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Pasquarella CIM, Auxilia F, Barchitta M, Cristina ML, D'Alessandro D, Mura I, Nobile M, Veronesi L, Albertini R, Agodi A. Air microbial sampling in operating theatres by active and passive methods: equation correlation from the GISIO-ISChIA study results and comparison with the EU GGMP recommendation, towards the definition of threshold values. Acta Biomed 2023; 94:e2023017. [PMID: 36786252 PMCID: PMC9987490 DOI: 10.23750/abm.v94i1.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 02/15/2023]
Abstract
The aim of this study was to calculate the equation of correlation between the microbial air contamination values obtained by active sampling (colony-forming units per cubic metre, CFU/m3) and by passive sampling (Index of microbial air contamination, IMA), by using the data from the ISChIA study, and to compare the values obtained with the recommended limits defined by the EU Guidelines to Good Manufacturing Practice (EU GGMP), 2008, for clean areas used to manufacture sterile medicinal products. Air sampling was performed during 335 elective prosthesis procedures. Correlation between CFU/m3 and IMA values was evaluated using the Spearman test; p<0.05 was considered to indicate significance. This equation was used to calculate the IMA values corresponding to the CFU/m3 recommended threshold values by EU GGMP for the different Grades of microbial contamination. The following correlation equation was obtained: y = 1.86 + 0.12x, where "x" = cfu/m3 value and "y" = IMA value. The relationships between CFU/m3 and IMA values obtained from active and passive sampling during the ISChIA study showed to be in line to those suggested by the EU GGMP for pharmaceutical manufacturing for Grade C and D. This study shows that the EU GGMP relationship could be considered valid also for operating theatres. Both methods, active and passive samplings, can be used to evaluate microbial air quality and highlight critical situations; however, in particular during the activity, passive sampling estimating the risk posed by airborne microorganisms to the surgical wound, can be considered more relevant, and for its simplicity, economy and standardization, can be suggested for routine microbial monitoring.
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Affiliation(s)
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; ASST Fatebenefratelli - Sacco, Milan, Italy.
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy.
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genoa, Genoa, Italy; Hospital Hygiene Unit, E.O. Ospedali Galliera, Genoa, Italy.
| | - Daniela D'Alessandro
- Department of Civil Building and Environmental Engineering, "Sapienza" University of Rome, Rome, Italy .
| | - Ida Mura
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
| | - Marta Nobile
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Roberto Albertini
- Department of Medicine and Surgery, University of Parma, Parma, Italy; U.O. Medicina Interna di Continuità, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy.
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Bravo G, Cattani G, Malacarne F, Tricarico P, Arnoldo L, Brunelli L, Zotti C, Moro ML, Diegoli G, Pezzotti P, Bella A, Pantosti A, Punzo O, Grossi A, Barchitta M, Agodi A, Castellini G, Marrazzo M, Auxilia F, Cavallaro G, Alborali GL, Mazzolini E, Brusaferro S. SPiNCAR: A systematic model to evaluate and guide actions for tackling AMR. PLoS One 2022; 17:e0265010. [PMID: 35271635 PMCID: PMC8912127 DOI: 10.1371/journal.pone.0265010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Italy records very alarming levels antimicrobial resistance (AMR), so a National Action Plan on Antimicrobial resistance (PNCAR) was developed, adopting the AMR European Union’s recommendations based on the results of the ECDC site visit of January 2017. For achieving PNCAR objectives, it is necessary to support and harmonize the implementation of recommendations in all the different healthcare levels (regional authorities and local trusts), so the SPiNCAR project was launched to create a tool for reaching this goal. Methods We developed a framework based on a scientific literature and national and international guidelines. Firstly, we identified the major intervention areas for tackling AMR, then, for each area, we built a set of standards, both for regional authorities than for local trusts. Every standard is composed by a set of essential and additional criteria, which refer to a minimum or supplemental performance level respectively. The contents were firstly discussed by the project’s team during face-to-face kick-off meetings, then confirmed with Delphi methodology and finally validated through a pilot study. Results The final framework consists of seven different areas that reflect the PNCAR structure: Governance, Surveillance and Monitoring, Appropriate Use of antimicrobials, Healthcare-associated Infections (HAIs) control and prevention, Education and Training, Alliance among Stakeholders, Implementation. The total number of standards for the regional framework was 34 with 264 criteria and for the local version 36 criteria with 279 standards. Conclusion The ongoing use of this tool, developed on international evidences and recommendations that were tailored on the Italian specific context, allows monitoring the improvement achieved over time and plan the next steps.
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Affiliation(s)
- Giulia Bravo
- Department of Medicine, University of Udine, Udine, Italy
| | | | | | | | - Luca Arnoldo
- Friuli Centrale Healthcare University Trust, Udine, Italy
- * E-mail:
| | - Laura Brunelli
- Friuli Centrale Healthcare University Trust, Udine, Italy
| | - Carla Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Maria Luisa Moro
- Regional Health and Social Agency of Emilia-Romagna, Bologna, Italy
| | - Giuseppe Diegoli
- Direzione Generale Cura della Persona, Salute e Welfare Regione Emilia-Romagna, Bologna, Italy
| | | | | | | | | | - Adriano Grossi
- Italian National Institute of Health, Rome, Italy
- ASL Roma 1, Rome, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | | | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan—ASST Fatebenefratelli- Sacco, Milan, Italy
| | | | - Giovanni Loris Alborali
- Direzione Generale Cura della Persona, Salute e Welfare Regione Emilia-Romagna, Bologna, Italy
| | - Elena Mazzolini
- Department of Epidemiology, Istituto Zooprofilattico Sperimentale delle Venezie, Padua, Italy
| | - Silvio Brusaferro
- Department of Medicine, University of Udine, Udine, Italy
- Italian National Institute of Health, Rome, Italy
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Castaldi S, Perrone PM, Luconi E, Marano G, Auxilia F, Maraschini A, Bono P, Alagna L, Palomba E, Bandera A, Boracchi P, Biganzoli E. Hospital acquired infections in COVID-19 patients in sub intensive care unit: analysis of two waves of admissions. Acta Biomed 2022; 93:e2022313. [PMID: 36300221 PMCID: PMC9686160 DOI: 10.23750/abm.v93i5.13402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/13/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIM The pandemic caused by SARS-COV-2 has increased Semi-Intensive Care Unit (SICU) admission, causing an increase in healthcare-associated infection (HAI). Mostly HAI reveals the same risk factors, but fewer studies have analyzed the possibility of multiple coinfections in these patients. The study aimed was to identify patterns of co-presence of different species describing at the same time the association between such patterns and patient demographics and, finally, comparing the patterns between the two cohorts of COVID-19 patients admitted at Policlinico during the first wave and the second one). METHODS All the patients admitted to SICUs during two COVID-19 waves, from March to June 2020 months and from October to December 2020, were screened following the local infection control surveillance program; whoever manifested fever has undergone on microbiological culture to detect bacterial species. Statistical analysis was performed to observe the existence of microbiological patterns through DBSCAN method. RESULTS 246 patients were investigated and 83 patients were considered in our study because they presented infection symptoms with a mean age of 67 years and 33.7% of female patients. During the first and second waves were found respectively 10 and 8 bacterial clusters with no difference regarding the most frequent species. CONCLUSIONS The results show the importance of an analysis which considers the risk factors for the possibility of co- and superinfection (such as age and gender) to structure a good prognostic tool to predict which patients will encounter severe coinfections during hospitalization.
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Affiliation(s)
- Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Pier Mario Perrone
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Ester Luconi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) “L. Sacco”, LITA Vialba Campus, Università degli Studi di Milano
| | - Giuseppe Marano
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) “L. Sacco”, LITA Vialba Campus, Università degli Studi di Milano
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Anna Maraschini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Patrizia Bono
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Laura Alagna
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Emanuele Palomba
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy, Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, 20122 Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy, Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, 20122 Milan, Italy
| | - Patrizia Boracchi
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) “L. Sacco” & DSRC, LITA Vialba Campus, Università degli Studi di Milano
| | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) “L. Sacco” & DSRC, LITA Vialba Campus, Università degli Studi di Milano
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4
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Castaldi S, Gandolfi CE, Franchini A, Galimberti PM, Piga M, Auxilia F, Porro A. The first major vaccination campaign against smallpox in Lombardy: the mass vaccination campaign against coronavirus…nothing new…only terminology. Acta Biomed 2022; 93:e2022101. [PMID: 35315406 PMCID: PMC8972850 DOI: 10.23750/abm.v93i1.11910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
Terminology, technology, communication and organizational strategies are different but we tried to compare the mass vaccination campaign against smallpox with the one we are doing against coronavirus.
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Affiliation(s)
- Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | - Antonia Franchini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy, CRC Centre for Environmental Health, University of Milan, Milan, Milano, Italy
| | | | - Maria Piga
- Department of Oncology and Hematology-Oncology, University of Milan, Milano, Italy, ASST Fatebenefratelli e Sacco, Milano, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy, ASST Fatebenefratelli e Sacco, Milano, Italy
| | - Alessandro Porro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy, CRC Centre for Environmental Health, University of Milan, Milan, Milano, Italy
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5
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Piscitelli A, Bevilacqua L, Labella B, Parravicini E, Auxilia F. A Keyword Approach to Identify Adverse Events Within Narrative Documents From 4 Italian Institutions. J Patient Saf 2022; 18:e362-e367. [PMID: 32910039 DOI: 10.1097/pts.0000000000000783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Existing methods for measuring adverse events in hospitals intercept a restricted number of events. Text mining refers to a range of techniques to extract data from narrative sources. The goal of this study was to evaluate the performance of an automated approach for extracting adverse event keywords from within electronic health records. METHODS The study involved 4 medical centers in the Region of Lombardy. A starting set of keywords was trained in an iterative process to develop queries for 7 adverse events, including those used by the Agency for Healthcare Research and Quality as patient safety indicators. We calculated positive predictive values of the 7 queries and performed an error analysis to detect reasons for false-positive cases of pulmonary embolism, deep vein thrombosis, and urinary tract infection. RESULTS Overall, 397,233 records were collected (34,805 discharge summaries, 292,593 emergency department notes, and 69,835 operation reports). Positive predictive values were higher for postoperative wound dehiscence (83.83%) and urinary tract infection (73.07%), whereas they were lower for deep vein thrombosis (5.37%), pulmonary embolism (13.63%), and postoperative sepsis (12.28%). The most common reasons for false positives were reporting of past events (42.25%), negations (22.80%), and conditions suspected by physicians but not confirmed by a diagnostic test (11.25%). CONCLUSIONS The results of our study demonstrated the feasibility of using an automated approach to detect multiple adverse events in several data sources. More sophisticated techniques, such as natural language processing, should be tested to evaluate the feasibility of using text mining as a routine method for monitoring adverse events in hospitals.
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Affiliation(s)
- Antonio Piscitelli
- From the Post-graduate School of Hygiene and Preventive Medicine, University of Milan, Milan
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6
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Piscitelli A, Agodi A, Agozzino E, Arrigoni C, Barchitta M, Brusaferro S, Castaldi S, Castiglia P, Cozzi L, D'Errico MM, De Caro F, De Giglio O, Iannazzo S, Laganà P, Laurenti P, Mascipinto S, Montagna MT, Mura I, Pasquarella C, Veronesi L, Rossi F, Ripabelli G, Rossini A, Scippa F, Sodano L, Squeri R, Staniscia T, Torregrossa V, Auxilia F. The Clean Care Contest: promoting hand hygiene among healthcare and medical students. Ann Ig 2021; 32:462-471. [PMID: 32744581 DOI: 10.7416/ai.2020.2370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite continuing efforts, compliance rates and knowledge of best practices in hand hygiene remain disappointing. Recognizing that conventional educational tools seem out of touch with young people and that the med and messages contents need refreshing, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health devised a novel approach to promote the creation of innovative educational tools for improving knowledge of, and compliance with, hand hygiene rules among healthcare and medical students. METHODS A contest in creating educational material on hand hygiene practices involved university students of nursing and medicine, and of other healthcare degrees. Students from the universities of the GISIO network were invited to create educational material (e.g., videos, posters, presentations, leaflets, and screensavers) to be presented by May 5th 2019 during the World Hand Hygiene Day / Save Lives: Clean Your Hands Global Annual Initiative of the World Health Organization). A local and a national winners were awarded. RESULTS Three different local and national contests were performed during 2016, 2017 and 2018. During the three-year period, more than 270 educational tools have been developed: 130 (48%) were judged useful for hand hygiene promotion campaigns. The most frequent projects participating in the contests were videos (39%), posters (29%), leaflets (14%), and others (18%) submitted by more than 1,500 students of nursing (40%), medicine (31%), dentistry (7%), and of other healthcare courses in 14 universities. Products were evaluated by a local committee and, subsequently, local winners represented their University in a national contest. CONCLUSIONS The contest provided a framework for the creation of innovative and potentially effective educational tools via an engaging approach that leveraged student creativity. Given the need to improve compliance rates, this study suggests that new ways can be advantageously explored to teach hand hygiene procedures and increase awareness of the importance of their consistent use among healthcare and medical students.
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Affiliation(s)
- A Piscitelli
- Hospital Health Management, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy
| | - E Agozzino
- Department of Experimental Medicine, University of Campania Vanvitelli, Napoli, Italy
| | - C Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Unit of Hygiene, University of Pavia, Italy
| | - M Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy
| | - S Brusaferro
- Department of Medicine, University of Udine, Italy
| | - S Castaldi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Ca' Granda, Milan, Italy
| | - P Castiglia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - L Cozzi
- School of Specialization in Pediatrics, University of Milan, Italy
| | - M M D'Errico
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Torrette di Ancona, Italy
| | - F De Caro
- Department of Medicine, Surgery, Odontoiatrics University of Salerno, Fisciano (SA), Italy
| | - O De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - S Iannazzo
- Department of Prevention, ASL Roma 3, Rome, Italy
| | - P Laganà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - P Laurenti
- Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - S Mascipinto
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - M T Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - I Mura
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - C Pasquarella
- Department of Medicine and Surgery University of Parma, Italy
| | - L Veronesi
- Department of Medicine and Surgery University of Parma, Italy
| | - F Rossi
- European Institute of Design, Milan, Italy
| | - G Ripabelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Italy
| | - A Rossini
- IRCCS Santa Lucia Foundation Rome, Italy
| | | | - L Sodano
- Our Lady of Good Counsel, Catholic University, Elbasan, Albania
| | - R Squeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - T Staniscia
- Department of Medicine and Aging Sciences, University of Chieti-Pescara "G. D'Annunzio", Chieti, Italy
| | - V Torregrossa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties University of Palermo, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, ASST Fatebenefratelli - Sacco, Milan, Italy
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Castaldi S, Luconi E, Rivieccio BA, Boracchi P, Marano G, Pariani E, Romano L, Auxilia F, Nicolussi F, Micheletti A, Manzi G, Salini S, Galli M, Biganzoli E. Are Epidemiological Estimates Able to Describe the Ability of Health Systems to Cope with COVID-19 Epidemic? Risk Manag Healthc Policy 2021; 14:2221-2229. [PMID: 34104013 PMCID: PMC8180273 DOI: 10.2147/rmhp.s290801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) epidemic is an infectious disease which was declared a pandemic and hit countries worldwide from the beginning of the year 2020. Despite the emergency vigilance plans, health systems in all countries experienced a different ratio of lethality, amount of admissions to intensive care units and quarantine management of positive patients. The aim of this study is to investigate whether some epidemiological estimates could have been useful in understanding the capacity of the Italian Regional Health Services to manage the COVID-19 epidemic. Methods We have compared data between two different Italian regions in the Northern part of Italy (Lombardy and Veneto) and the national data to determine whether different health strategies might be significant in explaining dissimilar patterns of the COVID-19 epidemic in Italy. Data have been extracted from a public database and were available only in an aggregated form. Results The regions in question displayed two different health policies to face the COVID-19 epidemic: while Veneto’s health service was largely territorially oriented, Lombardy’s strategy was more hospital-centered. Discussion The key to facing epidemics like this one consists in identifying solutions outside of hospitals. This however requires there be well-trained general practitioners and enough healthcare personnel working outside hospitals.
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Affiliation(s)
- Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Milan, Italy
| | - Ester Luconi
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | | | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | - Giuseppe Marano
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | - Elena Pariani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Milan, Italy
| | - Luisa Romano
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Milan, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Federica Nicolussi
- Department of Economics, Management and Quantitative Methods & DSRC, University of Milan, Milan, Italy
| | | | - Giancarlo Manzi
- Department of Economics, Management and Quantitative Methods & DSRC, University of Milan, Milan, Italy
| | - Silvia Salini
- Department of Economics, Management and Quantitative Methods & DSRC, University of Milan, Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
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Rivieccio BA, Micheletti A, Maffeo M, Zignani M, Comunian A, Nicolussi F, Salini S, Manzi G, Auxilia F, Giudici M, Naldi G, Gaito S, Castaldi S, Biganzoli E. CoViD-19, learning from the past: A wavelet and cross-correlation analysis of the epidemic dynamics looking to emergency calls and Twitter trends in Italian Lombardy region. PLoS One 2021; 16:e0247854. [PMID: 33630966 PMCID: PMC7906455 DOI: 10.1371/journal.pone.0247854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/15/2021] [Indexed: 01/22/2023] Open
Abstract
The first case of Coronavirus Disease 2019 in Italy was detected on February the 20th in Lombardy region. Since that date, Lombardy has been the most affected Italian region by the epidemic, and its healthcare system underwent a severe overload during the outbreak. From a public health point of view, therefore, it is fundamental to provide healthcare services with tools that can reveal possible new health system stress periods with a certain time anticipation, which is the main aim of the present study. Moreover, the sequence of law decrees to face the epidemic and the large amount of news generated in the population feelings of anxiety and suspicion. Considering this whole complex context, it is easily understandable how people "overcrowded" social media with messages dealing with the pandemic, and emergency numbers were overwhelmed by the calls. Thus, in order to find potential predictors of possible new health system overloads, we analysed data both from Twitter and emergency services comparing them to the daily infected time series at a regional level. Particularly, we performed a wavelet analysis in the time-frequency plane, to finely discriminate over time the anticipation capability of the considered potential predictors. In addition, a cross-correlation analysis has been performed to find a synthetic indicator of the time delay between the predictor and the infected time series. Our results show that Twitter data are more related to social and political dynamics, while the emergency calls trends can be further evaluated as a powerful tool to potentially forecast new stress periods. Since we analysed aggregated regional data, and taking into account also the huge geographical heterogeneity of the epidemic spread, a future perspective would be to conduct the same analysis on a more local basis.
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Affiliation(s)
- Bruno Alessandro Rivieccio
- Department of Laboratory Medicine, Division of Anatomic Pathology, Niguarda Hospital, Milan, Italy
- * E-mail:
| | | | - Manuel Maffeo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Public Health Post Graduate School, University of Milan, Milan, Italy
| | - Matteo Zignani
- Department of Computer Science, University of Milan, Milan, Italy
| | | | - Federica Nicolussi
- Department of Economics, Management and Quantitative Methods & Data Science Research Center, University of Milan, Milan, Italy
| | - Silvia Salini
- Department of Economics, Management and Quantitative Methods & Data Science Research Center, University of Milan, Milan, Italy
| | - Giancarlo Manzi
- Department of Economics, Management and Quantitative Methods & Data Science Research Center, University of Milan, Milan, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- ASST FBF-Sacco, Milan, Italy
| | - Mauro Giudici
- Department of Earth Sciences, University of Milan, Milan, Italy
| | - Giovanni Naldi
- Department of Environmental Science and Policy, University of Milan, Milan, Italy
| | - Sabrina Gaito
- Department of Computer Science, University of Milan, Milan, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Milan, Italy
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health & Data Science Research Center, University of Milan, Milan, Italy
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9
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Smaniotto C, Battistella C, Brunelli L, Ruscio E, Agodi A, Auxilia F, Baccolini V, Gelatti U, Odone A, Prato R, Tardivo S, Voglino G, Valent F, Brusaferro S, Balzarini F, Barchitta M, Carli A, Castelli F, Coppola C, Iannelli G, Milazzo M, Rosina B, Salerno C, Siliquini R, Sisi S. Sustainable Development Goals and 2030 Agenda: Awareness, Knowledge and Attitudes in Nine Italian Universities, 2019. Int J Environ Res Public Health 2020; 17:ijerph17238968. [PMID: 33276530 PMCID: PMC7730411 DOI: 10.3390/ijerph17238968] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022]
Abstract
Sustainable Development Goals (SDGs) and 2030 Agenda represent global development programs. Education can widen the acknowledgement of their relevance and their applications. This survey aims to assess awareness, knowledge and attitudes towards SDGs and sustainability among first-year students in nine Italian Universities. A Likert scale-based online questionnaire of 70 items was compiled by students from March to July 2019. It examined knowledge and expectations referred to sustainable development concepts, indicators and documents/models accounting for sociodemographic variables. Statistical analyses performed were Chi-square test, Fisher’s Exact test, Kendall’s W correlation coefficient, univariate and multivariate analysis. The questionnaire was completed by 1676 students. A low percentage referred a good knowledge of SDGs and 2030 Agenda, most of them had never attended related educational activities previously. Better knowledge of SDGs and 2030 Agenda was observed in case of previous specific educational activities (p < 0.001). The expectation towards university guaranteeing an education on SDGs was high, both for personal wisdom and for usefulness in future professional context. A significant difference (p < 0.001) in such expectations was found, as healthcare students were less interested than colleagues of other areas. The results showed low knowledge but interest towards sustainable development. A scheduled implementation of academic initiatives should be considered.
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Affiliation(s)
- Cecilia Smaniotto
- Department of Medicine, University of Udine, 33100 Udine, Friuli Venezia Giulia, Italy; (C.B.); (L.B.); (E.R.); (S.B.)
- Correspondence: ; Tel.: +39-0432-554767
| | - Claudio Battistella
- Department of Medicine, University of Udine, 33100 Udine, Friuli Venezia Giulia, Italy; (C.B.); (L.B.); (E.R.); (S.B.)
| | - Laura Brunelli
- Department of Medicine, University of Udine, 33100 Udine, Friuli Venezia Giulia, Italy; (C.B.); (L.B.); (E.R.); (S.B.)
- Friuli Centrale Healthcare and University Integrated Trust, 33100 Udine, Friuli Venezia Giulia, Italy;
| | - Edoardo Ruscio
- Department of Medicine, University of Udine, 33100 Udine, Friuli Venezia Giulia, Italy; (C.B.); (L.B.); (E.R.); (S.B.)
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Sicilia, Italy; (A.A.); (M.B.)
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Lombardia, Italy;
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Lazio, Italy; (V.B.); (C.S.)
| | - Umberto Gelatti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Lombardia, Italy;
| | - Anna Odone
- Faculty of Medicine and Surgery, University Vita-Salute San Raffaele, 20132 Milan, Lombardia, Italy; (A.O.); (F.B.)
| | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Puglia, Italy; (R.P.); (C.C.); (G.I.); (M.M.); (S.S.)
| | - Stefano Tardivo
- Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Veneto, Italy; (S.T.); (A.C.)
| | - Gianluca Voglino
- Department of Public Health Sciences and Pediatrics, University of Turin, 10124 Turin, Piemonte, Italy; (G.V.); (R.S.)
| | - Francesca Valent
- Friuli Centrale Healthcare and University Integrated Trust, 33100 Udine, Friuli Venezia Giulia, Italy;
| | - Silvio Brusaferro
- Department of Medicine, University of Udine, 33100 Udine, Friuli Venezia Giulia, Italy; (C.B.); (L.B.); (E.R.); (S.B.)
| | - Federica Balzarini
- Faculty of Medicine and Surgery, University Vita-Salute San Raffaele, 20132 Milan, Lombardia, Italy; (A.O.); (F.B.)
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Sicilia, Italy; (A.A.); (M.B.)
| | - Alberto Carli
- Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Veneto, Italy; (S.T.); (A.C.)
| | - Francesco Castelli
- University Research and Documentation Center for the 2030 Sustainable Development Agenda, Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, 25123 Brescia, Lombardia, Italy;
| | - Cristina Coppola
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Puglia, Italy; (R.P.); (C.C.); (G.I.); (M.M.); (S.S.)
| | - Giuseppina Iannelli
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Puglia, Italy; (R.P.); (C.C.); (G.I.); (M.M.); (S.S.)
| | - Marica Milazzo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Puglia, Italy; (R.P.); (C.C.); (G.I.); (M.M.); (S.S.)
| | - Barbara Rosina
- Advisory and Career Service, University of Milan, 20122 Milan, Lombardia, Italy;
| | - Carla Salerno
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Lazio, Italy; (V.B.); (C.S.)
| | - Roberta Siliquini
- Department of Public Health Sciences and Pediatrics, University of Turin, 10124 Turin, Piemonte, Italy; (G.V.); (R.S.)
| | - Sauro Sisi
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Puglia, Italy; (R.P.); (C.C.); (G.I.); (M.M.); (S.S.)
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10
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Consonni D, Bordini L, Nava C, Todaro A, Lunghi G, Lombardi A, Magioni D, De Palo F, Guerrieri L, Gatti M, Serra D, Polonioli M, Pratò S, Muscatello A, Bandera A, Auxilia F, Castaldi S. COVID-19: What happened to the healthcare workers of a research and teaching hospital in Milan, Italy? Acta Biomed 2020; 91:e2020016. [PMID: 32921712 PMCID: PMC7716960 DOI: 10.23750/abm.v91i3.10361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023]
Abstract
The paper wants to present the data of infection of the Health Care Workers of a research and teaching hospital in Milan, Italy. The majority (2554, 55.9%) of 4572 HCWs were tested for SARS-CoV-2 and 8.8% were found positive. Most of the tested workers were women, but we found higher relative frequency of positivity for men, even after adjustment for age, working area, and occupation. The higher frequency of positive tests in the medicine area is probably explained by the higher concentration in that area of COVID-19 patients. Conversely, the low frequency of positive HCWs in intensive care units is probably explained by the diffuse and continuous use of PPD. Our results show that HCWs in a research and teaching hospital in the most hit Region in Italy had a similar pattern of infection as all other HCWs all over the world. The problem of SARS-CoV-2 infections among the hospital personnel HCWs should remind us the concerns about hospital acquired infections both for patients and HCWs.
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Affiliation(s)
- Dario Consonni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Lorenzo Bordini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Carlo Nava
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Aldo Todaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giovanna Lunghi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Andrea Lombardi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Davide Magioni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Francesco De Palo
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Lidia Guerrieri
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Michele Gatti
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Daniele Serra
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Marco Polonioli
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Simone Pratò
- 2Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Italy.
| | - Antonio Muscatello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alessandra Bandera
- Centre for Multidisciplinary Research in Health Sciences (MACH), University of Milan, Italy.
| | - Francesco Auxilia
- Dept Biomedical Sciences for Health, University of Milan, Italy and ASST Fatebenefratelli e Sacco, Milan, Italy.
| | - Silvana Castaldi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Dept Biomedical Sciences for Health, University of Milan, Italy.
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11
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Castaldi S, Luconi E, Marano G, Auxilia F, Maraschini A, Bono P, Ungaro R, Bandera A, Boracchi P, Biganzoli E. Hospital Acquired Infections in COVID-19 patients in sub intensive care unit. Acta Biomed 2020; 91:e2020017. [PMID: 32921713 PMCID: PMC7717023 DOI: 10.23750/abm.v91i3.10376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 01/28/2023]
Abstract
The aim of this study is to assess the association among species of bacteria and to identify the presence of clusters of patients in sub intensive care unit with different profiles of infection, and to study the relationship between such profiles and patient demographics (gender, age), kind of investigations and material used to detect the infection. The findings need to analyse a bigger amount of data in the same setting to make evident that it is constant the infection only with Escherichia coli and Staphylocossus epidemidis and a third case in which more bacteria are inlvolved.
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Affiliation(s)
- Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Hospital, Milan, Italy.
| | - Ester Luconi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Italia.
| | - Giuseppe Marano
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
| | | | - Anna Maraschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Italia.
| | - Patrizia Bono
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Policlinico Milano Italia.
| | - Riccardo Ungaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Italia.
| | - Alessandra Bandera
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti University of Milan Italy .
| | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
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12
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Principi N, Carnevali D, Grimoldi L, Merlo A, Rodà F, Auxilia F, Lombardi F, Maini M, Brianti R, Castaldi S. Appropriate admission to rehabilitation: definition of a set of criteria through the Delphi Method. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Controlling inappropriateness of care, a widespread phenomenon, should be a global target in order to improve the quality of care, save money and ensure system sustainability. Inappropriateness is a relevant issue in public health and in rehabilitation medicine specifically. In fact, admitting a patient to a rehabilitation hospital or unit is a complex decision also due to the absence of shared and objective admission criteria. Aim of this study is to define clinical admission criteria and rules in rehabilitation medicine.
Methods
A three-round Delphi survey was conducted on a sample of rehabilitation medicine experts skilled in both rehabilitation and healthcare organization. The two initial rounds consisted of an electronic online questionnaire concerning appropriateness of admission to intensive rehabilitation while in the third one a report of the results was provided to the participants. The experts had to score their agreement with each item in the questionnaires, based on either a Likert scale or a dichotomous statement. Consensus between the experts was assessed.
Results
A total of 53 health professionals completed the Delphi survey. 19 out of 20 Italian regions were represented. The first round consisted of 8 multiple-choice questions questionnaire. The second round was designed thanks to the suggestions provided by the panelists in the previous one and consisted of a twelve items questionnaire. At the end of the survey, eight criteria of appropriateness of admission to rehabilitation were identified and five rules defining an appropriate admission to a rehabilitation facility were elaborated.
Conclusions
This study represents an attempt to create a worthwhile and reliable tool for a more conscious clinical practice in admission to rehabilitation, based on a set of shared criteria and rules.
Key messages
Improving appropriateness in healthcare delivery must be a primary goal in public health and in rehabilitation medicine specifically. Delphi method was applied to define shared clinical admission criteria and rules in rehabilitation.
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Affiliation(s)
- N Principi
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - D Carnevali
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - L Grimoldi
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - A Merlo
- LAM-Motion Analysis Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, San Sebastiano Hospital, Correggio, Italy
- Rehabilitation Medicine Service, Rehabilitation Geriatrics Department of the NHS21 University Hospital of Parma, Parma, Italy
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - F Rodà
- Rehabilitation Medicine Service, Rehabilitation Geriatrics Department of the NHS21 University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - F Lombardi
- Neurorehabilitation Unit, Azienda USL-IRCCS di Reggio Emilia, San Sebastiano Hospital, Correggio, Italy
| | - M Maini
- San Giacomo Hospital, Ponte dell'Olio, Piacenza, Italy
| | - R Brianti
- Rehabilitation Medicine Service, Rehabilitation Geriatrics Department of the NHS21 University Hospital of Parma, Parma, Italy
| | - S Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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13
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Auxilia F, Maraschini A, Bono P, Ungaro R, Luconi E, Biganzoli E, Castaldi S. COVID-19: new scenario old problems. Acta Biomed 2020; 91:90-91. [PMID: 32701922 PMCID: PMC8023089 DOI: 10.23750/abm.v91i9-s.10119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022]
Abstract
The short paper present the problem of hospital acquired infection in subintensive units og a research and teaching hospital.
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Affiliation(s)
- Francesco Auxilia
- Department of Biomedical Sciences for Health University of Milan, Italy.
| | - Anna Maraschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Patrizia Bono
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Riccardo Ungaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Ester Luconi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy.
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health and DSRC, University of Milan, Italy.
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14
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Merlo A, Rodà F, Carnevali D, Principi N, Grimoldi L, Auxilia F, Lombardi F, Maini M, Brianti R, Castaldi S. Appropriateness of admission to rehabilitation: definition of a set of criteria and rules through the application of the Delphi method. Eur J Phys Rehabil Med 2020; 56:537-546. [PMID: 32667147 DOI: 10.23736/s1973-9087.20.06148-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Controlling inappropriateness of care is an essential issue, especially in rehabilitation medicine. In fact, admitting a patient to a rehabilitation hospital or unit is a complex decision also due to the absence of shared and objective admission criteria. AIM The aim was to define clinical admission criteria and rules in rehabilitation medicine. DESIGN Survey based on the application of the Delphi method on a sample of rehabilitation medicine experts. SETTING Administration of electronic online questionnaires concerning appropriateness of admission to intensive rehabilitation. POPULATION Volunteer sample of 53 experts with the following inclusion criteria: being members of the Italian Society of Physical and Rehabilitation Medicine, having practical experience in the research field, agreeing to the confidentiality of the information and being skilled in both rehabilitation and healthcare organization. METHODS A three-round Delphi survey was conducted according to international guidelines. The two initial rounds consisted of an electronic online questionnaire while in the third one a report of the results was provided to the participants. The experts had to score their agreement with each item in the questionnaires, based on either a Likert scale or a dichotomous statement. Consensus between the experts was assessed. RESULTS A total of 53 health professionals completed the Delphi survey. 19 out of 20 Italian regions were represented. The first round consisted of 8 multiple-choice questions. The second round was designed according to the suggestions provided by the panelists in the previous one and consisted of a twelve items questionnaire. At the end of the survey, seven criteria of appropriateness of admission to rehabilitation were identified and five rules defining an appropriate admission to a rehabilitation facility were elaborated. CONCLUSIONS This study represents an attempt to create a worthwhile and reliable tool for a more conscious clinical practice in admission to rehabilitation, based on a set of shared criteria and rules. CLINICAL REHABILITATION IMPACT To increase appropriateness of admission to rehabilitation. Improving appropriateness in healthcare delivery must be a primary goal in order to improve healthcare quality, save money and ensure system sustainability.
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Affiliation(s)
- Andrea Merlo
- LAM-Motion Analysis Laboratory, Department of Neuromotor and Rehabilitation, San Sebastiano di Correggio Hospital, USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy.,Rehabilitation Medicine Service, Department of Rehabilitation Geriatrics, NHS-University Hospital of Parma, Parma, Italy.,Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Francesca Rodà
- Rehabilitation Medicine Service, Department of Rehabilitation Geriatrics, NHS-University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Italy
| | - Davide Carnevali
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy -
| | - Niccolò Principi
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ludovico Grimoldi
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Maggiore Polyclinic Hospital, IRCCS Ca' Granda Foundation, Milan, Italy
| | - Francesco Lombardi
- Unit of Neurorehabilitation, Department of Neuromotor and Rehabilitation, San Sebastiano di Correggio Hospital, USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Rodolfo Brianti
- Rehabilitation Medicine Service, Department of Rehabilitation Geriatrics, NHS-University Hospital of Parma, Parma, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Maggiore Polyclinic Hospital, IRCCS Ca' Granda Foundation, Milan, Italy
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15
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Moscheni M, Vergani P, Cetin I, Cromi A, Ghezzi F, Locatelli A, Iurlano E, Marconi A, Auxilia F, Bevilacqua L, Dell'Oro S, Picchetti CM, Scotti L, Trivelli M, Burato E. [The use of RCGO triggers in the obstetric - gynecological procedures: the impact on the reduction of adeverse events. The experience of the Lombardia Region]. Ig Sanita Pubbl 2020; 76:241-255. [PMID: 33161421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The last few weeks of pregnancy are critical to a baby's health because important organs, including the brain and lungs, are not completely developed until the end of pregnancy. The adverse events during labor and childbirth can have very serious physical, psychological and financial consequences for the child, the family, health professionals and the whole community. These events can be reduced through interventions aimed at improving the safety and quality of care, based on evidence-based knowledge, guidelines and practices that must be widely and effectively applied. This work reports the experience of the Lombardy Region on improvement actions in the obstetric and gynecological procedures for the reduction of adverse events and sentinel events through the monitoring and management of the RCGS trigger tool.
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Affiliation(s)
- M Moscheni
- Coordinatore del Gruppo di Lavoro regionale Trigger in sala parto
| | - P Vergani
- Direttore della Scuola di Specialità di Ostetricia e Ginecologia Università degli Studi di Milano Bicocca
| | - I Cetin
- Professore Ordinario di Ostetricia e Ginecologia, Università degli Studi di Milano
| | - A Cromi
- Professore Associato Ostetricia e Ginecologia Università degli Studi dell'Insubria
| | - F Ghezzi
- Professore Ordinario di Ostetricia e Ginecologia, Università degli Studi dell'Insubria
| | - A Locatelli
- Direttore S.C. Ostetricia e Ginecologia ASST Vimercate
| | - E Iurlano
- Dirigente Medico. Responsabile Sala Parto IRCCS Policlinico Milano
| | - A Marconi
- Professore Ordinario di Ostetricia e Ginecologia, Università degli Studi di Milano
| | - F Auxilia
- Risk Manager, ASST Fatebenefratelli Sacco
| | | | - S Dell'Oro
- Scuola di Specializzazione in Ostetricia e Ginecologia Università degli studi Milano Biccocca
| | - C M Picchetti
- Centro Regionale gestione del rischio in sanità e sicurezza del paziente, DG Welfare - Regione Lombardia
| | - L Scotti
- Centro Regionale gestione del rischio in sanità e sicurezza del paziente, DG Welfare - Regione Lombardia
| | - M Trivelli
- Direttore DG Welfare - Regione Lombardia
| | - E Burato
- Coordinatore Centro Regionale gestione del rischio in sanità e sicurezza del paziente, DG Welfare - Regione Lombardia
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16
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De Filippis G, Cavazzana L, Errico M, Olivieri P, Parravicini E, Curci R, De Murtas G, Gimigliano A, Carnevali D, Letzgus M, Visconti A, Castaldi S, Auxilia F. After the COVID 19 outbreak in Italy: What have we learnt? Travel Med Infect Dis 2020; 38:101761. [PMID: 32497768 PMCID: PMC7263234 DOI: 10.1016/j.tmaid.2020.101761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | - Laura Cavazzana
- Graduate School of Public Health, University of Milan, Italy
| | - Marisa Errico
- Medical Management Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Pietro Olivieri
- Medical Management Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Rossella Curci
- Medical Management Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | | | | | - Matteo Letzgus
- Graduate School of Public Health, University of Milan, Italy
| | | | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan - IRCCS Ca' Granda, Milan, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan - ASST Fatebenefratelli - Sacco, Milan, Italy
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17
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Franchini AF, Auxilia F, Galimberti PM, Piga MA, Castaldi S, Porro A. COVID 19 and Spanish flu pandemics: All it changes, nothing changes. Acta Biomed 2020; 91:245-250. [PMID: 32420960 PMCID: PMC7569644 DOI: 10.23750/abm.v91i2.9625] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 11/23/2022]
Abstract
The Corona Virus 19 (COVID 19) epidemic is an infectious disease which was declared as a pandemic and hit all the Countries, all over the world, from the beginning of the year 2020. There are many similarities between the COVID 19 epidemic and the Spanish flu epidemic. We considered some preventive measures which do not change in the two epidemics.
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Affiliation(s)
| | | | | | | | | | - Alessandro Porro
- Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Italy.
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Nembrini S, Ceretti E, Gelatti U, Castaldi S, Schulz P, Levaggi R, Auxilia F, Covolo L. Willingness to pay for risky lifestyles: results from the Pay for Others (PAY4O) study, Italy. Public Health 2020; 182:179-184. [DOI: 10.1016/j.puhe.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/03/2020] [Accepted: 01/09/2020] [Indexed: 10/24/2022]
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Rodà F, Bevilacqua L, Merlo A, Prestini L, Brianti R, Lombardi F, Auxilia F, Castaldi S. Evidence-Based Medicine and Clinical Practice: the first Italian attempt to define the appropriateness of rehabilitation admission criteria through the application of the Delphi method. Ann Ig 2020; 31:309-315. [PMID: 30714609 DOI: 10.7416/ai.2019.2264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND One of the consequences of today's global economic crisis is the need to control healthcare spending, in particular by improving the level of appropriateness. Thus, admission to rehabilitation has become an issue, especially as regards inappropriateness of resource allocation. The scientific literature suggests that more attention should be paid to the problem of clinical appropriateness in order to better identify the patients' actual needs. For the first time in Italy, this study aims at defining the appropriateness of intensive rehabilitation admission criteria through use of the Delphi method involving a panel of national experts. MATERIAL AND METHODS A three-round Delphi survey was conducted according to international guidelines. Electronic questionnaires were individually sent via e-mail to ensure the participants' anonymity throughout the process. Questions were mostly based on rehabilitation literature. RESULTS During the Delphi process, a total of 79 items were submitted to a heterogenous panel of rehabilitation experts who were asked to express their level of agreement to the item contents on a five-point Likert scale. At the end of the survey, a list of 19 appropriate criteria for admission to intensive rehabilitation facilities and 21 reasons for inappropriateness was drawn up. CONCLUSION This study represents the first attempt in Italy to define shared and objective appropriateness criteria for admission to intensive rehabilitation. Out of the total number of experts invited to participate (31), only 16 completed the entire survey. This poor participation rate unfortunately demonstrates the lack of awareness among Italian rehabilitation professionals, which is a further sign of both the scarcity of scientific evidence in this area and the need to reach consensus on admission criteria.
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Affiliation(s)
- F Rodà
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Italy
| | | | - A Merlo
- Motion Analysis Laboratory, Department of Rehabilitation, "S. Sebastiano" Hospital of Correggio, NHS Local Agency of Reggio Emilia, Italy
| | - L Prestini
- Quality and Risk Management Unit, ASST, Lecco, Italy
| | - R Brianti
- Rehabilitation Medicine Service, Rehabilitation Geriatrics Department, NHS-University Hospital of Parma, Italy
| | - F Lombardi
- Neurorehabilitation Service, "S. Sebastiano" Hospital of Correggio, NHS Local Agency of Reggio Emilia, Italy
| | - F Auxilia
- Department of Biomedical Science for Health, University of Milan, Italy
| | - S Castaldi
- Department of Biomedical Science for Health, University of Milan, Italy - Quality Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano, Italy
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Gianfredi V, Balzarini F, Gola M, Mangano S, Carpagnano LF, Colucci ME, Gentile L, Piscitelli A, Quattrone F, Scuri S, Mantovani LG, Auxilia F, Castaldi S, Capolongo S, Pelissero G, Odone A, Signorelli C. Leadership in Public Health: Opportunities for Young Generations Within Scientific Associations and the Experience of the "Academy of Young Leaders". Front Public Health 2019; 7:378. [PMID: 31921743 PMCID: PMC6928189 DOI: 10.3389/fpubh.2019.00378] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/25/2019] [Indexed: 12/03/2022] Open
Abstract
This paper outlines the characteristics of scientific leadership and the role of Scientific Associations with their specific activities. The recent activities of the Lombard Academy of Public Health are subsequently described, including the creation, in 2019, of the Academy of young leaders in public health. Comparing to other sectors, scientific leadership dynamics take into consideration different aspects. Besides awards (Nobel Prize or several other) and prestigious affiliations, eventual indicators might be academic roles, fundraising abilities, relevant positions among scientific associations, editors of prestigious journals or editorial series and, more recently, high bibliometric indicators. The peculiar topics of public health encompass interactions with institutions, authorities, politicians, involved in different levels in health policies. Recently, in Italy, the Ministry of Health has identified parameters to be accreditated as a scientific and technical association. The role of SItI (Italian Society of Hygiene), EUPHA, ASPHER, and WFPHA appears relevant in PH, in national and international contexts, with Italian praiseworthy members constantly achieving leading roles. Considering that few training opportunities aimed to improve research and leadership skills are available, Accademia Lombarda di Sanità Pubblica (ALSP) designed the AYLPH (Academy of Young Leaders in Public Health) program. AYLPH program is a 1-year training to shape leadership skills among young professionals. A set of didactic, theoretical and practical methods was offered and evaluated.
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Affiliation(s)
- Vincenza Gianfredi
- Post-graduate School of Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Federica Balzarini
- Post-graduate School of Hygiene and Preventive Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Marco Gola
- Department of Architecture, Built Environment and Construction Engineering, Politecnico di Milano, Milan, Italy
| | - Sveva Mangano
- Post-graduate School of Hygiene and Preventive Medicine, University of Milano-Bicocca, Milan, Italy
| | | | | | | | - Antonio Piscitelli
- Post-graduate School of Hygiene and Preventive Medicine, University of Milan, Milan, Italy
| | - Filippo Quattrone
- Post-graduate School of Hygiene and Preventive Medicine, University of Pisa, Pisa, Italy
| | - Stefania Scuri
- School of Pharmacological Sciences and Health Products, University of Camerino, Camerino, Italy
| | | | - Francesco Auxilia
- Post-graduate School of Hygiene and Preventive Medicine, University of Milan, Milan, Italy
| | - Silvana Castaldi
- Post-graduate School of Hygiene and Preventive Medicine, University of Milan, Milan, Italy
| | - Stefano Capolongo
- Department of Architecture, Built Environment and Construction Engineering, Politecnico di Milano, Milan, Italy
| | - Gabriele Pelissero
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Anna Odone
- Post-graduate School of Hygiene and Preventive Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Carlo Signorelli
- Post-graduate School of Hygiene and Preventive Medicine, University Vita-Salute San Raffaele, Milan, Italy
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21
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Brusaferro S, Arnoldo L, Finzi G, Mura I, Auxilia F, Pasquarella C, Agodi A. Hospital Hygiene and Infection Prevention and Control in Italy: state of the art and perspectives. Ann Ig 2019; 30:445-457. [PMID: 30374506 DOI: 10.7416/ai.2018.2245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Although hospital hygiene has a long history in Italy it is necessary to reflect about it because of the innovation in healthcare systems and because of the evolution due to European Union related activities. Different traditions exist in European countries about hospital hygiene and European Centre for Disease Prevention and Control (ECDC) adopted the term of "infection control and hospital hygiene" which includes all the engaged European healthcare professionals. We propose to modify hospital hygiene as "healthcare organisation hygiene" in order to focalise the attention to all care settings not only hospitals and to adopt the following definition: "all activities aimed to guarantee, in an appropriate, scientifically sound and efficient way, that structures and processes support healthcare practices in a safe comfortable and healthy environment both for patients, caregivers and healthcare workers". Hospital hygiene and its professionals, besides the long tradition, still remain a relevant pillar in guaranteeing quality and safety of healthcare in Italy.
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Affiliation(s)
- S Brusaferro
- Department of Medicine, University of Udine, Italy
| | - L Arnoldo
- Department of Medicine, University of Udine, Italy
| | - G Finzi
- Italian national association of hospital doctors (ANMDO), Italy
| | - I Mura
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - C Pasquarella
- Department of Medicine and Surgery, University of Parma, Ital
| | - A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy
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22
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Montagna MT, Mascipinto S, Pousis C, Bianchi FP, Caggiano G, Carpagnano LF, De Giglio O, Barbuti G, Auxilia F, Destrebecq A, Castaldi S, Baldovin T, Bargellini A, Righi E, Boccia G, Santoro E, Casini B, Baggiani A, Novati R, Oriani R, Odone A, Mezzoiuso AG, Orsi GB, Napoli C, Pasquarella C, Veronesi L, Ripabelli G, Sammarco ML, Rossini A, Squeri R, Laganà P, Antonuccio GM, Genovese C, Tardivo S, Torre I, Alfano R, Pennino F, Torregrossa MV, Barchitta M, Agodi A. Knowledge, experiences, and attitudes toward Mantoux test among medical and health professional students in Italy: a cross-sectional study. Ann Ig 2019; 30:86-98. [PMID: 30374514 DOI: 10.7416/ai.2018.2253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The World Health Organization's Action Framework for tuberculosis elimination in low-tuberculosis incidence countries includes the screening for active and latent tuberculosis in selected high-risk groups, including health care workers. In this context, medical and health profession students, exposed to nosocomial tuberculosis transmission during training and clinical rotations, are target populations for tuberculosis screening. No updated data are available on tuberculosis screening practice and knowledge of medical and health profession students in Italy. METHODS Within the activities Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health, we carried out a multicentre cross-sectional study to assess knowledge, attitude and practices on tuberculosis prevention and control among Medical, Dentistry, Nursing and other health professions' students. Students were enrolled in the study on a voluntary basis and were administered a previously piloted structured questionnaire. Logistic regression models were applied to explore knowledge on tuberculosis prevention by selected socio-demographic variables and University-based tuberculosis prevention practice. RESULTS Students of seventeen Universities across Italy participated in the study, and 58.2% of them received compulsory tuberculin skin test either at enrollment or while attending clinical practice. A total of 5,209 students filled the questionnaire. 37.7% were medicine and dentistry students (Group 1), 44.9% were nursing students (Group 2) and 17.4% were other health professions' students (Group 3). Age and gender had different distributions by groups, as well as knowledge and practice on tuberculin skin test. 84.4% of the study population (95% CI = 83.3-85.3) was aware of the existence of the tuberculin skin test, 74.4% (95% CI = 73.2-75.6) knew what is the first-level screening test for latent tuberculosis and only 22.5% (95% CI = 21.4-23.6) knew how to proceed after a positive tuberculin skin test result. Overall, knowledge on tuberculosis prevention was higher in Group 2 and lower Group 3, as compared to Group 1. CONCLUSION In Italy, the knowledge on tuberculosis screening among University students is generally good. To reduce some of the criticalities found among the different study courses, it would be appropriate to harmonize both the regulations on tuberculosis screening practices for admission to University courses, and the educational activities on the topic of tuberculosis, to be extended to all workers involved in health care setting.
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Affiliation(s)
- M T Montagna
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - S Mascipinto
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - C Pousis
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - F P Bianchi
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - G Caggiano
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - L F Carpagnano
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - O De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - G Barbuti
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - A Destrebecq
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - S Castaldi
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - T Baldovin
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Hygiene and Public Health Unit, Padova, Italy
| | - A Bargellini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Righi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - G Boccia
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - E Santoro
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - B Casini
- Department of Translational Research, N.T.M.S. - Hygiene and Epidemiology Unit, University of Pisa, Pisa, Italy
| | - A Baggiani
- Department of Translational Research, N.T.M.S. - Hygiene and Epidemiology Unit, University of Pisa, Pisa, Italy
| | - R Novati
- Medical Direction, Aosta Regional Hospital, Aosta, Italy
| | - R Oriani
- Medical Direction, Aosta Regional Hospital, Aosta, Italy
| | - A Odone
- Faculty of Medicine and Surgery, University Vita-Salute San Raffaele, Milan, Italy
| | - A G Mezzoiuso
- Faculty of Medicine and Surgery, University Vita-Salute San Raffaele, Milan, Italy
| | - G B Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - C Napoli
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - C Pasquarella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - L Veronesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - G Ripabelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - M L Sammarco
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - A Rossini
- Fondazione Santa Lucia, Institute for Research and Health Care, IRCCS, University of Tor Vergata, Rome, Italy
| | - R Squeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - P Laganà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - G M Antonuccio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - C Genovese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - S Tardivo
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - I Torre
- Department of Public Health, University of Napoli "Federico II", Napoli, Italy
| | - R Alfano
- Department of Public Health, University of Napoli "Federico II", Napoli, Italy
| | - F Pennino
- Department of Public Health, University of Napoli "Federico II", Napoli, Italy
| | - M V Torregrossa
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - M Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
| | - A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
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23
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Tardivo S, Moretti F, Agodi A, Appignanesi R, Baldovin T, Barchitta M, Brusaferro S, Canino R, Carli A, D'Errico MM, Giuliani G, Moro M, Mura I, Nobile M, Novati R, Pasquarella C, Privitera G, Rossini A, Sodano L, Torregrossa MV, Torri E, Auxilia F. Essential strategies in HAI prevention and control: performance assessment through the implementation of the HAI-CoSIP tool of the GISIO-SItI group. A pilot study in a sample of Italian Organizations. Ann Ig 2019; 30:502-508. [PMID: 30374513 DOI: 10.7416/ai.2018.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Healthcare-Associated Infections are a great concern for worldwide healthcare systems and represent a considerable threat to patient safety, leading to adverse clinical outcomes. A defined panel of indicators represents a key element to guide Healthcare Organizations towards identification of main gaps, implementation of effective actions and continuous improvements on Healthcare-Associated Infections prevention and control activities. A review on accreditation systems conducted by the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene Preventive Medicine and Public Health revealed a substantial heterogeneity of implemented standards and led to the development of a core set of indicators and requirements for Healthcare-Associated Infections' prevention and control within the hospital setting. The main aim of the study was to test the feasibility of the Healthcare-Associated Infections' prevention and control within the hospital setting tool to calculate performance scores on a sample of Italian Healthcare Organizations and to identify major critical issues. The potential benefits of the possibility of future implementation of the tool within Institutional Accreditation Programs is discussed. STUDY DESIGN Cross sectional pilot survey. METHODS The Healthcare-Associated Infections' prevention and control within the hospital setting included 96 criteria and 20 key areas including an area for outcomes indicators. For applicable criteria, standards fulfilment was evaluated according to a 4 point Likert scale. A composite score was calculated for each Healthcare Organization and five performance levels were identified. Data were further analysed by computing performance scores at the level of each area and requirement. RESULTS 20 Healthcare Organizations agreed to take part in this pilot study including two rehabilitative Healthcare Organizations. Among the whole sample a mean of 12.20% of requirements resulted not fulfilled, leaving space for further improvements. Critical areas were easily identified and the instrument was able to capture substantial differences between Healthcare Organizations. Only a few number of standards resulted "Not Applicable" (Mean = 4.71%) and most of them regarded Rehabilitative Healthcare Organizations. Mean composite performance index resulted 74.06% (SD = 16.96, range 36.30 - 94.27%); area of outcome indicators obtained a mean score of 56.17. CONCLUSION The Healthcare-Associated Infections' prevention and control within the hospital setting resulted an useful tool to assess Healthcare Organizations' performance in the field of Healthcare-Associated Infections prevention and control and to identify necessary actions for further improvements. The distribution of total scores by Healthcare Organizations showed a high heterogeneity. Implementation of the Healthcare-Associated Infections' prevention and control within the hospital setting tool as an institutional accreditation tool may help to drive the required harmonization at a national level of Healthcare-Associated Infections management and control strategies and overcome current substantial regional differences.
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Affiliation(s)
- S Tardivo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - F Moretti
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
| | - R Appignanesi
- Management Department, Asur Zt 12, San Benedetto del Tronto, Italy
| | - T Baldovin
- Department of Molecular Medicine, Section of Public Health, University of Padova, Padova, Italy
| | - M Barchitta
- Department of Molecular Medicine, Section of Public Health, University of Padova, Padova, Italy
| | - S Brusaferro
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - R Canino
- Medical Direction Department, Oglio-Po Hospital, Vicomoscano - Casalmaggiore, Cremona, Italy
| | - A Carli
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - M M D'Errico
- Department of Biomedical Science and Public Health, Polytechnic University of Marche, Torrette di Ancona, Ancona, Italy
| | - G Giuliani
- Medical Direction Department, Infections Control Committee, G.Salvini Hospital, Garbagnate Milanese, Milan, Italy
| | - M Moro
- Medical Direction Department, Infections Control Committee, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - I Mura
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - M Nobile
- Management Department, G. Pini Orthopedic Institute, University of Milan, Milan, Italy
| | - R Novati
- Medical Direction Department, Aosta Regional Hospital, Aosta, Italy
| | - C Pasquarella
- Department of Hygiene and Public Health, University of Parma, Parma, Italy
| | - G Privitera
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy
| | - A Rossini
- Medical Direction Department, IRCCS Santa Lucia Scientific Institute, Rome, Italy
| | - L Sodano
- Medical Direction Department San Camillo Forlanini Hospital, Rome, Italy
| | - M V Torregrossa
- Department of Sciences for Health Promotion "G. D'Alessandro", Hygiene Section, University of Palermo, Palermo, ItalY
| | - E Torri
- Department of Health and Social Policy, P.A. Trento, Trento, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Agodi A, Barchitta M, Auxilia F, Brusaferro S, D'Errico MM, Montagna MT, Pasquarella C, Tardivo S, Arrigoni C, Fabiani L, Laurenti P, Mattaliano AR, Orsi GB, Squeri R, Torregrossa MV, Mura I. Epidemiology of intensive care unit-acquired sepsis in Italy: results of the SPIN-UTI network. Ann Ig 2019; 30:470-481. [PMID: 30374508 DOI: 10.7416/ai.2018.2247] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Sepsis is the major cause of mortality from any infectious disease worldwide. Sepsis may be the result of a healthcare associated infection (HAI): the most frequent adverse events during care delivery especially in Intensive Care Units (ICUs). The main aim of the present study was to describe the epidemiology of ICU-acquired sepsis and related outcomes among patients enrolled in the framework of the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project. STUDY DESIGN Prospective multicenter study. METHODS The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance. RESULTS During the five editions of the SPIN-UTI project, from 2008 to 2017, 47.0% of HAIs has led to sepsis in 832 patients. Overall, 57.0% episodes were classified as sepsis, 20.5% as severe sepsis and 22.5% as septic shock. The most common isolated microorganisms from sepsis episodes were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. The case fatality rate increased with the severity of sepsis and the mean length of ICU-stay was significantly higher in patients with ICU-acquired sepsis than in patients without. CONCLUSION Our study provides evidence that ICU-acquired sepsis occurs frequently in Italian ICU patients and is associated with a high case fatality rate and increased length of stay. However, in order to explain these findings further analyses are needed in this population of ICU patients.
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Affiliation(s)
- A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - M Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - S Brusaferro
- Department of Medicine, University of Udine, Udine, Italy
| | - M M D'Errico
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - M T Montagna
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - C Pasquarella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - S Tardivo
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - C Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Unit of Hygiene, University of Pavia, Pavia, Italy
| | - L Fabiani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Laurenti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Institute of Public Health, Hygiene Section, Università Cattolica del Sacro Cuore, Roma, Italia
| | | | - G B Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - R Squeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - M V Torregrossa
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - I Mura
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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25
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Nobile M, Agodi A, Barchitta M, Brusaferro S, Castaldi S, D'Alessandro D, Montagna MT, Mura I, Tardivo S, Torregrossa MV, Zannini L, Pasquarella C, Auxilia F. The effectiveness of educational interventions in university training on hospital hygiene: results of action research. Ann Ig 2019; 30:111-120. [PMID: 30374516 DOI: 10.7416/ai.2018.2255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health promoted and conducted a study on teaching hospital hygiene, with particular reference to the prevention and control of healthcare-associated infections, with the aim of developing effective educational material starting from the results collected. MATERIAL AND METHODS First of all, a survey was carried out, targeting lecturers in hospital hygiene, with the purpose of investigating their perceptions regarding this issue. The available scientific literature was also reviewed in order to identify effective educational/teaching strategies for the prevention of healthcare-associated infections, so that valid training interventions could be subsequently developed. Finally, a trial-training intervention was implemented, and specific audio-visual teaching material was also tested. RESULTS The overall response rate to the survey was 42%, with good country-wide representativeness. The level of awareness of hospital hygiene issues by students resulted higher among trainee nurses (65%) than among medical students (44%). The teaching staff identified alternative educational methodologies to substitute the classical lecture (e.g.: case discussions) and, in most cases, the alternative solution appeared to be preferable. The teaching of hospital hygiene was better integrated with other disciplines and professional training activities in the degree courses for nurses than in those for doctors; the total number of hours assigned to such teaching was variable. The literature review highlighted that various educational approaches are used. The most common are presentations or lectures, but videos, posters, questionnaires and e-learning strategies are also used. Combining different instruments when designing an educational programme has proven to be an effective strategy. The training activity tested was positively evaluated by the participants; the possibility of multidisciplinary exchange of knowledge was particularly appreciated. CONCLUSION Having considered the issue of teaching hospital hygiene from the points of view of the different protagonists involved (educators and students), this enabled us to develop useful training material and a proposal for a shared educational intervention. The subject of hospital hygiene, in particular the one related to the prevention of healthcare-associated infections, is addressed in various courses and with different modalities; it is, therefore, important to standardize course contents and teaching methods, in order to facilitate multidisciplinary debate, especially starting from case studies.
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Affiliation(s)
| | - A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy
| | - M Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy
| | - S Brusaferro
- Department of Medicine, University of Udine, Italy
| | - S Castaldi
- Department of Medical Sciences for Health, University of Milan, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D D'Alessandro
- Department of Civil, Building and Environmental Engineering, Sapienza University of Rome, Italy
| | - M T Montagna
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Italy
| | - I Mura
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - S Tardivo
- Department of Diagnostic and Public Health, University of Verona, Italy
| | - M V Torregrossa
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Italy
| | - L Zannini
- Department of Biomedical Siences for Health, University of Milan, Italy
| | - C Pasquarella
- Department of Medicine and Surgery, University of Parma, Italy
| | - F Auxilia
- Department of Medical Sciences for Health, University of Milan, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Prigitano A, Esposto MC, Romanò L, Auxilia F, Tortorano AM. Azole-resistant Aspergillus fumigatus in the Italian environment. J Glob Antimicrob Resist 2019; 16:220-224. [DOI: 10.1016/j.jgar.2018.10.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 02/02/2023] Open
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Cavazzana L, Fornili M, Filocamo G, Agostoni C, Auxilia F, Castaldi S. Hospital clinical pathways for children affected by juvenile idiopathic arthritis. Ital J Pediatr 2018; 44:139. [PMID: 30458837 PMCID: PMC6245695 DOI: 10.1186/s13052-018-0576-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/29/2018] [Indexed: 11/17/2022] Open
Abstract
Background Juvenile idiopathic arthritis (JIA) is the most common pediatric chronic rheumatic disease, which requires constant follow-up over the years, due to relapses during its progression. To maintain a good quality of life, it is important to limit admissions as far as possible. With the development of a Diagnostic Therapeutic Assistance Pathway (DTAP), we aim to select patients with suitable clinical conditions to be moved from routine hospital management to day care or outpatient treatment, evaluating the number of patients to whom this would apply. Methods Monocentric study regarding admissions for JIA between 2014 and 2016 in a Pediatric Unit of a university hospital in Milan. Through an analysis of the medical records, relevant information was extracted and collected in a Microsoft™ Excel database; starting from the data collected during the first year, a DTAP was prepared for patients with active arthritis and appropriate clinical conditions. Results The study includes data from 223 JIA hospitalization cases involving 127 patients. Applying DTAP criteria, 32% patients would have avoided admissions and 23% would have been admitted less frequently. The data concerning the activities of the Unit for JIA patients showed a relevant drop in the number of hospitalizations since 2015, from 89 in 2014 to 66 and 68 in 2015 and 2016 respectively. Conclusion The opportunity offered by DTAP, has suggested feasible changes in hospitalization management and it’s use would promote the possibility of treating the children without hospitalization, or minimizing it. In conclusion DTAP application is a priority for the continuous improvement of clinical practice and quality of life for patients and their families.
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Affiliation(s)
- L Cavazzana
- Post Graduate School of Public Health, University of Milan, Milan, Italy.
| | - M Fornili
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Filocamo
- Intermediate Pediatric Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Intermediate Pediatric Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Montagna MT, De Giglio O, Napoli C, Diella G, Rutigliano S, Agodi A, Auxilia F, Baldovin T, Bisetto F, Arnoldo L, Brusaferro S, Busetti M, Calagreti G, Casini B, Cristina ML, Di Luzio R, Fiorio M, Formoso M, Liguori G, Martini E, Molino A, Mondello P, Mura I, Novati R, Orsi GB, Patroni A, Poli A, Privitera G, Ripabelli G, Rocchetti A, Rose F, Sarti M, Savini S, Silvestri A, Sodano L, Spagnolo AM, Tardivo S, Teti V, Torregrossa MV, Torri E, Veronesi L, Zarrilli R, Pacifico C, Goglio A, Moro M, Pasquarella C. Control and prevention measures for legionellosis in hospitals: A cross-sectional survey in Italy. Environ Res 2018; 166:55-60. [PMID: 29864633 DOI: 10.1016/j.envres.2018.05.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/09/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2-15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.
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Affiliation(s)
- Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy.
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Christian Napoli
- Department of Medical and S urgical Sciences and Translational Medicine, Sapienza University of Roma, Square A. Moro 5, 00185 Roma, Italy
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Serafina Rutigliano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Str. S. Sofia, 87, Comparto 10 Edificio C, 95123 Catania, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milano, Str. Pascal 36, 20133 Milano, Italy
| | - Tatjana Baldovin
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Hygiene and Public Health Unit, Str. Loredan, 18.35131 Padova, Italy
| | - Francesco Bisetto
- Presidio Ospedaliero di Camposampiero, AULss6 Euganea Str. P. Cosma 1, 35012 Camposampiero, PD, Italy
| | - Luca Arnoldo
- Department of Medicine, University of Udine, Str. Colugna 50, 33100 Udine, Italy
| | - Silvio Brusaferro
- Department of Medicine, University of Udine, Str. Colugna 50, 33100 Udine, Italy
| | - Marina Busetti
- University Hospital ASUITS, Microbiology Unit, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Gioia Calagreti
- Hospital "Alto Tevere", AUSL Umbria 1, Città di Castello, PG, Italy
| | - Beatrice Casini
- Department of Translational Research, N.T.M.S. - Hygiene and Epidemiology Unit, University of Pisa, Str. S. Zeno 35-39, 56127 Pisa, Italy
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Str. A. Pastore 1, 16132 Genova, Italy
| | | | | | - Maurizio Formoso
- Hospital "Miulli", Str. 127 km 4.1, Santeramo-Acquaviva delle Fonti, BA, Italy
| | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University "Parthenope", Napoli, Italy
| | - Enrica Martini
- AOU "Ospedali Riuniti", Str. Conca, 71, 60126 Ancona, Italy
| | - Andrea Molino
- Hospital "Madonna delle Grazie", Contrada Cattedra Ambulante s.nc. 75100 Matera, Italy
| | | | - Ida Mura
- Department of Biomedical Science, University of Sassari, Sassari, Italy
| | | | - Giovanni Battista Orsi
- Department of Public Health and Infectious Disease, Sapienza University of Roma, Roma, Italy
| | - Andrea Patroni
- ASST Valcamonica, Str. Manzoni 142, 25040 Esine, BS, Italy
| | - Anna Poli
- Hospital "San Giovanni di Dio", Str. Torre Galli 3, 50143 Firenze, Italy
| | - Gaetano Privitera
- Department of Translational Research, N.T.M.S. - Hygiene and Epidemiology Unit, University of Pisa, Str. S. Zeno 35-39, 56127 Pisa, Italy
| | - Giancarlo Ripabelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Rocchetti
- ASO "SS. Antonio, Biagio and C. Arrigo", Str. Venezia 17, 15121 Alessandria, Italy
| | | | - Mario Sarti
- Hospital "OCSAE", Str. Giardini 1355, Baggiovara, MO, Italy
| | - Sandra Savini
- AOU "Ospedali Riuniti", Str. Conca, 71, 60126 Ancona, Italy
| | - Antonio Silvestri
- Hospital "San Camillo Forlanini", Circonvallazione Gianicolense 87, 00152 Roma, Italy
| | - Luisa Sodano
- Hospital "San Camillo Forlanini", Circonvallazione Gianicolense 87, 00152 Roma, Italy
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genova, Str. A. Pastore 1, 16132 Genova, Italy
| | - Stefano Tardivo
- Department of Diagnostic and Public Health, University of Verona, Str. Le Grazie 8, 37134 Verona, Italy
| | | | - Maria Valeria Torregrossa
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Str. Vespro, 133, 90127 Palermo, Italy
| | - Emanuele Torri
- Department of Health ans Social Policy, Str. Gilli 4, 38123 Trento, Italy
| | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma, Str. Volturno 39, Parma, Italy
| | - Raffaele Zarrilli
- Department of Public Health, University of Napoli "Federico II", Str. S. Pansini, 5, Napoli, Italy
| | - Claudia Pacifico
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Matteo Moro
- Hospital "San Raffaele", Str. Olgettina 60, 20132 Milano, Italy
| | - Cesira Pasquarella
- Department of Medicine and Surgery, University of Parma, Str. Volturno 39, Parma, Italy
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Tardivo S, Moretti F, Nobile M, Agodi A, Appignanesi R, Arrigoni C, Baldovin T, Brusaferro S, Canino R, Carli A, Chiesa R, D'Alessandro D, D'Errico MM, Giuliani G, Montagna MT, Moro M, Mura II, Novati R, Orsi GB, Pasquarella C, Privitera G, Ripabelli G, Rossini A, Saia M, Sodano L, Torregrossa MV, Torri E, Zarrilli R, Auxilia F, SItI G. Definition of criteria and indicators for the prevention of Healthcare-Associated Infections (HAIs) in hospitals for the purposes of Italian institutional accreditation and performance monitoring. Ann Ig 2018; 29:529-547. [PMID: 29048451 DOI: 10.7416/ai.2017.2183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are an important issue in terms of quality of care. HAIs impact patient safety by contributing to higher rates of preventable mortality and prolonged hospitalizations. In Italy, analysis of the currently available accreditation systems shows a substantial heterogeneity of approaches for the prevention and surveillance of HAIs in hospitals. The aim of the present study is to develop and propose the use of a synthetic assessment tool that could be implemented homogenously throughout the nation. METHODS An analysis of nine international and of the 21 Italian regional accreditation systems was conducted in order to identify requirements and indicators implemented for HAI prevention and control. Two relevant reviews on this topic were further analyzed to identify additional evidence-based criteria. The project team evaluated all the requirements and indicators with consensus meeting methodology, then those applicable to the Italian context were grouped into a set of "focus areas". RESULTS The analysis of international systems and Italian regional accreditation manuals led to the identification respectively of 19 and 14 main requirements, with relevant heterogeneity in their application. Additional evidence-based criteria were included from the reviews analysis. From the consensus among the project team members all the standards were compared and 20 different thematic areas were identified, with a total of 96 requirements and indicators for preventing and monitoring HAIs. CONCLUSIONS The study reveals a great heterogeneity in the definition of accreditation criteria between the Italian regions. The introduction of a uniform, synthetic assessment instrument, based on the review of national and international standards, may serve as a self-assessment tool to evaluate the achievement of a minimum standards set for HAIs prevention and control in healthcare facilities. This may be used as an assessment tool by the Italian institutional accreditation system, also useful to reduce regional disparities.
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Affiliation(s)
- S Tardivo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - F Moretti
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - M Nobile
- Management Department, G. Pini Orthopedic Institute, University of Milan, Milan, Italy
| | - A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Catania, Italy
| | - R Appignanesi
- Management Department, Asur Zt 12, San Benedetto del Tronto, Italy
| | - C Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - T Baldovin
- Department of Molecular Medicine, Section of Public Health, University of Padova, Padova, Italy
| | - S Brusaferro
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - R Canino
- Medical Direction Department, Oglio-Po Hospital, Vicomoscano - Casalmaggiore, Cremona, Italy
| | - A Carli
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - R Chiesa
- Programming Acquisition and Control Department, Asl Brescia, Brescia, Italy
| | - D D'Alessandro
- Department of Civil Building and Environmental Engineering, Sapienza University of Rome, Rome, Italy
| | - M M D'Errico
- Department of Biomedical Science and Public Health, Polytechnic University of Marche, Torrette di Ancona, Ancona, Italy
| | - G Giuliani
- Department of Medical Direction, Infections Control Committee, G. Salvini Hospital, Garbagnate Milanese, Milan, Italy
| | - M T Montagna
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - M Moro
- Department of Medical Direction, Infections Control Committee, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - I I Mura
- Department of Biomedical Sciences, Hygiene Unit, University of Sassari, Sassari, Italy
| | - R Novati
- Medical Direction, Aosta Regional Hospital, Aosta, Italy
| | - G B Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - C Pasquarella
- Department of Hygiene and Public Health, University of Parma, Parma, Italy
| | - G Privitera
- Department of Translational Research, N.T.M.S., University of Pisa, Pisa, Italy
| | - G Ripabelli
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - A Rossini
- Department of Medical Direction, IRCCS Santa Lucia Scientific Institute, Rome, Italy
| | - M Saia
- Veneto Region Health Directorate, Palazzo Molin San Polo Venice, Italy
| | - L Sodano
- Department of Medical Direction, San Camillo Forlanini Hospital, Rome, Italy
| | - M V Torregrossa
- Department of Sciences for Health Promotion "G. D'Alessandro" - Hygiene Section, University of Palermo, Palermo, Italy
| | - E Torri
- Department of Health and Social Policy, Trento, Italy
| | - R Zarrilli
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Gisio SItI
- Italian Study Group of Hospital Hygiene - Italian Society of Hygiene, Preventive Medicine and Public Health, Italy
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Agodi A, Auxilia F, Barchitta M, Cristina ML, D'Alessandro D, Mura I, Nobile M, Pasquarella C, Gisio-SItI G. Risk of surgical site infections following hip and knee arthroplasty: results of the ISChIA-GISIO study. Ann Ig 2018; 29:422-430. [PMID: 28715055 DOI: 10.7416/ai.2017.2174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Surgical Site Infection (SSI) is one of the major complications following insertion of hip or knee prosthesis. The aim of the present study was to describe rates of SSIs and associated risk factors during hip and knee prosthesis procedures in Italian hospitals. METHODS Italian hospitals were invited to join the ISChIA (Surgical Site Infections in Arthroplasty Surgery) project and participated in the study on a voluntary basis. SSI surveillance was performed according to the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) -SSI protocol. The study population consisted of all patients who had a prosthetic knee or hip joint replacement between March 2010 and February 2011. Only elective operations were include. RESULTS A total of 14 hospitals and 1285 surgical procedures were included. SSI cumulative incidence was 1.3 per 100 hip and 2.4 per 100 knee surgical procedures; a significant positive trend of SSI incidences was observed with increasing SSI risk index. In multivariate analysis, considering hip procedures, the single independent risk factor associated to SSI was operation length (RR: 4.54; 95%CI: 1.06-19.48). For knee procedures, no significant risk factor was identified. CONCLUSIONS In the present study, SSI cumulative incidence was in the range of European data. However, a larger number of operations is needed to better estimate SSI rates. A second edition of the ISChIA project has been already conducted and results of the two surveys will provide new insight to further our knowledge for infection control.
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Affiliation(s)
- A Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - M Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - M L Cristina
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - D D'Alessandro
- Department of Civil Building and Environmental Engineering, 'Sapienza' University, Rome, Italy
| | - I Mura
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - M Nobile
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - C Pasquarella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gisio Gisio-SItI
- Italian Study Group of Hospital Hygiene - Italian Society of Hygiene, Preventive Medicine and Public Health, Italy
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Nembrini S, Ceretti E, Gelatti U, Castaldi S, Schulz P, Levaggi R, Auxilia F, Covolo L. Willingness to pay and risky behaviours: results from the Pay for Others (PAY4O) study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Nembrini
- Department of Economics and Management, University of Brescia, Brescia, Italy
| | - E Ceretti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - U Gelatti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - S Castaldi
- Section of Public Health, Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
- Quality Unit - IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - P Schulz
- Institute of Communication and Health, University of Lugano, Lugano, Switzerland
| | - R Levaggi
- Department of Economics and Management, University of Brescia, Brescia, Italy
| | - F Auxilia
- Section of Public Health, Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
- IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - L Covolo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Agodi A, Auxilia F, Barchitta M, Brusaferro S, D'Errico MM, Montagna MT, Pasquarella C, Tardivo S, Mura I. Monitoring the quality of health services in ICU: ten years of the SPIN-UTI network HAI surveillance. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Agodi
- University of Catania, Catania, Italy
| | | | | | | | - MM D'Errico
- University Politecnica delle Marche, Ancona, Italy
| | | | | | | | - I Mura
- University of Sassari, Sassari, Italy
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Agodi A, Barchitta M, Quattrocchi A, Spera E, Gallo G, Auxilia F, Brusaferro S, D’Errico MM, Montagna MT, Pasquarella C, Tardivo S, Mura I. Preventable proportion of intubation-associated pneumonia: Role of adherence to a care bundle. PLoS One 2017; 12:e0181170. [PMID: 28877171 PMCID: PMC5587225 DOI: 10.1371/journal.pone.0181170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 06/27/2017] [Indexed: 11/24/2022] Open
Abstract
Objective The aim of the present study was to estimate the preventable proportion of Intubation-Associated Pneumonia (IAP) in the Intensive Care Units (ICUs) participating in the Italian Nosocomial Infections Surveillance in ICUs (SPIN-UTI) network, taking into account differences in intrinsic patients’ risk factors, and additionally considering the compliance with the European bundle for IAP prevention. Methods A prospective patient-based survey was conducted and all patients staying in ICU for more than 2 days were enrolled in the surveillance. Compliance with the bundle was assessed using a questionnaire for each intubated patient. A twofold analysis by the parametric g-formula was used to compute the number of infections to be expected if the infection incidence in all ICUs could be reduced to that one of the top-tenth-percentile-ranked ICUs and to that one of the ICU with the highest compliance to all five bundle components. Results A total of 1,840 patients and of 17 ICUs were included in the first analysis showing a preventable proportion of 44% of IAP. In a second analysis on a subset of data, considering compliance with the European bundle, a preventable proportion of 40% of IAP was shown. A significant negative trend of IAP incidences was observed with increasing number of bundle components performed (p<0.001) and a strong negative correlation between these two factors was shown (r = -0.882; p = 0.048). Conclusions The g-formula controlled for time-varying factors is a valuable approach for estimating the preventable proportion of IAP and the impact of interventions, based entirely on an observed population in a real-world setting. However, both the study design that cannot definitively prove a causative relationship between bundle compliance and IAP risk, and the small number of patients included in the care bundle compliance analysis, may represent limits of the study and further and larger studies should be conducted.
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Affiliation(s)
- Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
- * E-mail:
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Annalisa Quattrocchi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Emiliano Spera
- Department of Mathematics and Informatics, University of Catania, Catania, Italy
| | - Giovanni Gallo
- Department of Mathematics and Informatics, University of Catania, Catania, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Marcello Mario D’Errico
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Maria Teresa Montagna
- Department of Biomedical Sciences and Human Oncology, University of Bari ‘Aldo Moro’, Bari, Italy
| | | | - Stefano Tardivo
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Ida Mura
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Prigitano A, Romanò L, Auxilia F, Castaldi S, Tortorano AM. Antibiotic resistance: Italian awareness survey 2016. J Infect Public Health 2017; 11:30-34. [PMID: 28285971 DOI: 10.1016/j.jiph.2017.02.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 10/20/2022] Open
Abstract
Antimicrobial resistance has become a public health priority worldwide. The WHO conducted a survey concerning the personal use of antibiotics, knowledge of appropriate use and awareness of the issue of resistance. A similar survey was conducted in Italy involving 666 young university students and 131 seniors attending courses of the University of the third age. Antibiotics seem to be taken with moderate frequency and appropriately: 30% of respondents took them in the past six months and 94% took these drugs only prescribed by a doctor, in the correct dose and for the proper duration. Notable confusion concerning the conditions treatable with antibiotics was detected (only 30% indicated gonorrhea, and 30-40% believed that antibiotics should be employed for fever, cold, and flu), while 94% of participants seemed aware of the problem of antibiotic resistance. Most of the respondents identified the behaviors that can reduce the phenomenon of resistance (regular handwashing and use of antibiotics only when prescribed and needed). The results of our survey, that involved people of high level of instruction and living in urban areas of northern regions, cannot be extended to all the Italian population. However, they provide valid elements to promote initiatives aimed to a more aware use of antibiotics.
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Affiliation(s)
- Anna Prigitano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Luisa Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Anna M Tortorano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.
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Agodi A, Barchitta M, Quattrocchi A, Spera E, Gallo G, Auxilia F, Brusaferro S, D’Errico MM, Montagna MT, Pasquarella C, Tardivo S, Mura I. Preventable proportion of Intubator-Associated Pneumonia in Italian ICUs: a G-computation analysis. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oggioni C, Za A, Auxilia F, Faccini M, Senatore S, Vismara C, Foti M, Scaturro M, Fontana S, Rota MC, Crippa F, Iapichino G, D'Arminio Monforte A, Ricci ML. Legionnaires' disease contracted from patient workplace: First report of a severe case of coinfection with varicella-zoster virus. Am J Infect Control 2016; 44:1164-1165. [PMID: 27311515 DOI: 10.1016/j.ajic.2016.03.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
Abstract
A middle-aged immunocompetent woman was diagnosed and treated for a severe pulmonary human herpesvirus 3 infection. During the treatment, an infection from Legionella pneumophila serogroup 1 was also diagnosed. This coinfection threatened the life of the patient and led to serious permanent sequelae. This report highlights the importance of preventing Legionella environmental contamination, suspecting Legionella coinfection in patients with viral pneumonia, and vaccinating susceptible adults against chickenpox.
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Calori GM, Colombo M, Navone P, Nobile M, Auxilia F, Toscano M, Drago L. Comparative evaluation of MicroDTTect device and flocked swabs in the diagnosis of prosthetic and orthopaedic infections. Injury 2016; 47 Suppl 4:S17-S21. [PMID: 27492065 DOI: 10.1016/j.injury.2016.07.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The evolution of new prosthetic and osteosynthetic devices has led to more surgical indications, and this is accompanied by an increased incidence of septic complications in orthopaedic and trauma surgery in the general population. The strategy for choosing surgical or therapeutic (conservative) treatment is based on the identification of the pathogen: knowledge of the aetiological agents is an essential element in the decision-making process to ensure the most effective treatment is administered. The pathogen also needs to be considered in the challenging case of doubtful infection, where perhaps the only sign is inflammation, for a more accurate prediction of progression to either sepsis or healing. Biofilm-related infections and low-grade infections may fall into this category. Biofilm slows the metabolism of microorganisms and prolongs their survival, which renders them resistant to antibiotics. Moreover, when microorganisms are embedded in the biofilm they are poorly recognised by the immune system and the infection becomes chronic. As recently demonstrated, isolation and identification of bacteria in biofilm is difficult as the bacteria are concealed. The development of an effective means of sample collection and laboratory methods that can dislodge bacteria from prosthetic surfaces has therefore become necessary. The primary aim of the study was to evaluate the reliability of an innovative technology (MicroDTTect), specifically applied to collect and transport explanted samples (prostheses, osteosynthetic devices, biological tissues), and compare with flocked swabs. The MicroDTTect system is quick and simple to use and, most importantly, is a closed system that is totally sterile and safe for the patient being treated. It contains a specific concentration of dithiotreitol (DTT) that can dislodge bacteria from the biofilm adhering to prosthetic surfaces. The numbers of positive and negative samples were measured to compare the MicroDTTect methodology with swab collection in 30 procedures. The results showed that MicroDTTect had a higher sensitivity compared to swabs (77% and 46%, respectively), and was associated with more positive results than swabs (35% and 20%, respectively). These preliminary results show that MicroDTTect is superior to swab collection for bacterial identification in orthopaedic surgery. The early identification of microorganisms that cause sepsis may help improve treatment strategies and the efficacy of therapy, which will lead to an increased healing rate, reduced severity of sequelae and improved quality of life.
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Affiliation(s)
- Giorgio Maria Calori
- Reparative Orthopaedic Surgery Department, G. Pini Institute, University of Milan, Italy.
| | - Massimiliano Colombo
- Reparative Orthopaedic Surgery Department, G. Pini Institute, University of Milan, Italy
| | - Paola Navone
- Management Department, G. Pini Institute, Milan, Italy
| | - Marta Nobile
- Management Department, G. Pini Institute, Milan, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Marco Toscano
- Laboratory of Clinical-Chemistry and Microbiology, IRCCS Galeazzi, Department of Biomedical Sciences for Health, Italy
| | - Lorenzo Drago
- Laboratory of Clinical Microbiology, Department of Biomedical Sciences for Health, University of Milan, Italy
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González-Lorenzo M, Tirani M, Piatti A, Coppola L, Gramegna M, Ruggiero F, Auxilia F, Moja L. [Decisional framework for varicella vaccine: challenges in the face of opportunity]. Recenti Prog Med 2016; 107:84-107. [PMID: 26901584 DOI: 10.1701/2152.23272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Decision makers adopt interventions, including vaccines, which are most beneficial to populations. A transparent, unbiased, and comprehensive framework based on evidence-based criteria is a promising tool to guide decision-making on vaccine adoption: we developed a multi-dimensional framework conceived from the DECIDE - Evidence to decision Framework (EtD framework). We validated the framework by conducting a real data and evidence set collection on varicella vaccination and tested it with a multidisciplinary group. METHODS The EtD framework presented evidence concerning the varicella vaccination organized in six dimensions: Burden of disease, Vaccine characteristics and impact of immunization program, Values and preferences, Resource use, Equity and Feasibility. Two reviewers completed each dimension with information about varicella vaccine. A multidisciplinary group of 42 participants were asked to evaluate the information in the framework, decide whether to introduce varicella vaccine in the national immunization program, assess the usefulness, and propose some impovements of the decision-making tool. RESULTS From 33 responders (79%) out of 42, 61% supported the adoption of the varicella vaccine as part of the national immunization program. A half (50%) favored the monovalent vaccine while the other half chose the tetravalent vaccine. About 90% of responders found information in the EtD framework comprehensive, easy to understand, and presented in a way that helped make decisions. CONCLUSIONS Complete and transparent information are welcome. The EtD identified a situation of important divergences between policy makers regarding the introduction and the choice of vaccine. In our case study, for example, a third of the multidisciplinary group did not recommend the adoption of varicella vaccine.
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Affiliation(s)
- Marien González-Lorenzo
- Unità di Epidemiologia Clinica, IRCCS - Istituto Ortopedico Galeazzi, Milano - Dipartimento di Scienze Biomediche per la Salute, Università di Milano
| | | | - Alessandra Piatti
- Direzione Generale Salute, UO Governo della Prevenzione, Regione Lombardia, Milano
| | - Liliana Coppola
- Direzione Generale Salute, UO Governo della Prevenzione, Regione Lombardia, Milano
| | - Maria Gramegna
- Direzione Generale Salute, UO Governo della Prevenzione, Regione Lombardia, Milano
| | - Francesca Ruggiero
- Unità di Epidemiologia Clinica, IRCCS - Istituto Ortopedico Galeazzi, Milano - Dipartimento di Scienze Biomediche per la Salute, Università di Milano
| | - Francesco Auxilia
- Dipartimento di Scienze Biomediche per la Salute, Università di Milano
| | - Lorenzo Moja
- Unità di Epidemiologia Clinica, IRCCS - Istituto Ortopedico Galeazzi, Milano - Dipartimento di Scienze Biomediche per la Salute, Università di Milano
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Nobile M, Navone P, Domeniconi G, Della Valle A, Daolio PA, Buccino NA, Auxilia F. Surgical site infections in oncologic orthopaedic prosthetics surgery. Ann Ig 2015; 27:711-7. [PMID: 26661912 DOI: 10.7416/ai.2015.2063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Literature reports an incidence of surgical site infections (SSIs) in oncological patients undergoing prosthetic replacement between 8% and 35% after first implantation and 43% after revision. The purpose of this retrospective study, conducted at the oncologic orthopaedic unit of G. Pini Orthopaedic Hospital in Milan, was to evaluate: - number of SSIs in oncological megaprosthetic reconstruction between 2008 and 2011, - possible risk factors associated with the onset of SSIs, - antibiotic prophylaxis applied. DESIGN AND METHODS We reviewed medical records of patients who underwent megaprosthetic reconstruction and collected data on whole treatment and follow up after discharge, focusing on possible risk factors implied in the onset of SSIs such as patient characteristics, site of surgery, duration of surgery, number of persons in the operating room, size of resection, antibiotic prophylaxis. We recorded every SSI which met the criteria set by the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol. RESULTS One-hundred and eleven surgeries were evaluated. Administration of prophylaxis was generally recorded and continued postoperatively for an average of 18.89 days, often depending on the length of the post-surgical stay. Mean duration of surgery was 254 minutes with an average of 7 persons attending the operating room. We recorded 6 SSIs.
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Affiliation(s)
- M Nobile
- Phd Program in Public Health, University of Milan, Italy - Orthopedic Institute, G. Pini, Milan, Italy
| | - P Navone
- Orthopedic Institute, G. Pini, Milan, Italy
| | - G Domeniconi
- Post graduate School in Public Health, University of Milan, Italy
| | | | - P A Daolio
- Orthopedic Institute, G. Pini, Milan, Italy
| | | | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Italy
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Agodi A, Auxilia F, Barchitta M, D’Errico MM, Montagna MT, Pasquarella C, Tardivo S, Mura I. Compliance with the European care bundle improves Intubator-Associated Pneumonia control in the ICU. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv172.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Agodi
- Department “GF Ingrassia”, University of Catania, Catania, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - M Barchitta
- Department “GF Ingrassia”, University of Catania, Catania, Italy
| | - MM D’Errico
- Department of Biomedical Science and Public Health, Politecnica delle Marche, Ancona, Italy
| | - MT Montagna
- Department of Biomedical Sciences and Human Oncology, Hygiene Section, University of Bari Aldo Moro, Bari, Italy
| | - C Pasquarella
- Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Parma, Italy
| | - S Tardivo
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - I Mura
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Schulz P, Nobile M, Disoteo O, Auxilia F. Diabetes and Health Literacy: the DHELY project. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nobile M, Cereda D, Bastiampillai AJ, Gabrielli E, Germeni E, Diviani N, Beghi G, Vitale A, Antonioli C, Gariani L, Gullotta R, Manes G, Auxilia F, Schulz P, Castaldi S. CALIS - CAncer Literacy and Information Seeking : a study in the setting of colorectal screening. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv172.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Agodi A, Auxilia F, Barchitta M, Cristina ML, Mura I, Nobile M, Pasquarella C. Compliance with guidelines on antibiotic prophylaxis in hip and knee arthroplasty in Italy: results of the GISIO-ISChIA project. Ann Ig 2015; 27:520-5. [PMID: 26152537 DOI: 10.7416/ai.2015.2042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Perioperative Antibiotic Prophylaxis (PAP) contributes considerably to the total amount of antibiotics used in hospitals and has been shown to be associated with increase in antibiotic resistance and healthcare costs. The level of compliance with the national guidelines of current practices of PAP for elective hip and knee prosthesis procedures in a network of Italian hospitals (the multicentre Surgical Site Infection surveillance project GISIO-ISChIA), has been evaluated. METHODS Compliance of the current prophylactic antibiotic practices with the published national guidelines was assessed for each included operative procedure, considering indication, timing of administration, prescribed antimicrobial agent and total duration of prophylaxis. RESULTS A total of 14 hospitals and 1285 surgical procedures were included. 99.4% of patients received antimicrobial prophylaxis pre-operatively and 73.0% of patients received PAP within the recommended time period (within 60 minutes before incision). The rate of compliance with discontinuation of PAP within 24 hours after initiation of surgery was 70.2%. Taking into account all doses administered, the antibiotic was chosen appropriately in 57.7% of patients. PAP was performed appropriately, in accordance with national guidelines, in 43.6% of surgical operations. CONCLUSIONS Given the increasing number of replacement procedures in Italy and in Europe, the gap between the evidence-based guidelines and practice must be appropriately addressed in order to improve PAP practices.
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Affiliation(s)
- Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Italy
| | | | - Ida Mura
- Department of Biomedical Sciences, University of Sassari, Italy
| | - Marta Nobile
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Cesira Pasquarella
- Department of Biomedical Biotechnological and Translational Sciences, University of Parma, Italy
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Agodi A, Auxilia F, Barchitta M, Cristina M, D'Alessandro D, Mura I, Nobile M, Pasquarella C, Avondo S, Bellocchi P, Canino R, Capozzi C, Casarin R, Cavasin M, Contegiacomo P, Deriu MG, Evola FR, Farsetti P, Grandi A, Guareschi D, Longhitano AM, Longo G, Malatesta R, Marenghi P, Marras F, Maso A, Mattaliano AR, Montella MT, Moscato U, Navone P, Romeo MA, Rossi F, Ruffino M, Santangelo C, Sartini M, Sessa G, Tardivo S, Tranquilli Leali P, Torregrossa MV, Vitali P. Operating theatre ventilation systems and microbial air contamination in total joint replacement surgery: results of the GISIO-ISChIA study. J Hosp Infect 2015; 90:213-9. [DOI: 10.1016/j.jhin.2015.02.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
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Agodi A, Auxilia F, Barchitta M, Brusaferro S, D'Errico MM, Montagna MT, Pasquarella C, Tardivo S, Mura I. Antibiotic consumption and resistance: results of the SPIN-UTI project of the GISIO-SItI. Epidemiol Prev 2015; 39:94-98. [PMID: 26499423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate trends and association between antibiotic consumption and resistance during an eight-year period, from 2006 to 2013. DESIGN Prospective multicenter study. SETTING AND PARTICIPANTS Intensive Care Units (ICUs) participating in the four editions of the Italian nosocomial infections surveillance in the ICU Network (Sorveglianza Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva, SPIN-UTI project). MAIN OUTCOME MEASURES The isolation density of selected species of microorganisms, antibiotic resistance rates (RRs), incidence density of resistant isolates and antimicrobial usage density were calculated. RESULTS RRs of carbapenem-resistant Acinetobacter baumannii, of carbapenem-resistant Klebsiella pneumoniae, of third-generation cephalosporin (3GC)-resistant K. pneumoniae and of 3GC-resistant Escherichia coli showed significant increasing trends (p ≤0.001). The consumption of each antibiotic class varied with years, although not significantly. Significant strongly positive correlations were detected between RRs and antibiotic consumption. CONCLUSIONS The present study describes high RRs and increasing trends of resistant microorganisms and highlights the need for continuous comprehensive strategies targeting not only the prudent use of antibiotics, but also infection control measures to limit the epidemic spread of resistant isolates.
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Affiliation(s)
- Antonella Agodi
- Dip. Scienze mediche, chirurgiche e tecnologie avanzate "G.F. Ingrassia", Università di Catania, Italy.
| | | | - Martina Barchitta
- Dip. Scienze mediche, chirurgiche e tecnologie avanzate "G.F. Ingrassia", Università di Catania, Italy
| | | | - Marcello Mario D'Errico
- Dip. Scienze biomediche e sanità pubblica, Università Politecnica delle Marche, Ancona, Italy
| | - Maria Teresa Montagna
- Dip. Scienze biomediche e oncologia umana, Sezione igiene, Università "Aldo Moro", Bari, Italy
| | - Cesira Pasquarella
- Dip. Scienze biomediche, biotecnologiche e traslazionali, Università di Parma, Italy
- Coordinator of the GISIO WG
| | - Stefano Tardivo
- Dip. Sanità pubblica e medicina di comunità, Università di Verona, Italy
| | - Ida Mura
- Dip. Scienze biomediche, Università di Sassari, Italy
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Nobile M, Navone P, Orzella A, Colciago R, Auxilia F, Calori G. Developing a model for analysis the extra costs associated with surgical site infections (SSIs): an orthopaedic and traumatological study run by the Gaetano Pini Orthopaedic Institute. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474909 DOI: 10.1186/2047-2994-4-s1-p68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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47
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González-Lorenzo M, Piatti A, Coppola L, Gramegna M, Demicheli V, Melegaro A, Tirani M, Parmelli E, Auxilia F, Moja L. Conceptual frameworks and key dimensions to support coverage decisions for vaccines. Vaccine 2015; 33:1206-17. [DOI: 10.1016/j.vaccine.2014.12.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
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Abstract
INTRODUCTION Surgical site infections (SSIs) in orthopaedic surgery are a demanding complication for the patient and in terms of economics. Many guidelines (GLs) are available on antibiotic prophylaxis as an effective preventive measure; however, these GLs are often ignored in practice. A surveillance study of SSIs in arthroplasty, promoted by the Italian Study Group of Hospital Hygiene of the Italian Society of Public Health (SitI), showed a high percentage of non-adherence to GLs on antibiotic prophylaxis. OBJECTIVES The purpose of this study was to review the existing GLs, share them within the hospital and then monitor their implementation. MATERIALS AND METHODS Information and training are considered to be great tools for implementation and sharing of GLs, which leads to significant improvements in clinical practice. A multidisciplinary team comprising infectious disease specialists, orthopaedic surgeons, nurse epidemiologists and public health specialists was established at the G. Pini Hospital in Milan to revise GLs, and to organise educational events for their implementation, sharing and dissemination. A checklist was devised for monitoring purposes. RESULTS GLs were presented to orthopaedic surgeons and nurse coordinators during two educational events. Meetings were organised in each unit to present the results of the surveillance of SSIs in arthroplasty and to discuss the reasons why the prophylaxis regimens adopted were not consistent with GLs. It was emphasised that the most important issue, on which there is consensus in the scientific literature, was related to the duration of prophylaxis beyond 24h. The review process for GLs was presented and pocket-sized GLs were given to surgeons. The importance of documenting on medical record any deviations from the GLs was emphasised. CONCLUSIONS Any changes in behaviour in clinical practice must be monitored and evaluated regularly. The monitoring of GLs in terms of correct choice of drug, timing of administration and duration of prophylaxis is made using a special checklist on a representative sample of medical records.
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Affiliation(s)
- M Nobile
- PhD Program in Public Health, Orthopaedic Institute, G. Pini - University of Milan, Italy
| | - S Bronzin
- Postgraduate School in Public Health, University of Milan, Italy
| | - P Navone
- Orthopaedic Institute, G. Pini - University of Milan, Italy
| | - M Colombo
- Reparative Orthopaedic Surgery Department, Orthopaedic Institute, G. Pini - University of Milan, Italy.
| | - G M Calori
- Reparative Orthopaedic Surgery Department, Orthopaedic Institute, G. Pini - University of Milan, Italy
| | - F Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Italy
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Agodi A, Auxilia F, Barchitta M, D'Errico MM, Montagna MT, Pasquarella C, Tardivo S, Mura I. [Control of intubator associated pneumonia in intensive care unit: results of the GISIO-SItI SPIN-UTI Project]. Epidemiol Prev 2014; 38:51-56. [PMID: 25759344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To document reported Intubator Associated Pneumonia (IAP) prevention practices in Intensive Care Units (ICUs) and attitudes towards the implementation of a measurement system. DESIGN In the framework of the SPIN-UTI project the «Italian Nosocomial Infections Surveillance in ICUs network», two questionnaires were made available online. The first was filled out by physicians working in ICUs in order to collect data on characteristics of physicians and ICUs, on clinical and measurement practices for IAP prevention, and attitudes towards the implementation of a measurement system. The second questionnaire was filled out for each intubated patient in order to collect data on prevention practices during ICU stay. SETTING AND PARTICIPANTS ICUs participating to the fourth edition (2012-2013) of the SPIN-UTI project. MAIN OUTCOME MEASURES Compliance to the component of the European bundle. RESULTS The components of the bundle for the prevention of IAP are implemented, although to a different level, in the 26 participating ICUs. Overall compliance to all five practices of the European bundle has been reported in 21.1% of the 768 included patients. CONCLUSIONS The present survey has documented a large potential for improvement in clinical and non-clinical practices aimed at preventing IAP in ICUs.
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Agodi A, Auxilia F, Brusaferro S, Chiesa R, D'Alessandro D, D'Errico MM, Finzi G, Meledandri M, Mongardi M, Montagna MT, Mura I, Orsi GB, Pasquarella C, Signorelli C, Zarrilli R. [Education and training in patient safety and prevention and control of healthcare associated infections]. Epidemiol Prev 2014; 38:153-157. [PMID: 25759361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Cesira Pasquarella
- Dipartimento di scienze biomediche, biotecnologiche e traslazionali, Università degli studi di Parma.
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