Fostering Flu Vaccination in Healthcare Workers: Forum Theatre in a University Hospital.

The World Health Organization recommends flu vaccination as the most effective way to prevent the disease and its severe outcomes and has established the minimum vaccination coverage for people at risk at 75%. Even though healthcare workers (HCWs) represent a strongly recommended target group for flu vaccination campaigns, the average coverage among them is still inadequate. In flu season 2015/2016, our University Hospital tested Forum Theatre (FT) as a new participative strategy to foster HCWs engagement regarding flu vaccination. The aim of this study was to evaluate HCWs' satisfaction with and perceived utility of FT. In 2015, five FT sessions were organized in hospital units which were considered at risk for flu based on the type of admitted patients. After each session, participants were asked to complete an assessment questionnaire. The χ² test or the t-test was used to compare the proportion of participants who were satisfied with the FT and considered it useful (utility score). Data was analyzed according to gender, profession, and age. In all, 16.5% of HCWs who worked in four out of five of the units identified, participated in the FT sessions. Questionnaire results indicated that 74% of spectators were satisfied with their experience and 70% considered this methodology a useful approach for other health issues. Gender, age, and profession did not influence satisfaction or utility scores. Participative strategies such as FT represent an innovative solution to increasing HCWs' awareness of the importance of flu vaccination and could positively impact their adherence to vaccination recommendations. FT can also be a meaningful HCW teaching tool for learning about and changing attitudes toward other clinic and public health issues.

Hospital efficiency: how to spend less maintaining quality?

INTRODUCTION: The recent global economic crisis is pushing governments worldwide to obtain a more explicit and urgent rationing of resources. The purpose of this study is to provide, through Data Envelopment Analysis (DEA), a methodological framework useful for investigating technical efficiency of hospital care. METHODS: To validate such framework, we compared 50 Italian public hospital trusts (AOs) to identify relative efficient using inputs and outputs from national databases. We also evaluated if, and how, efficiency is affected by various exogenous factors. RESULTS: On average, Italian AOs had an efficiency score of 77% (SD 0.12). Tobit regression model identified a positive association between efficiency and a lower case-mix index, being in the north of Italy, in a region with fiscal autonomy, with a higher public and a lower private expenditure on health as percentage of GDP. CONCLUSIONS: DEA may provide useful and especially objective information regarding the technical efficiency of hospital care and support hospital management and policy makers' decisions.

[A health promotion campaign to improve flu vaccination adherence among medical residents in an Italian Teaching Hospital]. / Una campagna di promozione della salute per migliorare l'adesione alla vaccinazione antinfluenzale nei medici in formazione specialistica in un ospedale universitario italiano.

INTRODUCTION: In Italy annual flu vaccination for health care workers is recommended but coverage is usually unsatisfying. The compliance is even worse among medical residents (MRs) both in literature, both in our experience: in the flu season 2014/ 15 only 0.6% of MRs enrolled at the Università Cattolica del Sacro Cuore (UCSC) were vaccinated. For this reason, during the influenza season 2015/16, the Institute of Public Health of the UCSC, in collaboration with the Health Management of the "Agostino Gemelli" Teaching Hospital (FPG) and with the directive board of the Medical Specialization Schools (SSM) present at the University has tested several strategies to improve awareness and adherence to flu vaccination campaign by its staff. This study aims to analyze the impact of the strategies used during the 2015/16 campaign on flu vaccination coverage among MRs of an important Italian Teaching Hospital. METHODS: The study was conducted among MRs enrolled at the UCSC - FPG in 2015/16. The data was collected by the Occupational Medicine which, during the influenza seasons, immunize MRs against influenza free of charge. For each variable - vaccination, area of specialization (surgical, medical, clinical services), typology of SSM - was measured the absolute and percentage frequency. In order to compare the flu vaccination coverage between seasons 2014/15 and 2015/16 and between areas of specialization in 2015/16 chi-square test was used (statistical significance level of 0.05). The data were analyzed using STATA Software. RESULTS: Were included in the analysis 42 SSM with a total of 1041 MRs. During the vaccination campaign 2015/16, flu vaccine was administered to 99 MRs (9.5%), 8.9% more than in the previous season (p<0.001). There is also a significant difference in vaccine coverage between surgical, medical and clinical services areas in 2015/16 (p <0.001). The highest vaccination coverage was recorded among MRs of Hematology and Urology (54.5%). However, no one MRs had undergone flu vaccination in about 40% of SSM. CONCLUSIONS: Seasonal flu vaccination among HCWs is important to protect patients as well as them self and their family members. Considering that MRs represent the next generation of HCWs, they should be sensitized about the importance of preventing the spread of influenza in hospital population, becoming an active part of the necessary cultural change. This study highlights a first and promising, although insufficient, increase in flu vaccination coverage among MRs enrolled at the UCSC - FPG after introducing simple strategies to promote vaccination itself and, more generally, positive and proactive behaviors. The study summarizes the results in the short term, but it is well known that cultural changes require time and constancy. Therefore, it will be useful to monitor the improvement over time and extend the assessment to all health care professionals.

Investigating the Role of Physical Education in Physical Activity Promotion: An Italian Multicenter Study.

BACKGROUND: Physical education (PE) can be considered an instrument for active lifestyle promotion, and PE teachers can motivate youths to continue their studies in the field of Movement Sciences (MS). METHODS: To evaluate the role of PE in higher secondary school in promoting physical activity (PA) and MS careers, previous PE experiences and current PA practice were investigated in a sample of Italian freshmen enrolled in different university degree courses. RESULTS: A total of 7033 questionnaires were completed by students from 14 universities (41.3% males, mean age 20 ± 2.76 years). Recreation seemed to be the principal aim (42.2%) pursued during PE lessons, which are based mainly on practical activities (51.7%). Of all respondents, 67.2% were satisfied with the PE received during higher secondary school, and 51.6% participated in extracurricular PA. Current practice of PA was reported by 58.1% of the sample. Extracurricular activities were associated with choice of MS curricula (odds ratio: 2.15; 95% confidence interval, 1.85-2.50) and with current practice of PA (odds ratio: 1.68, 95% confidence interval, 1.51-1.87). Geographical differences concerning lessons organization and satisfaction were registered (P < .01). CONCLUSIONS: To enhance its role in health promotion, PE teaching should be improved by increasing the time allocated to PE and by strengthening the provision of school-based extracurricular PA.

Non-fermentative gram-negative bacteria in hospital tap water and water used for haemodialysis and bronchoscope flushing: prevalence and distribution of antibiotic resistant strains.

This study provides a detailed description of the distribution of non-fermentative gram-negative bacteria (NFGNB) collected in water sources (tap water and water used for haemodialysis and bronchoscope flushing) from different wards of a tertiary care hospital. The aim is to identify risk practices for patients or to alert clinicians to the possible contamination of environment and medical devices. The resistance profile of NFGNB environmental isolates has shown that more than half (55.56%) of the strains isolated were resistant to one or more antibiotics tested in different antimicrobial categories. In particular, 38.89% of these strains were multidrug resistant (MDR) and 16.67% were extensively drug resistant (XDR). The most prevalent bacterial species recovered in water samples were Pseudomonas aeruginosa, Pseudomonas fluorescens, Ralstonia pickettii and Stenotrophomonas maltophilia. Analysis of antibiotic resistance rates has shown remarkable differences between Pseudomonadaceae (P. aeruginosa and P. fluorescens) and emerging pathogens, such as S. maltophilia and R. pickettii. Multidrug resistance can be relatively common among nosocomial isolates of P. aeruginosa, which represent the large majority of clinical isolates; moreover, our findings highlight that the emergent antibiotic resistant opportunistic pathogens, such as R. pickettii and S. maltophilia, isolated from hospital environments could be potentially more dangerous than other more known waterborne pathogens, if not subjected to surveillance to direct the decontamination procedures.