Observational Study

. 2025 Mar 25;20(3):e0319568.

doi: 10.1371/journal.pone.0319568. eCollection 2025.

An interoperable web-based platform to support health surveillance against latent tuberculosis infection in health care workers and students: The evolution of CROSSWORD study protocol

Angela Rizzi¹, Eleonora Nucera^{1

2}, Walter Mazzucco³, Pierpaolo Palumbo⁴, Domenico Staiti^{5

6}, Umberto Moscato^{7

8}, Francesco Maria De Simone⁵, Michela Sali^{9

10}, Luca Boldrini¹¹, Nikola Dino Capocchiano¹², Stefano Patarnello¹², Gabriele Rumi¹, Raffaella Chini¹, Valentina Carusi¹, Michele Centrone¹, Alessia Di Rienzo¹, David Longhino¹, Chiara Laface¹, Sabato Mellone¹³, Carmelo Massimo Maida³, Emanuele Cannizzaro³, Luigi Cirrincione³, Maria Gabriella Verso³, Annalisa Saracino¹⁴, Francesco Di Gennaro¹⁴, Luigi Vimercati¹⁵, Luigi De Maria¹⁵, Stefania Sponselli¹⁵, Giancarlo Scoppettuolo¹⁶, Roberta Pastorino¹⁷, Antonio Gasbarrini^{1

2

18}, Riccardo Inchingolo¹⁹

Affiliations

¹ UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
² Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
³ Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy.
⁴ Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Italy.
⁵ UOSD Sorveglianza sanitaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁶ Dipartimento di Scienze della vita e sanità pubblica, Università Cattolica Sacro Cuore, Rome, Italy.
⁷ Section of Occupational Health, Health Surveillance and Radioprotection Health, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
⁸ UOC of Hospital Hygiene, Department of Women's, Children's and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
⁹ Department of Laboratory and Infectious Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
¹⁰ Department of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Università Cattolica del Sacro Cuore, Rome, Italy.
¹¹ UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
¹² Gemelli Generator RWD, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
¹³ Health Sciences and Technologies-Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, Bologna, Italy.
¹⁴ Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica (DiMePRe-J), Clinica Universitaria Malattie Infettive, Policlinico di Bari, Italy.
¹⁵ Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University Hospital of Bari, 11 G. Cesare Square, , Bari, Italy.
¹⁶ UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
¹⁷ Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁸ UOC Gastroenterologia and UOC CEMAD Medicina Interna e Gastroenterologia, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
¹⁹ UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

PMID: 40132007
PMCID: PMC11936157
DOI: 10.1371/journal.pone.0319568

Observational Study

An interoperable web-based platform to support health surveillance against latent tuberculosis infection in health care workers and students: The evolution of CROSSWORD study protocol

Angela Rizzi et al. PLoS One. 2025.

. 2025 Mar 25;20(3):e0319568.

doi: 10.1371/journal.pone.0319568. eCollection 2025.

Authors

Affiliations

¹ UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
² Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
³ Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy.
⁴ Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Italy.
⁵ UOSD Sorveglianza sanitaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁶ Dipartimento di Scienze della vita e sanità pubblica, Università Cattolica Sacro Cuore, Rome, Italy.
⁷ Section of Occupational Health, Health Surveillance and Radioprotection Health, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
⁸ UOC of Hospital Hygiene, Department of Women's, Children's and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
⁹ Department of Laboratory and Infectious Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
¹⁰ Department of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Università Cattolica del Sacro Cuore, Rome, Italy.
¹¹ UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
¹² Gemelli Generator RWD, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
¹³ Health Sciences and Technologies-Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, Bologna, Italy.
¹⁴ Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica (DiMePRe-J), Clinica Universitaria Malattie Infettive, Policlinico di Bari, Italy.
¹⁵ Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University Hospital of Bari, 11 G. Cesare Square, , Bari, Italy.
¹⁶ UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
¹⁷ Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁸ UOC Gastroenterologia and UOC CEMAD Medicina Interna e Gastroenterologia, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
¹⁹ UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

PMID: 40132007
PMCID: PMC11936157
DOI: 10.1371/journal.pone.0319568

Abstract

Background: Tuberculosis (TB) prevention is a major goal in teaching hospital setting. Because of the possible progression or reactivation of latent disease, the screening of both health-care workers (HCWs) and students is an important issue in the TB control program.

Objective: to deploy a web-based platform interoperating health surveillance systems from different hospitals to define models based on the highlighted risk factors to predict the occurrence of Latent Tuberculosis Infection (LTBI) and to define prevention strategies and interventions.

Methods: This is a cross-sectional ambispective observational study without drug and device. The primary endpoint is the prevalence of LTBI. The secondary endpoint is the identification of possible risk factors of LTBI in a large cohort of HCWs and students.

Conclusions: This study aims to enrich the primary prevention measures against TB, having a high socio-economic-health impact in high-risk populations (HCWs and students) through an interoperable digital approach based on data obtained in three large Italian teaching hospitals. ClinicalTrials.gov: NCT05756582.

Copyright: © 2025 Rizzi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

**Fig 1. Schedule of enrolment, interventions, and assessments.**

**Fig 2. Health care workers and students questionnaire (English version).**
The specific 9 items self-test questionnaire, developed for the specific purpose and never administered before, administered to the enrolled HCWs and students.

**Fig 3. Chrono program of the Evolution of CROSSWORD Study.**
The Evolution of CROSSWORD study is an ambispective study including a retrospective phase focused on the analysis of data derived from the ongoing CROSSWORD Study, conducted at Fondazione Policlinico Universitario A. Gemelli IRCCS (FPG) and Università Cattolica del Sacro Cuore (UCSC) in Rome, and a prospective phase during which data will be collected from the University of Palermo (UNIPA) and the University of Bari (UNIBA)/ University Hospital of Bari, Italy.

See this image and copyright information in PMC

References

1. Global tuberculosis report 2023. Available at: https://www.who.int/publications-detail-redirect/9789240083851.
1. Broekmans JF. Reichman and Hershfield’s tuberculosis: a comprehensive, international approach , third edition, parts A and B. Bulletin of the World Health Organization. 2007;85:418. doi: 10.2471/06.039339 - DOI
1. Lee S, Lee W, Kang S-K. Tuberculosis infection status and risk factors among health workers: an updated systematic review. Ann Occup Environ Med. 2021;33:e17. doi: 10.35371/aoem.2021.33.e17 - DOI - PMC - PubMed
1. Gupta RK, Calderwood CJ, Yavlinsky A, Krutikov M, Quartagno M, Aichelburg MC, et al.. Discovery and validation of a personalized risk predictor for incident tuberculosis in low transmission settings. Nat Med. 2020;26(12):1941–9. doi: 10.1038/s41591-020-1076-0 - DOI - PMC - PubMed
1. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm. - PubMed

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An interoperable web-based platform to support health surveillance against latent tuberculosis infection in health care workers and students: The evolution of CROSSWORD study protocol

Affiliations

An interoperable web-based platform to support health surveillance against latent tuberculosis infection in health care workers and students: The evolution of CROSSWORD study protocol

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical