Measurement of a possible patch-testing outcome indicator.

BACKGROUND: Clinical performance measurements often employ outcome indicators to express the extent to which health services achieve a given clinical result. OBJECTIVE: The objective of our study was to develop an outcome indicator of patch testing. We identified and measured as a possible indicator the ratio of patients with allergic and/or photo-allergic contact dermatitis clinically cured/improved as a result of identification of relevant allergens. PATIENTS/METHODS: Patients with positive reactions considered relevant to their current dermatitis were interviewed by telephone 2 months after patch/photo-patch testing in order to assess their clinical outcome in relation to the recommended elimination of supposedly relevant allergens. RESULTS: Over a 4-year period positive reactions were seen in 1397 out of 2857 tested patients. Relevance was considered current in 578 subjects, and 506 of them were interviewed. Remission/significant improvement following allergen(s) contact avoidance was reported by 431 patients, the outcome indicator (431/506) thus scoring 85.2%. Among the 75 patients who reported no improvement, 41 had not avoided contact with the offending substance(s), 17 had other persistent concomitant skin conditions, and 17 were unchanged despite elimination of the alleged relevant allergens. CONCLUSIONS: The ratio of relevantly patch-test-positive patients resolved/improved after allergen avoidance is a useful patch-testing outcome indicator.

Adherence to international and national recommendations for the prevention of surgical site infections in Italy: results from an observational prospective study in elective surgery.

BACKGROUND: An observational prospective study of the perioperative procedures for prevention of surgical site infections (SSIs) was carried out in a tertiary referral teaching hospital in Liguria, Italy, to evaluate their adherence to international and national standards. METHODS: A 1-month survey was performed in all surgical departments, monitored by turns by trained survey teams. Data regarding presurgical patient preparation and intraoperative infection control practices were collected. RESULTS: A total of 717 elective interventions were actively monitored in 703 patients who underwent surgery. Hair-shaving was performed mainly using a razor (92%) by the nurses (72.8%) on the day before the operation (83.5%). All of the patients showered, either with a common detergent (87%) or with an antiseptic solution (13%). Antimicrobial prophylaxis was administered properly in 75.7% of the patients at induction of anaesthesia; however, according to current Italian guidelines, inappropriate prophylaxis was provided in 55.2% patients. Appropriate antisepsis of the incision area was done in 97.4% of the operations, and nearly 90% of the interventions lasted less than the respective 75th percentile. The doors of the operating theatres were mostly open during the duration of the operation in 36.3% of the cases. CONCLUSIONS: This review of infection control policies identified significant opportunities for improving the safety and the quality of routine surgical practice.