A multidisciplinary primary prevention intervention to increase adherence to the Mediterranean diet: a pilot study.

BACKGROUND: The role of the Mediterranean Diet (MD) in reducing cardiovascular (CV) risk is widely demonstrated and many studies have shown the effectiveness of educational interventions in primary prevention. This study aimed to evaluate the impact of a multidisciplinary educational intervention, that included nutritional, psychological and physical activity coaching, on adherence to MD and on CV risk. METHODS: In a Roman neighborhood, general practitioners enrolled 41 subjects to take part in the educational intervention from November 2018 (T0) to November 2019 (T1). Participants' anthropometric measures, haematochemical parameters and CV risk score were assessed before and after the intervention. Furthermore, their adherence to MD was evaluated through the analysis of food frequency questionnaires using Medi-Lite. RESULTS: The study found a significant reduction of 2.5 points in individual CV risk score, and an increase of 2.5 point in adherence to the MD. The stratification by gender showed statistically significant decreases in weight of 1.16 kg, BMI of 0.47, LDL cholesterol of 14.00 mg/dL, and individual CV risk score of 1.16 points among female participants. CONCLUSIONS: These results show that a multidisciplinary educational intervention model including the adoption of MD could be an effective strategy in Public Health for CV primary prevention and improvement of people's lifestyles.

Potential Use of a Combined Bacteriophage-Probiotic Sanitation System to Control Microbial Contamination and AMR in Healthcare Settings: A Pre-Post Intervention Study.

Microbial contamination in the hospital environment is a major concern for public health, since it significantly contributes to the onset of healthcare-associated infections (HAIs), which are further complicated by the alarming level of antimicrobial resistance (AMR) of HAI-associated pathogens. Chemical disinfection to control bioburden has a temporary effect and can favor the selection of resistant pathogens, as observed during the COVID-19 pandemic. Instead, probiotic-based sanitation (probiotic cleaning hygiene system, PCHS) was reported to stably abate pathogens, AMR, and HAIs. PCHS action is not rapid nor specific, being based on competitive exclusion, but the addition of lytic bacteriophages that quickly and specifically kill selected bacteria was shown to improve PCHS effectiveness. This study aimed to investigate the effect of such combined probiotic-phage sanitation (PCHSφ) in two Italian hospitals, targeting staphylococcal contamination. The results showed that PCHSφ could provide a significantly higher removal of staphylococci, including resistant strains, compared with disinfectants (-76%, p < 0.05) and PCHS alone (-50%, p < 0.05). Extraordinary sporadic chlorine disinfection appeared compatible with PCHSφ, while frequent routine chlorine usage inactivated the probiotic/phage components, preventing PCHSφ action. The collected data highlight the potential of a biological sanitation for better control of the infectious risk in healthcare facilities, without worsening pollution and AMR concerns.

[Transmission of Sars-Cov-2 and ventilation of indoor environments. Technical notes and preventive measures]. / Trasmissione di Sars-Cov-2 e ventilazione di ambienti confinati. Note tecniche e indicazioni di prevenzione.

Knowledge about the new infectious disease COVID-19, which first spread in the city of Wuhan in China, in December 2019, is based on the evidence retrieved from coronaviruses previously known to humans. The main transmission ways of the new SARS-CoV-2 virus are respiratory droplets and direct and close contact with infected individuals and contaminated surfaces. To date, some scientific publications provide initial evidence that SARS-CoV-2 can be detected in the air, thus assuming a further route of infection, that airborne, although these results are to be considered preliminary and they need careful interpretation. In support of this hypothesis, ventilation systems, aimed to improve indoor air, could represent an easy way to spread and promote the virus infection especially in hospitals and in all health facilities where the presence of infected individuals is potentially high as well as the possibility of infection by air. Indeed, by generating jets of air at different speeds, they can interfere with the mission of respiratory particles and determine an environmental diffusion of the potentially contaminating droplet. Therefore, ventilation systems could provide a potential transmission channel for the viral load able to spread out in indoor air. Nonetheless, good management, technical and operational practices may lead to a low risk of contagion, both in community and health environments.

[The assessment of the sanitation of surfaces and instruments in the context of hospital refection]. / Idoneità igienico-sanitaria delle superfici e degli strumenti nella ristorazione collettiva: analisi di un'esperienza nella realtà ospedaliera.

The Authors present the results of an experience carried out in a University General Hospital, for the assessment of the sanitation of surfaces and instruments in the context of hospital refection. A specific procedure has been quarterly implemented in order to verify the correct execution of the sanitization procedures. In the time-period September 2016 - March 2020 Petri dishes and tampons were used in order to determine the following microbiological parameters and indicators: total bacterial load at 30 degrees C, Coliforms, Listeria monocytogenes, Salmonella spp, Staphylococcus aureus, Escherichia coli and mycetic load. Only 7 out of 82 sanitized surfaces (8.5% of the total) were found to be not complying, only for total bacterial load at 30 degrees C, mycetic load and Coliforms. The systematic application of this procedure and the results of the survey conducted, comforting as a whole, confirm the attention reserved to the hygienic level of surfaces, tools, equipment and utensils, in the context of the centralized catering service of the hospital, in which the Health Department, sharing with the UOC Hospital Hygiene the specific hygienic procedure, has always been at the forefront of the proposal of interventions, considering the increased susceptibility and vulnerability of the hospitalized patients.

[Vaccination, attitudes and perception of parents. Study in the ASL of Salerno]. / Vaccinazioni, attitudini e percezione dei genitori. Indagine nella ASL di Salerno.

OBJECTIVE: Despite the many advances obtained thanks to vaccination, in recent years it has been a marked drop in vaccination coverage. In fact, data show the failure in reaching the 95% of coverage, equal to the safety threshold for almost all vaccinations. This is due to the phenomenon of vaccine hesitancy. Aim of this study is to describe knowledge, attitudes and perceptions respect to childhood vaccinations in a sample of parents of patients of a Free Choice Pediatrician (PLS) in the territory of Salerno Local Healthcare Service, (ASL) to assess what might be the educational needs of parents to decrease the hesitation. METHODS: A quantitative observational descriptive and phenomenological study was conducted, recruiting parents belonging to a PLS in ASL Salerno, through a questionnaire constructed ad hoc. RESULTS: Parents are not always favorable to vaccination and for some vaccine they fear a bond with a pharmaceutical business. All have vaccinated their children but not for all available vaccinations. DISCUSSION AND CONCLUSIONS . Through the educational means of the PLS doubts about vaccinations are minor and the sample of children is vaccinated, although parents appear not totally supportive and considers vaccinations as a warranty by the ASL. The sample has shown a discrepancy between the health workers about the need to vaccinate or not. Hence the need to train the health care professional before and make him responsible and then inform, through a dedicated path, who should receive the vaccine.

[Vaccination among healthcare workers in Italy: a narrative review]. / La vaccinazione negli operatori sanitari in Italia: una revisione narrativa di letteratura.

Vaccination of healthcare workers (HCWs) is a public health tool of the utmost importance and the Italian National Vaccine Prevention Plan (PNPV) 2017-2019 recommends several vaccinations in this population group. Nevertheless, vaccine hesitancy is influencing HCWs' attitude towards vaccination. Moreover, a large number of measles cases have been reported in Italy among HCWs in 2017 and 2018. In Italy there is no national registry for vaccinations, so data on vaccine coverage among HCWs are not readily accessible. The aim of this literature review is to describe the most recent data about vaccination coverage among HCWs in Italy. We also report studies that evaluated the effectiveness of strategies to increase influenza vaccine uptake. We included all studies conducted in Italy and published between 2008 and 2018, regarding vaccines recommended by the PNPV 2017-2019 (hepatitis B, influenza, pertussis, measles, mumps, rubella, varicella, and tuberculosis). Our findings confirm that low vaccination coverage levels among HCWs exist in several Italian regions and cities, highlighting a relevant gap towards targets set by the PNPV. Studies that evaluated the effectiveness of multicomponent interventions to increase vaccination coverage found only minimal to moderate increases in uptake levels. It is therefore crucial to tackle vaccine hesitancy in HCWs, by identifying effective strategies able to significantly increase vaccine coverage, in order to decrease the risk of nosocomial infections, prevent transmission of preventable diseases to patients, and reduce indirect costs related to HCW absenteeism due to illness.

[Hospital foodservice through the Cook Chill system: a two-year experience in a University teaching hospital, Italy]. / La ristorazione in ospedale mediante il sistema "Cook and Chill": un'esperienza di 2 anni in un Policlinico Universitario.

The Authors present their two-year experience regarding an evaluation of the hygienic quality of ready-to-eat foods in a hospital foodservice, both for patients' meals and hospital staff, prepared by using the Cook Chill system. According to the microbiological parameters provided by International Guidelines, 23 of 27 food samples that were collected and analyzed were found to be satisfactory, one was acceptable and only three were unsatisfactory (two for aerobic colony count and one both for aerobic colony count and hygienic procedure). Escherchia coli, Staphylococcus aureus, Salmonella, Listeria monocytogenes, and Clostridium perfringens were absent in all of the analyzed products, The study results are encouraging and confirm the need to always verify that the different phases of production of hospital meals are correctly implemented, even when the foodservice is out-sourced. This has always been considered a priority in the study hospital, where the Health Department is at the forefront both in control and verification of food safety practices and in offering training activities, especially in view of the increased susceptibility of hospitalized patients.

[Control of antimicrobial resistance in the food chain: a narrative review]. / Contrasto all'antibiotico-resistenza nella catena alimentare: una revisione narrativa.

A poor environmental management and the deterioration of health and hygiene conditions (lack of awareness and attention to hygienic standards, to measures for preventing transmission of infection, and to appropriate use of antimicrobial therapies) facilitate the selection, release and diffusion of resistant pathogens in the environment, which can very easily contaminate the food chain. Antimicrobial resistance is a major problem worldwide, involving many sectors: medicine, veterinary medicine, breeding, agriculture, economy and commerce. In addition, the expanding globalization and increasing movements of both goods and people across countries and continents have drastically exacerbated the situation. In this difficult context, professionals of both the food and health sectors have an important role to play and their active participation is essential, together with that of citizens and patients themselves. For this very reason, national programs to combat antimicrobial resistance are needed, with a special focus on surveillance, antimicrobial stewardship, training of professionals and citizens, all the while assuring the availability of economic resources to achieve these goals. The "One Health" initiative is intended to strengthen the link between different scientific disciplines, such as human and veterinary medicine, since the phenomenon of antimicrobial resistance may be further aggravated by microbial transmission from animals to humans, directly or indirectly through the consumption of food. The aim of this narrative review is to give an overview of what is known about antimicrobial resistance related to food chain, to illustrate its extent and epidemiology in Italy, in Europe and globally, and to discuss the measures required to fight antimicrobial resistance including good practices on the use of antibiotics.

[Hygienic safety of infant milk powder formulas in hospital setting]. / La sicurezza igienica del latte in polvere per la prima infanzia nella realtà ospedaliera.

The authors present the results of a study whose aim was to assess the hygienic quality of powder and reconstituted milk for early childhood, in a University General Hospital in Rome, Italy. This procedure is an integral part of the systematic verification activities that the hospital Health Management department considers as a priority for patient safety. The absence of contamination in all tested samples confirms the suitability of adopted procedures to ensure a safe product, considering the increased vulnerability of newborns, especially if preterm.

[Resident physicians' participation to the activities of the hospital hygiene unit in a teaching hospital: a pilot study]. / Partecipazione dei medici in formazione specialistica alle attività dell'unità operativa complessa "Igiene ospedaliera" in un policlinico universitario: studio pilota.

INTRODUCTION: The Hospital Hygiene Unit ensures hospital patient safety, through surveillance and control of environmental conditions of risk. In this context, resident physicians in Hygiene and Preventive Medicine of the Catholic University of the Sacred Heart (UCSC) are required to attend the unit to acquire professional skills, for two months (four weeks in the first year of residency and four weeks in the second year). In the initial phase of the rotation, residents are acquainted with the organization and assigned activities. Ongoing meetings with the tutor take place to verify the progress of activities in which they are involved; verification of acquired skills is performed at the end of the period of attendance. The aim of the study was to evaluate resident doctors' opinions about their training experience, in order to assess the perceived quality and pursue continuous improvement of the training program. MATERIALS AND METHODS: A questionnaire was administered to resident physicians attending the first three years of residency; the survey consisted of 11 multiple choice questions on organization, attendance, training and overall satisfaction and 3 open-ended questions on strengths, weaknesses and proposals for improvement. RESULTS: Fourteen of 15 residents (93.3%) completed the questionnaire: seven were male, five were first-year residents, five were second-year and four were third-year residents. Overall, 78% gave a positive assessment of the quality of training; in particular, 11 of 14 residents reported that the experience was very relevant to their training in Hygiene and Preventive Medicine. Responses regarding the training organization were also mostly positive (75%), as were those regarding attendance (57%) and overall satisfaction (67%). Fifty percent reported difficulties in combining this internship with the other activities planned with their tutor. CONCLUSIONS: Positive opinions prevail in all areas of assessment, although there are some aspects that can be improved, including the possibility to extend the period of attendance. Overall, training activities at the Operative Unit of Hospital Hygiene are appreciated by resident physicians, who consider them an important opportunity for professional growth.

[The progressive patient care program as a model of field training of public health practitioners: the experience of the Roman Public Health Academy]. / L'ospedale ad Intensità di cura come modello di formazione condivisa sul campo: l'esperienza dell'Accademia Romana di Sanità Pubblica.

The management of healthcare facilities has become increasingly complex in recent years, leading to a greater demand for public health physicians in Italy. Public Health physicians are responsible for evaluating community needs, with particular attention to health determinants and, at the same time, to final user feedback. During their training, they must acquire the competencies to manage a wide range of problems. The Roman Public Health Academy (ARSP) was developed to motivate young residents in Public Health to acquire the knowhow, skills and abilities required of a public health practitioner. It therefore implemented a special training program offering different educational opportunities for residents. In particular, the program offers a team of three young residents field training opportunities, allowing them to become engaged in solving complex technical and management problems. In this paper we describe the methods through which, following a specific request by the director of a hospital in Rome, the team supported a project involving the reorganization of several hospital wards. The aim of the reorganization was to enhance the performance and efficiency of the wards, according to the Progressive Patients Care program.

Fostering Flu Vaccination in Healthcare Workers: Forum Theatre in a University Hospital.

The World Health Organization recommends flu vaccination as the most effective way to prevent the disease and its severe outcomes and has established the minimum vaccination coverage for people at risk at 75%. Even though healthcare workers (HCWs) represent a strongly recommended target group for flu vaccination campaigns, the average coverage among them is still inadequate. In flu season 2015/2016, our University Hospital tested Forum Theatre (FT) as a new participative strategy to foster HCWs engagement regarding flu vaccination. The aim of this study was to evaluate HCWs' satisfaction with and perceived utility of FT. In 2015, five FT sessions were organized in hospital units which were considered at risk for flu based on the type of admitted patients. After each session, participants were asked to complete an assessment questionnaire. The χ² test or the t-test was used to compare the proportion of participants who were satisfied with the FT and considered it useful (utility score). Data was analyzed according to gender, profession, and age. In all, 16.5% of HCWs who worked in four out of five of the units identified, participated in the FT sessions. Questionnaire results indicated that 74% of spectators were satisfied with their experience and 70% considered this methodology a useful approach for other health issues. Gender, age, and profession did not influence satisfaction or utility scores. Participative strategies such as FT represent an innovative solution to increasing HCWs' awareness of the importance of flu vaccination and could positively impact their adherence to vaccination recommendations. FT can also be a meaningful HCW teaching tool for learning about and changing attitudes toward other clinic and public health issues.

[Risk perception and biological parameters related to obesity in a sample population of the city of Rome, Italy: nurses' contribution to supporting health-related decisions]. / Percezione del rischio e parametri biologici correlati all'obesità in una popolazione campione della città di Roma. Il contributo dell'infermiere a supporto delle decisioni per la salute.

INTRODUCTION: Obesity is a major public health problem because it is a risk factor for various chronic diseases and its incidence is constantly increasing due to changes in diet and lifestyle. In Italy, studies show that 32% of the population aged between 18 and 69 years is overweight and 10% is obese. The aim of this study was to measure the anthropometric characteristics of a sample population of the city of Rome (Italy) and correlate these with dietary habits and socio-demographic characteristics of participants in order to evaluate their specific health and educational needs. METHODS: A cross-sectional study was conducted in February 2015 by administering an ad-hoc questionnaire to subjects over 18 years of age attending a General Practitioner's practice in Rome (Italy). The questionnaire collected demographic, clinical and anthropometric data, and information regarding dietary habits. RESULTS: The sample consisted of 150 individuals with a mean age of 47,8 years. Fifty nine percent were women. The mean Body Mass Index (BMI) was 26.7. The average blood pressure was 131/80 mmHg. BMI values were higher in respondents with a lower educational level and BMI was significantly associated with the quality of the source of nutrition information used. CONCLUSIONS: Poor and unreliable information regarding proper nutrition can correlate with the risk of overweight and the consequent development of chronic diseases. The family or community nurse could play a critical role in prevention, by helping to provide correct information for specific populations and by planning training and prevention activities with the GP.

[Hygienic suitability of food and food-contact surfaces in a hospital canteen: the experience of a University Hospital in Italy]. / Idoneità igienico-sanitaria di alimenti e superfici in una mensa ospedaliera: un'esperienza in un Policlinico Universitario.

The Authors present the results of a study performed during a time-period of two years, to evaluate the hygienic quality of ready-to-eat foods, prepared and served in a hospital catering service, and the microbiological status of food-contact surfaces. Food hygiene was evaluated using non-pathogenic indicator microorganisms. The study was part of the verification activities that the hospital Health Department considers as a priority in order to guarantee patient safety. Only one of 52 food samples tested was considered unsatisfactory; the examined surfaces were not fully satisfactory in one of four cases. The study results, although encouraging as a whole, especially with respect to the hygienic safety of food prepared and served in the hospital, confirm the need to continuously verify that the appropriate environmental sanitation procedures are applied, even in the case of outsourcing. Considering the increased susceptibility of hospitalized patients, this remains a priority in the hospital where the study was performed.

[A health promotion campaign to improve flu vaccination adherence among medical residents in an Italian Teaching Hospital]. / Una campagna di promozione della salute per migliorare l'adesione alla vaccinazione antinfluenzale nei medici in formazione specialistica in un ospedale universitario italiano.

INTRODUCTION: In Italy annual flu vaccination for health care workers is recommended but coverage is usually unsatisfying. The compliance is even worse among medical residents (MRs) both in literature, both in our experience: in the flu season 2014/ 15 only 0.6% of MRs enrolled at the Università Cattolica del Sacro Cuore (UCSC) were vaccinated. For this reason, during the influenza season 2015/16, the Institute of Public Health of the UCSC, in collaboration with the Health Management of the "Agostino Gemelli" Teaching Hospital (FPG) and with the directive board of the Medical Specialization Schools (SSM) present at the University has tested several strategies to improve awareness and adherence to flu vaccination campaign by its staff. This study aims to analyze the impact of the strategies used during the 2015/16 campaign on flu vaccination coverage among MRs of an important Italian Teaching Hospital. METHODS: The study was conducted among MRs enrolled at the UCSC - FPG in 2015/16. The data was collected by the Occupational Medicine which, during the influenza seasons, immunize MRs against influenza free of charge. For each variable - vaccination, area of specialization (surgical, medical, clinical services), typology of SSM - was measured the absolute and percentage frequency. In order to compare the flu vaccination coverage between seasons 2014/15 and 2015/16 and between areas of specialization in 2015/16 chi-square test was used (statistical significance level of 0.05). The data were analyzed using STATA Software. RESULTS: Were included in the analysis 42 SSM with a total of 1041 MRs. During the vaccination campaign 2015/16, flu vaccine was administered to 99 MRs (9.5%), 8.9% more than in the previous season (p<0.001). There is also a significant difference in vaccine coverage between surgical, medical and clinical services areas in 2015/16 (p <0.001). The highest vaccination coverage was recorded among MRs of Hematology and Urology (54.5%). However, no one MRs had undergone flu vaccination in about 40% of SSM. CONCLUSIONS: Seasonal flu vaccination among HCWs is important to protect patients as well as them self and their family members. Considering that MRs represent the next generation of HCWs, they should be sensitized about the importance of preventing the spread of influenza in hospital population, becoming an active part of the necessary cultural change. This study highlights a first and promising, although insufficient, increase in flu vaccination coverage among MRs enrolled at the UCSC - FPG after introducing simple strategies to promote vaccination itself and, more generally, positive and proactive behaviors. The study summarizes the results in the short term, but it is well known that cultural changes require time and constancy. Therefore, it will be useful to monitor the improvement over time and extend the assessment to all health care professionals.

Performance of interferon-γ release assays in the diagnosis of confirmed active tuberculosis in immunocompetent children: a new systematic review and meta-analysis.

BACKGROUND: Tuberculosis (TB) is a global public health problem, causing morbidity and mortality in adults and children. The most reliable diagnostic tools currently available are the in vivo Tuberculin Skin Test (TST) and the ex vivo Interferon-γ release assays (IGRAs). Several clinical, radiological, and bacteriological features make the detection of active (overt disease) TB in children difficult. Although recently developed immunological assays such as QuantiFERON-TB Gold In-Tube (QFT-IT) and T-SPOT®.TB are commonly used to identify active TB in adults, different evidence is required for diagnosis in children. The purpose of this study was to reassess the sensitivity and specificity of IGRAs in detecting microbiologically confirmed active TB in immunocompetent children. METHODS: A systematic review and meta-analysis of studies reporting on the diagnostic accuracy of tests for TB in immunocompetent children aged 0-18 years, with confirmation by positive M. tuberculosis cultures, were undertaken. Electronic databases were searched up to September 2015 and study quality assessment was performed using QUADAS-2. RESULTS: Fifteen studies were included in our meta-analysis. Results showed that there were no significant differences in sensitivity between TST (88.2%, 95% confidence interval [CI] 79.4-94.2%), QFT-IT (89.6%, 95% CI 79.7-95.7%) and T SPOT (88.5%, 95% CI 80.4-94.1%). However, both QFT-IT (95.4%, 95% CI 93.8-96.6%) and T-SPOT (96.8%, 95% CI 94.2-98.5%) have significantly higher specificity than TST (86.3%, 95% CI 83.9-88.6%). CONCLUSIONS: QFT-IT and T-SPOT have higher specificity than TST for detecting active TB cases in immunocompetent children.

[Street food safety in Rome, Italy]. / La sicurezza alimentare nello "street food": un'esperienza nella città di Roma.

The Authors describe the results of inspections carried out in 22 street food outlets in the city of Rome, Italy, from 7 April to 28 May 2014. In general, structural requirements of outlets were met but some critical aspects related to hygiene, in particular of instruments, surfaces and worktops, were identified. Results suggest the need to ensure compliance with sanitation requirements of this particular type of food outlet, in order to ensure food safety and, consequently, consumers' health.

[Vocational training in public health during medical school: a pilot study]. / Tirocinio professionalizzante in Sanità Pubblica nel Corso di Laurea in Medicina e Chirurgia. Un'esperienza pilota.

UNLABELLED: The need to integrate clinical and public health training of medical students is increasingly important. Future physicians need to be able to deal with new, complex and growing public health challenges. MATERIALS AND METHODS: A literature search was performed through Pubmed to identify the conceptual reference framework. Meetings were carried out to identify the most appropriate modalities and priorities required for drafting the project, to identify the skills to be acquired by students, to decide on teaching formats and methods to assess student learning, to draw up the teaching schedule, to define the statistical methods to be used to assess student satisfaction, and to perform the statistical analysis of results. Training in hospital hygiene and environmental safety was carried out through presentation of a relevant case. After being divided into groups the students attended the three units (Environmental Microbiology, Environmental Xenobiotics, Genetic Epidemiology and Molecular Biology) of the Hygiene Section of a Public Health Institute. Training in Organization and Health Programming involved presentation of a set of indicators for the definition of objectives and assessment of health systems or services. RESULTS: The literature search led to the identification of the relevant literature. With regard to student satisfaction, 96% of those who replied to the questionnaire gave an overall positive review of the training course (at least 3 on a scale from 1 to 5). CONCLUSIONS: the overall high level of student satisfaction suggests that the proposed model may be exportable. Further developments will be the assessment of trends regarding functioning of the organizational model and perceived teaching quality.

[Comparison of conventional culture methods and quantitative real-time PCR methods for the detection of Legionella pneumophila in water samples in a large University teaching hospital in Rome, Italy]. / Confronto tra il metodo colturale standard e la real-time PCR per l'identificazione di Legionella pneumophila in campioni di acqua.

The aims of this study were to identify the best threshold value for the real-time PCR method in detecting the presence of Legionella pneumophila in water samples, and to evaluate the prognostic significance of negative results obtained with the molecular method. From 2011 to 2014, 77 water samples were collected from hospital wards of a large University teaching hospital in Rome (Italy) and screened for L.pneumophila by the standard culture method and by real-time PCR. The high sensitivity and negative predictive value of real-time PCR make this method suitable as a quick screening tool to exclude the presence of L. pneumophila in water samples in the hospital setting.

[Definition of "Safety and Hygiene Packages" as a management model for the Hospital Hygiene Service (HHS)]. / Definizione di "Pacchetti Sicurezza e Igiene" come modello organizzativo e gestionale per la sicurezza in Ospedale di un Servizio di Igiene Ospedaliera.

The purpose of this research is to identify and formalize the Hospital Hygiene Service activities and products, evaluating them in a cost accounting management view. The ultimate aim, is to evaluate the financial adverse events prevention impact, in an Hospital Hygiene Service management. A three step methodology based on affinity grouping activities, was employed. This methodology led us to identify 4 action areas, with 23 related productive processes, and 86 available safety packages. Owing to this new methodology, we was able to implement a systematic evaluation of the furnished services.