[Experiences with outbreaks of nosocomial infections]. / Erfahrungen aus dem Ausbruchmanagement bei nosokomialen Infektionen.

Ten years after the publication of the recommendation: "Outbreak management and structural proceedings in case of cumulative occurrence of nosocomial infections" of the federal commission of hospital hygiene, these recommendations are now being re-evaluated. To date, the recommendations have proven valid and have maintained their significance for an effective management. However, besides new hygienic-microbiological methods and an increased sensitivity of the perception of nosocomial outbreaks by the public, by politicians and by the press, it is necessary to consider new issues in this field. Outbreaks are tragic events placing an extraordinary burden on all persons involved, which can have significant consequences. Therefore, it is necessary to ensure prompt outbreak management by experienced professionals who must combine a systematic on-site inspection, hygienic-microbiological investigation and typing methods used with epidemiological approaches. To assure these requirements, the support of independent reference centres such as universal hygiene institutes should be guaranteed. Politicians should be involved only after a scientific evaluation of the details of the outbreak has been made. A national documentation centre, e.g. at the Robert Koch Institute, should be established, thereby making experiences with outbreaks widely available.

[The ASL and hospitals: a model of emerging management]. / ASL e ospedali: un modello di gestione emergente.

The authors analysed the advantages and drawbacks of the legislative rules in the Italian medical services. They underline the impediments to the improvement in the quality and efficiency of both the organizing models and the control system of administration. The authors consider a new trend in the administration system taking place in the most innovative and dynamic units and they analyze the efficacy and speediness of diffusion of this new system. The new model could be extended to the ASL and Hospital as a possible improvement of the present situation. The article is structured in two main parts; in the first one the legal changing, that took place in the last year, in the organization of the national medical system is critically examined; the second one summarized the most significant innovation brought by the new administrative system of ASL and hospital.