Interprofessional Communication Team for Caregivers of Patients Hospitalized in the COVID-19 Wards: Results From an Italian Experience.

Background: During the COVID-19 pandemic, emergency restrictions did not allow clinician family meetings and relatives' visits. In Molinette Hospital, a new communication model between healthcare providers and families of COVID-19 affected patients was developed by a team of physicians and psychologists. The study's aims were to investigate caregivers' distress and to analyse their satisfaction with the communications provided. Methods: A cross-sectional study was conducted among caregivers of patients of Molinette Hospital COVID wards. Between April and June 2020, all caregivers were contacted 2 weeks after the patient's discharge/death to assess their satisfaction with the communications received through an online survey. Results: A total of 155 caregivers completed the survey. Caregivers' distress level was found to be higher in women than men (p = 0.048) and in caregivers whose relative died compared to the caregivers whose relative was discharged (p < 0.001). More than 85% of caregivers defined communication "excellent"/"very good"; being male was associated with higher satisfaction levels than women (ß = -0.165, p = 0.046). Besides daily communication, 63 caregivers (40.6%) received additional support from a psychologist of the team. Conclusions: To our knowledge, this is the first study presenting, in an emergency, a new model of communication provided by a team of physicians and psychologists, and analyzing satisfaction with it. This model was highly appreciated by caregivers and it limited the discomfort caused by the restrictions on relatives' visits. It would be interesting to further evaluate the possibility of extending a communication model that includes doctors and psychologists in routine clinical practice.

Impact of a bundle on surgical site infections after hip arthroplasty: A cohort study in Italy (2012-2019).

BACKGROUND: Surgical site infections (SSIs) are an extremely serious complication of hip arthroplasty, estimated to affect up to nearly 3% of procedures. In Italy, SSIs are monitored through a national surveillance system (Sistema Nazionale Sorveglianza delle Infezioni del Sito Chirurgico, SNICh). Several studies suggest bundled interventions are effective in reducing SSI rates in orthopaedic surgery. MATERIALS AND METHODS: A bundled intervention was implemented in 2012 in 34 out of the 49 hospitals of the North-West of Italy participating in SNICh. A cohort study was conducted between January 1st, 2012 and December 31st, 2019 to evaluate the impact of the intervention on SSI rates after hip arthroplasty. The four elements of the bundle are: appropriate preoperative shower, preoperative hair removal, perioperative normothermia, antibiotic prophylaxis. Data on compliance with the bundle and the occurrence of infection were collected. RESULTS: In total, 18,791 procedures were included in the study. Full bundle compliance was achieved in 27.9% of procedures. The percentage of fully compliant procedures significantly increased over time from introduction of the bundled intervention (R2 0.799, p-value 0.003). Multivariable analysis found a significant association between full bundle compliance and reduced SSI rate, with a reduction of the odds of infection of 31% (95% CI 0.5-0.96; p 0.026). CONCLUSION: Results of this study support bundled interventions as an effective implementation strategy for infection prevention and control practices in hip replacement surgery. This simple bundle protocol could be easily implemented in settings with limited resources.

Surgical Site Infections in Italy, 2009-2015: Incidence, Trends, and Impact of Surveillance Duration on Infection Risk.

Background: Surveillance programs have proven to be effective in reducing surgical site infection (SSI) rates. In 2008 Piedmont, which is a northwestern region of Italy, joined the Italian national surveillance system (Sistema Nazionale Sorveglianza Infezioni del Sito Chirurgico [SNICh]). The aims of this study were to evaluate SSI rates and trends in Piedmont from 2009 to 2015 for the two most frequently performed surgical procedures, hip arthroplasty and colon surgery, and to estimate whether the number of years of participation in a surveillance program and the number of monitored surgical procedures have an impact on the incidence of SSIs. Methods: Data were collected through the national surveillance system. Procedure-specific SSI rates were calculated, overall and by year of participation in the network. Trends in SSI rates were evaluated in relation to the duration of surveillance and the number of monitored procedures using Poisson regression analysis. Results: A total of 16,288 procedures were monitored from 37 hospitals. The overall adjusted SSI rates were 8.61% after 6,050 colon surgery procedures and 1.16% after 10,238 hip arthroplasty procedures. Each year of increase in participation was associated with a substantial risk reduction for SSI in both procedure categories: 7% for colon surgery (risk ratio [RR] 0.93; 95% confidence interval [CI] 0.89-0.97) and 20% (RR 0.80; 95% CI 0.73-0.88) for hip arthroplasty. Conversely, an increase in the number of monitored procedures was not associated with a substantial decrease in SSI risk: an overall RR of 0.99 (95% CI 0.98-1.00) and 1.00 (95% CI 0.99-1.00) was found for every one unit increase in the number of monitored procedures for colon surgery and hip arthroplasty respectively. Conclusions: These results support the efficacy of systematic surveillance in reducing SSIs, increasing with the number of years of participation, and suggest the volume of monitored procedures has no significant impact on SSI risk.

Surgical antimicrobial prophylaxis prescribing practices and impact on infection risk: Results from a multicenter surveillance study in Italy (2012-2017).

BACKGROUND: Italy is one of the largest consumers of broad-spectrum agents (BSAs) in Europe. This study evaluated surgical antimicrobial prophylaxis (SAP) compliance with the Italian national guidelines and its impact on surgical site infection (SSI) risk. METHODS: A prospective study was conducted in 42 hospitals participating in the national surveillance system for SSIs. SAP compliance was evaluated considering antibiotic choice, duration of administration, and timing of first dose. Trends in the consumption of 5 BSAs were also evaluated. RESULTS: Between 2012 and 2017, 24,861 surgical procedures were monitored. The risk ratios (RRs) for appropriate SAP increased by 22% each year, and significant increasing trends over time were found for overall compliance, timing, and duration. Adequate antibiotic choice and duration of administration were associated with a significantly reduced SSI risk (RR = 0.57; 95% confidence interval [CI], 0.5-0.65 vs RR = 0.51; 95% CI, 0.45-0.57, respectively), and overall compliance was associated with a RR of 0.65 (95% CI, 0.59-0.72). CONCLUSIONS: These findings suggest that appropriate narrow-spectrum agents could be more effective than BSAs in preventing SSIs. Interventions to improve SAP compliance with guidelines could significantly contribute to reducing antimicrobial resistance by reducing SSIs and promoting more prudent use of antimicrobials.