Appropriateness of perioperative antibiotic prophylaxis in two Italian hospitals: a pilot study.

BACKGROUND: Appropriate perioperative antibiotic prophylaxis has been shown to be an effective measure for preventing surgical site infections and to avoid complications including increased antimicrobial resistance. The objective of the present study was to evaluate the appropriateness of perioperative antibiotic prophylaxis in two Italian hospitals. STUDY DESIGN: In 2016 a survey was prospectively carried out at two hospitals (identified as A and B) and all patients who underwent a surgical operation were enrolled. METHODS: For each patient, perioperative antibiotic prophylaxis data were collected and appropriateness of perioperative antibiotic prophylaxis was assessed according to the national guidelines (SNLG-17, 2011). RESULTS: During the study period, 107 and 467 operations were included. Compliance to perioperative antibiotic prophylaxis according to indication was 72.3% (hospital A) and 77.9% (hospital B). Perioperative antibiotic prophylaxis was administered <60 min before the skin incision in 89.1% of surgical procedures in hospital A and in 78.4% in hospital B. In hospital A, the recommended molecule of antibiotic was correctly administered in 87.8% of surgeries (n= 36), while, in hospital B, the antibiotic was correctly administered only in 9.8% of surgeries. Antibiotic prophylaxis was not extended postoperatively or did not exceed 24 hours after the end of the surgery in 99% and 8.9% of the procedures in hospital A and B, respectively. CONCLUSION: Our study found an overall low compliance to perioperative antibiotic prophylaxis mainly regarding antibiotic choice and total duration of prophylaxis. The Italian Study Group of Hospital Hygiene - Italian Society of Hygiene, Preventive Medicine and Public Health, together with the National Association of Hospital Physician, promoted the implementation of the project "Choosing wisely - Hospital Hygiene", and, among the list of the 5 procedures with the highest evidence of inappropriateness, the timing and the duration of administration of perioperative antibiotic prophylaxis have been included and a multicenter study has been launched to evaluate the appropriateness of perioperative antibiotic prophylaxis components in all the participating Italian hospitals.

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.

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.

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.

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.

[Hemolytic-uremic syndrome: association with vero cytotoxin-producing Escherichia coli. An epidemiological and microbiological study on possible animal reservoirs]. / La sindrome emolitica-uremica: associazione con escherichia coli verocitotossina produttori. Indagine epidemiologica e microbiologica sui possibili serbatoi animali.

Vero cytotoxin-producing strains of Escherichia coli (VTEC) appear to be in man associated with a range of clinical symptoms from mild non bloody diarrhoea to haemorrhagic colitis and severe haemolytic uraemic syndrome (HUS). We present two patients affected by HUS who were investigated to determine evidence of infection by VTEC. In one of the patient free fecal cytotoxin active on Vero cells was detected as well as seroconversion of VT-neutralizing antibody titre. Both children were living in the same county town, but all parents denied any animal contact. The source of infection was not identified but one child had eaten ground beef during the period immediately prior to the onset of symptoms. Epidemiological informations are presented and the results of a study on the possible animal reservoir are illustrated. Fecal cultures were performed on 38 stools specimen obtained from non diarrheal beef cattle and pork. One VT- producing Escherichia coli strain was isolated in pork faeces (20 stools sample) whereas two VTEC were found in cattle faeces (18 stool sample).

School-related behavior in children with cancer.

Ninety-one children with cancer (thirty-seven with leukemia and fifty-four with solid tumors)--school aged (elementary and middle school), residing in Emilia-Romagna Region (Italy), and receiving treatment at the Department of Pediatrics (III), University of Bologna, from August 1973 to April 1987--took part in a study of school behavior as perceived by the teacher. The research was carried out through a 29-item forced-choice questionnaire based on the questionnaire proposed by Deasy-Spinetta for a similar study in the U.S.A. Results revealed that children with cancer have a school behavior scoring at levels significantly lower than controls. There are more difficulties for children attending middle than elementary school, for children on therapy than off therapy, and for children with leukemia than with solid tumors. In conclusion, the main obstacle to school performance seems to be lower attendance, which is mainly due to treatment and clinic visits and probably in part to an overprotection and an excessive concern on the part of physicians and parents.

[Maxillary sinusitis in children: clinical and diagnostic aspects]. / Le sinusiti mascellari in età pediatrica: aspetti clinici e diagnostici.

Acute or chronic sinusitis is often overlooked and poorly understood in the pediatric population as many children have frequent episodes of upper respiratory infections that confuse accurate diagnosis. The authors present a prospective study in 89 children with clinical and radiographic presence of maxillary sinusitis in order to underline the most frequent clinical symptoms and signs and the most significant diagnostic procedures that help confirm precise definition of this common disease. The authors also discuss the relationship with allergic factors, clinical causes of poor sinus drainage, and environmental factors that may increase the possibility of sinus infection.

[Cohen syndrome. Contribution to its clinical delineation]. / La sindrome di Cohen. Contributo alla sua delineazione clinica.

The authors report a case with features of the Cohen syndrome: characteristic cranio-facial appearance with prominent nasal bridge, short philtrum, prominent upper central incisors, micrognathia, truncal obesity of mid-childhood onset, muscle hypotonia, mental deficiency, limb anomalies associated with other clinical expressivity present among the previous reported cases. The reported case is of particular interest: the distal limbs anomalies are peculiar with marked shortening of metacarpals and metatarsals. A review of the other cases is also reported and discussed in order to stress the most frequent manifestations of the syndrome and delineate the major clinical characteristics.

Phase II study of idarubicin administered i.v. to pediatric patients with acute lymphoblastic leukemia.

A total of 17 pediatric patients with pretreated acute lymphoblastic leukemia were included in a phase II study of idarubicin. Four of 16 complete remissions were obtained, confirming the activity of the drug in this indication. Toxicity was acceptable, though caution is needed in patients who have already received high cumulative doses of anthracyclines.