Point prevalence surveys on healthcare acquired infections in medical and surgical wards of a teaching hospital in Rome.

BACKGROUND: Healthcare acquired infections (HAI) are an important cause of morbidity and mortality in hospitals worldwide. Aim of the study was to analyze nine years surveillance activity, carried out by point prevalence surveys from 2007 to 2015, in a 450-bed teaching hospital in Rome. METHODS: Point prevalence surveys were carried out every year in the medical and surgical wards following the same methodology. In accordance with definitions used by the Centers for Disease Control, all infections occurred more than 48 hours after hospital admission were considered HAI, and included in the study. Baseline characteristics, clinical features, isolated pathogens (only for the period 2011-2015) and antimicrobial resistance were recorded. RESULTS: During the nine years point prevalence surveys a total 2,840 patients were enrolled. Overall 136 (4.79%) patients developed 180 (6.34%) HAI. The most frequent HAI were respiratory tract infections (RTI), which accounted for 35.0% of all HAI, followed by surgical site infections (SSI) 22.2%, urinary tract infections (UTI) 19.4%, bloodstream infections (BSI) 17.2%, and others 6.1%. HAI related to major invasive risk procedures were also evaluated. SSI/patients undergoing surgery 3.99%, UTI/ patients with urinary catheter 4.17% and BSI/patients with CVC 9.42%. Over one-half of all patients surveyed (1,532, 53.9%) were receiving antibiotics at the time of our study. Among them 892 (58.2%) for treatment, 641 (41.8%) for prophylaxis. In the latter group, 109 (17.0%) underwent extra-short term, 89 (13.9%) short term and 443 (69.1%) a long term prophylaxis. During the period 2011-2015 out of 110 HAI episodes 71 (64.5%) were confirmed microbiologically. In total 106 pathogens were isolates, Gram-negative bacteria (63.2%) were isolated more frequently than Gram-positive bacteria (28.3%). CONCLUSIONS: The overall HAI prevalence in our hospital was consistent with those reported in other studies in Italy. The study underlined the role of Gram-negative bacteria in HAI and the need for antimicrobial stewardship. It also provided useful baseline data for rational priorities in allocation of resources, for further infection control activities.

Features and organization of Pain Centers in the Lazio Region, Italy, in 2011.

BACKGROUND: Evidence on pain management highlights the importance of a multidisciplinary approach in order to achieve optimal therapeutic results. Such programs can be guaranteed by the Centers for Pain Management (CPMs), in which multidisciplinary teams are able to provide advanced and specialized activities for the assessment, diagnosis and treatment of chronic benign pain. To date, information related to healthcare supply and the organizational structure of these centers in Italy is incomplete. The aim of this paper was to provide an overview of the healthcare network of the CPMs in the Lazio region. METHODS: A descriptive survey was conducted in all the 37 CPMs existing in the Lazio region in 2011 of which 28 participated. RESULTS: CPMs were located either in Universities or in public or private hospital facilities. They included a clinic, a Day Hospital service, Day surgery and day-beds. CPMs were managed by anaesthesiologists who, in most instances, did not work in a multidisciplinary team. The number of other health professionals available, such as nurses, psychologists and physiotherapists, was limited. CPMs mainly provided drug therapy, Complementary Alternative Medicine (CAM) and complex interventional treatments. The median waiting time was 30 days. The clinics were not homogeneously distributed in the region with a higher concentration in Rome (56%), followed by other provinces of the Lazio region (26%) and the province of Rome (18%). Clearly, Rome was the city which offered the greatest range of healthcare services and the highest number of consultations with patients, which significantly differed from those of the other areas (χ²=19.6 p<0.01). CONCLUSIONS: In 2011, the availability of CPMs was not equally distributed throughout the territory, and there was an over-utilization of the facilities in Rome and an under-utilization in the provincial areas. Moreover, this study showed a lack of a multi-professional approach to chronic pain management.

[Smoking cessation and weight gain]. / Trattamento per la disassuefazione dal fumo ed incremento ponderale.

Cigarette smoking is the single most important preventable cause of death and illness. Smoking cessation is associated with substantial health benefits, but weight gain after smoking cessation is perceived to be a barrier against quitting smoking. The aim of the study was to analyse predictors of weight gain after smoking cessation. The sample included 1067 residents, aged 18-70 years, in a health district of Rome who answered to an anonymous postal questionnaire. Among them 482 were former smokers; 398 provided lifetime histories of both body weight and smoking and were considered in the analysis. 52.5% (49.3% M; 60.5% F) reported weight gain after smoking cessation; among these 25.4% reported a weight gain > or =5 kg. The multivariate logistic regression analysis showed a direct association between female gender (OR 1.9, CI 95% 1.1-3.2), age - 45 years (45-65 years: OR 2.5, CI 95% 1.4-4.4; > 64 years OR 2.1, CI 95% 1.0-4.0), number of cigarettes per day >20/day (OR 3.8, CI 95% 1.3-11.5) and weight gain after smoking cessation. The relevance of weight gain following smoking cessation suggests that health benefits associated with smoking cessation may to some extent be negated by the detrimental effects on health of associated weight gain. Smoking cessation programmes should therefore consider incorporating follow-up support to prevent weight gain; regular measurements of body weight together with dietary indications and increase of physical activity are basic factors to implement in the intervention of smoking cessation.

[The HACCP method for personnel education]. / Il metodo HACCP come strumento di formazione del personale.

In order to guarantee an alimentary safety it is necessary to estimate the real meant sanitary risk as probability of insurgence of microbiological pathologies and to develop the concepts of the HACCP therefore as indicated from D.lgs. 155/97. In six scholastic catering services, some which three had applied system HACCP and three not, have been conduct microbiological analyses on the superficial ones, the staff and the alimony. It has been estimated the effectiveness of the system HACCP observing the modifications been necessary during the trend temporal, through 5 series of samples, carried out in three years 2000-2002. The not optimal situation emerged from the search confirms that the use of the handbook of CPI and the self-control based on method HACCP needs of time and professional contributions for one they corrected management.

[Accessibility and quality to health social services in Italy for the patients with rare diseases: the opinion of associations]. / Accessibilità e qualita dei servizi socio-sanitari italiani per i pazienti con malattie rare: il parere delle associazioni.

This paper concerns the first phase of a study about the perception of social and health needs of people with rare diseases. The study was performed by the National Center for Rare Diseases at the Italian National Institute of Health (Istituto Superiore di Sanità - ISS). The project wants to be an example of collaboration between the research and the association worlds. Responsible of Associations of Patients and their relatives were asked their opinion about the accessibility and quality of important features of health and social services (accessibility and quality of diagnostic, pharmacological, psychological and rehabilitative interventions, social support, school and vocational training, information that was given to relatives). An ad hoc questionnaire was developed through focus groups. The questionnaire was completed by 108 associations (26,5% of the associations thar are recorded in the ISS database). Average scores showed satisfaction only for some variables and a negative gradient north-south was observed. The most frequent complaints were about information, quality of school and job training services and availability of psychological support. The study showed an high level of dissatisfaction with availability, quality and integration health and social services.

[Prevention of oral cancer: practice patterns in a dentists' group]. / Prevenzione del cancro orale: la pratica odontoiatrica in un campione di operatori.

Annually, 3000 people in our country die for oral cancer. Contrarily to other forms of cancer that require the use of instrumental diagnostic tools, the oral cavity is easy to examine and the cancer is usually preceded by precancerous conditions. The problem of the diagnostic delay can be explained through a underestimation of the lesions of the oral cavity by patients and a lack of sensibilization to prevention topics from dentists. Our work has inquired in the activity of a group of dentist with more than ten years than experience on accuracy of the anamnesis, objective exam and appropriate of the resource to specialists, and that with the aim not to measure the clinical abilities but to estimate the attitude towards the Prevention topics, in special way in the field of the malignant tumors of the oral cavity.

[Opinions and attitudes on oral cancer in a sample of students attending a state secondary school in Rome. A pilot study]. / Opinioni e attitudini sul cancro della bocca in un campione di studenti di un liceo romano. Uno studio pilota.

BACKGROUND: This study aimed to evaluate knowledge and awareness in a group of secondary school students on the subject of risk factors and strategies used in the prevention of oral cancer. METHODS: The study took the form of a questionnaire which was filled in by a group of 106 secondary school students. The questionnaire was divided into 3 sections: the first analysed the general characteristics of the sample population; the second investigated their knowledge on the specific subject of this study; the last regarded exposure to risk factors and the role played by the dentist and family doctor in the prevention of oral cancer. RESULTS: Of the 106 students taking part in the study, 42% were male and 58% female. 30% of the group felt it was not possible to prevent cancer in general. 6% associated cigarette smoking with oral cancer, whereas 15% identified alcohol as a risk factor for the same pathology. 30% of the group thought that it was not possible to prevent oral cancer. In the event of a suspected oral lesion, 44% would consult the family doctor, 25% would go to the dentist and 3% to a dental technician. CONCLUSIONS: This study highlights the need improve knowledge of prevention methods in oral cancer. Although young people do not have a high risk of developing oral cancer, they represent a means of conveying information in a social and familial context, thus enabling an early diagnosis, and they also represent the preferred target for primary prevention activities.

Nutritional variables related to gingival health in adolescent girls.

In order to study the nutritional variables associated with gingival health, a case-control study was designed to control strong variables whose effect on gingival status may obscure the potential effect of weaker ones, such as nutrition. Two groups of 27 gingivitis-affected and -unaffected female adolescents were selected. All were aged 17-19 years, with mean age of the two groups statistically not different. All were non-smokers, all reported daily toothbrushing frequency of twice/day or more, and none had clinical signs of hyponutrition. Mean DMFT of the two groups was statistically not different. The effect of nutritional variables, obtained by a three-day food record and by assessing the nutritional status of the girls, on presence/absence of gingivitis was evaluated by a variety of stepwise logistic regression analyses. Age (positive correlation), riboflavin, calcium and frequency of fibre intake (negative correlations) significantly explained the risk for gingivitis. Strong intercorrelation between riboflavin and calcium was also found, due to the high quantity of milk consumed by the girls, since this food provided the main source of riboflavin and calcium. The data suggest that some dietary measures may be useful for the maintenance of healthy gingival status.

[Anti-HBV vaccination and continuing education of health personnel: proposal for a priority index in various hospital units]. / Vaccinazione anti-HBV ed aggiornamento negli operatori sanitari: proposta di un indice delle priorità in diversi reparti ospedalieri.

This work defines an "hazard index of unit" for the occupational transmission of the HBV to the aim to establish the priorities in the activity of promotion of the hepatitis B vaccine turned to health personnel. It has been estimated the prevalence of the potentiality infecting for the HBV in patients coming to various unit and the cover immunization against HBV in personnel and used the incidence of exposures to biological risk, always reported to the single units, found in the within of the activity of the Committee of Control of the Hospitals infections in our hospital. The analysis evidences three areas to risk: infectious diseases, general surgery and obstetrics and gynecology.

[Findings on the occurrence of complications caused by DEV and HDVC (delta) vaccines]. / Rilievo della incidenza delle complicanze da vaccini DEV e HDCV (delta).

The complications arising from two different anti-rabies vaccines were compared: DEV (duck embryo vaccine; the schedule included 14 daily doses plus 3 boosters) and HDCV (human diploid cells vaccine; the schedule included 5 doses plus 1 booster). 2646 patients were immunised, following a post-exposure prophylaxis, at the Antirabies Unit of the Institute of Hygiene of Rome. Among the 1434 patients immunised with DEV, 364 (25.38%) developed side-effects, whilst among the 1212 subjects immunised with HDCV only 47 (3.88%) developed side-effects. Using DEV the more frequent complications were as follows: fever (48.62%), regional adenopathy (49.45%), erythema (89.29%), local induration (41.48%). Using HDCV the main complication was fever (65.96%). The principal association of complication in DEV were: erythema + induration + edema + adenopathy + fever; general malaise + asthenia + adenopathy; dizziness + headache. Hyperthermia resulted often associated with regional adenopathy and the general malaise with the headache in the vaccinated with HDCV. All complications were widely distributed during the period of immunisation. However most side-effects arose following the 5th DEV dose or the 2nd HDCV dose. Regional adenopathy, was the more persistent and less tolerated symptom, also local erythema showed a long persistence, whilst the other symptoms regressed within 48-72 hours with proper therapy and rest. Sex and age did not influence the incidence nor the type of complications. Neither neuroparalysis was detected nor serious impairment of health. In our study the coincidence of unwanted effects, following an antirabies immunisation, seems lower than that described in the literature. This was probably due to the high level of purification of the vaccine and possibly to the different recording of the minor symptoms.

Spontaneous abortion in relation to the presence of hexachlorobenzene in the Italian environment.

This study determined hexachlorobenzene (HCB) levels in the blood of women who had suffered spontaneous abortions (120 cases) and women with healthy reproductive functions (120 controls). Samples were collected in 1984 during an epidemiological investigation into the relation between polychlorobiphenyl levels in the blood and spontaneous abortion in the women. Evaluation of the HCB data showed no significant differences between the groups, the blood of the group with spontaneous abortion containing 1.6 +/- 1.6 ppb HCB compared with 1.5 +/- 1.1 ppb for the control group.