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.

Healthcare Associated Infections: educational intervention by "Adult Learning" in an Italian teaching hospital.

BACKGROUND: An educational intervention for HAI prevention based on a combination of training, motivation and subsequent application in the current clinical practice in an Italian teaching hospital. METHODS: In 2015-2016 a pilot mandatory training on HAI targeted to HCWs was organized in the 450 bed teaching hospital Sant'Andrea in Rome. By adopting the "Impact/control matrix" prioritization tool, the relative level of impact (risk in causing or favoring HAI) and control (possibility for HCWs to prevent HAI) attributed by the participants to the issues associated to HAI during their working groups was evaluated. RESULTS: Overall, 34 physicians, 43 nurses and 15 non clinical professionals participated actively in seven courses, identifying 58 different issues related to HAI, which were reported 128 times. Results showed frequently that, within the same type of issue, HCW referred various levels of impact (risk in causing or favoring HAI) and personal control (possibility for HCW to prevent HAI). Overall staff shortage was the most reported problem by HCW in our hospital. Also hand washing was regarded as a main problem, but HCW expressed the feeling that individuals could act more successfully on this issue (high or medium control). Results showed that staff frequently did not know how to handle correctly visitors, similarly many colleagues expressed some difficulty in communicating information to patients and relatives on HAI. Surprisingly, "antimicrobial therapy" and "excessive invasive procedures" were not particularly highlighted by the personnel. HCW expressed satisfaction for the course approac. CONCLUSIONS: The study showed an overall good level of knowledge regarding the importance and principles of infection control in our teaching hospital HCW. However personnel perceived a variability in the impact of many issues on HAI and even more on the personal possibility to control their effect. In order to improve HCW compliance with HAI prevention programs, the "Adult Learning" model seems to be very useful.

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.

[Global health education in Italian medical schools: survey from 2007 to 2010]. / L'insegnamento della Salute Globale nelle Facoltà di Medicina e Chirurgia in Italia: l'offerta formativa nel triennio 2007-2010.

Global Health (GH) issues are becoming a common feature of Medical and Public Health Schools worldwide. In Italy the Network for Education on Global Health (RIISG) was created with the purpose of spreading the concept of GH. The aim of the study was to assess the availability of educational opportunities in Italian Health Faculties from 2007 to 2010. A survey was carried out using a questionnaire administered to Professors. A frequency distribution of GH elective courses, grouped by three Italian geographical areas (North, Centre, South and Islands), for each academic year was assessed. The features of the courses - consistent with the pattern of course, suggested by RIISG - were analysed through a score. From 2007 onwards, in chronological order the surveyed faculties were 40, 36, 36 and the main coverage of survey was 92%. The courses listed were 26, 22 and 40 respectively for each academic year considered. The average of the courses number highlighted an increasing trend: national mean rose from 0.65 (SD +/- 1.53) in 2007 to 1.11 (SD +/- 1.18) in 2010. Regarding the evaluation of consistency a national improvement was shown. The assessment revealed a limited educational offer and differences between macroareas. Further investigations are needed.

Study of Aedes albopictus dispersal in Rome, Italy, using sticky traps in mark-release-recapture experiments.

We report the results of three mark-release-recapture experiments carried out in an urban area in Rome, Italy, to study the active dispersal of Aedes albopictus (Diptera: Culicidae). The 4.3% recapture rate obtained supports the use of sticky traps in MRR experiments to study the dispersal of Ae. albopictus females. Most fluorescent dust-marked females were recaptured at the gravid stage at 50-200 m from the release sites during the first 9 days after release. The average of daily-MDTs (Mean Distance Traveled) was 119 m and the maximum observed distance travelled ranged from 199 m to 290 m in the three replicates. These data provide the first information about the dispersal of Ae. albopictus in a temperate European area and appear to be consistent with the few data available on this subject from other urban areas, where dispersal was constrained by physical barriers. Although caution should be taken in generalizing these results, they should be considered when planning control activities in urban areas in Italy, as well as in other European countries. This is particularly relevant if control is intended to interrupt pathogen transmission in cases of possible arbovirus epidemics, such as the Chikungunya outbreak that occurred in Ravenna, Italy in 2007.

Burden of HIV/AIDS infection before and during the civil war in Somalia.

Somalia has suffered a massive internal population displacement and exodus that began in 1988 and is still ongoing during the prolonged and intermittent civil war. This review looks at the burden of HIV infection in Somali and the impact of civil war on its epidemiology. Serosurveys have indicated that HIV was not present in Somalia before the civil war and to date Somalia has had an HIV prevalence markedly below that of its neighbours. However, due to the ongoing war HIV sentinel surveillance cannot reach most of the affected areas in Somalia and the current HIV infection problem may be greater than the figures indicate.

[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.

[Customer satisfaction study in two roman hospitals: comparison between "cook & serve" and "cook & chill"]. / Indagine sulla customer satisfaction in due ospedali romani: il legame fresco-caldo e il legame refrigerato a confronto.

We studied patient's satisfaction rate for hospital dishes comparing "cook & chill" method with "cook & serve". As principal instrument we used a comparative questionnaire, anonymous and self-compiled, which is able to evaluate the differences of customer satisfaction's rate between the two methods.

[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.

[Epidemiologic survey of medical and non-medical personnel in a public dental clinic]. / Indagine epidemiologica sul personale medico e non medico di una struttura sanitaria odontoiatrica di terzo livello.

Hepatitis B and C and Mycobacterium tuberculosis infection represent an occupational problem for the dentist. Few data are available in literature about the situation in our country. An epidemiological survey was carried out to evaluate the prevalence of Hepatitis B (HbsAb) and C (HCVab) markers and the exposure to Mycobacterium tuberculosis (Tine test) of the whole population of a public dental clinic (247 dental care workers). Furthermore participants were asked to fill a questionnaire to assess their vaccination status. 67,2% of the subjects were found to be positive for HbsAb (77,4% of medical personnel and 28,8% of the auxiliary medical personnel). Only one subject was found positive for anti-HCV (0,4%). 12,5% of the population showed a positive Tine test (15,4% of medical personnel and 1,9% of the auxiliary medical personnel). Our data show a difference between the percentage of subjects who were vaccinated (2,4%) and those who were positive to the Tine test (12,5%).

[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.

[Mini Nutritional Assessment (MNA) and nutritional risk in elderly. A proposal of nutritional surveillance system for the Department of Public Health]. / Il Mini Nutritional Assessment (MNA) e la valutazione del rischio nutrizionale in età geriatrica. Proposta di un modello operativo di sorveglianza nutrizionale all'interno del Dipartimento di Prevenzione.

Objective of the study is to present an intervention model to evaluate nutritional risk of institutionalised elderly, suitably with the aims and resources of the Hygiene of Nutrition Services, and to individuate predictive variables of nutritional vulnerability. 237 subjects from the residential homes of ASL RMB were involved in the study; to each subject was administered: a) the Mini Nutritional Assessment (MNA); b) a questionnaire for the analysis of the risk factors. Multivariate logistic regression analysis was performed to evaluate the influence of the risk factors on nutritional status. On the basis of BMI the prevalence of malnutrition is 6.5% and the prevalence of overweight and obesity is respectively 41.6% and 22.9%; on the basis of MNA, 5.1% of the subjects is malnourished and 60.3% at risk for malnutrition. The absence of chewing difficulties (OR 2.94; I.C. 1.46-5.91) and the habit to eat all foods served at meals (OR 2.83; I.C. 1.46-5.91) are associated with a good nutritional status. The age > or = 90 years is a risk factor for malnutrition at the limit of statistical significance (OR 0.44; I.C. 0.14-1.00). Carrying out the MNA resulted easy and quick, confirming the hypothesis for feasibility of this protocol in the Hygiene of Nutrition Services. The results highlight an high nutritional risk of the elderly nursing home residents and the importance of planning programs of nutritional surveillance with particular attention on masticatory function impairments, meal intake and on the oldest subjects among the elderly as a group greatly vulnerable. We believe that these areas are very important in defining public health intervention programs.

Body composition and blood pressures in school children 6-14 years of age.

The relationship between parameters of estimated body composition (FFM = fat free mass, FM = fat mass, %F = percentage fat) and blood pressure was examined in a sample of 1418 school-children (712 males, 706 females), 6-14 years of age from L'Aquila and its province (Abruzzo), Italy. Systolic and diastolic blood pressures increased from 6-14 years in both sexes (males: systolic pressure 93.08 ± 14.95 to 122.29 ± 13.27 mm Hg; diastolic pressure: 59.60 ± 11.60 to 74.83 ± 8.35 mm Hg; females: systolic pressure: 97.12 ± 13.16 to 120.56 ± 8.02 mm Hg; diastolic pressure: 61.93 ± 10.23 to 76.67 ± 4.85 mm Hg). FFM and FM estimated by anthropometry and bioelectrical impedance, exhibited similar growth trends (Anthropometry: in males, FFM: 20.55-47.20 kg and FM: 4.14-12.01 kg; in females, FFM: 19.95-41.90 kg and FM: 5.03-15.84 kg; Impedance: in males, FFM: 18.40-47.30 kg and FM: 6.26-11.91 kg; in females, FFM: 17.47-36.97 kg and FM: 7.61-20.77 kg). Correlations between body composition parameters and blood pressures were generally significant. In particular, there was a strong relationship between systolic blood pressure and both FM and %F, the correlations being higher when the body composition parameters were estimated by anthropometry. Am. J. Hum. Biol. 9:535-544, 1997. © 1997 Wiley-Liss, Inc.

A randomized clinical trial of the effect of yoghurt on the human salivary microflora.

Yoghurt is active against some human pathogens, so this experiment tested whether it is also active against the salivary microflora. A clinical trial was designed, with volunteers aged between 23 and 37 years. Initially, for 8 weeks, they consumed neither yoghurt nor casein-free soybean ice cream (phase 1). They were then split randomly into test (yoghurt) and control (ice cream) groups and required to consume 125 g of these foods twice daily for 8 weeks (phase 2) and then to avoid them for the following 2 weeks (phase 3). Many potential sources of microbial fluctuation were standardized. Salivary samples were then collected at regular intervals of 2 weeks. For each group and phase, the mean logarithms of the salivary counts for total viable flora, oral streptococci, mutans streptococci, lactobacilli and Candida were calculated. The prevalence of Streptococcus thermophilus and Lactobacillus bulgaricus was also assessed. Twenty test and 22 control participants completed the study. At phase 2, the mean for mutans streptococci was lower in the test than in the control group (3.6 vs. 4.0 log colony-forming units/ml; P=0.02). Moreover, the mean had decreased in all test participants with high phase 1 means for lactobacilli as compared to only 36.4% of those with low phase 1 means (P=0.01). L. bulgaricus was transiently detected in three test participants during phase 2. These results suggest that yoghurt does have some activity against the salivary microflora, but this does not seem to be due to the installation of yoghurt microorganisms in the mouth.

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.

Rampant early childhood dental decay: an example from Italy.

OBJECTIVES: This study sought to estimate the prevalence and related prediction factors for dental caries in 3- to 5-year-old children in Rome, Italy. METHODS: From a sample of 2,025 children, 1,494 (73.8%) were included in the analysis. Children with at least two primary maxillary incisors showing evidence of caries experience were considered affected by rampant early childhood dental decay (RECDD). Behavioral and socioeconomic variables, mutans streptococci counts, diet, and nutritional status were investigated for their association with RECDD using regression analysis. RESULTS: The prevalence of any caries was 27.3 percent, and was 7.6 percent for RECDD. Among all children, mean dft and dt scores per person were 1.1 (SD = 2.4) and 0.9 (SD = 2.3), respectively; among those classified as having RECDD, scores were 6.9 (SD = 4.2) and 6.7 (SD = 4.3), respectively. Children with RECDD had 56 percent of all the decayed teeth in the sample. Low and medium social classes, use of a baby bottle filled with sweetened beverages, high salivary mutans streptococcal levels, and malnutrition were directly associated with RECDD; milk and yogurt consumption and low Plaque Index scores were inversely associated with the condition. CONCLUSIONS: The high prevalence of RECDD suggests that the implementation of preventive programs should be a priority for dental public health. Because of its high prevalence among children as young as 3 years of age, preventive measures targeted toward pregnant women and toddlers should be developed and tested, while kindergarten students could be used for monitoring RECDD prevalence and for detection of communities at risk.

Effect of sucrose and glucose on the susceptibility of Streptococcus mutans to cephalosporins.

The effect of the type of sugar used as substrate on the susceptibility of Streptococcus mutans to antibiotics was evaluated. Thirty strains, grown in excess of sucrose (s-MIC) and in excess of glucose (g-MIC), were tested for susceptibility to four cephalosporins. About 21% of the strains were sensitive in the presence of sucrose and resistant in the presence of glucose, whereas only 3% of the strains showed the opposite situation. The mean values of the s-MICs of the four cephalosporins were significantly lower than those of the g-MICs. These findings may also be explained by the synthesis, in excess of sucrose, of insoluble glucan by Streptococcus mutans which increases the interbacterial distance and promotes antibiotic diffusion. Given the susceptibility of Streptococcus mutans grown in excess of sucrose to cefotaxime and cefepime, these antibiotics may be used in the primary prevention of infective endocarditis, when subjects predisposed to endocarditis need invasive dental therapy.

Salivary levels of mutans streptococci associated with restorations: a case-control study.

Our aim was to estimate whether restorative therapy with amalgam and composite resin could decrease salivary mutans streptococcal level, thus also decreasing the risk for other caries development. We selected a case group of 93 children with detectable salivary mutans levels (i.e., at least 1x10(4) cfu/ml), and a control group (n=93 subjects) with undetectable levels. Children had the same age (12 years), no extracted teeth, crowns, temporary fillings, and restorations other than amalgam and composite resin, and the two groups had similar gender distribution. We clinically examined children and recorded active caries, restorations and oral hygiene level by means of gingival bleeding on probing; we also investigated sucrose intake at breakfast. The case group had statistically significant higher prevalence of restorations (36.6% vs. 18.3%), active caries (44.1% vs. 12.9%), and bad oral hygiene (84.9% vs. 68.8%) than the control group. However, the logistic regression analysis showed that presence of active caries was the only significant variable associated with mutans streptococci (OR=4.0; p=0.0002), while the effects of sucrose intake and of restorations were marginally significant. This apparent contrast between statistical analyses was due to the concomitant presence, in children with detectable mutans streptococci level, of restorations and decayed teeth at the same time, and, on the basis of the multivariate analysis, presence of mutans streptococci in these children was explained by the presence of active caries, more than restorations.

[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.