Tetanus is a life-threatening, vaccine-preventable disease caused by tetanospasmin and tetanolysin, which are potent neurotoxins produced by Clostridium tetani, an anaerobic, spore-forming bacterium. Due to the widespread presence of spores in the environment, the disease cannot be eradicated. However, global tetanus prevention initiatives have contributed to a significant decline in tetanus incidence worldwide. Aiming to present the tetanus trends in Romania, we conducted a retrospective analysis of the tetanus surveillance data. During the study period (2010–2023), 97 cases of tetanus were reported in Romania (median: 6.5; IQR: 5–7) with an average incidence rate of 0.03 per 100,000 inhabitants (95% CI: 0.02–0.04; range: 0.01–0.09). The highest incidence rates were recorded among people aged 1 to 14 years old (0.09 per 100,000 inhabitants, 95% CI: 0.06–0.13; range: 0.00–0.20), male (0.05 per 100,000 inhabitants; 95% CI: 0.03–0.06; range: 0.03–0.12), and from rural areas (0.05 per 100,000 inhabitants; 95% CI: 0.03–0.08; range: 0.01–0.17). A decline in the number of tetanus cases of 7% by year was observed, which is supported by the statistical analysis showing a p-value of 0.005 (IRR: 0.93; 95% CI: 0.88–0.98). However, the same decline in tetanus incidence was not supported by the statistical analysis (IRR: 0.93; 95% CI: 0.44–1.98; p = 0.9). Forty-seven tetanus deaths were recorded, with an average case fatality ratio of 42% (95% CI: 25.62–57.92; range: 0–100), showing a decreasing trend of 9% by year (IRR: 0.91; 95% CI: 0.89–0.93). Although the annual number of tetanus cases in Romania has shown a slight downwards trend, its situation has remained relatively stable, as shown by the tetanus incidence. Moreover, the case fatality rate continues to be high. Therefore, our study emphasizes the importance of achieving high vaccination uptake among children and adolescents, raising awareness of the importance of booster doses in adults, and improving the management of tetanus-prone wounds.

Healthcare-associated infections (HAIs) in long-term care facilities (LTCFs) are a public health problem worldwide. The aim of this narrative review is to summarize and to provide a comprehensive overview of the current surveillance methods used in LTCFs. We conducted a search of the PubMed database starting from 2000 onward. We found 324 articles that were systematically evaluated by the titles, abstracts, and full texts, and we selected 42 records. These articles were dispersed across North America, Europe, Australia, and Asia. We identified articles describing the results from active or passive surveillance and from a point prevalence study (PPS). The most frequently used method was PPSs in 30 studies, followed by 12 articles reporting active surveillance results and 3 articles describing active surveillance findings. The case definitions applied in 16 articles were those provided by the Centers for Disease Control and Prevention, followed by the McGeer and European Centre for Disease Prevention and Control definitions in 15 and 13, respectively. Twenty-six studies described the method used to calculate the HAI indicator (incidence, incidence density, or prevalence). The articles on PPSs reported prevalence per 100 patients (22 articles), whereas those on active and passive surveillance reported the incidence density per 1000 patient-days. PPSs effectively identified HAIs in LTCFs through standardized data collection and essential interpretive information. The variability in surveillance methods, case definitions, HAI types, and indicator calculation approaches highlights the need for standardized surveillance protocols and methodologies in LTCFs worldwide. Furthermore, these findings emphasize the importance of implementing appropriate surveillance systems and targeted public health measures to effectively address the specific needs and vulnerabilities of the LTCF population in our country.

The COVID-19 pandemic and the broader epidemiological context may have affected healthcare-associated infections (HAIs) and antimicrobial use (AU), including among the paediatric population. This study used seven point prevalence surveys (PPSs) to characterise HAIs and AU and to observe trends over time at a paediatric hospital in Bucharest. We collected data from 977 patients and identified 31 HAIs in 28 patients with an overall prevalence of 2.9%. During the COVID-19 years, prevalence was higher (4.0%), but no trend was detected. Variables such as surgical ward (aOR: 4.88; CI: 1.63–14.59; p = 0.012) and age (aOR: 0.89; CI: 0.81–0.97; p = 0.012) were associated with HAI occurrence. AU prevalence was 72.6%, with no specific trend across the study period (p = 0.48) overall or by ward. Most prescribed antibiotics were from the Watch category (65.5%), with an upward trend across the study period (p < 0.0001), while the Access category registered a downward trend. In conclusion, HAI prevalence did not vary significantly with the epidemiological context. Antibiotic use in the Watch category increased during the pandemic, while the Access category declined. These findings highlight the importance of surveillance for infection prevention and control at the hospital level, and the need for antimicrobial stewardship, guidelines, and continuing medical education on appropriate prescribing practices in paediatric care.

Occupational exposure to blood and body fluids (OEBBF) continues to represent an important public health problem due to the associated medical, social and economic consequences. Young healthcare workers are at high risk of OEBBF because of their lack of experience, hesitation before performing a task and the nature of the task performed. This study aims to comparatively evaluate the knowledge, attitudes and perceptions on OEBBF among students from the Faculty of Medicine and the Faculty of Dental Medicine at Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, during the 2021–2022 academic year in order to facilitate the adaptation of educational materials used in training programs. Out of the 911 students who completed the questionnaire, 55% (502) correctly identified hepatitis B virus (HBV) as having the highest risk of transmission after an OEBBF, with statistically significantly higher percentages among Dental Medicine students (152; 60% vs. 350; 53%; p = 0.003). However, lower percentages of Dental Medicine students recognized the protective concentration of antibodies against HBV (173; 68% vs. 536; 82%; p < 0.001) or reported knowing to be vaccinated against hepatitis B (110; 43% vs. 459; 70%; p < 0.001). Additionally, higher percentages of Dental Medicine students reported not having an antibodies concentration measurement since they started their clinical practice (206; 81% vs. 439; 67%; p < 0.001). If an OEBBF were to occur, 43% (391) reported that they would induce bleeding, either instinctively (210; 23%) or because they considered it necessary (181; 20%). Ninety-three students (10%) reported at least one past OEBBF; 59 (63%) reported it to their supervisors. Statistically significantly higher percentages of Dental Medicine students reported a high perceived risk of exposure compared to Medicine students (117; 46% vs. 202; 31%; p < 0.001), with the finding supported by univariable and multivariable analyses. In conclusion, the reporting frequency of past OEBBF in our study population was low. However, enhanced efforts are required to improve knowledge and awareness regarding OEBBF risk and preventive measures. Additionally, efforts should focus on assessing the level of protection against hepatitis B among Dental Medicine students and on promoting timely reporting to ensure appropriate post-exposure management.