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Introduction: Lyme disease is caused by an infection with Borrelia burgdorferi sensu latu (B. burgdorferi sl.) which is carried by Ixodes ticks. The disease has not been considered to be endemic in Iceland and no cases of Icelandic origin have been published. The epidemiology of Lyme disease in Iceland has never been studied. The objective of this study was to provide basic epidemiological information about Lyme disease in Iceland., Material and Methods: Included in the study were all pa--tients who had a measurement of serum antibodies against B. burgdorferi sl. or were diagnosed with Lyme disease (ICD-10, A69.2) at Landspítali University Hospital in Iceland from 2011-2015. Clinical data regarding these patients was retrospectively collected from medical records and the database of the Department of clinical microbiology at Landspítali University Hospital., Results: 501 patient had a measurement of serum antibodies against B. burgdorferi sl. and 11 patients were clinically diag-nosed with Lyme disease during the study period. 33 patients fulfilled criteria for a confirmed diagnosis of Lyme disease. 32 (97%) patients had erythema migrans and one (3%) patient had neuroborreliosis. An average of 6.6 cases were diagnosed a year (two cases per 100,000 persons/year). All cases originated abroad., Conclusions: Lyme disease is rare in Iceland. On average around 6 to 7 cases are diagnosed every year, primarily localised infec-tions presenting as erythema migrans. None of the cases had a definitive Icelandic origin and the yearly number of cases has not been increasing.

Background: Evaluations are essential to judge the success of public health programmes. In Europe, the proportion of public health programmes that undergo evaluation remains unclear. The European Centre for Disease Prevention and Control sought to determine the frequency of evaluations amongst European national public health programmes by using national hand hygiene campaigns as an example of intervention., Methods: A cohort of all national hand hygiene campaigns initiated between 2000 and 2012 was utilised for the analysis. The aim was to collect information about evaluations of hand hygiene campaigns and their frequency. The survey was sent to nominated contact points for healthcare-associated infection surveillance in European Union and European Economic Area Member States., Results: Thirty-six hand hygiene campaigns in 20 countries were performed between 2000 and 2012. Of these, 50% had undergone an evaluation and 55% of those utilised the WHO hand hygiene intervention self-assessment tool. Evaluations utilised a variety of methodologies and indicators in assessing changes in hand hygiene behaviours pre and post intervention. Of the 50% of campaigns that were not evaluated, two thirds reported that both human and financial resource constraints posed significant barriers for the evaluation., Conclusion: The study identified an upward trend in the number of hand hygiene campaigns implemented in Europe. It is likely that the availability of the internationally-accepted evaluation methodology developed by the WHO contributed to the evaluation of more hand hygiene campaigns in Europe. Despite this rise, hand hygiene campaigns appear to be under-evaluated. The development of simple, programme-specific, standardised guidelines, evaluation indicators and other evidence-based public health materials could help promote evaluations across all areas of public health.

Introduction: Needlesticks, bodyfluid exposure and bites (incident) put healthcare workers (HCWs) at risk of hepatitis B, C and HIV particularly if patients are infected (high risk incident). The risk of infection is greatest from bore-hollow needles. The aim of the study was to describe the epidemiology of reported incidents and evaluate underreporting by HCWs at Landspítali University Hospital (LUH)., Methods: A retrospective descriptive study of reported incidents during 1986-2011. The ratio of incidents was calculated according to the HCWs age and profession and distribution by source and wards. The ratio of high risk incidents and vaccination status against HBV at time of incident was determined as well as underreporting during 01.01.2005-31.12.2011., Results: At least 4089 incidents occured during the study period but 3587 were reported and blood samples taken from 2578 patients. Approximately a third of the incidents were associated with non-compliance with standard precaution and 54,7% of needlesticks were associated with bore-hollow needles. Few reports came from physicians and medical students (17,9%). During the study period 50,3% HCWs were vaccinated against HBV at time of incident. High risk incidents were 94 (2.6%), mostly related to hepatitis C (64,9%). Two HCWs became infected with HCV. During 2005-2011 underreporting was estimated to be 28,0%., Conclusion: Improved education of standard precaution when handling needles and sharps at LUH may reduce the number of incidents. Introduction of safety-needles and safety-devices may greatly reduce needlesticks as a large number of incidents were associated with hollow needles. Improved HBV vaccination among HCWs and reporting incidents should be encouraged.

Background: We describe the main characteristics of patients that required intensive care due to the influenza (H1N1) outbreak in 2009., Methods: Retrospective and prospective analysis of medical records from patients admitted to ICU with positive RT-PCR for (H1N1)., Results: During a six week period in the fall of 2009, 16 patients were admitted to intensive care in Iceland with confirmed H1N1 infection. Mean age was 48 years (range 1-81). Most patients were considered quite healthy but the majority had risk factors such as smoking, obesity or hypertension. All but one had fever, cough, dyspnea and bilateral infiltrates on chest x-ray and developed any organ failures (mean SOFA score 7). 12 needed mechanical ventilation and two extra corporeal membrane oxygenation (ECMO). Mean APACHE II score was 20. No patient died in the ICU but one elderly patient with multiple underlying diseases died a few days after being discharged from the ICU., Conclusions: (1) The incidence of severe influenza A (H1N1) that leads to ICU admission appears to be high in Iceland. (2) Many patients developed acute respiratory distress syndrome in addition to other organ failures, and required additional measures for oxygenation such as prone position, nitric oxide inhalation and ECMO. (3) 28 day mortality was low. (4) This study will aid in future outbreak planning in Iceland. Key words: influenza A, pneumonia, multiple organ failure, death rate, intensive care, ventilator therapy, ECMO.