Written versus verbal information for patients' education on healthcare-associated infections: a cross-sectional study.

In 2008, Piedmont region, Italy, recommended delivering written information on healthcare-associated infection (HCAI) to every patient admitted to hospitals. We interviewed 363 patients admitted to five hospitals to evaluate whether patients who received written information were more informed about HCAI than the other patients. We found no statistically significant difference between the two groups. We did observe that knowledge of HCAI was significantly lower among women and significantly higher among patients with higher education and those admitted to a surgical ward.

Evaluation of hearing aid benefit through a new questionnaire: CISQ (Complete Intelligibility Spatiality Quality).

The purpose of this work was to create a rapid and simple instrument to evaluate the benefits of a hearing aid, that was at the same time reliable and complete. We created a new questionnaire by integration of other well consolidated psychometric tests to better investigate all the aspects that contribute in determining the hearing aid benefit, also considering as important some areas that are not usually considered (spatiality and quality of sound). We started from a 36-item questionnaire divided in six subscales (spatiality and quality of signal, intelligibility in silence, background noise intelligibility, averseness and reverberation), and submitted it to patients before hearing aid application and at 2-3 months after that. A statistically significant difference between results before and after hearing aid application was found. To obtain the final 30-item questionnaire, we analyzed the reliability of each subscale using Cronbach's alpha coefficient, and eliminated the item whose internal consistency was lower for every subscale. For these reasons, the CISQ questionnaire is a rapid and simple test that can be considered a reliable and complete instrument to evaluate the benefits of a hearing aid.

The influence of operational and organizational stressors on the well-being of municipal police officers.

BACKGROUND: Helping professions are at a high risk of developing occupational stress that can cause negative effects at individual and organizational levels. OBJECTIVES: This article attempts to examine the presence of operational and organizational stressors as potential predictors of burnout and psychosomatic symptoms among municipal police officers. METHODS: A cross-sectional study of municipal police officers working in a town in Northern Italy was conducted. A self-report questionnaire was administered to all the officers serving the population of this town (N = 88). RESULTS: Regression analyses revealed that organizational stressors affected emotional exhaustion and cynicism, whereas operational stressors were associated with psychosomatic symptoms. CONCLUSIONS: These findings suggest that operational and organizational stressors can affect the level of psychosomatic well-being of municipal police officers, but at the same time reveal the existence of their specific effects on the outcome variables. In this perspective, individual psychological support and group interventions should be carried out not only to deal with traumatic events but also to manage chronic stressors. This is one of the first studies in Italy investigating municipal police officers' well-being as potentially related to specific job stressors. Nevertheless, our results are based on police officers employed by the municipality of a single town; it would be therefore useful to extend the research to larger samples.

Occupational stress and job satisfaction of healthcare staff in rehabilitation units.

BACKGROUND: Occupational stress and job dissatisfaction are recognized risk factors for healthcare professionals and can lead to a decrease in work performance and in the quality of care offered, and to poorer health of workers. Research in the rehabilitation care setting is very limited and needs to be explored. OBJECTIVES: To investigate occupational stress, job satisfaction and their relationships with organizational factors among healthcare staff in rehabilitation units. METHODS: A cross-sectional study of healthcare staff working in two rehabilitation units was conducted. They were sent two self-administered questionnaires, the Occupational Stress Indicator (OSI) and the Areas of Work life Scale (AWS), in order to assess occupational stress and job satisfaction. One-way ANOVA was used to explore work stress among two groups of workers, characterized by high and low job satisfaction levels. Stepwise multiple linear regression analysis was conducted to assess the association between job satisfaction and organizational risk factors. RESULTS: A total of 90 questionnaires were returned (response rate 53%). The main sources of stress were unfairness, conflict between personal and organizational values, lack of reward and workload Workers with low job satisfaction significantly scored higher in work-related stress in regard to various aspects of work, and in lower job control. Regression analysis showed that the most important predictors of job satisfaction were fairness and workload. CONCLUSIONS: The results of this study showed that job dissatisfaction is strongly associated with work stress and certain organizational risk factors. This study suggests the importance of focusing on the psychosocial factors in the work environment and job satisfaction in order to improve the well-being of rehabilitation healthcare staff.

Incidence of surgical-site infections in orthopaedic surgery: a northern Italian experience.

SUMMARYA prospective cohort study with a 1-year telephone follow-up was performed to estimate the incidence of surgical-site infections (SSIs) in hip and knee prostheses. Twenty-five public hospitals equipped with orthopaedic units in two Italian regions were involved. An 8-month surveillance period was set to obtain significant data at a regional level and data were collected by the infection control nurses of each centre. One-year follow-up was completed in 75% of cases. SSIs were recorded in 45 cases (incidence rate 1·9/100 person-years, 95% CI 1·4-2·5). Thirty-six percent of SSIs were diagnosed during hospitalization and 95·3% within 90 days post-operation. This incidence is similar to that reported by European and USA surveillance systems. The proposed investigative method proved to be reliable and feasible. A prolonged surveillance for at least 3 months post-operation yields a good estimate of SSI in joint replacements.

[Objective assessment of risk factors of work-stress: first experience of application of the method OSFA(Objective Stress Factors Analysis)]. / La valutazione obiettiva dei fattori di rischio stress lavoro-correlati: prime esperienze applicative del metodo OSFA (Objective Stress Factors Analysis).

The OSFA (Objective Stress Factors Analysis) method is an approach to stress evaluation based on objective risk factors recording, according to the Italian law (legislative decree 81/08) as well as to national and international guidelines. The method evaluates the work conditions recognized as hazardous for the workers' psychophysical health. It comprises two main phases: phase A (company data analysis) and phase B (analysis of work-related stress conditions). Particularly, phase B is centred on the work conditions peculiar to the different organizational units, and it is conducted by means of structured interviews to experienced employees who know the specific company reality. The interviews, based on a 72 items questionnaire, take into consideration four main work aspects: organization, social environment, safety, and management. The final version of the instrument has been tested on 13 medium-small companies of Lumbardy (Italy), operating in various fields, with a number of employees ranging from 5 to 107 (median = 37). These first OSFA method experimentations allowed to verify its adequacy in relation to the exhaustiveness of the examined areas, the intelligibility of the items, and their capacity to discriminate the stress risk factors peculiar to the various productive activities. The preliminary results indicate that the described approach is easy to apply, and favourably accepted by employers and workers for its objectivity. Additionally, the OSFA method allows to plan preventive and ameliorative interventions, according to both the legislative decree 81/08 and the European agreement of October 8, 2004. Finally, the information obtained can represent the basis for a further stress risk evaluation through subjective evaluation methods.

[Evaluation of usability of an e-learning software in healthcare]. / Valutazione dell'usabilità di un sistema per l'e-learning in ambito sanitario.

The usability study of a software system aims at improving learning times and task execution, as well as decreasing the number of errors and increasing the user satisfaction. Goal of the present study is to assess the usability of a healthcare e-learning software in relationship with professional and personal variables. To eighty healthcare operators have been administered: a) a questionnaire for the assessment of their skills in using PCs and their opinions on e-learning; b) SUS and SUMI questionnaires for the evaluation of system usability; c) the LOC-L questionnaire, to assess the type of individual locus-of-control, either internal or external. The data analysis resulted in positive usability assessment for the system here considered. No relationship could be found between SUS scores and the number hours per week spent in using the PC, the experience and opinions of users on e-learning systems. Data from the LOC-L questionnaire show how usability scores are not influenced by the type of individual locus-of-control. The results here obtained show how SUS and SUMI questionnaires can be effectively employed to assess usability of an e-learning software system.

[Factors influencing uptake of influenza vaccination in healthcare workers. Findings from a study in a general hospital]. / Fattori condizionanti l'adesione alla vaccinazione antiinfluenzale nel personale sanitario. Esiti di una indagine in un ospedale di base.

Despite recommendations, influenza vaccination coverage in health professionals remains low throughout the world. In order to identify reasons for adherence or refusal we conducted a study within our hospital by means of interview questionnaires which were distributed to health care workers to reveal factors influencing acceptance or refusal of vaccination and to get suggestions to improve vaccination coverage. There is good overlap between our results and data obtainable from international literature: the main motivating factor for vaccination is personal protection against influenza, while only a significantly smaller part gave protection of patients as a reason. The main factors for not adhering to vaccination are belief the vaccine is not effective, influenza-related sick leave, fear of adverse effects and lack of availability. These data point out the need for more information concerning the importance of influenza infection within risk groups, the safety and effectiveness of the vaccine. Further, it is suitable to increase availability of the vaccine free of charge.

Noise-induced hearing loss and hearing aids requirement.

Subjective disturbances, due to hearing loss, are auditory disability and handicap which can be evaluated with a questionnaire. The present study refers to a population of industrial workers affected by noise-induced hearing loss. Aim of the study is to identify the minimal level of hearing loss over which the patient felt changes in his quality of life, and the average auditory threshold at which the patient considered the application of a hearing aid useful or necessary. The sample comprised 180 males with noise-induced hearing loss. Each subject received a questionnaire designed for this study. Data show a correlation between disability, handicap and the degree of noise-induced hearing loss. The most relevant problems in noise-induced hearing loss are correlated with disability rather than handicap. 35 dB can be considered as the level above which these devices can be suggested to patients. Hearing aids can become a therapeutic instrument even in the presence of a low degree of hearing loss.

[Job perception, work conditions and burnout in emergency workers]. / Percezione del lavoro, contesti professionali e burnout negli operatori dell'emergenza.

The psychological syndrome of burnout in the helping professions has received much attention. Numerous studies have investigated the risk factors involved and their negative consequences for those whose work brings them into contact with people in states of physical and psychological suffering. In particular, emergency workers like police officers, fire-fighters and ambulance personnel who witness critical events are at high risk of developing negative psychological effects. Despite the ample literature investigating burnout in single emergency worker categories, currently there are few studies that deal with this topic from a comparative point of view, i.e. comparing the conditions of wellbeing of emergency workers across different organizations. The main aim of this pilot study was to compare different categories of emergency workers (83 ambulance workers, 42 operators of 118--free local health emergency service, 112 fire-fighters and 61 police officers) in order to identify which present a condition of wellbeing and which, on the contrary, may foster the burnout syndrome. Subjects were administered the Organizational Checkup System (OCS) to evaluate subjects' risk of burnout and their perception of their own work role and of their organizational environment. The second aim of this paper was to compare subjects on the basis of the main socio-demographic characteristics (gender, age and work seniority) in order to verify the presence of meaningful differences due, not just to the specific work category, but also to different subjective variables. The findings showed a condition of wellbeing, e.g. a high level of Energy and Involvement, in police officers as compared to 118 operators, who instead displayed a psychological state of burnout. Concerning the perception of organizational characteristics, fire-fighters displayed significant Control on tasks performed and good Social Integration in their work team. Furthermore, we noted the alignment of personal and organizational Values particularly among ambulance personnel and 118 operators. In conclusion, these findings could be useful in planning preventive interventions in the training and organization of the emergency workers tasks. In fact, the training process should give subjects a greater awareness of the psychological risks linked to their job and equip them with coping strategies; organizational actions should enhance job quality providing the workers with skills and tools to effectively manage daily working activities.

[Characteristics of personality in subjects who complain vexing on [corrected] workplace]. / Caratteristiche di personalità in un campione di soggetti che lamentano vessazioni sul posto di lavoro.

A few authors maintain the characteristics of personality might play an important role in the developing of mobbing, others did not find out any differences personality profiles in subject exposed to harassment compared to non-exposed ones. This study assesses, the psychological features of the sample of 276 subjects (114 males, 162females) admitted to a unit of Occupational Medicine, using Minnesota Multiphasic Personality Inventory MMPI-2. Increase in score over 65 cut off compared to clinical scales was found out: Hypochondria, Depression, Hysteria, Paranoia and compared to content scale: Anxiety and Health concerns. No significant different resulted between males and females as regards clinical scales. To conclude our date confirm the hypothesis of a remarkable psychic discomfort in subjects complaining about harassment work. This discomfort, in compliance with the date of literature seem to be characterized by depression, anxiety and somatizations. However show a tendency to focus on working problems and a disposition to persecutories tendencies. All the above said characteristics might be due to negative working conditions or they reflect a psychological frailty which made the subjects more vulnerable to working stress.

[Surveillance for bacteremia related to vascular access in hemodialysis]. / Sorveglianza delle infezioni batteriche ematiche e correlate all'accesso vascolare in dialisi.

Infections occur frequently in chronic dialysis patients. An incidence study of 13 months' duration (December 2003-January 2004) on nosocomial bacterial infections was performed in a dialysis center (Rivoli Hospital) in the Piedmont region of northern Italy. Data were collected according to a modified CDC methodology (CDC Dialysis Surveillance Network). The total incidence of infections was 4.55/100 patients/month and was lower than that reported for other reference series (CDC 6.16/100 patients/month). The low incidence was associated with a greater use of low-risk vascular access (fistula) than in other countries such as the U.S. The infection rates were: vascular access 1.73% (1.55% local infections, 0.18% access-related bacteremia); 0.82% wound infections; 0.91% pneumonia; 1% urinary tract infections; 0.09% other bacteremias. The hospital utilization rate was 6.9/100 patients/month. Blood cultures were performed in only 28.4% of patients who had received a course of antibiotics. Antibiotics were widely used but the use of vancomycin was less than reported elsewhere (e.g., CDC surveillance). The prevalence of methicillin-resistant Staphylococcus aureus (28 strains isolated) was high (>50%), whereas no vancomycin-resistant enterococci were isolated. Preventing nosocomial bacterial infections in chronic dialysis patients is a top priority; therefore, a surveillance system along the lines of the CDC model should be adopted by all dialysis centers. The risk of nosocomial infection is strongly associated with the type of vascular access.

Quality of work life in a cohort of Italian health workers.

BACKGROUND: Quality of work life (QWL) includes some objective and subjective factors which may condition operations and other inner aspects concerning the quality of relationships and methods of management. AIM: To analyse the quality of work life indicators in a cohort of Italian health workers. METHODS: Semi-structured interviews were conducted, to assess the quality of work life through the identification of the most important indicators and to evaluate the degree of satisfaction and the importance of each indicator. 112 health operators were interviewed. All workers belonged to the same local health service in North West Italy. RESULTS: We have pointed out some macro areas which are relevant to define work life quality of the analysed sample: relationships with colleagues, work organization, taking care of patients, professional ability and professional growth. The weekly number of patients seems to be important to determine the differences among the workers in the quality perceived in their work life. CONCLUSIONS: The collected data contribute to define which indicators must be taken into consideration in order to complete an evaluation of the quality of health organizations; this includes also the subjective variables connected to the quality of the work life.

Italian validation of the "Constructed Meaning Scale": preliminary results.

The sense or meaning (constructed meaning) that a person attributes to their own illness is one of the factors involved in the process of adaptation. The Constructed Meaning Scale (CMS), originally developed in the United States by Fife in 1995, is a brief 8-item survey investigating the subjective meaning that patients associate with their disease. The purpose of this study was to validate an Italian version of the CMS in a sample of patients with chronic disabling disease. The validation process consisted of 4 steps: (1) creation of an Italian version (translation and back translation); (2) administration of the translated version to a small sample of patients affected by different types of disease to verify its comprehensibility; (3) administration of the final version to a sample of 122 patients affected by chronic disabling conditions; (4) statistical analysis. The Italian version of the CMS was found to have the following psychometric properties: range of total-item correlation = .30 to .64; Cronbach's Alpha = .79; correlation with CBA 2.0 Depression Scale = -.44. We isolated two factors through VARIMAX factor analysis, which we defined as "disease as permanent damage" and "process of adaptation". The Italian version of the CMS is easy to understand and minimizes possible cultural biases. The psychometric properties of the scale are satisfactory.

[Regional surveillance of occupational percutaneous and mucocutaneous exposure to blood-borne pathogens in health care workers: strategies for prevention]. / Sorveglianza regionale delle esposizioni professionali percutanee o mucocutanee a patogeni a trasmissione ematica negli operatori sanitari: aree di intervento preventivo.

BACKGROUND: Several studies have investigated both the frequency and modality of occurrence of occupational exposure of health-care workers to blood-borne pathogens. At the moment no complete epidemiological data are available covering the hospitals of an entire Region. OBJECTIVES AND METHODS: To describe the characteristics of mucocutaneous and percutaneous exposure to body fluids of the healthcare workers in 47 out of the 56 public hospitals (90% of a total 15,000 beds, 28,000 health-care workers full time equivalent) in Piedmont, Northern Italy (4.5 million inhabitants) over a three-year period (1999-2002), using SIROH (Studio Italiano Rischio Occupazionale da HIV) model to collect the data. RESULTS AND CONCLUSIONS: 5174 percutaneous injuries (12.7/100 beds) and 1724 mucocutaneous exposure (4.1/100 beds) were recorded. Surveillance data were similar to those collected in other multi-hospital studies. The variability of rates between hospitals was high, most likely due to the amount of underreporting. The categories most at risk of percutaneous and mucocutaneous exposure were, respectively, surgeons (9.3/100 surgeons) and midwives (2.9/100 midwives). Needles (syringe, winged steel, suture) were the medical devices most frequently involved in percutaneous injuries, 60% of which occurred after the use of such devices. Eighty-three per cent of healthcare workers had been HBV-vaccinated versus only 45% of cleaning staff. After percutaneous injuries with exposure to an HIV positive source only 40% of those exposed received post-exposure prophylaxis; in the case of mucocutaneous exposure the rate was 11%. We recorded 2 seroconversions following occupational exposure to an HCV positive source (risk of seroconversion: 0,2%). In order to implement preventive programmes the use of safety devices, an increase in the number of HBV-vaccinated contract workers, the use of chemoprophylaxis for HIV exposure, and the use of protective equipment are deemed necessary.

[Assessment of occupational stress among workers in rehabilitation medicine]. / Indagine sullo stress occupazionale di operatori della medicina riabilitativa.

Emerging evidence confirms the risk of distress in staff involved in the Helping Professions resulting in the possibility of reduced efficacy and efficiency of the structure which offers health services. The aim of the present study was to reveal the presence of burnout and its relationships with environmental and organizational factors of health care professionals enrolled in medical rehabilitation. 88 health care professionals underwent a psychometric assessment by filling the Organizational Checkup System Questionnaire (OCS) for measuring burnout and associated organizational factors. Data analysis demonstrated the presence of major emotional distress (p = 0.05) in the group who had an executive role (social-assistants and assistant nurses), especially regarding organization factors linked with: Overwork (p = 0.009), lack of Leadership (p = 0.01), lack of Comprehension of modifications offered by the structure (p = 0.0001) and Professional Development (p = 0.016). OCS revealed to be a sensitive psychometric instrument, especially for the identification of organizational weaknesses, which can stimulate the application of strategies to prevent the burnout syndrome and to improve coping skills.

[Burnout in volunteer health workers]. / II burnout negli operatori sanitari volontari.

While diverse studies carried out in nursing and medical personnel have demonstrated that health workers can be subject to burnout, little effort has been focused on investigating burnout in volunteer hospital workers. The aim of the present study was to verify if burnout exists with volunteer auxiliary personnel and investigate what organizational conditions may favour it. The study was carried out on 80 volunteer workers of the Red Cross of Mortara (PV), subdivided into two categories: those performing emergency interventions and those performing routine services. For the evaluation of burnout, the Italian version of the Maslach Burnout Inventory was used, together with a qualitative type of methodology. A 5-factor multivariate analysis (sex x shift x team x seniority x role), having as dependent variables the three scales of the MBI, showed that the highest values of depersonalization and fulfillment are found in the emergency team, and that subjects with least seniority are those who are least satisfied or fulfilled. The category of team-leader resulted as that with the highest values of emotional burnout, while sex- and shift-based differences were restricted to routine service workers. Despite these differences, findings showed that subjects are minimally affected by problems linked to burnout, although some relational and organizational difficulties emerged with the medical staff that underlie a certain degree of professional dissatisfaction.

[Environmental hygiene of the surgery suites for the control of surgical wound infection: Italian legislation and international guidelines]. / L'igiene ambientale dei blocchi operatori nel controllo delle infezioni del sito chirurgico alla luce della normativa nazionale e delle indicazioni internazionali.

Aim of the study is to describe the application of surgical site infection (SSI) control procedures in general surgery operating rooms of Piedmont region hospitals. A specific data collection form was designed to record information. 54 questionnaires were compiled. Piedmont legislation related to operating rooms' equipment is obeyed in more than 90% of hospitals. Nevertheless, there are some critical aspects than could be risk factors for SSI or that are not useful in order to prevent them: use of UV radiation (11.3%), use of tacky mats at the entrance of the operating room (5.7%), special cleaning of operating rooms after contaminated or dirty operations (73.6%) and routine environmental sampling (10%) that is strongly recommended by ISPESL guideline in disagreement with international recommendations. Steam autoclave is used for surgical instruments sterilization by 100% of hospitals, but only 50% of them performs an annual validation of both autoclave performance and sterilization procedures. The study gave useful information in order to promote some structural modifications and personnel education for efficacious SSI prevention and control.