Waiting time for outpatient specialist care in Lombardy Region: evaluating accessibility and quality of information on websites of public health agencies and healthcare structures.

BACKGROUND: Waiting time for outpatient specialist care is an ever-present problem for all Countries with a universal healthcare system. In Italy, information about waiting times must be available on all websites belonging to public health agencies and healthcare structures. The aim of the present descriptive study is to evaluate the accessibility and quality of such information on websites of all public health agencies and healthcare structures in Lombardy Region. METHODS: All websites belonging to 8 health agencies (ATS), 27 public hospitals (ASST), 4 research and teaching hospitals (IRCCS) were analyzed using a newly designed 30-item checklist. The items were scored 0/1 and grouped in five categories: Accessibility, Architecture, Content, Interactivity, Utility. RESULTS: In all, 76.3% of websites reported their waiting times directly, but three did not update data at least monthly as required by current legislation. Less than half of websites provided information aimed at raising awareness and tackling no-shows, and only 10.5% explained the role of private practice in public structures when maximum waiting times are exceeded. CONCLUSIONS: The lack of exposition of waiting times on some websites belonging to ATS, ASST and IRCCS appears to be a relevant issue. There is also little empowering information that may help tackle waiting times themselves. These results warrant further efforts to improve accessibility, quality and transparency of information for all citizens.

Willingness to pay for risky lifestyles: results from the Pay for Others (PAY4O) study, Italy.

OBJECTIVES: We assess the individual willingness to pay for diseases arising from risky lifestyles and investigate the personal factors that influence such willingness. STUDY DESIGN: We conducted an online survey with 821 respondents in Italy. The questionnaire was distributed via Facebook® in July and August 2016. The questionnaire covered sociodemographic characteristics, health status, behaviour and psychological attitudes, economic status, and opinion about covering the healthcare costs related to overeating, unhealthy diet, sedentary lifestyles, alcohol abuse, tobacco smoking, driving under the influence of alcohol, and illegal drug use by. METHODS: We performed the following: (1) the study of the patterns in the dependent variables by principal component analysis; (2) analysis of the determinants by Holdout Variable Importance measure obtained in Random Forest; and (3) we used ordered logit models. RESULTS: Participants agreed with the idea that public health care should be provided for problems arising from bad eating habits and sedentary lifestyle (50.4%), whereas the health care consequences of the other risky behaviours should not be publicly financed by the Italian National Health Service. CONCLUSIONS: Our study gives an overview of the willingness to pay of a population living in a country where financing of the Health Service is based on general taxation. So, these results may be generalized, with due caution, to all the countries where the Health Service offers universal coverage and is operated by the government, but of course not to scenarios related to market-based or social health insurance systems.

The main critical issues of the gym environment in an Italian city.

BACKGROUND: The lack of a consistent national regulation regarding gym facilities, combined with the growth and transformation of the world of fitness, has led to an uncontrolled situation, where, especially in metropolitan areas, low cost gyms are continuously popping up, often not respecting the structural and hygienic requirements. AIM OF THE STUDY: Objective of this study is to evaluate the results of a monitoring programme about the gym environment, to highlight the main critical issues. METHODS: In 2018 a randomized sample of 90 gyms was inspected in Milan, using a checklist with three sections of inquiry and the resulting data were analysed through a series of multivariate regression models. RESULTS: As per the various aspects analysed, many outcomes with low scores concerned franchised gyms, which have shown to be unsatisfactory in many respects; in addition, the lack of L. pneumophila risk containment procedures has been observed in the facilities without a swimming pool, compared to those with it. CONCLUSIONS: The study results offer a clear picture of the gym environment, identifying many inadequacies for different hygienic and safety aspects; therefore, it has been possible to understand which issues need particular attention in order normalize the situation, which should be checked by future investigative steps.

Tobacco and e-cigarette smoking habits among Italian healthcare students.

BACKGROUND: Healthcare professionals might play a significant role in tobacco control. The aims of this study were to investigate tobacco cigarette and electronic cigarette (e-cigarette) consumption among university students enrolled in courses of the healthcare area, and to understand whether training in healthcare could induce to smoking cessation. STUDY DESIGN: Cross-sectional survey using a self-administered, structured questionnaire. METHODS: Tobacco smoking habits of 560 students of four different medical area courses at the University of Milan, enrolled both in the first and in the last course year during the 2017-2018 academic year, were collected. RESULTS: The prevalence of smokers was 34.8%, almost the same for males and females, and higher in Italian students compared to foreigners. Smoking prevalence was higher among employed (46.9%) than unemployed (35.1%) students, without differences between healthcare and non-healthcare workers. The influence of family, and particularly friends, is confirmed to be relevant. About 25% of respondents tried e-cigarettes, mainly smokers (44.6%) and former smokers (38.6%) with the goal of quitting smoking. More than 44% were dual users of both tobacco cigarettes and e-cigarettes. Comparing smoking habits between first-year and final-year students, only students of healthcare assistance course showed a significant drop in smoking during the university studies. CONCLUSIONS: The implementation of specific educational curricula on smoking dangers and on smoking cessation techniques might have the double effect of supporting students in quitting smoking and of properly preparing them for their future task of helping people to quit smoking.

The Clean Care Contest: promoting hand hygiene among healthcare and medical students.

INTRODUCTION: Despite continuing efforts, compliance rates and knowledge of best practices in hand hygiene remain disappointing. Recognizing that conventional educational tools seem out of touch with young people and that the med and messages contents need refreshing, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health devised a novel approach to promote the creation of innovative educational tools for improving knowledge of, and compliance with, hand hygiene rules among healthcare and medical students. METHODS: A contest in creating educational material on hand hygiene practices involved university students of nursing and medicine, and of other healthcare degrees. Students from the universities of the GISIO network were invited to create educational material (e.g., videos, posters, presentations, leaflets, and screensavers) to be presented by May 5th 2019 during the World Hand Hygiene Day / Save Lives: Clean Your Hands Global Annual Initiative of the World Health Organization). A local and a national winners were awarded. RESULTS: Three different local and national contests were performed during 2016, 2017 and 2018. During the three-year period, more than 270 educational tools have been developed: 130 (48%) were judged useful for hand hygiene promotion campaigns. The most frequent projects participating in the contests were videos (39%), posters (29%), leaflets (14%), and others (18%) submitted by more than 1,500 students of nursing (40%), medicine (31%), dentistry (7%), and of other healthcare courses in 14 universities. Products were evaluated by a local committee and, subsequently, local winners represented their University in a national contest. CONCLUSIONS: The contest provided a framework for the creation of innovative and potentially effective educational tools via an engaging approach that leveraged student creativity. Given the need to improve compliance rates, this study suggests that new ways can be advantageously explored to teach hand hygiene procedures and increase awareness of the importance of their consistent use among healthcare and medical students.

Evidence-Based Medicine and Clinical Practice: the first Italian attempt to define the appropriateness of rehabilitation admission criteria through the application of the Delphi method.

BACKGROUND: One of the consequences of today's global economic crisis is the need to control healthcare spending, in particular by improving the level of appropriateness. Thus, admission to rehabilitation has become an issue, especially as regards inappropriateness of resource allocation. The scientific literature suggests that more attention should be paid to the problem of clinical appropriateness in order to better identify the patients' actual needs. For the first time in Italy, this study aims at defining the appropriateness of intensive rehabilitation admission criteria through use of the Delphi method involving a panel of national experts. MATERIAL AND METHODS: A three-round Delphi survey was conducted according to international guidelines. Electronic questionnaires were individually sent via e-mail to ensure the participants' anonymity throughout the process. Questions were mostly based on rehabilitation literature. RESULTS: During the Delphi process, a total of 79 items were submitted to a heterogenous panel of rehabilitation experts who were asked to express their level of agreement to the item contents on a five-point Likert scale. At the end of the survey, a list of 19 appropriate criteria for admission to intensive rehabilitation facilities and 21 reasons for inappropriateness was drawn up. CONCLUSION: This study represents the first attempt in Italy to define shared and objective appropriateness criteria for admission to intensive rehabilitation. Out of the total number of experts invited to participate (31), only 16 completed the entire survey. This poor participation rate unfortunately demonstrates the lack of awareness among Italian rehabilitation professionals, which is a further sign of both the scarcity of scientific evidence in this area and the need to reach consensus on admission criteria.

The effectiveness of educational interventions in university training on hospital hygiene: results of action research.

BACKGROUND: The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health promoted and conducted a study on teaching hospital hygiene, with particular reference to the prevention and control of healthcare-associated infections, with the aim of developing effective educational material starting from the results collected. MATERIAL AND METHODS: First of all, a survey was carried out, targeting lecturers in hospital hygiene, with the purpose of investigating their perceptions regarding this issue. The available scientific literature was also reviewed in order to identify effective educational/teaching strategies for the prevention of healthcare-associated infections, so that valid training interventions could be subsequently developed. Finally, a trial-training intervention was implemented, and specific audio-visual teaching material was also tested. RESULTS: The overall response rate to the survey was 42%, with good country-wide representativeness. The level of awareness of hospital hygiene issues by students resulted higher among trainee nurses (65%) than among medical students (44%). The teaching staff identified alternative educational methodologies to substitute the classical lecture (e.g.: case discussions) and, in most cases, the alternative solution appeared to be preferable. The teaching of hospital hygiene was better integrated with other disciplines and professional training activities in the degree courses for nurses than in those for doctors; the total number of hours assigned to such teaching was variable. The literature review highlighted that various educational approaches are used. The most common are presentations or lectures, but videos, posters, questionnaires and e-learning strategies are also used. Combining different instruments when designing an educational programme has proven to be an effective strategy. The training activity tested was positively evaluated by the participants; the possibility of multidisciplinary exchange of knowledge was particularly appreciated. CONCLUSION: Having considered the issue of teaching hospital hygiene from the points of view of the different protagonists involved (educators and students), this enabled us to develop useful training material and a proposal for a shared educational intervention. The subject of hospital hygiene, in particular the one related to the prevention of healthcare-associated infections, is addressed in various courses and with different modalities; it is, therefore, important to standardize course contents and teaching methods, in order to facilitate multidisciplinary debate, especially starting from case studies.

Knowledge, experiences, and attitudes toward Mantoux test among medical and health professional students in Italy: a cross-sectional study.

BACKGROUND: The World Health Organization's Action Framework for tuberculosis elimination in low-tuberculosis incidence countries includes the screening for active and latent tuberculosis in selected high-risk groups, including health care workers. In this context, medical and health profession students, exposed to nosocomial tuberculosis transmission during training and clinical rotations, are target populations for tuberculosis screening. No updated data are available on tuberculosis screening practice and knowledge of medical and health profession students in Italy. METHODS: Within the activities Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health, we carried out a multicentre cross-sectional study to assess knowledge, attitude and practices on tuberculosis prevention and control among Medical, Dentistry, Nursing and other health professions' students. Students were enrolled in the study on a voluntary basis and were administered a previously piloted structured questionnaire. Logistic regression models were applied to explore knowledge on tuberculosis prevention by selected socio-demographic variables and University-based tuberculosis prevention practice. RESULTS: Students of seventeen Universities across Italy participated in the study, and 58.2% of them received compulsory tuberculin skin test either at enrollment or while attending clinical practice. A total of 5,209 students filled the questionnaire. 37.7% were medicine and dentistry students (Group 1), 44.9% were nursing students (Group 2) and 17.4% were other health professions' students (Group 3). Age and gender had different distributions by groups, as well as knowledge and practice on tuberculin skin test. 84.4% of the study population (95% CI = 83.3-85.3) was aware of the existence of the tuberculin skin test, 74.4% (95% CI = 73.2-75.6) knew what is the first-level screening test for latent tuberculosis and only 22.5% (95% CI = 21.4-23.6) knew how to proceed after a positive tuberculin skin test result. Overall, knowledge on tuberculosis prevention was higher in Group 2 and lower Group 3, as compared to Group 1. CONCLUSION: In Italy, the knowledge on tuberculosis screening among University students is generally good. To reduce some of the criticalities found among the different study courses, it would be appropriate to harmonize both the regulations on tuberculosis screening practices for admission to University courses, and the educational activities on the topic of tuberculosis, to be extended to all workers involved in health care setting.

Resource allocation criteria in a hospital.

INTRODUCTION: Allocate fixed resources among competing users is a challenge in terms of hospital management in order to obtain the best performance considering strategic objectives. In order to address this need, a system of evaluation in an important research and teaching hospital was designed. This study describes resource allocation criteria in a hospital focusing on the evaluation system and its developed application methodology. METHODS: The indicator system allows the strategic management to rapidly detect the priorities in the evaluations of the Strategic, Organizational, Managerial, Economic, Research and Qualitative conditions of each unit. The chosen indicators are expressed with three numerical values, (1 indicating critical status, 2 acceptable conditions and 3 a good operational situation). RESULTS AND DISCUSSION: The adopted evaluation system considered different thematic areas: Strategic, Organizational, Managerial, Economic, Research and Qualitative. In order to define each area, 3 fields of evaluation have been chosen. The indicators have been structured according to a pyramid system allowing creating a single indicator for each area for each unit. Furthermore, a single indicator has been fixed in order to facilitate a first consideration on whether to carry out or not closer examinations of the most critical units. This manuscript describes an attempt to define objective criteria for the allocation of scarce resources in order to achieve the hospital's strategic objectives. The indicators identified allow to obtain an overall score for each unit, which allows the management to prioritize the needs.

Prevention of healthcare associated infections: a descriptive study.

BACKGROUND: This study aims to verify whether there are, and to which degree, knowledge and adherence to guidelines on the prevention and control of healthcare associated infections by nursing staff. Study design. A descriptive study was conducted on a sample of nurses in the areas of medicine, surgery, and its own specialties of the Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico in Milan from 1st December 2015 to 29th February 2016. METHODS: The knowledge of the nursing staff have been investigated through the use of questionnaires with anonymous self-reporting method; inspections in the wards using observational grids were carried out in order to verify adherence to best-practice principles. The data collected concern, both for the knowledge and for the practice, the following macro-areas: a) Cleaning, disinfection and sterilization, b) Hand hygiene, c) Standard and isolation precautions, d) Prevention of catheter-related urinary tract infections, e) Prevention of catheter-related bacteremia, f) Prevention of surgical site infections, g) Prevention of respiratory tract infections. Statistical analyzes were performed using Microsoft Office Excel and STATA software. RESULTS: 245 nurses from 16 wards were involved. In each wards 4 inspections were conducted. 128 completed questionnaires were returned, all considered for the analysis of data; the adhesion was 52.2%. The participants achieved an overall score of 15.0 ± 4.1 (mean ± SD) on a maximum achievable score of 23 and >75% of them have reached a sufficient level. Among the most positive results, it must be underlined that nurses have demonstrated a higher level of knowledge for hand hygiene, with >81% correct answers; that the lumens of central venous catheters, when not in use, were kept covered with a protective cap in more than 99% of cases; that, for patients bearers of urinary catheter, the urinary drainage bag was maintained below the level of the bladder, as recommended, in more than 91% of the cases. On the contrary, as a very negative result, we found the greatest knowledge gap as regards cleaning, disinfection and sterilization, with a number of incorrect answers approaching 50%; furthermore, 64% of nurses wore jewels on their wrists, and / or hands when in action; finally, the alcohol-based handrub device could be easily reached from at least one of the beds of the room in less than 13% of the cases. CONCLUSION: Some knowledge gaps and differences with respect to adherence to best-practice principles for the prevention and control of healthcare associated infections was highlight by the present study.

The characteristics of caregivers attending adult and paediatric patients in a Milan hospital.

BACKGROUND: The role of the caregiver has received increasing attention in recent years. This is due in part to today's longer life expectancy, which has resulted in a larger population affected by chronic pathologies. But it is also due to the lack of suitable solutions provided by the social and health structures. This research aims to investigate in depth the characteristics and the needs of caregivers involved with adult and paediatric patients who are receiving treatment for acute pathologies in hospitals. Study Design. Questionnaire. METHODS: A questionnaire was used that was validated in a previous study. It was administered in the period from March 2014 to January 2015 at the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano in six wards. The questionnaire was anonymous. RESULTS: We administered 364 questionnaires which enabled us to identify the characteristics of adult and paediatric patients' caregivers. Those in hospitals are prevalently women. Adult patients' caregivers tend to be from 40 to 79 years of age, those of paediatric patients from 20 to 59. Adult patients' caregivers may often be the husband/wife (35%), or a son/daughter (32%). Paediatric patients' caregivers for paediatric patients are almost always parents (97%). The states of mind and the sensations felt by caregivers are anxiety and tension. CONCLUSION: The increasing number and severity of the conditions of people needing care, the changing family composition and the economic crisis have compelled caregivers to perform tasks requiring technical skills that should not be expected from them, but which the circumstances do not allow them to evade. It emerges from an analysis of the data provided by this research that a more complete use could be made of caregivers' potentials by involving them to a greater extent in the care process by the healthcare providers.

Adhesions small bowel obstruction in emergency setting: conservative or operative treatment?

Adhesions small bowel obstructions (aSBO) are among the leading causes of emergency operative intervention. About the 80% of aSBO cases resolve without a surgical treatment. It's important to identify which patients could undergo a conservative treatment to prevent an useless surgery The aim of this study is to determine findings that can indicate whether patients with aSBO should undergo a conservative or a surgical treatment. 313 patients with diagnosis of submission of aSBO were restudied. Patients were divided into two groups based on the different type of treatment received, 225 patients who underwent surgical treatment within 24 hours after admission, 88 patients which underwent conservative treatment successfully. For each patient, clinical, hematochemical and radiological findings have been analysed. The treatment of aSBO should be, at the beginning, conservative except that cases that presents clinical and/or CT-scan findings predictive for a surgical treatment (free peritoneal fluid, mesenterial edema, transitional point) or a peritonitis (pneumatosis intestinalis, pneumoperitoneum).

Survey on professional training in three Italian. Post-Graduate Schools of Public Health.

BACKGROUND: In 2005 the European Union (EU) recognized the equivalence within its member states of qualifications conferred by post-graduate schools (PGS) in public health. In Italy, ministerial decree no. 176 of 1st August 2005 defined the training goals and the related training programmes (Training Activities) leading to conferral of the qualification of specialist in Public Health and Preventive Medicine (PHPM). This study aimed to develop and validate an assessment tool for professional training programmes. The purpose has been to identify and evaluate their typical features and, at the same time, to enable comparison between Italian PGSs in PHPMs. METHODS: In the first phase, a multiple-choice questionnaire was created, using a Likert scale with scores from 1 to 6. This was prepared by post-graduates attending the Milan PGS. This tool was validated by applying it to a pilot sample of post-graduates attending the Milan PGS in PHPM. Following this, a second round of discussion and validation of the model took place, involving 61 post-graduates attending PGSs in PHPM at the Universities of Palermo, Pisa and Turin. A web platform was used that enabled the survey to be created and managed by defining and managing pre-set interview templates. RESULTS: The questionnaire consisted of three sections: Section A - Twenty-eight percent of post-graduates attended their training programme in a university or research centre, 29.8% in a hospital and 35.1% in a Local Health Unit. This training program lasted more than 12 months in 37% of the cases. Section B - The answers were all above pass-level (3 to 4 = satisfactory) except as regards the level of empowerment and the workload, which was judged to be unsatisfactory overall.The skills of the staff present in the facility attended were judged favourably (3.5). Section C - Section C investigates the duration and autonomy of the activities performed during the training programmes aimed at meeting the training requirements set out in ministerial decree no. 176/2005. Among respondents, 87% had taken part in ongoing statistical public health analyses, 81% had given presentations and contributed posters in public health congresses and 79% had planned or implemented an epidemiological survey. CONCLUSIONS: A pre-set form for the assessment of training programmes by the post-graduates themselves is a useful tool with which to obtain their feedback. Public health providers must be able to view their training programme as a means of developing the numerous skills the profession requires. Eventually, they must be capable of acting autonomously, and to this end they need to interact with the numerous tutors with whom they come into contact. These latter were judged very favourably by the survey.

A web-based incident reporting system: a two years' experience in an Italian research and teaching hospital.

BACKGROUND: A web-based incident reporting system (IRS) is a tool allowing healthcare workers to voluntary and anonymously report adverse events/near misses. In 2010, this system was introduced in a research and teaching hospital in metropolitan area in the North part of Italy, in order to detect errors and to learn from failures in care delivery. The aim of this paper is to assess whether and how IRS has proved to be a valuable tool to manage clinical risk and improve healthcare quality. MATERIALS AND METHODS: Adverse events are reported anonymously by staff members with the use of an online template form available in the hospital intranet. We retrospectively reviewed the recorded data for each incident/near miss reported between January 2011 and December 2012. RESULTS: The number of reported incidents/near misses was 521 in 2011 and 442 in 2012. In the two years the admissions were 36.974 and 36.107 respectively. We noticed that nursing staff made more use of IRS and that reported errors were basically related to prescription and administration of medications. CONCLUSIONS: Much international literature reports that adverse events and near misses are 10% of admissions. Our data are far from that number, thus meaning that a failure in reporting adverse events exists. This consideration, together with the high number of near misses in comparison with occurred errors, leads us to speculate that adverse events with serious consequences for patients are marginally reported. Probably the lack of a strong leadership considering IRS as an instrument for improving quality and operators' reluctance to overcome the culture of blame may negatively affect IRS.

Health-related quality of life in Kazakh heart failure patients evaluated by the Minnesota living with heart failure questionnaire and comparison with a published large international sample.

BACKGROUND: To assess health-related quality of life (HRQL) in Kazakh patients (n=285) treated in Cardiology Department of the Emergency Hospital of Semey during 2012 with acute myocardial infarction and to compare results with HRQL measured in 21 countries (n=3,847). METHODS: Telephone interviews survey was conducted in February 2014 with the Russian translation of Minnesota Living with Heart Failure Questionnaire (MLHFQ). Descriptive statistics were used to characterize the sample according to each single item of MLHFQ and grouping them in three subset concerning physical, emotional, and social environment dimensions of patients' life. The distribution of scores was evaluated in terms of floor and ceiling effects; Cronbach's alpha coefficient was calculated for the different dimensions to assess internal consistency. RESULTS: Mean age of sample is 60.8 years, most of patients are male (71.6%) and retired (43.5%). The total MLHFQ score was generally low at a moderate degree (mean 34.7, range 0-105). Physical dimension score (mean 14.92) shows mild to moderate impairment in HRQL and a better perception than the average of the control countries (14.9 vs 16.6); emotional status (mean 4.8) is moderately adequate and better than the controls (4.8 vs 7.2); social environment (9.82) showed significant impairment of HRQL and a worse evaluation (9.82 vs 7.8). CONCLUSIONS: Kazakh patients reported better emotional and physical HRQL as consequence of the social structure where family environment promotes emotional support and improves self-care, social environment affects the total MLHFQ score that is low and related to the requested availability of free medicines.

Swimming pools and health-related behaviours: results of an Italian multicentre study on showering habits among pool users.

OBJECTIVES: Showering before entering a swimming pool is highly recommended to reduce the risk of biological and chemical contamination. This study evaluated the behaviour of indoor swimming pool users; analysed the variables associated with lack of showering; and assessed awareness of the importance of showering. STUDY DESIGN: Cross-sectional study. METHODS: A self-administered questionnaire was used to collect data about users of swimming pools located in five different Italian cities. The association between specific variables and the lack of showering was assessed. P < 0.05 was considered to indicate statistical significance. RESULTS: In total, 4356 questionnaires were analysed. Sixty-five percent of interviewees always showered before entering the pool. The main reason given for pre-swim showering was 'to wash oneself' (50.5%); or 'to get used to the temperature of the water' (44.3%); and 5.2% answered 'for both reasons'. Risk factors significantly associated with lack of showering were: female sex (odds ratio (OR) 1.37, 95% confidence interval (CI) 1.2-1.59), age 14-17 years (OR 5.09, 95% CI 3.40-7.64); not reading the swimming pool rules (OR 1.24, 95% CI 1.10-1.41); living in Central Italy (OR 3.3, 95% CI 2.65-4.1) or Southern Italy (OR 1.35, 95% CI 1.18-1.55); and previous/current attendance of a swimming course (OR 1.7, 95% CI 1.48-1.97). CONCLUSIONS: The results revealed low compliance with the rule of showering before entering a swimming pool, and little awareness of the preventive role of showering in the hygienic management of swimming pools. There is a need for targeted educational interventions to inform swimming pool users of the reasons for the importance of showering before entering a pool.

Analysis of nosocomial acquired Clostridium difficile infection in an Italian research and teaching hospital.

BACKGROUND: Clostridium difficile (Cd) infection is a nosocomial plague which is correlated with several clinical and medical factors such as antibiotics intake. It is known that prevention is possible through infection control measures both clinical and epidemiological. METHODS: We examined the data from a study about Cd infection in four internal medicine wards in a teaching and research hospital in the north part of Italy in a two years period. The wards are only slightly different in size, plan, structures, nursing staff and patient's characteristics but have a different room' organization, lay out and different level of continuous education programs for nursing personnel. RESULTS: We reported a high incidence of the infection and a non-significant difference between wards also looking to the different possibility-capacity of taking preventive measures and the different level of nursing staff continuous educational performance. CONCLUSION: The analysis of the data we obtained was the basis to write a protocol and to start a training course for the medical and nursing personnel of the four wards on the managing of patients infected with Cd infection. On March 2011 we started a one year longitudinal study about the Cd infections in the same wards with the purpose of evaluating the adherence to the protocol, monitoring the incidence of infection and studying the risk factors of the infected patients related to the proper use of the protocol on Cd.

Study for the quality assessment of abstracts presented to Italian public health national conferences: a six years survey.

BACKGROUND: Oral and poster presentations at congresses are essential to spread scientific knowledge among the medical community. Many scientific societies have analyzed the quality of papers presented at their meetings but no information on abstracts' evaluation has been presented in Public Health field. DESIGN AND METHODS: This study aims to examine the quality of abstracts presented at annual meetings of Italian Public Health Society (SItI) in the period 2005-2010 through a validated checklist grid, evaluating eight dimensions: Inherency, Structure, Originality, Objectives, Study design, Sources, Results, Conclusions. Each item was scored from 0 to 3 points (max score: 24) and we used the average score in our study (15) as threshold of good quality. A multivariate analysis was performed in order to investigate predictors of score of abstracts presented. RESULTS: A total of 4,399 abstracts (1,172 oral communications, 3,227 posters) was examined. Around 60% were submitted by Universities and around 40% were from Central Italy. The highest quality was found in the fields of Vaccines (average score 18.9), Infectious Diseases (18) and in abstracts submitted by Universities (16.4). Predictors of lower quality identified were geographical area and affiliation (p= 0.002). Abstracts containing well-written Results, Conclusions and Objectives (3 points) were more likely to be of high quality(OR=55.6, OR=41.9, and OR=157.4; p>0.001) CONCLUSIONS: This is the first European study evaluating the quality of abstracts in the public health field. A reliable evaluation tool is fundamental to offer a transparent methodology of assessment and to improve the quality of research.

ICU environmental surfaces are a reservoir of fungi: species distribution in northern Italy.

BACKGROUND: Preventing and reducing nosocomial infections is a public health goal. Concern about healthcare-associated fungal infections has increased in recent years due to the emergence and spread of new pathogens, increasing antifungal resistance and outbreaks in hospital settings. AIM: To investigate the presence of medically relevant fungal species on environmental surfaces in 12 intensive care units of eight hospitals in Milan, Italy. METHODS: Environmental samplings, using contact plates on surfaces near bed stations and medical workstations, were conducted between November 2019 and January 2020. Fungi isolated were identified, and some were tested in vitro for antifungal susceptibility. FINDINGS: In total, 401 environmental samples were collected from 61 bed stations and 17 medical workstations. Positive samples were found in all hospitals except one, with positivity rates ranging from 4% to 24.2%. Filamentous fungi were found mainly on infusion pumps (23.2%) and patient tables (21.2%), whereas yeasts were found mainly on computers (25%) and floors (10.9%). Fungi were isolated from 12% of total samples. Filamentous fungi, mainly Aspergillus fumigatus, grew in 70.8% of positive samples, and yeasts grew in 27.1%, mainly Candida parapsilosis (42.8%) and Candida glabrata (28.6%). Fungi were detected near patients' beds and on surfaces at workstations, indicating potential for environment-to-patient, patient-to-patient and healthcare worker-to-patient transmission. CONCLUSIONS: Surveillance in hospital settings through environmental sampling may be an important component of fungal infection prevention.

[Investigation and comparison of behaviours of adults and children in swimming pools]. / Indagine conoscitiva e confronto dei comportamenti degli utenti adulti e bambini delle piscine.

The swimmers health's protection must be achieved through the implementation of structures that respect safety standards, the best management of the structures and the users'compliance with rules that minimize the potential risks to health, now clearly identified by the World Health Organization in specific guidelines and by the national and regional legislation. An anonymous questionnaire has been used in order to detect the level of knowledge of hygienic risks and the behaviour of costumers (adults and children) of swimming pool. Comparing the answers, statistically significant differences in the behaviours of adults and children were found in order to protect their own and others' health. In particular children do shower and go through footbath before entering the swimming pool more than adults (respectively 89.2% versus 77.4% and 89.2% versus 79.4%). No differences in the behaviours of the two groups were found in the use of dedicated footwear and caps. Children are predisposed to follow the rules because they are more loyal to duty, while adults comply with the rules only when it is clear the advantage to protect their health. This paper underline the importance of health education programs that can help people to understand the importance of adopting certain behaviours in order to prevent risks and promote health for the benefit of all.