skin-cleansing: 68.7% at home (45.6% chlorhexidine sponge; 11.9% clippers); (C) Intraoperative skin disinfection: 46.9% single chlorhexidine; 25% double chlorhexidine-povidone-iodine;15.4% single povidone-iodine; (D) Tranexamic acid (TXA) to reduce bleeding/SSI: 96% yes (51% double IV dose, 35.2% single IV dose, 23.6% intra-articular injection); (E) Surgical suction drain: 52% do not use drains; 19.7% use a drain < 24 h; (F) Intra-articular lavage: 64.9% use only saline; 28.1% use dilute povidone-iodine; (G) Antibiotic local delivery to prevent PJI: 82.4% use antibiotic-added cement. Postoperative: (A) Routine monitoring of PJI serologic markers: 42% only in symptomatic patients; 34.2% do not; 20.8% in all patients; (B) Serologic markers to rule in/out PJI: 95.9% CRP; 71% SEDRATE; 60.6% WBC; (C) Synovial fluid test to rule in/out PJI: 79.6% culture/sensitivity; 69.5% WBC count; 31.4% CRP. CONCLUSIONS: This survey demonstrated that notable differences still exist in the application of PJI preventive measures across different geographic areas: Optimizing the patient preoperatively and applying multimodal intraoperative strategies represent newer, clinically relevant steps in the effort to reduce the burden of PJI. More uniform guidelines still need to be produced from international scientific societies in order facilitate a more comprehensive approach to this devastating complication. LEVEL OF EVIDENCE: IV.

Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates recommendations.

PURPOSE: The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. METHODS: A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. RESULTS: The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. CONCLUSION: Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe return.

Recommendations for resuming elective hip and knee arthroplasty in the setting of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates Survey of Members.

PURPOSE: The COVID-19 pandemic has disrupted the health care system around the entire globe. A consensus is needed about resuming total hip and knee procedures. The European Hip Society (EHS) and the European Knee Association (EKA) formed a panel of experts that have produced a consensus statement on how the safe re-introduction of elective hip and knee arthroplasty should be undertaken. METHODS: A prospective online survey was done among members of EHS and EKA. The survey consisted of 27 questions. It includes basic information on demographics and details the participant's agreement with each recommendation. The participant could choose among three options (agree, disagree, abstain). Recommendations focussed on pre-operative, peri-operative, and post-operative handling of patients and precautions. RESULTS: A total of 681 arthroplasty surgeons participated in the survey, with 479 fully completing the survey. The participants were from 44 countries and 6 continents. Apart from adhering to National and Local Guidelines, the recommendations concerned how to make elective arthroplasty safe for patients and staff. CONCLUSION: The survey has shown good-to-excellent agreement of the participants with regards to the statements made in the recommendations for the safe return to elective arthroplasty following the first wave of the COVID-19 pandemic.

Are contemporary femoral components sizing and design likely to affect functional results in TKA? A mathematical model of an implanted knee to predict knee forces.

PURPOSE: This study is aimed to investigate the effects of the choice of femoral and tibial components on several mechanical outputs that might be associated with total knee replacement surgery outcomes using a validated computational model: the Kansas knee simulator. METHODS: Two models from the same range of implants were taken into account: Model 1, the femoral component fitted the femoral epiphysis, with physiological positioning of the articulating surface using a 10-mm-thick tibial component, and in Model 2, the femoral component was 4 mm smaller than in Model 1, and a 14-mm-thick tibial component was used with a similar tibial resection and the tibio-femoral joint line was 4 mm more proximal to compensate the increased posterior bone resection and maintain proper soft-tissue tension in flexion. Changes in reaction forces and contact pressures between the components, changes in extensor muscle forces and changes in patello-femoral joint kinematics during walking gait have been studied. RESULTS: While the computational model predicted that most kinematic and kinetic outputs, including tibio-femoral and patello-femoral joint motions, contact forces, pressures and areas, were similar for Model 1 and Model 2, and a dramatic difference has been found in the extensor muscle forces necessary to flex and extend the knee. To reproduce the same knee motion with a knee reconstructed as in Model 2, a patient would need to generate approximately 40% greater extensor muscle force throughout the gait cycle in order to do so. CONCLUSION: As a consequence of such a large increase in the extensor muscle force, the knee motions would probably be compromised and, subsequently, a patient with a knee reconstructed as in Model 2 would be less likely to be able to reproduce normal knee function and therefore more likely to report poor outcome.

[Alcohol consumption risk among health care workers of the Santa Croce e Carle Hospital of Cuneo: index of prevalence, predictors and enforcement actions to dissuade alcohol consumption]. / Consumo di alcol a rischio fra gli operatori dell'Azienda Ospedaliera Santa Croce e Carle di Cuneo: indici di prevalenza, predittori e interventi di contrasto all'assunzione di alcol.

OBJECTIVES: 1691 workers of a hospital in Northern Italy underwent medical examinations in order to identij the prevalence index of alcohol consumption posing a risk, to assess the ability of some bio-anthropometric variables to predict the condition of a risk drinker, and to assess the results of a programme designed to reduce alcohol intake. METHODS: Certain blood parameters were examined and two basic alcohol consumption questionnaires were administered to identify drinkers at risk. Subjects showing a high CDT ratio were given an in-depth interview to assess alcohol intake. Drinkers at risk were enrolled in an alcohol dissuasion programme consisting of brief interventions andfollow-up assessments repeated every three months for a year. RESULTS: 63 subjects (3.7% of the total) were classified as drinkers at risk. By means of a logistic regression test the variables male gender and smoking showed a statistically significant association with the condition of drinkers at risk, while working in inpatient wards showed only a trend towards risk (p=0.06). After a year 42 (70%) of the 60 subjects who completed the alcohol consumption dissuasion programme had reduced alcohol consumption and 18 (30%) had not changed their habits. CONCLUSIONS: The prevalence of alcohol consumption posing a risk among hospital workers was low; blood parameters and alcohol consumption questionnaires routinely used to determine alcohol intake showed low ability to identif a risk condition, bio-anthropometric variables were statistically associated with a higher probability of alcohol consumption posing a risk, programmes to reduce alcohol intake among health workers proved to be effective.

[Identification of risk factors for work-related stress in a hospital: a qualitative and quantitative approach]. / L'identificazione dei fattori di rischio stress lavoro-correlato in un'Azienda Sanitaria Ospedaliera: un approccio quali-quantitativo.

BACKGROUND: Italian legislation establishes the obligation for the employer to assess any risks to the safety and health of workers, including those relating to work-related stress (WRS). Several studies have proved the existence of a link between WRS and both individual diseases and organizational results. OBJECTIVE: The research aimed at detecting WRS risk factors in a hospital consisting of 53 departments employing 2334 workers. METHODS: A qualitative and quantitative approach was adopted divided into six steps: 1) analysis of the hospital indicators; 2) semistructured interviews of the 53 department heads; 3) preparation of a checklist including 42 WRS risk indicators; 4) observation by shadowing of the 53 departments; 5) setting up of 53 focus groups with staff from each department; 6) distribution of the check-list to a representative sample of 747 employees. RESULTS: Data analysis showed a "low" level of WRS risk regarding the hospital as a whole, a "medium" level regarding six transversal indicators and eight departments. Three indicators considered particularly significant were examined in detail: "workplace and ergonomic conditions", "shift work", "interruptions in work flow". CONCLUSIONS: The results helped to identifj a series of best practices aimed at reducing WRS risk that are applicable to other health care settings. The qualitative and quantitative approach produced a keen involvement of the employees of the hospital which will positively encourage the real efficacy of the measures taken.

[Prevalence of job fitness restrictions in the period 2007-2009 and analysis of predictors of restrictions among hospital health care workers]. / Prevalenza dei giudizi di limitazione dell'idoneità alla mansione nel triennio 2007-2009 e analisi dei predittori delle limitazioni fra gli operatori sanitari di un'azienda ospedaliera.

BACKGROUND: Little is known about the prevalence rates of job fitness restrictions (JFR) and the impact of demographics on JFR among Italian health care workers (HCW). OBJECTIVE: To examine the prevalence rates of JFR among HCW of an Italian hospital in the years 2007-2009 and to estimate ability of demographic variables to predict JFR. METHODS: The number of HCW with JFR was divided by the number of HCW in service at the end of each year from 2007 to 2009 to calculate prevalence of JFR. The variables age, gender, employment, type of contract, and place of birth of the HCW in service at the end of 2009 were compared to JFR, by univariate and multivariate analysis. RESULTS: Prevalence rates of JFR were 15.2% in 2007, 15.6% in 2008, and 13.8% in 2009. The most frequent JFR were related to manual load handling (177 in 2007, 185 in 2008, and 155 in 2009). HCW of the female gender (OR: 1.69; CI: 1.17-2.43), aged > 42 years (OR: 1.66; CI: 1.30-2.13), health professionals (OR: 2.46; CI: 1.61-3.78), part-time (OR: 1.34; CI: 1.00-1.80), from other Italian regions (OR: 1.79; CI: 1.30-2.46), or other countries (OR: 2.37; CI: 1.46-5.12), showed statistically significant increases in JFR. Only a few demographic variables were associated with greater likelihood of JFR for exposure to manual handling, hazardous substances and organizational constraints. CONCLUSIONS: These data should be used to plan interventions to support the subgroups of HCW at increased risk of JFR

[Association between demographic characteristics and psychosocial factors of job stress in a sample of health care workers employed in two Italian hospitals]. / Correlazioni tra variabili demografiche e fattori psicosociali di stress occupazionale in un campione di operatori sanitari di due aziende ospedaliere.

BACKGROUND: Job stress has negative effects on both health care work ers' (HCW) health and on work organization. OBJECTIVES: To assess whether the presence of stressful conditions, individually considered, or combined in the iso-strain model, is significantly associated with specific socio-demographic characteristics, also with the aim of providing organizational tools for management to reduce stress in the working environment according to Italian law 81/2008. METHODS: The extended version of the Job Content Questionnaire was administered to 265 healthy HCW in seven paired wards of two hospitals. The five psychosocial scales Job Demand (JD), Job Control (JC), Social Support (SS), Skill Underutilization (SuS), and Job Insecurity (JI) were calculated. The factors JD, JC, and SS were combined together to separate a group of 33 HCW in iso-strain conditions from another group of 232 HCW not in iso-strain conditions. Several socio-demographic variables were collected. RESULTS: Statistically significant associations were found between socio-demographic characteristics and psychosocial factors, whereas the iso-strain conditions were not related to any socio-demographic parameter. CONCLUSIONS: Data suggest the need for alternative policies to reduce job stress: for example, actions addressed to operative units or HCW with specific socio-demographic characteristics could be effective in improving individual psychosocial factors; however, integrated actions aimed at reorganizing the working environment as a whole should be implemented to correct iso-strain conditions.

[Correlation between job satisfaction and stress factors, burn-out and psychosocial well-being among nurses working in different healthcare settings]. / Correlazione tra soddisfazione lavorativa e fattori di stress, burnout e benessere psicosociale tra infermieri che lavorano in differenti ambiti sanitari.

The aim of this study was to evaluate the prevalence and the causing factors of job dissatisfaction in three subgroups of nurses working in different context: i) hospital wards for acute patients, ii) units for long-term patients, and iii) home care for chronic patients. An anonymous, self report questionnaire was used, composed by socio-demographic, burnout, stress and psychosocial (INRS) standardized variables. A specific summarizing item was also employed to evaluate the perception of job satisfaction. One hundred thirty seven out of 190 delivered questionnaires were returned (72.1%). About 30% of the total sample is unsatisfied, 28% of the sample suffered emotional exhaustion, 20% depersonalization, and 43% declared a low level of personal accomplishment. Stress scores beyond the threshold value of 17 were found for anguish (22.7 +/- 155), anxiety (22.3 +/- 15.8) and gastroenteric symptoms (19.0 +/- 17.8). Psychosocial scores beyond the threshold value of 50 were found for the variables general job load (56.7 +/- 19.8), attention (83.8 +/- 20.9), and social support from the supervisor (51.3 +/- 25.3). The logistic regression analysis suggested that coming from extracommunitarian Countries (OR: 3.76; CI: 1.04-13.65; p < 0.05), working with acute patients (OR: 2.94; CI: 0.85-10.11; p = 0.08), home-care of chronic patients (OR: 73; CI: 11.27-473.0; p < 0.001), assumption of psychodrugs (OR: 5.01; CI: 1.40-17.92 p < 0.01), and anxiety (OR: 3,71; CI: 1.20-11.44; p < 0.05), were factors significantly associated with a low job satisfaction compared to the other subgroups. On the contrary, a high work degree of work involvement (OR: 0.37; CI: 0.14-0.97; p < 0.05) resulted to be a protective factor respect to job disaffection. These findings suggest that changes that have been occurring in the last years in the social conditions and in health organization in Italy can deeply influence the degree of job satisfaction among the nurses. In order to improve the analysis of the welfare state of the health workers, more effective methods of analysis should be used, in addition to the questionnaires.

Effects of extra virgin olive oil supplementation at two different low doses on lipid profile in mild hypercholesterolemic subjects: a randomised clinical trial.

Olive oil, the principal fat of Mediterranean Diet, is known to improve several cardiovascular risk factors at relatively high doses together with intensive modifications of dietary habits. Since this is hard to obtain in the long term, an intervention with encapsulated oil supplements might be more feasible. Aim of this preliminary study was to investigate the effects of the supplementation of a moderate amount of encapsulated extra virgin olive oil vs a lower dose in mildly hypercholesterolemic subjects, as part of their established diet, on blood lipid profile. A prospective randomized study was performed. Thirty-four mildly hypercholesterolemic subjects [age, mean+/-SD: 46+/-7 yr; total cholesterol (TC): 235+/-28 mg/dl] were randomly assigned to receive 2 g (group A) or 4 g (group B) per os of extra-virgin olive oil for 3 months. TC, triglycerides (TG), LDL cholesterol, HDL cholesterol, apolipoprotein A1 (Apo-AI), apolipoprotein B (Apo-B), and atherogenic index of plasma (AIP) were evaluated at the beginning and at the end of the study. In group B, but not in group A, a significant reduction of Apo-B values (7%) was observed; TG concentrations showed a trend towards reduction and Apo-A1 values a trend towards increase (9%). A significant decrease in Apo-B/Apo-A1 ratio (p<0.01) was also observed in group B. Extra virgin olive oil supplementation significantly decreased AIP from baseline in group B (p<0.05). The results of the present study seem to suggest that the daily supplementation, on top of the normal diet, of at least 4 g of extra virgin olive oil, in mildly hypercholesterolemic subjects, is associated to favorable modifications of the plasmatic lipid profile.

[Relationship between musculoskeletal disorders and work-related awkward postures among a group of health care workers in a hospital]. / Correlazione tra disturbi muscolo-scheletrici e posture disergonomiche in un gruppo di operatori sanitari di un'azienda ospedaliera.

BACKGROUND: There are few studies in the Italian literature on musculoskeletal disorders (MSD) among health care workers (HCW) keeping and holding awkward postures during their job. OBJECTIVES: The aims of this study were to determine the prevalence of low-back, neck and upper limb complaints and the association between risk factors and MSD in HCW working in 15 wards of the Hospital of Cuneo. METHODS: A questionnaire was submitted to 113 HCW. Information about demographic and occupational factors, and MSD characteristics were collected to be statistically elaborated. RESULTS: The prevalence of complaints regarding at least one of the 3 body regions was 71% in the whole sample (80 subjects). Low back, neck and upper limb were interested, respectively, in 58.4%, 50.4% and 25.7% of the cases. Logistic regression showed a significant association of MSD with score > 7 on the Borg scale (OR = 9.70; CI: 2.01-46.9; p < 0.01), positive musculoskeletal clinical history (OR = 3.67; CI: 1.24-10.88; p < 0.05), and visual defects (OR = 2.88; CI: 1.07-7.81; p < 0.05). Based on the answers from the questionnaire, the onset of MSD was attributed in 41 cases to organizational problems, and in 14 cases to the ergonomic characteristics of the job. CONCLUSIONS: The index of prevalence of MSD associated to work-related awkward postures (71%) is very high, greater than that observed among HCW exposed to manual lifting of weights (21%) in the hospital. Thereafter, assessment of exposure and containment of such occupational risk must be considered useful.

[Results and significance of a baseline tuberculin skin test programme among health care workers in a hospital setting]. / Risultati e significato della sorveglianza tubercolinica di base fra i lavoratori di un'azienda sanitaria ospedaliera esposti a rischio professionale.

BACKGROUND: Due to the resurgence of tuberculosis (Tb), health care workers (HCW) are considered at increased risk for Latent Tuberculosis Infection (LTI). According to the national guidelines health care facilities are required both to perform tuberculin skin tests (TsT) on all employees with potential occupational exposure to Tb and to analyze the results obtained. However, only a limited number of studies can be found in the literature reporting data of Tb prevalence in Italian hospitals. OBJECTIVES: The aim of this study was to determine the prevalence of and the relative risks for positive TsT among employees of the Hospital of Cuneo. METHODS: After informed consent, a questionnaire and a TsT according to the Mantoux technique were administered to the 2368 employees of the hospital exposed to occupational risk for Tb. The variables considered for the univariate and multivariate analysis included several anthropometric, occupational and clinical factors RESULTS: 274 of the 2210 employees who completed the screening programme had positive TsT (12.4%). Only one subject had been treated for active Tb. Factors significantly associated with a positive TsT were duration of employment (odds ratio [OR]:4.90, CI: 2.25-10.66, for length of employment 10-17 years; and OR: 8.77, CI: 3.53-21.81, for length >17 years; p < 0.001); working in a Tb high-risk occupational setting (OR 4.26, CI: 1.90-9.57for level of "limited" risk and OR: 5.68, CI: 2.47-13.07 for level of "medium" risk; p < 0.001); belonging to nurse or assistant nurse job categories (OR: 2.80, CI: 1.09-7.19; p < 0.05); history of active or latent Tb infection (OR: 11.54, CI: 5.54-24.06; p < 0.001); birth in a foreign country (OR: 4.40, CI: 1.30-14.85; p = 0.01); and BCG immunization (OR: 2.51, CI: 1.68-3.75; p < 0.001). Seventeen subjects had a positive reaction after a two-step test (0.8%). Boosting occurred among elderly employees (mean age: 48, 3 +/- 8.0 yrs), with long duration of employment (22, 2 +/- 10.5 yrs), vaccinated with BCG (17/17). CONCLUSIONS: Our data suggest that a baseline survey based on TsT is useful to assess the prevalence of and risk factors for TLI in a health care setting. The high rate of participation in the survey (93.3%) was probably due to the training and awareness efforts aimed specifically at exposed HCW.

[Collateral effects of a project of latex rubber removal in a hospital institution]. / Effetti collaterali di un progetto di bonifica dal latice della gomma in un'azienda sanitaria ospedaliera.

Within a stepwise approach to remove natural rubber latex products from the hospital of Cuneo, latex gloves for examination were completely replaced by nitrile powder free gloves. About a month after their introduction in the whole facility, 31 health care workers (HCW) presented with symptoms of dermatitis characterized by erythema, itching, dryness and chapping on the dorsum of the hands. The symptoms typically appeared 1-3 days after the first nitrile gloves employment, 1-3 hours after they were put on. On the basis of both a detailed clinical examination and specific laboratory tests a diagnosis of irritant contact dermatitis was confirmed in all symptomatic HCW. Samples of nitrile gloves were submitted for analysis by a university toxicological laboratory. Evident traces of a powder containing calcium carbonate were found inside of the gloves. Therefore the declaration of the firm that the product was absolutely powder free must be considered wrong. We suppose that frequent and prolonged contacts between the alcaline pH of the powder found in the gloves and the acid pH of the skin of the hands - together with other individual and environmental factors - could have determined the onset of the symptoms in the HCW. In spite of this adverse reaction, a significant reduction (-68%) of the incidence of latex sensitization and latex-related symptoms was observed in 2006 compared to 2005. We conclude that the complete removal of latex gloves from the workplace is a favourable preventive measure and that switching to nitrile powder free devices is a safe and cost-effective alternative to the latex gloves. However, it is always advisable to demand to the producer a formal declaration of compliance to the security standards of the medical devices.

[Consequences of work environment on the ability judgment in a hospital company in Piemonte]. / Conseguenze dell'evoluzione dell'ambiente di lavoro sui giudizi di idoneita in un'Azienda Sanitaria Ospedaliera Piemontese.

The aim of this study is to analyze whether the changes recently occurred in the Italian society and in the occupational context can influence the prevalence of job restrictions among health care workers (HCW) of the Cuneo Hospital, between 1998 and 2006. After subdivision in: nurses, physicians, auxiliary nurses, administrative staff, and technicians, sociodemographic data of HCW were collected. In 2006, the total amount (+176), number of part-time (+274), mean age (+2.6 ys) and seniority (+2.1 ys) of HCW--this latter not for physicians and technicians-- were significantly increased (p < 0.001) compared to 2000. The prevalence of job inability--obtained dividing all the new restrictions expressed for each year between 1998-2000, 2001-2003, and 2004-2006 by the number of HCW working at the end of each period--increased, respectively, from 12.1% to 12.7%, to 16.1% (chi2 = 18.6; p < 0.001). The higher percentage of inability was observed among physicians (+ 183%) and administrative staff (+7/1%). In each period, subjects with job restrictions resulted to be younger than the whole HCW (p < 0.001). In conclusion, the number of job restrictions is rising but it doesn't seem to be associated to the increase of age and seniority among HCW.

[Implementation and application of an index method for assessment of occupational biological risk in a hospital setting]. / Implementazione ed applicazione di un metodo ad indici per la valutazione del rischio da esposizione occupazionale ad agenti biologici in ambito ospedaliero.

BACKGROUND: Over the last years several mathematical methods have been proposed by The Italian Society for Occupational Health and Industrial Hygiene (SIMLII) with the aim of assessing exposure to occupational risks. The current way of assessing biological risk is based on the widely used but poorly accurate formula R = P x D. Use of more complex methods of assessment of exposure involves many problems due to: complexity and poor standardisation of micro-organisms concentration, ubiquitary diffusion of biological agents in the working environment, lack of dose-response curves, uncertainty about the existence of an effective infection threshold for many micro-organisms, etc. OBJECTIVES: In order to assess occupational exposure to biological risk in health care settings an index method was developed according to the Guidelines for health surveillance of health care workers drawn up by SIMLII. METHODS: A check-list containing the features of the two main modes of transmission of infectious diseases (blood-borne and air-borne) was applied to the wards of Cuneo Hospital. The selected variables were combined, according to the different transmission modalities, into two mathematical models producing, for each of them, a numeric value of the degree of the risk. RESULTS AND CONCLUSIONS: The cut-off values chosen to separate both the final degrees of exposure by blood-borne (mild, medium and high) or by air-borne transmission (very low, very limited, limited, medium) were statistically different (P < 0.001). The most important determinants of the differences found in the comparison between different exposure levels were: frequency of work manoeuvres at high risk of exposure and/or frequency of performance, building deficiencies, extent of application of the work and behaviour procedures, degree of training, number of occupational injuries, the occupation of physician, and, for the nursing category, duty in a medical ward. This index method seems to assure better results, both in terms of efficacy and appropriateness, compared to the methods previously used to assess biological exposure. The results justify the need for further investigation.

Onychomycosis caused by Blastoschizomyces capitatus.

Blastoschizomyces capitatus was cultured from the nail of a healthy patient with onychomycosis. The identity of the isolate was initially established by standard methods and ultrastructural analysis and was verified by molecular probing. Strains ATCC 200929, ATCC 62963, and ATCC 62964 served as reference strains for these analyses. To our knowledge, this is the first case of nail infection secondary to paronychia caused by this organism reported in the English literature.

A nosocomial cluster of Candida inconspicua infections in patients with hematological malignancies.

Candida inconspicua was recovered from three patients with hematological malignancies. Two patients had intravenous-catheter-associated fungemia, whereas the third had fungal hepatitis. The three cases of infection occurred over a period of 1 month in patients staying in adjacent single rooms. In vitro susceptibility testing of fungal strains showed all isolates to be resistant to fluconazole, with MICs greater than 32 microg/ml. All of the strains had identical DNA restriction profiles and randomly amplified polymorphic DNA fingerprints. These data suggest a nosocomially acquired infection emanating from a common source within the hospital environment.

Necrotizing pneumonia caused by Penicillium chrysogenum.

We report a case of necrotizing pneumonia due to Penicillium chrysogenum in a 57-year-old woman operated on for lung cancer. The residual right lower pulmonary lobe was infiltrated by Penicillium chrysogenum. The patient underwent a second pulmonary right lobectomy and was successfully treated with oral itraconazole. To our knowledge, this is the first case of pneumonia due to P. chrysogenum.

The impact of rufloxacin given as prophylaxis to patients with cancer on their oral and faecal microflora.

A single dose of 200 mg/day rufloxacin was investigated for preventing infection and for its impact on the commensal flora in a pilot study of 62 patients undergoing cytotoxic treatment for cancer. No infection caused by Gram-negative bacilli occurred among 54 assessable patients but prophylaxis was replaced by empirical treatment for fever in 19 cases and because of an adverse event, in a further three cases. The remaining 32 patients completed prophylaxis. The number of oral Branhamella spp., faecal Enterobacteriaceae and Bacteriodes spp. were significantly reduced whereas there was little effect of rufloxacin on the numbers of the other oral and faecal microflora. However, resistance to rufloxacin increased among both oral viridans streptococci, coagulase negative staphylococci and the faecal enterococci. These preliminary data suggest that selective oral antimicrobial prophylaxis for patients with cancer might be achieved with once-daily rufloxacin.