Hand Hygiene Practices during the COVID-19 Pandemic in Northern Italy: Assessment of Compliance Rates Measured by Direct Observation and Alcohol-Based Handrub Usage

Hand hygiene (HH) is among the most effective measures for reducing the transmission of healthcare-associated infections and SARS-CoV-2. We aimed to assess HH practices among healthcare workers (HCWs) of three hub hospitals in Northern Italy during the COVID-19 pandemic, by assessing HH compliance measured by direct observation and alcohol-based handrub usage. An observational study was conducted over a period of three months, between February and April 2021. HH compliance audits were conducted using the WHO My 5 Moments for HH approach. Multivariable logistic regression was used to evaluate independent predictors of HH compliance: ward type, HCW category and HH indication. Spearman correlation was used to investigate the relationship between HH compliance and alcohol-based handrub consumption. In total, 2880 HH opportunities were observed, with an overall compliance of 68%. Significant differences were found in compliance rates across ward types, HCW categories and HH indications. The mean alcohol-based handrub usage among included wards was 41.63 mL/PD. No correlation was identified between compliance rates and alcohol-based handrub consumption (ρ 0.023, p 0.943). This study provided a snapshot of HH practices in a pandemic context, which could be useful as a reference for future studies

Cost‐effectiveness analysis of revisional Roux‐en‐Y gastric bypass: laparoscopic vs. robot assisted

There is controversy over the possible advantages of the robotic technology in revisional bariatric surgery. The aim of this study is to report the experience of a high-volume bariatric center on revisional Roux-en-Y gastric bypass with robot-assisted (R-rRYGB) and laparoscopic (L-rRYGB) approaches, with regards to operative outcomes and costs. Patients who underwent R-rRYGB and L-rRYGB between 2008 and 2021 were included. Patients’ baseline characteristics and perioperative data were recorded. The primary endpoint was the overall postoperative morbidity. A full economic evaluation was performed. One-way and two-way sensitivity analyses were performed on laparoscopic anastomotic leak and reoperation rates. A total of 194 patients were included: 44 (22.7%) L-rRYGB and 150 (77.3%) R-rRYGB. The robotic approach was associated with lower overall complication rate (10% vs. 22.7%, p = 0.038), longer operative time, and a reduced length of stay compared to L-rRYGB. R-rRYGB was more expensive than L-rRYGB (mean difference 2401.1€, p < 0.001). The incremental cost-effective ratio (ICER) was 18,906.3€/complication and the incremental cost-utility ratio was 48,022.0€/QALY (quality-adjusted life years), that is below the willingness-to-pay threshold. Decision tree analysis showed that L-rRYGB was the most cost-effective strategy in the base-case scenario; a probability of leak ≥ 13%, or a probability of reoperation ≥ 14% following L-rRYGB, or a 12.7% reduction in robotic costs would be required for R-rRYGB to become the most cost-effective strategy. R-rRYGB was associated with higher costs than L-rRYGB in our base-case scenario. However, it is an acceptable alternative from a cost-effectiveness perspective

Cost-effectiveness analysis of revisional Roux-en-Y gastric bypass: laparoscopic vs. robot assisted

There is controversy over the possible advantages of the robotic technology in revisional bariatric surgery. The aim of this study is to report the experience of a high-volume bariatric center on revisional Roux-en-Y gastric bypass with robot-assisted (R-rRYGB) and laparoscopic (L-rRYGB) approaches, with regards to operative outcomes and costs. Patients who underwent R-rRYGB and L-rRYGB between 2008 and 2021 were included. Patients’ baseline characteristics and perioperative data were recorded. The primary endpoint was the overall postoperative morbidity. A full economic evaluation was performed. One-way and two-way sensitivity analyses were performed on laparoscopic anastomotic leak and reoperation rates. A total of 194 patients were included: 44 (22.7%) L-rRYGB and 150 (77.3%) R-rRYGB. The robotic approach was associated with lower overall complication rate (10% vs. 22.7%, p = 0.038), longer operative time, and a reduced length of stay compared to L-rRYGB. R-rRYGB was more expensive than L-rRYGB (mean difference 2401.1€, p < 0.001). The incremental cost-effective ratio (ICER) was 18,906.3€/complication and the incremental cost-utility ratio was 48,022.0€/QALY (quality-adjusted life years), that is below the willingness-to-pay threshold. Decision tree analysis showed that L-rRYGB was the most cost-effective strategy in the base-case scenario; a probability of leak ≥ 13%, or a probability of reoperation ≥ 14% following L-rRYGB, or a 12.7% reduction in robotic costs would be required for R-rRYGB to become the most cost-effective strategy. R-rRYGB was associated with higher costs than L-rRYGB in our base-case scenario. However, it is an acceptable alternative from a cost-effectiveness perspective

Tailoring Antimicrobial Stewardship (AMS) Interventions to the Cultural Context: An Investigation of AMS Programs Operating in Northern Italian Acute-Care Hospitals

Antibiotic misuse and overuse are important contributors to the development of antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) programs are coordinated sets of actions aiming to promote appropriate antibiotic use, improving patient outcomes whilst reducing AMR. Two main organizational models for AMS programs have been described: restrictive strategies (RS) vs. enabling strategies (ES). Evaluating and understanding social and cultural influences on antibiotic decision-making are critical for the development of successful and sustainable context-specific AMS programs. Characteristics and surrogate outcomes of AMS programs operating in acute-care hospitals of Piedmont in north-western Italy were investigated. The aim of this study was assessing whether RS vs. ES operating in our context were associated with different outcomes in terms of total antimicrobial usage and percentage of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant enterobacteria (CRE) over invasive isolates. In total, 24 AMS programs were assessed. ES were more frequently chosen compared to RS, with the latter being implemented only in broader AMS programs involving enabling components (combined strategy, CS). This study found no difference in evaluated outcomes among hospitals implementing ES vs. CS, suggesting both approaches could be equally valid in our context