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.

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.

[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.

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

Antibacterial activity of yoghurt against viridans streptococci in vitro.

OBJECTIVE: Yoghurt consumption leads to a selective decrease in the oral level of mutans streptococci. It is not clear whether this decrease is due to the bactericidal activity of yoghurt or other mechanisms. The present study investigated the differences in susceptibility to yoghurt between several strains of viridans streptococci. DESIGN: The sources of variation were minimised, at the expense of the external validity of the study, using culture collection strains. Each strain was tested separately on five occasions in planktonic form and logarithmic growth phase. Two strains of each of the following Streptococcus species were tested: mutans, sobrinus, gordonii, oralis, parasanguinis and sanguinis. One millilitre [10(8) colony-forming units (cfu)] of each strain was incubated (37 degrees C, 60min) with 9mL of fat-free plain yoghurt containing Streptococcus thermophilus and Lactobacillus bulgaricus (10(8) and 10(7)cfu/g, respectively) in gently vortexed tubes. Survival rates were calculated every 15min by dividing the number of viable cells, obtained using conventional laboratory procedures, by the baseline number. RESULTS: Survival rates were 8% (S. mutans 6519T), 12% (S. mutans 31738), 35% (S. oralis 25671) and >50% (all other species tested) after 15min, and 0.01% (S. mutans) and >10% (all other species tested) after 30min. Overall, S. parasanguinis and S. sobrinus were the most resistant species. When heat-treated yoghurt (<10cfu/g bacteria and inactivated bacteriocins) was used, this antibacterial activity was not found. CONCLUSION: In vitro, yoghurt with live bacteria showed selective anti-mutans activity, suggesting that the overall decrease in mutans streptococci in vivo could be due to a bactericidal effect on S. mutans but not on S. sobrinus.

[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.

[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.

[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.

[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.

[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%).

Gendered experiences of conflict and co-operation in heterosexual relations of Somalis in exile in Gothenburg, Sweden.

Political upheaval and poverty at home has been forcing many Somalis to immigrate. These immigrants do not only leave their physical house, families, relatives, loved ones, friends, but also familiarities, culture, customs, and often they do end up in no man's land being between their own and new home culture. Available reports suggest that there are about 15,000 Somalis in Sweden and their majority came here from late 1989 to 1996. About one third these immigrants live in and around the city of Gothenburg. This paper explores and describes gendered experiences of conflict and co-operation in heterosexual relations of Somalis in exile in Gothenburg, Sweden. A qualitative sociological in-depth interviews with 6 women and 7 men was performed during May 1999 to January 2000. A follow up focus group interviews with 10 people (2 women and 8 men) was also carried on. The results show that both the Somali culture and Muslim religion do not support the children being taught sex education in schools or the names of the sex organs being pronounced other than to be used as metaphors. The girls, unlike their age group males, experience a very painful and terrifying process during childhood in which their self-esteem is downgraded by means of serious degrading traditional active violence such as female genital mutilation and visible virginity control. The narratives tell stories in which Somali women are degraded and expected to obey in situations characterised by their man's arbitrariness. They are subject to a very extensive form of social control, which is especially pronounced on issues regarding sexuality. Their integrity as women is, consequently set aside. When Somali refugees came to Sweden some of them came to adopt much of the modern lifestyle and cultural norm systems, preferable young people and some of the females. Relating to a new culture with its new expectations on the norm obedience also created changes in self-esteem. Exile situation tends to generate horizontal conflicts, among spouses and between groups of people. It also tends to generate vertical conflicts because now generations stand up against each other and this is especially pronounced when it is about issues of sexuality and sexual relations. The young generations questions their parents authority. They are now living in new social context and perceive risks, as well as possibilities. Their new dreams and choices, however, do not fit their parents' expectations, which sometimes leads to big problems. From a traditional perspective these deviants lack of respect for traditions and the original culture. From a male perspective this means more specifically a lack of respect for male dominance and superiority.

[Hygiene education in the Laureate Course of Dentistry and Dental Prosthetics: evaluation of student knowledge about the risk of infection in a dental practice environment]. / L'insegnamento di Igiene nel Corso di Laurea in Odontoiatria e Protesi dentaria: valutazione delle conoscenze degli studenti sul rischio infettivo in ambito odontoiatrico.

Hygiene education for dental students is crucial in order to control and reduce the risk of infections in their future professional practices. The aim of this study was to evaluate the improvement in university students' knowledge of infectious disease prevention, dental instruments and environmental decontamination following the Course in Dental Hygiene and Prevention. 595 questionnaires were submitted to dental students at twelve Italian Universities; 335 were filled out before the Course began and 260 at the end of the same course. The students in both the PRE-course and at the POST-course evaluations demonstrated adequate knowledge regarding the transmission of infections in dental practices, knowledge improved following the Hygiene course.

[Comparison between different methods to monitor the microbial level of indoor air contamination in the dental office]. / Confronto tra diversi metodi di monitoraggio microbiologico dell'aria degli ambulatori odontoiatrici.

There is no unanimous consensus on the best methodology to monitor the microbial contamination level of the air in the dental offices. Therefore, we compared a precise but expensive and complex active air sampler (Surface Air System--SAS) with a passive method (Air Microbiological Index--AMI) and a microbial parameter of salivary microrganisms, (oral streptococci--OS), with other, more simply detectable, yet more generic, parameters (staphilococci--ST total viable flora--TVF). We tested the various combinations of systems and parameters in three multi-chair dental departments, for two different weekdays, before (T0) and during (T1) the working period. Using non-parametric statistical tests we analysed, (i) the difference between T0 and T1 contamination levels assessed by various methods, in order to confirm their efficacy; (ii) the association between parameters, in order to assess whether generic parameters were as reliable as the specific parameter; (iii) the association between sampling systems, in order to test whether AMI could efficaciously substitute the active samplers. The microbial levels were significantly higher at T1 than at T0, excluding ST assessed by SAS. The parameters were highly inter-correlated. However, for low SO levels, the level of the association of this parameter with the others decreased. The results provided by SAS and AMI were also significantly correlated. However, for low contamination levels this association was not significant. In conclusion, the complex and expensive method (SO level assessed by SAS) seems more reliable for low aerial contamination levels, whereas for high levels, more simple and cheap methods could also be used.

[Multicentric survey on hygienic aspects in private dental practice]. / Indagine multicentrica sugli aspetti igienico-sanitari legati all'assistenza odontoiatrica privata.

The aim of this research was to evaluate the knowledge of cross-infection hazards in private dental practices, and their control procedures. The survey, carried out by questionnaire in 11 Italian cities, showed that dental personnel do not completely follow the main procedures for infection control. The interviewed subjects usually wear gloves (95.5%), masks (90.1%) and glasses (91.2%), less frequently caps (23.9%) and coats (54.9%). They use steam sterilizers (92.9%) and periodically check the effectiveness (80.6%). Regarding individuals protection, 20.5% is not vaccinated against HBV and only 55.2% of those previously vaccinated has checked their immunity. Moreover, the majority of subjects underestimate the infection hazards especially for air-transmitted diseases.