Validation of intensive care unit-acquired infection surveillance in the Italian SPIN-UTI network.

Validity is one of the most critical factors concerning surveillance of nosocomial infections (NIs). This article describes the first validation study of the Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) project (SPIN-UTI) surveillance data. The objective was to validate infection data and thus to determine the sensitivity, specificity, and positive and negative predictive values of NI data reported on patients in the ICUs participating in the SPIN-UTI network. A validation study was performed at the end of the surveillance period. All medical records including all clinical and laboratory data were reviewed retrospectively by the trained physicians of the validation team and a positive predictive value (PPV), a negative predictive value (NPV), sensitivity and specificity were calculated. Eight ICUs (16.3%) were randomly chosen from all 49 SPIN-UTI ICUs for the validation study. In total, the validation team reviewed 832 patient charts (27.3% of the SPIN-UTI patients). The PPV was 83.5% and the NPV was 97.3%. The overall sensitivity was 82.3% and overall specificity was 97.2%. Over- and under-reporting of NIs were related to misinterpretation of the case definitions and deviations from the protocol despite previous training and instructions. The results of this study are useful to identify methodological problems within a surveillance system and have been used to plan retraining for surveillance personnel and to design and implement the second phase of the SPIN-UTI project.

[Thermal comfort in perioperatory risk's evaluation]. / Il comfort termico indicatore del rischio perioperatorio.

Studies till now conducted about operating rooms' microclimate have been focused mainly on operators' thermal comfort, considering that uneasiness conditions may compromise their working performance. In last years, nevertheless, the anesthesiologic community recalled attention on patients' risks determined by perioperatory variations of normothermia, underlining the necessity of orientating studies to individuate microclimate characteristics act to guarantee thermal comfort of the patient too. Looking at these considerations, a study has been conducted in the operating rooms of the hospital-university Firm and the n.1 USL of Sassari, finalized, on one hand, to determinate microclimate characteristics of the operating blocks and to evaluate operators' and patients' thermal comfort, on the other to individuate, through a software simulation, microclimate conditions that ensure contemporarily thermal comfort for both the categories. Results confirm the existence of a thermal "gap" among operators and patients, these last constantly submitted to "cold-stress", sometimes very accentuated. So, we underline microclimate's importance in operating rooms, because there are particular situations that can condition perioperatory risks. Moreover it can be useful to integrate risk's classes of the American Society of Anestesiology (ASA) with a score attributed to the PMV/PPD variation, reaching more real operatory risk indicators.