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.

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.

[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.

[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.

[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.

[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.

Hospital-acquired infections in Italy: a region wide prevalence study.

Between October and December 2000, a region-wide prevalence study of hospital-acquired infections (HAI) was conducted in all public hospitals (59 facilities with ca. 16000 beds; 560000 admission yearly) in Piemonte Region, Italy, and in the one hospital of the neighbouring autonomous region of Valle d'Aosta. The study population comprised a total of 9467 patients hospitalized for at least 24 h. The prevalence of HAI was 7.84%, with marked differences in prevalence among the participating hospitals (range: 0-47.8%). The higher relative frequency of urinary tract infections (UTI; 52.7%) was due to the inclusion of urine cultures obtained on the day of the study from asymptomatic UTI in catheterized patients. A significant correlation was found with major risk factors related to medical procedures (urinary catheter, mechanical ventilation, surgical drainage, intravascular catheters). Patients with HAI were found to be older and to have a greater mean length of stay in hospital. Multiple logistic regression analyses showed that lack of independence, indwelling urinary catheter and mechanical ventilation were the risk factors more significantly associated with HAI. The use of antibiotics, in particular prophylactic agents used in surgery (cephalosporins, glycopeptides), provided an incentive for corrective intervention in antibiotic administration and in training of healthcare workers.

Preventability of percutaneous injuries in healthcare workers: a year-long survey in Italy.

The aim of the study was to examine the preventability of percutaneous injuries either through the adoption of correct behaviour or by the use of needles with safety features. We analysed the report forms of occupational needlestick or sharps injuries in a sample of healthcare workers exposed to the risk of percutaneous injuries in the period between 1 June 2000 and 31 May 2001; the forms were returned to the regional SIROH (Italian Study on Occupational Exposure to HIV) centre in which all hospitals of the Piemonte region (Italy) participate. Percutaneous injuries caused by needles (injection, phlebotomy, infusion), suture needles and scalpels were analysed; three samples were extracted according to the type of device that caused the injury. In the sample of 439 needlestick-related percutaneous injuries, 74% were caused by incorrect health worker behaviour and 26% were unpreventable, seventy-nine percent of accidents caused by incorrect behaviour and 24% of accidents could have been prevented by using needles with safety features. In the sample of 221 suture needle and 114 scalpel injuries, incorrect health worker behaviour was identified in 26.2% and 14%, respectively, and unpreventable causes in 73.8% and 50.9%, respectively. A high rate of percutaneous injuries, especially those involving needles for injection, phlebotomy, infusion, and scalpels, could be prevented by adopting safe work behaviour practices and using personal protection equipment. The introduction of devices with safety features could lead to a significant reduction in the number of injuries from needles.

Factors influencing hospital infection control policies in Italian hospitals.

A study was undertaken to determine the resources available in Italian hospitals for the control of nosocomial infections and the factors favouring a successful approach. During January-May 2000 a questionnaire about infection control was sent to the hospital health director of all Italian National Health System hospitals treating acute patients and with more than 3500 admissions in 1999. An active programme was defined as a hospital infection control committee (HICC) meeting at least four times in 1999, the presence of a doctor with infection control responsibilities, a nurse employed in infection control and at least one surveillance activity and one infection control guideline issued or updated in the past two years. There was a response rate of 87.5% (463/529). Almost fifteen percent (69/463) of hospitals had an active programme for Infection Control and 76.2% (353/463) had a HICC. Seventy-one percent (330/463) of the hospitals had a hospital infection control physician and 53% (250/463) had infection control nurses. Fifty-two percent (242/463) reported at least one surveillance activity and 70.8% (328/463) had issued or updated at least one guidance document in the last two years. The presence of regional policies [odds ratio (OR) 8.7], operative groups (OR 4.2), at least one full-time nurse (OR 4.6) and a hospital annual plan which specified infection control (OR 2.1) were statistically associated with an active programme in the multivariate analysis.