Redefining the technical and organizational competences of children vaccination clinics in order to improve performance. A practical experience at the ULSS 12 Venetian Public Health and Hygiene Service.

INTRODUCTION: Since Regione Veneto suspended compulsory vaccination for children in 2008, and because of an increasing disaffection of parents to the vaccine practice, the vaccination rates have been slowly but steadily decreasing. The aim of this study was to analyze internal and external factors of immunization reduction and to implement potential solutions of the problem. METHODS: Servizio Igiene e SanitàPubblica of ULSS 12 Venezi-na (SISP - Hygiene and Public Health Service) analyzed and addressed both, the reasons of parents who do not vaccinate their children and the internal problems regarding vaccination clinics management, information to families, procedures and guidelines and, in general, the communication skills of the vaccination staff. RESULTS: A positive trend in vaccination rates was observed, especially in Venice historical centre. Moreover the staff reported a better working atmosphere and benefit from sharing common goals and procedures, even though the workforce was reduced of about 30% in terms of equivalent unit (EU). DISCUSSION: The continuous quality improvement method followed in this experience led to a steady increase in vaccination coverage in all territorial clinics, to a better adhesion of guidelines and standard operating procedures and to a general professional empowerment of SISP staff. The service now offered to the population is better and more efficient, since the workforce has been reduced. Future goals are to improve information about vaccinations among the population.

Nipple care, sore nipples, and breastfeeding: a randomized trial.

Sore and cracked nipples are common and may represent an obstacle to successful breastfeeding. In Italy, it is customary for health professionals to prescribe some type of ointment to prevent or treat sore and cracked nipples. The efficacy of these ointments is insufficiently documented. The incidence of sore and cracked nipples was compared between mothers given routine nipple care, including an ointment (control group), and mothers instructed to avoid the use of nipple creams and other products (intervention group). Breastfeeding duration was also compared between the two groups. Eligible mothers were randomly assigned, after informed consent, to one of the two groups. No difference was found between the control (n = 96) and the intervention group (n = 123) in the incidence of sore and cracked nipples and in breastfeeding duration. However, several factors were associated with sore nipples and with breastfeeding duration. The use of a pacifier and of a feeding bottle in the hospital were both associated with sore nipples at discharge (p = 0.02 and p = 0.03, respectively). Full breastfeeding up to 4 months postpartum was significantly associated with the following early practices: breastfeeding on demand, rooming-in at least 20 hours/day, non-use of formula and pacifier, no test-weighing at each breastfeed. The incidence of sore and cracked nipples and the duration of breastfeeding were not influenced by the use of a nipple ointment. Other interventions, such as providing the mother with guidance and support on positioning and latching, and modifications of hospital practices may be more effective in reducing nipple problems.