Renovation and creation of a Biocontainment Unit: the experience of Azienda Ospedaliero-Universitaria Pisana (Pisa, Italy).

Infectious diseases are a major public health concern. In recent decades, there has been a succession of bacterial and viral diseases, which when added to the endemic diseases found in certain areas of the world, can become a global health problem. In emergency medicine we talk a lot about Mass Casualty Incident (MCI) preparedness, but the main focus today is bio-preparedness. Therefore, especially after the Ebola experience, much investment has been made in the development of Biocontainment Units (BCUs). At present, in Italy there are no national realities that have experimented the construction of a completely new biocontainment units detached from the Emergency Department (ED) RNPP-funded. Given this, the project of the Azienda Ospedaliero-Universitaria Pisana (AOUP) is to make renovations on existing ED structure and build an entire new facility for biocontainment.

Evaluation, Description and Magnitude of Readmission Phenomenon in Azienda Ospedaliero Universitaria Pisana (AOUP) for Chronic-Degenerative Diseases in the Period 2018-2021.

BACKGROUND: Readmissions are hospitalizations following a previous hospitalization (called index hospitalization) of the same patient that occurred in the same facility or nursing home. They may be a consequence of the progression of the natural history of a disease, but they may also reveal a previous suboptimal stay, or ineffective management of the underlying clinical condition. Preventing avoidable readmissions has the potential to improve both a patient's quality of life, by avoiding exposure to the risks of re-hospitalization, and the financial well-being of health care systems. METHODS: We investigated the magnitude of 30 day repeat hospitalizations for the same Major Diagnostic Category (MDC) in the Azienda Ospedaliero Universitaria Pisana (AOUP) over the period from 2018 to 2021. Records were divided into only admissions, index admissions and repeated admission. The length of the stay of all groups was compared using analysis of variance and subsequent multi-comparison tests. RESULTS: Results showed a reduction in readmissions over the period examined (from 5.36% in 2018 to 4.46% in 2021), likely due to reduced access to care during the COVID-19 pandemic. We also observed that readmissions predominantly affect the male sex, older age groups, and patients with medical Diagnosis Related Groups (DRGs). The length of stay of readmissions was longer than that of index hospitalization (difference of 1.57 days, 95% CI 1.36-1.78 days, p < 0.001). The length of stay of index hospitalization is longer than that of single hospitalization (difference of 0.62 days, 95% CI 0.52-0.72 days, p < 0.001). CONCLUSIONS: A patient who goes for readmission thus has an overall hospitalization duration of almost two and a half times the length of the stay of a patient with single hospitalization, considering both index hospitalization and readmission. This represents a heavy use of hospital resources, about 10,200 more inpatient days than single hospitalizations, corresponding to a 30-bed ward working with an occupancy rate of 95%. Knowledge of readmissions is an important piece of information in health planning and a useful tool for monitoring the quality of models of patient care.

Role of environmental sanitization in health clinics: evaluation of potassium peroxymonosulfate (KMPS) efficacy at two different concentrations.

BACKGROUND: Healthcare-associated infections (HAI) are closely related to several factors, such as prolonged hospital stay in high-risk areas and intensive care units, potentially predisposing underlying conditions. It has also been demonstrated that HAI incidence may be related to non-respected standards of assistance, such as not adequately cleaned structures or medical devices contaminated by environmental bacteria and multidrug resistant enterobacteria. OBJECTIVE: In this case it has been carried on an efficacy evaluation of a microionization system using potassium peroxymonosulfate (KMPS) for outpatient clinics indoor air disinfection. MATERIAL AND METHODS: Two outpatient clinics (AMB-1 and AMB-2) were treated with KMPS (1% and 2% concentration), at the end of routinary clinic activities. Microbial sampling of air (settle plates) and surfaces (contact plates) were submitted before and after sanitizing, checking total microbial load at 37°C, possible opportunistic pathogens and moulds. RESULTS: Sanitizing system at 1% concentration was efficient in mesophilic bacteria reduction (max 83%). Moreover, total abatement of Klebsiella pneumoniae in AMB1 and Acinetobacter lwoffi in AMB2 has been seen, both on surfaces. Regarding air samplings, 89% moulds reduction has been seen, as observed on surfaces. Scaling up concentration to 2%, mesophilic bacteria reduction was ≥ 94%, both in air and on surfaces of the outpatient clinics. Same results have also been seen on moulds, whose maximum reduction was 97%. DISCUSSION: Comparing results at different concentrations it has been observed that 2% KMPS induces an higher average reduction of mesophilic bacteria and moulds than 1%. BACKGROUND: In this regard, microbial reduction percentage, either on surfaces or in the air, can be considered positive for outpatient clinics and healthcare settings indoor decontamination.

New insights in the expression of stromal caveolin 1 in breast cancer spread to axillary lymph nodes.

Recent evidence suggests that a loss of expression of caveolin in the stromal compartment (sCav-1) of human invasive breast carcinoma (IBC) may be a predictor of disease recurrence, metastasis and poor outcome. At present, there is little knowledge regarding the expression of sCav-1 at the metastatic sites. We therefore studied sCav-1 expression in IBCs and in their axillary lymph nodes to seek a correlation with cancer metastasis. 189 consecutive invasive IBCs (53 with axillary lymph node metastases and 136 without) were studied by immunohistochemistry, using a rabbit polyclonal anti-Cav-1 antibody. In IBCs sCav-1 was evaluated in fibroblasts scattered in the tumor stroma whereas in lymph nodes sCav-1 was assessed in fibroblast-like stromal cells. For the first time, we observed a statistically significant progressive loss of sCav-1 from normal/reactive axillary lymph nodes of tumors limited to the breast to metastatic axillary lymph nodes, through normal/reactive axillary lymph nodes of tumors with axillary metastatic spread. These data indicate that Cav-1 expressed by the stromal compartment of lymph nodes, somehow, may possibly contribute to metastatic spread in IBC.