Development of a checklist as self-assessment tool to evaluate the reprocessing of endoscopic instruments in an Italian teaching hospital.

OBJECTIVE: The present study aims to develop a checklist, as a self-assessment tool, for evaluating all the items involved in the endoscope reprocessing that could be useful for the improvement and/or development of a safety endoscope reprocessing system. MATERIALS AND METHODS: A three-step modified Delphi method, with an embedded qualitative component, was adopted to develop the checklist. According to it, corrective actions were performed before its further re-administration. Contextually, the microbiological surveillance of the endoscopes and of the wash disinfector machine was carried out. RESULTS: Five areas were included in the checklist. After the 1st checklist application, only one of three wards reached the excellent scores in all the items. The other two wards showed an improvement in the Traceability and Endoscope Reprocessing areas after corrective actions. The McNemar's test reported significant difference in the proportion of satisfactory results before and after the 1st and 2nd checklist application. The microbiological surveillance, conducted after the 1st administration, showed unsatisfactory results for the 2 bronchoscopes available in the Intensive Care Unit and for 2 automated endoscope reprocessors. The analysis performed after the 2nd administration showed good results. CONCLUSIONS: The periodic administration of the checklist is functional for a self-assessment of quality reprocessing procedures carried out in the large endoscopic services and in the wards occasionally providing those services, according to the good practice guidelines and for any corrective actions to increase the safety.

Chronic obstructive pulmonary disease (COPD) exacerbation: impact of comorbidities on length and costs during hospitalization.

OBJECTIVE: A retrospective cohort study was performed, using administrative database of the Local Health Unit Roma-A (LHU RM-A). The included subjects were residing in one of the four districts and were hospitalized for COPD exacerbation in healthcare facilities of the LHU during years 2010-2012. PATIENTS AND METHODS: The aim of the present study is to evaluate the impact of comorbidities, length and costs of hospital stay in patients with COPD exacerbations. Chronic obstructive pulmonary disease (COPD) is often associated with other diseases (cardiovascular diseases, diabetes, metabolic syndrome, chronic renal failure, depression) that can increase risk of mortality and hospitalization. RESULTS: A total of 1890 COPD patients are included in the study. The mean length of hospitalization is 12.25 days (SD ± 10.91), 11.63 days (SD ± 9.76) and 11.91 days (SD ± 9.69) with a mean cost of hospitalization amounting to euro 3683.48 (SD ± 2037.12), 3356.82 (SD ± 1674.86) and 3706.81 (SD ± 2087.72) in 2010, 2011 and 2012 respectively. The presence and number of comorbidities are positively and significantly associated to the length and cost of hospitalization. In particular, patients with cardiovascular diseases or diabetes mellitus associated with other comorbidities present the highest values of hospital stay and cost. The cost and the length of hospitalization were significantly linked to the number of comorbidities. CONCLUSIONS: Comorbidities play an important role in the hospital management of COPD exacerbation, increasing health care costs related to this disease.