Control and prevention measures for legionellosis in hospitals: A cross-sectional survey in Italy

Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey (R) platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2-15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented

Hospital hygiene in Italy: the GISIO-SItI survey

none37BACKGROUND: In Italy there are no rules concerning the establishment of a hospital hygiene structure in hospitals and other healthcare settings, and the hospital organization plans vary widely. The aim of the survey, carried out by the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive medicine and Public health, was to evaluate the presence in the hospital organization plan of a structure referred to as Hospital hygiene, or including in its denomination the words "hygiene" or "hospital hygiene", the activities carried out, the relation to other areas, like patient safety, the type and quantity of professionals involved, the strengths and the critical aspects. METHODS: A semi-structured questionnaire was administered to Healthcare Trusts representing all Italian Regions through the members of the above Study Group. RESULTS: 35 Trusts, 13 in Northern, 8 in Central, 14 in Southern Italy (including Sicily and Sardinia), completed the questionnaire. In 19 Trusts (54.3%) a structure whose denomination included the words "hospital hygiene" or "hygiene" was present. The activities related to the management of infectious risk were most represented, carried out autonomously or in collaboration, but many other activities were covered. In all hospitals the activities of the Hospital Hygiene Unit inter-linked with those of the clinical risk, with different forms of collaboration. CONCLUSION: This survey, even though on a limited sample, provided a picture of hospital hygiene at a national level, showing a considerable heterogeneity and highlighting critical issues but also strengths. It is essential to share organizational and management models that enhance and promote hospital hygiene, to ensure the appropriateness of healthcare practices offered in a safe and comfortable environment to patients, operators, and visitors.nonePasquarella C, Ciorba V, Arnoldo L, Auxilia F, Baldovin T, Barchitta M, Bianco A, Calagreti G, Casini B, Cristina ML, De Giglio O, D'Errico MM, Fabiani L, Laganà P, Laurenti P, Mattaliano AR, Molino A, Montagna MT, Moscato U, Mura I, Napoli C, Novati R, Orsi GB, Privitera G, Ripabelli G, Rossini A, Sodano L, Squeri R, Tardivo S, Teti V, Torregrossa MV, Torri E, Vantaggiato MD, Veronesi L, Zarrilli R, Agodi A, Brusaferro SPasquarella, C; Ciorba, V; Arnoldo, L; Auxilia, F; Baldovin, T; Barchitta, M; Bianco, A; Calagreti, G; Casini, B; Cristina, Ml; De Giglio, O; D'Errico, Mm; Fabiani, L; Laganà, P; Laurenti, P; Mattaliano, Ar; Molino, A; Montagna, Mt; Moscato, U; Mura, I; Napoli, C; Novati, R; Orsi, Gb; Privitera, G; Ripabelli, G; Rossini, A; Sodano, L; Squeri, R; Tardivo, S; Teti, V; Torregrossa, Mv; Torri, E; Vantaggiato, Md; Veronesi, L; Zarrilli, R; Agodi, A; Brusaferro,

Hospital hygiene and infection prevention and control in Italy: State of the art and perspectives

Although hospital hygiene has a long history in Italy it is necessary to reflect about it because of the innovation in healthcare systems and because of the evolution due to European Union related activities. Different traditions exist in European countries about hospital hygiene and European Centre for Disease Prevention and Control (ECDC) adopted the term of "infection control and hospital hygiene" which includes all the engaged European healthcare professionals. We propose to modify hospital hygiene as "healthcare organisation hygiene" in order to focalise the attention to all care settings not only hospitals and to adopt the following definition: "all activities aimed to guarantee, in an appropriate, scientifically sound and efficient way, that structures and processes support healthcare practices in a safe comfortable and healthy environment both for patients, caregivers and healthcare workers". Hospital hygiene and its professionals, besides the long tradition, still remain a relevant pillar in guaranteeing quality and safety of healthcare in Italy

Hospital Hygiene and Infection Prevention and Control in Italy: state of the art and perspectives.

none80Although hospital hygiene has a long history in Italy it is necessary to reflect about it because of the innovation in healthcare systems and because of the evolution due to European Union related activities. Different traditions exist in European countries about hospital hygiene and European Centre for Disease Prevention and Control (ECDC) adopted the term of "infection control and hospital hygiene" which includes all the engaged European healthcare professionals. We propose to modify hospital hygiene as "healthcare organisation hygiene" in order to focalise the attention to all care settings not only hospitals and to adopt the following definition: "all activities aimed to guarantee, in an appropriate, scientifically sound and efficient way, that structures and processes support healthcare practices in a safe comfortable and healthy environment both for patients, caregivers and healthcare workers". Hospital hygiene and its professionals, besides the long tradition, still remain a relevant pillar in guaranteeing quality and safety of healthcare in Italy.noneBrusaferro S, Arnoldo L, Finzi G, Mura I, Auxilia F, Pasquarella C, Agodi A; C. Arrigoni, M. Barchitta, G. Calella, B. Casini, M.L. Cristina, MM D’Errico, P. Laurenti, M.D. Masia, M.T. Montagna, I. Mura, G. Olivieri, A. Orsi, G.B. Orsi, L. Pesapane, G. Ripabelli, L. Sodano, R. Squeri, V. Teti, M.V. Torregrossa, E. Torri, R. Zarrilli, B.M. Are, A. Brighenti, S. Mascipinto, S. Iannazzo, F.P. D’Ancona, G. Sessa, A. Motta, R., Appignanesi, F. Argiolas, T. Baldovin, A. Bargellini, S. Berdini, G. Boccia, G. Calagreti, T. Caldarulo, F. Campanella, R. Chiesa, V. Ciorba, R. Contrisciani, D. D’Alessandro, O. De Giglio, L. Fabiani, G.M. Fara, G. Giuliani, P. Laganà, A. Marani, A.R. Mattaliano, A. Molino, M. Montesano, F. Moretti, M. Moro, U. Moscato, C. Napoli, N. Nicolotti, M. Nobile, R. Novati, F. Palumbo, A. Piana, G. Privitera, E. Prospero, A. Quattrocchi, E. Righi, V. Romano Spica, F. Rossi, A. Rossini, S. Schieppati, G. Sotgiu, S. Tardivo, I. Torre, F. Valeriani, L. Veronesi, C. Zotti.S, Brusaferro; L, Arnoldo; G, Finzi; I, Mura; F, Auxilia; C, Pasquarella; A, Agodi; Arrigoni, C.; Barchitta, M.; Calella, G.; Casini, B.; Cristina, M. L.; D’Errico, Mm; Laurenti, P.; Masia, M. D.; Montagna, M. T.; Mura, I.; Olivieri, G.; Orsi, A.; Orsi, G. B.; Pesapane, L.; Ripabelli, G.; Sodano, L.; Squeri, R.; Teti, V.; Torregrossa, M. V.; Torri, E.; Zarrilli, R.; Are, B. M.; Brighenti, A.; Mascipinto, S.; Iannazzo, S.; D’Ancona, F. P.; Sessa, G.; Motta, A.; Appignanesi, R.; Argiolas, F.; Baldovin, T.; Bargellini, A.; Berdini, S.; Boccia, G.; Calagreti, G.; Caldarulo, T.; Campanella, F.; Chiesa, R.; Ciorba, V.; Contrisciani, R.; D’Alessandro, D.; De Giglio, O.; Fabiani, L.; Fara, G. M.; Giuliani, G.; Laganà, P.; Marani, A.; Mattaliano, A. R.; Molino, A.; Montesano, M.; Moretti, F.; Moro, M.; Moscato, U.; Napoli, C.; Nicolotti, N.; Nobile, M.; Novati, R.; Palumbo, F.; Piana, A.; Privitera, G.; Prospero, E.; Quattrocchi, A.; Righi, E.; Romano Spica, V.; Rossi, F.; Rossini, A.; Schieppati, S.; Sotgiu, G.; Tardivo, S.; Torre, I.; Valeriani, F.; Veronesi, L.; Zotti., C

Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial

BACKGROUND: The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes. METHODS: TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50-75 years with type 2 diabetes inadequately controlled with metformin monotherapy (2-3 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15-45 mg) or a sulfonylurea (5-15 mg glibenclamide, 2-6 mg glimepiride, or 30-120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856. FINDINGS: Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57·3 months. The primary outcome occurred in 105 patients (1·5 per 100 person-years) who were given pioglitazone and 108 (1·5 per 100 person-years) who were given sulfonylureas (hazard ratio 0·96, 95% CI 0·74-1·26, p=0·79). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0·0001). Moderate weight gain (less than 2 kg, on average) occurred in both groups. Rates of heart failure, bladder cancer, and fractures were not significantly different between treatment groups. INTERPRETATION: In this long-term, pragmatic trial, incidence of cardiovascular events was similar with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as add-on treatments to metformin. Both of these widely available and affordable treatments are suitable options with respect to efficacy and adverse events, although pioglitazone was associated with fewer hypoglycaemia events. FUNDING: Italian Medicines Agency, Diabete Ricerca, and Italian Diabetes Society